I see lots of women in my office with completely normal vulvar anatomy who ask “Is my vagina normal?”. Many of us worry about this part of the body and how we measure up. Every day someone apologizes to me for not shaving, not showering in the past 2 hours, having a perceived abnormal odor, or even for just needing an exam. All of this is pretty typical behavior and shows how anxious we are about our genitalia. It is normal to wonder about odor, symmetry, length, width, and hair distribution. There are lots of reasons why this happens.
● Most of us aren’t comfortable talking about our pelvic anatomy. We may not even have the right words. A study from the Eve Appeal, a British advocacy group, showed that only a third of women in the UK could identify the different parts of the female anatomy.
● Female sexual organs are mostly on the inside, resulting in some mystery and mystique. Since we don’t see them, it is hard to recognize the full spectrum of normal. Boys grow up changing in locker rooms and using urinals and have a much better understanding of their “normal.”
● Media attention to the vulva tends to focus on a “Barbie-Doll” like image- hairless and fairly undefined. This anatomy doesn’t really reflect normal or natural but is the standard comparison.1
● Medical images of the vulva focus on the location of the different organs but do not illustrate the great variation in size, shape and color that exists.
● Grooming and removing the pubic hair has become more common. Removing the hair raises awareness about the vulva and can reveal personal asymmetries.2 Just like my left foot is slightly bigger than my right.
● There is an increasing amount of marketing about cosmetic genital surgery which suggests that there are lots of abnormal vulvas out there that need to be fixed. Surgeries to make the labia minora smaller have increased 50% since 2014. There is also an increase in direct to consumer advertising about vaginal “rejuvenation”- a term used for laser and radiofrequency treatments of the vagina. These procedures are poorly studied and not currently FDA approved but popular.2
So What Is A Normal Vagina?
Vaginas come in all different shapes, sizes and colors. To start to understand this, Well, let’s learn some vaginal anatomy.
Female Anatomy Chart
There are the labia majora (big lips that are on the outside, one on the right and one on the left) and the labia minora (small lips that are more to the middle, one on the right and one on the left). Not all things in anatomy are well named but these structures are, the names mean big and small lips. The labia majora are usually about 8 cm long (just over 3 inches) and 2.5cm wide (1 inch). This is roughly the size of my pointer finger. But their dimensions are highly variable and usually change based on your weight. These labia are analogous to the scrotum. These lips have sweat glands and hair. They are pigmented and have fat tissue.2
The labia minora tend to be thinner. On average, they are 4 cm long and 1.5 cm wide.4 That is a little smaller than my pinky. Their size is highly variable, however, and depends on age, estrogen status, genetics, and the number of deliveries you have had. These lips have little fat and no sweat or hair glands. Jamie McCartney , an artist who did a project called “The Great Wall of Vagina” said, “There are as many appearances of the vulva as there are of the face.” And that is largely because of the many normal shapes and sizes of the labia minora. The labia minora often stick out past the rest of the anatomy. Sometimes, they are tucked away. One side can be bigger than the other. Studies have shown that perfect symmetry is rare and one side is almost always bigger than the other.2,3
The labia frame the introitus which is the opening to the vagina. The introitus can get larger with deliveries and time. It tends to be smaller if your levator or kegel muscles are strong. An average size in 2-4 cm. There is no magic “right size” to the vaginal opening. And while it is common to think smaller is better, sometimes smaller just results in pain with sex. The clitoris is at the top (12 o’clock). It is around 4.5mm wide and 7mm long, roughly the size of a jelly bean.2
Normal Vaginal Anatomy
The anatomy is really only considered to be abnormal if it actively creates problems for you. “Abnormal” is not diagnosed based on size and shape. There have only been 3 times in my career when I have asked someone if their labia bothered them based on their appearance. And only 1 woman felt that they were a problem. The labia minora can be uncomfortable or painful if they are long enough to rub on clothing like skinny jeans. They may also be bothersome during sports, like bike riding. The labia can be torn during a delivery or an accident. This can result in a sensitive area or big changes in the appearance of one labia. They can pull and be uncomfortable during sex. But if they aren’t causing physical symptoms, the rule of thumb is to leave your sensitive labia alone.
Do Girls Have 3 Holes?
This is a common question. Women who are born XX at birth will have 3 holes in their genital region. The most anterior is the urethra which is for peeing. The middle one is the vaginal opening, as seen above in the diagram. The vaginal opening is where a tampon is inserted. The most posterior opening is the anus which is where women poop.
More Resources On Vaginal Anatomy
If you are more of a visual person and need to see the huge range of normal in the vulvar anatomy, check out the Great Wall of Vagina at greatwallofvagina.co.uk . This project, which amazes me on so many levels, took 400 volunteers, aged 18 to 76, and created plaster casts of their vulvas. Ten panels were then made out of the casts. The goal was to normalize the anatomy. And as they say, a picture is worth a thousand words.
- Schick VR et al. Evulvalution: The Portrayal of Women’s External Genitalia and Physique across Time and the Current Barbie Doll ideals. J Sex Research 48;1:74-81.
- Elective Female Genital Cosmetic Surgery Committee Opinion No.795, Obstet Gynecol 2020; 135(1):e36-42.
- Widschwendter A et al Perception of Labial Size and Objective Measurements- Is there a correlation? A cross-sectional study in a cohort not seeking labioplasty. J Sex Med 2020;17:461-9.
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