vulva

File:Vulva and Clitoris 1.png

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The human vulva is made up of the following:

The mons pubis is a soft mound of fatty tissue in the pubic region covering the pubic bone.{{cite web |title=Anatomy and Physiology of the Female Reproductive System · Anatomy and Physiology |url=http://philschatz.com/anatomy-book/contents/m46392.html |publisher=Phil Schatz.com |language=en-us |access-date=14 March 2018 |archive-date=24 May 2020 |archive-url=https://web.archive.org/web/20200524102556/https://philschatz.com/anatomy-book/contents/m46392.html |url-status=live }} {{lang|la|Mons pubis}} is Latin for "pubic mound" and is present in both sexes to act as a cushion during sexual intercourse, and is more pronounced in the female. The variant term mons veneris ('mound of Venus') is used specifically for females.{{cite book|last1=Gould|first1=George Milbry|title=An Illustrated Dictionary of Medicine, Biology and Allied Sciences|date=1894|pages=[https://archive.org/details/b21443038/page/649 649], 684, 778–779, 1212, 1610|publisher=Balliére, Tindall & Cox|location=London|oclc=1045367748|url=https://archive.org/details/b21443038}}{{cite book|editor1-last=Stevenson|editor1-first=Angus|editor2-last=Lindberg|editor2-first=Christine A.|title=New Oxford American Dictionary|year=2010|publisher=Oxford University Press|edition=3rd|isbn=978-0195392883|url=https://www.lexico.com/en/definition/mons_pubis|quote=The rounded mass of fatty tissue lying over the joint of the pubic bones, in women typically more prominent and also called the mons Veneris.|access-date=18 September 2019|archive-date=5 November 2019|archive-url=https://web.archive.org/web/20191105164820/https://www.lexico.com/en/definition/mons_pubis|url-status=dead}}

The labia minora are the small inner pair of skin folds that protect the openings.{{cite book |last1=Pocock |first1=Gillian |last2=Richards |first2=Christopher D. |title=Human physiology : the basis of medicine |date=2006 |publisher=Oxford University Press |location=Oxford |isbn=9780198568780 |page=438 |edition=3rd.}} The large outer pair of folds are the labia majora, which contain and protect the labia minora and other structures of the vulva. The labia majora meet at the front of the mons pubis, and meet posteriorly at the urogenital triangle (the anterior part of the perineum) below the anus.{{cite book |last1=Tortora |first1=Gerard J |last2=Derrickson |first2=Bryan |title=Principles of anatomy and physiology. |date=2008 |publisher=Wiley |location=Hoboken, N.J. |isbn=9780470233474 |pages=235–236 |edition=12th}}{{cite journal |last1=Hennekam |first1=RC |last2=Allanson |first2=JE |last3=Biesecker |first3=LG |last4=Carey |first4=JC |last5=Opitz |first5=JM |last6=Vilain |first6=E |title=Elements of morphology: standard terminology for the external genitalia. |journal=American Journal of Medical Genetics. Part A |date=June 2013 |volume=161A |issue=6 |pages=1238–63 |doi=10.1002/ajmg.a.35934 |pmid=23650202|pmc=4440541 }} The labia minora are often pink or brownish black, relevant to the person's skin color.{{cite book |title=100 Questions & Answers About Vulvar Cancer and Other Diseases of the Vulva and Vagina |author=Burrows |date=7 October 2009 |publisher=Jones & Bartlett Learning |url=https://books.google.com/books?id=NAPC-IQWtv4C&q=difference+in+color+in+vulvar+tissue&pg=PA6 |access-date=18 March 2018 |language=en |isbn=9781449630911 |archive-date=22 January 2022 |archive-url=https://web.archive.org/web/20220122095433/https://books.google.com/books?id=NAPC-IQWtv4C&q=difference+in+color+in+vulvar+tissue&pg=PA6 |url-status=live }}

The grooves between the labia majora and minora are called the interlabial sulci, or interlabial folds.{{cite book |last1=Neill |first1=Sallie |last2=Lewis |first2=Fiona |title=Ridley's The Vulva |url=https://books.google.com/books?id=S_rKEDWL9BcC&q=interlabial+sulcus&pg=PA186 |publisher=John Wiley & Sons |access-date=14 March 2018 |language=en |date=6 July 2009 |isbn=9781444316698 |archive-date=22 January 2022 |archive-url=https://web.archive.org/web/20220122095431/https://books.google.com/books?id=S_rKEDWL9BcC&q=interlabial+sulcus&pg=PA186|url-status=live}} The labia minora meet posteriorly as the frenulum (fourchette).{{cite book |last1=Fischer |first1=Gayle |last2=Bradford |first2=Jennifer |title=The Vulva: A Practical Handbook for Clinicians |publisher=Cambridge University Press |year=2023 |page=6 |access-date=December 28, 2024 |isbn=978-1-00909-596-9 |url=https://books.google.com/books?id=LEPGEAAAQBAJ&printsec=frontcover&dq=%22fourchette%22+%22labia+minora%22&hl=en&newbks=1&newbks_redir=0&source=gb_mobile_search&ovdme=1&sa=X&ved=2ahUKEwipnuj82sqKAxVpmbAFHQdSFlUQ6AF6BAgKEAM#v=onepage&q=%22fourchette%22%20&f=false}}

Located at the anterior junction of the labia minora is the clitoris, a highly erogenous sexual organ. The visible portions of the clitoris are the glans and frenulum. Typically, the glans is roughly the size and shape of a pea, and can vary in size from about 6 mm to 25 mm (less than an inch).{{cite book |last1=King |first1=Bruce M. |title=Human sexuality today |date=1996 |publisher=Prentice Hall |location=Upper Saddle River, N.J. |isbn=978-0130149947 |pages=24–28 |edition=2nd}} The size can also vary when the clitoris is erect, which happens when two regions of erectile tissue known as the corpora cavernosa (along with the bulbs and crura, which both constitute the root of the clitoris){{cite book |last=Singh |first=Vishram |title=Textbook of Anatomy- Abdomen and Lower Limb, Volume 2- E-Book|year=2023 |url=https://books.google.com/books?id=lELGEAAAQBAJ&pg=PA215|publisher=Elsevier Health Sciences |isbn=978-3-66243-680-6}} fill with blood, making the shaft engorged. The glans contains many nerve endings, which makes it highly sensitive. The only known function of the clitoris is to focus on sexual feelings. The clitoral hood is a protective fold of skin and it may partially or completely cover the shaft and glans.{{cite book |last1=Fahmy |first1=Mohamed |title=Rare Congenital Genitourinary Anomalies: An Illustrated Reference Guide |url=https://books.google.com/books?id=BpOeBQAAQBAJ&q=does+clitoral+hood+cover+the+glans&pg=PA142 |access-date=18 March 2018 |publisher=Springer |language=en |date=27 November 2014 |isbn=9783662436806 |archive-date=22 January 2022 |archive-url=https://web.archive.org/web/20220122100945/https://books.google.com/books?id=BpOeBQAAQBAJ&q=does+clitoral+hood+cover+the+glans&pg=PA142 |url-status=live}} The hood may be partially or completely hidden within the pudendal cleft.{{cite journal |last1=O'Connell |first1=HE |last2=Sanjeevan |first2=KV |last3=Hutson |first3=JM |title=Anatomy of the clitoris |journal=The Journal of Urology |date=October 2005 |volume=174 |issue=4 Pt 1 |pages=1189–95 |pmid=16145367 |doi=10.1097/01.ju.0000173639.38898.cd |s2cid=26109805}}

The area between the labia minora where the vaginal introitus and the urinary meatus (openings of the vagina and urethra respectively) are located is the vestibule. The meatus is below the clitoris and atop the introitus. The introitus is sometimes partly covered by a membrane called the hymen. The hymen will usually rupture during the first episode of vigorous sex, and the blood produced by this rupture has been seen to signify virginity. However, the hymen may also rupture spontaneously during exercise or be stretched by normal activities such as the use of tampons and menstrual cups, or be so minor as to be unnoticeable, or be absent. In some rare cases, the hymen may completely cover the introitus, requiring a surgical procedure called a hymenotomy.{{cite book |title=Wilkinson and Stone Atlas of Vulvar Disease |pages=187–188 |publisher=Lippincott Williams & Wilkins |year=2012 |isbn=9781451132182 |edition=3rd |last=Wilkinson |first=Edward J.}} Two greater vestibular glands known as Bartholin's glands open into either side of the introitus and secrete a mucous vaginal lubricant.{{cite journal |last1=Lee |first1=MY |last2=Dalpiaz |first2=A |last3=Schwamb |first3=R |last4=Miao |first4=Y |last5=Waltzer |first5=W |last6=Khan |first6=A |title=Clinical Pathology of Bartholin's Glands: A Review of the Literature |journal=Current Urology |date=May 2015 |volume=8 |issue=1 |pages=22–5 |pmid=26195958 |doi=10.1159/000365683 |pmc=4483306}} The openings of the lesser vestibular glands, known as Skene's glands, are found on either side of the urethral meatus.{{cite journal |vauthors=Rodriguez FD, Camacho A, Bordes SJ, Gardner B, Levin RJ, Tubbs RS |title=Female ejaculation: An update on anatomy, history, and controversies. |journal=Clinical Anatomy |year=2020 |volume=34 |issue=1 |pages=103–107 |pmid=32681804 |doi=10.1002/ca.23654 |s2cid=220634920 |url=https://onlinelibrary.wiley.com/doi/full/10.1002/ca.23654 |access-date=26 September 2020 |archive-date=22 November 2021 |archive-url=https://web.archive.org/web/20211122113328/https://onlinelibrary.wiley.com/doi/full/10.1002/ca.23654 |url-status=live}}

File:1116 Muscle of the Female Perineum.png]]

Pelvic floor muscles help to support the vulvar structures. The voluntary, pubococcygeus muscle, part of the levator ani muscle partially constricts the vaginal opening.{{cite journal |last1=Raizada |first1=V |last2=Mittal |first2=RK |title=Pelvic floor anatomy and applied physiology |journal=Gastroenterology Clinics of North America |date=September 2008 |volume=37 |issue=3 |pages=493–509, vii |doi=10.1016/j.gtc.2008.06.003 |pmid=18793993 |pmc=2617789}} Other muscles of the urogenital triangle support the vulvar area and they include the transverse perineal muscles, the bulbospongiosus, and the ischiocavernosus muscles.{{cite book |editor1-last=Shaw |editor1-first=Robert |last1=Maclean |first1=Allan |last2=Reid |first2=Wendy |title=Gynaecology |chapter=40 |publisher=Churchill Livingstone/Elsevier |location=Edinburgh, New York |year=2011 |isbn=978-0-7020-3120-5 |pages=599–612}} The bulbospongiosus muscle decreases the vaginal opening. They play a role in the vaginal contractions of orgasm by causing the vestibular bulbs to contract.{{cite journal |last1=Puppo |first1=V |title=Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. |journal=Clinical Anatomy |date=January 2013 |volume=26 |issue=1 |pages=134–52 |doi=10.1002/ca.22177 |pmid=23169570 |s2cid=14737481 }}

The tissues of the vulva are highly vascularised and blood supply is provided by the three pudendal arteries.{{cite book |last1=Albert |first1=Daniel |title=Dorland's illustrated medical dictionary. |date=2012 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416062578 |page=140 |edition=32nd}} Venous return is via the external and internal pudendal veins.{{cite book |last1=Albert |first1=Daniel |title=Dorland's illustrated medical dictionary. |date=2012 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416062578 |page=2043 |edition=32nd}}

The organs and tissues of the vulva are drained by a chain of superficial inguinal lymph nodes located along the blood vessels.{{Cite web |title=Superficial Inguinal Lymph Nodes — Medical Definition |website=www.medilexicon.com |url=http://www.medilexicon.com/medicaldictionary.php?t=51862 |access-date=25 March 2018|archive-date=12 May 2016|archive-url=https://web.archive.org/web/20160512223255/http://www.medilexicon.com/medicaldictionary.php?t=51862|url-status=dead}}

The ilioinguinal nerve originates from the first lumbar nerve and gives branches that include the anterior labial nerves, which supply the skin of the mons pubis and the labia majora.{{cite book |last1=Albert |first1=Daniel |title=Dorland's illustrated medical dictionary |date=2012 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416062578 |pages=1256–1257 |edition=32nd}} The perineal nerve is one of the terminal branches of the pudendal nerve and this branches into the posterior labial nerves to supply the labia. The pudendal nerve branches include the dorsal nerve, which gives sensation to the clitoris. The clitoral glans is seen to be populated by a large number of small nerves, a number that decreases as the tissue changes towards the urethra.{{cite journal |last1=Oakley |first1=SH |last2=Mutema |first2=GK |last3=Crisp |first3=CC |last4=Estanol |first4=MV |last5=Kleeman |first5=SD |last6=Fellner |first6=AN |last7=Pauls |first7=RN |title=Innervation and histology of the clitoral-urethal complex: a cross-sectional cadaver study |journal=The Journal of Sexual Medicine |date=September 2013 |volume=10 |issue=9 |pages=2211–8 |doi=10.1111/jsm.12230|pmid=23809460}} The density of nerves at the glans indicates that it is the center of heightened sensation. Cavernous nerves from the uterovaginal plexus supply the erectile tissue of the clitoris.{{cite book |last1=Albert |first1=Daniel |title=Dorland's illustrated medical dictionary |date=2012 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416062578 |page=1255 |edition=32nd}} These are joined underneath the pubic arch by the dorsal nerve of the clitoris.{{cite journal |last1=Yucel |first1=S|last2=De Souza |first2=A Jr |last3=Baskin |first3=LS |title=Neuroanatomy of the human female lower urogenital tract |journal=The Journal of Urology|date=July 2004 |volume=172 |issue=1 |pages=191–5 |doi=10.1097/01.ju.0000128704.51870.87|pmid=15201770}}

The pudendal nerve enters the pelvis through the lesser sciatic foramen and continues medial to the internal pudendal artery. The point where the nerve circles the ischial spine is the location where a pudendal block of local anesthetic can be administered to inhibit sensation to the vulva.{{cite web |title=Clinical Case - Perineum & External Genitalia |publisher=The University of Michigan |url=http://anatomy.med.umich.edu/reproductive_system/perineum_case.html |date=27 February 2009 |access-date=26 March 2018 |url-status=dead |archive-url=https://web.archive.org/web/20090227105212/http://anatomy.med.umich.edu/reproductive_system/perineum_case.html |archive-date=27 February 2009}} A number of smaller nerves split off from the pudendal nerve. The deep branch of the perineal nerve supplies the muscles of the perineum and a branch of this supplies the bulb of the vestibule.{{cite book |last1=Hoffman |first1=Barbara |title=Williams gynecology |date=2011 |publisher=McGraw-Hill Medical |location=New York |isbn=9780071716727 |pages=794–806 |edition=2nd |display-authors=etal}}{{cite book|last1=Chung|first1=Kyung Won|title=Gross anatomy |url=https://archive.org/details/brsgrossanatomy00chun_972|url-access=limited|date=2005|publisher=Lippincott Williams & Wilkins |location=Philadelphia|isbn=978-0-7817-5309-8|page=[https://archive.org/details/brsgrossanatomy00chun_972/page/n281 268]|edition=5th}}

File:Ausprägung der Labia Minora.jpeg

There is a great deal of variation in the appearance of the vulva. Much of this variation lies in the significant differences in the size, shape, and color of the labia minora. Though called the smaller lips, they can often be of considerable size and may protrude outside the labia majora. This variation has also been evidenced in a large display of 400 vulval casts called the Great Wall of Vagina created by Jamie McCartney to fill the lack of information of what a normal vulva looks like. The casts taken from a large and varied group of women showed clearly that there is much variation. Other variations of the vulva include the appearance of Fordyce spots and clitoral phimosis (when the clitoral hood cannot retract past the glans).

Researchers from the Elizabeth Garret Anderson Hospital, London, measured multiple genital dimensions of 50 women between the ages of 18 and 50, with a mean age of 35.6:{{cite journal |last1=Lloyd |first1=Jillian |last2=Crouch |first2=Naomi S. |last3=Minto |first3=Catherine L. |last4=Liao |first4=Lih-Mei |last5=Creighton |first5=Sarah M. |date=May 2005 |title=Female genital appearance: "normality" unfolds |journal=British Journal of Obstetrics and Gynaecology|volume=112|issue=5|pages=643–646 |citeseerx=10.1.1.585.1427|doi=10.1111/j.1471-0528.2004.00517.x |pmid=15842291 |s2cid=17818072 |url=http://www.newviewcampaign.org/userfiles/file/BJOG%2005-normal-genitalia.pdf |archive-url=https://web.archive.org/web/20111005144436/http://www.newviewcampaign.org/userfiles/file/BJOG%2005-normal-genitalia.pdf |archive-date=5 October 2011 |url-status=live}}

{{Main |Development of the reproductive system}}

File:Human genitalia - development 1.png from indifferent to both sexes—female on right]]

In week three of the development of the embryo, mesenchyme cells from the primitive streak migrate around the cloacal membrane.{{cite book |last1=Sadler |first1=T. |title=Langman's medical embryology |url=https://archive.org/details/langmansmedicale00sadl_655 |url-access=limited |date=2010 |publisher=Lippincott Williams & Wilkins |location=Philadelphia |isbn=9780781790697 |pages=[https://archive.org/details/langmansmedicale00sadl_655/page/n264 253]–258 |edition=11th}} Early in the fifth week, the cells form two swellings called the cloacal folds.{{cite book |last1=Larsen |first1=William J. |title=Human embryology |url=https://archive.org/details/humanembryology0003lars |url-access=registration |date=2001 |publisher=Churchill Livingstone |location=Philadelphia, Pa. |isbn=978-0443065835 |pages=[https://archive.org/details/humanembryology0003lars/page/284 284]–288 |edition=3rd}} The cloacal folds meet in front of the cloacal membrane and form a raised area known as the genital tubercle. The urorectal septum fuses with the cloacal membrane to form the perineum. This division creates two areas one surrounded by the urethral folds and the other by the anal folds. These areas become the urogenital triangle and the anal triangle.{{cite book |last1=Tortora |first1=Gerard J |last2=Anagnostakos |first2=Nicholas P |title=Principles of anatomy and physiology |date=1987 |publisher=Harper & Row |location=New York |isbn=978-0060466695 |pages=[https://archive.org/details/principlesofanat05tort/page/727 727]–728 |edition=5th |url=https://archive.org/details/principlesofanat05tort |url-access=registration }} The area between the vulva and the anus is known as the clinical perineum.

At the same time, a pair of swellings on either side of the urethral folds known as the genital swellings develop into the labioscrotal swellings. Sexual differentiation takes place, and at the end of week six in the female, hormones stimulate further development and the genital tubercle bends and forms the clitoris. The urogenital sinus persists as the vulval vestibule, vestibular glands and urethra. The urethral folds form the labia minora and the labioscrotal swellings form the labia majora.{{cite book |vauthors=Merz E, Bahlmann F |title=Ultrasound in Obstetrics and Gynecology |volume=1 |publisher=Thieme Medical Publishers |year=2004|page=129|isbn=978-1-58890-147-7}}{{cite book |vauthors=Schuenke M, Schulte E, Schumacher U |title=General Anatomy and Musculoskeletal System |publisher=Thieme Medical Publishers |isbn=978-1-60406-287-8 |year=2010 |page=192 |url=https://books.google.com/books?id=NK9TgTaGt6UC&pg=PA192 |access-date=October 27, 2015 |archive-date=July 23, 2014 |archive-url=https://web.archive.org/web/20140723044038/http://books.google.com/books?id=NK9TgTaGt6UC&pg=PA192 |url-status=live }}

The uterovaginal canal or genital canal, forms in the third month of the development of the urogenital system. The lower part of the canal is blocked off by a plate of tissue, the vaginal plate. This tissue develops and lengthens during the third to fifth months and the lower part of the vaginal canal is formed by a process of desquamation or cell shedding. The end of the vaginal canal is blocked off by an endodermal membrane, which separates the opening from the vestibule. In the fifth month, the membrane degenerates but leaves a remnant called the hymen.

The newborn's vulva may be swollen or enlarged as a result of having been exposed, via the placenta, to her mother's increased levels of hormones.{{cite web |title=Hormonal effects in newborns: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/001911.htm |website=MedlinePlus |language=en |access-date=18 Mar 2018 |archive-date=28 July 2018 |archive-url=https://web.archive.org/web/20180728062623/https://medlineplus.gov/ency/article/001911.htm |url-status=live }} The labia majora are closed.{{cite journal |last1=Puppo |first1=V |title=Embryology and anatomy of the vulva: the female orgasm and women's sexual health |journal=European Journal of Obstetrics, Gynecology, and Reproductive Biology |date=January 2011 |volume=154 |issue=1 |pages=3–8 |doi=10.1016/j.ejogrb.2010.08.009 |pmid=20832160|s2cid=30716752 }} These changes disappear over the first few months. During childhood before puberty, the lack of estrogen can cause the labia to become sticky and to ultimately join firmly together. This condition is known as labial fusion and is rarely found after puberty when estrogen production has increased.

Puberty is the onset of the ability to reproduce, and takes place over two to three years, producing a number of changes.{{cite book |last1=Campbell |first1=Neil |title=Biology |url=https://archive.org/details/biolog00camp |url-access=limited |date=1990 |publisher=Benjamin/Cummings Pub. Co. |location=Redwood City, Calif. |isbn=978-0805318005 |pages=[https://archive.org/details/biolog00camp/page/939 939]–946 |edition=2nd}}{{cite journal |last1=Marshall |first1=WA |last2=Tanner |first2=JM |title=Variations in pattern of pubertal changes in girls |journal=Archives of Disease in Childhood |date=June 1969 |volume=44 |issue=235 |pages=291–303 |pmid=5785179|pmc=2020314 |doi=10.1136/adc.44.235.291 }} The structures of the vulva become proportionately larger and may become more pronounced. Pubarche, the first appearance of pubic hair develops, firstly on the labia majora, and later spreads to the mons pubis, and sometimes to the inner thighs and perineum. Pubic hair is much coarser than other body hair, and is considered a secondary sex characteristic.{{cite web |url=http://www2.hu-berlin.de/sexology/ATLAS_EN/html/secondary_characteristics.html |title=Secondary Characteristics |work=hu-berlin.de |url-status=dead |archive-url=https://web.archive.org/web/20110927075821/http://www2.hu-berlin.de/sexology/ATLAS_EN/html/secondary_characteristics.html |archive-date=27 September 2011 }} Pubarche can occur independently of puberty. Premature pubarche may sometimes indicate a later metabolic-endocrine disorder seen at adolescence. The disorder sometimes known as a polyendocrine disorder is marked by elevated levels of androgen, insulin, and lipids, and may originate in the fetus. Instead of being seen as a normal variant it is proposed that premature pubarche may be seen as a marker for these later endocrine disorders.{{cite journal |last1=Ibáñez|first1=L |last2=Potau|first2=N |last3=Dunger|first3=D |last4=de Zegher|first4=F |title=Precocious pubarche in girls and the development of androgen excess |journal=Journal of Pediatric Endocrinology & Metabolism |date=2000 |volume=13 |issue=Suppl 5 |pages=1261–3 |pmid=11117666}}

Apocrine sweat glands secrete sweat into the pubic hair follicles. This is broken down by bacteria on the skin and produces an odor,{{cite web |title=Sweating and body odor: Causes |url=http://www.mayoclinic.org/diseases-conditions/sweating-and-body-odor/basics/causes/con-20014438 |publisher=Mayo Clinic |access-date=16 April 2016 |archive-date=15 April 2016 |archive-url=https://web.archive.org/web/20160415191548/http://www.mayoclinic.org/diseases-conditions/sweating-and-body-odor/basics/causes/con-20014438 |url-status=live }} which some consider to act as an attractant sex pheromone. The labia minora may grow more prominent and undergo changes in color. At puberty, the first monthly period known as menarche marks the onset of menstruation.{{cite book |last1=Pocock |first1=Gillian |last2=Richards |first2=Christopher D. |title=Human physiology : the basis of medicine |date=2006 |publisher=Oxford University Press |location=Oxford |isbn=9780198568780 |page=446 |edition=3rd}}

In prepubertal girls, the skin of the vulva is thin and delicate, and its neutral pH makes it prone to irritation.{{cite web |title=Vulval and vaginal problems in prepubertal females |author=Vanessa Ngan |year=2002 |url=https://www.dermnetnz.org/topics/vulval-and-vaginal-problems-in-prepubertal-females |publisher=DermNet NZ |language=en |access-date=26 March 2018 |archive-date=20 September 2018 |archive-url=https://web.archive.org/web/20180920123022/https://www.dermnetnz.org/topics/vulval-and-vaginal-problems-in-prepubertal-females |url-status=live }} The production of the female sex hormone estradiol (an estrogen) at puberty, causes the perineal skin to thicken by keratinising, and this reduces the risk of infection.{{cite book |last1=Goldstein|first1=S. |title=Pediatric and adolescent gynecology |date=2004 |publisher=Lippincott Williams & Wilkins |location=Philadelphia, PA |isbn=978-0781744935 |pages=120–155 |edition=5th}} Estrogen also causes the laying down of fat in the development of the secondary sex characteristics. This contributes to the maturation of the vulva with increases in the size of the mons pubis, and the labia majora and the enlargement of the labia minora.{{cite book |last1=Hall |first1=John E |title=Guyton and Hall textbook of medical physiology |date=2011 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416045748 |pages=993–1000 |edition=12th}}

In pregnancy, the vulva and vagina take on a bluish coloring due to venous congestion. This appears between the eighth and twelfth week and continues to darken as the pregnancy continues. Estrogen is produced in large quantities during pregnancy and this causes the vulva to become enlarged. The vaginal opening and the vagina are also enlarged.{{cite book |last1=Hall |first1=John E. |title=Guyton and Hall textbook of medical physiology |date=2011 |publisher=Saunders/Elsevier |location=Philadelphia, PA |isbn=9781416045748 |pages=1008–1014 |edition=12th}} After childbirth, a vaginal discharge known as lochia is produced and continues for about ten days.

During menopause, hormone levels decrease, which causes changes in the vulva known as vulvovaginal atrophy. The decreased estrogen affects the mons, the labia, and the vaginal opening and can cause pale, itchy, and sore skin. Other visible changes are a thinning of the pubic hair, a loss of fat from the labia majora, a thinning of the labia minora, and a narrowing of the vaginal opening. This condition has been renamed by some bodies as the genitourinary syndrome of menopause as a more comprehensive term.{{Cite journal |last1=Faubion|first1=Stephanie S. |last2=Sood|first2=Richa |last3=Kapoor|first3=Ekta |date= December 2017|title=Genitourinary Syndrome of Menopause: Management Strategies for the Clinician; Concise Review for Physicians |journal=Mayo Clinic Proceedings |volume=92 |issue=12 |pages=1842–1849 |doi=10.1016/j.mayocp.2017.08.019|pmid=29202940 |doi-access=free }}

{{Main |Female reproductive system}}

The vulva has a major role to play in the reproductive system. It provides entry to, and protection for the uterus, and the right conditions in terms of warmth and moisture that aids in its sexual and reproductive functions. The vulva is richly innervated and provides pleasure when properly stimulated. The mons pubis provides cushioning against the pubic bone during intercourse.

A number of different secretions are associated with the vulva, including urine (from the urethral opening during urination through control of the external sphincter muscle), sweat (from the apocrine glands), menses (leaving from the vagina via the introitus), sebum (from the sebaceous glands), alkaline fluid (from the Bartholin's glands), mucus (from the Skene's glands), vaginal lubrication from the vaginal wall and smegma. Smegma is a white substance formed from a combination of dead cells, skin oils, moisture and naturally occurring bacteria, that forms in the genitalia.{{cite dictionary |title=Definition of SMEGMA |url=http://www.merriam-webster.com/dictionary/smegma |dictionary=Merriam-Webster |access-date=20 April 2016 |archive-date=19 May 2020 |archive-url=https://web.archive.org/web/20200519113012/https://www.merriam-webster.com/dictionary/smegma |url-status=live }} In females, this thickened secretion collects around the clitoris and labial folds. It can cause discomfort during sexual activity as it can cause the clitoral glans to stick to the hood, and is easily removed by bathing. Aliphatic acids known as copulins are also secreted in the vagina. These are believed to act as pheromones. Their fatty acid composition, and consequently their odor changes in relation to the stages of the menstrual cycle.{{cite web |title=Pheromones Sex attraction |url=http://evolution.anthro.univie.ac.at/institutes/urbanethology/resources/articles/articles/publications/226-2005-humanPheromones-sexAttraction.pdf |access-date=1 March 2018 |archive-date=26 July 2019 |archive-url=https://web.archive.org/web/20190726230615/http://evolution.anthro.univie.ac.at/institutes/urbanethology/resources/articles/articles/publications/226-2005-humanPheromones-sexAttraction.pdf |url-status=dead }}

{{main|Human sexual response cycle |Sexual arousal}}

{{Further|Orgasm#Females}}

File:Labia becoming engorged with blood as female reaches arousal.jpg

The clitoris and the labia minora are both the most erogenous areas of the vulva. The labia majora are also somewhat erogenous.{{cite book|last=Kinsey|first=Alfred|title = Sexual Behavior in the Human Female |year = 1998|page=159|publisher=Indiana University Press |isbn=978-0-25333-411-4 |url=https://books.google.com/books?id=9GpBB61LV14C&pg=PA159}} Local stimulation can involve the clitoris, vagina and other perineal regions. The clitoris (especially the glans) is the human female's most sensitive erogenous zone and generally the primary anatomical source of human female sexual pleasure.{{Cite book |last1=Greenberg |first1=Jerrold |url=https://books.google.com/books?id=1NC5R0RozBYC&pg=PP1|title=Exploring the Dimensions of Human Sexuality |last2=Bruess |first2=Clint |last3=Conklin|first3=Sarah|date=2010-03-10|publisher=Jones & Bartlett Learning|isbn=978-0-7637-7660-2 |language=en |access-date=1 January 2021 |archive-date=13 June 2013|archive-url=https://web.archive.org/web/20130613231741/http://books.google.com/books?id=1NC5R0RozBYC&pg=PP1|url-status=live}} Sexual stimulation of the clitoris (by a number of means) can result in widespread sexual arousal and, if maintained, can result in orgasm. Stimulation to vulvar orgasm is optimally achieved by a massaging sensation, such as oral sex (cunnilingus), fingering, and tribadism (two women rubbing vulvas together).

Sexual arousal results in a number of physical changes in the vulva. During arousal, the Bartholin's glands produce more vaginal lubrication. Vulval tissue is highly vascularised; arterioles dilate in response to sexual arousal and the smaller veins will compress after arousal,{{cite book |last1=Fox |first1=Kent M. |last2=Van De Graaff |first2=Stuart Ira |title=Concepts of human anatomy and physiology |date=1989 |publisher=Wm. C. Brown Publishers |location=Dubuque, Iowa |isbn=978-0697056757 |pages=[https://archive.org/details/conceptsofhumana00vand/page/958 958–963] |edition=2nd |url=https://archive.org/details/conceptsofhumana00vand/page/958 }} so that the clitoris and labia minora increase in size. Increased vasocongestion in the vagina causes it to swell, decreasing the size of the vaginal opening by about 30%. Clitoral erection takes place, which retracts the clitoral hood, causing the glans to appear. The labia majora have swollen from blood flow,{{cite book | url=https://books.google.com/books?id=RY0n2CGS5EcC | title=Sexuality Now: Embracing Diversity | publisher=Cengage Learning | author=Carroll, Janell L. | year=2011 | isbn=978-0-495-60274-3 | pages=86–88, 116–120, 253–256}} and slightly separated, revealing a thick and engorged labia minora.{{cite book | title=Our Sexuality | publisher=Cengage Learning | last1=Crooks | first1= Robert | last2=Baur | first2=Karla | year=2014 | isbn=978-1-133-94336-5 | pages=50–54, 113–116, 163–171}} The labia minora sometimes change considerably in color, going from pink to red in lighter skinned women who have not borne a child, or red to dark red in those who have.

During orgasm, rhythmic muscle contractions occur in the outer third of the vagina, as well as the uterus and anus. Contractions become less intense and more randomly spaced as the orgasm continues. The number of contractions that accompany an orgasm vary depending on its intensity. An orgasm may be accompanied by female ejaculation, causing liquid from the Skene's glands to be expelled through the urethra. The pooled blood begins to dissipate, although at a much slower rate if an orgasm has not occurred. The vagina and its opening return to their normal relaxed state, and the rest of the vulva returns to its normal size, position and color.{{cite journal |last1=Basson |first1=R |title=The female sexual response: a different model |journal=Journal of Sex & Marital Therapy |date=Jan–Mar 2000 |volume=26 |issue=1 |pages=51–65 |doi=10.1080/009262300278641 |pmid=10693116|doi-access=free }}

{{main|Vulvar disease}}

Irritation and itching of the vulva is called pruritus vulvae. This can be a symptom of many disorders, some of which may be determined by a patch test. The most common cause of irritation is thrush, a fungal infection. Vulvovaginal health measures can help to prevent many disorders including thrush.{{cite web |title=Thrush in men and women |url=https://www.nhs.uk/conditions/thrush-in-men-and-women/ |publisher=NHS UK |access-date=25 March 2018 |date=2018-01-09 |archive-date=25 September 2018 |archive-url=https://web.archive.org/web/20180925180408/https://www.nhs.uk/conditions/thrush-in-men-and-women/ |url-status=live }} Infections of the vagina such as vaginosis and of the uterus may produce vaginal discharge, which can be an irritant when it comes into contact with the vulvar tissue.{{cite journal |last1=Mastromarino |first1=Paola |last2=Vitali |first2=Beatrice |last3=Mosca |first3=Luciana |title=Bacterial vaginosis: a review on clinical trials with probiotics |url=http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf |journal=New Microbiologica |date=2013 |volume=36 |issue=3 |pages=229–238 |pmid=23912864 |access-date=26 March 2016 |archive-date=18 May 2015 |archive-url=https://web.archive.org/web/20150518165920/http://www.newmicrobiologica.org/PUB/allegati_pdf/2013/3/229.pdf |url-status=live }}{{cite journal |last1=Rimoin |first1=Lauren P. |last2=Kwatra|first2=Shawn G. |last3=Yosipovitch |first3=Gil |title=Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations |journal=Dermatologic Therapy |volume=26 |issue=2 |year=2013 |pages=157–167 |issn=1396-0296 |doi=10.1111/dth.12034|pmid=23551372 |s2cid=3500357 }} Inflammation as vaginitis, vulvovaginitis and vulvitis can result from this causing irritation and pain.{{cite web |title=Vaginitis – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/vaginitis/symptoms-causes/syc-20354707 |publisher=Mayo Clinic |language=en |access-date=18 March 2018 |archive-date=7 July 2006 |archive-url=https://web.archive.org/web/20060707220310/http://www.mayoclinic.com/health/vaginitis/DS00255 |url-status=live }} Ingrown hairs resulting from pubic hair shaving can cause folliculitis where the hair follicle becomes infected; or give rise to an inflammatory response known as pseudofolliculitis pubis.{{cite web |url=http://www.pamf.org/teen/health/skin/pubichairremoval.html |title=Pubic Hair Removal – Shaving |publisher=Palo Alto Medical Foundation |access-date=13 November 2011 |archive-date=7 September 2012 |archive-url=https://archive.today/20120907210406/http://www.pamf.org/teen/health/skin/pubichairremoval.html|url-status=live}} A less common cause of irritation is genital lichen planus, another inflammatory disorder. A severe variant of this is vulvovaginal-gingival syndrome, which can lead to narrowing of the vagina,{{cite journal |last=Panagiotopoulou |first=N |author2=Wong, CS |author3=Winter-Roach, B |title=Vulvovaginal-gingival syndrome |journal=Journal of Obstetrics and Gynaecology |date=April 2010 |volume=30 |issue=3 |pages=226–30 |pmid=20373919 |doi=10.3109/01443610903477572 |s2cid=45115301 }} or vulva destruction.{{cite journal|last=Schlosser|first=BJ|title=Lichen planus and lichenoid reactions of the oral mucosa |journal=Dermatologic Therapy |date=May–Jun 2010 |volume=23|issue=3|pages=251–67|doi=10.1111/j.1529-8019.2010.01322.x|pmid=20597944|s2cid=37730720|doi-access=free}} Many types of infection and other diseases including some cancers may cause irritation.

{{Main|Sexually transmitted infection}}

File:Molluscaklein.jpg]]

File:SOA-Pediculosis-pubis.jpg

Vulvar organs and tissues can become affected by different infectious agents such as bacteria and viruses, or infested by parasites such as lice and mites. Over thirty types of pathogen can be sexually transmitted, and many of these affect the genitals. Most STIs do not produce symptoms or symptoms may be mild and not be indicative of an STI.{{cite web |title=Sexually transmitted infections (STIs) Fact sheet N°110 |url=https://www.who.int/mediacentre/factsheets/fs110/en/ |publisher=WHO |access-date=30 November 2014 |date=November 2013 |url-status=live |archive-url=https://web.archive.org/web/20141125133056/http://www.who.int/mediacentre/factsheets/fs110/en/|archive-date=25 November 2014 }} The practice of safe sex can greatly reduce the risk of infection from many sexually transmitted pathogens.{{cite web |title=safe sex {{!}} Definition of safe sex in English by Oxford Dictionaries |url=https://en.oxforddictionaries.com/definition/safe_sex |publisher=Oxford Dictionaries |access-date=18 March 2018 |archive-date=25 September 2018 |archive-url=https://web.archive.org/web/20180925180452/https://en.oxforddictionaries.com/definition/safe_sex |url-status=dead }} The use of condoms (either male or female condoms) is one of the most effective methods of protection.

Bacterial infections include: chancroid – characterised by genital ulcers known as chancres; granuloma inguinale showing as inflammatory granulomas often described as nodules; syphilis –the primary stage classically presents with a single chancre, a firm, painless, non-itchy ulcer, but there may be multiple sores;{{cite web |title=Syphilis - CDC Fact Sheet (Detailed) |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |publisher=Centers for Disease Control and Prevention |access-date=3 February 2016 |date=2 November 2015 |archive-date=30 July 2018 |archive-url=https://web.archive.org/web/20180730092959/https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm |url-status=live }} and gonorrhea that very often presents no symptoms but can result in discharge.{{cite web |title=STD Facts - Gonorrhea |url=https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm |publisher=Centers for Disease Control and Prevention |language=en-us |access-date=11 December 2017 |date=2017-12-11 |archive-date=16 December 2016 |archive-url=https://web.archive.org/web/20161216052928/http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm |url-status=live }}

Viral infections include human papillomavirus infection (HPV) – this is the most common STI and has many types.{{cite book|last1=Milner|first1=Danny A.|title=Diagnostic Pathology: Infectious Diseases E-Book |url=https://books.google.com/books?id=YJ_uCQAAQBAJ&pg=PA40|publisher=Elsevier Health Sciences|language=en|date=3 June 2015 |isbn=9780323400374 |access-date=19 October 2020|archive-date=3 August 2020|archive-url=https://web.archive.org/web/20200803112415/https://books.google.com/books?id=YJ_uCQAAQBAJ&pg=PA40|url-status=live}} Genital HPV can cause genital warts. There have been links made between HPV and vulvar cancer, though HPV most often causes cervical cancer.{{cite web|title=Human papillomavirus (HPV) and cervical cancer |url=https://www.who.int/mediacentre/factsheets/fs380/en/|publisher=WHO|date=June 2016|url-status=live|archive-url=https://web.archive.org/web/20160805111143/http://www.who.int/mediacentre/factsheets/fs380/en/|archive-date=5 August 2016}} Genital herpes is mostly asymptomatic but can present with small blisters that break open into ulcers.{{cite web |url=https://www.cdc.gov/std/herpes/STDFact-herpes-detailed.htm |title=Genital Herpes – CDC Fact Sheet|publisher=Centers for Disease Control and Prevention|date=9 February 2017|access-date=20 December 2017|archive-date=31 December 2014|archive-url=https://web.archive.org/web/20141231122747/http://www.cdc.gov/std/herpes/STDFact-Herpes-detailed.htm|url-status=live}} HIV/AIDS is mostly transmitted through sexual activity, and the vulva in some cases can be affected by sores.{{cite journal |last1=Zweizig |first1=Susan |last2=Korets |first2=Sharmilee |last3=Cain |first3=Joanna M. |title=Key concepts in management of vulvar cancer |journal=Best Practice & Research Clinical Obstetrics & Gynaecology |volume=28 |issue=7 |year=2014 |pages=959–966 |issn=1521-6934 |doi=10.1016/j.bpobgyn.2014.07.001 |pmid=25151473}}

A highly contagious viral infection is molluscum contagiosum, which is transmissible on close contact and causes water warts.{{cite journal|last1=Stock|first1=I|title=[Molluscum contagiosum--a common but poorly understood "childhood disease" and sexually transmitted illness].|journal=Medizinische Monatsschrift für Pharmazeuten|date=August 2013|volume=36|issue=8|pages=282–90|pmid=23977728}}{{cite web |title=Risk Factors - Molluscum Contagiosum |publisher=Centers for Disease Control and Prevention |url=https://www.cdc.gov/poxvirus/molluscum-contagiosum/risk.html |access-date=24 March 2016 |archive-date=10 June 2017 |archive-url=https://web.archive.org/web/20170610203738/https://www.cdc.gov/poxvirus/molluscum-contagiosum/risk.html |url-status=live}}

Parasitic infections include trichomoniasis, pediculosis pubis, and scabies. Trichomoniasis is transmitted by a parasitic protozoan and is the most common non-viral STI.{{cite journal |last1=de Waaij |first1=DJ |last2=Dubbink |first2=JH |last3=Ouburg |first3=S |last4=Peters |first4=RPH |last5=Morré |first5=SA |title=Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: a cross-sectional study |journal=BMJ Open |date=8 October 2017 |volume=7 |issue=10 |pages=e016959 |doi=10.1136/bmjopen-2017-016959 |pmid=28993385 |pmc=5640031}} Most cases are asymptomatic but may present symptoms of irritation and a discharge of unusual odor.{{cite web |title=STD Facts - Trichomoniasis |url=https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm |publisher=Centers for Disease Control and Prevention |language=en-us |access-date=5 October 2017 |archive-date=19 February 2013 |archive-url=https://web.archive.org/web/20130219210323/http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm |url-status=live }} Pediculosis pubis, commonly called crabs, is a disease caused by the crab louse an ectoparasite. When the pubic hair is infested, the irritation produced can be intense.{{cite journal|last1=Leone|first1=PA|title=Scabies and pediculosis pubis: an update of treatment regimens and general review.|journal=Clinical Infectious Diseases|date=1 April 2007 |volume=44 |issue=Suppl 3 |pages=S153–9 |doi=10.1086/511428 |pmid=17342668 |doi-access=free}} Scabies, also known as the "seven year itch", is caused by another ectoparasite, the mite Sarcoptes scabiei, giving intense irritation.

{{Main|Vulvar cancer}}

Malignancies can develop in the glabrous and hair-bearing parts of the vulva.{{Cite journal |last1=Wohlmuth |first1=Christoph |last2=Wohlmuth-Wieser |first2=Iris |date=December 2019 |title=Vulvar malignancies: an interdisciplinary perspective |journal=Journal of the German Society of Dermatology |volume=17 |issue=12 |pages=1257–1276 |doi=10.1111/ddg.13995 |issn=1610-0387 |pmc=6972795 |pmid=31829526}} Based on the cellular origin and histology, vulvar cancers are classified into squamous cell carcinomas, melanomas, basal cell carcinomas, adenocarcinomas, sarcomas and invasive extramammary Paget's disease. Squamous cell carcinomas represent the most common variant of vulvar cancers and account for approximately 75%. These are usually found in the labia, particularly the labia majora.{{cite web |title=About vulval cancer |url=http://www.cancerresearchuk.org/about-cancer/type/vulval-cancer/about/the-vulva |publisher=Cancer Research UK |access-date=6 April 2016 |archive-date=14 April 2016 |archive-url=https://web.archive.org/web/20160414234117/http://www.cancerresearchuk.org/about-cancer/type/vulval-cancer/about/the-vulva |url-status=live }} The second most common vulvar cancer is basal cell carcinoma, which rarely spreads to regional lymph nodes or distant organs. The third most common subtype is vulvar melanoma. Studies have shown that vulvar melanomas appear to have a different tumor biology and mutational characteristics compared to skin melanomas, which has a direct impact on the medical treatment of vulvar melanomas.{{cite web |title=Types of vulval cancer |url=http://www.cancerresearchuk.org/about-cancer/vulval-cancer/stages-types-grades/types |publisher=Cancer Research UK |access-date=19 March 2018 |language=en |archive-date=31 December 2017 |archive-url=https://web.archive.org/web/20171231203821/http://www.cancerresearchuk.org/about-cancer/vulval-cancer/stages-types-grades/types |url-status=live}}{{Cite journal |last1=Wohlmuth |first1=Christoph |last2=Wohlmuth-Wieser |first2=Iris |last3=May |first3=Taymaa |last4=Vicus |first4=Danielle |last5=Gien |first5=Lilian T. |last6=Laframboise |first6=Stéphane |date=April 2020 |title=Malignant Melanoma of the Vulva and Vagina: A US Population-Based Study of 1863 Patients |journal=American Journal of Clinical Dermatology |volume=21 |issue=2 |pages=285–295 |doi=10.1007/s40257-019-00487-x |issn=1179-1888 |pmc=7125071 |pmid=31784896}}

Signs and symptoms of vulvar cancer can include: itching, or bleeding; skin changes including rashes, sores, lumps or ulcers, and changes in vulvar skin coloration. Pelvic pain might also occur especially during urinating and sex.{{cite web |title=CDC - What Are the Symptoms of Vaginal and Vulvar Cancers? |publisher=Centers for Disease Control and Prevention |language=en-us |url=https://www.cdc.gov/cancer/vagvulv/basic_info/symptoms.htm |access-date=18 March 2018 |archive-date=27 July 2019 |archive-url=https://web.archive.org/web/20190727154152/https://www.cdc.gov/cancer/vagvulv/basic_info/symptoms.htm |url-status=live }} However, a significant proportion remains asymptomatic in early disease stages, often delaying its diagnosis. As such, 32% of women with vulvar melanoma already have regional involvement or distant metastases at the time of diagnosis, which significantly impacts prognosis.

Surgery (with or without removal of regional lymph nodes) is usually the primary treatment modality. Typically, a wide-local excision is performed, in which the tumor is excised including a safety-margin of healthy tissue to ensure its entire removal, which is confirmed by a pathologist. In more advanced disease, a (partial) vulvectomy may need to be performed in order to remove some or all of the vulva.{{cite journal |last1=Fuh |first1=KC |last2=Berek |first2=JS |title=Current management of vulvar cancer. |journal=Hematology/Oncology Clinics of North America |date=February 2012 |volume=26 |issue=1 |pages=45–62 |doi=10.1016/j.hoc.2011.10.006 |pmid=22244661}} Advanced-stage melanomas can be treated with checkpoint inhibitors.{{Cite journal|last1=Wohlmuth|first1=Christoph|last2=Wohlmuth-Wieser|first2=Iris|last3=Laframboise|first3=Stéphane|date=2020-11-24|title=Clinical Characteristics and Treatment Response With Checkpoint Inhibitors in Malignant Melanoma of the Vulva and Vagina|journal=Journal of Lower Genital Tract Disease|volume=25|issue=2|pages=146–151|doi=10.1097/LGT.0000000000000583|issn=1526-0976|pmid=33252450|pmc=7984764}}

Labial fusion, also called labial adhesion, is the fusion of the labia minora. This affects a number of young girls and is not considered unduly problematic. The condition can usually be treated using creams, or it may right itself with the release of hormones at the onset of puberty.{{cite web |title=NHS Direct Wales - Encyclopaedia : Labial fusion |url=http://www.nhsdirect.wales.nhs.uk/encyclopaedia/l/article/labialfusion/ |publisher=NHS Direct Wales |access-date=26 March 2018 |archive-date=27 September 2011 |archive-url=https://web.archive.org/web/20110927123832/http://www.nhsdirect.wales.nhs.uk/encyclopaedia/l/article/labialfusion/ |url-status=live }}{{cite web |title=Labial adhesion in prepubertal girls |author=Amanda Oakley |location=Hamilton, New Zealand |date=2011 |url=https://www.dermnetnz.org/topics/labial-adhesion-prepubertal-girls/ |publisher=DermNet NZ |language=en |access-date=26 March 2018 |archive-date=2 October 2018 |archive-url=https://web.archive.org/web/20181002180612/https://www.dermnetnz.org/topics/labial-adhesion-prepubertal-girls/ |url-status=live }}

Clitoromegaly is an enlarged clitoris caused by either anabolic steroids or an intersex condition.

Vulvodynia is chronic pain in the vulvar region. There is no single identifiable cause.{{cite journal |pmid=21542444 |year=2011 |last1=Feldhaus-Dahir |first1=M |title=The causes and prevalence of vestibulodynia: A vulvar pain disorder |journal=Urologic Nursing |volume=31 |issue=1 |pages=51–4 |doi=10.7257/1053-816X.2012.31.1.51 }} A subtype of this is vulvar vestibulitis but since this is not thought to be an inflammatory condition it is more usually referred to as vestibulodynia.{{cite journal|last1=Bergeron|first1=S|last2=Binik|first2=YM|last3=Khalifé|first3=S|last4=Pagidas|first4=K|title=Vulvar vestibulitis syndrome: a critical review.|journal=The Clinical Journal of Pain|date=March 1997|volume=13|issue=1|pages=27–42|pmid=9084950|doi=10.1097/00002508-199703000-00006}} Vulvar vestibulitis usually affects pre-menopausal women.

Pudendal nerve entrapment can cause sharp pain or numbness in the vulva. This condition can be caused by activities such as cycling, giving birth, or prolonged sitting.

A number of skin disorders such as lichen sclerosus, and lichen simplex chronicus can affect the vulva. Crohn's disease of the vulva is an uncommon form of metastatic Crohn's disease, which manifests as a skin condition showing as hypertrophic lesions or vulvar abscesses.{{cite journal |last1=Barret|first1=Maximilien |last2=de Parades|first2=Vincent |last3=Battistella|first3=Maxime |last4=Sokol|first4=Harry |last5=Lemarchand|first5=Nicolas |last6=Marteau|first6=Philippe |title=Crohn's disease of the vulva |journal=Journal of Crohn's and Colitis |volume=8 |issue=7 |year=2014 |pages=563–570 |issn=1873-9946 |doi=10.1016/j.crohns.2013.10.009|pmid=24252167 |doi-access=free }} Papillary hidradenomas are nodules that can ulcerate and are mostly found on the skin of the labia or of the interlabial folds. Another more complex ulcerative condition is hidradenitis suppurativa, which is characterised by painful cysts that can ulcerate, and recur, and can become chronic lasting for many years.{{cite journal |last1=Stewart|first1=KMA |title=Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn Disease, and Aphthous Ulcers |journal=Obstetrics and Gynecology Clinics of North America |date=September 2017 |volume=44 |issue=3 |pages=453–473 |doi=10.1016/j.ogc.2017.05.009|pmid=28778643}}{{cite journal |last1=Talmant|first1=JC |last2=Bruant-Rodier|first2=C |last3=Nunziata|first3=AC |last4=Rodier|first4=JF |last5=Wilk|first5=A |title=[Squamous cell carcinoma arising in Verneuil's disease: two cases and literature review] |journal=Annales de Chirurgie Plastique et Esthétique |date=February 2006 |volume=51 |issue=1 |pages=82–6 |doi=10.1016/j.anplas.2005.11.002 |pmid=16488526}} Chronic cases can develop into squamous cell carcinomas. An asymptomatic skin disorder of the vulval vestibule is vestibular papillomatosis, which is characterised by fine, pink projections from either the epithelium of the vulva or from the labia minora. Dermatoscopy can distinguish this condition from genital warts.{{cite journal |last1=Kim|first1=SH |last2=Seo|first2=SH |last3=Ko|first3=HC |last4=Kwon|first4=KS |last5=Kim|first5=MB |title=The use of dermatoscopy to differentiate vestibular papillae, a normal variant of the female external genitalia, from condyloma acuminate |journal=Journal of the American Academy of Dermatology |date=February 2009 |volume=60 |issue=2 |pages=353–5 |doi=10.1016/j.jaad.2008.08.031|pmid=19150287 }} A subtype of psoriasis, an autoimmune disease, is inverse psoriasis in which red patches can appear in the skin folds of the labia.{{cite journal |last1=Weigle |first1=N |last2=McBane |first2=S |title=Psoriasis |journal=American Family Physician |date=1 May 2013 |volume=87 |issue=9 |pages=626–33 |pmid=23668525}}

The vulvar region is at risk for trauma during childbirth.{{cite journal |last1=Dudley |first1=Lynn M |last2=Kettle |first2=Christine |last3=Ismail |first3=Khaled MK |last4=Dudley |first4=Lynn M |title=Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth |year=2013|doi=10.1002/14651858.CD008977.pub2 |pmid=24065561 |journal=Cochrane Database Syst Rev |pages=CD008977 |issue=9 |url=http://eprints.staffs.ac.uk/267/1/CD008977.pdf |access-date=28 December 2018 |archive-date=10 August 2017 |archive-url=https://web.archive.org/web/20170810050418/http://eprints.staffs.ac.uk/267/1/CD008977.pdf|url-status=live}}

During childbirth, the vagina and vulva must stretch to accommodate the baby's head (approximately {{convert|9.5|cm|1|abbr=on}}). This can result in tears known as perineal tears in the vaginal opening, and other structures within the perineum.{{cite book |last1=Finn |first1=Martha |last2=Bowyer |first2=Lucy |last3=Carr |first3=Sandra |last4=O'Connor |first4=Vivienne |last5=Vollenhoven |first5=Beverley |title=Women's Health: A Core Curriculum |date=2005 |publisher=Elsevier |location=Australia |isbn=978-0-7295-3736-0}} An episiotomy (a pre-emptive surgical cutting of the perineum) is sometimes performed to facilitate delivery and limit tearing. A tear takes longer to heal than an incision. Tears and incisions may be repaired using sutures that may be layered.{{cite web|title=Perineal Trauma: Assessment and Repair |url=http://www.thewomens.org.au/PerinealTraumaAssessmentandRepair |website=the women's |access-date=1 October 2011 |url-status=dead |archive-url=https://web.archive.org/web/20111001014558/http://www.thewomens.org.au/PerinealTraumaAssessmentandRepair |archive-date=1 October 2011}} Among the methods of hair removal evaluated for pre-surgeries, pubic hair shaving known as prepping, was seen to increase the risk of surgical site infections.{{cite journal |last1=Lefebvre|first1=A. |last2=Saliou|first2=P. |last3=Lucet|first3=J.C. |last4=Mimoz|first4=O. |last5=Keita-Perse|first5=O. |last6=Grandbastien|first6=B. |last7=Bruyère|first7=F. |last8=Boisrenoult|first8=P. |last9=Lepelletier|first9=D. |last10=Aho-Glélé|first10=L.S. |title=Preoperative hair removal and surgical site infections: network meta-analysis of randomized controlled trials |journal=Journal of Hospital Infection |volume=91 |issue=2 |year=2015 |pages=100–108 |issn=0195-6701 |doi=10.1016/j.jhin.2015.06.020 |pmid=26320612 }}{{cite book |last1=King|first1=Bruce |title=Human sexuality today |date=1996 |publisher=Prentice Hall |location=Upper Saddle River, N.J. |isbn=978-0130149947 |page=178 |edition=2nd}} No advantages have been demonstrated in the routine shaving of pubic hair prior to childbirth.{{cite journal |last1=Basevi|first1=Vittorio |last2=Lavender|first2=Tina |last3=Basevi|first3=Vittorio |title=Routine perineal shaving on admission in labour |year=2014 |doi=10.1002/14651858.CD001236.pub2 |journal=Reviews |volume=2014 |pmid=25398160 |issue=11 |page=CD001236|pmc=7076285 }}

{{main|Genitoplasty|Cosmetic surgery}}

Genitoplasties are plastic surgeries that can be carried out to repair, restore or alter vulvar tissues,{{cite web |title=genitoplasty |url=https://medical-dictionary.thefreedictionary.com/genitoplasty |publisher=TheFreeDictionary |access-date=18 March 2018 |archive-date=3 October 2018 |archive-url=https://web.archive.org/web/20181003141635/https://medical-dictionary.thefreedictionary.com/genitoplasty |url-status=live }} particularly following damage caused by injury or cancer treatment. These procedures include vaginoplasty and vulvoplasty, which can also be performed as a cosmetic surgery. Other cosmetic surgeries to change the appearance of external structures include labiaplasties.{{cite journal |last1=Wong |first1=CS |last2=Bhimji |first2=SS |title=Labiaplasty, Labia Minora Reduction |journal=StatPearls |date=January 2018 |pmid=28846226}} Some of these procedures, vaginoplasties and vulvoplasties, are also carried out as sex reassignment surgeries.{{cite web |last1=Munro |first1=Donald |title=Trans Media Watch |url=http://www.transmediawatch.org/timeline.html |publisher=Trans Media Watch |access-date=18 March 2018 |language=en |archive-date=18 December 2019 |archive-url=https://web.archive.org/web/20191218150249/http://transmediawatch.org/timeline.html |url-status=dead }}{{cite book |last1=Carroll |first1=Lynne |last2=Mizock |first2=Lauren |title=Clinical Issues and Affirmative Treatment with Transgender Clients, An Issue of Psychiatric Clinics of North America, E-Book |url=https://books.google.com/books?id=lvwTDgAAQBAJ&pg=PT111 |publisher=Elsevier Health Sciences |language=en |access-date=7 February 2017 |isbn=9780323510042 |date=2017-02-07 |archive-date=6 August 2020 |archive-url=https://web.archive.org/web/20200806191009/https://books.google.com/books?id=lvwTDgAAQBAJ&pg=PT111 |url-status=live }}

The use of cosmetic surgeries has been criticized by clinicians.{{cite news |last=Bourke |first=Emily |title=Designer vagina craze worries doctors |publisher=Australian Broadcasting Corporation |date=2009-11-12 |url=http://www.abc.net.au/news/stories/2009/11/12/2741446.htm?site=local |access-date=5 March 2016 |archive-date=12 November 2012 |archive-url=https://web.archive.org/web/20121112002110/http://www.abc.net.au/news/stories/2009/11/12/2741446.htm?site=local |url-status=dead }}{{cite journal |last = Liao |first = Lih Mei |author2=Sarah M Creighton |title = Requests for cosmetic genitoplasty: how should healthcare providers respond? |journal = BMJ |volume = 334 |issue = 7603 |pages = 1090–1092 | date = 24 May 2007| url= | doi = 10.1136/bmj.39206.422269.BE| pmid = 17525451 | pmc = 1877941}} The American College of Obstetricians and Gynecologists recommends that women be informed of the risks of these surgeries. They refer to the lack of data relevant to their safety and effectiveness and to the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring.{{cite journal

| author = American College of Obstetricians and Gynecologists

|year = 2007

|title = Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures

|url = http://www.newviewcampaign.org/userfiles/file/ACOG%20gen.cosm.surg.pdf

|archive-url = https://web.archive.org/web/20081230104932/http://www.newviewcampaign.org/userfiles/file/ACOG%20gen.cosm.surg.pdf

|archive-date = 30 December 2008

|page = 2 |website=New View Campaign }} There is also a percentage of people seeking cosmetic surgery who may be suffering from body dysmorphic disorder and surgery in these cases can be counterproductive.{{cite journal|last1=Tignol|first1=J|last2=Martin-Guehl|first2=C|last3=Aouizerzate|first3=B|title=[Body dysmorphic disorder (BDD)].|journal=Presse Médicale |date=January 2012|volume=41|issue=1|pages=e22–35|pmid=21831574|doi=10.1016/j.lpm.2011.05.021}}

{{see also|Vagina#Society and culture|Vulva activism}}

{{Further |Genital modification and mutilation}}

File:Labiaplastia.jpg and clitoral hood reduction]]

File:Muff March Harley Street 2.jpg movement opposes the ideals of female cosmetic genital surgeries: The Muff March in London, 2011]]

In some cultural practices, particularly in the African Khoikhoi and Rwanda cultures, the labia minora are purposefully stretched by repeated pulling on them and sometimes by attaching weights.{{cite news|title=Rwandan Women View The Elongation Of Their Labia As Positive|url=https://www.medicalnewstoday.com/releases/97388.php|work=Medical News Today|language=en|access-date=27 March 2018|archive-date=17 June 2018|archive-url=https://web.archive.org/web/20180617192548/https://www.medicalnewstoday.com/releases/97388.php|url-status=live}}{{cite web|title=Jan Nederveen Pieterse, Wit over zwart · dbnl|url=http://www.dbnl.org/tekst/nede008wito01_01/nede008wito01_01_0013.php|website=DBNL|language=nl|access-date=28 March 2018|archive-date=21 May 2019|archive-url=https://web.archive.org/web/20190521162053/https://www.dbnl.org/tekst/nede008wito01_01/nede008wito01_01_0013.php|url-status=live}} Labia stretching is a recognised, familial cultural practice in parts of Eastern and Southern Africa.{{cite journal|last1=Martínez Pérez|first1=G|last2=Mubanga|first2=M|last3=Tomás Aznar|first3=C|last4=Bagnol|first4=B|title=Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation.|journal=Journal of Sex Research|date=2015|volume=52|issue=8|pages=857–67|doi=10.1080/00224499.2014.1003027|pmid=26147362|s2cid=8307959}}{{cite journal|last1=Audet|first1=CM|last2=Blevins|first2=M|last3=Cherry|first3=CB|last4=González-Calvo|first4=L|last5=Green|first5=AF|last6=Moon|first6=TD|title=Understanding intra-vaginal and labia minora elongation practices among women heads-of-households in Zambézia Province, Mozambique.|journal=Culture, Health & Sexuality|date=May 2017|volume=19|issue=5|pages=616–629|doi=10.1080/13691058.2016.1257739|pmid=27921861|pmc=5460297}} This is a desired and encouraged practice by the women (starting at puberty) in order to promote better sexual satisfaction for both parties.{{cite web|url=http://apps.who.int/iris/bitstream/10665/75182/1/WHO_RHR_HRP_12.25_eng.pdf|title=Health and beauty: vaginal practices: Indonesia (Yogyakarta), Mozambique (Tete), South Africa (KwaZulu-Natal), and Thailand (Chonburi)|publisher=World Health Organization|access-date=27 March 2018|archive-date=26 October 2013|archive-url=https://web.archive.org/web/20131026024448/http://apps.who.int/iris/bitstream/10665/75182/1/WHO_RHR_HRP_12.25_eng.pdf|url-status=live}} The achieved extensions can hang down below the labia majora for up to seven inches. Children in the African diaspora practise this too, so it occurs within immigrant communities in, for example, Britain, where a BBC News report labelled it a hidden form of child abuse.{{cite news|title=Labia stretching: Why some British girls are told to do it|url=https://www.bbc.co.uk/news/av/magazine-39448355/labia-stretching-why-some-british-girls-are-told-to-do-it|access-date=24 April 2018 |publisher=BBC News |date=7 April 2017|archive-date=16 April 2019|archive-url=https://web.archive.org/web/20190416081435/https://www.bbc.co.uk/news/av/magazine-39448355/labia-stretching-why-some-british-girls-are-told-to-do-it|url-status=live}} The girls are subject to familial and social pressure to conform.{{cite news|last1=Akumu|first1=Patience|title=Labia elongation: Invaluable culture or dangerous practice?|url=http://www.observer.ug/lifestyle/73-people-society/8909-labia-elongation-invaluable|access-date=24 April 2018|work=The Observer – Uganda|date=16 June 2010|language=en-gb|archive-date=22 September 2018|archive-url=https://web.archive.org/web/20180922173808/https://www.observer.ug/lifestyle/73-people-society/8909-labia-elongation-invaluable|url-status=live}}

In some cultures, including modern Western culture, women have shaved or otherwise removed the hair from part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would remove the hair on either side of their pubic triangles, to avoid exhibiting pubic hair.{{cite book |first1=Heinz|last1=Tschachler |first2=Maureen|last2=Devine |first3=Michael|last3=Draxlbauer |title=The EmBodyment of American Culture |url=https://archive.org/details/bub_gb_6pQTxa3gkvQC|pages=[https://archive.org/details/bub_gb_6pQTxa3gkvQC/page/n57 61]–62 |publisher=LIT Verlag |location=Berlin-Hamburg-Münster |year=2003 |isbn=978-3-8258-6762-1}} Other women prefer to retain their vulva hair. The removal of hair from the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, usually in the form of bikini waxing or Brazilian waxing, but has been prevalent in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography.{{Cite journal |last1=Rowen TS |last2=Gaither TW |last3=Awad MA |last4=Osterberg E |last5=Shindel AW |last6=Breyer BN |date=October 2016 |title=Pubic Hair Grooming Prevalence and Motivation Among Women in the United States |journal=JAMA Dermatology |volume=152 |issue=10 |pages=1106–1113 |doi=10.1001/jamadermatol.2016.2154 |pmid=27367465 |issn=2168-6068 |url=https://escholarship.org/content/qt3km422pc/qt3km422pc.pdf?t=obzy7r |doi-access=free |access-date=2 September 2019 |archive-date=14 March 2020 |archive-url=https://web.archive.org/web/20200314065231/https://escholarship.org/content/qt3km422pc/qt3km422pc.pdf?t=obzy7r |url-status=live }}{{Cite book|last1=Farage|first1=Miranda A.|last2=Maibach|first2=Howard I.|title=The Vulva: Anatomy, Physiology, and Pathology|url=https://books.google.com/books?id=beenEjKmvPwC&q=vulval+hair+removal&pg=PA203|publisher=CRC Press|access-date=27 March 2018|language=en|date=19 April 2016|isbn=9781420005318|archive-date=4 March 2022|archive-url=https://web.archive.org/web/20220304215323/https://books.google.com/books?id=beenEjKmvPwC&q=vulval+hair+removal&pg=PA203|url-status=live}} Hair removal may include all, most, or some of the hair.Helen Bickmore; Milady's Hair Removal Techniques: A Comprehensive Manual; Thomson Delmar Learning; 2003; {{ISBN|1-4018-1555-3}} French waxing leaves a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft called a landing strip. Islam teaching includes Muslim hygienical jurisprudence a practice of which is the removal of pubic hair.{{cite book | url=https://books.google.com/books?id=53EPNr8qeLgC&q=Pubic+and+armpit+hair+must+also+be+shaven.+islam&pg=PA169 | title=Living in the Shade of Islam: A Comprehensive Reference of Theory and Practice | publisher=Tughra Books | date=2003 | last=Ismail |first=Buyukcelebi | page=169 | isbn=978-1-932-09921-8}}

File:Klitorisvorhautpiercing und Piercing der inneren Schamlippen.jpg above and the labia piercing]]

File:Fresh hanabira.jpg

Several forms of genital piercings can be made in the vulva, and include the Christina, Princess Albertina, Isabella, Nefertiti, fourchette, and labia piercings. Piercings are usually performed for aesthetic purposes, but some forms like the clitoral hood piercing (or rarely glans piercing) might also enhance pleasure during sex. Though they are common in traditional cultures, intimate piercings are a fairly recent trend in Western society.{{cite web |url=https://www.nbcnews.com/id/wbna18039467 |title=Can selfish lovers ever give as good as they get? Plus, the perks of piercings and how to get her to hurry up already |publisher=MSNBC |date=4 December 2007 |access-date=13 November 2011 |archive-date=4 September 2018 |archive-url=https://web.archive.org/web/20180904094108/http://www.nbcnews.com/id/18039467/ |url-status=live }}{{Cite journal |url=http://www.ajog.org/article/S0002-9378(05)00448-5/abstract |title=First glimpse of the functional benefits of clitoral hood piercings |journal=American Journal of Obstetrics and Gynecology |volume=193 |issue=3 |pages=675–676 |access-date=13 November 2011 |doi=10.1016/j.ajog.2005.02.130 |pmid=16150259 |year=2005 |last1=Millner |first1=Vaughn S. |last2=Eichold |first2=Bernard H. |last3=Sharpe |first3=Thomasina H. |last4=Lynn |first4=Sherwood C. |archive-date=2 August 2020 |archive-url=https://web.archive.org/web/20200802030449/https://www.ajog.org/article/S0002-9378%2805%2900448-5/abstract |url-status=live }}{{cite web |url=http://www.safepiercing.org/wp-content/uploads/2009/03/point31.pdf |title=VCH Piercings, by Elayne Angel, Seite 16-17, The Official Newsletter of The Association of Professional Piercers |access-date=2011-11-13 |url-status=dead |archive-url=https://web.archive.org/web/20111122063400/http://www.safepiercing.org/wp-content/uploads/2009/03/point31.pdf |archive-date=22 November 2011 }} Other forms of permanent modifications of the vulva for cultural, decorative or aesthetic reasons are genital tattoos or scarification (so-called "Hanabira").

Female genital surgery includes laser resurfacing of the labia to remove wrinkles, labiaplasty (reducing the size of the labia) and vaginoplasty. In September 2007, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion on these and other female genital surgeries, including "vaginal rejuvenation", "designer vaginoplasty", "revirgination", and "G-spot amplification". This opinion states that the safety of these procedures has not been documented. The ACOG and the ISSVD recommend that women seeking these surgeries need to be informed about the lack of data supporting these procedures and the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring.{{Cite journal |last1=Vieira-Baptista |first1=Pedro |last2=Almeida |first2=Gutemberg |last3=Bogliatto |first3=Fabrizio |last4=Bohl |first4=Tanja Gizela |last5=Burger |first5=Matthé |last6=Cohen-Sacher |first6=Bina |last7=Gibbon |first7=Karen |last8=Goldstein |first8=Andrew |last9=Heller |first9=Debra |date=July 2018 |title=International Society for the Study of Vulvovaginal Disease Recommendations Regarding Female Cosmetic Genital Surgery |journal=Journal of Lower Genital Tract Disease |volume=22 |issue=4 |language=en |pages=415–434 |doi=10.1097/lgt.0000000000000412 |pmid=29994815 |s2cid=51613481 |issn=1526-0976}}

With the growing popularity of female cosmetic genital surgeries, the practice increasingly draws criticism from an opposition movement of cyberfeminist activist groups and platforms, called the labia pride movement. The major point of contention is that heavy advertising for these procedures, in combination with a lack of public education, fosters body insecurities in women with larger labia in spite of the fact that there is normal and pronounced individual variation in the size of labia. The preference for smaller labia is a matter of a fashion fad and is without clinical or functional significance.{{cite news

| last = Clark-Flory

| first = Tracy

| title = The "labia pride" movement: Rebelling against the porn aesthetic, women are taking to the Internet to sing the praises of "endowed" women.

| work = Salon.com

| date = February 17, 2013

| url = http://www.salon.com/2013/02/17/the_labia_pride_movement/

| access-date = 14 March 2013

| archive-date = 30 September 2018

| archive-url = https://web.archive.org/web/20180930152620/https://www.salon.com/2013/02/17/the_labia_pride_movement/

| url-status = live

}}{{cite news

| last = Sourdès

| first = Lucile

| title = Révolution vulvienne: Contre l'image de la vulve parfaite, elles se rebellent sur Internet

| publisher = Rue89

| date = 21 February 2013

| url = http://tempsreel.nouvelobs.com/rue89/rue89-rue69/20130221.RUE3416/contre-l-image-de-la-vulve-parfaite-elles-se-rebellent-sur-internet.html

| access-date = 14 March 2013

| archive-date = 12 October 2017

| archive-url = https://web.archive.org/web/20171012070723/http://tempsreel.nouvelobs.com/rue89/rue89-rue69/20130221.RUE3416/contre-l-image-de-la-vulve-parfaite-elles-se-rebellent-sur-internet.html

| url-status = live

}}

Female genital mutilation mostly involves the partial or complete removal of the vulva.{{cite web |title=Female genital mutilation |publisher=World Health Organization |url=https://www.who.int/mediacentre/factsheets/fs241/en/ |date=2016 |access-date=21 February 2018 |archive-date=21 August 2015 |archive-url=https://web.archive.org/web/20150821210120/http://www.who.int/mediacentre/factsheets/fs241/en/ |url-status=live }} Female genital mutilation is carried out in thirty countries in Africa and Asia with more than 200 million girls being affected, and some women (as of 2018). Nearly all of the procedures are carried out on young girls. The practices are also carried out globally among migrants from these areas. Female genital mutilation is claimed to be mostly carried out for cultural traditional reasons. According to the research conducted under In the Name of Tradition, FGM/C is more common in Sunni countries and less common in Shia societies.{{Cite book |title=Ahmady, Kameel Et al 2015: In the Name of Tradition (A Comprehensive Research Study on Female Genital Mutilation / Cutting (FGM/C) in Iran), Un-Cut/Voices Press, Germany. |author-link=Kameel Ahmady}}{{Cite news |last=Dehghan |first=Saeed Kamali |date=2015-06-04 |title=Female genital mutilation practised in Iran, study reveals |url=https://www.theguardian.com/world/2015/jun/04/female-genital-mutilation-iran-fgm |access-date=2024-01-18 |work=The Guardian |language=en-GB |issn=0261-3077}}{{Cite web |title=Anthropologist reveals FGM practised in western, southern Iran. Reuters |website=Reuters |url=https://www.reuters.com/article/us-iran-fgm-idUSKBN0P60OF20150626}}{{cite journal | doi=10.1016/j.jogc.2019.11.039 | title=12. Harmful traditions practice: A comprehensive study on female genital mutilation | date=2020 | last1=Ahmady | first1=Kameel | journal=Journal of Obstetrics and Gynaecology Canada | volume=42 | issue=2 | pages=e21 | s2cid=214163821 }}

FGM/C can have harmful effects on their physical and mental health. Various official and unofficial research reports also confirm these complications. In its various reports, the World Health Organization has considered FGM/C as an action that endangers women's health in various ways. This organization stated in a report published in January 2023 that FGM/C has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and it interferes with the natural functions of girls' and women's bodies. Although all forms of FGM/C are associated with increased risk of health complications, the risk is greater with more severe forms of FGM/C.{{Cite web |title=Female genital mutilation |url=https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation |access-date=2024-01-18 |website=www.who.int |language=en}}{{Cite web |date=2024-01-17 |title=Female Genital Mutilation |url=https://www.afro.who.int/health-topics/female-genital-mutilation |access-date=2024-01-18 |website=WHO {{!}} Regional Office for Africa |language=en}}{{Cite web |title=Female Genital Mutilation Hurts Women and Economies |url=https://www.who.int/news/item/06-02-2020-female-genital-mutilation-hurts-women-and-economies |access-date=2024-01-18 |website=www.who.int |language=en}}

The American National Library of Medicine also stated in an article in 2018 that the consequences of FGM/C have both physiological and psychological complications, including short- and long-term complications. The method in which the procedure is performed may determine the extent of the short-term complications. If the process was completed using unsterile equipment, no antiseptics, and no antibiotics, the victim may have increased risk of complications. Primary infections include staphylococcus infections, urinary tract infections, excessive and uncontrollable pain, and hemorrhaging. Infections such as human immunodeficiency virus (HIV), Chlamydia trachomatis, Clostridium tetani, and herpes simplex virus (HSV) 2 are significantly more common among women who underwent Type 3 mutilation compared with other categories.{{Cite journal |last1=Klein |first1=Elliot |last2=Helzner |first2=Elizabeth |last3=Shayowitz |first3=Michelle |last4=Kohlhoff |first4=Stephan |last5=Smith-Norowitz |first5=Tamar A. |date=2018-07-10 |title=Female Genital Mutilation: Health Consequences and Complications—A Short Literature Review |journal=Obstetrics and Gynecology International |volume=2018 |pages=7365715 |doi=10.1155/2018/7365715 |doi-access=free |issn=1687-9589 |pmc=6079349 |pmid=30116269}}{{Cite web |title=Figure 3 {{!}} Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings |url=https://www.hindawi.com/journals/ogi/2018/5043512/fig3/ |access-date=2024-01-18 |website=www.hindawi.com |language=en}}{{Cite journal |doi=10.1155/2018/5043512 |s2cid=13662969 |title=Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings |date=2018 |last1=Kimani |first1=Samuel |last2=Esho |first2=Tammary |last3=Kimani |first3=Violet |last4=Muniu |first4=Samuel |last5=Kamau |first5=Jane |last6=Kigondu |first6=Christine |last7=Karanja |first7=Joseph |last8=Guyo |first8=Jaldesa |journal=Obstetrics and Gynecology International |volume=2018 |pages=1–12 |doi-access=free |pmid=29736171 |pmc=5875060 }}

File:Gynaecology-1822.jpg]]

The word vulva is Latin for "womb". It derives from the 1540s in referring to the womb and female sexual organs, from the earlier volvere meaning to turn, roll or revolve, with further derivatives such as used in volvox, and volvulus (twisted bowel).{{cite web|title=Vulva {{!}} Define Vulva at Dictionary.com|url=http://www.dictionary.com/browse/vulva?s=t|access-date=23 March 2018|archive-date=23 March 2018|archive-url=https://web.archive.org/web/20180323155338/http://www.dictionary.com/browse/vulva?s=t|url-status=live}}{{cite web|url=http://www.etymonline.com/index.php?search=vulva|title=vulva |website=Online Etymology Dictionary |access-date=1 July 2007|archive-date=7 February 2017|archive-url=https://web.archive.org/web/20170207010929/http://www.etymonline.com/index.php?search=vulva|url-status=live}} The naming of the female (and male) genitals as {{lang|la|pudenda membra}}, meaning parts to be ashamed of, dates from the mid-17th century.{{cite book|last1=Dictionaries|first1=Oxford|title=Paperback Oxford English Dictionary|url=https://books.google.com/books?id=mYicAQAAQBAJ&q=pudenda+membra&pg=PA582|publisher=Oxford University Press|language=en|access-date=10 May 2012|isbn=9780199640942|date=2012-05-10|archive-date=4 March 2022|archive-url=https://web.archive.org/web/20220304215547/https://books.google.com/books?id=mYicAQAAQBAJ&q=pudenda+membra&pg=PA582|url-status=live}} The naming influenced the general perception of the vulva and this is shown in depicted gynaecological procedures. The examiner shown in the Obstetrical examination dated 1822, is adopting the compromise procedure where the woman's genitals cannot be seen.{{cite web|title=Women's problems in early 1800s|url=http://www.bronwenevans.com/womens-problems-in-early-1800s/|website=Bronwen Evans|date=15 April 2016 |access-date=30 March 2018|archive-date=21 May 2018|archive-url=https://web.archive.org/web/20180521085717/http://www.bronwenevans.com/womens-problems-in-early-1800s/|url-status=live}}{{cite journal|last1=Balayla|first1=J|title=Male physicians treating Female patients: Issues, Controversies and Gynecology.|journal=McGill Journal of Medicine|date=June 2011|volume=13|issue=1|pages=72|pmid=22399872 |pmc=3296153}}

In 2021, a study in the UK showed that few are able to label the structure of the vulva correctly.{{Cite journal|last1=El-Hamamsy|first1=Dina|last2=Parmar|first2=Chanel|last3=Shoop-Worrall|first3=Stephanie|last4=Reid|first4=Fiona M.|date=31 March 2021|title=Public understanding of female genital anatomy and pelvic organ prolapse (POP); a questionnaire-based pilot study|url=https://doi.org/10.1007/s00192-021-04727-9|journal=International Urogynecology Journal|volume=33|issue=2|pages=309–318|doi=10.1007/s00192-021-04727-9|pmid=33787954|pmc=8803818|s2cid=232423955|issn=1433-3023|access-date=23 October 2021|archive-date=4 March 2022|archive-url=https://web.archive.org/web/20220304215555/https://link.springer.com/article/10.1007/s00192-021-04727-9|url-status=live}}{{Cite web|last=Geddes|first=Linda|date=30 May 2021|title=Most Britons cannot name all parts of the vulva, survey reveals|url=http://www.theguardian.com/lifeandstyle/2021/may/30/most-britons-cannot-name-parts-vulva-survey|url-status=live|access-date=23 October 2021|newspaper=The Guardian|archive-date=26 October 2021|archive-url=https://web.archive.org/web/20211026151243/https://www.theguardian.com/lifeandstyle/2021/may/30/most-britons-cannot-name-parts-vulva-survey}}{{Cite web|last=Morgan|first=Eleanor|date=16 October 2021|title=Viva la vulva: why we need to talk about women's genitalia|url=https://www.theguardian.com/lifeandstyle/2021/oct/16/viva-la-vulva-why-we-need-to-talk-about-women-genitalia|url-status=live|access-date=23 October 2021|newspaper=The Guardian|archive-date=23 October 2021|archive-url=https://web.archive.org/web/20211023182058/https://www.theguardian.com/lifeandstyle/2021/oct/16/viva-la-vulva-why-we-need-to-talk-about-women-genitalia}} There are many sexual slang terms used for the vulva.For slang terms for the vulva, see WikiSaurus:female genitalia — the WikiSaurus list of synonyms and slang words for female genitalia in many languages. "Cunt", a medieval word for the vulva and once the standard term, has become a vulgarism, and in other uses one of the strongest offensive and abusive swear words in English-speaking cultures. The word has been replaced in normal usage by a few euphemisms including "pussy" (vulgar slang) and "fanny" (UK), which used to be a common pet name.{{cite book |title=A Dictionary of First Names |year=1990 |url=https://archive.org/details/dictionaryoffirs00hank |url-access=registration |publisher=Oxford University Press |isbn=978-0-19-211651-2 |edition=2nd |quote=Pet form of Frances, very popular in the 18th and 19th centuries, but now much rarer}} In the UK, these terms have other non-sexual meanings that lend themselves to double entendres, such as "pussy", which is used as a term of endearment for a pet cat, "pussy cat".{{cite book|last=Silverton|first=Peter|title=Filthy English: The How, Why, When And What Of Everyday Swearing|url=https://books.google.com/books?id=xSErq0ssG74C&pg=PT182|year=2011|publisher=Granta Publications|isbn=978-1-84627-452-7|page=182|access-date=2017-02-22|archive-date=8 May 2016|archive-url=https://web.archive.org/web/20160508010955/https://books.google.com/books?id=xSErq0ssG74C&pg=PT182|url-status=live}}{{cite book|last=Rosewarne|first=Lauren|title=American Taboo: The Forbidden Words, Unspoken Rules, and Secret Morality of Popular Culture|url=https://books.google.com/books?id=XWijAQAAQBAJ&pg=PA82|year=2013|publisher=ABC-CLIO|isbn=978-0-313-39934-3|pages=81–82|quote=While pussy as a euphemism for vagina is very common in popular parlance, Mrs Slocombe was actually talking about her pet cat. In this context, the use of "pussy" works as a double entendre rather than as a euphemism.|access-date=12 May 2016|archive-date=17 May 2016|archive-url=https://web.archive.org/web/20160517141413/https://books.google.com/books?id=XWijAQAAQBAJ&pg=PA82|url-status=live}}{{cite book |last1=Jeffries |first1=Stuart |title=Mrs Slocombe's Pussy: Growing Up in Front of the Telly |date=2008 |publisher=Flamingo |quote=Mrs Slocombe's pussy changed all that.[...]It was funny, surely, because it dissolved that secret source of female power into a double entendre.}} In North American informal use, the term "pussy" can also refer to a weak or effeminate man,{{cite web |title=pussy {{!}} Definition of pussy in English |url=https://en.oxforddictionaries.com/definition/pussy |publisher=Oxford Dictionaries |access-date=14 February 2018 |archive-date=3 October 2018 |archive-url=https://web.archive.org/web/20181003141717/https://en.oxforddictionaries.com/definition/pussy |url-status=dead }} and "fanny" is a term used for the buttocks.{{cite web |title=fanny {{!}} Definition of fanny in English |url=https://en.oxforddictionaries.com/definition/fanny |publisher=Oxford Dictionaries |access-date=14 February 2018 |archive-date=3 October 2018 |archive-url=https://web.archive.org/web/20181003141726/https://en.oxforddictionaries.com/definition/fanny |url-status=dead }} Other slang terms are "muff", "snatch", and "twat".{{cite book|last1=Hollander|first1=Anne|title=Seeing Through Clothes|url=https://books.google.com/books?id=CSItqzbG9nIC&q=crotch+art&pg=PA220|publisher=University of California Press|date=22 March 1993|isbn=9780520082311|access-date=19 October 2020|archive-date=4 March 2022|archive-url=https://web.archive.org/web/20220304215548/https://books.google.com/books?id=CSItqzbG9nIC&q=crotch+art&pg=PA220|url-status=live}}{{cite web|title=vagina {{!}} Synonyms of vagina |url=https://en.oxforddictionaries.com/thesaurus/vagina|archive-url=https://web.archive.org/web/20180331040455/https://en.oxforddictionaries.com/thesaurus/vagina|url-status=dead|archive-date=31 March 2018|publisher=Oxford Dictionaries}} "Vagina" is often incorrectly used as a synonym for vulva since it is separate from that anatomy.

{{Main|Vagina and vulva in art}}

File:Loz roku1.png with vulva portrayal]]

Some cultures have long celebrated and even worshipped the vulva. During the Uruk period ({{circa}} 4000–3100 BC), the ancient Sumerians regarded the vulva as sacred{{cite book |last=Dening |first=Sarah |date=1996 |chapter=Chapter 3: Sex in Ancient Civilizations |title=The Mythology of Sex |chapter-url=http://www.ishtartemple.org/myth.htm |location=London, England |publisher=Macmillan |isbn=978-0-02-861207-2 |url-access=registration |url=https://archive.org/details/mythologyofsexan0000deni }}{{cite book |last=Leick |first=Gwendolyn |title=Sex and Eroticism in Mesopotamian Literature |publisher=Routledge |year=2013 |isbn=978-1-134-92074-7 |location=New York |page=96 |orig-year=1994 |url=https://books.google.com/books?id=WKoWblE4pd0C&pg=PA64 |access-date=3 January 2018 |archive-date=14 April 2021 |archive-url=https://web.archive.org/web/20210414055100/https://books.google.com/books?id=WKoWblE4pd0C&pg=PA64 |url-status=live }} and a vast number of Sumerian poems praising the vulva of Inanna, the goddess of love, sex, and fertility, have survived. In Sumerian religion, the goddess Ninimma is the divine personification of the vulva.{{cite book |last=Ceccarelli |first=Manuel |date=2016 |title=Enki und Ninmah: Eine mythische Erzählung in sumerischer Sprache |url=https://books.google.com/books?id=0mI552wy2ccC&q=Nin-imma+personification+of+female+genitalia&pg=PA21 |location=Tübingen, Germany |publisher=Mohr Siebeck |series=Orientalische Relionen in der Antik |volume=16 |isbn=978-3-16-154278-7 |page=21 |access-date=19 October 2020 |archive-date=3 September 2021 |archive-url=https://web.archive.org/web/20210903085735/https://books.google.com/books?id=0mI552wy2ccC&q=Nin-imma+personification+of+female+genitalia&pg=PA21 |url-status=live }}{{cite book|last=Launderville|first=Dale|date=2010|title=Celibacy in the Ancient World: Its Ideal and Practice in Pre-Hellenistic Israel, Mesopotamia, and Greece|url=https://books.google.com/books?id=yDe0gv9GJQcC&q=Nin-imma&pg=PA184|series=A Michael Glazier Book|location=Collegeville, Maryland|publisher=Liturgical Press|isbn=978-0-8146-5734-8|page=184|access-date=19 October 2020|archive-date=3 September 2021|archive-url=https://web.archive.org/web/20210903085725/https://books.google.com/books?id=yDe0gv9GJQcC&q=Nin-imma&pg=PA184|url-status=live}} Vaginal fluid is always described in Sumerian texts as tasting "sweet" and, in a Sumerian bridal hymn, a young maiden rejoices that her vulva has grown hair. Clay models of vulvas were discovered in the temple of Inanna at Ashur.{{cite book|last1=Black|first1=Jeremy|first2=Anthony|last2=Green|title=Gods, Demons and Symbols of Ancient Mesopotamia: An Illustrated Dictionary|url=https://books.google.com/books?id=05LXAAAAMAAJ&q=Inana|publisher=The British Museum Press|year=1992|isbn=978-0-7141-1705-8|pages=150–152|access-date=19 October 2020|archive-date=20 November 2020|archive-url=https://web.archive.org/web/20201120094829/https://books.google.com/books?id=05LXAAAAMAAJ&q=Inana|url-status=live}}

Some major Hindu traditions such as Shaktism, a goddess-centered tradition, revere the vulva and vagina under the name yoni.{{cite dictionary|title=Yoni|url=http://www.merriam-webster.com/dictionary/yoni|dictionary=Merriam-Webster|access-date=30 March 2016|archive-date=18 October 2018|archive-url=https://web.archive.org/web/20181018201504/https://www.merriam-webster.com/dictionary/yoni|url-status=live}}{{cite book|chapter-url=http://www.oxfordreference.com/view/10.1093/acref/9780198610250.001.0001/acref-9780198610250-e-2801|language=en|access-date=27 March 2018|doi=10.1093/acref/9780198610250.001.0001|isbn=9780198610250|chapter=Yoni|publisher=Oxford University Press|date=January 2009|archive-date=18 October 2018|archive-url=https://web.archive.org/web/20181018122537/http://www.oxfordreference.com/view/10.1093/acref/9780198610250.001.0001/acref-9780198610250-e-2801|url-status=live |title=A Dictionary of Hinduism }} The goddess as Devi is worshipped as the supreme deity.{{cite book|last1=Flood|first1=Gavin D.|title=An Introduction to Hinduism|url=https://archive.org/details/introductiontohi0000floo|url-access=registration|page=[https://archive.org/details/introductiontohi0000floo/page/82 82]|quote=devi.|publisher=Cambridge University Press|access-date=27 March 2018|language=en|date=13 July 1996|isbn=9780521438780}} The yoni is a representation of the female deity and is found in many temples as a focus for prayer and offerings. It is also represented symbolically as a mudra in spiritual practices, including yoga.{{cite web|title=Mudra Photo Gallery|url=https://www.thoughtco.com/mudra-photo-gallery-4051990|access-date=18 March 2018|archive-date=18 October 2018|archive-url=https://web.archive.org/web/20181018122736/https://www.thoughtco.com/mudra-photo-gallery-4051990|url-status=live}}

Sheela na gigs are figurative carvings of naked women displaying an exaggerated vulva. They are found in ancient and medieval European contexts. They are displayed on many churches, but their origin and significance is debatable. A main line of thinking is that they were used to ward off evil spirits. Another view is that the sheela na gig was a divine assistant in childbirth.{{cite book |last1=Freitag |first1=Barbara |title=Sheela-na-gigs: Unravelling an Enigma |url=https://books.google.com/books?id=Y03UDxXyOb8C |publisher=Psychology Press |access-date=24 February 2018 |language=en |date=2004 |isbn=9780415345521 |archive-date=2 November 2020 |archive-url=https://web.archive.org/web/20201102134920/https://books.google.com/books?id=Y03UDxXyOb8C |url-status=live }}{{cite book |last1=Andersen|first1=Jørgen |title=The witch on the wall : medieval erotic sculpture in the British isles|date=1977 |publisher=Roskilde & Bagger |location=Copenhagen |isbn=978-87-423-0182-1}} Starr Goode explores the image and possible meanings of the Sheela na gig and Baubo images in particular, but writes also about the recurring image worldwide. Through hundreds of photographs, she demonstrates that the image of a female displaying her vulva is not specific to European religious art or architecture, but that similar images are found in the visual arts and in mythical narratives of goddesses and heroines parting their thighs to reveal what she calls, "sacred powers". Her theory is that "the image is so rooted in our psyches that it seems as if the icon is the original cosmological center of the human imagination".{{cite book |last1=Goode |first1=Starr |title=Sheela na gig: The Dark Goddess of Sacred Power |date=2016 |publisher=Inner Traditions |isbn=9781620555958 |url=http://www.simonandschuster.com/books/Sheela-na-gig/Starr-Goode/9781620555958 |access-date=9 January 2017 |archive-date=18 October 2018 |archive-url=https://web.archive.org/web/20181018161752/http://www.simonandschuster.com/books/Sheela-na-gig/Starr-Goode/9781620555958 |url-status=live }}

File:Origin-of-the-World.jpg}}, an oil painting by Gustave Courbet]]

{{Lang|fr|L'Origine du monde}} (Origin of the World), painted by Gustave Courbet in 1866, was an early Realist painting of a vulva that only became exhibited many years later.{{cite web|title=Musée d'Orsay: Gustave Courbet The Origin of the World|url=http://www.musee-orsay.fr/en/collections/works-in-focus/search/commentaire/commentaire_id/the-origin-of-the-world-3122.html|publisher=Musée d'Orsay|access-date=27 March 2018|language=en|archive-date=19 March 2016|archive-url=https://web.archive.org/web/20160319102750/http://www.musee-orsay.fr/en/collections/works-in-focus/search/commentaire/commentaire_id/the-origin-of-the-world-3122.html|url-status=dead}} The painting was commissioned by Ottoman diplomat Halil Şerif Paşa. The woman used as the model for the painting was probably Halil's lover Constance Quéniaux.{{Cite news|last=Dickey|first=Christopher|url=https://www.thedailybeast.com/the-muslim-playboy-behind-paris-most-scandalous-painting|title=The Muslim Playboy Behind Paris' Most Scandalous Painting|date=2019-01-01|work=The Daily Beast|access-date=2020-03-27|language=en|archive-date=19 July 2020|archive-url=https://web.archive.org/web/20200719004411/https://www.thedailybeast.com/the-muslim-playboy-behind-paris-most-scandalous-painting|url-status=live}} However, another potential model is Marie-Anne Detourbay, who was also a lover of Halil Şerif Pasha.{{Cite news|last=Agence France-Presse|url=https://www.theguardian.com/artanddesign/2018/sep/25/origin-of-gustave-courbet-scandalous-painting-revealed|title=Mystery solved? Identity of Courbet's 19th-century nude revealed|date=2018-09-25|work=The Guardian|access-date=2020-03-27|language=en-GB|issn=0261-3077|archive-date=4 April 2020|archive-url=https://web.archive.org/web/20200404192848/https://www.theguardian.com/artanddesign/2018/sep/25/origin-of-gustave-courbet-scandalous-painting-revealed|url-status=live}}

Japanese sculptor and manga artist Megumi Igarashi has focused much of her work on painting and modelling vulvas and vulva-themed works. She has used molds to create dioramas – three-dimensional models of her vulva with the hope of demystifying the female genitals.{{cite news |last1=McCurry |first1=Justin |title=Vagina selfie for 3D printers lands Japanese artist in trouble |url=https://www.theguardian.com/world/2014/jul/15/vagina-selfie-for-3d-printers-lands-japanese-artist-in-trouble |access-date=2018-03-04 |work=The Guardian |date=15 July 2014 |archive-date=4 March 2018 |archive-url=https://web.archive.org/web/20180304172608/https://www.theguardian.com/world/2014/jul/15/vagina-selfie-for-3d-printers-lands-japanese-artist-in-trouble |url-status=live }}

An art installation called The Dinner Party by feminist artist, Judy Chicago, portrays a symbolic history of famous women. The dinner plates each depict an elaborate vulval form and they are arranged in a triangular vulva shape.{{cite book |author=Judy Chicago |others=photography by Donald Woodman|title=The dinner party : from creation to preservation|date=2007|publisher=Merrell Publishers |location=London |isbn=978-1-85894-370-1 |page=289}} Another installation was made by British artist Jamie McCartney who used the casts of four hundred vulvas to create The Great Wall of Vagina in 2011. The casts are life-size. Explanations written by the project's sexual health adviser accompany these. The purpose of the artist was to "address some of the stigmas and misconceptions that are commonplace".{{cite book |last=McCartney |first=Jamie |title=The great wall of vagina |publisher=Jamie McCartney |location=Brighton |year= 2011 |isbn=978-0956878502 }}{{cite news |title='The Great Wall Of Vagina' Is, Well, A Great Wall Of Vaginas (NSFW) |url=https://www.huffingtonpost.com/2014/01/08/the-great-wall-of-vagina_n_4556309.html |access-date=18 March 2018 |newspaper=Huffington Post |date=2014-01-08 |archive-date=8 October 2017 |archive-url=https://web.archive.org/web/20171008025846/http://www.huffingtonpost.com/2014/01/08/the-great-wall-of-vagina_n_4556309.html |url-status=live }}

Vulve d'éléphante.jpg|Vulva of an Asian elephant

German Shepherd vulva.jpg|Vulva of a dog (German Shepherd)

Vulva of a horse.jpg|Vulva of a horse

Vulva of a domestic cat.jpg|Vulva of a cat

Orangutan vulva.jpg|Vulva of a Bornean orangutan

As a rule, only the external female genitals of placental mammals are referred to as the "vulva", although the term is also used in the scientific literature for functionally comparable structures in other animal groups such as marsupials{{Cite book |last1=Tyndale-Biscoe |first1=C. Hugh |url=https://books.google.com/books?id=HpjovN0vXW4C&q=vulva |title=Reproductive Physiology of Marsupials |last2=Renfree |first2=Marilyn |date=1987-01-30 |publisher=Cambridge University Press |isbn=978-0-521-33792-2 |language=en}} and roundworms (Nematoda).E. Szabó, B. Hargitai, A. Regos u. a.: "TRA-1/GLI controls the expression of the Hox gene lin-39 during C. elegans vulval development". In: Developmental Biology. Vol. 330, no. 2, 2009, pp. 339–348. {{PMID|19361495}}.

For comparison, birds, reptiles, amphibians, and monotremes have a cloaca. An organ system like a vulva does not exist.

The vulva of a placental consists of the following along with its variations:

• Clitoris: Made up of the root, glans and body and is usually retracted into a prepuce. Inside the clitoris of many non-human placentals is the baubellum, a small bone that possibly has origins in copulation. In horses and dogs, the clitoris is contained in clitoral fossa, which is a small pouch of tissue.{{cite book|last=Kustritz |first=Margaret V. Root|title= The Dog Breeder's Guide to Successful Breeding and Health Management |publisher=Saunders Elsevier|year=2006 |page=116 |isbn= 978-1-41603-139-0 |url= https://books.google.com/books?id=rqIa-9jew_MC&pg=PA116}}{{cite book |last1=Budras |first1=Klaus-Dieter |last2=Sack |first2=W. O. |last3=Rock |first3=Sabine |last4=Wünsche |first4=Anita |last5=Henschel |first5=Ekkehard |title=Anatomy of the Horse: An Illustrated Text |publisher=Wiley |year=2003 |page=76 |isbn=978-3-89993-003-0 |url=https://books.google.com/books?id=CUFN_K0AHgsC&pg=PA76}}
• Labia: A small, thin pair of lip-like structures that protect the vestibule. They are known as the labia vulvae in carnivorans and ungulates and as the labia minora in primates.{{cite book|last=McEntee |first=Mark |title= Reproductive Pathology of Domestic Mammals |publisher=Elsevier Science |year=2012 |page=192 |access-date=November 10, 2023 |isbn= 978-0-32313-804-8 |url=https://books.google.com/books?id=j87wTz362roC&pg=PA192}}{{cite book |last=Blüm |first=Volker |publisher=Springer Berlin Heidelberg |year=2012 |title=Vertebrate Reproduction: A Textbook |page=74 |access-date=November 19, 2023 |isbn=978-3-64271-074-2 |url=https://books.google.com/books?id=JZfzCAAAQBAJ&pg=PA74}}{{cite book |last1=Andrews |first1=Anthony |last2=Boden |first2=Edward |publisher=Bloomsbury Publishing |year=2015 |title=Black's Veterinary Dictionary |page=484 |access-date=December 15, 2023 |isbn=978-1-40814-955-3 |url=https://books.google.com/books?id=Aw1fBwAAQBAJ&pg=PA484}}{{cite book |last1=Studdert |first1=Virginia P. |last2=Gray |first2=Clive C. |publisher=Elselvier Health Sciences |year=2011 |title=Saunders Comprehensive Veterinary Dictionary E-Book |page=1183 |isbn=978-0-70204-744-2 |url=https://books.google.com/books?id=6dvQAQAAQBAJ&pg=PA1183}} The labia majora only exist in primates (including humans). Afrotherians do not have distinguishable labia.{{cite journal |last1=Pavlicev |first1=Mihaela |last2=Herdina |first2=Anna Nele|last3=Wagner |first3=Günter |publisher=National Library of Medicine |year=2022 |title= Female Genital Variation Far Exceeds That of Male Genitalia: A Review of Comparative Anatomy of Clitoris and the Female Lower Reproductive Tract in Theria |journal=Integrative and Comparative Biology |volume=62 |issue=3 |pages=581–601 |doi=10.1093/icb/icac026 |pmid=35524696 |pmc=9494530 }}
• Vestibule/vulvar opening: In humans, other great apes, and some rodents, the vestibule is a flat and short external space that contains separate urethral and vaginal openings. In most other placentals, the urethra and vagina join as an internal vestibule (urogenital sinus), hence both urine and offspring exit through an orifice called the vulvar opening.{{cite book|last=McEntee|first=Mark|url= https://books.google.com/books?id=AiISEAAAQBAJ&pg=SA14-PA30|title= Reproductive Pathology of Domestic Mammals|page=208|year=2012|publisher=Elsevier Science|isbn=978-0-32313-804-8}}{{cite book|last1=Sjaastad|first1=Oystein V.|last2=Sand|first2=Olav|last3=Hove|first3=Knut|url=https://books.google.com/books?id=5Uw-LJlU3I8C&pg=PA704|title=Physiology of Domestic Mammals|page=704|year=2010|publisher=Scandinavian Veterinarian Press|isbn= 978-8-29174-307-3}}

During estrus, the clitoris of a mare (female horse) everts as the labia contracts by opening and closing. This is colloquially known as "winking".{{cite book|last=Evans |first=Warren J.|title=The Horse|publisher=W. H. Freeman|year=1990 |page=323 |access-date=December 3, 2023 |isbn= 978-0-71671-811-6 |url=https://books.google.com/books?id=j87wTz362roC&pg=PA192}} Throughout the menstrual cycle, some female primates' vulvar and anal regions will swell (sexual swelling) to attract a male, though the fundamental reason for this function is up for debate.{{Cite book|url=https://books.google.com/books?id=sOyUnJrhmEkC|title=Advances in the Study of Behavior|date=1983-09-22|publisher=Academic Press|isbn=9780080582740|language=en}}

The vulva of a spotted hyena has a large clitoris known as a pseudo-penis for copulating, giving birth and urinating, as well as fused labia (pseudo-scrotum). This can make it difficult to correctly sex the species.

File:Vulva-handsign-Yoni-mudra.svg|Vulva hand sign used as a yogic mudra

File:NAMA Phallus ailé.jpg|Attic red-figure lid depicting three vulvae and a winged penis

{{Portal|Anatomy}}

• Artificial vulva
• Blue vulva
• Camel toe
• Carpel
• Clitoral enlargement
• Elongated labia
• Epigyne
• Genital ulcer
• Human external male genitalia
• Penis
• Scrotum
• Koro (disease)
• Mammalian penis
• Pussyhat
• Vulvar myiasis

{{Gray's}}

{{Reflist}}

{{Commons category multi|Vulvas|Vulva symbols}}

{{Wiktionary|vulva}}

• [http://www2.ljworld.com/news/2003/may/04/v_is_for/ {{"'}}V' is for vulva, not just vagina"] by Harriet Lerner—Discussing common misuse of the word "vagina"
• [http://www.scarleteen.com/article/advice/out_out_damn_uti Vulvar hygiene and Urinary Tract Infections] by Heather Corinna (illustrations; no explicit photos)

{{Female reproductive system| state=collapsed}}

{{Human regional anatomy}}

{{STD and STI}}

{{Muscles of perineum|state=collapsed}}

{{Muscles of abdomen|state=collapsed}}

{{Women's health}}

{{Authority control}}

Category:Human female reproductive system

Category:Mammal female reproductive system

Category:Pelvis

Category:Sex organs

Category:Urinary system