Meet Your Vulva: The Forgotten Anatomy Every Woman Deserves to Understand
There is a part of the body that gets overlooked more than almost any other, and it is not the vagina. It is the vulva. I have had patients point vaguely downward and say, "something is wrong with my vagina," when what they are actually describing, the itching, the irritation, the visible changes, is happening entirely on the vulva. The confusion is understandable. Even physicians routinely use the word "vagina" to mean the entire external genital region, and that is simply not accurate.
I will be direct with you: most OB/GYNs received very little training on the vulva or the clitoris during residency. The vulva was treated as an afterthought, something to move past on the way to the Pap smear and the cervix. Looking back on my own training, it is striking how little time we spent on the structures women live with, worry about, and experience symptoms in every single day.
That gap in training has consequences for the care you receive. So let's correct it. The vulva deserves a real, clear, clinical introduction, and that is exactly what we are going to do here.
Vulva, not vagina
Let's start with the language, because precision matters in medicine. The vagina is the internal canal. The vulva is everything on the outside: the labia majora (the outer, hair-bearing folds), the labia minora (the inner folds), the clitoris and its hood, and the vestibule (the ring of tissue you cross to enter the vagina). When we collapse all of that into “the vagina,” we lose the ability to describe what is actually happening and where. That matters for diagnosis, and it matters for your care.
It is also worth saying clearly: the vulva looks different on every person. If you have ever seen a collection of vulva casts displayed side by side, in all their variation of shape and size and proportion, the message is immediate and unmistakable. There is no single normal. Your anatomy is yours, and it is not a problem to be corrected.
The clitoris and clitoral adhesions
Here is something most women have never been told: the clitoral hood is designed to retract and release from the glans clitoris. When it doesn't, when the hood adheres down and stays there, we call those clitoral adhesions. I keep a 3D-printed clitoris in my office, and when I bring it out, most patients are genuinely stunned. And honestly, so were many of us as physicians. We operate in the pelvis. We spent years in training. And still we found ourselves asking: why did no one ever teach us this?
Several things can contribute:
A history of painful sex, recurrent yeast infections, or urinary tract infections
Lichen sclerosus (a skin condition of the vulva)
Blunt perineal trauma
A low-estrogen state, including perimenopause and menopause
Long-term oral contraceptive use
Not everyone with clitoral adhesions has noticeable symptoms. But some do. And because this area is almost never examined, you could go years without knowing it's there, or that it's quietly behind chronic discomfort, a muted or changed orgasm, or increasing difficulty reaching orgasm at all. Sometimes tiny hardened "keratin pearls" (small collections of dead skin cells, often less than a millimeter across) get trapped beneath the hood and cause persistent irritation. They are so small they are genuinely difficult to remove, even under magnification.
This is exactly why I perform a clitoral exam on every patient, including at well-woman visits, and I explain what I am doing and why before I do it. The reaction is almost always the same: "I'm sorry, what?" Because no one ever told them this part of their body could even be examined, let alone that it should be. I usually smile and say: I am a vulva doctor. If you come see me, this is going to happen, every time.
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What a thorough vulvar exam actually looks like
A careful vulvar exam is, above all else, a visual one. A skilled clinician narrates every step, moves slowly, and makes clear that you can say stop at any moment. Here is what we are actually assessing:
The skin of the labia majora and minora for whitening, redness, creases that suggest inflammation, or lesions
Structural changes: are the labia minora still present, or have they begun to resorb with estrogen loss?
The clitoris and hood, with gentle retraction of the hood to visualize the glans directly
The vestibule, often with a gentle Q-tip test to map precisely where any discomfort or pain originates
I keep a large mirror nearby so we can look together. In my experience, most patients are far more curious than they are uncomfortable, and many have simply never taken a mirror to this part of their own body. One patient looked up at me and said she felt like she was "meeting my clitoris for the first time." I told her: yes, and she has been here all along, waiting for you to pay attention.
“Where did my labia go?”
This one genuinely surprises people. Without estrogen, the labia minora can shrink significantly. If yours were small to begin with, they can resorb to the point where they feel like they have nearly disappeared. If they were longer, that degree of change is far less likely. It is typically the lower two-thirds that resorb, and sometimes only the upper third. In most cases, this is a direct consequence of estrogen loss, nothing more alarming than that.
There are two distinct skin conditions, lichen sclerosus and lichen planus, that cause true scarring and structural loss of the labia minora through chronic inflammation in the crease between the majora and minora. When those upper structures fuse, the clitoral hood can become involved and the clitoris more difficult to visualize. I want to be clear about something here: that kind of fusion is a concern specific to women with those diagnosed skin conditions, not to women whose primary issue is low estrogen. You do not need to borrow that fear. We have enough to pay attention to in menopause without adding concerns that do not actually apply to your situation.
The good news: vulvar tissue responds to estrogen
For the tissue changes driven by low estrogen, vaginal estrogen is genuinely effective. It restores tissue quality, brings back healthy blood flow, and helps these structures maintain the moisture and elasticity they need to function well. One patient described it better than any clinical definition I could offer: “It’s like I was a dry raisin, and now I’m a grape.” Exactly right. Plump, resilient tissue is precisely what we are working toward.
For clitoral adhesions that are actually causing symptoms (pain, decreased sensation, difficulty with orgasm), there is a gentle, in-office, non-surgical release. We use thorough topical numbing (and some of us offer nitrous oxide for additional comfort), careful magnification to capture fine detail, and precise technique to free the adhesions and remove any keratin pearls. When there are no symptoms, intervention is often not needed at all. For too long, women have been told to simply endure this. You do not have to.
Why This Matters
Too much of this gets quietly dismissed. A woman brings something up, her clinician nods without the tools or the time to actually address it, and she walks out still carrying the problem. The reality is that clinicians who focus specifically on vulvar health are often the only ones who are genuinely examining this part of the body with any regularity. That gap in care has real consequences.
You deserve a clinician who looks carefully, listens fully, and believes you. You also deserve to know your own anatomy. If you have never taken a mirror and looked, consider this your invitation. I mean that sincerely. The more we say the word vulva out loud, in exam rooms and in everyday conversation, the less alone every woman in that situation feels.
If anything here sounds familiar, a change you have noticed, discomfort that has never been properly examined, or simply a desire to understand your own body with more clarity, you do not have to keep waiting for someone to take it seriously. That conversation is exactly what Sky Women's Health is here for. Apply for membership and let's start there.
Warmly,
Dr. Carolyn Moyers, Board-Certified OBGYN | Menopause Society Certified | ISSWSH Fellow
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
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