In mammals, the vagina is the fibromuscular, tubular part of the female genital tract extending, in humans, from the vulva to the cervix. The outer vaginal opening is normally partly covered by a membrane called the hymen. At the deep end, the cervix (neck of the uterus) bulges into the vagina. The vagina allows for sexual intercourse and childbirth, and channels menstrual flow (menses), which occurs as part of the monthly menstrual cycle.
The vagina’s location and structure varies among species, and can vary in size. Female mammals usually have two external openings in the vulva, the urethral opening for the urinary tract and the vaginal opening for the genital tract. This is different from male mammals, who usually have a single urethral opening for both urination and reproduction. The vaginal opening is much larger than the nearby urethral opening, and both are protected by the labia in humans. In amphibians, birds, reptiles and monotremes, the cloaca is the single external opening for the gastrointestinal tract, the urinary, and reproductive tracts.
To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity, vaginal moisture increases during sexual arousal in human females and also in other female mammals. This increase in moisture provides vaginal lubrication, which reduces friction.
The texture of the vaginal walls creates friction for the penis during sexual intercourse and stimulates it toward ejaculation, enabling fertilization. Along with pleasure and bonding, women’s sexual behavior with others (which can include heterosexual or lesbian sexual activity) can result in sexually transmitted infections (STIs), the risk of which can be reduced by recommended safe sex practices. Other disorders may also affect the human vagina.
The vagina and vulva have evoked strong reactions in societies throughout history, including negative perceptions and language, cultural taboos, and their use as symbols for female sexuality, spirituality, or regeneration of life. In common speech, the word vagina is often used to refer to the vulva or to the female genitals in general. By its dictionary and anatomical definitions, however, vagina refers exclusively to the specific internal structure, and understanding the distinction can improve knowledge of the female genitalia and aid in health care communication.
The vagina is an elastic, muscular canal with a soft, flexible lining that provides lubrication and sensation. The vagina connects the uterus to the outside world. The vulva and labia form the entrance, and the cervix of the uterus protrudes into the vagina, forming the interior end.
The vagina receives the penis during sexual intercourse and also serves as a conduit for menstrual flow from the uterus. During childbirth, the baby passes through the vagina (birth canal).
Vaginal discharge is a constant presence in women who menstruate. It can begin as early as a few months before your period first starts in adolescence. It generally tapers off after menopause.
Vaginal discharge is the way a woman’s body expels fluid and cells. The production of vaginal discharge can vary from woman to woman, and can change in consistency and appearance depending on many factors.
These factors include:
- menstrual cycle
Itching down there that just won’t go away is uncomfortable to talk about, and even more uncomfortable to deal with. But before you assume you’re dealing with yeast infection symptoms (which is likely, but not certain), it’s important to know the symptoms of other common conditions and talk to a doctor. Vaginal itching that just won’t go away could be something as innocuous as irritation from a dull razor or something that requires immediate treatment like a sexually transmitted disease (STD).
“In general, I don’t recommend people try to treat symptoms at home before they come in, unless they’re sure it’s something they’ve had before like a yeast infection,” says Mae K. Borchardt, MD, a gynecologist at Houston Methodist Hospital. “If that one treatment doesn’t work, don’t keep trying over-the-counter products or home remedies. Go to a doctor, and once we know what you’re dealing with, there are lots of products you can get over-the-counter and use to treat it at home.”
The hymen is a thin membrane of tissue that surrounds and narrows the vaginal opening. It may be torn or ruptured by sexual activity or by exercise.
What Does Vaginal Discharge Mean?
Burris describes vaginal discharge as fluid released by glands in the vagina and cervix. The fluid carries dead cells and bacteria out of the body, and vaginal discharge helps keep the vagina clean and prevent infection. Burris also says normal vaginal discharge varies in amount and ranges in color from clear to milky, white discharge. Discharge may have a slight odor as well, although a foul, fishy odor is a sign of an infection.
“There are times when discharge amounts can change,” Burris says. “Immediately after a period, there is almost no discharge. Two to three days after the period ends, there is a thick, white discharge. A few days later, the consistency changes to appear more like mucous. Before ovulation, the discharge becomes clear and sticky, and before the next period, discharge is thick and white in consistency.”
Vaginal discharge during pregnancy is thin, white, milky and mild smelling. The amount of discharge also increases during pregnancy. However, during perimenopause and menopause, discharge decreases due to low levels of estrogen.
The following can cause estrogen levels to drop, leading to Little to no Vaginal discharge:
- Medicines or hormones used in the treatment of breast cancer, endometriosis, fibroids or infertility
- Surgery to remove the ovaries
- Radiation treatment to the pelvic area
- Severe stress, depression or intense exercise
Types of vaginal discharge
There are several different types of vaginal discharge. These types are categorized based on their color and consistency. Some types of discharge are normal. Others may indicate an underlying condition that requires treatment.
A bit of white discharge, especially at the beginning or end of your menstrual cycle, is normal. However, if the discharge is accompanied by itching and has a thick, cottage cheese-like consistency or appearance, it’s not normal and needs treatment. This type of discharge may be a sign of a yeast infection.
If thick, white discharge goes along with other symptoms, such as itching, burning and irritation, it is probably due to a yeast infection. If not, it is normal discharge.
Clear and watery
A clear and watery discharge is perfectly normal. It can occur at any time of the month. It may be especially heavy after exercise.
Clear and stretchy
When discharge is clear but stretchy and mucous-like, rather than watery, it indicates that you are likely ovulating. This is a normal type of discharge.
Brown or bloody
Brown or bloody discharge is usually normal, especially when it occurs during or right after your menstrual cycle. A late discharge at the end of your period can look brown instead of red. You may also experience a small amount of bloody discharge between periods. This is called spotting.
If spotting occurs during the normal time of your period and you’ve recently had sex without protection, this could be a sign of pregnancy. Spotting during an early phase of pregnancy can be a sign of miscarriage, so it should be discussed with your OB-GYN.
In rare cases, brown or bloody discharge can be a sign of advanced cervical cancer. This is why it’s important to get a yearly pelvic exam and Pap smear. Your gynecologist will check for cervical abnormalities during these procedures.
Brown discharge may be caused by irregular period cycles. If brown discharge keeps appearing, a patient should schedule an appointment with a provider to be evaluated. This could be a sign of uterine or cervical cancer. Additionally, during menopause, a woman should not have any type of vaginal bleeding, which is also a sign of uterine cancer.
Yellow or green
Yellow discharge is abnormal discharge, as this is a sign of a bacterial infection or sexually transmitted infection.
A yellow or green discharge, especially when it’s thick, chunky, or accompanied by an unpleasant smell, isn’t normal. This type of discharge may be a sign of the infection trichomoniasis. It’s commonly spread through sexual intercourse.
Having green discharge is not normal. This is a sign of bacterial infection or a sexually transmitted infection. Anyone experiencing green discharge should see her provider.
Yeast infection discharge is caused by an overgrowth of fungus in the vagina. Symptoms of yeast infection discharge include a thick, white, cottage cheese-like discharge, along with itching, redness, irritation and burning. Roughly 90 percent of women will have a yeast infection at some point in their life. Yeast infections are not contagious, and over-the-counter antifungal creams are available for a patient to use. But, if symptoms don’t improve with treatment or she has more than four yeast infections in a year, she should see her provider.
“Stay aware of normal and abnormal changes in vaginal discharge. This allows patients to identify infection and other problems. If you have any questions about the type of vaginal discharge you’re experiencing, contact your provider,” Burris says.
Structure of Vagina
The human vagina is an elastic muscular canal that extends from the vulva to the cervix. It is pink in color, and it connects the vulva to the cervix. The part of the vagina surrounding the cervix is called the fornix. The opening of the vagina lies in the urogenital triangle in the perineum, between the opening of the urethra and the anus.
The vaginal canal then travels upwards and backwards, between the urethra at the front, and the rectum at the back. Near the upper vagina, the cervix protrudes into the vagina on its front surface at approximately a 90 degree angle. The vaginal and urethral openings are protected by the labia.
When not sexually aroused, the vagina is a collapsed tube, with the anterior and posterior walls placed together. The lateral walls, especially their middle area, are relatively more rigid. Because of this, the collapsed vagina has an H-shaped cross section. Behind, the inner vagina is separated from the rectum by the recto-uterine pouch, the middle vagina by loose connective tissue, and the lower vagina by the perineal body.
Where the vaginal lumen surrounds the cervix of the uterus, it is divided into four continuous regions or vaginal fornices; these are the anterior, posterior, right lateral, and left lateral fornices. The posterior fornix is deeper than the anterior fornix.
Supporting the vagina are its upper third, middle third and lower third muscles and ligaments. The upper third are the levator ani muscles, and the transcervical, pubocervical, and sacrocervical ligaments. It is supported by the upper portions of the cardinal ligaments and the parametrium. The middle third of the vagina involves the urogenital diaphragm. The lower third is supported by the perineal body.
Vaginal Opening and Hymen
The vaginal opening is at the posterior end of the vulval vestibule, behind the urethral opening. The opening to the vagina is closed by the labia minora in virgins and in females who have never given birth (nulliparous), but may be exposed in females who have given birth (parous).
The hymen is a membrane of tissue that surrounds or partially covers the vaginal opening. The effects of intercourse and childbirth on the hymen are variable. Where it is broken, it may completely disappear or remnants known as carunculae myrtiformes may persist. Otherwise, being very elastic, it may return to its normal position. Additionally, the hymen may be lacerated by disease, injury, medical examination, masturbation or physical exercise. For these reasons, virginity cannot be definitively determined by examining the hymen.
Variations and Size
The length of the vagina varies between women of child-bearing age. Because of the presence of the cervix in the front wall of the vagina, there is a difference in length between the front (anterior) wall, approximately 7.5 cm (2.5 to 3 in) long, and the back (posterior) wall, approximately 9 cm (3.5 in) long. During sexual arousal, the vagina expands both in length and width.
If a woman stands upright, the vaginal canal points in an upward-backward direction and forms an angle of approximately 45 degrees with the uterus. The vaginal opening and hymen also vary in size; in children, although the hymen commonly appears crescent-shaped, many shapes are possible.
Development of the Reproductive System
An illustration showing a cut-away portion of the vagina and upper female genital tract (only one ovary and fallopian tube shown). Circular folds (also called rugae) of vaginal mucosa can be seen
The vaginal plate is the precursor to the vagina. During development, the vaginal plate begins to grow where the fused ends of the paramesonephric ducts (Müllerian ducts) enter the back wall of the urogenital sinus as the sinus tubercle.
As the plate grows, it significantly separates the cervix and the urogenital sinus; eventually, the central cells of the plate break down to form the vaginal lumen. This usually occurs by the twenty to twenty-fourth week of development. If the lumen does not form, or is incomplete, membranes known as vaginal septae can form across or around the tract, causing obstruction of the outflow tract later in life.
During sexual differentiation, without testosterone, the urogenital sinus persists as the vestibule of the vagina. The two urogenital folds of the genital tubercle form the labia minora, and the labioscrotal swellings enlarge to form the labia majora.
Sources differ on which portion of the vagina is formed from the Müllerian ducts and which from the urogenital sinus by the growth of the sinovaginal bulb. Dewhurst’s Textbook of Obstetrics and Gynaecology states, “Some believe that the upper four-fifths of the vagina is formed by the Müllerian duct and the lower fifth by the urogenital sinus, while others believe that sinus upgrowth extends to the cervix displacing the Müllerian component completely and the vagina is thus derived wholly from the endoderm of the urogenital sinus.” It adds, “It seems certain that some of the vagina is derived from the urogenital sinus, but it has not been determined whether or not the Müllerian component is involved.”
Medium-power magnification micrograph of a H&E stained slide showing a portion of a vaginal wall. Stratified squamous epithelium and underling connective tissue can be seen. The deeper muscular layers are not shown. The black line points to a fold in the mucosa.
The wall of the vagina from the lumen outwards consists firstly of a mucous membrane of stratified squamous epithelium that is not keratinized, with an underlying lamina propria of connective tissue. Secondly, there is a layer of smooth muscle with bundles of circular fibers internal to longitudinal fibers. Lastly, is an outer layer of connective tissue called the adventitia. Some texts list four layers by counting the two sublayers of the mucosa (epithelium and lamina propria) separately.
The lamina propria is rich in blood vessels and lymphatic channels. The muscular layer is composed of smooth muscle fibers, with an outer layer of longitudinal muscle, an inner layer of circular muscle, and oblique muscle fibers between. The outer layer, the adventitia, is a thin dense layer of connective tissue and it blends with loose connective tissue containing blood vessels, lymphatic vessels and nerve fibers that are between pelvic organs. The vaginal mucosa is absent of glands.
It forms folds (or rugae), which are more prominent in the outer third of the vagina; they appear as transverse ridges and their function is to provide the vagina with increased surface area for extension and stretching.
Folds of mucosa (or vaginal rugae) are shown in the front third of a Vagina
A normal cervix of an adult as seen through the vagina (per vaginam or PV) using a bivalved vaginal speculum. The blades of the speculum are above and below and stretched vaginal walls are seen on the left and right.
The epithelium of the ectocervix is continuous with the vaginal epithelium. The vaginal epithelium is made up of layers of cells, including the basal cells, the parabasal cells, the superficial squamous flat cells, and the intermediate cells. The basal layer of the epithelium is the most mitotically active and reproduces new cells.
The superficial cells shed continuously and basal cells replace them. Estrogen induces the intermediate and superficial cells to fill with glycogen. Cells from the lower basal layer transition from active metabolic activity to death (apoptosis). In these mid-layers of the epithelia, the cells begin to lose their mitochondria and other organelles. The cells retain an usually high level of glycogen compared to other epithelial tissue in the body.
Under the influence of maternal estrogen, the vagina of a newborn is lined by thick stratified squamous epithelium (or mucosa) for two to four weeks after birth. Between then to puberty, the epithelium remains thin with only a few layers of cuboidal cells without glycogen. The epithelium also has few rugae and is red in color before puberty.
When puberty begins, the mucosa thickens and again becomes stratified squamous epithelium with glycogen containing cells, under the influence of the girl’s rising estrogen levels. Finally, the epithelium thins out from menopause onward and eventually ceases to contain glycogen, because of the lack of estrogen.
Flattened squamous cells are more resistant to both abrasion and infection. The permeability of the epithelium allows for an effective response from the immune system since antibodies and other immune components can easily reach the surface.
The vaginal epithelium differs from the similar tissue of the skin. The epidermis of the skin is relatively resistant to water because it contains high levels of lipids. The vaginal epithelium contains lower levels of lipids. This allows the passage of water and water-soluble substances through the tissue.
Keratinization happens when the epithelium is exposed to the dry external atmosphere. In abnormal circumstances, such as in pelvic organ prolapse, the mucosa may be exposed to air, becoming dry and keratinized.
Blood and Nerve Supply
Blood is supplied to the vagina mainly via the vaginal artery, which emerges from a branch of the internal iliac artery or the uterine artery. The vaginal arteries anastamose (are joined) along the side of the vagina with the cervical branch of the uterine artery; this forms the azygos artery, which lies on the midline of the anterior and posterior vagina. Other arteries which supply the vagina include the middle rectal artery and the internal pudendal artery, all branches of the internal iliac artery.
Three groups of lymphatic vessels accompany these arteries; the upper group accompanies the vaginal branches of the uterine artery; a middle group accompanies the vaginal arteries; and the lower group, draining lymph from the area outside the hymen, drain to the inguinal lymph nodes. Ninety-five percent of the lymphatic channels of the vagina are within 3 mm of the surface of the vagina.
Two main veins drain blood from the vagina, one on the left and one on the right. These form a network of smaller veins, the vaginal venous plexus, on the sides of the vagina, connecting with similar venous plexuses of the uterus, bladder, and rectum. These ultimately drain into the internal iliac veins.
The nerve supply of the upper vagina is provided by the sympathetic and parasympathetic areas of the pelvic plexus. The lower vagina is supplied by the pudendal nerve.
It’s important to rule out more serious causes—for instance, vaginal itching may be caused by trichomoniasis, a common STD that requires a powerful antibiotic to treat. (Cases of trichomoniasis are on the rise. Here’s what you need to know about the disease.) In rare cases, itching accompanied by a non-healing ulcer may not be a sign of vaginal infection, but rather of vulvar cancer.
Vaginitis: Inflammation of the vagina, commonly from a yeast infection or bacterial overgrowth. Itching, discharge, and change of odor are typical symptoms. Vaginitis is treated with antibiotics or antifungal medication.
Vaginismus: Involuntary spasm of the vaginal muscles during sexual intercourse. Emotional distress about sex, or medical conditions, can be responsible. Depending on the cause, it can be treated with medicine, counseling or some other types of therapy.
Genital warts: Genital warts may affect the vulva,vagina, and cervix. Treatments can remove vaginal warts, which are caused by human papillomavirus (HPV).
Trichomoniasis: Infection of the vagina by a microscopic parasite called trichomonas. Trichomoniasis is transmitted by sex and is easily curable.
Bacterial vaginosis (BV): A disruption in the balance of healthy bacteria in the vagina, often causing odor and discharge. Douching, or sex with a new partner can cause BV. BV is treated with antibiotics.
Herpes simplex virus (HSV): The herpes virus can infect the vulva, vagina, and cervix, causing small, painful, recurring blisters and ulcers. Having no noticeable symptoms is also common. The virus is transmitted sexually. It can be treated, but not cured.
Gonorrhea: This sexually transmitted bacterial infection most often infects the cervix. Half the time, there are no symptoms, but vaginal discharge and itching may occur. It can cause pelvic inflammatory disease and infertility. It is treated with antibiotics.
Chlamydia: The bacterium Chlamydia trachomatis causes this sexually transmitted infection. Only half of women will have symptoms, which may include vaginal discharge or pain in the vagina or abdomen. It can cause pelvic inflammatory disease and infertility. Chlamydia is treated with antibiotics.
Vaginal cancer: Cancer of the vagina is extremely rare. Abnormal vaginal bleeding or discharge are symptoms.
Vaginal prolapse: Due to weakened pelvic muscles (usually from childbirth), the rectum, uterus, or bladder pushes on the vagina. In severe cases, the vagina protrudes out of the body.
What to Expect
Vaginal discharge usually begins around the time a girl gets her first period. It can start up to six months before you have your first period. This is when the body is undergoing many hormonal changes. The type of vaginal discharge your body produces can shift during your menstrual cycle and during your lifetime. You may find it is heavier or lighter at different times.
Generally, healthy vaginal discharge:
- appears clear or white in color
- has a slight odor, but not one that is strong smelling
- can leave a yellowish tint on your underwear
- changes in consistency depending on your menstrual cycle
Vaginal discharge is made up of fluids from your uterus, cervix, and vagina. When your body releases an egg from your ovary, you may notice that your vaginal discharge is thicker. This change in discharge may can indicate peak fertility times.
During pregnancy, your body may produce more vaginal discharge than usual. As you age and experience menopause, your body may produce less or no vaginal discharge because the body is no longer ovulating and estrogen levels shift. As a result, women who are in perimenopause, menopause, or post menopause may experience vaginal dryness.
When to talk to a doctor?
Most of the time, vaginal discharge is not something you should worry about. You should contact your doctor if you notice your vaginal discharge has changed from its typical consistency, color, and smell, or if you have other symptoms in your vaginal area.
You should discuss your vaginal discharge with your doctor if:
- it has changed in consistency and appears yellow, green, or even gray
- it resembles cottage cheese in color and consistency
- it looks foamy or frothy
- it has a strong smell of fish, yeast, or another odor
- it is brown or blood-stained
Also contact your doctor if you experience vaginal itching, swelling, burning, or pain.
Unusual vaginal discharge may be a sign that you have an infection, a sexually transmitted disease (STD), or another health condition that could include:
- yeast infection
- bacterial vaginosis
- pelvic inflammatory disease (PID)
You may also experience a change in vaginal discharge because of a foreign object in your vagina. This can include pieces of toilet paper. If a child experiences vaginal discharge before puberty, there may be a possibility that a foreign object is in the vagina.
Abnormal discharge may also be a side effect of douching. Douching is cleaning the inside of the vagina with water or other products. Douching is not necessary for a woman and may actually cause infection. It can interfere with the normal balance of bacteria in the vagina. One in 4 women in the United States between ages 15 and 44 douche. It is not recommended by doctors. Douching is linked to infections, STDs, and even fertility problems.
Abnormal vaginal discharge is not a symptom of one single infection or health condition. Your doctor will need to review your symptoms and may conduct tests to determine the cause of unusual vaginal discharge.
Tests may include:
- physical exams
- pap smears
- samples reviewed under a microscope
- pH tests
If you have a yeast infection, your doctor will prescribe an antifungal medicine in pill or cream form. Other conditions, like trichomoniasis or bacterial vaginosis, may require an antibiotic in addition to other treatments. STDs should be treated with antibiotics. It’s possible for you to have more than one infection at a time.
Tips for vaginal health
To keep your vagina healthy:
- Clean only the outside of your vagina with soap and water when bathing.
- Avoid using scented products, such as scented tampons or douching products.
- Wear clothing that breathes, especially in high humidity, to avoid vaginal irritation. That includes tight pants or other restrictive garments.
- Change out of wet clothes or bathing suits quickly.
- Visit your doctor regularly for testing and checkups if you are sexually active.
- Discuss any irregular vaginal discharge immediately, before the condition worsens.
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