Physical imperfections are usually visible to the naked eye. Flaws can range from minimal irregularities such as a receding hairline or having one eye slightly larger than the other. Others can be stark abnormalities such as a distorted limb or a blatant handicap. We base these deviations on our everyday observations of what we perceive as ‘normal’. However, when it comes to the more private area of our bodies, it may be more difficult to differentiate between normal and abnormal.
Pelvic appearance and health continue to remain private subjects for most. Typically, women don’t whip off their panties or take selfies of their lady parts in order to ask someone, “Am I normal down there?” In fact, a 2015 Australian study shows that 50% of women have no idea what a normal vagina looks like. 53% have never seen a real-life vagina other than their own, and 15% have only ever seen one in science videos.
The research continued to say that many women rely on pornographic material to compare their private parts to what they think might be the norm. Based on those often misconstrued observations, a staggering 1 in 7 women request labiaplasty because what they see on TV and elsewhere appears to be different from their own.
What Am I Supposed to Look Like? What is Considered ‘Normal’ Down There?
Unlike men, whose sexual organs are mostly external, the outer visible parts of your genitalia are limited to the vulva, which can be seen when facing a mirror standing up. Even those parts may be obscured by pubic hair unless you opt for a waxed or shaven appearance. The rest of your sexual organs are internal, and investigating them for possible problems can only be done by pulling back the labia or having your gynecologist discern any possible abnormalities during your annual checkup.
There are several parts to the vulva, but most women are concerned with the appearance of the following:
Mons pubis or mons veneris: The gently sloped shaven or unshaven mound you see when facing a mirror. The mound size depends on hormone levels and weight. The mons pubis enlarges at puberty and sinks at menopause due to estrogen levels. In some cases, sharp pains in this area can occur, sometimes during later stages of pregnancy or even after, and if this discomfort is excessive, you should consult your physician.
The appearance of the mons pubis is different from woman to woman and can fluctuate in size with weight, childbirth or during the aging process. If you find yours to be unsightly, monsplasty (a pubic lift) can reduce, lift or tighten sagging in this area, thus improving its size and appearance.
Labia majora: The two outer sides of the vulva called labia majora resemble pads or cheeks that are separated by lip-like tissue (pudendal cleft). These labia extend from the mons pubis all the way down to the base of the vulva and perineum. They consist of fatty tissue that contains oil and sweat glands.
A slight musty smell is normal, and you may even emit a somewhat metallic odor around menstruation. Foul smell or discharge should be checked. Labia majora size is different from one woman to the next. Just as you can have one foot bigger than the other, labial size varies and perfect symmetry is actually more unusual than the norm.
Color varies from a normal skin tone to a deep purple, just like your facial lips. However, should you develop cysts, new moles, lumps, ulcers, experience excessive pain, itching or any discomfort that is not eased by wearing looser or cotton lined underwear, consult your physician.
A prominent labia may sometimes result in what is referred to as ‘camel toe’, where the pudendal cleft of the labia can be seen through tighter clothing. You may find this extremely embarrassing, however, labiaplasty can correct this problem.
Labia minora: These are thinner inner lips that come into view when lightly spreading the labia majora apart. In some women, the labia minora can protrude from the labia majora and this is not an abnormality. As with labia majora, color differs from one woman to the next.
Clitoris: The small, knobby, sexually sensitive sponge-like tissue located on the anterior top of the vulva is your clitoris. The visible portion of the clitoris is about the size of a pencil eraser. It can either protrude or be nestled in tissue called a clitoral hood. Both are normal—much like belly buttons that vary from person to person. Some are embedded and referred to as innies while others, known as outies, may jut out. Sometimes, the clitoral hood may be too thick or protrude too much, causing chafing and discomfort. This may interfere with sexual pleasure and gratification. A procedure called clitoral hoodectomy can correct this, either for aesthetic purposes, for physical comfort or as a medical necessity.
Urethra: Located just below the clitoris and above the vagina, the urethra is the portal for urine to pass. It is about 1-½” long. Any swelling, discomfort, pain upon urination, lumps, abdominal pressure, blood in your urine, itching, discharge, discomfort during sex, or inflammation should be discussed with your doctor.
Vaginal opening (introitus): The channel leading to the vagina and its interior. Color varies and can range from a light pink hue to a deep wine color. Size and shape also differ from woman to woman. It can be cylindrical, round or oval. As with most of your genitalia, any discomfort, pain, difficulty with sex or urination, lumps, unusual bleeding, itching, discharge, foul smell, inflammation, visible protrusions of inner organs, or growths should be reported to your gynecologist.
Perineum: This is the small section of triangularly shaped fibro muscular tissue that begins at the base of the vulva and extends to the anus. The distance between the two can vary greatly from female to female. As with all lady parts, there are no set measurements that are considered ‘normal’ or ‘abnormal’.
The perineum serves as a structural support for several internal organs. It is also referred to as an erogenous zone.
The perineum may need to be surgically incised to allow for a safe delivery of a baby (episiotomy). It is then stitched and allowed to heal. Due to the trauma the perineum may suffer as a result of childbirth, women may experience complications (prolapse) later on that may require surgical intervention (perineoplasty). Should you experience bowel problems, incontinence, pain in the perineal area or in your thighs, back, abdomen or waist, speak to your doctor.
Anus: This is the end of the digestive tract and external opening that allows for fecal elimination. Depending on your skin tones, its color can range from pink to reddish brown. The opening is puckered and closed unless either eliminating fecal matter or inserting an object such as a finger or other probe.
If you experience pain, itching, difficulty or burning during a bowel movement, have uncontrollable bowel movements (fecal incontinence), notice blood, pus, swelling, a hard mass, any discharge or mucous, discuss this with your doctor.
I’ve Been Told I’m ‘Normal’ Down There But I Still Don’t Like the Way I Look. Do I Need to be ‘Abnormal’ to Qualify for Surgery?
Not at all. Mental health and physical health go hand in hand. If you’re not happy with your body and feel cosmetic GYN surgery can make you feel better about yourself and give you more confidence, there are a range of cosmetic procedures available to you. Dr. Michael Litrel (MD, FPMRS, FACOG) participates in RealSelf.com, an online forum on cosmetic treatments and aesthetic medicine. Not only is he highly skilled in performing cosmetic surgery, his expertise includes any necessary pelvic surgery you may require. He can answer your questions frankly and honestly. He’ll even look at any ‘selfies’ you may wish to provide on RealSelf.com to help ascertain whether you may benefit from a cosmetic GYN procedure. Of course, an in-person consultation with Dr. Litrel is required prior to final decision making.
Just as a regular breast examination is essential to your health and well-being, it’s a good idea to take a peek down there from time to time. By looking at your body and listening to cues, you may counteract an issue before it interferes with your pelvic health.
Typically, if you feel good, have a satisfying sex life, suffer no discomfort, experience no unpleasant leaks or odors, or don’t suddenly have bits and pieces poking out that don’t seem to belong, you are perfectly ‘normal’ down there. Maintain your annual gynecological checkups and pay attention to any changes that concern you. To schedule an appointment with one of our FPMRS doctors, call 770.720.7733.