Get to know your Vulva: A Guide to Self Examination

In Female Pelvic Pain by Stephanie PrendergastLeave a Comment

By Rachel Gelman, DPT

Let’s just start with the word vagina. Vagina. It sounds like an infection at best. Maybe a medical instrument. ‘Hurry, nurse, bring me the vagina.’ Vagina. Vagina. It doesn’t matter how many times you say the word, it never sounds like a word you want to say. ”-Eve Ensler, The Vagina Monologues

There are many reasons why I think women have insecurities about their genitalia, but this quote in particular speaks to one reason; vagina is a weird word. No one wants to say it. It becomes like an anatomical Voldemort, the body part that shall not be named. So, when no one wants to say the word, no one wants to talk about it. Without healthy conversation, women are left misinformed. In fact most people do not realize that the area they are referring to is technically not the vagina, but the vulva. Today, I am here to encourage you to grab a mirror, and take the time to look at your vulva.

A majority of my female patients tell me they have never looked “down there.”  Many express concerns that their genitals look “bad” or “wrong.” I always find it interesting that my male patients never report concerns about the appearance of their penis. In fact,  many of my male patients have given me in-depth descriptions of their genitalia. I always think how impressive it would be if one of my female patients could describe her labia with such accuracy. Obviously, men are at an advantage as the penis is external and easier to check out on a daily basis. However, there is still a level of shame or insecurity surrounding the vulva. There is the obvious history in our culture that has led to this, especially during the Victorian Era, which founded the idea that women should not be sexual beings, and that their genitals are meant to be kept private. One could also look at the impact of pornography and the recent rise in labiaplasties as a contributing factor into why women worry that their genitals don’t look “right”. Now, I think pornography can be a great tool to spice up a relationship, but it should not be used as a way to judge a typical body type. Porn is basically an X-rated Hollywood. When someone worries their genitals do not look the same as an adult film star, it is equivalent to saying, “My face doesn’t look like Angelina Jolie on the cover of Elle!” It is just not a realistic expectation. Women should start to see this part of their body as they would any other physical feature; as something unique to only them. It should be a source of confidence, not discomfort or embarrassment.

I will step down from my feminist soap-box, and now tell you why it is important for your  health to look at your vulva. As a woman, your body will go through many changes thanks to hormonal fluctuations that come along with puberty, pregnancy and menopause. Therefore, it is important to be aware of what your “normal” is regarding your genitals, so that you can monitor if any changes occur as you age. Also, there are some dermatological conditions, cancers, STDs and side effects of certain medications that if caught and treated early can be no big deal, but if left unchecked can turn into a bigger issue.

You can also think of this as an opportunity to become friends with your vulva. Even if you just become acquaintances, the more you “get to know” your body the better you will begin to feel about it. That kind of confidence can help with your overall self-esteem and can improve your sexual function. You should know your body best and take pride in it’s uniqueness.

So, what should your vulva look like?

Your vulva should have a few keys parts:

  • A mound of fatty tissue, usually covered in pubic hair known as the mons pubis
  • Two outer skin folds which are known as the labia majora
  • Within the labia majora are a smaller set of skin folds known as the labia minora
  • At the top, which can be considered 12:00 if the vulva was a clock, is the clitoris, under the clitoral hood
  • Below the clitoris, is the urethra, the opening where one urinates from
  • Below that is a larger opening, the vagina, that leads to the vaginal canal
  • Directly below the vagian is a small patach of skin known as the perineum


The appearance of a woman’s vulva can vary from person to person. There has been a lot of research over the years that supports the fact that there is no “normal” standard regarding female genitalia and, even more, the data collected shows that the dimensions of a woman’s vulva can vary from person to person. Some women’s labia majora and minora are the same size, while other women’s labia minora are bigger than their labia majora. There are many variations, which is why I often tell patients that their vulva’s are snowflakes, each unique in their own special way. So next time you have a moment alone, grab a hand mirror and say “hello” to your vulva. Try to identify the different structures listed above and take note of what your vulva looks like. Are there any moles or markings on the skin? Notice if there is any discoloration of the skin or tissue of the vulva, especially if this is new for you and you are having other symptoms such as pain with intercourse, itching, difficulty with urination etc. Also, vaginal discharge can be normal but contact your doctor if the discharge is any of the following: green or dark yellow, foamy, has a strong odor, or there is a change in the amount or consistency. Try to make a vulvar self-examination part of your health routine, as you would a self breast examination. However, just like brushing your teeth everyday does not replace a trip to the dentist, a vulvar self-examination should not replace your annual trip to the gynecologist.

Hopefully this post has inspired you to bust out your hand mirror and take a peek, but if you are still unsure or maybe just want to read more, I suggest you check out the following sites (some may be NSFW):

Readers we want to hear from you! How well do you know your vulva? Please share in the comments section below!

And if you haven’t already, SUBSCRIBE to this blog (up top, to the right, under Stephanie’s photo!), so you can get weekly updates in your inbox, and follow us on Facebook and Twitter where the conversation on pelvic health is ongoing!


Rachel Gelman, DPT

is a Bay Area native, and currently practices in our San Francisco office. She received her bachelor’s degree in Biology from the University of Washington in Seattle and her Doctorate in Physical Therapy from Samuel Merritt University. Rachel grew up dancing and is excited to have recently returned to the dance studio. Outside of dance, Rachel enjoys going to the gym, discovering new brunch spots and spoiling her adorable niece and nephew.


What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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