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53-414: The labia minora are situated between the labia majora and together form the labia . The labia minora are homologous to the penile raphe and ventral penile skin in males. The labia minora extend from the clitoris obliquely downward, laterally, and backward on either side of the vulval vestibule , ending between the bottom of the vulval vestibule and the labia majora. The posterior ends (bottom) of

106-528: A number of conditions, including infections and imbalances in vaginal flora or pH . Sometimes, abnormal vaginal discharge may not have a known cause. In one study looking at women presenting to clinic with concerns about vaginal discharge or a foul smell in their vagina, it was found that 34% had bacterial vaginosis and 23% had vaginal candidiasis (yeast infection). 32% of patients were found to have sexually transmitted infections including Chlamydia , Gonorrhea , Trichomonas , or Genital Herpes . Diagnosing

159-548: A result of the body's increased levels of estrogen and progesterone. The discharge is usually white or slightly gray, and may have a musty smell. The normal discharge of pregnancy does not contain blood or cause itching. The pH of the vaginal discharge in pregnancy tends to be more acidic than normal due to increased production of lactic acid. This acidic environment helps to provide protection from many infections, though conversely it also makes women more susceptible to vaginal yeast infections. Discharge may be red and heavy for

212-511: A rise in the popularity of labiaplasty , surgery to alter the labia—usually, to make them smaller. On the other hand, there is an opposite movement of labia stretching . Its proponents stress the beauty of long labia and their positive role in sexual stimulation of both partners. Labiaplasty is also sometimes sought by women who have asymmetrical labia minora to adjust the shape of the structures towards identical size. Labia stretching has traditionally been practised in some African nations in

265-559: A sample of discharge under the microscope showing trichomonads moving on the slide. However, in women with trichomonas the organism is typically detected in only 60-80% of cases. Other testing, including a culture of the discharge or a PCR assay, are more likely to detect the organism. Treatment is with a one time dose of oral antibiotics , most commonly metronidazole or tinidazole. Chlamydia and gonorrhea can also cause vaginal discharge, though more often than not these infections do not cause symptoms. The vaginal discharge in chlamydia

318-643: A thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections , bacterial vaginosis , and sexually transmitted infections . The characteristics of abnormal vaginal discharge vary depending on

371-735: Is a gram stain showing a relative lack of lactobacilli and a polymicrobial array of gram negative rods, gram variable rods, and cocci. BV may be treated with oral or intravaginal antibiotics, such as metronidazole , or lactobacillus. Vaginal yeast infection or vaginal candidiasis results from overgrowth of candida albicans, or yeast, in the vagina. This is a relatively common infection, with over 75% of women having experienced at least one yeast infection at some point in their life. Risk factors for yeast infections include recent antibiotic use, diabetes mellitus , immunosuppression, increased estrogen levels, and use of certain contraceptive devices including intrauterine devices, diaphragms, or sponges. It

424-436: Is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix , and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have

477-402: Is a vertical fissure between the labia majora starting at the basal point of the mons pubis . After puberty, the clitoral hood and the labia minora can protrude into the pudendal cleft to a variable degree. The labia majora are thicker in front, and form the anterior labial commissure where they meet below the mons pubis . Posteriorly, they are not really joined, but appear to become lost in

530-473: Is an infection caused by a change in the vaginal flora, which refers to the community of organisms that live in the vagina. It is the most common cause of pathological vaginal discharge in women of childbearing age and accounts for 40–50% of cases. In BV, the vagina experiences a decrease in a bacterium called lactobacilli, and a relative increase in a multitude of anaerobic bacteria with the most predominant being Gardnerella vaginalis . This imbalance results in

583-478: Is associated with vaginal discharge. It can be transmitted by way of the penis to the vagina, the vagina to the penis, or from vagina to vagina. The discharge in Trichomonas is typically yellowish-green in color. It sometimes is frothy and can have a foul smell. Other symptoms may include vaginal burning or itching, pain with urination, or pain with sexual intercourse. Trichomonas is diagnosed by looking at

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636-580: Is known as the urogenital triangle , which separates it from the anal region. Between the labia majora and the inner thighs are the labiocrural folds . Between the labia majora and labia minora are the interlabial sulci. Labia majora atrophy after menopause . While the labia majora is present in all female primates, many have them until adulthood or become inconspicuous around that period. Primates besides humans that always have visible labia majora are bonobos , strepsirrhines , tarsiers , cebid monkeys , and gibbons . In non-primate female mammals ,

689-405: Is made by looking at a sample taken during speculum exam under the microscope that shows hyphae (yeast), or from a culture. The symptoms described above may be present in other vaginal infections, so microscopic diagnosis or culture is needed to confirm the diagnosis. Treatment is with intra-vaginal or oral anti-fungal medications. Trichomonas vaginitis is an infection acquired through sex that

742-499: Is made up of transudate from the vaginal walls and secretions from glands ( Skene's and Bartholin's ). The solid components or elements are exfoliated epithelial cells from the vaginal wall and cervix as well as some of the bacteria that inhabit the vagina. These bacteria that live in the vagina do not typically cause disease. In fact, they can protect the individual from other infectious and invasive bacteria by producing substances such as lactic acid and hydrogen peroxide that inhibit

795-399: Is named the clitoral hood . The lower part passes beneath the glans clitoridis and becomes united to its under surface, forming, with the inner lip of the opposite side, the frenulum clitoridis . The clitoral hood serves to cover most of the time the shaft and sometimes the glans (which is very sensitive to the touch) to protect the clitoris from mechanical irritation and from dryness. Yet

848-513: Is not a sexually transmitted infection. Candida vaginal infections are common; an estimated 75% of women will have at least one yeast infection in their lifetime. Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. Vaginal itching is the most common symptom of candida vulvovaginitis. Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. The diagnosis of Candida vulvovaginitis

901-410: Is thin-walled and has a different microbiota; additionally, the vulva in pre-pubertal girls lacks pubic hair. These features makes the vagina more prone to bacterial infection. The bacteria that are more commonly responsible for vaginal discharge in pre-pubertal girls are distinct from those in other age groups, and include Bacteroides , Peptostreptococcus , and Candida (yeast). These can derive from

954-405: Is typically pus-filled, but it is important to note that in around 80% of cases chlamydia does not cause any discharge. Gonorrhea can also cause pus-filled vaginal discharge, but gonorrhea is similarly asymptomatic in up to 50% of cases. If the vaginal discharge is accompanied by pelvic pain, this is suggestive of pelvic inflammatory disease (PID), a condition in which the bacteria have moved up

1007-426: Is unknown, and BV is not considered an STI. The diagnosis of BV is made by a health care provider based on the appearance of the discharge, discharge pH > 4.5, presence of clue cells, when viewing the collected discharge from speculum exam under the microscope, and a characteristic fishy odor when the discharge is placed on a slide and combined with potassium hydroxide ("whiff test"). The gold standard for diagnosis

1060-495: The labia minora , interlabial sulci , clitoral hood , clitoral glans , frenulum clitoridis , the Hart's Line , and the vulval vestibule , where the external openings of the urethra and the vagina are located. Each labium majus has two surfaces, an outer, pigmented and covered with strong, pubic hair ; and an inner, smooth and beset with large sebaceous follicles. The labia majora are covered with squamous epithelium . Between

1113-500: The menstrual cycle . In the days right after menstruation, vaginal discharge is minimal, and its consistency is thick and sticky. When approaching ovulation , the rising estrogen levels cause a concomitant increase in vaginal discharge. The amount of discharge produced at ovulation is 30 times greater than the amount produced directly following menstruation. The discharge also changes in color and consistency during this time, becoming clear with an elastic consistency. After ovulation

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1166-613: The mons pubis to the perineum . Together with the labia minora , they form the labia of the vulva . The labia majora are homologous to the male scrotum . Labia majora is the Latin plural for big ("major") lips. The Latin term labium/labia is used in anatomy for a number of usually paired parallel structures, but in English, it is mostly applied to two pairs of parts of the vulva —labia majora and labia minora . Traditionally, to avoid confusion with other lip-like structures of

1219-549: The Department of Gynaecology, Elizabeth Garrett Anderson Hospital in London, measured the labia and other genital structures of 50 women from the age of 18 to 50, with a mean age of 35.6. The study has since been criticized for its "small and homogenous sample group" consisting primarily of white women. The results were: Due to the frequent portrayal of the pudendal cleft without protrusion in art and pornography, there has been

1272-528: The East and South and the South Pacific. The inner lips serve to protect from mechanical irritation, dryness and infections of the highly sensitive area of the vulval vestibule with vaginal and urethral openings in it between them. During vaginal intercourse, they may contribute to stimulation of the whole vestibule area, the clitoris and the vagina of the woman and the penis of her partner. Stimulation of

1325-515: The Primates order. When the labia vulvae are closed together, they form a pudendal cleft. The joining of the labia vulvae top and bottom are respectively referred to as the anterior and posterior commissures. Labia majora In primates , and specifically in humans, the labia majora ( sg. : labium majus ), also known as the outer lips or outer labia , are two prominent longitudinal skin folds that extend downward and backward from

1378-555: The bacterial population in pre-pubertal girls is dominated by staphylococcus species, in addition to a range of anaerobes, enterococci, E. coli , and lactobacillus. During puberty , the hormone estrogen begins to be produced by the ovaries. Even before the beginning of menses (up to 12 months before menarche , typically at the same time as the development of breast buds ) vaginal discharge increases in amount and changes in composition. Estrogen matures vaginal tissues and causes increased production of glycogen by epithelial cells of

1431-401: The body's progesterone levels increase, which causes a decrease in the amount of vaginal discharge. The consistency of the discharge once again becomes thick and sticky and opaque in color. The discharge continues to decrease from the end of ovulation until the end of menstruation, and then after menstruation, it begins its rise again. During pregnancy, vaginal discharge volume increases as

1484-472: The body, the vulvar labia were termed by anatomists in Latin as labia majora ( or minora) pudendi. Embryologically, they develop from labioscrotal folds . The labia majora after puberty may become of a darker color than the skin outside them and grow pubic hair on their external surface. The main function of the labia majora is to cover and protect the other parts of the vulva. The labia majora contain

1537-434: The cause of abnormal vaginal discharge can be difficult, though a potassium hydroxide test or vaginal pH analysis may be used. When abnormal discharge occurs with burning, irritation, or itching on the vulva , it is called vaginitis . It is important to seek care when abnormal vaginal discharge or changes to vaginal discharge are noticed. Associated symptoms with pathological causes of vaginal discharge include: itching of

1590-404: The cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse . Normal vaginal discharge is composed of cervical mucus, vaginal fluid, shedding vaginal and cervical cells, and bacteria. The majority of the liquid in vaginal discharge is mucus produced by glands of the cervix . The rest

1643-434: The cervix. The physician will insert the speculum into the vagina while the patient lies on their back to exam for foreign bodies, vaginal warts, inflammation, as well as rashes/bruises. A sample of the vaginal discharge is then collected using a cotton-swab and tested for pH and under microscopy. The most common causes of pathological vaginal discharge in adolescents and adults are described below. Bacterial vaginosis (BV)

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1696-625: The characteristic vaginal discharge experienced by patients with BV. The discharge in BV has a characteristic strong fishy odor, which is caused by the relative increase in anaerobic bacteria.[1] The discharge is typically thin and grey, or occasionally green. It sometimes is accompanied by burning with urination. Itching is rare. The exact reasons for the disruption of vaginal flora leading to BV are not fully known. However, factors associated with BV include antibiotic use, unprotected sex, douching, and using an intrauterine device (IUD). The role of sex in BV

1749-406: The clitoris may occur through tension of the clitoral hood and its frenulum by the inner labia pulling at them. During sexual arousal, they are lubricated by the mucus secreted in the vagina and around it to make penetration painless and protect them from irritation. As the female external urethral opening (meatus) is also situated between labia minora, they may play a role in guiding the stream of

1802-405: The discharge pools in the deepest portion of the vagina (the posterior fornix ) and exits the body over the course of a day with the force of gravity. A typical reproductive-age woman produces 1.5 grams (half to one teaspoon) of vaginal discharge every day. During sexual arousal and sexual intercourse, the amount of fluid in the vagina increases due to engorgement of blood vessels surrounding

1855-431: The exterior genitalia, irritation or inflammation of the external genitalia, green or foam-like discharge, bloody discharge not associated with menstruation, different odors, new or worsening pain associated with the discharge, or pain with sex or urination. Self-treatment is not recommended and can worsen symptoms. Upon the diagnosis of vaginitis, a speculum exam is performed to evaluate the vagina, vaginal discharge, and

1908-401: The external environment or the anus. The labia minora in non-primate placental mammals (namely Euungulata and Carnivora ) are a sole pair of small labia that protect the internal vestibule and are rather called the labia vulvae or simply labia . In primates, they are called labia minora to differentiate them from the labia majora , the latter of which are a feature only present in

1961-447: The first few days after birth. This is due to exposure to estrogen while in utero. Neonatal vaginal discharge may be white or clear with a mucous texture, or it may be bloody from normal transient shedding of the endometrium . The vagina of girls before puberty is thinner and has a different bacterial flora. Vaginal discharge in pre-pubertal girls is minimal with a neutral to alkaline pH ranging from 6 to 8.   The composition of

2014-446: The first few days as it consists of blood and the superficial mucous membrane that lined the uterus during pregnancy. This discharge normally begins to taper and should become more watery and change in color from pinkish brown to yellowish white. With the drop in estrogen levels that comes with menopause , the vagina returns to a state similar to pre-puberty. Specifically, the vaginal tissues thin, and become less elastic; blood flow to

2067-421: The growth of other bacteria. The normal composition of bacteria in the vagina ( vaginal flora ) can vary, but is most commonly dominated by lactobacilli . On average, there are approximately 10 to 10 bacteria per milliliter of vaginal discharge. Normal vaginal discharge is clear, white, or off-white. The consistency can range from milky to clumpy, and odor is typically mild to non-existent. The majority of

2120-427: The hood is movable and can slide during clitoral erection or be pulled upwards a little for greater exposure of the clitoris to sexual stimulation . On the opposed surfaces of the labia minora are numerous sebaceous glands not associated with hair follicles. They are lined by stratified squamous epithelium on those surfaces. Like the whole area of the vulval vestibule, the mucus secreted by those glands protects

2173-442: The labia from dryness and mechanical irritation. Being thinner than the outer labia, the inner labia can be also more narrow than the former, or wider than the labia majora, thus protruding in the pudendal cleft and making the term minora (Latin for smaller) essentially inapplicable in these cases. They can also be smooth or frilled, the latter being more typical of longer or wider inner labia. From 2003 to 2004, researchers from

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2226-404: The labia majora are absent since the labioscrotal swellings have disappeared as a fetus. Because of this, the pudendal cleft refers to the slit between the labia vulvae in those mammals. The fat pad of the labia majora can be used as a graft , often as a so-called "Martius labial fat pad graft", and can be used, for example, in urethrolysis . Vaginal discharge Vaginal discharge

2279-427: The labia minora are usually joined across the middle line by a flap of skin, named the frenulum of labia minora . On the front, each lip forks dividing into two portions surrounding the clitoris. The upper part of each lip passes above the clitoris to meet the upper part of the other lip—which will often be a little larger or smaller—forming a fold which overhangs the glans clitoridis (clitoral tip or head); this fold

2332-451: The mostly pediatric condition known as labial fusion . If fused labia prevent urination, urine may accumulate and cause pain and inflammation. In adult females, irritation of the area may be caused by wearing too-tight underwear (especially where wider inner labia protrude in the pudendal cleft); while G-strings , which rub against the labia during body movements, may cause irritation or lead to infection from bacteria transferred from either

2385-406: The neighboring integument, ending close to, and nearly parallel to, each other. Together with the connecting skin between them, they form another commissure , the posterior labial commissure , which is also the posterior boundary of the vulva. The interval between the posterior commissure and the anus , from 2.5 to 3 cm in length, constitutes the perineum . The anterior region of the perineum

2438-597: The reproductive tract. Foreign objects can cause a chronic vaginal discharge with a foul odor. Common foreign objects found in adolescents and adults are tampons, toilet paper, and objects used for sexual arousal. The most common reason pre-pubertal females go to the gynecologist is concern about vaginal discharge and vaginal odor. The causes of abnormal vaginal discharge in pre-pubertal girls are different than in adults and are usually related to lifestyle factors such as irritation from harsh soaps or tight clothing. The vagina of pre-pubertal girls (due to lack of estrogen)

2491-490: The two, there is a considerable quantity of areolar tissue and fat , besides vessels, nerves , and glands . Below the skin of the labia majora, there is a tissue called the dartos muliebris , which gives them a wrinkled appearance. The labia majora constitute the lateral boundaries of the pudendal cleft . The pudendal cleft, also known as the vulvar cleft or cleft of Venus ( rima vulvae or rima pudendi in Latin),

2544-410: The urine during female urination . Being very sensitive by their structure to any irritation, and situated in the excretion area where traces of urine, vaginal discharge , smegma and even feces may be present, the inner lips may be susceptible to inflammatory infections of the vulva such as vulvitis . The likelihood of inflammation may be reduced through appropriate regular hygienic cleansing of

2597-538: The vagina decreases; the surface epithelial cells contain less glycogen. With decreased levels of glycogen, the vaginal flora shifts to contain fewer lactobacilli, and the pH subsequently increases to a range of 6.0-7.5.  The overall amount of vaginal discharge decreases in menopause. While this is normal, it can lead to symptoms of dryness and pain during penetrative sexual intercourse. These symptoms can often be treated with vaginal moisturizers/lubricants or vaginal hormone creams . Abnormal discharge can occur in

2650-473: The vagina. These higher levels of glycogen in the vaginal canal support the growth of lactobacilli over other bacterial species. When lactobacilli use glycogen as a food source, they convert it to lactic acid. Therefore, the predominance of lactobacilli in the vaginal canal creates a more acidic environment. In fact, the pH of the vagina and vaginal discharge after puberty ranges between 3.5 and 4.7. The amount and consistency of vaginal discharge change with

2703-714: The vagina. This engorgement of blood vessels increases the volume of transudate from the vaginal walls. Transudate has a neutral pH, so increases in its production can temporarily shift vaginal pH to be more neutral. Semen has a basic pH and can neutralize the acidity of the vagina for up to 8 hrs. The composition and amount of vaginal discharge changes as an individual goes through the various stages of sexual and reproductive development. However, some individuals may experience changes in vaginal discharge due to underlying conditions such as stress, diabetes, inflammatory disorders, lactation, certain medications, or autoimmune diseases. In neonates , vaginal discharge sometimes occurs in

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2756-419: The vulval vestibule dry with toilet tissue after urination to avoid irritation and infections from residual drops of the urine in the area. However, incorrect choice of cleansing agents, or their incorrect application, may itself cause labial irritation and require medical attention. Over-vigorous rubbing of the labia of little girls while washing, combined with the lack of estrogen in their bodies, may lead to

2809-425: The whole vulval vestibule, using water and medically tested cleansing agents designed for vulvas. To avoid contamination of the vulva with fecal bacteria, it is recommended that the vulva is washed only from front to back, from mons pubis to the perineum and anus . Apart from water and special liquid cleansing agents (lotions), there are commercially available wet wipes for female intimate hygiene. Some women wipe

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