VULVA

The word vulva describes the sexually sensitive outer region of the female reproductive system. The area is unfortunately susceptible to a variety of infections which are collectively known as vulvitis.

Most prominent among the parts of the vulva are the two pairs of 'lips' or labia. The outer and larger - labia major consist of thick folds of skin that cover and protect most of the other parts. They become thinner at the base and merge with the perineum (the skin over the area between the vulva and the anus). At the top the outer lips merge with the skin and hair on the pad of fatty tissue that covers the pubic bone, the monspubis or monsveneris - often referred to as the Mount of Venus.

Within the labia major are the labia minora or 'lesser lips'. They join at the top to form a protective hood over the sensitive clitoris, dividing into folds which surround it. They also protect the opening to the urethra or water passage. The area between the labia minora is largely taken up by a space called the vestibule. Before a woman is sexually active, the space is mostly covered by the hymen. This varies in shape, size and toughness, and although it is usually either torn or stretched during the first sexual intercourse, it may either be strong enough to make intercourse difficult or alternatively have been previously ruptured by strenuous exercise, masturbation or tampons. The tags of skin which many women have around the vestibule are the remains of the hymen, and are called the carbuncular myrtiformes. At the back the labia minor join to form the fourchette, which is often ruptured during the first childbirth.

THE CLITORIS AND GLANDS

The clitoris is actually similar in structure to the penis, even to the extent of having a hood of labia equivalent to the foreskin and a small connecting band of tissue called the frenulum. It is primarily an organ of sexual excitement. It is extremely sensitive, and when stimulated its spongy tissue fills with blood and becomes erect. Friction on the erect clitoris - either by movement of the penis during intercourse or by some other means - will usually lead to orgasm. Other parts of the vulva also respond to sexual stimulation: the labia contain erective tissue and often become enlarged during love-making; and the Bartholin's glands become active.

There are two pairs of glands associated with the vulva. The first are Skene's glands which lie just below the clitoris and secrete an alkaline fluid which reduces the natural acidity of the vagina. The other, larger pair lies in the bottom of the vestibule. These are Bartholin's glands and they secrete fluid when a woman is sexually aroused, so that the entrance to the vagina becomes moist and can more easily accommodate the penis. These glands are normally about the size of a pea and not prominent. They are liable however to venereal and other infections, becoming swollen, red and tender. This condition (Bartholintis) requires treatment with antibiotics. In some cases, an abcess forms in one of the glands - a Bartholin's access - and this may need to be incised to release the pus.

VULVITIS

This means inflammation of the vulva or of some part of it, the labia being the structures most often involved. Although vulvitis is mostly due to an infection, such as thrush (monilia) or trichomdniasis ('trich'), it can also result from the friction of tight underwear or jeans, excessive rubbing or scratching, damage from stale urine or sweat, chemical effects of vaginal deodorants or allergy to some material or cosmetic preparation with which it comes in contact. Vulvitis is a likely complication of diabetes and obesity; senile vulvitis develops among the elderly as a result of decreased hormone levels. Currently on the increase is the form known as genital herpes, caused by infection from the herpes simplex virus.

SYMPTOMS AND TREATMENTS

Irrespective of cause, the symptoms of vulvitis are basically the same. The skin becomes red, sore and itchy; there may be some swelling. If there is a great deal of irritation - pruritus vulvae - scratching may add considerably to the problem, making the labia even more sore and inflamed.

In herpes, small blisters develop; these burst leaving tender ulcers which allow bacteria to enter the vagina and cause further infection.

Treatment of vulvitis depends upon cause. It is therefore usually necessary to go to your doctor or to a Special Clinic to get proper diagnosis and treatment. Meanwhile, you can get some relief by wearing only loose panties or none at all, dusting the area with talcum powder and scrupulously avoiding scratching.