Parting the Curtains - A Woman's Handbook of Sex and Sexuality

The Clitoris

Outer lips (or labia majora): The external folds of skin, one on each side, which typically have the same “puffy” look in most women, and which act as a cushion against the male pubic bone during intercourse.

Vulva: The external genital organs; it is everything you see when you part the outer lips.

Inner lips (or labia minora): The internal skin folds that are visible once the outer lips are parted. The size of the inner lips varies greatly among women.

Vestibule: the area within the inner lips that includes the vaginal and urethral openings.

Urethral opening (urinary meatus): This is the visible end of the urethra through which we release urine out of the body. The urethral opening is located just above the vaginal opening within the vestibule, and is surrounded by protective fatty, estrogenic-rich tissue, which gives it the appearance of a small, soft blob of tissue. Continuing inward from the urethral opening is the itself, which terminates at the bladder. The urethra lies parallel to the lower third of the vagina, as if it were a pipe that runs along its ceiling, thus making it intimately connected to vaginal sensations. The underside of the urethra, which forms the ceiling of the vagina, is also lined with fatty, estrogenic tissue, which serves as a cushion during vaginal penetrations of any kind (tampons, intercourse, etc.). When estrogen is compromised, however, as in the case of menopause, the protective estrogenic tissue begins to thin-out, making the urethra more reactive to penetration.

Vaginal opening (introitus): Found within the inner lips, at the very bottom of the genital oval. It is the entrance to the vaginal canal, which continues into the pelvis and ends at the cervix.

Cervix: A donut-shaped structure with a small opening at the center, which serves as the entrance to the uterus (womb).

Clitoris: A woman’s primary erogenous organ, similar in size and feel to a (very sensitive!) small pebble. We can only see its tip—glans clitoris—which is situated above the urethral and vaginal openings. In other words, the clitoris is not inside the vagina, a common misconception. The clitoris is shaped like a wishbone with its “legs” (right crus + left crus = crura) extending down on either side of the vagina and containing spongy tissue (corpus cavernosum) that engorges with blood upon arousal, similar to penile erection. The skin fold covering the glans clitoris—clitoral hood, or prepuce—is the female’s analog to the male’s foreskin.

Women need clitoral stimulation for sexual arousal, whether by direct contact—with a hand, tongue, or vibrator, for example—or indirect contact, when the shaft of the penis rubs the clitoris and/or tugs on the inner lips just the right way during intercourse, leading to what is known as a “vaginal orgasm” (a subject we discuss in greater length in Chapter Five).

What About the Hymen?

Although there remains a stubborn misconception that a “virgin” will always have an intact hymen, the truth is that most women age 20 and older do not have a hymen, or only have a partial hymen, even if they have never had any vaginal penetration. How is this possible, you ask? Because unlike the prepubescent and adolescent vagina, the adult vaginal tissue has been under the influence of estrogen for several years, which causes it to elasticize and expand.

That said, there is no shortage of myths floating around about the hymen, so let’s dispel the two most common right away:

• You cannot break a hymen by exercising, bike riding, or riding a horse
• The hymen is not visible through the genital lips; its presence can only be confirmed with an internal examination

Explore

Just like we encourage our patients, we encourage you, too, to look at your genitals and get to know them a bit better. Using a mirror, explore the outer lips (labia majora), inner lips (labia minora), clitoris, and clitoral hood, as well as the place where your urine comes out (urethral meatus), and the vaginal opening located right below it. Don’t be surprised if the vagina seems closed up—this is quite normal, especially for women who have not had multiple vaginal births.

If you can, insert a lubricated finger into your vagina up to your middle knuckle, and gently move your finger around to get a sense of what your vagina feels like. With your finger still inside, try squeezing your muscles as though to prevent yourself from passing urine or from making a bowel movement. If you are able to feel your pelvic floor muscles tightening, you have just done a Kegel exercise by contracting your PC (pubococcygeus) muscle. While your finger is inside your vagina, you may want to feel around: above is the underside of your pubic bone and the urethra that is just under it; below is the rectal canal; the sides feel soft and flexible like the inside of your mouth.

Kegel Exercises

Kegel exercises are the squeezing of the muscles of the pelvic floor, named after Dr. Arnold Kegel (1894-1981), a gynecologist who pioneered this approach as a non-surgical treatment of genital muscle weakness associated with urinary incontinence (bladder control) and organ (i.e., uterine, bladder) prolapse. Today, they may be referred to as Kegels, or PC exercises, or pelvic floor exercises, with the term PC referring to the pubococcygeus muscle, one of the primary muscles involved in doing these squeezes. We recommend these exercises for every woman at every age.

When should women do these exercises?

• Do them regularly, as in 4-5 times per week to enhance genital health, unless instructed otherwise by your healthcare provider;
• During pregnancy and after childbirth to facilitate recovery;
• In the early stages of organ prolapse to minimize the feeling that ‘something is falling out of my vagina;’
• In case of injury/neurological deficit to restore muscle tone and function, as instructed by your healthcare provider, and
• As an orgasm exercise. Yes, you read that right. The pelvic floor muscles have voluntary and involuntary fibers and are the ones that give you an orgasm with their unique ability to quiver, contract, and squeeze as you are enjoying the culmination of sexual arousal. Many women also instinctively (voluntarily) contract them in a rhythmic manner during intercourse, squeezing the penis to the man’s delight.

If you’re new to “Kegels,” it may be easiest to first try doing them while lying down. As you get stronger, you can do them while sitting and standing. The great thing about Kegels—as we hope you’ll discover—is that you can do them anywhere, anytime except while voiding (urinating), and no one will know but you.

This exercise program has two components: fast and slow contractions.

• Fast contractions: Contract and release, contract and release, with only a momentary pause between each repetition. The goal is to be able to do 30 repetitions in a row.
• Slow contractions: Contract the muscles and hold for 10 seconds, then release and rest for 10 seconds before starting the next repetition. The goal is to do 10 repetitions in a row.

Patience is key when it comes to Kegels. It will take training to be able to do the above-mentioned number of repetitions, so don’t give up! Keep a log of your progress, and you should see great results within 3-6 weeks.

Not sure you’re doing them right? Or having trouble feeling if you’re doing them at all? Speak to your healthcare provider or to a pelvic floor physical therapist, who can give you direct guidance.

Myths and Facts

As we’ve mentioned, too many women remain ignorant about their own genitals . . . and the abundance of myths, rumors, and misconceptions floating around certainly doesn’t help. Consider the following:

• MYTH: The vagina is sterile, requiring special cleaning methods to keep it that way. FACT: The vagina is not at all sterile, but is host to a multitude of various types of bacteria, which together comprise the vaginal flora that promotes vaginal health. The composition of this flora changes with age, stress, hormone levels, diet, antibiotics, and sexual activity, and is best managed by taking probiotics, so talk to your healthcare provider or to a nutritionist for details and recommendations. As for cleaning the vagina, it is self-cleaning! Meaning, there is no need to douche or do anything else, unless otherwise instructed by a healthcare provider.
• MYTH: Things can get lost inside the vagina. For some reason, there remains a perception among some women that the vagina is a long, continuous canal that starts at the genitals and continues deep into the body. So, it’s not surprising that women often ask us if anything—a tampon, say—can “get lost” up there. FACT: The vagina is...