The Gynae Geek: Your no-nonsense guide to ‘down there’ healthcare. Dr Mitra Anita

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       Clitoris and clitoral hood Your clitoris is shaped like the wishbone of a chicken. The clitoral head, about the size of a small pea, is the visible part of the clitoris, but is, in fact, just the tip of the iceberg, because extending down either side underneath the skin are two arms, each about 5–7cm long. The clitoris is made of the same kind of spongy tissue that is found in the centre of a penis, which fills with blood to produce an erection, and the same thing happens to the clitoris during arousal. The clitoral head has the same embryological origin as the head of the penis but contains about two to three times as many nerves, and might explain why it doesn’t need to be pressed like a doorbell with a dead battery, which many men don’t realise. The sensitive nature is also the reason that there is a fold of skin usually covering it, called the clitoral hood.

       Urethral opening The urethra is the tube that empties urine from the bladder. It’s much shorter in women, at only about 5cm, compared to 20cm in men, which is why women are more likely to get urinary tract infections (UTIs). This is also the reason why you should wipe front to back after using the toilet, and urinate after sex in order to avoid helping the spread of bacteria into the urethra and up into the bladder. Some women may be able to see their urethral opening, while others cannot, and that’s because it can be quite high up, sometimes even almost inside the vagina. I’ve seen many a medical student try to put a catheter into the clitoris, but it’s always the boys who blush the most when I politely redirect them to the urethra!

       Periurethral/Skene’s glands I’ve often been asked at parties by overexcited men about female ejaculation. Well, these are the glands that are responsible for this phenomenon, and they are the female version of the prostate gland. The fluid they make is thought to offer some protection against the bugs that cause UTIs. Infrequently, they can get blocked and swell up, causing a cyst, which can sometimes be confused with a vaginal-wall prolapse.

       Vagina This refers to the muscular tube inside that goes from your vaginal opening on the outside, up to the cervix. Your vagina cannot be seen from the outside (hence the inaccuracy of the question: ‘Does my vagina look normal?’), and at about 7–9cm long, it has an amazing degree of elasticity and can expand in all directions – enough to allow for the birth of a baby. Its expansive nature also means it can also accommodate many a foreign object.Possibly the most unusual thing I’ve ever removed from someone’s vagina was a disco ball. Not a massive one from the ceiling of a 70s club, but one that was golf-ball-sized and originally belonged on a key chain. It was 7 a.m., and the end of a particularly harrowing night shift in A&E, but having been told that the offending object was a key ring, I thought it would be a quick job. Then the triage nurse casually added: ‘Oh, by the way, Doc, the key ring itself has snapped off and it’s just the disco ball left inside now …’ Needless to say, it certainly was a challenge, largely due to the fact that your vagina can make a pretty impressive vacuum, but I got it out in the end. If the owner of said disco ball is reading this, I just want to say how much I still feel your pain and embarrassment to this very day.

       Labia majora These are the larger, skin-covered outer lips of the vulva. The skin here is usually darker than the rest of the surrounding skin and has a fatty layer underneath that plays a protective role.

       Labia minora These are the inner, more fleshy-looking lips, that are usually quite red or pink and probably what cause the most concern with regards to what’s ‘normal’. Most women’s labia minora will be visible below the labia majora and it’s common for them to be asymmetrical. The average size ranges from 2–10cm in length and 1–5cm in width1 and consequently the appearance of the labia minora varies significantly from one woman to the next. It’s kind of ironic how teenage boys (and let’s be honest, most immature men) boast about the size of their penis, yet women are expected to have neat, tucked-in labia that never see the light of day. Why is this? Because they originate from the same embryological structure. It is normal for them to seem to enlarge slightly with age due to loss of collagen and oestrogen, both of which support the structure of the tissue.

       Perineum This is the area between the back of the vaginal opening and the anus.

       Pelvic-floor muscles Your pelvic floor is underneath the skin of the perineum and is made up of several muscles and pieces of connective tissue that act as a sling to hold your insides in. Pelvic-floor weakness can lead to prolapse of the vaginal walls, bladder, urethra or the uterus. A lot of people think you can only get a prolapse if you’ve had a baby, or if you’ve had a vaginal delivery, during which these muscles may tear or be cut to facilitate delivery. However, this is not the case, and it can happen to anyone – regardless of whether they’ve only ever had C-sections, or even if they’ve never had a baby. The pelvic-floor muscles also help you to maintain control of your bladder and bowel.