Anatomy and Function of the Vagina and Pelvic Muscles, Part 1 The-Clitoris.

com Jump to Functions of the Vagina Jump to Anatomy of Vagina Jump to Nerves of Vagina and Pelvis Jump to Blood Supply of Vagina Jump to Developmental Anomalies Jump to The Protective Vaginal Environment Jump to Vaginal and Vulvar Fluids Jump to Normal Vaginal and Vulvar Fluids Photographs! Jump to Sensitivity to Se"ual Stimulation #o to $o% to Se"ually Stimulate the Vagina &ntroduction This article primarily addresses the internal female reproductive organs' if you %ant to learn more a(out the e"ternal female genital organs please see the articles a(out the vulva and locating the vagina) *are of the vagina is addressed in the article a(out hygiene' and vaginal infections are addressed in the article a(out vaginitis) &t is important to note that %hen you read through medical references and +ournals you ,uic-ly (ecome a%are of the fact that there is still a lot %e don.t -no% a(out normal female se"ual and reproductive anatomy and function' and there is some degree of de(ate %ithin the medical community concerning these su(+ects) Very little is %ritten in stone' and the enormous amount of normal diversity may prevent any concise conclusions) /ost %omen pro(a(ly need to -no% %hat is normal for them' and go from there' rather than loo-ing to their peers for e"amples of normalcy) &f you start out not -no%ing %hat is normal for you' it (ecomes more difficult to -no% %hat is a(normal' and potential causes for it) Starting in childhood' girls should (e encouraged to e"plore their (ody so they -no% %hat is normal for them) As they near and progress through pu(erty they need to (e fully a%are of the changes that occur' and also that their peers are e"periencing the same or similar changes) As they (egin e"ploring partnered se" and e"periencing the changes associated %ith reproduction and aging they may then -no% more clearly %hen things have changed' and %hen things are no longer normal) #irls and %omen should (e encouraged to 0play doctor0 on a regular (asis) 1omen at least 23 years of age may %ant to start a photographic record of %hat their healthy vulva and vagina loo- li-e' for future reference) 4! Then if concerns should arise' they can sho% their doctor ho% things %ere in the past compared to the present) Functions of the Vagina The vagina is an e"tremely elastic multipurpose muscular passage that e"tends (et%een the vesti(ule' %hich is part of the vulva' and the cervi"' %hich forms the lo%er portion of the uterus) The normal functions of the vagina include5

*onducting normal vaginal and cervical fluids out of the (ody during the entire menstrual cycle' (eginning at pu(erty and e"tending to menopause) *reating an environment that helps protect the internal reproductive organs from disease) Acting as a conduit through %hich menses passes out of the (ody during a %oman.s menstrual period) Producing vaginal lu(rication during se"ual arousal' despite not having any type of glands) /otivating %omen (y means of a vaginal ache to see- out vaginal penetration during se"ual arousal6 com(ined %ith se"ual desire this potentially motivates %omen to reproduce' to engage in partnered se") Serving as a passage out of the (ody for a (a(y during vaginal delivery) Providing a doctor %ith access to the cervi" and internal reproductive organs during a gynecological e"am' so they may perform a PAP test and (imanual e"amination) Producing varying degrees of pleasure for %omen during their se"ual activities' alone and %ith a partner6 potentially providing re%ard for engaging in a reproductive activity) &f a %oman has male se"ual partners' acting as a potential receptacle for fingers' dildos' other se" toys' a penis' and possi(ly male e+aculate during vaginal intercourse) &f a %oman has female se"ual partners' acting as a potential receptacle for fingers' dildos' other se" toys' and a dildo in a harness during vaginal intercourse)

Anatomy of Vagina The normal appearance of the vagina and pelvic muscles are most often misrepresented in illustrations in anatomy and se"uality pu(lications' as the images are (ased on e"aminations of the (ody conducted after death' and medical artists usually have to distort their appearance for reasons of visual clarity) The resulting images most often portray the vagina as an open cavity %ithin the (ody' %hich is definitely not the case) This false presentation is sometimes a source of confusion for young %omen trying to e"plore and discover their (ody' and couples e"ploring partnered se") The follo%ing photographs reveal ho% the vulva and vaginal orifice normally loofor one %oman) /ore e"amples are availa(le in the articles a(out locating the vagina and the hymen)

The vagina.s e"ternal orifice is located %ithin the vesti(ule of the vulva' %hich is the area situated (et%een the inner la(ia) The vesti(ule' highlighted in the follo%ing illustration' is also the location of the urethral orifice' Bartholin.s and vesti(ular glands' and hymen) As indicated in the photographs sho%n a(ove' the vesti(ule and vaginal and urethral orifices aren.t al%ays as clearly evident and defined as indicated in this illustration) The color of the mucosal tissue of the vesti(ule changes during pu(erty' from reddish to a dull pin-' %hile also (ecoming softer in appearance' and the tissues more fle"i(le6 estrogen deficiency and menopause may reverse these changes) 7!

From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany) The vesti(ule and vulva are not flat' nor do they all appear the same %hen e"amined) &n the follo%ing illustration' the vulva on the right depicts %hat Dr) Dic-inson (elieved represented an 0average0 vesti(ule6 orientated %ith a %oman lying on her (ac- %ith legs straight) <(serve ho% the urethral orifices' la(eled 0meatus'0 are each in a different location in relation to the vaginal orifice) The urethral orifice on the left appears to (e located %ithin the vaginal orifice' %hereas the one on the right is clearly separated from it) This %ill influence not only the urine stream' (ut also %here a %oman %ill find her urethral orifice %hen she desires to locate it) This may e"plain %hy some %omen (elieve they urinate and e+aculate through their vaginal orifice rather than their urethra) =rine may flo% out of the vaginal orifice if there is a vaginal fistula' %hich is an a(normal passage (et%een the vagina and urethra' (ladder' or rectum)

*olor *ode5 *litoral #lans > Blue' Pu(ic Bone > ?ello%' $ymen > #reen' Vagina > 8ed) From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany) 8elated &llustration ; Te"t ! Something that is very important to note is' %hen a %oman is standing or sitting upright her vulva and vesti(ule are parallel to the ground) 1hen she is on her hands and -nees her vulva is vertical' and %hile lying on her (ac- the angle depends on the inclination of her hips) The follo%ing illustrations provide some indication of the various angles at %hich the vagina is positioned %ithin the pelvis %hen a %oman is laying her (ac- %ith her legs and hips elevated at different heights) The resulting inclination of the vagina %ill determine at %hat angle and direction fingers' tampons' penises' and other o(+ects must (e positioned to (e successfully inserted) &ncorrect placement of the o(+ect can cause in+ury to the vulva and hymen) These four illustrations also demonstrate ho% the depth of the vesti(ule and vulva varies from %oman to %oman' %hich influences the apparent depth of the vagina %hen o(+ects are inserted)

*olor *ode5 *litoral #lans > Blue' Pu(ic Bone > ?ello%' $ymen > #reen' Vagina > 8ed) From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany)

Belo%' & have rotated one of the illustrations sho%n a(ove to provide an indication of the angle of the vagina %hen a %oman is on her hands and -nees' as some couples have e"perienced difficulty %ith rear entry se"ual positions' even if they have (een successful in the missionary position) This illustration demonstrates %hy the penis must (e angled up to%ards the small of a %oman.s (ac-' and enter from (elo%' %hen a %oman is entered from (ehind)

*olor *ode5 Pu(ic Bone > ?ello%' $ymen > #reen' Vagina > 8ed) From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany) This illustration demonstrates the angle of the vagina %hen a %oman is standing' %hich is a position sometimes recommended %hen inserting a tampon6 if you raise one leg then your vulva %ill tilt up%ard' changing the angle of your vagina)

*olor *ode5 Pu(ic Bone > ?ello%' $ymen > #reen' Vagina > 8ed) From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany)

The vaginal orifice is maintained in a normally closed position (y the pelvic muscles' %hich are highlighted in the follo%ing illustration) =nli-e the urethral orifice and anus' the vaginal orifice does not form a %atertight seal' %hich results in (ody fluids flo%ing freely from the vagina' if they are of sufficient ,uantity) The urethra and anus each have a sphincter' the vagina does not) This means %omen don.t have voluntary control over the release of their vaginal fluids' %hich can (e a cause for emotional distress %hen they are in large ,uantities or occur at seemingly inappropriate times)

*opyright 2:32' The Federation of Feminist 1omen.s $ealth *enters) &llustrated By5 Su@ann #age' 9 Ac' 8N*' NP The follo%ing /8& image and illustration demonstrate ho% the superficial female se"ual and reproductive organs are normally located in very close pro"imity to one another' %ithout any open cavities or voids) 1hen an o(+ect enters the vagina it %ill most li-ely place pressure on the surrounding structures' including the urethra and erectile (ul(s of the clitoris)

The Journal of =rology' Volume 2A:' 23:B>23:C' June 2::3) $elen E) <.*onnel' John /) $utson' *olin 8) Anderson' and 8o(ert J) Plenter

The follo%ing illustrations demonstrate ho% the mid>vagina is normally in the shape of an $) <(serve ho% close the organs are together' anytime something enters the vagina' regardless of si@e' the (ody must ma-e room for it) &f the ad+acent (ladder or rectum are storing %aste li,uid and material this may influence a %oman.s a(ility to insert o(+ects into her vagina' and the physical sensations e"perienced %hile doing so)

From the (oo- 0Eve.s Secrets0 Page 22D) Author5 Josephine 9o%ndes Sevely)

This is an internal vie% loo-ing do%n to%ard the vulva and anus) The pu(ic (ones are at the top of the image' the tail(one coccy"! is at the (ottom) *linically <riented Anatomy5 Fifth Edition) *opyright BDD4 9ippincott 1illiams ; 1il-ins) *ontinued > Part B 8eferences Notes Anatomy and Function of the Vagina and Pelvic Muscles, Part 2

>

A A EA Bac- to Part 2

Jump to Functions of the Vagina Jump to Anatomy of Vagina Jump to Nerves of Vagina and Pelvis Jump to Blood Supply of Vagina Jump to Developmental Anomalies Jump to The Protective Vaginal Environment Jump to Vaginal and Vulvar Fluids Jump to Normal Vaginal and Vulvar Fluids Photographs! Jump to Sensitivity to Se"ual Stimulation #o to $o% to Se"ually Stimulate the Vagina The follo%ing illustration reveals the deep pelvic muscles' (ut also incorrectly sho%s the vagina as an open cavity %ithin the (ody' partly as a result of (eing (ased on human dissections) F! During life' the pelvic muscles are al%ays under a slight amount of tension' %hich is necessary to hold the contents of the pelvis in place' as other%ise they %ould (e forced out (y gravity) This normal tension' called resting or (asal tone' holds the vagina closed e"cept %hen something is inserted) &f these muscles are too tight' inserting o(+ects into the vagina may (e painful or impossi(le) &f they are in+ured or %ea-' then incontinence or prolapse photographs of prolapse! are a possi(ility) This is %hy it is very important for the pelvic muscles to (e strong yet fle"i(le) *ontrary to common fol-lore' a tight vagina' re,uiring the presence of tense pelvic muscles' isn.t normal or healthy)

From the (oo- A New View of a Woman's Body) *opyright 2:32' The Federation of Feminist 1omen.s $ealth *enters) &llustrated By5 Su@ann #age' 9 Ac' 8N*' NP

The follo%ing illustrations reveal the typical placement and alignment of the vagina and uterus %ithin the (ody' and %hat happens to their alignment %hen the pelvic muscles (ecome %ea-6 the pelvic muscles have (een highlighted in red) F! Also note ho% the vagina normally doesn.t follo% a straight line into the (ody' %hich is something important to (e a%are of %hen inserting rigid o(+ects) /8& images sho%n farther do%n on the page also reveal this internal alignment) &n BDG of %omen the uterus is normally tilted to the rear rather than the front or straight up' %hich you can learn more a(out here and here)

Female Pelvic Floor Anatomy5 The Pelvic Floor' Supporting Structures' and Pelvic <rgans' Sender $erschorn' /D' F8*S*) Please See Note F! Beyond the pelvic muscles' the vagina' uterus' and other pelvic organs are held in place (y several supporting structures) These features are commonly left out of anatomy illustrations for reasons of visual clarity' (ut give the false impression the organs simply float %ithin the pelvis) The follo%ing illustration provides an indication of ho% comple" and e"tensive these supporting structures are) The orientation of this illustration may (e a (it confusing5 picture a %oman standing' the vulva is at the (ottom' the tail (one is to the left' and the pu(ic (one is to the right) 1hile the presented shape of the vagina' at three different locations' aren.t completely accurate' they do demonstrate ho% the supporting structures influence the shape of the vagina at these locations)

*ontemporary Vie%s on Female Pelvic Anatomy) By /atthe% D) Bar(er /D) To see image more clearly' do%nload PDF file) &nside the pelvic cavity' the vagina merges %ith the cervi") Since the cervi" is made up of a different type of tissue than the uterus it is considered an entirely separate organ)H2I &n a %ay' the

cervi" forms the e"ternal orifice for some of the internal female reproductive organs the uterus' fallopian tu(es' and ovaries!) The cervi" must act as a (arrier to the outside %orld (ecause o(+ects and microscopic organisms can enter into the vagina relatively easily' %hich %ould place the uterus and a developing fetus at ris- of infection if it did not) This is also %hy the vagina has an ela(orate system of defenses that help protect against un%anted invasions' %hile still allo%ing one e"tremely important invasion6 more on that later) &t is the cervi" that must create a physical (arrier that %ill -eep harmful organisms out of the internal pelvic organs' or a pelvic infection P&D! is a possi(ility) /enstruation serves to help protect the uterus and internal reproductive organs from infection (y periodically shedding its lining' (ecause if sperm can at times enter the uterus through the cervi" so might other organisms) 2! The vagina increases in si@e a (it at its +unction %ith the cervi"' (ut is still a collapsed potential space) The cervi" pro+ects do%n into the vagina6 envision a tennis (all inserted into a soc-) The area (et%een the cervi" and vaginal %all is called a forni") There are the anterior front!' posterior (ac-!' and lateral side! fornices' %ith the posterior forni" (eing the largest potential space) The follo%ing illustration sho%s the anterior and posterior fornices' and demonstrates ho% this causes the front %all of the vagina to (e slightly shorter than the rear %all' (y a(out 2JB inch 2)BF cm! on average)HBI

*linically <riented Anatomy5 Fifth Edition) *opyright BDD4 9ippincott 1illiams ; 1il-ins) 1hen not se"ually aroused' the front %all of the vagina is a(out F inches C)4 cm! on average in length' %ith a range of B)F to F)C inches A)3 to :)F cm!' and the rear %all is a(out F)A inches 3)3 cm! in length on average' %ith a range of B)3 to 7)B inches C)2 to 2D)4 cm!) The %idth of the vagina is 2)7 inches F)7 cm! on average' %ith a range of D)3 to B)D inches B)2 to A)D cm!)HBI This length does not ta-e into account the depth of the vulva' %hich is the distance (et%een the outer la(ia and vaginal orifice' commonly called the introitus or vesti(ule' and depicted in the illustrations sho%n a(ove) The depth of the introitus is a(out 2 inch B)4 cm! on average' ranging from AJ3 to 2 FJ7 inches 2)A to 7)4 cm!)HFI This means on average' the vulva and vagina can receive o(+ects 7 to 7)A inches in length' depending on %hether the o(+ect enters the anterior or posterior vaginal forni") &t also means the average penis' having a length of A)2 to A): inches 2B): to 27): cm!' is sufficiently long to fill the length of the vagina)H7I During se"ual arousal' the vagina is reported to lengthen (y up to a(out ADG B!' resulting in a length of perhaps 7 2JB inches 22)7 cm!) This last o(servation is de(ata(le' as a study performed in 2::2 using /8& found only the front %all of the vagina increased in length' and then only (y 2 cm D)7 inches!) The uterus. position 0hardly changed)0

indicating it is unli-ely the vagina increases much in length during se"ual arousal)HAI The vagina may stretch under pressure' %hen an o(+ect is inserted' (ut it doesn.t appear to do much of this on its o%n) The follo%ing /8& images demonstrate the potential space created (y the vaginal fornices) The first image sho%s the normal resting position of the vagina' cervi"' uterus' and (ladder) &n the second image' a li,uid gel has (een in+ected into the vagina to aid in creating a medical diagnosis' (ut in the process demonstrates the shape and elasticity of the upper vagina and the area surrounding the cervi") This is important to note' as it helps illustrate %here a tampon or a penis should (e positioned if they are to fit comforta(ly and fully %ithin the vagina) &f o(+ects are angled incorrectly %hen inserted they may hit against the cervi" rather then entering into the vagina fully)

*olor *ode5 Bladder > Blue' Pu(ic Bone > ?ello%' =terus > Purple' *ervi" > Teal' Vagina > 8edJPin-) /8& of the Female Pelvis =sing Vaginal #el' /ichKle A) Bro%n2' 8o(ert F) /attrey' Stephan Stamato and *laude B) Sirlin) &n the follo%ing /8& images o(serve ho% large the (ladder' highlighted in (lue' has (ecome in the image on the right' and ho% this has altered the position of the uterus and vagina) This change in si@e is the result of increased urine (eing stored %ithin the (ladder' as the (ladder is much li-e a (alloon that re,uires internal out%ard pressure for it to e"pand) This pressure and resulting movement of the internal organs may in part e"plain %hy a full (ladder alters a %oman.s se"ual e"periences' and may even trigger physical se"ual arousal) The original reference does not comment on the significance of the increased si@e of the (ladder)!

*olor *ode5 Bladder > Blue' Pu(ic Bone > ?ello%' =terus > Purple' Vagina > #reen) /agnetic resonance imaging of male and female genitals during coitus and female se"ual arousal' 1illi(rord 1ei+mar Schult@' Pe- van Andel' &da Sa(elis' Eduard /ooyaart The follo%ing images reveal the position of the erect penis during vaginal intercourse' %hen couples are in the missionary position) The tip of the penis is positioned in the posterior forni") Some %omen find it pleasura(le %hen the penis and other o(+ects press or (ump into the cervi" during se"ual activities' others find it uncomforta(le or painful) The cause of these different e"periences is un-no%n' (ut one potential cause of pain is endometriosis)

/idsagittal image of the anatomy of se"ual intercourse e"periment 2B!) PLpenis' =rLurethra' PeLperineum' =Luterus' SLsymphysis' BL(ladder' &Lintestine' 9ALlum(ar A' ScLscrotum) /agnetic resonance imaging of male and female genitals during coitus and female se"ual arousal' 1illi(rord 1ei+mar Schult@' Pe- van Andel' &da Sa(elis' Eduard /ooyaart The follo%ing photographs reveal %hat the inside of the vagina loo-s li-e %hen vie%ed through a speculum) As you can see' there are many (umps and ridges' %hich are called rugae) This irregular surface may cause concern %hen %omen e"plore their vagina for the first time' as the vagina is often portrayed as a perfectly smooth tu(e) From the time a girl is a fe% %ee- old infant until she e"periences the onset of pu(erty her vagina loo-s and functions much differently than sho%n here) 7!

From the (oo- A Ne% Vie% of a 1oman.s Body) *opyright 2:32' The Federation of Feminist 1omen.s $ealth *enters The follo%ing photograph reveals %hat the vaginal %all loo-s li-e %hen vie%ed straight on' %hich isn.t normally possi(le) This accordion li-e appearance is the result of the vagina.s a(ility to stretch sufficiently to allo% an erect penis or full term infant to enter)

http5JJli(rary)med)utah)eduJ1e(PathJFE/$T/9JFE/D37l The %all of the vagina is comprised of three layers of tissue5 The inner most mucosal or mucus layer is made up of the same tissue as the inside of your mouth' non-eratini@ed stratified s,uamous epithelium) These s-in cells are sensitive to the hormonal changes of the menstrual cycle' namely the hormone estrogen)H4I Despite (eing a mucus mem(rane there are no glands inside the vagina that produce mucus secretions) Normal vaginal moisture 0percolates0 through the epithelium from the a(undant (lood vessels present in the underlying tissue lamina propria!) During the reproductive years' the normal vaginal environment is 0+ust moist0 rather than producing a steady volume of fluid) There is a slight amount of fluid that seeps from the vagina in varying amounts throughout the menstrual cycle6 this topic is addressed in the article a(out hygiene)H4I The vagina also rea(sor(s some of the moisture present)H4I The normal or (asal level of moisture present in the vagina isn.t commonly sufficient to facilitate se"ual intercourse) During se"ual arousal' transudate and cervical mucus form tiny 0(ead>li-e droplets0 that slo%ly' or not so slo%ly' pool together coating the vaginal canal' and most often the vesti(ule and (eyond)H4I 0The smooth' slippery ,uality of the formed fluid is pro(a(ly due to its pic- up of sialoproteins coating the vaginal epithelium from the cervical secretion)0H4I

http5JJ%%%)siumed)eduJMd-ingBJergJ8EDAF()htm The middle' muscular or muscularis layer' of the vagina is comprised of t%o separate layers of smooth muscle' an outer longitudinal length%ise! and an inner circular donut shaped! layer) 1omen don.t have voluntary control over these muscles) They are normally under a small amount of tension' and active throughout the menstrual cycle' (ut especially during the onset of menstruation' though %omen generally aren.t a%are of this' e"cept %hen it (ecomes painful dysmenorrheic pain!)H4I At this time' & don.t (elieve %e -no% ho% these involuntary muscles

function during intercourse and other se"ual activities) &nvoluntary contraction of these muscles may cause pain and prevent vaginal penetration' resulting in a condition called vaginismus) The outer elastic layer of the vagina provides structural support)H4I The follo%ing photograph illustrates ho% the female prostate gland' commonly called the #> Spot' may pro+ect into the vaginal canal6 this may not (e a 0typical0 e"ample) &t isn.t unusual for there to (e a raised ridge or area of firmness along the front or top %all of the vagina that may produce pleasure and female e+aculation %hen stimulated during se"ual activity) This feature is more pronounced in some %omen than others) &t is possi(le for this s%elling to (e indicative of infection' if associated %ith additional signs of infection) &n this e"ample' you can see evidence of the underlying individual ducts that ma-e up the prostate gland' though they empty into the urethra and possi(ly the vulva rather than the vagina)

The follo%ing illustration demonstrates ho% the urethra may pro+ect noticea(ly into the vaginal canal) &t isn.t -no%n if this illustration is (ased on an actual %oman' or meant to graphically illustrate ho% the urethra lies %ithin the vaginal %all of all %omen' even though the t%o organs are usually sho%n as completely separate and isolated) A! This illustration could sho% %hat the inside of the vagina loo-ed li-e in the e"ample discussed and illustrated a(ove' %here the urethral orifice appears to (e %ithin the vaginal orifice) Stimulation of the top or front %all of the vagina %ill most li-ely stimulate the female urethra and prostate gland' and this is li-ely %hy the ma+ority of %omen have said vaginal stimulation results in an urge or desire to urinate' at varying degrees of fre,uency and intensity during their se"ual activities)

*linically <riented Anatomy5 Fifth Edition) *opyright BDD4 9ippincott 1illiams ; 1il-ins) The follo%ing illustration gives you an idea of ho% much the vulva and vagina can dilate to allo% the passage of an infant during child(irth) The (lac- outline indicates the location of the pelvic (ones that form the (irth canal) &f the (irth canal is found to (e too small for vaginal delivery' necessitating a *aesarian section' it is (ecause the pelvic (ones are positioned too close together for the si@e of the (a(y.s head' not (ecause the vagina is too small)H2I This illustration' and one sho%n a(ove' allo% us to see ho% the vagina must stretch in the direction of the anus %hen o(+ects are inserted' or pass through it) Stretching or pressing the vagina in the direction of the pu(ic (ones is li-ely to crush the urethra' prostate gland' and other soft tissues in the area' causing pain and possi(le in+ury)

From the (oo- Atlas of Human Sex Anatomy (y 8o(ert 9atou Dic-inson /)D)' F)A)*)S)) *opyright 2:7: The 1illiams ; 1il-ins *ompany)

*ontinued > Part F 8eferences Notes natomy and Function of the Vagina and Pelvic Muscles, Part 3
>

A A EA Bac- to Part B

Jump to Functions of the Vagina Jump to Anatomy of Vagina Jump to Nerves of Vagina and Pelvis Jump to Blood Supply of Vagina Jump to Developmental Anomalies Jump to The Protective Vaginal Environment Jump to Vaginal and Vulvar Fluids Jump to Normal Vaginal and Vulvar Fluids Photographs! Jump to Sensitivity to Se"ual Stimulation #o to $o% to Se"ually Stimulate the Vagina Nerves of Vagina and Pelvis The vagina doesn.t share the same nervous system throughout' as indicated in the follo%ing illustrations) The outer one>third of the vagina is part of the somatic nervous system %hile the inner t%o>thirds is part of the autonomic nervous system' and there is a region %here the t%o nervous systems are intermi"ed) This means the outer vagina is sensitive to the full range of sensations' (ut the inner vagina is sensitive primarily to pressure and pain) The most comple" area of innervation is li-ely that of the female prostate' as the nerves for the vagina' prostate' and urethra are potentially intermingled' (ut at a minimum are in very close pro"imity) This is perhaps %hy 4F percent of %omen have indicated the front %all of their vagina is the most sensitive to stimulation) *hild(irth' pelvic surgery' and trauma to the clitoris and vulva may adversely affect se"ual sensitivity and sensation)

*linically <riented Anatomy5 Fifth Edition) *opyright BDD4 9ippincott 1illiams ; 1il-ins) The area highlighted in tan vulva' anus' outer vagina! is supplied (y the somatic nervous system' the areas highlighted in green and yello% internal organs! are part of the autonomic nervous system)

*linically <riented Anatomy5 Fifth Edition) *opyright BDD4 9ippincott 1illiams ; 1il-ins) The vaginal nerves indicated in green are sensitive to the full range of sensation' those in orange are primarily sensitive to pressure and pain) The location of diseases and in+uries affecting the nervous system %ill determine %hich organs retain sensitivity' and the type of sensations possi(le in those areas' though individual e"periences do vary) Blood Supply of Vagina The (lood supply to the vagina' pelvic organs' and vulva is e"tremely important to female se"ual arousal and pleasure) 1ithout ade,uate (lood flo% vaginal lu(rication may (e insufficient and vaginal and vulvar sensitivity decreased) All forms of vascular disease' including cardiovascular disease' are li-ely to adversely influence female se"ual function) Pelvic surgery' including hysterectomy' may alter (lood flo% to the pelvic and se"ual organs) #ood general health is essential to good se"ual health and performance)

1i-ipedia5 Vaginal Artery) Additional illustrations Female Se"ual Anatomy) *ontinued > Part 7 8eferences Notes Anatomy and Function of the Vagina and Pelvic Muscles, Part 4
>

A A EA Bac- to Part F

Jump to Functions of the Vagina Jump to Anatomy of Vagina Jump to Nerves of Vagina and Pelvis Jump to Blood Supply of Vagina Jump to Developmental Anomalies Jump to The Protective Vaginal Environment Jump to Vaginal and Vulvar Fluids Jump to Normal Vaginal and Vulvar Fluids Photographs! Jump to Sensitivity to Se"ual Stimulation #o to $o% to Se"ually Stimulate the Vagina Developmental Anomalies The manner in %hich the internal female reproductive organs form during fetal development may result in some structural a(normalities that alter the appearance and function of the vagina5

There may (e a complete a(sence of a vagina) A longitudinal vaginal septum may form resulting in the appearance of t%o vaginas located side>(y>side)

A transverse vaginal septum may form resulting in a partial or complete (loc-age of the vagina' perhaps giving the appearance of a short vagina) This may prevent menses from e"iting the (ody' resulting in a(dominal menstrual discomfort (ut no menstrual discharge) The Protective Vaginal Environment

&t may surprise you to -no% there is a vi(rant and essential ecosystem %ithin the vagina that helps protect %omen from disease) During early childhood' from the age of a fe% months until the age of eight to thirteen' the vaginal environment is relatively dormant' (ut %ith the onset of pu(erty that ,uic-ly changes) 7! The reason (eing' %ith pu(erty comes the desire to reproduce' to participate in partnered se"' %hich e"poses a %oman.s vagina to (ody fluids and living organisms from her se"ual partner s!) The onset of menstrual (leeding during pu(erty may also provide a food source for potentially harmful organisms) <ur internal (ody' (elo% the surface of the s-in' has defenses against harmful invasions that cause disease' (ut it is much safer if the potentially harmful organisms are -ept totally outside of the (ody' and this is the reason for the protective vaginal environment) The vaginal and vulvar environment creates greater ris- for %omen than men %hen it comes to se"ually transmitted diseases' especially compared to uncircumcised men) C! The reason (eing' during vaginal intercourse' if (arriers to the transfer of (ody fluids aren.t used' namely condoms and other safe se" practices' then (ody fluids smegma and e+aculate! and s-in cells from the (ody and penis' if her partners are male' and (ody fluids vaginal and vulvar! and s-in cell from the (ody and vulva' if her partners are female' are potentially deposited %ithin the vagina) The vagina is a dar-' %arm' and moist environment that is suita(le for microscopic organisms to live' and more importantly' reproduce and coloni@e) An army of one (acterium isn.t much of a ha@ard' an army of trillions is) To %ard off this invasion' the vagina develops a defensive army of it o%n' an army of (eneficial (acteria) &n the case of the vagina' 0clean and sterile0 is a(solutely not of (enefit) The last thing a %oman should do' or feel compelled to do' is clean her vagina' as this is potentially harmful to her and her vagina)

To see an animation sho%ing the cycle of the vaginal ecosystem please clic- here) Animation is B)F mega(ytes in si@e) The vaginal environment is normally acidic' (ut the level of acidity varies throughout the menstrual cycle5

0Vaginal p$ varies a lot during the cycle too) At the start of menstrual flo%' the p$ is already increased' pea-ing at around C)D) The p$ then drops sharply to (et%een 7)D and 7)A over the ne"t three days and remains constant until day B2' although it may rise slightly %ith ovulation) Bacterial populations sho% great variations during the menstrual cycle6 as %ould (e e"pected' they are highest in the menstrual flo%' possi(ly (ecause menstrual (lood acts as source of nutrition' or (ecause of the rising p$ associated %ith menstrual (lood)0 H2I The normally acidic vaginal environment is potentially harmful to organisms that enter the vagina' including sperm' %hich could pose a (arrier to reproduction) To the healthy vagina and (ody' sperm are seen as a potentially harmful invader' as they are a living organism %ith DNA different from your o%n) To help overcome this' during se"ual arousal the vaginal lu(ricant reduces the acidic level of the vagina' allo%ing sperm to survive as they travel through the vagina)H2I 1omen %ho e"perience se"ual arousal on a fre,uent (asis may have a less acidic vaginal environment than those %ho do not' (ecause the vagina doesn.t have time to return to a more acidic state (et%een periods of arousal' %hich /A? e"pose %omen to increased ris- for infection) 0&t can ta-e up to eight hours after intercourse for the p$ to return to normal6 %omen %ho are very se"ually active rarely possess a vaginal (acterial population characteristic of lo% 7)A! p$)0H2I Becoming se"ually aroused a hundred times a day or engaging in partnered se" e,ually as often &S N<T a pro(lem' AS 9<N# AS you don.t e"pose yourself to disease in the process) Fre,uent se"ual arousal' something you li-ely have no control over' isn.t harmful' nor is fre,uent partnered se" %ith the same healthy partner' nor is mastur(ation) The increased ris- results from e"posure to pathogens) The greater the num(er of se"ual partners' the greater the chances you %ill (e e"posed to disease) This is %hy it is important to limit the num(er of se"ual partners you have' and to (e sure your partner' and o(+ects that you insert into the vagina' are clean and disease free) Pathogens are microscopic' meaning you can.t tell (y loo-ing %hether your se"ual partner has them) *ondoms are a must' even if you are using another form of (irth control) *ondoms should (e used (ecause male e+aculate also reduces the acidity of the vagina' potentially increasing the chances for a vaginal infection follo%ing intercourse) ?ou should also use reasona(le care %hen mastur(ating' (y -eeping o(+ects you insert into your vagina clean) Notes5 Soap is potentially harmful to the vagina and vulva' %hen you use soap to %ash your hands and o(+ects you insert into your vagina' (e sure to rinse them thoroughly %ith clean %ater) Don.t use soap on the vulva or in the vagina' only rinse the vulva %ith clean %ater5 the vagina cares for itself) The vagina may (e a(raded' scratched' or cut %hen inserting a tampon applicator or during normal se"ual activity' alone and %ith a partner' %hich may allo% the (ody to (e invaded (y potentially harmful organisms) To"ic Shoc- Syndrome is an e"ample of %hen the (ody.s defenses are una(le to %ard off an invading organism inside the vagina) The in+ury doesn.t cause the infection' rather it allo%s pathogens to more easily enter the (ody' &F they are present) /any

potentially harmful organisms are normally found inside the vagina' (ut a healthy vaginal environment helps -eep them from (ecoming sufficient in num(er to cause harm) 1hen the protective vaginal environment is out of (alance' (acterial vaginosis BV! may result) Symptoms of BV include a(normal discharge' odor' pain' itching' or (urning) BV is the most common gynecological complaint) Vaginal and Vulvar Fluids There are several (ody fluids that may appear at the vesti(ule' especially %ith the onset of pu(erty' though some vaginal fluids are present throughout life) During the reproductive years the amount of fluid is normally increased' though the amount is dependent on medications and (irth control methods prescri(ed (y your doctor) Based on emails & receive' it appears some teens and young %omen are totally una%are of their normal daily vaginal fluids' at least until they engage in some ne% activity' li-e partnered se"' then fearing a negative conse,uence to that activity' they mista-e their normal vaginal fluids for an indication of disease) At the onset of pu(erty girls should (e made a%are of the normal cycle of these fluids' so they %ill have a (etter understanding of ho% their (ody normally %or-s' and %ont mista-e the normal for (eing a(normal) *ontri(utors to the vaginal and vulvar fluids H2I5

<il and s%eat from oil and s%eat glands of the vulva HSe(aceous glandsI Secretions from the speciali@ed vulvar glands called Bartholin.s and S-ene.s glands HFemale ProstateI /oisture that comes through the vaginal %alls called transudate! HVaginal lu(ricationI *ells shed from vaginal %alls /ucus from the cervi" Fluid from the Fallopian tu(es and uterus Products from the (acteria that live in the vagina Hslightly acidic fluid and %asteI Salt %ater physiologic HnormalI saline Hsalt containing %aterI that ma-es up most (odily fluids and mucus! HProstatic fluids' including prostate>specific antigen PSA! and mucusI H/enstrual fluid' mensesI

&ndications of normal vaginal fluids5 0Depending on the time of the menstrual cycle' secretions ma-e a clear' mil-y %hite' or faintly yello% discharge) Sometimes there is a stringy mucus) The discharge may (e some%hat slippery or clumpy) /ost %omen have small %hite or yello% stains on their under%ear' varying %ith their

menstrual cycles) Normal secretions also form small dry yello%>%hite fla-es or clumps in the pu(ic hair surrounding the vaginal opening) Some %omen have enough normal secretions to ma-e them feel %et all the time) 1hat if you never notice any dischargeN That.s normal too) ?our secretions pro(a(ly remain in the vagina %ithout appearing on the outside) 0The im ortant thin! is that normal secretions do not itch" #urn" or irritate. Normal secretions do not have a (ad odor' although secretions that stay on the under%ear may develop a slightly sour smell) Normal secretions do not contain any (lood' even in microscopic amounts) 0Some %omen complain of having too much vaginal discharge all the time' so heavy in fact that they feel they need to %ear sanitary pads or tampons throughout their cycle) First of all' it.s un%ise to %ear such protection continually' so please don.t) Seemingly e"cessive discharge can happen %hen there are mucus producing cells from the endocervical canal on the cervi"6 more mucus is produced' %hich in turn contri(utes to increased discharge) =nfortunately' %e do not have a good %ay to improve this annoying situation) &f cultures for herpes' chlamydia' and gonorrheaOorganisms that can infect the columnal epithelial cells of the cervical canalOare negative' if other parts of the evaluation sho% no a(normal findings' and if future pregnancy is desired' destroying the cells %ith heat or free@ing may eliminate the e"cess mucus' %hich can impair fertility) But if testing has sho%n that the mucus or discharge is normal' %omen of child(earing age %ho e"perience this pro(lem are (est advised to put up %ith the %etness)0 H2I See Ta(le 2 Amount of Vaginal Fluid Throughout /enstrual *ycle H2I5 Average5 2)4 grams per eight hour period 2 /a"imum5 Day 27 <vulation > 2):4 grams /inimum5 Days C and B4 > 2)7 grams gram e,uals 2J7 teaspoon! almost 2JB a teaspoon!

1omen on (irth control pills e"perience less change in the amount of fluid produced' as a result of the pill regulating their hormone levels) Normal Vaginal and Vulvar Fluids Sebum5 Produced (y the oil se(aceous! glands of the vulva) Note5 <il producing se(aceous glands are called Fordyce Spots %hen there is no associated hair follicle) They present as 0small 2>Amm!' slightly elevated yello%ish or %hite papules or spots that can appear on the glans or shaft of the penis' la(ia of the female' inside of the chee-s and on the lips)0 &f they appear on the penile glans then they also appear on the clitoral glans)

ormal Vaginal Fluid !Physiologic "eu#orrhea$ 5 Normal vaginalJvulvar fluid is descri(ed here and here' and during pu(erty and adolescence PDF!) Se%ual "ubrication5 &n greatly varying amounts

9eft =naroused > 8ight Se"ually Aroused) 1i-ipedia5 Vaginal 9u(rication

From &ervi%5

http5JJ%%%)(eautifulcervi")comJ Menstrual5

/enstruation Sensitivity to Se"ual Stimulation The reported sensitivity of a %oman.s vagina depends on factors li-e ho% the ,uestion is phrased and the method and conte"t of the stimulation)

1hen as-ed if they are satisfied %ith the sensitivity of their vagina, 4C>CAG of %omen indicate they are satisfied and BA>FFG are dissatisfied) 2 out of F to 7 %omen is dissatisfied! Source 2 Source B 1hen as-ed if they are satisfied %ith the sensitivity of their body during penile>vaginal intercourse' 3A>3CG of %omen indicate they are satisfied' and 2F>2AG are dissatisfied) 2 out of C to 3 %omen is dissatisfied! Source 2 Source B <n a scale of D to 2D5
o

<n average' %hen inserting a tampon %omen indicate the level of sensation is 7)C) <n average' %hen as-ed ho% much sensation they e"perience %hen inserting their o%n fingers into their vagina' one finger scores A)7' t%o fingers 4)A' and three fingers C)F) <n average' %hen as-ed ho% much sensation they e"perience %hen their partner inserts their fingers into their vagina' one finger scores 4)A' t%o fingers C)4' and three fingers 3)7) 1hen their partner inserts their penis into their vagina they indicate an average level of sensation of 3)F) Source

1hen as-ed ho% sensitive their vagina is in comparison to other %omen' FFG (elieve their vagina is more sensitive' F3G (elieve it is e,ually sensitive' and 22G 2 out of 2D! (elieve it is less sensitive) Source 1hen as-ed' 0Based on your e"periences' do you (elieve' the vagina is (eing presented (y the media ne%s' mainstream movies' and maga@ines! as (eing more sensitive to stimulation than it actually isN0 ABG of %omen agree and 2AG disagree %ith the statement) Source 1hen as-ed' 0Based on your e"periences' do you (elieve' the vagina is (eing presented (y the adult entertainment industry erotica and adult maga@ines and movies! as (eing more sensitive to stimulation than it actually isN0 44G of %omen agree and 22G disagree %ith the statement) Source CDG indicate they have a #>Spot %ith varying degrees of distinction BBG very distinct' FBG distinct' 24G (arely noticea(le!) Source

Additional information concerning vaginal sensitivity is availa(le in the article a(out anal se") The outcome of that se"ual stimulation varies from %oman to %oman as %ell)

<n average' %hen their partner stimulates only their vagina' A>CG indicate their level of se"ual arousal decreases' BD>B4G indicates it remains the same' and 4:>CFG indicate it increases) BC>FDG 2 out of F to 7! do not e"perience an increase in their level of arousal) Source 2 Source B <n average' %hen their partner stimulates only their vagina %ith their fingers they e"perience orgasm 7DG of the time' or B out of A times) Source During penile>vaginal intercourse' AG indicate their level of se"ual arousal decreases' 27> BBG indicates it remains the same' and CF>32G indicate it increases) 2:>BCG 2 out of 7 to A! do not e"perience an increase in their level of arousal) Source 2 Source B During penile>vaginal intercourse' %ithout additional forms of se"ual stimulation' %omen e"perience orgasm F4>F:G of the time on average' or B out of every A e"periences) B3> FDG or 2 out of F to 7 never e"periences orgasm %ithout additional forms of stimulation) Source 2 Source B 1omen e"perience female e+aculation at varying degrees of fre,uency)
o o o o

During se"ual arousal 7DG During orgasm 74G) During mastur(ation 72G) 1ith a male partner5

During manual stimulation of their vulva BFG

During cunnilingus 23G During manual stimulation of vagina %ith fingers 2:G 1hile (eing stimulated (y a dildo or other o(+ect 2DG During penile vaginal intercourse 2:G During anal stimulation 7>4G)

1ith a female partner5

During manual stimulation of their vulva 22G During cunnilingus :G During manual stimulation of vagina %ith fingers 2DG 1hile (eing stimulated (y a dildo or other o(+ect 3G During anal stimulation F>7G)

Source 2 Source B Source F 8eferences Notes Anatomy of the Vagina 'eferences

>

A A EA

Anatomy of the Vagina #eneral 8eferences5

The V Boo$% A &octor's 'uide to Com lete Vul(o(a!inal Health' Eli@a(eth #) Ste%art' /)D)) *ontemporary Vie%s on Female Pelvic Anatomy' /atthe% D) Bar(er /D Female Pelvic Floor Anatomy5 The Pelvic Floor' Supporting Structures' and Pelvic <rgans' Sender $erschorn' /D' F8*S* Female #enital Anatomy' *enter for Se"ual /edicine at Boston =niversity School of /edicine Atlas of $uman Se" Anatomy' 8o(ert 9atou Dic-inson /)D)' F)A)*)S)'*opyright 2:7: The 1illiams ; 1il-ins *ompany) A Ne% Vie% of a 1oman.s Body' The Federation of Feminist 1omen.s $ealth *enters' &llustrated By5 Su@ann #age' 9 Ac' 8N*' NP *linically <riented Anatomy5 Fifth Edition' 9ippincott 1illiams ; 1il-ins)

Eve.s Secrets' Josephine 9o%ndes Sevely)

*ited 8eferences5 2) The V Boo$% A &octor's 'uide to Com lete Vul(o(a!inal Health (y Eli@a(eth #) Ste%art' /)D) *opyright BDDB) B) Vaginal Anatomy and Physiology' Siddi,ue' Sohail A) /D' Journal of Pelvic /edicine and Surgery5 Novem(erJDecem(er BDDF > Volume : > &ssue 4 > pp B4F>BCB F) Atlas of $uman Se" Anatomy' 8o(ert 9atou Dic-inson /)D)' F)A)*)S)' *opyright 2:7: The 1illiams ; 1il-ins *ompany) 7) $uman penis si@e' 1i-ipedia)com A) /agnetic resonance imaging of male and female genitals during coitus and female se"ual arousal' 1illi(rord 1ei+mar Schult@' Pe- van Andel' &da Sa(elis' Eduard /ooyaart 4) Female #enital Anatomy' *enter for Se"ual /edicine at Boston =niversity School of /edicine C) *ontemporary Vie%s on Female Pelvic Anatomy' /atthe% D) Bar(er /D Anatomy of the Vagina otes
>

A A EA

Anatomy of the Vagina Notes5 2! <ral *ontraceptives <*! can (e used to inhi(it menstruation) At this time' this is (elieved to decrease the ris- of pelvic infections' perhaps (ecause <*.s alter the cervical mucus) The cervical mucous li-ely acts as a (arrier to harmful organisms) 8eference 2' 8eference B' 8eference F' 8eference 7 B! 1hen %riting this article & couldn.t find the reference from %hich & came a(out my prior claim of a ADG increase in the length of the vagina during se"ual arousal) Some references say the vagina lengthens' (ut they don.t usually state (y ho% much) 8eference 7 states5 0So the e"ceptional man %hose erect penis is eight inches long can still ma-e love to any %oman' providing he e"cites her properly and introduces his organ very slo%ly) &f he does this' her vagina %ill lengthen (y 2AD or BDD per cent H2 2JB to B times its normal lengthI to accommodate him)0 The vagina may stretch %hen an o(+ect is inserted' (ut se"ual arousal alone doesn.t appear to lengthen it (y all that much) 8eference 2' 8eference B' 8eference F' 8eference 7 F! /8& images of living su(+ects have indicated the pelvic muscles are normally not 0(o%l0 shaped' rather 0&n a %oman %ith normal pelvic floor function' the levator ani muscle comple" in its tonically HnormalI contracted state has an intricate three>dimensional structure in %hich its anterior HfrontI portion pu(ococcygeus and pu(orectalis! is oriented vertically as a sling around the mid>urethra' vagina' and anorectum and its posterior HrearI portion the pu(ococcygeus! has a hori@ontal up%ardly (iconve" shape resem(ling a (utterfly %ing Figure F!)0 HCI Belo%' & have enlarged and enhanced the image provided in the cited reference)

7! 0At (irth' the vagina is 7 cm H2)4 inchesI long' lengthens appro"imately 2 cm HD)7 inchesI during early childhood and 3 cm HF)2 inchesI during late childhood' and reaches mature length of 2D to 2B cm H7 to 7 FJ7 inchesI (y menarche) The vagina at (irth resem(les the mature vagina %ith its deep cryptic rugae and folds secondary to Has a result of theI maternal estrogenic effect Hraised estrogen levelI) As maternal estrogen levels fall in the infant %ithin the first fe% %ee-s after (irth' the vaginal %all (ecomes dry' thin' nonelastic' and nonrugated) The vagina remains in this ,uiescent state until the onset of pu(erty) During early pu(erty' increased estrogen levels affect the vaginal epithelia He"posed s-in surfaceI) Such pu(ertal changes can (e noted on e"amination (y identification of the more mature dull pin- color of the vaginal mucosa Hmucus tissueI' increased vaginal secretions' and increased vaginal %all fle"i(ility compared %ith the prepu(ertal findings of the red translucent mucosa' sparse secretions' and a relatively rigid vaginal %all)0 From )udol h's *ediatrics% +dition ,-' (y *olin D 8udolph' A(raham / 8udolph' /argaret P $ostetter' #eorge 9ister' and Norman J Siegel' editors A! 0The close physical pro"imity of the urethra and the clitoris to the anterior vaginal %all suggests an association (et%een these anatomical structures and se"ual function) &n fact' the anterior vaginal %all is an active organ' transmitting during intercourse' the effect of penile thrusting in the vagina to the clitoris' (y stretching the t%o ligaments that insert around its (ase)0 /easurement of the Thic-ness of the =rethrovaginal Space in 1omen %ith or %ithout Vaginal <rgasm' Journal of Se"ual /edicine Volume A &ssue F' Pages 42D > 423 0The distal vagina is a structure that is so interrelated %ith the clitoris that it is a matter of some de(ate %hether the t%o are are truly separate structures) The same relationship applies to the female urethra) Though in anatomical terms it is possi(le to dissect one structure fully from the other' the three structures distal HouterI vagina' clitoris' and urethra! share (lood supply and innervation)0 The Anatomy of the Distal Vagina5 To%ards =nity' Journal of Se"ual /edicine Volume A &ssue 3' Pages 233F > 23:2 4! &n the =)S) it is illegal for anyone to ta-e a photograph of the vulva or vagina of anyone under the age of 23' and this includes the %oman herself) =nfortunately' electronic images are easy to distri(ute' %hich means they are potentially a matter of pu(lic record once created' especially if a computer or cell phone is lost or stolen' or the images are voluntarily shared %ith a friend or se"ual partner %ho later shares them %ith third>parties' %hich is a common occurrence) At present' our legal system does not ma-e a distinction (et%een appropriate and inappropriate use

of technology (y those not yet considered an adult (y the legal system' hence everything is considered illegal) For %omen 23 and older' they may %ant to pass%ord protect these images (y using encryption soft%are' some of %hich is availa(le for free) <(viously' the pass%ord should (e -no%n only to the %oman herself' as sharing the pass%ord defeats the purpose of having one' and easy to remem(er ten or more years later) C! & do not %ant to appear as though & support male circumcision %ithout reservation' as men %ere around for thousands of years prior to the invention of circumcision' yet %e still survived and evolved as a species6 other mammals appear to e"ist ,uite %ell %ith intact fores-ins) *ircumcision D<ES reduce the rate of $&V transmission' (ut the primary ris- factor isn.t associated %ith a penis having an intact fores-in' (ut rather %ith having multiple se"ual partners' as %ell as other ris- factors) &f a man %ith an intact fores-in never engages in penile>vaginal or penile>anal intercourse' and other ris-y activities' then he %ill more than li-ely never ac,uire $&V) The greater the num(er of se"ual partners he has' and the poorer his personal hygiene ha(its' the greater his ris- for ac,uiring $&V and other STDs' and spreading it to his se"ual partners) *ircumcision reduces (ut D<ES N<T eliminate the ris- of contracting and spreading $&V and other STDs) /y concern is that men %ho are circumcised may (elieve they are immune to $&V' %hich is a(solutely not true) The same principle applies to young %omen' and eventually young men' %ho get the $PV vaccine6 getting vaccinated does not eliminate all the other ris-s factors' only potentially (linds us too them) Strictly and ideally' from a medical perspective' men and %omen should limit the num(er of se"ual partners they e"change (ody fluids %ith to those the plan to conceive a (a(y %ith' or at least as fe% as possi(le' to protect their overall health and ,uality of living) This is (ecause harmful organisms are constantly evolving' and the speed at %hich they spread around the %orld has reduced from years to hours) This ho%ever does not rule out the possi(ility for engaging in partnered se" %ith more than one person during your lifetime)