Let's talk about the vulva and how it changes in puberty

What is the Vulva? 

(See diagram below)

The vulva is the female external genitalia. It is often mistakenly called the vagina and many other names! It is not a term used very often and many people have little awareness of their vulval anatomy.

Let’s take a look at the anatomy in detail

Mons pubis

The mound of skin which covers the pubic bone. Usually, hair bearing after puberty.

Labia Majora

Large lips which surround the other structures. Skin covered and usually hair bearing after puberty.

Labia minora

Small lips inside the labia majora, non-hair bearing and made of mucous membrane. These enfold and protect the vaginal and urethral opening.

Labia minora are often very small in pre-pubertal females and grow during puberty under the influence of oestrogen. The posterior fourchette is where the labia minora meet behind the vaginal opening.


The clitoris is essential for normal sexual arousal in females. To date we have not discovered any other function for the clitoris. It is located at the front of the vulva where the labia minora meet. The glans or tip of the clitoris can vary in size and is protected by the clitoral hood or prepuce. It is the most richly innervated organ in the body. The internal part of the clitoris is made up of 2 crura which are not visible and extend backwards from the clitoral glans. They have a large blood and nerve supply and become swollen when sexually aroused.

Urethral opening

This is a tiny opening behind the clitoris and allows the passage of urine from the bladder.

Vaginal opening

This is behind the urethral orifice and is a larger opening. The vagina is a muscular/elastic tube connecting the vulva to the cervix (entrance to the uterus or womb).  Many people use the word vagina when in fact they mean vulva. It is covered by mucous membrane and is self-cleaning as it secretes various fluids sometimes seen as discharge. It is partially covered by the hymen and once again there are many variations of hymenal anatomy.


Strictly speaking not part of the vulva. But important to be aware of its relationship to the vagina, especially when learning where to put a tampon!

The area between the vaginal opening and the anus is called the perineum.


Vulval changes pre to post puberty

The vulva changes dramatically during puberty, but surprisingly little is noticed as the girl develops. Attention is usually on more obvious changes such as the increase in height, development of bodily hair, breast development. Meanwhile the vulva is quietly adapting to its adult role, enabling sexual enjoyment and childbirth.

Changes occur under the influence of oestrogen, testosterone and progesterone and include:


The colour of the “skin’ or surface of the vulva, From a reddish pink to a softer pink colour. This represents thickening of the tissues and increased elasticity.


Pubic hair develops initially along the edges of the labia majora spreading outwards and upwards over 3-5 years eventually covering the mons pubis and often the upper inner thighs.

Labial growth

Often a cause for concern as the labia minora often grow quite quickly before the labia majora. Labia minora can be quite asymmetric during puberty (like breasts) and often take to time to even out. They can be long or short, vary in colour from pink to dark brown, have smooth or wrinkled skin, be obvious or not at all noticeable. They are very sensitive structures and swell and release fluids during sexual arousal. The appearance does not interfere with their function.

I have seen many young peri-pubertal girls and their mums who are really concerned that something is seriously wrong. I recommend that you check out the resources at the end of this blog to see the endless variations of labia minora.


This is a surgical procedure to remove or trim part of the labia minora, nearly always performed for cosmetic reasons. It became one of the commonest surgical cosmetic procedures in 2019 when 165,000 were performed worldwide.  The increase in demand was likely due to increased availability of on-line pornography, social media, and the trend for removing pubic hair making the labia minora more obvious. The coveted look was the Barbie slit!  And this was long before the Barbie movie with its stunning closing line ‘I’m here to see a gynaecologist’!!!!

Many teenage girls visited my clinics requesting this surgery. UK and USA medical bodies have advised against labiaplasty in teenage girls until at least age 18 years.  There are many reasons for this:

  1. Many young teenagers are very vulnerable and with further maturity and development of the genitalia become at ease with the appearance of their labia.
  2. The labia are not fully developed and may be asymmetric in teenagers, the longer labium removed aged 14-15 years, only for the other labium to grow later requiring another operation to even things out!
  3. The labia are important for the sexual response in women and interfering with the anatomy may interfere with this function.
  4. This is a surgical procedure usually not medically necessary. Complications can arise in 1:15 patients and revision surgeries are needed in 4.1% of cases.

My job in clinic was to reassure the girl and her mother that there was nothing wrong with her labia (if that was the case!). To reassure that further development would occur and that the labia would likely become less obvious. And, that if at age 18-20 years she still wanted surgery that the best option was to attend a surgeon who specialised in this area.


The clitoris grows and develops during puberty. Most of the development is internal however and not very noticeable. Externally, the clitoral hood and glans grows, and sensitivity increases to allow for orgasm.


Changes entirely during puberty. Again, there are wide variations in hymenal configurations. The prepubertal hymen is a very delicate thin membrane, reddish in colour, with no elasticity and is exquisitely sensitive. The prepubertal hymen should never be touched as this will cause pain. (It is important to be aware of this when nappy changing or helping your toddler with toileting.)

After puberty the hymen has thickened up like the surface of the vulva, become more elastic and has developed flower-like “petals” or projections which allow the passage of tampons, penises and babies!

The myth of virginity and hymenal integrity is still alive and well. Inserting a tampon can disrupt the hymen as can strenuous sports such as horse-riding and gymnastics. This does not mean that virginity is lost. The definition of virginity is “the state of a person who has never engaged in sexual intercourse” and checking the hymen to determine if a person has had sexual intercourse is quite useless.

Hymen problems

 An imperforate hymen will be diagnosed after a girl gets her period and the menstrual blood cannot escape causing significant pain. This is quite rare and easily treated with a simple surgical procedure under general anaesthetic.

A micro-perforate or rigid hymenal tissue can be a little more difficult to diagnose. Usually the girl/woman will have had difficulty inserting or removing a tampon and will find sexual intercourse painful or impossible. Once again, a simple surgical procedure will sort this out.

Hymenal tags are common and noticed as finger like projections from the hymen. This is harmless but can be removed if causing distress.

A hymenal loop is a small band of hymenal tissue extending across the vaginal opening. Usually noticed if the girl finds it difficult to remove a tampon. Insertion of the tampon is fine as the top is rounded but the bottom of the tampon is square shaped, and the loop may get caught on the edges. Once again removal is a simple surgical procedure.


Strictly speaking the vagina is not part of the vulva. It grows during puberty and is usually the length of your hand. The mucous membrane covering the vaginal surface changes during puberty and begins to make secretions which can be seen as discharge. Discharge varies according to the menstrual cycle, and we need to be aware of these changes. After a period, there is often little discharge until ovulation takes place. Then you may notice a clear stretchy discharge in your underwear (like uncooked egg white!). After this the discharge can become white or yellow and sometimes can be quite noticeable. Green is not normal, and you should get this checked out. There may be a slight odour, but a fishy smell is not normal and again should be checked.

The vagina is a musculo-elastic structure which allows sexual intercourse and childbirth. It can expand dramatically but recovers amazingly well.

Care of the vulva/vagina

I would first recommend that you get to know your vulva. We use a hand mirror in our clinic to show young girls the various parts of her vulva. I would recommend something similar at home!

As mentioned, the vulva and vagina are covered with mucous membrane like our mouths, noses, and ears. We need to treat our vulvas differently to other parts of our body.

I recommend cleaning the area with water only, using a detachable shower head or clean flannel. Ensure you clean the area thoroughly but avoid any scrubbing! Avoid chemicals as we would in our mouths and nose. That means no soaps, bubble baths/bombs, creams unless prescribed /recommended by a health care professional and no feminine hygiene products. So many symptoms occurring in the vulva are a response of this sensitive tissue to the harsh chemicals we expose it to. Cleaning from front to back avoids sweeping forward bacteria which may be lingering around the anus. Vaginal washes and douches are not recommended. The vagina is a self-cleaning organ like the nose and introducing chemical washes or even water can bring bacteria in from the outside.

In the same manner we should avoid harsh washing powders and fabric conditioners on our underwear and clothes. Wearing breathable underwear is a good idea as is avoiding synthetic fabrics where possible. Tight clothes can aggravate a problem, and this includes some yoga pants which are often very snug and contain lots of synthetic fabrics. Changing out of sweaty gym gear and wet swimming togs as soon as possible is a good practise.

And finally, I strongly recommend that you consider what type of menstrual products you use. So many pads and tampons contain bleach and other chemicals which are in intimate contact with these sensitive tissues. And often the surface of the vulva is already compromised by the menstrual blood at the time of the month. It is a no brainer to use the most natural products you can get your hands on. Your body will thank you for it and so will planet Earth! Reusables such as cloth pads, period pants and menstrual cups are also worth considering.

Reading the labels on everything we buy will open our eyes. This includes food, clothes, sanitary wear, and the cosmetics, creams and washes we use. I always aim for the simplest product with the shortest list of ingredients and preferably those I’ve heard of before and don’t need a science degree to understand! We need to become more savvy consumers and try to simplify our shopping lists. This will improve our physical and financial health and also the health of our planet.

I hope you found this interesting and informative. For too long we have been ignorant about our vulvas and what a fascinating structure it is! So much goes on in our bodies in the normal course of our lives that we are unaware of. I think it’s time we paid attention to our amazing vulvas!.

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