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"We have read for you": our vagina

Although half of the world's population has a vagina, not much is known about this amazing organ.

A 2016 survey found that a large portion, 65%, of young women have trouble saying "vagina", many of them prefer to use other mostly terms of indearment.

Regardless whatever you decide to call it, there is one thing we all agree on: the vagina is vital for human reproduction and plays an important role in sexual satisfaction.

The vagina is a female reproductive organ that changes throughout a woman's life. It has a multitude of functions in response to the hormonal changes appreciated during puberty, menstruation, pregnancy and menopause.

The vagina is an elastic muscle tube 7-10 cm long that extends from the vulva (female external genitals, including the labia minora and the clitoris) to the cervix where it ends in an anterior and posterior fornix. The vaginal canal is placed between urethra and bladder and rectum. The vaginal opening is at the back of the vulvar vestibule, behind the urethral opening. It is surrounded on both sides by the innermost labia minora and the labia majora on the outside. A thin perforated layer of hymen partially forms the entrance of the vaginal opening. The vaginal canal has an external fibrous adventitia, an intermediate layer of smooth muscle cells and an inner layer of mucosa. The inner mucosa has transverse folds called rugae that can also be detected by touch.

Vagina physiology changes dramatically in the course of a woman's life in response to hormonal changes. At birth, vagina is strongly estrogenized by maternal hormones and this causes the vagina to have an acidic pH with a predominance of lactobacilli.

During this time, the walls contain a high percentage of glycogen. When hormonal levels decrease, approximately four weeks after delivery, the physiology of the vagina will enter a prepubertal stage with a neutral environment with respect to the alkaline environment associated with less acid-producing bacteria.

During woman development, the vagina will mature due to adrenal and gonadal maturation. During the reproductive years, lactic acid producing bacteria predominate once again.

When women enter the premenopausal period and finally enter menopause, vaginal tissue atrophies due to ovarian quiescence and low levels of concomitant estrogens. Colonization with enteric flora may increase at this time.

The vagina has multiple functions that include:

• menstruation: channel for the release of menstrual blood

• immune defense: protection against harmful pathogens through acidic pH, local flora and chemical signaling

• reproduction: receptacle for sperm and as birth canal

• sexual functions: response to arousal and sexual pleasure

Normal vaginal pH ranges from 3.8 to 4.5. The pH is directly influenced by bacteria that produce lactic acid and helps to maintain local flora, kill sperm and produce immune protection against bacterial proliferation.

Let's look at some important points together:

1. when we talk about the vagina, we immeditely think of the intimate parts of a woman, but this is a mistake. The word vagina actually refers to a specific part of the female reproductive system. It is the muscular tube that begins from the vulva (external female genitals, including the labia and the clitoris) to the cervix (the terminal part of the uterus)

2. tormal vaginal pH is less than 4.5. Lactobacilli, known as Döderlein Lactobacilli or Döderlein Flora, are the "good" bacteria that live in the vagina; they help to maintain normal pH levels and prevent bacteria growth that can cause infections. When lactobacilli levels decrease, vaginal pH levels can exceed 4.5, making the vaginal environment vulnerable to infection. For this reason, it is important to verify the presence of lactobacilli, measure the pH or require a specific bacterial count in the reference laboratory

3. it is precisely because useful bacteria live in the genitals that we should avoid the use of scented and aggressive soaps and other products not indicated to clean the intimate parts. The use of these products interferes with the natural balance of vaginal bacteria and can lead to the infections mentioned above. Actually, we don't need to worry too much about our vaginal hygiene, since it takes care of itself. There are glands inside the vagina that secrete fluids that help to keep the internal environment clean. Our vaginas are sensitive areas. The advice is to wash at least once a day with water or neutral and delicate detergents

4. our vagina can benefit by performing regular exercises being a muscular tube surrounded by pelvic muscles. I do not mean "training" in a sexual sense, although research has shown that regular sexual activity can help to keep the vagina healthy. I am talking about an evaluation and a reeducation of the pelvic floor. The pelvic muscles can be both weakened and hyper contracted. Both cases lead to problems of medium or severe gravity. Pelvic floor strengthening exercises, also known as Kegel exercises, are usually performed to help the urinary incontinence control, but research has shown that they can also help to improve sexual satisfaction

How? Kegel exercises help to keep vaginal muscles toned and trained, making sex more pleasant and to reach orgasm easier.

However, it is important to make a first evaluation with a specialist to identify a series of exercises suitable for any need. In fact, depending on whether we face hypertonicity, contractures or loss of elasticity (for example, after giving birth), we can choose between a series of exercises, manipulations, massages, accessories or specific machinery specifically designed.

The hypertonicity of the pelvic floor is a little known problem, however, it is responsible for a large part of the disorders of the female genital sphere such as pains during sexual intercourse, heartburn, generalized discomfort, urinary disorders and the so-called sensation of electric shock.

In the case of prolonged discomfort without an obvious cause, it is always good to investigate the health status of our pelvic muscles!

5. our perineum has thousands of nerves. The clitoris is considered by many women as the node of sexual pleasure and this is not surprising; the tip of the clitoris alone has 8,000 nerve endings, more than double the number of nerve endings of the penis which makes it the most sensitive part of a woman's erogenous zone.

Being a very innervated area when it is irritated or inflamed, the perception of the symptomatology will be greater. During some situations, the mucous membranes become so weak and thin that they make the innervations extremely sensitive.

In these cases, it is good to preserve this delicate part from the action of other aggressive agents since they can be found in some non-specific creams and instead, resort to natural methods such as hyaluronic acid based cream, marigold, mauve, sage, aloe vera and have a lot of patience and perseverance to return everything to a healthy state.

Relaxation and breathing techniques and poultices of cold or hot water can also be useful depending on the body's response.

We must pay attention and take care of this important area of the body. "Do it yourself" is often used, driven perhaps by shame and fear and with the risk of causing further damage.

For this reason, it is advisable not to use antibacterial or antifungal creams or suppositories without first consulting a doctor, exuding and determining the presence of an infection.

The risk of taking unnecessary and harmful substances is really very high. In the presence of inflammation, the use of creams with antibiotics and cortisone is not only not decisive, but by killing good bacteria, there is a risk of further worsening of the clinical picture.


Physiology, Vaginal. Joann M. Gold; Isha Shrimanker, 2019

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