Experts say

Dr. Tan Toh Lick

Obstetric & Gynaecology, Thomson Women's Clinic

Dr Tan graduated from King’s College London in 1997 and undertook his specialist training in London and Kent, UK. He worked in London as a consultant obstetrician and gynaecologist before relocating to Singapore in 2013. Dr Tan is on the UK’s General Medical Council and Singapore Medical Council’s specialist registers. He is also a Fellow of the Royal College of Obstetricians and Gynaecologists, and has RCOG special skills accreditation in minimally invasive surgery, gynaecological ultrasound, subfertility management and medical education. Apart from practicing, he enjoys teaching and currently runs medical education programmes for general practitioners and specialists.
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Erin Chen

Sexual Wellness Advocate, Sex & Relationship Counselor

Erin is an advocate for the inclusion of sexual wellness as part of everyday healthy living. She holds a Masters degree in Sexual Health Counselling from the University of Sydney, and helps people discover and confidently explore intimacy and pleasure within oneself or with another. Her career in sexual wellness began with the founding of Lila Sutra, a company that has disrupted sexual taboos in Singapore. In 2017, she launched SPARK – Asia’s first sexual wellness festival that brings together entrepreneurs, advocates and the general community to advance the modern conversation on intimacy, sexual health, and gender.
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Dr. Felix Li

Aesthetic Medicine, Dr Felix Li Thomson Wellth Clinic

Dr. Li earned his medical degree from the National University of Singapore, and is accredited by the Aesthetic Practice Oversight Committee of the Singapore Medical Council in aesthetic procedures. He regularly attends local and international conferences on aesthetic and anti-ageing medicine, as well as advanced anatomy workshops and masterclasses to keep abreast of the field’s rapid advances.
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What do you think is the best way to open up the topic of vulva conversations? Do you think it’s best done from woman to woman?
I don’t think there is a “best” way to open up. For a lot of people, starting this conversation would most likely feel awkward and uncomfortable – which is completely normal when it’s something we’re not used to talking about! Here are a few suggestions that you can try to bring this topic up:

  • Share! If you come across an article, video, piece of art or anything that resonates with you – try sharing that with your friends or partner. Follow it up with something like, “What are your thoughts?” Articles are a great way to open conversations.
  • Be normal! Easier said than done, I know. This will take some practice – try to treat the conversation like a normal topic… there is no reason why we can’t talk about vulvas or sexual wellness the same way we talk about other parts of life – be it yoga, fashion, sports! A lot of the time, others feel awkward too when we’re awkward about it. So the more normal you are with the topic, the more space you provide for others around you to open up. Again, this takes practice – think of it as building your muscle memory for having authentic conversations.

From my experience, most women feel more comfortable discussing vulvas with other women; however, it’s really whoever you feel comfortable with that matters – the gender and their genitalia don’t really matter.

Erin Chen
5 April 2019
The vagina has been known to be self-cleaning and also has a very specific PH-range that is required to prevent infections and other issues. Is it true that the Vulva is self-cleaning with a specific pH range too?
The vulva requires care to stay healthy. Keeping the vulva clean and dry is generally enough. However, do not douche, powder or use feminine sprays. Rinse the vulva, if necessary, with a perineal irrigation bottle, and dry the area by gentle patting rather than hair dryers. If there is mild vulva discomfort, soaking in warm water and using an emollient may be helpful. If the problem persists, or if there is any discharge, lesion or pain, then a review by a family doctor or gynaecologist is warranted.

The pH of different body parts is different, and this applies to the vulva too. However, this pH rises during menopause, reducing the antimicrobial defence of the vulva during menopause.

Dr. Tan Toh Lick
10 April 2019
Can hormonal changes in your body affect the health of the vulva (i.e. Menopause / pregnancy etc.)?

At puberty, fatty tissues deposit around the vulva increasing the size of the labia majora and mon pubis. In some girls, the pink labia minora may become darker. Pubic hair also starts to appear around this time. The vulva then remains similar until pregnancy.

During pregnancy, the vulva can become engorged and varicosities are common. Pigmentation of the vulva, as with other areas of the skin, can be significant. During a vaginal delivery, the muscles and ligaments supporting the vagina may be damaged. As the baby is delivered, perineal tears or episiotomies may further affect the appearance of the vulva. The return of the higher oestrogen hormone level after breastfeeding will generally improve the elasticity and lubrication of the area.

After menopause, the labia majora lose its substance and become less full. Like the skin on other parts of the body, it becomes thinner and loses its elasticity. Hair greying, loss and reduced growth are also observed.

Dr. Tan Toh Lick
10 April 2019

Is the skin of the Vulva the same as the skin of the rest of the body or is it more sensitive in comparison?
The skin of the labia majora and the perineum are covered with skin just like on the rest of the body. In contrast, the labia minora are lined with a mucous membrane, whose surface is kept moist by fluid secreted by specialised cells.

The area is often moist from normal vaginal discharge, sweating and in some women, incontinence. The combination of being close to the germs from the anus and being moist increases its risk of being infected. This is particularly so during the menopause when skin pH rises leading to less antimicrobial defence of the skin. Further, lipid production is reduced after the menopause which slows the healing process.

Dr. Tan Toh Lick
3 April 2019
I’ve always thought that the vagina and the vulva refer to the same area. Can you explain the anatomical difference between the two body parts and what is the specific function of the Vulva?

The vagina refers to the elastic muscular tube extending from the external genitals to the neck of the womb (cervix). It is a reproductive conduit connecting the external environment to the internal genitalia. During sexual intercourse, it receives the penis and allows the sperm to swim up into the womb. Conversely, it allows blood flow to be expelled from the womb during menstruation, and the baby during vaginal childbirth.

The vulva refers to the external female genital organs which are composed of the mons pubis, labia majora and minora, clitoris, urethral opening, vestibule and perineum.

The labia majora refers to the large, fleshy folds of tissue that enclose and protect the other external genital organs. The labia minora lie just inside the labia majora and surround the vestibule, which is the area around the openings to the vagina and urethra. A rich supply of blood vessels gives the labia minora a pink colour. The clitoris is a small protrusion at the upper end between the labia minora. The urethral opening allows the passage of urine. The perineum refers to the area between the vagina and anus.

Dr. Tan Toh Lick
3 April 2019

 

What are the specific functions of the clitoris, labia majora and labia minora?

The clitoris can be aroused and erect when sexually stimulated. This stimulation of the clitoris can cumulate into an orgasm.

The fleshy padded tissue of the labia majora protect the other external genital organs. They also contain sweat and sebaceous glands, which produce lubricating secretions particularly during sexual intercourse.

During sexual stimulation, the labia minora swell as their blood vessels become engorged with blood. This narrows the vaginal opening and makes them more sensitive to stimulation.

Dr. Tan Toh Lick
3 April 2019