The anatomy of your anatomy: vaginas!

As promised from my last post, I am going to attempt to explain and illustrate the anatomy of the female genitalia….aka “your bits” (if you’re a female that is).   It is important to understand what you own, and as I type it will become apparent why.

It is also important to understand why I did not go any further than grade 9 art. As I draw it will become apparent why.

If you are a man and are thinking of switching off because this is irrelevant to you directly……keep reading.  You might not own the bits yourself, but certainly someone you know and love just might (think of your mother….see you definitely know one person!). And you might just solve a big calamity someday by understanding what’s going on down there, and sharing some insight into common misconceptions.

So while it is quiet, and raining, on a Friday night (rather, my children are two floors away competing over who can make their father’s ears bleed), I am writing about vaginas, and what lays beyond in an attempt to clear up a LOT of confusion.

On Wednesday, I had a lovely new patient come in for a pap smear.  Completely healthy (as per her meet and greet appointment), I knew she had had no surgeries, was on no medications and was otherwise fit as a fiddle.  The only outstanding issue was that she had not had a pap smear for a very long time.

After a rather uncomfortable ten or so minutes of searching for her cervix, I asked the obvious question.  “Are you sure that you haven’t had anything removed?”.  She thought for a minute, and said “does having a vaginal hysterectomy count?”.

Yes, yes it does.

I had put this woman through many women’s idea, of torture by performing an unnecessary pap smear.  For, after acquiring her surgical notes, it was to be found that she did not any longer own a cervix.

She was shocked.

Thus this post.

Two days later and I had another woman incredibly upset because she was having vaginal bleeding, and her friends and family had convinced her she must have cancer of her ovary, womb or cervix.    I gently remindered her that she had had all of those things removed twenty years before during her hysterectomy.

“Oh that’s what they take out?”

She had a straight forward case of post menopausal atrophy that was bleeding, and can be fairly, easily fixed, (i.e the drying of vaginal tissues that occurs in some women after they stop getting their period).

She had been very stressed out for a number of weeks without reason.

On the same day as my patient with vaginal bleeding, was a patient who was convinced that she had lost a tampon inside of herself.  She was worried that it would be in her uterus and that we would not be able to find it. She was worried that something horrible would happen as a result.  I reassured her immediately that due to her rather clever female architecture, this was not physically possible.

These kind of misunderstandings/misinformation are common.  Looking for a cervix that doesn’t exist is common.  More worrying however, is that women are anxious and losing sleep about parts of their body that they might not even have any more.  Their misunderstanding is causing them grave stress.

The problem is, it’s hard to understand our anatomy.    Text books and standard drawings can make things even worse.

It’s like me looking at a picture of a car engine.  I own a car.  But I have no idea how it works, or what is broken when it starts making loud noises and billowing out smoke.  If someone wants to explain to me, like I am a two year old, how a car works, that would really be appreciated.  As the last time I tried to look at the manual, something in my soul died.

It can be incredibly difficult knowing what’s going on.

Textbook drawings of female bits look like this:

If your brain is anything like mine first was (before starting medical school), this made zero sense to me.  I had no idea where this was supposed to go or why something buried in me looked like a ram with very hairy ears.   If you are medically insightful, were into weird textbooks at an early age, or had some hippie minded/over educated parents, then you might know exactly what this is.   But then again this post is not for you.

If you are like the rest of us, then there will be confusion. Perhaps lots.  This is supposed to be a cross section drawing of the female reproductive system. I.e. if someone sliced you in half and then removed your top half from your bottom half, this would be your view looking down on your own legs….sort of.

Clear as mud?  Thought so.

So, in the next couple of paragraphs, with my terrible pictures as aids, I am going to try to lay out the basics of the female reproductive system.  If this makes things more confusing, I can only apologize.

So first thing to know;  in a woman’s lower body, there appears to be two main holes (there are actually three)

If you get a mirror (and if you were a cartoon), and squat over it in your birthday suit, then you might see something that looks like this

The top hole being the opening to your vagina (or vaginal canal)

The bottom hole being your anus, or where the poop comes out.  It does look a bit like a spider in the drawing, forgive me.

If you look a bit more carefully with your mirror you will notice a few more things like this:

If you start at the top of the picture, there is your clitoris. The little fleshy bit that most women need to have stimulated to reach orgasm.

The middle “blacked-in” hole, holds opening 1. and opening 2.

Opening 1. Is your urethra.  That is where your pee/urine comes out.

Opening 2. Is your vagina.

So your urethra sits within the top wall of your vagina during the first little bit of your vaginal canal.

Opening 3. is your anus.  This is where your stool/poop comes out.

So we are going to pretend that we are going on a hike through the largest hole.  So get on your backpack, we are heading through hole #2.  We are going for a walk through your vaginal canal

Your vagina is a dark canal (a bit like a hallway or tunnel)  and as you come from the outside of your body and hike along toward the inside of your body, you will notice a few things.

1) It is a bit moist and warm in here.

2) Straight ahead of you is a fleshy looking door.  It looks a bit like a donut from straight on.  That is your cervix.

3) If you were to look up, then a long pipe like structure would be embedded into the tissue of the ceiling of the end of your vaginal tunnel. This is your urethra.  Don’t bump your head! (it would be roughly where the “enter here” sign is pointing)

So now you are heading toward the end of the tunnel and you see this

The round thing, that like looks like a donut, at the end of your vaginal canal (with the “Do not enter” sign on it),  is your cervix.

This is roughly what your doctor sees when he/she is doing a pap smear.  We are using that awful “duck beak” thing called a speculum to hold the walls of your vagina open so that we can see the “donut” at the end of the tunnel.   We then scrape your cervix (gently) with a brush so that someone specially trained can look at the cells we have sent them from your donut (cervix) to see if you have any signs or changes that would make us think that you might have cervical cancer.

This is why you have a pap smear done.

The donut shaped “door” at the end of the tunnel does not open. However, just like a donut, it has a hole in it.

If you crawl through the hole that is in the middle of your cervix (don’t try this at home 😉  you will see:

A large room ahead of you. This is your uterus.

To the left of you, your uterus almost comes to a close like the point of a triangle. But it has a small hole in it. If you squeeze yourself into this hole you will be in your left fallopian tube, which leads to a small, almond shaped structure which is your left ovary.  There is the same on the right (my right ovary in this drawing, fell off of the page).

So that is the long and the short of the female reproductive system.

We have missed all of the outside bits that together form your “vulva”.  This group of strutures including your labia (lips), and the vaginal opening (to name a couple), are what most people refer to as their “vagina” . However, as you now know the vagina is comprised of an opening and a canal that leads to your cervix.

Now have a quick look at some of the ways in which this anatomy might be relevant to you:

Hopefully now you understand a little bit more about the basics of the female reproductive system (one that has not had any parts removed).

Thanks for checking it out, and for keeping in mind,

a) none of this is to scale (ie you should never try to climb inside a vagina, it is not physically possible)

b) my drawings are horrendous.  But hopefully they helped you with the basics.