Vagina

In mammals, the vagina is a muscular and tubular part of the female genital tract, which, in humans, extends from the vulva to the cervix. The outer vaginal opening may be partly covered by a membrane called the hymen. At the deep end, the cervix (neck of the uterus) bulges into the vagina. The vagina allows for sexual intercourse and childbirth, and channels menstrual flow, which occurs periodically as part of the menstrual cycle.

The vagina has been studied in humans more than it has been in other animals. Its location and structure varies among species, and may vary in size within the same species. Female mammals usually have the opening of the urethra of the urinary system separate to the vaginal opening of the genital tract. This is different to male mammals, who usually have a single opening, the external urethral opening for both urination and reproduction. The vaginal opening is much larger than the nearby urethral opening, and both are protected by the labia in humans. In amphibians, birds, reptiles and monotremes, the cloaca is the single external opening for the gastrointestinal tract and the urinary and reproductive tracts.

To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity, vaginal moisture increases during sexual arousal in human females and also in other female mammals. This increase in moisture is vaginal lubrication, which reduces friction. The texture of the vaginal walls creates friction for the penis during sexual intercourse and stimulates it toward ejaculation, enabling fertilization. Along with pleasure and bonding, women's sexual behavior with others (which can include heterosexual or lesbian sexual activity) can result in sexually transmitted infections (STIs), the risk of which can be reduced by recommended safe sex practices. Other disorders may also affect the human vagina.

The vagina and vulva have evoked strong reactions in societies throughout history, including negative perceptions and language, cultural taboos, and their use as symbols for female sexuality, spirituality, or regeneration of life. In common speech, the word vagina is often used to refer to the vulva or to the female genitals in general. By its dictionary and anatomical definitions, however, vagina refers exclusively to the specific internal structure, and understanding the distinction can improve knowledge of the female genitalia and aid in health care communication.

Etymology and definition
The term vagina is from Latin vāgīnae, literally "sheath" or "scabbard"; the Latinate plural of vagina is vaginae. The vagina may also be referred to as "the birth canal" in the context of pregnancy and childbirth. Although by its dictionary and anatomical definitions, the term vagina refers exclusively to the specific internal structure, it is colloquially used to refer to the vulva or to both the vagina and vulva.

Using the term vagina to mean "vulva" can pose medical or legal confusion; for example, a person's interpretation of its location might not match another person's interpretation of the location. Medically, the vagina is the muscular canal between the hymen (or remnants of the hymen) and the cervix, while, legally, it begins at the vulva (between the labia). Scholars such as Craig A. Hill argue that incorrect use of the term vagina is likely because not as much thought goes into the anatomy of the female genitalia. This has contributed to an absence of correct vocabulary for the external female genitals, even among health professionals, which can pose sexual and psychological harm with regard female development. Because of this, researchers endorse correct terminology for the vulva.

Overview


The human vagina is an elastic muscular canal that extends from the vulva to the cervix. It is reddish pink in color, and it connects the outer vulva to the cervix of the uterus. The part of the vagina surrounding the cervix is called the fornix. The opening of the vagina lies near the middle of the perineum, between the opening of the urethra and the anus. The vaginal canal then travels upwards and backwards, between the urethra at the front, and the rectum at the back. Near the upper vagina, the cervix protrudes into the vagina on its front surface at approximately a 90 degree angle. The vaginal and urethral openings are protected by the labia.

In its unexcited state, the vagina is a collapsed tube, with the anterior and posterior walls placed together. The lateral walls, especially their middle area, are relatively more rigid. Because of this, the collapsed vagina has a H-shaped cross section. Behind, the inner vagina is separated from the rectum by the recto-uterine pouch, the middle vagina by loose connective tissue, and the lower vagina by the perineal body. Where the vaginal lumen surrounds the cervix of the uterus, it is divided into four continuous regions or vaginal fornices; these are the anterior, posterior, right lateral, and left lateral fornices. The posterior fornix is deeper than the anterior fornix.

Supporting the vagina are its upper third, middle third and lower third muscles and ligaments. The upper third are the levator ani muscles (transcervical, pubocervical) and the sacrocervical ligaments; these areas are also described as the cardinal ligaments laterally and uterosacral ligaments posterolaterally. The middle third of the vagina concerns the urogenital diaphragm (also described as the paracolpos and pelvic diaphragm). The lower third is the perineal body; it may be described as containing the perineal body, pelvic diaphragm and urogenital diaphragm.

Vaginal opening and hymen
The vaginal opening (orifice or introitus) is at the outer end of the vulva, posterior to the opening of the urethra, at the posterior end of the vestibule. The opening is closed by the labia minora in female virgins and in females who have never given birth (nulliparae), but may be exposed in females who have given birth (parous females).

The hymen is a membrane of tissue that surrounds or partially covers the vaginal opening. The effects of vaginal intercourse and childbirth on the hymen are variable. If the hymen is sufficiently elastic, it may return to nearly its original condition. In other cases, there may be remnants (carunculae myrtiformes), or it may appear completely absent after repeated penetration. Additionally, the hymen may be lacerated by disease, injury, medical examination, masturbation or physical exercise. For these reasons, it is not possible to definitively determine whether or not a girl or woman is a virgin by examining her hymen.

Variations and size
The length of the vagina varies between women of child-bearing age. Because of the presence of the cervix in the front wall of the vagina, there is a difference in length between the front (anterior) wall, approximately 7.5 cm (2.5 to 3 in) long, and the back (posterior) wall, approximately 9 cm (3.5 in) long. During sexual arousal, the vagina expands in both length and width. If a woman stands upright, the vaginal tube points in an upward-backward direction and forms an angle of approximately 45 degrees with the uterus and of about 60 degrees to the horizontal. The vaginal opening and hymen also vary in size; in children, although a common appearance of the hymen is crescent-shaped, many shapes are possible.

Development
The vaginal plate is the precursor to the vagina. During development, the vaginal plate begins to grow where the solid ends of the paramesonephric ducts (Müllerian ducts) enter the back wall of the urogenital sinus. As the plate grows, it separates the sinus into the urethra and the vagina and extends the vagina by pushing the cervix deeper. Originally full of cells, as the central cells of the plate break down, the lumen of the vagina is formed. This usually occurs by the twenty to twenty-fourth week of development. If the lumen does not form, or is incomplete, membranes across or around the tract called septae can form, which may cause obstruction of the outflow tract later in life.

During sexual differentiation of females, without testosterone, the urogenital sinus persists as the vestibule of the vagina. The two urogenital folds (elongated spindle-shaped structures that contribute to the formation of the urethral groove on the belly aspect of the genital tubercle) form the labia minora, and the labioscrotal swellings enlarge to form the labia majora.

There is debate as to which portion of the vagina is formed from the Müllerian ducts and which from the urogenital sinus by the growth of the sinovaginal bulb. Dewhurst's Textbook of Obstetrics and Gynaecology states, "Some believe that the upper four-fifths of the vagina is formed by the Müllerian duct and the lower fifth by the urogenital sinus, while others believe that sinus upgrowth extends to the cervix displacing the Müllerian component completely and the vagina is thus derived wholly from the endoderm of the urogenital sinus." It adds, "It seems certain that some of the vagina is derived from the urogenital sinus, but it has not been determined whether or not the Müllerian component is involved."

Microanatomy


The wall of the vagina from the lumen outwards consists firstly of a mucosa of non-keratinized stratified squamous epithelium with an underlying lamina propria of connective tissue, secondly a layer of smooth muscle with bundles of circular fibers internal to longitudinal fibers, and thirdly an outer layer of connective tissue called the adventitia. Some texts list four layers by counting the two sublayers of the mucosa (epithelium and lamina propria) separately. The lamina propria is rich in blood vessels and lymphatic channels. The muscular layer is composed of smooth muscle fibers, with an outer layer of longitudinal muscle, an inner layer of circular muscle, and oblique muscle fibers between. The outer layer, the adventitia, is a thin dense layer of connective tissue, and it blends with loose connective tissue containing blood vessels, lymphatic vessels and nerve fibers that is present between the pelvic organs.

The mucosa forms folds or rugae, which are more prominent in the outer third of the vagina; they appear as transverse ridges and their function is to provide the vagina with increased surface area for extension and stretching.

The epithelial covering of the cervix is continuous with the epithelial lining of the vagina. The vaginal mucosa is absent of glands. The vaginal epithelium consists of three rather arbitrary layers of cells – superficial flat cells, intermediate cells and basal cells  – and estrogen induces the intermediate and superficial cells to fill with glycogen. The superficial cells exfoliate continuously and basal cells replace them. Under the influence of maternal estrogen, newborn females have a thick stratified squamous epithelium for two to four weeks after birth. After that, the epithelium remains thin with only a few layers of cells without glycogen until puberty, when the epithelium thickens and glycogen containing cells are formed again, under the influence of the girl's rising estrogen levels. Finally, the epithelium thins out during menopause onward and eventually ceases to contain glycogen, because of the lack of estrogen. In abnormal circumstances, such as in pelvic organ prolapse, the vaginal epithelium may be exposed becoming dry and keratinized.

Blood and nerve supply
Blood is supplied to the vagina via the vaginal arteries, branches of the internal iliac arteries. These form two vessels called the azygos arteries which lie on the midline of the anterior and posterior vagina. Other arteries which supply the vagina include branches of the uterine artery, the middle rectal artery, and the internal pudendal artery, all branches of the internal iliac artery. Three groups of lymphatic vessels accompany these arteries; the upper group accompanies the vaginal branches of the uterine artery; a middle group accompanies the vaginal arteries; and the lower group, draining lymph from the area outside the hymen, drain to the inguinal lymph nodes.

Two main veins drain blood from the vagina, one on the left and one on the right. These form a network of smaller veins (an anastomosis) on the sides of the vagina, connecting with similar networks of the uterine, vesical and rectal networks. These ultimately drain into the internal iliac veins.

The nerve supply of the upper vagina is provided by the sympathetic and parasympathetic areas of the pelvic plexus. The lower vagina is supplied by the pudendal nerve supplying the lower area.

Secretions
The vagina provides a path for menstrual blood and tissue to leave the body. In industrial societies, tampons, menstrual cups and sanitary napkins may be used to absorb or capture these fluids. Vaginal secretions are primarily from the uterus, cervix, and vaginal epithelium in addition to minuscule vaginal lubrication from the Bartholin's glands upon sexual arousal. It takes little vaginal secretion to make the vagina moist; secretions may increase during sexual arousal, the middle of menstruation, a little prior to menstruation, or during pregnancy.

The Bartholin's glands, located near the vaginal opening, were originally considered the primary source for vaginal lubrication, but further examination showed that they provide only a few drops of mucus. The significant majority of vaginal lubrication is now believed to be provided by plasma seepage from the vaginal walls, which is called vaginal transudation. Vaginal transudation, which initially forms as sweat-like droplets, is caused by vascular engorgement of the vagina (vasocongestion), resulting in the pressure inside the capillaries increasing the transudation of plasma through the vaginal epithelium.

Before and during ovulation, the mucus glands within the cervix secrete different variations of mucus, which provides an alkaline, fertile environment in the vaginal canal that is favorable to the survival of sperm. As women age, vaginal lubrication naturally decreases. After menopause, the body produces less estrogen, which, unless compensated for with hormone replacement therapy, causes the vaginal walls to thin out significantly.

Sexual activity
The concentration of the nerve endings near the entrance of the vagina (the lower third) usually provide pleasurable vaginal sensations when stimulated during sexual activity, and many women additionally derive pleasure from a feeling of closeness and fullness during penetration of the vagina. The vagina as a whole, however, lacks nerve endings, which commonly hinders a woman's ability to receive sufficient sexual stimulation, including orgasm, solely from penetration of the vagina. Although some scientific examinations of vaginal wall innervation indicate no single area with a greater density of nerve endings, or that only some women have a greater density of nerve endings in the anterior vaginal wall, heightened sensitivity in the anterior vaginal wall is common among women. These cases indicate that the outer one-third of the vagina, especially near the opening, contains the majority of the vaginal nerve endings, making it more sensitive to touch than the inner (or upper) two-thirds of the vaginal barrel. This factor makes the process of child birth significantly less painful, because an increased number of nerve endings means that there is an increased possibility for pain and pleasure.

Besides penile penetration, there are a variety of ways that pleasure can be received from vaginal stimulation, including by masturbation, fingering, oral sex (cunnilingus), or by specific sex positions (such as the missionary position or the spoons sex position). Heterosexual couples may engage in cunnilingus or fingering as forms of foreplay to incite sexual arousal, with penile-vaginal penetration as the primary sexual activity, or they may engage in them in addition to penile-vaginal penetration; in other cases, heterosexual couples use the latter acts as a way to preserve virginity or as a type of birth control. By contrast, lesbians and other women who have sex with women commonly engage in cunnilingus or fingering as main forms of sexual activity. Some women and couples use sex toys, such as a vibrator or dildo, for vaginal pleasure.

The clitoris additionally plays a part in vaginal stimulation, as it is a sex organ of multiplanar structure containing an abundance of nerve endings, with a broad attachment to the pubic arch and extensive supporting tissue to the mons pubis and labia; it is centrally attached to the urethra, and research indicates that it forms a tissue cluster with the vagina. This tissue is perhaps more extensive in some women than in others, which may contribute to orgasms experienced vaginally.

During sexual arousal, and particularly the stimulation of the clitoris, the walls of the vagina lubricate. This begins after ten to thirty seconds of sexual arousal, and increases in amount the longer the woman is aroused. It reduces friction or injury that can be caused by insertion of the penis into the vagina or other penetration of the vagina during sexual activity. The vagina lengthens during the arousal, and can continue to lengthen in response to pressure; as the woman becomes fully aroused, the vagina expands in length and width, while the cervix retracts. With the upper two-thirds of the vagina expanding and lengthening, the uterus rises into the greater pelvis, and the cervix is elevated above the vaginal floor, resulting in "tenting" of the mid-vaginal plane. As the elastic walls of the vagina stretch or contract, with support from the pelvic muscles, to wrap around the inserted penis (or other object), this stimulates the penis and helps to cause the male to experience orgasm and ejaculation, which in turn enables fertilization.

An area in the vagina that may be an erogenous zone is the G-spot (also known as the Gräfenberg spot); it is typically defined as being located at the anterior wall of the vagina, a couple or few inches in from the entrance, and some women experience intense pleasure, and sometimes an orgasm, if this area is stimulated during sexual activity. A G-spot orgasm may be responsible for female ejaculation, leading some doctors and researchers to believe that G-spot pleasure comes from the Skene's glands, a female homologue of the prostate, rather than any particular spot on the vaginal wall; other researchers consider the connection between the Skene's glands and the G-spot area to be weak. The G-spot's existence, and existence as a distinct structure, is still under dispute, as its reported location can vary from woman to woman, appears to be nonexistent in some women, and it is hypothesized to be an extension of the clitoris and therefore the reason for orgasms experienced vaginally.

Childbirth
The vagina provides a channel to deliver a newborn to its independent life outside the body of the mother. When childbirth (or labor) nears, several symptoms may occur, including Braxton Hicks contractions, vaginal discharge, and the rupture of membranes (water breaking). When water breaking happens, there may be an uncommon wet sensation in the vagina; this could be an irregular or small stream of fluid from the vagina, or a gush of fluid.

When the body prepares for childbirth, the cervix softens, thins, moves forward to face the front, and may begin to open. This allows the fetus to settle or "drop" into the pelvis. When the fetus settles into the pelvis, this may result in pain in the sciatic nerves, increased vaginal discharge, and increased urinary frequency. While these symptoms are likelier to happen after labor has already begun for women who have given birth before, they may happen approximately ten to fourteen days before labor in women experiencing the effects of nearing labor for the first time.

The fetus begins to lose the support of the cervix when uterine contractions begin. With cervical dilation reaching a diameter of more than 10 cm to accommodate the head of the fetus, the head moves from the uterus to the vagina. The elasticity of the vagina allows it to stretch to many times its normal diameter in order to deliver the child.

Vaginal births are more common, but there are sometimes complications and a woman might undergo a caesarean section (commonly known as a C-section) instead of a vaginal delivery. The vaginal mucosa has an abnormal accumulation of fluid (edematous) and is thin, with few rugae, a little after birth. The mucosa thickens and rugae return in approximately three weeks once the ovaries regain usual function and estrogen flow is restored. The vaginal opening gapes and is relaxed, until it returns to its approximate pre-pregnant state by six to eight weeks in the period beginning immediately after the birth (the postpartum period); however, it will maintain a larger shape than it previously had.

Vaginal microbiota
The vagina is a dynamic ecosystem that undergoes long-term changes, from neonate to puberty and from menarche to menopause. Healthy vaginal microbiota consists of species and genera which generally do not cause symptoms, infections, result in good pregnancy outcomes, and is dominated mainly by Lactobacillus species. Under the influence of hormones, such as estrogen, progesterone and follicle-stimulating hormone (FSH), the vaginal ecosystem undergoes cyclic or periodic changes. Average vaginal pH varies significantly during a woman's lifespan, from 7.0 in premenarchal girls, to 3.8-4.4 in women of reproductive age to 6.5-7.0 during menopause without hormone therapy and 4.5-5.0 with hormone replacement therapy. Estrogen, glycogen and lactobacilli are important factors in this variation.

General
The vagina is self-cleansing and therefore usually does not need special hygiene. Doctors generally discourage the practice of douching for maintaining vulvovaginal health. Since a healthy vagina is colonized by a mutually symbiotic flora of microorganisms that protect its host from disease-causing microbes, any attempt to upset this balance may cause many undesirable outcomes, including but not limited to abnormal discharge and yeast infection.

The vagina and cervix are examined during gynecological examinations of the pelvis, often using a speculum, which holds the vagina open for visual inspection or taking samples (see pap smear). This and other medical procedures involving the vagina, including digital internal examinations and administration of medicine, are referred to as being "per vaginam", the Latin for "via the vagina", often abbreviated to "p.v.". Examination of the vagina may also be done during a cavity search. The healthy vagina of a woman of child-bearing age is acidic, with a pH normally ranging between 3.8 and 4.5.; this is due to the degradation of glycogen to the lactic acid by enzymes secreted by the Döderlein's bacillus, which is a normal commensal of the vagina. The acidity delays or slows the growth of many strains of pathogenic microbes. An increased pH of the vagina (with a commonly used cut-off of pH 4.5 or higher) can be caused by bacterial overgrowth, as occurs in bacterial vaginosis and trichomoniasis, or rupture of membranes in pregnancy. There are different types of bacterial vaginosis.

Intravaginal administration is a route of administration where the substance is applied to the inside of the vagina. Pharmacologically, it has the potential advantage to result in effects primarily in the vagina or nearby structures (such as the vaginal portion of cervix) with limited systemic adverse effects compared to other routes of administration.

Infections, safe sex, and disorders
There are many infections, diseases and disorders that can affect the vagina, including candidal vulvovaginitis, vaginitis, vaginismus, sexually transmitted infections (STIs) or cancer. Vaginitis is an inflammation of the vagina, and is attributed to several vaginal diseases, while vaginismus is an involuntary tightening of the vagina muscles caused by a conditioned reflex, or disease, during vaginal penetration. HIV/AIDS, human papillomavirus (HPV), genital herpes and trichomoniasis are some of the STIs that may affect the vagina, and health sources recommend safe sex (or barrier method) practices to prevent the transmission of these and other STIs.

Safe sex commonly involves the use of condoms (also known as male condoms), but female condoms, which give women more control during the safe sex practice, may also be used; both condoms keep semen from coming in contact with the vagina, which can also help prevent unwanted pregnancy. There is, however, little research on whether female condoms are as effective as male condoms at preventing STIs, and they are slightly less effective than male condoms at preventing pregnancy, which may be due to the female condom not fitting as tightly as the male condom or because it can slip into the vagina and spill semen.

Cervical cancer may be prevented by pap smear screening and HPV vaccines. Vaginal cancer is very rare, and is primarily a matter of old age; its symptoms include abnormal vaginal bleeding or vaginal discharge.

There can be a vaginal obstruction, such as one caused by agenesis, an imperforate hymen or, less commonly, a transverse vaginal septum; these cases require differentiation because surgery for them significantly varies. When there is a lump obstructing the vaginal opening, it is likely a Bartholin's cyst.

Vaginal prolapse is characterized by a portion of the vaginal canal protruding (prolapsing) from the opening of the vagina. It may result in the case of weakened pelvic muscles, which is a common result of childbirth; in the case of this prolapse, the rectum, uterus, or bladder pushes on the vagina, and severe cases result in the vagina protruding out of the body. Kegel exercises have been used to strengthen the pelvic floor, and may help prevent or remedy vaginal prolapse.

Modification
The vagina, including the vaginal opening, may be altered as a result of genital modification during vaginoplasty or labiaplasty; for example, alteration to the inner labia (also known as the vaginal lips or labia minora). There is no evidence that such surgery improves psychological or relationship problems; however, the surgery has a risk of damaging blood vessels and nerves.

Female genital mutilation (FGM), another aspect of female genital modification, may additionally be known as female circumcision or female genital cutting (FGC). FGM has no known health benefits. The most severe form of FGM is infibulation, in which there is removal of all or part of the inner and outer labia (labia minora and labia majora) and the closure of the vagina; this is called Type III FGM, and it involves a small hole being left for the passage of urine and menstrual blood, with the vagina being opened up for sexual intercourse and childbirth.

Perceptions, symbolism and vulgarity
Various perceptions of the vagina have existed throughout history, including the belief it is the center of sexual desire, a metaphor for life via birth, inferior to the penis, visually unappealing, inherently unpleasant to smell, or otherwise vulgar. These views can largely be attributed to sex differences, and how they are interpreted. David Buss, an evolutionary psychologist, stated that because a penis is significantly larger than a clitoris and it is "on display and ready to be noticed" while the vagina is not, and males urinate through the penis, boys are taught from childhood "to touch and hold their penises" while girls are often taught that they should not touch their own genitals, as if there is harm in doing so. Buss attributed this to the reason why many women are not as familiar with their genitalia as men are familiar with their own, and that researchers assume these sex differences explain why boys learn to masturbate before girls, and masturbate more often than girls.

The word vagina is commonly avoided in conversation, and many people are confused about its anatomy; for example, the fact the vagina is not used for urination. This is exacerbated by phrases such as "boys have a penis, girls have a vagina", which causes children to think that girls have one orifice in the pelvic area. Author Hilda Hutcherson stated, "Because many of us [women] have been conditioned since childhood through verbal and nonverbal cues to think of our genitals as ugly, smelly and unclean, we aren't able to fully enjoy intimate encounters because of fear that our partner will be turned off by the sight, smell, and taste of our genitals." She added that women, unlike men, did not have locker room experiences in school where they compared each other's genitals, and so many women wonder if their genitals are normal. Scholar Catherine Blackledge stated that having a vagina meant she would typically be treated less well than a "vagina-less person" and that she "could be expected to work all [her] life for less money than if [she] was minus female genitalia"; it meant she "could expect to be treated as a second-class citizen".

Negative views of the vagina are simultaneously contrasted by views that it is a powerful symbol of female sexuality, spirituality, or life. Author Denise Linn stated, "[The vagina] is a powerful symbol of womanliness, openness, acceptance, and receptivity. It is the inner valley spirit." Sigmund Freud placed significant value on the vagina, postulating the concept of vaginal orgasm, that it is separate from clitoral orgasm, and that, upon reaching puberty, the proper response of mature women is a change-over to vaginal orgasms (meaning orgasms without any clitoral stimulation). This theory, however, made many women feel inadequate, as the majority of women cannot achieve orgasm via vaginal intercourse alone. Regarding religion, the vagina represents a powerful symbol as the yoni in Hindu, and this may indicate the value that Hindu society has given female sexuality and the vagina's ability to birth life. While, in ancient times, the vagina was often considered equivalent (homologous) to the penis, with anatomists Galen (129 AD – 200 AD) and Vesalius (1514–1564) regarding the organs as structurally the same except for the vagina being inverted, anatomical studies over latter centuries showed the clitoris to be the penile equivalent. Another perception of the vagina was that the release of vaginal fluids would cure or remedy a number of ailments; various methods were used over the centuries to release "female seed" (via vaginal lubrication or female ejaculation) as a treatment for suffocation ex semine retento (suffocation of the womb), green sickness, and possibly for female hysteria. Methods included a midwife rubbing the walls of the vagina or insertion of the penis or penis-shaped objects into the vagina. Supposed symptoms of female hysteria included faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and "a tendency to cause trouble". It may be that women who were considered suffering from the condition would sometimes undergo "pelvic massage" — stimulation of the genitals by the doctor until the woman experienced "hysterical paroxysm" (i.e., orgasm). In this case, paroxysm was regarded as a medical treatment, and not a sexual release. The categorization of female hysteria has ceased to be recognized as a medical condition since the 1920s.

The vagina and vulva have additionally been termed many vulgar names, three of which are cunt, twat, and pussy. Cunt is used as a derogatory epithet referring to people of either sex. This usage is relatively recent, dating from the late nineteenth century. Reflecting different national usages, cunt is described as "an unpleasant or stupid person" in the Compact Oxford English Dictionary, whereas Merriam-Webster has a usage of the term as "usually disparaging and obscene: woman", noting that it is used in the U.S. as "an offensive way to refer to a woman"; and the Macquarie Dictionary of Australian English states that it is "a despicable man". When used with a positive qualifier (good, funny, clever, etc.) in Britain, New Zealand and Australia, it can convey a positive sense of the object or person referred to. Some feminists of the 1970s sought to eliminate disparaging terms such as "cunt". In the context of pornography, Catharine MacKinnon argued that use of the word acts to reinforce a dehumanisation of women by reducing them to mere body parts. "Twat" is widely used as a derogatory epithet, especially in British English, referring to a person considered obnoxious or stupid. Pussy can indicate "cowardice or weakness", and "the human vulva or vagina" or by extension "sexual intercourse with a woman". In contemporary English, use of the word pussy to refer to women is considered derogatory or demeaning, treating people as sexual objects.

In contemporary literature and art
The vagina loquens, or "talking vagina", is a significant tradition in literature and art, dating back to the ancient folklore motifs of the "talking cunt". These tales usually involve vaginas talking due to the effect of magic or charms, and often admitting to their unchastity. Another folk tale regarding the vagina is "vagina dentata" (Latin for "toothed vagina"). In these folk tales, a woman's vagina is said to contain teeth, with the associated implication that sexual intercourse might result in injury, emasculation, or castration for the man involved. These stories were frequently told as cautionary tales warning of the dangers of unknown women and to discourage rape.

In 1966, the French artist Niki de Saint Phalle collaborated with Dadaist artist Jean Tinguely and Per Olof Ultvedt on a large sculpture installation entitled "hon-en katedral" (also spelled "Hon-en-Katedrall", which means "she-a cathedral") for Moderna Museet, in Stockholm, Sweden. The outer form is a giant, reclining sculpture of a woman with her legs spread. Museum patrons can go inside her body by entering a door-sized vaginal opening. Sainte Phalle stated that the sculpture represented a fertility goddess who was able to receive visitors into her body and then "give birth" to them again. Inside her body is a screen showing Greta Garbo films, a goldfish pond and a soft drink vending machine. The piece elicited immense public reaction in magazines and newspapers throughout the world. From 1974 to 1979, Judy Chicago, a feminist artist, created the vagina-themed installation artwork "The Dinner Party". It consists of 39 elaborate place settings arranged along a triangular table for 39 mythical and historical famous women. Virginia Woolf, Susan B. Anthony, Sojourner Truth, Eleanor of Aquitaine, and Theodora of Byzantium are among those honored. Each plate, except the one corresponding to Sojourner Truth (a Black woman), depicts a brightly-colored, elaborately styled vagina-esque form. After it was produced, despite resistance from the art world, it toured to 16 venues in six countries to a viewing audience of 15 million.

The Vagina Monologues, a 1996 episodic play by Eve Ensler, has contributed to making female sexuality a topic of public discourse. It is made up of a varying number of monologues read by a number of women. Initially, Ensler performed every monologue herself, with subsequent performances featuring three actresses; latter versions feature a different actress for every role. Each of the monologues deals with an aspect of the feminine experience, touching on matters such as sexual activity, love, rape, menstruation, female genital mutilation, masturbation, birth, orgasm, the various common names for the vagina, or simply as a physical aspect of the body. A recurring theme throughout the pieces is the vagina as a tool of female empowerment, and the ultimate embodiment of individuality.

In 2012, an image of an 1866 Gustave Courbet painting of the female genitals, entitled "The Origin of the World", being posted on Facebook led to a legal dispute. After a French teacher posted an image of the painting, Facebook considered the image to be pornographic and suspended his account for violating its terms of use. The Huffington Post called the painting "a frank image of a vagina." Mark Stern of Slate, who called the painting a stunning, brilliant "....cornerstone of the French Realistic movement", stated that the teacher sued the website for allegedly violating his freedom of speech. In October 2013, artist Peter Reynosa created a "... red and white acrylic painting [that] depicts [pop singer] Madonna painted in the shape of a defiant yonic symbol that looks like a vagina or vulva."

Reasons for vaginal modification
Reasons for modification of the female genitalia other than FGM include voluntary cosmetic operations and surgery for intersex conditions, which can involve surgery to the vagina, labia minora, or clitoris. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions (such as an intersex condition), and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range.

Significant controversy surrounds FGM, with the World Health Organization (WHO) being one of many health organizations that have campaigned against the procedures on behalf of human rights, stating that it is "a violation of the human rights of girls and women" and "reflects deep-rooted inequality between the sexes". FGM has existed at one point or another in almost all human civilizations, most commonly to exert control over the sexual behavior, including masturbation, of girls and women. It is carried out in several countries, especially in Africa, and to a lesser extent in other parts of the Middle East and Southeast Asia, on girls from a few days old to mid-adolescent, often to reduce sexual desire in an effort to preserve vaginal virginity. It may also be that FGM was "practiced in ancient Egypt as a sign of distinction among the aristocracy"; there are reports that traces of infibulation are on Egyptian mummies.

Custom and tradition are the most frequently cited reasons for FGM, with some cultures believing that not performing it has the possibility of disrupting the cohesiveness of their social and political systems, such as FGM also being a part of a girl's initiation into adulthood. Often, a girl is not considered an adult in a FGM-practicing society unless she has undergone FGM.

Other animals
The vagina is a feature of animals in which the female is internally fertilized, other than by traumatic insemination. The shape of the vagina varies among different animals. In placental mammals and marsupials, the vagina leads from the uterus to the exterior of the female body. Female marsupials have two lateral vaginas, which lead to separate uteri, but both open externally through the same orifice. The urethra and vagina of the female spotted hyena exits through the clitoris, allowing the females to urinate, copulate and give birth through the clitoris. The canine female vagina contracts during copulation, forming a copulatory tie.

In birds, monotremes, and some reptiles, a homologous part of the oviduct leads from the shell gland to the cloaca. In some jawless fish, there is neither oviduct nor vagina and instead the egg travels directly through the body cavity (and is fertilised externally as in most fish and amphibians). In insects and other invertebrates, the vagina can be a part of the oviduct (see insect reproductive system). Females of some waterfowl species have developed vaginal structures called dead end sacs and clockwise coils to protect themselves from sexual coercion.

In 2014, the scientific journal Current Biology reported that four species of Brazilian insects in the genus Neotrogla were found to have sex-reversed genitalia. The male insects of those species have vagina-like openings, while the females have penis-like organs.