Weighing the Impact of Vulvar Medical Stigma and Gynecological Care

The seemingly immortal stigmatization of gynecological care has an untold impact on many women.

Countless campaigns have tried to shed the shame attached to it, yet gynecological care is still sidelined, leaving some women alone in their struggles.

There is one section of gynecological health that is particularly stigmatized, mainly because few people can accurately define it: Meet the vulva. Consisting of the mons pubis, labia majora and minora, clitoris, vulvar vestibule, urethra, Bartholin's glands and Skene's glands, the vulva is essential to women's sexual and overall health.

While roughly 50 percent of the people in the world have a vagina, one quarter of women in the United States do not know where it is, according to a 2020 poll commissioned by Intimina, a sexual wellness brand, and conducted by OnePoll. This finding indicates that the associated stigma continues to flourish unchecked.

Failing education and underfunded research 

Although significant progress has been made since the days when "wandering wombs" and "hysteria" were the diagnoses for many of women's ailments, the stigma attached to gynecological care endures.

It is no secret that gynecological care is unequally funded, with one 2020 study published in Gynecology Oncology journal indicating that gynecological cancers showed a nearly universal decrease in research funds based on funding to lethality scores.

While generations before us faced more difficulties securing gynecological healthcare and contended with a complete absence of sex education, the stigma lives on. A lack of education has left many people without the knowledge to communicate medical or physical needs to physicians or partners, leaving them ill-equipped to address concerns and likely to endure far more pain than is necessary before seeking help.

"I think the stigma impacts patients significantly," said Anna Cabeca, D.O., an OB-GYN based in Dallas and author of "The Hormone Fix." "When there is a level of embarrassment in talking about it, many women won't say when they're in pain or in discomfort, when they experience dryness or lack of sensitivity or sexual desire, enjoyment or arousal."

The culture around vulva health has long been one of silence and avoidance. As a result, unhelpful myths and misinformation often usurp science.

Visual and functional stigma

More young people are being subjected to the "perfect vulva" in pornography, with the average child in the United States seeing porn for the first time around the age of 12, according to a 2022 report by Common Sense Media.

"In porn, many actors have hairless vulvas and may have undergone labiaplasties," said Naomi Sutton, M.B.B.S., a consultant physician with Family Planning Association in Derby, England. "Unless this is counteracted by education, conversations and images of the wonderful variety of vulvas which exist, it may lead to feelings of shame and discomfort with this part of the body. This can then lead to the avoidance of seeking help for genital problems and routine cervical screening tests."

Pornography and celebrities selling products designed for vulvas can dictate what a "good" one looks like, but this body part is diverse. Bodies are not beauty trends, so the vulva's appearance simply cannot come in and out of fashion.

Vulva stigma is not limited to appearance, though—it also triggers fears around function.

"We do not hesitate to seek help when it comes to concerns around fertility that involve our uterus and ovaries," explained Jessherin Sidhu, M.D., the medical director at Insync Medical in Singapore and consultant for Smile Makers Vulva Talks program. "But when it comes to things like the way our vulva might smell or the way our vulva might look, we hesitate a little because many do not want to come across as they're being too nitpicking around their vulva, or they go, 'Perhaps this is just normal for my vulva to smell or look a certain way.'"

Checking your vulva

The first step to shattering vulva stigma is taking on the responsibility yourself. You must understand your own body before breaking down associated taboos.

Take a mirror and explore your vulva. Make a mental note of its properties and focus on celebrating its uniqueness, not criticizing its differences from other vulvas. If seeing yourself up close and personal is too daunting, try exploring with your sense of touch first.

Most importantly, conduct regular checks, Sidhu advised.

"A vulva check doesn't have to be effortful," she said. "It's something that you can do during a shower. Rubbing your fingers across your vulva, starting right at the top of the apex of the vulva where the clitoris sits, and gliding your fingers right down along both sides on the left or the right of the clitoris allows you to feel for lumps or bumps in that area, which might signify something that has changed or something that could potentially be abnormal."

Remedying the stigma

To permanently shift the tide of stigma, education has to take priority. Improving it starts at home with using the anatomically correct terminology, not substituting euphemisms or incorrect words.

"We do not start off as a child embarrassed about our bodies. These emotions are, therefore, learned responses, and parental guidance can have a huge influence on this," Sutton explained. "If genitals, including vulvas, are talked about like feet or noses at home, it allows the child to grow up with a much better chance at having a positive body image."

If you are concerned about raising these issues as a patient, prepare by writing down key phrases, such as, "Please, can you be gentle during this exam?" and "Explain every step before you do it." Remember, your physician is there to help you, not judge you.

"For anyone who feels nervous or embarrassed about coming to seek help for a vulval health issue, please try to be reassured that looking at genitals is part of our jobs as a healthcare professional," Sutton said. "We totally understand that it can be difficult and sometimes may even be triggering if you have experienced sexual assault or medical trauma. Please talk to your healthcare professional about your concerns, and we can adapt the examination to suit you."

While society has work to do before eliminating vulva stigma, progress is made on an individual basis. There is always time to learn to embrace your vulva and empower yourself to shed the stigma, as Sutton said.

"I don't think it is ever too late to learn to love your vulva, or at least make peace with it if you feel that you are not the best of friends," she said. "Immerse yourself in healthy messages and view normal-looking vulvas."

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