Many transgender people who were assigned male sex at birth undergo feminizing hormones and gender reassignment surgery (GRS) for gender affirmation. GRS typically includes vaginoplasty, a procedure to construct a neovagina.
During vaginoplasty, surgeons create both the outer and inner vagina using skin from the scrotum. This includes the labia majora, clitoris and hymen.
Vulva
The vulva is the outer female genital organs. It includes the mons pubis (the rounded bump of flesh above your pubic bone) and the opening of the vagina, the muscular canal for sex, childbirth and menstruation. The vulva also contains the labia majora and labia minora, clitoris, hymen, vestibule, Skene glands and Bartholin glands.
The labia majora — the two outer skin folds that look like lips — cover and protect the other external genital organs. The inner labia, known as the labia minora, are smaller and closer to the vaginal and urethral openings. The clitoris is a small organ that has thousands of nerve endings and, when sexually stimulated, becomes erect and swollen with blood. The clitoral hood and vestibule are a soft fold of skin that covers the clitoris and protects the glans, or tip.
While it’s common to see a trans woman’s vulva as a messy bundle of tissue, it is important to remember that the vulva is actually quite well designed. For example, a woman’s vulva is built to accommodate a penis of almost any length and girth. This is because the spongy mucus membrane that lines the inner vagina expands significantly when sexually aroused. In addition, despite their appearance as a mess of tissue, the vulva is actually very strong and has many muscle attachments.
Clitoris
A female homologue of the male penis, the clitoris has a long history as a sexual organ. It develops (as the penis does) from a tubercle in an undifferentiated common tissue anlagen of the embryo, and it plays a central role during tactile stimulation.
It is a bit more than a pea-sized bump on the top of your vulva. Its “legs,” called the crura, extend inside your body, anchored by a spongy portion of tissue (called the corpus cavernosa) on either side. These legs, when aroused, expand like an erectile muscle, and they send signals to the vulva that trigger sexual responses.
The tip of the clitoris, which is visible through a small flap of skin called the clitoral hood, is covered with a generous supply of sensitive nerve endings, which contribute to the sensations of orgasm. It can be as small as a pea or as big as a thumb. It may be covered or uncovered by the inner labia minora, which vary in size and shape in cisgender women.
Like the penis, the clitoris can cause pain when touched in the wrong way. It can also become irritated by infections such as bacterial vaginosis, yeast infection, and herpes. This is why it’s important to dilate frequently. Dilating will not only help reduce friction, but it will also increase the width of your vulva.
Labia Majora
The labia majora (singular: labium majus) are a pair of rounded folds of skin and adipose that form part of the external female genitalia. They cover and protect the inner, more delicate and sensitive structures of the vulva, such as the labia minora, clitoris, and vaginal orifice. They are homologous to the scrotum with testicles in males, and develop from the same embryological tissue.
Labia majora are thick flaps of skin on either side of the mons pubis, and they contain fatty tissue that give them support and flexibility. They are covered with pubic hair and have a wide range of size, shape, color, and texture, and they may be wrinkled or smooth. One or the other of the labia may be longer than the other, and they can be shorter or even absent. They are sometimes described as the “lips” of the vulva.
Inside the labia majora are the labia minora, which resemble small lips and also have a wide range of size, shape, and texture. They are surrounded by a rich supply of blood vessels, which make them appear pink in color and engorged during sexual stimulation. The area between the labia minora and the anus is called the vulva vestibule, and it contains the openings to the urethra and the vaginal orifice.
The vestibule receives additional innervation from the genitofemoral nerve, and it gives rise to paraurethral glands (also known as Bartholin’s glands) and Skene’s glands. A recent study of the vaginal flora in transgender women with and without symptoms of odor or discharge found Staphylococcus, Streptococcus, Enterococcus, Mobiluncus, and Bacteroides species to be the most common organisms, while lactobacilli were rare and candida was not present.
Hymen
Just like the vulva, your hymen is unique to you. It’s a thin piece of membrane located at the bottom of the vaginal opening, and it can take on different shapes and sizes. It can be ring-shaped, donut-shaped, or crescent-shaped, and it can be very thin or very thick. It may also have perforations shaped like a half-moon.
Hymens are made of elastic tissue, so they wear down and tear over time, generally as a result of daily activities, hormonal changes, tampon use, or sexual activity. When your hymen tears, you might experience light bleeding or spotting. It’s important to note, though, that this is normal and not a sign of virginity.
Your hymen is not always visible, and it can be difficult to know what shape it’s taking. However, if you want to check it out, you can do so with a hand mirror or ask your doctor.
Examining the hymen is not a good way to determine sexual history, and it can lead to societal and individual harms. Girls and women are often subjected to forensic examinations of the genital region, which can lead to mistrust and disrespect for bodily sovereignty, as well as physical discomfort and pain. In addition, reliance on the hymen can lead to misdiagnosis and inaccurate conclusions about sexual violence.
