Editing Vagina (section)

==Clinical significance==

===Pelvic examinations===
[[File:Spéculum en plastique.jpg|thumb|right|alt=Photograph of a transparent speculum on a white surface|A disposable plastic bi-valved vaginal [[Speculum (medical)|speculum]] used in [[Pelvic examination|gynecological examination]]]]
[[File:Cervix uteri, breastfeeding woman after 2 births.jpg|thumb|alt=Photograph of a cervix as described in caption|A normal [[cervix]] of an adult as seen through the vagina ({{lang|la|per vaginam}} or PV) using a [[Speculum (medical)#Vaginal|bivalved vaginal speculum]]. The blades of the speculum are above and below and stretched vaginal walls are seen on the left and right.]]
Vaginal health can be assessed during a [[pelvic examination]], along with the health of most of the organs of the female reproductive system.<ref name="Damico"/><ref>{{Cite web|url=https://www.cancer.gov/publications/dictionaries/cancer-terms|title=NCI Dictionary of Cancer Terms|website=National Cancer Institute|access-date=January 5, 2018|date=February 2, 2011|archive-date=September 14, 2018|archive-url=https://web.archive.org/web/20180914111122/https://www.cancer.gov/publications/dictionaries/cancer-terms|url-status=live}}</ref><ref name="Vickery">{{cite book|vauthors=Vickery DM, Fries JF|title=Take Care of Yourself: The Complete Illustrated Guide to Medical Self-Care|publisher=[[Da Capo Press]]|isbn=978-0-7867-5218-8|year=2013|url=https://books.google.com/books?id=dXqEAAAAQBAJ|access-date=October 27, 2015|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000858/https://books.google.com/books?id=dXqEAAAAQBAJ|url-status=live}}</ref> Such exams may include the [[Pap test]] (or cervical smear). In the United States, Pap test screening is recommended starting around 21 years of age until the age of 65.<ref>{{Cite web|url=https://www.cdc.gov/cancer/knowledge/provider-education/cervical/recommendations.htm|title=CDC - Cervical Cancer Screening Recommendations and Considerations - Gynecologic Cancer Curriculum - Inside Knowledge Campaign|website=Centers for Disease Control and Prevention|language=en-us|access-date=January 19, 2018|archive-date=January 19, 2018|archive-url=https://web.archive.org/web/20180119060654/https://www.cdc.gov/cancer/knowledge/provider-education/cervical/recommendations.htm|url-status=live}}</ref>  However, other countries do not recommend pap testing in non-sexually active women.<ref name=US2012>{{Cite journal|vauthors=Moyer VA|s2cid=36965456 |date=September 2016 |title=Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement.|journal=Annals of Internal Medicine|volume=156|issue=12|pages=880–91|pmid=22711081|doi=10.7326/0003-4819-156-12-201206190-00424}}</ref> Guidelines on frequency vary from every three to five years.<ref name=US2012/><ref name=Saslow2012>{{Cite journal|vauthors= Saslow D |title=American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer|journal=Journal of Lower Genital Tract Disease|volume=16|issue=3|pages=175–204|year =2012|doi=10.1097/LGT.0b013e31824ca9d5|pmid=22418039|pmc=3915715}}</ref><ref name="cancer.org">{{cite web|title=Can Cervical Cancer Be Prevented?|publisher=[[American Cancer Society]]|date=November 1, 2017|access-date=January 7, 2018|url=http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervical-cancer-prevention|archive-date=December 10, 2016|archive-url=https://web.archive.org/web/20161210123552/http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-prevention|url-status=live}}</ref> Routine pelvic examination on women who are not pregnant and lack symptoms may be more harmful than beneficial.<ref name="Qa2014">{{cite journal|vauthors=Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD |date=July 1, 2014|title=Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians.|journal=Annals of Internal Medicine|volume=161|issue=1|pages=67–72|doi=10.7326/M14-0701|pmid=24979451|citeseerx=10.1.1.691.4471|s2cid=12370761 }}[Free text]</ref> A normal finding during the pelvic exam of a pregnant woman is a bluish tinge to the vaginal wall.<ref name="Damico"/>

Pelvic exams are most often performed when there are unexplained symptoms of discharge, pain, unexpected bleeding or urinary problems.<ref name="Damico">{{cite book|title=Health & physical assessment in nursing|vauthors=Damico D|publisher=Pearson|year=2016|isbn=978-0-13-387640-6|location=Boston|page=665}}</ref><ref name="Mayo">{{Cite web|url=https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135|title=Pelvic exam - About - Mayo Clinic|website=www.mayoclinic.org|language=en|access-date=January 4, 2018|archive-date=January 5, 2018|archive-url=https://web.archive.org/web/20180105012302/https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135|url-status=live}}</ref><ref name=AW2007>{{cite book|vauthors=Hinrichsen C, Lisowski P|title=Anatomy Workbook|publisher=[[World Scientific Publishing Company]]|isbn=978-981-256-906-6|year=2007|page=101|url=https://books.google.com/books?id=1rxhPgAACAAJ&q=Anatomy+Workbook+Colin+Hinrichsen|access-date=October 19, 2020|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000703/https://books.google.com/books?id=1rxhPgAACAAJ&q=Anatomy+Workbook+Colin+Hinrichsen|url-status=live}}</ref> During a pelvic exam, the vaginal opening is assessed for position, [[symmetry]], presence of the hymen, and shape. The vagina is assessed internally by the examiner with gloved fingers, before the speculum is inserted, to note the presence of any weakness, lumps or [[Nodule (medicine)|nodules]]. Inflammation and discharge are noted if present. During this time, the Skene's and Bartolin's glands are palpated to identify abnormalities in these structures. After the digital examination of the vagina is complete, the speculum, an instrument to visualize internal structures, is carefully inserted to make the cervix visible.<ref name="Damico"/> Examination of the vagina may also be done during a [[cavity search]].<ref name="Stering">{{cite book|url=https://books.google.com/books?id=2rlUcxpsck4C&pg=PA80|title=Police Officer's Handbook: An Introductory Guide|vauthors=Stering R|publisher=[[Jones & Bartlett Learning]]|year=2004|isbn=978-0-7637-4789-3|page=80|access-date=April 2, 2017|archive-date=April 3, 2017|archive-url=https://web.archive.org/web/20170403111503/https://books.google.com/books?id=2rlUcxpsck4C&pg=PA80|url-status=live}}</ref>

Lacerations or other injuries to the vagina can occur during [[sexual assault]] or other [[sexual abuse]].<ref name="Dalton" /><ref name="Damico" /> These can be tears, bruises, inflammation and abrasions. Sexual assault with objects can damage the vagina and [[X-ray]] examination may reveal the presence of foreign objects.<ref name="Dalton" /> If consent is given, a pelvic examination is part of the assessment of sexual assault.<ref name = Hoffman>{{Cite book |title=Williams gynecology |date=2012|publisher=McGraw-Hill Medical |vauthors=Hoffman B, Schorge J, Schaffer J, Halvorson L, Bradshaw K, Cunningham F |isbn=978-0-07-171672-7|edition=2nd |location=New York|pages=371|oclc=779244257}}</ref> Pelvic exams are also performed during pregnancy, and women with high risk pregnancies have exams more often.<ref name="Damico"/><ref>{{Cite web|url=https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests|title=Prenatal care and tests {{!}} womenshealth.gov|website=womenshealth.gov|language=en|access-date=January 5, 2018|date=December 13, 2016|archive-date=April 18, 2019|archive-url=https://web.archive.org/web/20190418234111/https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests|url-status=live}}{{PD-notice}}</ref>

===Medications===
[[Intravaginal administration]] is a [[route of administration]] where the medication is inserted into the vagina as a creme or tablet. [[Pharmacological]]ly, this has the potential advantage of promoting [[therapeutic effect]]s primarily in the vagina or nearby structures (such as the [[vaginal portion of cervix]]) with limited systemic [[adverse effect]]s compared to other routes of administration.<ref name="Ranade">{{cite book |vauthors=Ranade VV, Cannon JB |title=Drug Delivery Systems |edition=3rd |publisher=[[CRC Press]] |isbn=978-1-4398-0618-0 |year=2011 |page=337 |url=https://books.google.com/books?id=PBfLKBTQk0cC&pg=PA337 |access-date=October 27, 2015 |archive-date=May 6, 2016 |archive-url=https://web.archive.org/web/20160506164911/https://books.google.com/books?id=PBfLKBTQk0cC&pg=PA337 |url-status=live }}</ref><ref name="Lehne">{{cite book|vauthors=Lehne RA, Rosenthal L|title=Pharmacology for Nursing Care|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-29354-9|year=2014|page=1146|url=https://books.google.com/books?id=udTsAwAAQBAJ&pg=PA1146|access-date=October 27, 2015|archive-date=May 6, 2016|archive-url=https://web.archive.org/web/20160506162710/https://books.google.com/books?id=udTsAwAAQBAJ&pg=PA1146|url-status=live}}</ref> Medications used to ripen the cervix and induce labor are commonly administered via this route, as are estrogens, contraceptive agents, [[propranolol]], and [[antifungal medication|antifungals]]. [[Vaginal ring]]s can also be used to deliver medication, including [[birth control]] in [[contraceptive vaginal ring]]s. These are inserted into the vagina and provide continuous, low dose and consistent drug levels in the vagina and throughout the body.<ref>{{Cite journal|vauthors=Srikrishna S, Cardozo L |s2cid=25185650 |date=April 2013 |title=The vagina as a route for drug delivery: a review |journal=International Urogynecology Journal|language=en|volume=24|issue=4|pages=537–543|doi=10.1007/s00192-012-2009-3|pmid=23229421 |issn=0937-3462}}</ref><ref>{{Cite web|url=https://www.medscape.org/viewarticle/504375_5|title=The Benefits of Vaginal Drug Administration—Communicating Effectively With Patients: The Vagina: New Options for the Administration of Medications|date=January 8, 2018|website=www.medscape.org|publisher=Medscape|access-date=January 8, 2018|archive-date=October 18, 2015|archive-url=https://web.archive.org/web/20151018010055/http://www.medscape.org/viewarticle/504375_5|url-status=live}}</ref>

Before the baby emerges from the womb, an injection for pain control during childbirth may be administered through the vaginal wall and near the [[pudendal nerve]]. Because the pudendal nerve carries motor and sensory fibers that innervate the pelvic muscles, a [[Pudendal nerve#Anesthesia|pudendal nerve block]] relieves birth pain. The medicine does not harm the child, and is without significant complications.<ref name="Maclean2011">{{cite book|title=Gynaecology |vauthors=Maclean A, Reid W |publisher=Churchill Livingstone/Elsevier|year=2011|isbn=978-0-7020-3120-5|veditors=Shaw R |location=Edinburgh New York|pages=599–612|chapter=40}}</ref>

===Infections, diseases, and safe sex===
{{Main|Vaginal disease|Safe sex}}
Vaginal infections or diseases include [[Vaginal yeast infection|yeast infection]], [[vaginitis]], [[sexually transmitted infection]]s (STIs) and [[cancer]]. ''Lactobacillus gasseri'' and other ''Lactobacillus'' species in the vaginal flora provide some protection from infections by their secretion of [[bacteriocins]] and [[hydrogen peroxide]].<ref>{{Cite journal|vauthors = Nardis C, Mosca L, Mastromarino P|date=September 2013|title=Vaginal microbiota and viral sexually transmitted diseases|journal=Annali di Igiene: Medicina Preventiva e di Comunità|language = en | volume=25|issue=5|pages=443–456|issn=1120-9135|pmid=24048183|doi=10.7416/ai.2013.1946}}</ref> The healthy vagina of a woman of child-bearing age is [[acid]]ic, with a [[pH#Living systems|pH]] normally ranging between 3.8 and 4.5.<ref name="King"/> The low pH prohibits growth of many strains of [[pathogen]]ic microbes.<ref name="King"/> The acidic balance of the vagina may also be affected by semen,<ref>{{Cite journal |last1=Baldewijns |first1=Silke |last2=Sillen |first2=Mart |last3=Palmans |first3=Ilse |last4=Vandecruys |first4=Paul |last5=Van Dijck |first5=Patrick |last6=Demuyser |first6=Liesbeth |date=2021-07-02 |title=The Role of Fatty Acid Metabolites in Vaginal Health and Disease: Application to Candidiasis |journal=Frontiers in Microbiology |volume=12 |doi=10.3389/fmicb.2021.705779 |doi-access=free |issn=1664-302X |pmc=8282898 |pmid=34276639}}</ref><ref>{{Cite journal |last1=Jewanraj |first1=Janine |last2=Ngcapu |first2=Sinaye |last3=Liebenberg |first3=Lenine J. P. |date=Nov 2021 |title=Semen: A modulator of female genital tract inflammation and a vector for HIV-1 transmission |journal=American Journal of Reproductive Immunology |language=en |volume=86 |issue=5 |pages=e13478 |doi=10.1111/aji.13478 |issn=1046-7408 |pmc=9286343 |pmid=34077596}}</ref> pregnancy, menstruation, [[diabetes]] or other illness, [[oral contraceptive pill|birth control pills]], certain [[antibiotics]], poor diet, and stress.<ref name="Leifer">{{cite book|vauthors=Leifer G|title=Introduction to Maternity and Pediatric Nursing - E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-29358-7|year=2014|page=276|url=https://books.google.com/books?id=T5I3BQAAQBAJ&pg=PA276|access-date=December 20, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211423/https://books.google.com/books?id=T5I3BQAAQBAJ&pg=PA276|url-status=live}}</ref> Any of these changes to the acidic balance of the vagina may contribute to yeast infection.<ref name="AAOS">{{cite book |url=https://books.google.com/books?id=6yMMs8OCqU4C&pg=PA766 |title=AEMT: Advanced Emergency Care and Transportation of the Sick and Injured |vauthors=[[AAOS]] |publisher=[[Jones & Bartlett Publishers]] |year=2011 |isbn=978-1-4496-8428-0 |page=766 |access-date=December 20, 2017 |archive-url=https://web.archive.org/web/20190703215958/https://books.google.com/books?id=6yMMs8OCqU4C&pg=PA766 |archive-date=July 3, 2019 |url-status=live}}</ref> An elevated pH (greater than 4.5) of the vaginal fluid can be caused by an overgrowth of bacteria as in [[bacterial vaginosis]], or in the parasitic infection [[trichomoniasis]], both of which have vaginitis as a symptom.<ref name="King"/><ref name="Alldredge">{{cite book|vauthors=Alldredge BK, Corelli RL, Ernst ME|title=Koda-Kimble and Young's Applied Therapeutics: The Clinical Use of Drugs|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-1-60913-713-7|year=2012|pages=1636–1641|url=https://books.google.com/books?id=qcVpuHngXK0C&pg=PA1636|access-date=October 27, 2015|archive-date=April 24, 2016|archive-url=https://web.archive.org/web/20160424182703/https://books.google.com/books?id=qcVpuHngXK0C&pg=PA1636|url-status=live}}</ref> Vaginal flora populated by a number of different bacteria characteristic of bacterial vaginosis increases the risk of adverse pregnancy outcomes.<ref>{{Cite journal|vauthors=Lamont RF, Sobel JD, Akins RA, Hassan SS, Chaiworapongsa T, Kusanovic JP, Romero R |date=April 2011 |title=The vaginal microbiome: new information about genital tract flora using molecular based techniques |journal=BJOG: An International Journal of Obstetrics & Gynaecology|language=en|volume=118|issue=5|pages=533–549|doi=10.1111/j.1471-0528.2010.02840.x |pmc=3055920 |pmid=21251190 |issn=1471-0528}}</ref> During a pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections.<ref name="Damico"/><ref>{{Cite web|url=https://www.cancer.gov/publications/dictionaries/cancer-terms|title=NCI Dictionary of Cancer Terms|website=National Cancer Institute|access-date=January 4, 2018|date=February 2, 2011|archive-date=September 14, 2018|archive-url=https://web.archive.org/web/20180914111122/https://www.cancer.gov/publications/dictionaries/cancer-terms|url-status=live}}{{PD-notice}}</ref>

Because the vagina is self-cleansing, it usually does not need special hygiene.<ref name="Grimes">{{cite book|vauthors=Grimes JA, Smith LA, Fagerberg K|title=Sexually Transmitted Disease: An Encyclopedia of Diseases, Prevention, Treatment, and Issues: An Encyclopedia of Diseases, Prevention, Treatment, and Issues|publisher=[[ABC-CLIO]]|isbn=978-1-4408-0135-8|year=2013|pages=144, 590–592|url=https://books.google.com/books?id=wagNAgAAQBAJ&pg=PA144|access-date=December 11, 2017|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704043222/https://books.google.com/books?id=wagNAgAAQBAJ&pg=PA144|url-status=live}}</ref> Clinicians generally discourage the practice of [[douche|douching]] for maintaining vulvovaginal health.<ref name="Grimes"/><ref>{{cite journal |author2-link=Sten H. Vermund| vauthors = Martino JL, Vermund SH | title = Vaginal douching: evidence for risks or benefits to women's health | journal = Epidemiologic Reviews | volume = 24 | issue = 2 | pages = 109–24 | date = 2002 | pmid = 12762087 | pmc = 2567125 | doi = 10.1093/epirev/mxf004 }}</ref> Since the vaginal flora gives protection against disease, a disturbance of this balance may lead to infection and abnormal discharge.<ref name="Grimes"/> Vaginal discharge may indicate a vaginal infection by color and odor, or the resulting symptoms of discharge, such as irritation or burning.<ref name="McGrath">{{cite book|vauthors=McGrath J, Foley A|title=Emergency Nursing Certification (CEN): Self-Assessment and Exam Review|publisher=[[McGraw Hill Professional]]|isbn=978-1-259-58715-3|year=2016|page=138}}</ref><ref name="Wright">{{cite book|vauthors=Wright, WF|title=Essentials of Clinical Infectious Diseases|publisher=[[Demos Medical Publishing]]|isbn=978-1-61705-153-1|year=2013|page=269|url=https://books.google.com/books?id=gGlXEntvU34C&pg=PA269|access-date=January 3, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211233/https://books.google.com/books?id=gGlXEntvU34C&pg=PA269|url-status=live}}</ref> Abnormal vaginal discharge may be caused by STIs, diabetes, douches, fragranced soaps, bubble baths, birth control pills, yeast infection (commonly as a result of antibiotic use) or another form of vaginitis.<ref name="McGrath"/> While vaginitis is an inflammation of the vagina, and is attributed to infection, hormonal issues, or irritants,<ref name="Ferri">{{cite book|vauthors=Ferri FF|title=Ferri's Clinical Advisor 2013|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-08373-7|year=2012|pages=1134–1140|url=https://books.google.com/books?id=OR3VERnvzzEC&pg=PA1134|access-date=October 27, 2015|archive-date=March 26, 2015|archive-url=https://web.archive.org/web/20150326122056/http://books.google.com/books?id=OR3VERnvzzEC&pg=PA1134|url-status=live}}</ref><ref name="Sommers">{{cite book|vauthors=Sommers MS, Fannin E|title=Diseases and Disorders: A Nursing Therapeutics Manual|publisher=[[F.A. Davis]]|isbn=978-0-8036-4487-8|year=2014|page=115|url=https://books.google.com/books?id=pIEsBQAAQBAJ&pg=PA1115|access-date=March 10, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044834/https://books.google.com/books?id=pIEsBQAAQBAJ&pg=PA1115|url-status=live}}</ref> [[vaginismus]] is an involuntary tightening of the vagina muscles during vaginal penetration that is caused by a [[conditioned reflex]] or disease.<ref name="Ferri"/> Vaginal discharge due to yeast infection is usually thick, creamy in color and odorless, while discharge due to bacterial vaginosis is gray-white in color, and discharge due to trichomoniasis is usually a gray color, thin in consistency, and has a fishy odor. Discharge in 25% of the trichomoniasis cases is yellow-green.<ref name="Wright"/>

[[HIV/AIDS]], [[human papillomavirus]] (HPV), [[genital herpes]] and trichomoniasis are some 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.<ref name="Hales">{{Cite book|vauthors=Hales D|title=An Invitation to Health Brief 2010-2011|publisher=[[Cengage Learning]]|year=2008|pages=269–271|isbn=978-0-495-39192-0|url=https://books.google.com/books?id=oP91HVIMPRIC&pg=PA269|access-date=October 27, 2015|archive-date=December 31, 2013|archive-url=https://web.archive.org/web/20131231143640/http://books.google.com/books?id=oP91HVIMPRIC&pg=PA269|url-status=live}}</ref><ref name="Alexander">{{cite book|vauthors=Alexander W, Bader H, LaRosa JH|title=New Dimensions in Women's Health|isbn=978-1-4496-8375-7|publisher=[[Jones & Bartlett Learning|Jones & Bartlett Publishers]]|year=2011|page=211|url=https://books.google.com/books?id=GVPHhIM3IZ0C&pg=PA211|access-date=October 27, 2015|archive-date=July 15, 2014|archive-url=https://web.archive.org/web/20140715160215/http://books.google.com/books?id=GVPHhIM3IZ0C&pg=PA211|url-status=live}}</ref> Safe sex commonly involves the use of [[condom]]s, and sometimes [[female condom]]s (which give women more control). Both types can help avert pregnancy by preventing semen from coming in contact with the vagina.<ref name="Knox and Schacht">{{cite book|vauthors=Knox D, Schacht C|title=Choices in Relationships: Introduction to Marriage and the Family|isbn=978-0-495-09185-1|publisher=[[Cengage Learning]]|year=2007|pages=296–297|url=https://books.google.com/books?id=Q3XD0VEYGSUC&pg=PA296|access-date=January 16, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211359/https://books.google.com/books?id=Q3XD0VEYGSUC&pg=PA296|url-status=live}}</ref><ref name="Kumar and Gupta">{{cite book|vauthors=Kumar B, Gupta S|title=Sexually Transmitted Infections|isbn=978-81-312-2978-1|publisher=[[Elsevier Health Sciences]]|year=2014|pages=126–127|url=https://books.google.com/books?id=kQ9tAwAAQBAJ&pg=PA126|access-date=January 16, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211232/https://books.google.com/books?id=kQ9tAwAAQBAJ&pg=PA126|url-status=live}}</ref> There is, however, little research on whether female condoms are as effective as male condoms at preventing STIs,<ref name="Kumar and Gupta"/> and they are slightly less effective than male condoms at preventing pregnancy, which may be because the female condom fits less tightly than the male condom or because it can slip into the vagina and spill semen.<ref name="Hornstein and Schwerin">{{cite book|vauthors=Hornstein T, Schwerin JL|title=Biology of Women|isbn=978-1-4354-0033-7|publisher=[[Cengage Learning]]|year=2012|pages=126–127|url=https://books.google.com/books?id=2iD1CAAAQBAJ&pg=PA326|access-date=January 16, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211314/https://books.google.com/books?id=2iD1CAAAQBAJ&pg=PA326|url-status=live}}</ref>

The vaginal lymph nodes often trap [[cancer]]ous cells that originate in the vagina. These nodes can be assessed for the presence of disease. Selective surgical removal (rather than total and more invasive removal) of vaginal lymph nodes reduces the risk of complications that can accompany more radical surgeries. These selective nodes act as sentinel lymph nodes.<ref name="Sabater"/> Instead of surgery, the lymph nodes of concern are sometimes treated with [[radiation therapy]] administered to the patient's pelvic, inguinal lymph nodes, or both.<ref name = NIHI>{{cite web |url=https://www.cancer.gov/types/vaginal/hp/vaginal-treatment-pdq#section/_45 |publisher=National Institutes of Health |website=National Cancer Institute |date=February 9, 2017 |title=Stage I Vaginal Cancer |access-date=December 14, 2017 |archive-date=April 9, 2019 |archive-url=https://web.archive.org/web/20190409134644/https://www.cancer.gov/types/vaginal/hp/vaginal-treatment-pdq#section/_45 |url-status=live }}{{PD-notice}}</ref>

[[Vaginal cancer]] and [[vulvar cancer]] are very rare, and primarily affect older women.<ref name="Salhan">{{cite book|vauthors=Salhan S|title=Textbook of Gynecology|publisher=JP Medical Ltd|isbn=978-93-5025-369-4|year=2011|page=270|url=https://books.google.com/books?id=4g5Wgc3Bh18C&pg=PA270|access-date=October 27, 2015|archive-date=May 6, 2016|archive-url=https://web.archive.org/web/20160506180140/https://books.google.com/books?id=4g5Wgc3Bh18C&pg=PA270|url-status=live}}</ref><ref name="Paludi">{{cite book|vauthors=Paludi MA|title=The Praeger Handbook on Women's Cancers: Personal and Psychosocial Insights|publisher=[[ABC-CLIO]]|isbn=978-1-4408-2814-0|year=2014|page=111|url=https://books.google.com/books?id=HQpvBAAAQBAJ&pg=PA111|access-date=October 27, 2015|archive-date=May 6, 2016|archive-url=https://web.archive.org/web/20160506162920/https://books.google.com/books?id=HQpvBAAAQBAJ&pg=PA111|url-status=live}}</ref> [[Cervical cancer]] (which is relatively common) increases the risk of vaginal cancer,<ref name="cancer.org2">{{cite web|title=What Are the Risk Factors for Vaginal Cancer?|publisher=[[American Cancer Society]]|date=October 19, 2017|access-date=January 5, 2018|url=https://www.cancer.org/cancer/vaginal-cancer/causes-risks-prevention/risk-factors.html|archive-date=January 6, 2018|archive-url=https://web.archive.org/web/20180106120444/https://www.cancer.org/cancer/vaginal-cancer/causes-risks-prevention/risk-factors.html|url-status=live}}</ref> which is why there is a significant chance for vaginal cancer to occur at the same time as, or after, cervical cancer. It may be that their causes are the same.<ref name="cancer.org2"/><ref name="Salhan"/><ref name="Chi">{{cite book|vauthors=Chi D, Berchuck A, Dizon DS, Yashar CM|title=Principles and Practice of Gynecologic Oncology|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-1-4963-5510-2|year=2017|page=87|url=https://books.google.com/books?id=4RYIDgAAQBAJ&pg=PT87|access-date=December 14, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211236/https://books.google.com/books?id=4RYIDgAAQBAJ&pg=PT87|url-status=live}}</ref> Cervical cancer may be prevented by pap smear screening and [[HPV vaccine]]s, but HPV vaccines only cover HPV types 16 and 18, the cause of 70% of cervical cancers.<ref name="Berek">{{cite book |vauthors=Berek JS, Hacker NF |title=Berek and Hacker's Gynecologic Oncology|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-0-7817-9512-8|year=2010|page=225 |url=https://books.google.com/books?id=bA3ODcFV-5oC&pg=PA225}}</ref><ref name="Bibbo">{{cite book|vauthors=Bibbo M, Wilbur D|title=Comprehensive Cytopathology E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-26576-8|year=2014|page=49|url=https://books.google.com/books?id=2FPOAwAAQBAJ&pg=PA49|access-date=December 14, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211319/https://books.google.com/books?id=2FPOAwAAQBAJ&pg=PA49|url-status=live}}</ref>  Some symptoms of cervical and vaginal cancer are [[dyspareunia]], and abnormal [[vaginal bleeding]] or vaginal discharge, especially [[postcoital bleeding|after sexual intercourse]] or menopause.<ref name="Daniels">{{cite book|vauthors=Daniels R, Nicoll LH|title=Contemporary Medical-Surgical Nursing|publisher=[[Cengage Learning]]|isbn=978-1-133-41875-7|year=2011|page=1776|url=https://books.google.com/books?id=wUAJAAAAQBAJ&pg=PA1776|access-date=December 14, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703220036/https://books.google.com/books?id=wUAJAAAAQBAJ&pg=PA1776|url-status=live}}</ref><ref name="Washington">{{cite book|vauthors=Washington CM, Leaver DT|title=Principles and Practice of Radiation Therapy|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-28781-4|year=2015|page=749|url=https://books.google.com/books?id=zzMwBwAAQBAJ&pg=PA749|access-date=December 14, 2017|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044836/https://books.google.com/books?id=zzMwBwAAQBAJ&pg=PA749|url-status=live}}</ref> However, most cervical cancers are [[asymptomatic]] (present no symptoms).<ref name="Daniels"/> Vaginal intracavity brachytherapy (VBT) is used to treat [[Endometrial cancer|endometrial]], vaginal and cervical cancer. An applicator is inserted into the vagina to allow the administration of radiation as close to the site of the cancer as possible.<ref name=":1">{{Cite web|url=http://radonc.ucla.edu/gynecologic-brachytherapy-treatment|title=Cervical, Endometrial, Vaginal and Vulvar Cancers - Gynecologic Brachytherapy|website=radonc.ucla.edu|access-date=December 13, 2017|archive-date=December 14, 2017|archive-url=https://web.archive.org/web/20171214015448/http://radonc.ucla.edu/gynecologic-brachytherapy-treatment|url-status=live}}</ref><ref>{{Cite journal|vauthors=Sabater S, Andres I, Lopez-Honrubia V, Berenguer R, Sevillano M, Jimenez-Jimenez E, Rovirosa A, Arenas M |date=August 9, 2017 |title=Vaginal cuff brachytherapy in endometrial cancer – a technically easy treatment? |journal=Cancer Management and Research |volume=9|pages=351–362|doi=10.2147/CMAR.S119125|issn=1179-1322|pmc=5557121|pmid=28848362 |doi-access=free }}</ref> Survival rates increase with VBT when compared to external beam radiation therapy.<ref name=":1" /> By using the vagina to place the emitter as close to the cancerous growth as possible, the systemic effects of radiation therapy are reduced and cure rates for vaginal cancer are higher.<ref>{{Cite journal |vauthors=Harkenrider MM, Block AM, Alektiar KM, Gaffney DK, Jones E, Klopp A, Viswanathan AN, Small W |date=January–February 2017 |title=American Brachytherapy Task Group Report: Adjuvant vaginal brachytherapy for early-stage endometrial cancer: A comprehensive review|journal=Brachytherapy|language=en|volume=16|issue=1|pages=95–108|doi=10.1016/j.brachy.2016.04.005|pmid=27260082 |pmc=5612425 }}</ref> Research is unclear on whether treating cervical cancer with radiation therapy increases the risk of vaginal cancer.<ref name="cancer.org2"/>

===Effects of aging and childbirth===
Age and hormone levels significantly correlate with the pH of the vagina.<ref name="Wilson">{{cite book|vauthors=Wilson M|title=Microbial Inhabitants of Humans: Their Ecology and Role in Health and Disease|publisher=[[Cambridge University Press]]|isbn=978-0-521-84158-0|year=2005|page=214|url=https://books.google.com/books?id=q9Qx9oRKO_kC&pg=PA214|access-date=January 14, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211238/https://books.google.com/books?id=q9Qx9oRKO_kC&pg=PA214|url-status=live}}</ref> Estrogen, glycogen and lactobacilli impact these levels.<ref name="Long"/><ref name="Mack"/> At birth, the vagina is acidic with a pH of approximately 4.5,<ref name="Wilson"/> and ceases to be acidic by three to six weeks of age,<ref name="Wilson 2">{{cite book|vauthors=Wilson CB, Nizet V, Maldonado Y, Remington JS, Klein JO|title=Remington and Klein's Infectious Diseases of the Fetus and Newborn E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-34096-0|year=2014|page=1053|url=https://books.google.com/books?id=W9b1BQAAQBAJ&pg=PA1053|access-date=January 14, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044743/https://books.google.com/books?id=W9b1BQAAQBAJ&pg=PA1053|url-status=live}}</ref> becoming alkaline.<ref name="Schafermeyer">{{cite book|vauthors=Schafermeyer RW, Tenenbein M, Macias CG, Sharieff G, Yamamoto L|title=Strange and Schafermeyer's Pediatric Emergency Medicine, Fourth Edition|publisher=[[McGraw Hill Professional]]|isbn=978-0-07-182924-3|year=2014|page=567}}</ref> Average vaginal pH is 7.0 in pre-pubertal girls.<ref name="Long">{{cite book|vauthors=Long SS, Prober CG, Fischer M|title=Principles and Practice of Pediatric Infectious Diseases E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-46132-0|year=2017|page=362|url=https://books.google.com/books?id=Xw7VDgAAQBAJ&pg=PA362|access-date=January 9, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211310/https://books.google.com/books?id=Xw7VDgAAQBAJ&pg=PA362|url-status=live}}</ref> Although there is a high degree of variability in timing, girls who are approximately seven to twelve years of age will continue to have labial development as the hymen thickens and the vagina elongates to approximately 8&nbsp;cm. The vaginal mucosa thickens and the vaginal pH becomes acidic again. Girls may also experience a thin, white vaginal discharge called [[leukorrhea]].<ref name="Schafermeyer"/> The vaginal microbiota of adolescent girls aged 13 to 18 years is similar to women of reproductive age,<ref name="Mack">{{cite book|vauthors=Mack A, Olsen L, Choffnes ER|title=Microbial Ecology in States of Health and Disease: Workshop Summary|publisher=[[National Academies Press]]|isbn=978-0-309-29065-4|year=2014|page=252|url=https://books.google.com/books?id=wl-fAwAAQBAJ&pg=PT252|access-date=January 9, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211315/https://books.google.com/books?id=wl-fAwAAQBAJ&pg=PT252|url-status=live}}</ref> who have an average vaginal pH of 3.8–4.5,<ref name="King"/> but research is not as clear on whether this is the same for premenarcheal or perimenarcheal girls.<ref name="Mack"/> The vaginal pH during menopause is 6.5–7.0 (without [[Hormone replacement therapy (menopause)|hormone replacement therapy]]), or 4.5–5.0 with hormone replacement therapy.<ref name="Mack"/>
[[File:Vaginal Mucosa Normal vs Menopause.png|thumb|alt=Side-by-side illustration depicting thinning effects of menopause on musoca of vaginal wall|Pre-menopausal vaginal mucosa (left) versus menopausal vaginal mucosa (right)]]

After menopause, the body produces less estrogen. This causes [[atrophic vaginitis]] (thinning and inflammation of the vaginal walls),<ref name="Beckmann"/><ref name="Di Saia">{{cite book|vauthors=Di Saia PH|title=Clinical Gynecologic Oncology|publisher=Elsevier Health Sciences|isbn=978-0-323-07419-3|year=2012|page=140|url=https://books.google.com/books?id=fmUU5mNbH5kC&pg=PA140|access-date=October 27, 2015|archive-date=May 6, 2016|archive-url=https://web.archive.org/web/20160506163839/https://books.google.com/books?id=fmUU5mNbH5kC&pg=PA140|url-status=live}}</ref> which can lead to vaginal itching, burning, bleeding, soreness, or [[vaginal dryness]] (a decrease in lubrication).<ref name="Ward">{{cite book|vauthors=Ward S, Hisley S|title=Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families|publisher=[[F. A. Davis Company]]|isbn=978-0-8036-4490-8|pages=147–150|date=2015|url=https://books.google.com/books?id=XozHCQAAQBAJ&pg=RA1-PA147|access-date=August 13, 2017|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044842/https://books.google.com/books?id=XozHCQAAQBAJ&pg=RA1-PA147|url-status=live}}</ref> Vaginal dryness can cause discomfort on its own or discomfort or pain during sexual intercourse.<ref name="Ward"/><ref name="Schuiling">{{cite book|vauthors=Schuiling, Likis FE|title=Women's Gynecologic Health|publisher=[[Jones & Bartlett Publishers]]|isbn=978-0-7637-5637-6|page=305|date=2013|url=https://books.google.com/books?id=pj_ourS3PBMC&pg=PA305|access-date=January 9, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703215946/https://books.google.com/books?id=pj_ourS3PBMC&pg=PA305|url-status=live}}</ref> [[Hot flash]]es are also characteristic of menopause.<ref name="Leifer"/><ref name="Jones 2">{{cite book|vauthors=Jones RE, Davis KH|title=Human Reproductive Biology|publisher=[[Academic Press]]|isbn=978-0-12-382185-0|page=127|date=2013|url=https://books.google.com/books?id=M4kEdSnS-pkC&pg=PA127|access-date=August 13, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211321/https://books.google.com/books?id=M4kEdSnS-pkC&pg=PA127|url-status=live}}</ref> Menopause also affects the composition of vaginal support structures. The vascular structures become fewer with advancing age.<ref name="Mulhall 2">{{Cite book |page=19|title=Cancer and sexual health |date=2011|publisher=Humana Press|vauthors=Mulhall JP, Incrocci L, Goldstein I |isbn=978-1-60761-915-4|location=New York|oclc=728100149}}</ref>  Specific [[collagen]]s become altered in composition and ratios. It is thought that the weakening of the support structures of the vagina is due to the physiological changes in this connective tissue.<ref name="Walters">{{Cite book |title=Urogynecology and reconstructive pelvic surgery |vauthors=Walters MD, Karram MM |isbn=978-0-323-11377-9 |edition=4th |location=Philadelphia |publisher=Elsevier Saunders |date=2015 |pages=60–82 |oclc=894111717}}</ref>

Menopausal symptoms can be eased by estrogen-containing vaginal creams,<ref name="Jones 2"/> non-prescription, non-hormonal medications,<ref name="Ward"/> vaginal estrogen rings such as the [[Femring]],<ref name="Smith">{{cite book|vauthors=Smith BT|title=Pharmacology for Nurses|publisher=[[Jones & Bartlett Publishers]]|isbn=978-1-4496-8940-7|page=80|date=2014|url=https://books.google.com/books?id=7P-9BQAAQBAJ&pg=PA80|access-date=January 11, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704043206/https://books.google.com/books?id=7P-9BQAAQBAJ&pg=PA80|url-status=live}}</ref> or other hormone replacement therapies,<ref name="Jones 2"/> but there are risks (including adverse effects) associated with hormone replacement therapy.<ref name="Greenstein">{{cite book|vauthors=Greenstein B, Greenstein A|title=Concise Clinical Pharmacology|publisher=[[Pharmaceutical Press]]|isbn=978-0-85369-576-9|page=186|date=2007|url=https://books.google.com/books?id=JM2vUhP6WAQC&pg=PA186|access-date=August 13, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211422/https://books.google.com/books?id=JM2vUhP6WAQC&pg=PA186|url-status=live}}</ref><ref name="Moscou">{{cite book|vauthors=Moscou K, Snipe K|title=Pharmacology for Pharmacy Technicians - E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-29265-8|page=573|date=2014|url=https://books.google.com/books?id=ZtHsAwAAQBAJ&pg=PA573|access-date=January 11, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704043201/https://books.google.com/books?id=ZtHsAwAAQBAJ&pg=PA573|url-status=live}}</ref> Vaginal creams and vaginal estrogen rings may not have the same risks as other hormone replacement treatments.<ref name="Gladson">{{cite book|vauthors=Gladson B|title=Pharmacology for Rehabilitation Professionals - E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-1-4377-0756-4|page=212|date=2010|url=https://books.google.com/books?id=6wgPsqi9nO8C&pg=PA212|access-date=January 11, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211236/https://books.google.com/books?id=6wgPsqi9nO8C&pg=PA212|url-status=live}}</ref> Hormone replacement therapy can treat vaginal dryness,<ref name="Smith"/> but a [[Personal lubricant#Vaginal lubricants|personal lubricant]] may be used to temporarily remedy vaginal dryness specifically for sexual intercourse.<ref name="Schuiling"/> Some women have an increase in sexual desire following menopause.<ref name="Ward"/> It may be that menopausal women who continue to engage in sexual activity regularly experience vaginal lubrication similar to levels in women who have not entered menopause, and can enjoy sexual intercourse fully.<ref name="Ward"/> They may have less vaginal atrophy and fewer problems concerning sexual intercourse.<ref name="Lowdermilk">{{cite book|vauthors=Lowdermilk DL, Perry SE, Cashion MC, Alden KR|title=Maternity and Women's Health Care - E-Book|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-39019-4|year=2014|page=133|url=https://books.google.com/books?id=urzuBQAAQBAJ&pg=PA133|access-date=January 13, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044807/https://books.google.com/books?id=urzuBQAAQBAJ&pg=PA133|url-status=live}}</ref>

Vaginal changes that happen with aging and childbirth include mucosal redundancy, rounding of the posterior aspect of the vagina with shortening of the distance from the distal end of the anal canal to the vaginal opening, [[Diastasis (pathology)|diastasis]] or disruption of the [[pubococcygeus muscle]]s caused by poor repair of an [[episiotomy]], and [[Bleb (medicine)|blebs]] that may protrude beyond the area of the vaginal opening.<ref name="Siemionow">{{cite book|vauthors=Siemionow MZ, Eisenmann-Klein M|title=Plastic and Reconstructive Surgery|publisher=[[Springer Science & Business Media]]|isbn=978-1-84882-513-0|pages=688–690|date=2010|url=https://books.google.com/books?id=9WFZ1pE0AFMC&pg=PA688|access-date=August 13, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211257/https://books.google.com/books?id=9WFZ1pE0AFMC&pg=PA688|url-status=live}}</ref> Other vaginal changes related to aging and childbirth are [[stress urinary incontinence]], [[rectocele]], and [[cystocele]].<ref name="Siemionow"/> Physical changes resulting from pregnancy, childbirth, and menopause often contribute to stress urinary incontinence. If a woman has weak [[pelvic floor]] muscle support and tissue damage from childbirth or pelvic surgery, a lack of estrogen can further weaken the pelvic muscles and contribute to stress urinary incontinence.<ref name="Gulanick">{{cite book|vauthors=Gulanick M, Myers JL|title=Nursing Care Plans - E-Book: Nursing Diagnosis and Intervention|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-42810-1|year=2016|page=111|url=https://books.google.com/books?id=NK2ADQAAQBAJ&pg=PA111|access-date=January 13, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044804/https://books.google.com/books?id=NK2ADQAAQBAJ&pg=PA111|url-status=live}}</ref> [[Pelvic organ prolapse]], such as a rectocele or cystocele, is characterized by the descent of pelvic organs from their normal positions to impinge upon the vagina.<ref name="Ramaseshan">{{Cite journal|vauthors=Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses T|date=September 19, 2017|title=Pelvic floor disorders in women with gynecologic malignancies: a systematic review|journal=International Urogynecology Journal|volume=29|issue=4|language=en|pages=459–476|doi=10.1007/s00192-017-3467-4|pmid=28929201|pmc=7329191|issn=0937-3462}}</ref><ref name="niddk_Cystocele">{{Cite news|url=https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women/cystocele-prolapsed-bladder|title=Cystocele (Prolapsed Bladder) {{!}} NIDDK|work=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=January 15, 2018|language=en-US|archive-date=June 17, 2018|archive-url=https://web.archive.org/web/20180617092854/https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women/cystocele-prolapsed-bladder|url-status=live}}</ref> A reduction in estrogen does not cause rectocele, cystocele or [[uterine prolapse]], but childbirth and weakness in pelvic support structures can.<ref name="Lowdermilk"/> Prolapse may also occur when the pelvic floor becomes injured during a [[hysterectomy]], gynecological cancer treatment, or heavy lifting.<ref name="Ramaseshan"/><ref name="niddk_Cystocele"/> Pelvic floor exercises such as [[Kegel exercise]]s can be used to strengthen the pelvic floor muscles,<ref>{{Cite news|url=https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women/kegel-exercises|title=Kegel Exercises {{!}} NIDDK|work=National Institute of Diabetes and Digestive and Kidney Diseases|access-date=January 15, 2018|language=en-US|archive-date=April 22, 2018|archive-url=https://web.archive.org/web/20180422224842/https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women/kegel-exercises|url-status=live}}</ref> preventing or arresting the progression of prolapse.<ref name="pmid22161382">{{cite journal |vauthors=Hagen S, Stark D |s2cid=205171605 |title=Conservative prevention and management of pelvic organ prolapse in women |journal=Cochrane Database Syst Rev |volume=12 |issue=12 |pages=CD003882 |year=2011 |pmid=22161382 |doi=10.1002/14651858.CD003882.pub4 }}</ref> There is no evidence that doing Kegel exercises [[Isotonic contraction|isotonically]] or with some form of weight is superior; there are greater risks with using weights since a foreign object is introduced into the vagina.<ref>{{cite journal|vauthors=Herbison GP, Dean N|title=Weighted vaginal cones for urinary incontinence|journal=The Cochrane Database of Systematic Reviews|date=July 8, 2013|volume=2013 |issue=7|pages=CD002114|pmid=23836411|doi=10.1002/14651858.CD002114.pub2 |doi-access=free |pmc=7086390}}</ref>

During the third stage of labor, while the infant is being born, the vagina undergoes significant changes. A gush of blood from the vagina may be seen right before the baby is born. Lacerations to the vagina that can occur during birth vary in depth, severity and the amount of adjacent tissue involvement.<ref name="Dalton" /><ref name=":2" /> The laceration can be so extensive as to involve the rectum and [[Human anus|anus]]. This event can be especially distressing to a new mother.<ref name=":2" /><ref>{{Cite journal|vauthors=Kettle C|date=August 2010|title=Absorbable suture materials for primary repair of episiotomy and second degree tears|journal=Journal of Evidence-Based Medicine|language=en|volume=3|issue=3|pages=185|doi=10.1111/j.1756-5391.2010.01093.x |doi-access=free |pmid=20556745|pmc=7263442|issn=1756-5391|url=http://eprints.staffs.ac.uk/268/1/CD000006.pdf|access-date=December 3, 2019|archive-date=August 18, 2019|archive-url=https://web.archive.org/web/20190818225808/http://eprints.staffs.ac.uk/268/1/CD000006.pdf|url-status=live}}</ref> When this occurs, [[fecal incontinence]] develops and stool can leave through the vagina.<ref name=":2">{{Cite book |title=Maternal-newborn Nursing: The Critical Components of Nursing Care |publisher=F.A. Davis |vauthors=Durham R, Chapman L |year=2014|isbn=978-0-8036-3704-7|edition=2nd |location=Philadelphia|pages=212–213|oclc=829937238}}</ref> Close to 85% of [[spontaneous vaginal birth]]s develop some form of tearing. Out of these, 60–70% require [[suturing]].<ref name="kettle_et_al_2017">{{Cite journal |title=Comparative analysis of continuous and interrupted suturing techniques for repair of episiotomy or second degree perineal tear|journal=Cochrane Database of Systematic Reviews |volume=2012 |vauthors=Kettle C, Dowswell T, Ismail KM |year=2017|issue=11 |pages=CD000947|language=en|doi=10.1002/14651858.cd000947.pub3|pmid=23152204 |pmc=7045987 }}</ref><ref name="Fernando">{{Cite journal |vauthors=Fernando R |s2cid=219223164 |date=January 2011 |title=Episiotomy or perineal tears: compared with catgut, synthetic sutures reduce risk of short-term pain and need for resuturing; rapidly absorbing sutures comparable to synthetic but reduce the need for suture removal |journal=Evidence-Based Nursing|language=en|volume=14|issue=1|pages=17–18|doi=10.1136/ebn1110|issn=1367-6539|pmid=21163794}}</ref> Lacerations from labor do not always occur.<ref name="Anderson" />

===Surgery===
The vagina, including the vaginal opening, may be altered as a result of surgeries such as an episiotomy, [[vaginectomy]], [[vaginoplasty]] or [[labiaplasty]].<ref name="Siemionow"/><ref name=Tabers>{{cite book|vauthors=Venes D|title=Taber's Cyclopedic Medical Dictionary|url=https://archive.org/details/taberscyclopedic00vene_746|url-access=limited|publisher=F.A. Davis|isbn=978-0-8036-2977-6|year=2009|page=[https://archive.org/details/taberscyclopedic00vene_746/page/n2467 2433]}}</ref> Those who undergo vaginoplasty are usually older and have given birth.<ref name="Siemionow"/> A thorough examination of the vagina before a vaginoplasty is standard, as well as a referral to a [[urogynecologist]] to diagnose possible vaginal disorders.<ref name="Siemionow"/> With regard to labiaplasty, reduction of the labia minora is quick without hindrance, complications are minor and rare, and can be corrected. Any scarring from the procedure is minimal, and long-term problems have not been identified.<ref name="Siemionow"/>

During an episiotomy, a surgical incision is made during the second stage of labor to enlarge the vaginal opening for the baby to pass through.<ref name="Anderson" /><ref name=":1" /> Although its routine use is no longer recommended,<ref name=ACOG165>{{cite journal|title=Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.|journal=Obstetrics and Gynecology|date=July 2016|volume=128|issue=1|pages=e1–e15|pmid=27333357|doi=10.1097/AOG.0000000000001523|author1=American College of Obstetricians Gynecologists' Committee on Practice Bulletins—Obstetrics|s2cid=20952144}}</ref> and not having an episiotomy is found to have better results than an episiotomy,<ref name="Anderson" /> it is one of the most common medical procedures performed on women. The incision is made through the skin, vaginal epithelium, subcutaneous fat, perineal body and superficial transverse perineal muscle and extends from the vagina to the anus.<ref name="medline_482">{{Cite web |url=https://medlineplus.gov/ency/patientinstructions/000482.htm |title=Episiotomy: MedlinePlus Medical Encyclopedia |website=Medlineplus.gov |language=en |access-date=December 13, 2017 |archive-date=December 14, 2017 |archive-url=https://web.archive.org/web/20171214072136/https://medlineplus.gov/ency/patientinstructions/000482.htm |url-status=live }}</ref><ref name = "Ellis">{{Cite book |vauthors=Ellis H, Mahadevan V |title=Clinical anatomy : applied anatomy for students and junior doctors |date=2013 |publisher=Wiley-Blackwell |isbn=978-1-118-37377-4|edition=13th |location=Chichester, West Sussex, UK |pages=148 |oclc=856017698}}</ref> Episiotomies can be painful after delivery. Women often report pain during sexual intercourse up to three months after laceration repair or an episiotomy.<ref name="kettle_et_al_2017"/><ref name="Fernando"/> Some surgical techniques result in less pain than others.<ref name="kettle_et_al_2017"/> The two types of episiotomies performed are the medial incision and the medio-lateral incision. The median incision is a perpendicular cut between the vagina and the anus and is the most common.<ref name="Anderson" /><ref>{{Cite journal |vauthors=Verghese TS, Champaneria R, Kapoor DS, Latthe PM |date=October 2016 |title=Obstetric anal sphincter injuries after episiotomy: systematic review and meta-analysis |journal=International Urogynecology Journal|language=en|volume=27|issue=10|pages=1459–1467|doi=10.1007/s00192-016-2956-1|pmid=26894605 |issn=0937-3462|pmc=5035659}}</ref> The medio-lateral incision is made between the vagina at an angle and is not as likely to tear through to the anus. The medio-lateral cut takes more time to heal than the median cut.<ref name="Anderson" />

Vaginectomy is surgery to remove all or part of the vagina, and is usually used to treat malignancy.<ref name=Tabers/> Removal of some or all of the sexual organs can result in damage to the nerves and leave behind scarring or [[Adhesion (medicine)|adhesions]].<ref name="Holland">{{cite book|title=Psycho-oncology|vauthors=Holland JC, Breitbart WD, Jacobsen PB|publisher=[[Oxford University Press]]|year=2015|isbn=978-0-19-936331-5|page=220|url=https://books.google.com/books?id=oy9mBgAAQBAJ&pg=PA220|access-date=December 12, 2017|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211443/https://books.google.com/books?id=oy9mBgAAQBAJ&pg=PA220|url-status=live}}</ref> Sexual function may also be impaired as a result, as in the case of some cervical cancer surgeries. These surgeries can impact pain, elasticity, vaginal lubrication and sexual arousal. This often resolves after one year but may take longer.<ref name="Holland"/>

Women, especially those who are older and have had multiple births, may choose to surgically correct vaginal laxity. This surgery has been described as vaginal tightening or rejuvenation.<ref name="Goodman">{{cite book|title=Female Genital Plastic and Cosmetic Surgery|vauthors=Goodman, MP|publisher=[[John Wiley & Sons]]|year=2016|isbn=978-1-118-84848-7|page=287|url=https://books.google.com/books?id=RJ-ECwAAQBAJ&pg=PT287|access-date=January 4, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044746/https://books.google.com/books?id=RJ-ECwAAQBAJ&pg=PT287|url-status=live}}</ref> While a woman may experience an improvement in [[self-image]] and sexual pleasure by undergoing vaginal tightening or rejuvenation,<ref name="Goodman"/> there are risks associated with the procedures, including infection, narrowing of the vaginal opening, insufficient tightening, decreased sexual function (such as [[Dyspareunia|pain during sexual intercourse]]), and [[rectovaginal fistula]]. Women who undergo this procedure may unknowingly have a medical issue, such as a prolapse, and an attempt to correct this is also made during the surgery.<ref name="Cardozo">{{cite book|url=https://books.google.com/books?id=Bb7ZDQAAQBAJ&pg=PT2962|title=Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set|vauthors=Cardozo L, Staskin D|publisher=[[CRC Press]]|year=2017|isbn=978-1-4987-9661-3|pages=2962–2976|access-date=January 4, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044737/https://books.google.com/books?id=Bb7ZDQAAQBAJ&pg=PT2962|url-status=live}}</ref>

Surgery on the vagina can be elective or cosmetic. Women who seek cosmetic surgery can have [[congenital]] conditions, physical discomfort or wish to alter the appearance of their genitals. Concerns over average genital appearance or measurements are largely unavailable and make defining a successful outcome for such surgery difficult.<ref name="Lloyd">{{cite journal |vauthors=Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM |date=May 2005 |title=Female genital appearance: 'normality' unfolds |journal=British Journal of Obstetrics and Gynaecology |volume=112 |issue=5 |pages=643–646 |doi=10.1111/j.1471-0528.2004.00517.x |doi-access=free |pmid=15842291}}</ref> A number of [[sex reassignment surgery|sex reassignment surgeries]] are available to [[transgender]] people. Although not all [[intersex]] conditions require surgical treatment, some choose genital surgery to correct atypical anatomical conditions.<ref>{{Cite web|url=https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries|title=Gender Confirmation Surgeries|website=American Society of Plastic Surgeons|language=en|access-date=January 4, 2018|archive-date=June 12, 2020|archive-url=https://web.archive.org/web/20200612071848/https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries|url-status=live}}</ref>

===Anomalies and other health issues===
{{See also|Vaginal atresia}}
[[File:Vagina US.png|right|thumb|alt=Ultrasonograph depicting urinary bladder at the top, above the uterus to its bottom-left and vagina to its bottom-right|An [[Medical ultrasonography|ultrasound]] showing the [[urinary bladder]] (1), uterus (2), and vagina (3)]]
[[Vaginal anomalies]] are defects that result in an abnormal or absent vagina.<ref name= emed2>{{Cite web |date=April 13, 2016 |author=Lawrence S Amesse |title=Mullerian Duct Anomalies: Overview, Incidence and Prevalence, Embryology |url=https://emedicine.medscape.com/article/273534-overview#a4 |access-date=January 31, 2018 |archive-url=https://web.archive.org/web/20180120070642/https://emedicine.medscape.com/article/273534-overview |archive-date=2018-01-20 |url-status=live}}</ref><ref>{{Cite web|url=http://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/vaginal-anomalies|title=Vaginal Anomalies-Pediatrics-Merck Manuals Professional Edition|access-date=January 6, 2018|archive-date=January 29, 2019|archive-url=https://web.archive.org/web/20190129072510/https://www.merckmanuals.com/professional/pediatrics/congenital-renal-and-genitourinary-anomalies/vaginal-anomalies|url-status=live}}</ref> The most common obstructive vaginal anomaly is an [[imperforate hymen]], a condition in which the hymen obstructs menstrual flow or other vaginal secretions.<ref name="Pfeifer">{{cite book|vauthors=Pfeifer SM|title=Congenital Müllerian Anomalies: Diagnosis and Management|publisher=[[Springer Publishers|Springer]]|isbn=978-3-319-27231-3|year=2016|pages=43–45|url=https://books.google.com/books?id=7TyVDAAAQBAJ&pg=PA43|access-date=January 31, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703215939/https://books.google.com/books?id=7TyVDAAAQBAJ&pg=PA43|url-status=live}}</ref><ref name="Zhu">{{cite book|vauthors=Zhu L, Wong F, Lang J|title=Atlas of Surgical Correction of Female Genital Malformation|publisher=[[Springer Publishers|Springer]]|isbn=978-94-017-7246-4|year=2015|page=18|url=https://books.google.com/books?id=-l54CgAAQBAJ&pg=PA18|access-date=April 2, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211243/https://books.google.com/books?id=-l54CgAAQBAJ&pg=PA18|url-status=live}}</ref> Another vaginal anomaly is a [[transverse vaginal septum]], which partially or completely blocks the vaginal canal.<ref name="Pfeifer"/> The precise cause of an obstruction must be determined before it is repaired, since corrective surgery differs depending on the cause.<ref name="Coran">{{cite book|vauthors=Coran AG, Caldamone A, Adzick NS, Krummel TM, Laberge JM, Shamberger R|title=Pediatric Surgery|publisher=[[Elsevier Health Sciences]]|isbn=978-0-323-09161-9|year=2012|page=1599|url=https://books.google.com/books?id=QpabASTwF_sC&pg=PA1599|access-date=March 4, 2015|archive-date=May 15, 2015|archive-url=https://web.archive.org/web/20150515033701/https://books.google.com/books?id=QpabASTwF_sC&pg=PA1599|url-status=live}}</ref> In some cases, such as isolated [[vaginal agenesis]], the external genitalia may appear normal.<ref name="Nucci">{{cite book|vauthors=Nucci MR, Oliva E|title=Gynecologic Pathology E-Book: A Volume in the Series: Foundations in Diagnostic Pathology|publisher=[[Elsevier Health Sciences]]|isbn=978-94-017-7246-4|year=2015|page=77|url=https://books.google.com/books?id=7fbLXoJy9MUC&pg=PA77|access-date=April 2, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211232/https://books.google.com/books?id=7fbLXoJy9MUC&pg=PA77|url-status=live}}</ref>

Abnormal openings known as [[fistula]]s can cause [[urine]] or [[Human feces|feces]] to enter the vagina, resulting in incontinence.<ref name="Bodner-Adler">{{cite journal|date=February 22, 2017 |title=Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis|journal=PLOS ONE|volume=12|issue=2|pages=e0171554|doi=10.1371/journal.pone.0171554|pmid=28225769|pmc=5321457|vauthors=Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K|bibcode=2017PLoSO..1271554B|doi-access=free}}</ref><ref name="Köckerling">{{cite journal|date=2015|title=Treatment of Fistula-In-Ano with Fistula Plug - a Review Under Special Consideration of the Technique|journal=Frontiers in Surgery|volume=2|pages=55|doi=10.3389/fsurg.2015.00055|pmid=26528482|pmc=4607815|vauthors=Köckerling F, Alam NN, Narang SK, Daniels IR, Smart NJ|doi-access=free}}</ref> The vagina is susceptible to fistula formation because of its proximity to the [[Urinary tract|urinary]] and [[Gastrointestinal tract|gastrointestinal]] tracts.<ref name="Priyadarshi">{{cite journal|date=June 2016|title=Genitourinary Fistula: An Indian Perspective|journal=Journal of Obstetrics and Gynaecology of India|volume=66|issue=3|pages=180–4|doi=10.1007/s13224-015-0672-2|pmc=4870662|pmid=27298528|vauthors=Priyadarshi V, Singh JP, Bera MK, Kundu AK, Pal DK}}</ref> Specific causes are manifold and include obstructed labor, hysterectomy, [[malignancy]], radiation, [[episiotomy]], and bowel disorders.<ref name="Raassen">{{cite journal|date=December 2014|title=Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries|journal=International Urogynecology Journal|language=en|volume=25|issue=12|pages=1699–706|doi=10.1007/s00192-014-2445-3|pmid=25062654|vauthors=Raassen TJ, Ngongo CJ, Mahendeka MM|pmc=4234894}}</ref><ref name="Maslekar">{{cite journal|date=December 2012|title=The challenge of pouch-vaginal fistulas: a systematic review|journal=Techniques in Coloproctology|volume=16|issue=6|pages=405–14|doi=10.1007/s10151-012-0885-7|pmid=22956207|vauthors=Maslekar S, Sagar PM, Harji D, Bruce C, Griffiths B|s2cid=22813363}}</ref> A small number of vaginal fistulas are [[congenital]].<ref name="Fernandez">{{cite journal|date=September 2015|title=Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief review of the literature |journal=Investigacion Clinica|volume=56|issue=3|pages=301–7|pmid=26710545|vauthors=Fernández Fernández JÁ, Parodi Hueck L}}</ref> Various surgical methods are employed to repair fistulas.<ref name="Tenggardjaja">{{cite journal | vauthors = Tenggardjaja CF, Goldman HB | s2cid = 27012043 | title = Advances in minimally invasive repair of vesicovaginal fistulas | language = en | journal = Current Urology Reports | volume = 14 | issue = 3 | pages = 253–61 | date = June 2013 | pmid = 23475747 | doi = 10.1007/s11934-013-0316-y }}</ref><ref name="Bodner-Adler" /> Untreated, fistulas can result in significant [[disability]] and have a profound impact on [[quality of life]].<ref name="Bodner-Adler"/>

[[Vaginal evisceration]] is a serious complication of a [[vaginal hysterectomy]] and occurs when the [[vaginal cuff]] [[Wound dehiscence|ruptures]], allowing the [[small intestine]] to protrude from the vagina.<ref name="Hoffman" /><ref name="Cronin">{{Cite journal|date=April 2012|title=Vaginal cuff dehiscence: Risk factors and management|journal=American Journal of Obstetrics and Gynecology|volume=206|issue=4|pages=284–288|doi=10.1016/j.ajog.2011.08.026|issn=0002-9378|pmc=3319233|pmid=21974989|doi-access=free|vauthors=Cronin B, Sung V, Matteson K}}</ref>

[[Cyst]]s may also affect the vagina. Various types of [[vaginal cysts]] can develop on the surface of the vaginal epithelium or in deeper layers of the vagina and can grow to be as large as 7&nbsp;cm.<ref name=lall>{{Cite journal |vauthors=Lallar M, Nandal R, Sharma D, Shastri S |date=January 20, 2015 |title=Large posterior vaginal cyst in pregnancy|journal=BMJ Case Reports|volume=2015|pages=bcr2014208874 |doi=10.1136/bcr-2014-208874|issn=1757-790X|pmc=4307045|pmid=25604504}}</ref><ref>{{Cite web|url=https://medlineplus.gov/ency/article/001509.htm|title=Vaginal cysts: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=February 17, 2018|archive-date=November 2, 2020|archive-url=https://web.archive.org/web/20201102003330/https://medlineplus.gov/ency/article/001509.htm|url-status=live}}</ref> Often, they are an incidental finding during a routine pelvic examination.<ref name=":0">{{Cite journal |vauthors=Elsayes KM, Narra VR, Dillman JR, Velcheti V, Hameed O, Tongdee R, Menias CO |s2cid=31444644|date=October 2007|title=Vaginal masses: magnetic resonance imaging features with pathologic correlation|journal=Acta Radiologica  |volume=48|issue=8|pages=921–933|doi=10.1080/02841850701552926|issn=1600-0455|pmid=17924224}}</ref> Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele.<ref name=lall/> Cysts that can be present include [[Müllerian cyst]]s, [[Gartner's duct cyst]]s, and [[epidermoid cyst]]s.<ref name=":4">{{Cite book|url=https://books.google.com/books?id=TYlZsGdwqrQC&q=Vaginal+cyst&pg=PA220|title=Gynecology: Integrating Conventional, Complementary, and Natural Alternative Therapy|vauthors=Ostrzenski A|date=2002|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-2761-7|language=en|access-date=October 19, 2020|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000717/https://books.google.com/books?id=TYlZsGdwqrQC&q=Vaginal+cyst&pg=PA220|url-status=live}}</ref><ref>{{cite journal|vauthors=Hoogendam JP, Smink M |date=April 6, 2017|title=Gartner's Duct Cyst|journal=New England Journal of Medicine|volume=376|issue=14|pages=e27|doi=10.1056/NEJMicm1609983|pmid=28379795}}</ref> A vaginal cyst is most likely to develop in women between the ages of 30 and 40.<ref name=lall/> It is estimated that 1 out of 200 women has a vaginal cyst.<ref name= lall/><ref name="Marisa R.">{{Cite book|url=https://books.google.com/books?id=r7EOW0jm2CoC&q=Vaginal+cyst&pg=PA96|title=Gynecologic Pathology|vauthors=Nucci MR, Oliva E|date=January 1, 2009|publisher=Elsevier Health Sciences|isbn=978-0-443-06920-8|pages=96|language=en|access-date=October 19, 2020|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000420/https://books.google.com/books?id=r7EOW0jm2CoC&q=Vaginal+cyst&pg=PA96|url-status=live}}</ref> The [[Bartholin's cyst]] is of vulvar rather than vaginal origin,<ref name="Robboy 2">{{cite book|vauthors=Robboy SJ|title=Robboy's Pathology of the Female Reproductive Tract|publisher=[[Elsevier Health Sciences]]|isbn=978-0-443-07477-6|year=2009|page=117|url=https://books.google.com/books?id=ab545XL-MBEC&pg=PA117|access-date=March 8, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703220034/https://books.google.com/books?id=ab545XL-MBEC&pg=PA117|url-status=live}}</ref> but it presents as a lump at the vaginal opening.<ref name="Marx">{{cite book|vauthors=Marx J, Walls R, Hockberger R|title=Rosen's Emergency Medicine - Concepts and Clinical Practice|publisher=[[Elsevier Health Sciences]]|isbn=978-1-4557-4987-4|year=2013|page=1314|url=https://books.google.com/books?id=uggC0i_jXAsC&pg=PA1314|access-date=February 24, 2015|archive-date=May 15, 2015|archive-url=https://web.archive.org/web/20150515033915/https://books.google.com/books?id=uggC0i_jXAsC&pg=PA1314|url-status=live}}</ref> It is more common in younger women and is usually without symptoms,<ref name="Cash">{{cite book|vauthors=Cash JC, Glass CA|title=Sternberg's Diagnostic Surgical Pathology, Volume 1|publisher=[[Springer Publishing Company]]|isbn=978-0-8261-5351-7|year=2017|page=425|url=https://books.google.com/books?id=9tRJDwAAQBAJ&pg=PA425|access-date=February 15, 2018|archive-date=July 3, 2019|archive-url=https://web.archive.org/web/20190703211347/https://books.google.com/books?id=9tRJDwAAQBAJ&pg=PA425|url-status=live}}</ref> but it can cause pain if an [[abscess]] forms,<ref name="Cash"/> block the entrance to the [[vulval vestibule]] if large,<ref name="Sternberg">{{cite book|vauthors=Sternberg SS, Mills SE, Carter D|title=Sternberg's Diagnostic Surgical Pathology, Volume 1|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-0-7817-4051-7|year=2004|page=2335|url=https://books.google.com/books?id=TM5-h0Fo9_4C&pg=PA2335|access-date=February 15, 2018|archive-date=July 4, 2019|archive-url=https://web.archive.org/web/20190704044848/https://books.google.com/books?id=TM5-h0Fo9_4C&pg=PA2335|url-status=live}}</ref> and impede walking or cause painful sexual intercourse.<ref name="Cash"/>