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Genital Health

Genital health is an important part of a person’s overall sexual well-being, and it’s common to have questions. The following are topics that people are often curious about:

Shape and Size

The shape and size of one’s genitals has been a concern for many people throughout history because in some cultures and society we have associated the overall appearance of our genitals to determine sexual desirability.  That being said, there is no such thing as “normal” when it comes to the shape and size of genitalia.

Puberty

As people go through puberty, their bodies change.  Some of these changes include deepening of the voice, development of body hair, and maturation of genitalia.  Puberty happens at different ages and speeds, though most people are fully developed physically by the age of 20.

During puberty, it is normal for youth to be concerned about how their bodies are developing and to compare their body parts to their peers.  For some trans people, the size and presence of body parts, including the size of a penis or the beginning of menses can cause distress.

What’s “Normal”?

Just like variations of other body parts that are considered normal for different people (like eye colour), so are variations in shape and size of genitalia.

Vulvar Anatomy

A Vulva, or what many refer to as a vagina, is considered the external genitalia.  This external genitalia includes the mons, the clitoris, the urethra, the outer labia, the inner labia, and the vaginal opening.  The size, length, and colour of the inner labia, as well as other parts of the vulva, varies significantly from person to person.  The inner labia may be thick or thin, long or barely visible, and range in colour from purple, red, pink, black, or brown, depending on your colouring.  Variations in the labia are normal, as well as both sides of the labia being different shapes and sizes.

Penile Anatomy

A penis is made up of several parts: the glans (head) of the penis, the shaft, the foreskin, and the urethra.  In circumcised people, the foreskin is surgically removed.  The size, length, and colour of the shaft, as well as other parts of the penis, varies significantly from person to person.  Many people have penises that are darker than the skin on the rest of their body, with a brownish or reddish appearance.  It’s also possible for a penis to be lighter than the skin on the rest of the body.There is no ‘normal’ size for a fully-developed penis. Some people have a rare condition called micropenis, where the penis does not develop to an average adult size range. 

Different studies have shown a range of average sizes:

  • Length when flaccid/soft (not erect/hard): 2-4 inches
  • Length when erect/hard: 5-6 inches
  • Thickness when erect: 3-4 inches around

Smells

Genitals are in a part of your body that is usually very warm and often doesn’t get the kind of ventilation other exposed parts of your body get. As a result, they often smell musty, similarly to the way sweat smells.  

When it comes to hygiene, the best way to take care of your genitals is by gently washing them with mild soap and warm water whenever you shower, after exercise or excessive sweating, and after masturbation or sex.

If you’re uncomfortable with the way your genitals smell, it may be tempting to use products like scented tampons or antibacterial soaps; however, these products can be harmful for the delicate skin on your genitals and even throw off your natural pH balance.  It is best to stick to unscented, mild soaps and choosing undergarments made from natural materials (like cotton and hemp) to best assist with ventilation of the genital area.

For people who have periods or monthly bleeding cycles (menstrual cycles), your vulvar smell may change depending on what stage of your period you are in, such as during the time you’re bleeding where the vulva may smell slightly metallic.  Semen inside the vagina can also tend to cause changes in scent for a few days while the vagina cleans itself. Changes in diet or starting a new dietary supplement can affect the natural smell, as well as changes in hormone levels (like with hormone replacement therapy or menopause).

The most common reason for unpleasant vaginal smell is an imbalance of the natural acidity of the vagina/internal genitals. This imbalance can cause the bacteria that are normally present to grow too much. This overgrowth of the normal vaginal flora is called bacterial vaginosis (or BV). BV can clear on its own or be treated with prescription antibiotics.

Resources

https://www.scarleteen.com/article/bodies/innies_outies_the_vagina_clitoris_uterus_and_more

https://www.scarleteen.com/article/advice/out_out_damn_smell

Discharge and Secretions

Discharge and secretions from the genitals can be normal.  If you’re wondering if the discharge you are experiencing is normal, read the information below.

Penile Anatomy

Discharge from a penis is normal when engaging in sexual activity, whether that be masturbation or any type of sex.  When a person with a penis is aroused, the penis may expel a small amount of clear or white/yellowish discharge called pre-ejaculate.  If this person then experiences an orgasm, the penis will expel anywhere from ¼ to 1 teaspoon of ejaculate.  Again, the colour of this ejaculate will be clear or white/slightly yellowish.

If you are experiencing any discharge that is not linked to sexual activity or thought, or is a variation of what your normal discharge looks like, such as a change in consistency or colour, it is best to see a healthcare provider as this could be a sign of infection.  

Vaginal Anatomy

Discharge and secretions from the vagina is a sign that the vagina is cleaning and regulating itself, meaning that secretions from the vagina are totally normal and are commonly experienced all or most of the time.  These secretions may increase in amount and consistency over the menstrual cycle with the following being considered normal and healthy:

  • During ovulation and sexual arousal – discharge is clear and thin
  • During less fertile times in the menstrual cycle – discharge is white or slightly yellowish and thick, the consistency of paste

People normally experience a moderate amount of mild, but not unpleasant smelling discharge from the vagina every day.  This discharge often will appear on undergarments and on the inner labia.  Just before or just after the menstrual cycle, the discharge may have a brown tint to it, which is again, totally normal.

If you are experiencing any discharge that is chunky or looks like cottage cheese, is watery, is profuse, has a strong odour, or is grayish, greenish, yellow, or pinkish, it is best to see a healthcare provider as this could be a sign of infection. 

Resources

https://www.scarleteen.com/article/bodies/honorably_discharged_a_guide_to_vaginal_secretions

Hair

Pubic hair grows on and around the genital area of teens and adults, including over the pubic bone, the labia, the base of the penis, the scrotum and the upper inner thighs.

Managing pubic hair

Trimming, shaping or removing pubic hair is a personal preference. Some people prefer to let their pubic hair grow naturally, while other people like to trim or remove their pubic hair entirely.

People trim their pubic hair for many different reasons. Pubic hair can be trimmed to stop it from showing outside a bathing suit, to prevent it from being caught on clothing or zippers, or to stop it from being caught on a condom. Many people trim their pubic hair for esthetic reasons.

Removing pubic hair

There are no known health benefits to removing pubic hair. A common belief is that pubic hair removal improves hygiene, but it is not necessary to remove the hair to keep the genital area clean.

Methods to temporarily remove pubic hair include scissors, shaving, sugaring, cream hair removers, waxing and laser hair removal. The only method that permanently removes hair is electrolysis.

Risks of removing pubic hair

There are a number of possible risks or side effects of removing your pubic hair, including: 

  • Rash, redness or razor burn. You can lower the risk of this by using a new razor each time and shaving only in the direction of the hair growth.
  • Infection in the hair root called folliculitis. This can be treated using an antibiotic cream. Clean your skin with soap and water and gently pat dry or dry using a hair dryer on the cool setting before applying a thin layer of antibiotic cream. It is best to wait until the infection clears before removing the hair again.
  • Chemical burn from cream hair removers. You should consider doing a skin test on your inner arm first to see if you may have an allergic reaction. Choose a product that is made for sensitive genital skin and do not leave on longer than recommended.
  • Spreading molluscum contagiosum by shaving. It is best to trim down the hair around the molluscum bumps and wait until the bumps have cleared before shaving again.

Resources

Hair removal for men – A comprehensive how-to guide

Hair removal for women – A comprehensive how-to guide

Hair removal for teens – Shaving tips for teen girls

Coloring pubic hair – Tips for dyeing pubic hair

https://www.scarleteen.com/article/advice/troublesome_pubes

https://www.scarleteen.com/article/advice/to_shave_or_not_to_shave_heres_the_answer

https://www.scarleteen.com/article/advice/what_are_these_bumps_on_my_penis

https://www.scarleteen.com/article/advice/shaving_woes

Douching

Douching comes from the French word ‘douche’ which means ‘to wash’. Douching means to clean a body cavity like a vagina/internal genitals or rectum with water. People may choose to douche for a variety of reasons, including medical or hygienic reasons, but it is often not necessary.

Penile Cleaning

If you have a penis, you can keep it clean by washing it the same way you wash the rest of your body – gently with some soap and warm water.  If you have foreskin, gently pull back the foreskin and wash however much of the head is exposed with warm water.

Vaginal/internal genital douching

Natal vaginas

For people who were born with a vagina (natal vagina), your vagina is a self-cleaning organ. Douching of natal vaginas is not medically recommended. Douching can flush out the healthy bacteria.  Douching does not prevent pregnancy.  Store-bought douches can contain ingredients like vinegar, baking soda and /or perfume. These ingredients can irritate the vaginal tissue, causing burning and dryness. This can make you more likely to get STIs. 

Some people use douching because of concerns about vaginal smell. It is normal for vaginas/internal genitals to have their own smell and it can change throughout the menstrual cycle. 

Neo vaginas

For people who were not born with a vagina/internal genitals but who have undergone vaginoplasty as a gender-affirming surgery (neo vagina), your vagina is not a self-cleaning organ. Routine douching is usually medically recommended to aid healing and clean the area.

Anal douching

Anal douching is often used to clean out the lower rectum before anal sex.

Anal douching involves gently introducing a half cup of slightly warm water into the rectum.  This action stimulates a bowel movement and the area is then gently rinsed out until the water comes out clear. Some people buy a ½ cup-size bulb syringe from the pharmacy for this purpose.

It is recommended to use room temperature or slightly warm water only, as soap or other additives can irritate the rectal lining and increase the risk of getting STIs.

Resources

Online

Vancouver Coastal Health – Tips for a healthy vagina

Canadian Women’s Health Network – Keeping your Vagina Healthy

Scarleteen – A guide to vaginal secretions

TransCare BC – Information on vaginoplasty, including aftercare

Anal Douching – A blog with tips on anal douching for anal sex

Scarleteen – Hygiene

Books

Anal Pleasure and Health: A guide for men, women and couples by Jack Morin

Modifications to Genitals

There is no particular way that genitals are supposed to look. Still, there are reasons that some people choose to make changes to the appearance of their genitals. One reason is for gender affirmation, which is when someone makes changes to their appearance to be more in line with the gender that they identify with, if it is different than what they were assigned at birth. Other people might choose to change the size and shape of their genitals. Most genital modifications, especially surgeries, come with important health considerations. Talk to a health care provider and look for trusted resources such as those developed by TransCare BC if this is something you are considering. 

Surgical Options for Changing Vulvar Anatomy

  • Labiaplasty – a surgery that reduces the labia minora or augementation of the labia majora.
  • Vaginolasty – a gender-affirming surgery that creates a vagina and vulva, and removes and inverts the penis, testes, and scrotum.
  • Vulvoplasty – a gender-affirming surgery that creates a vulva, including mons, labia, clitoris, and urethral opening, and removes the penis, scrotum, and testes.

For more information on gender-affirming surgery, please visit http://www.phsa.ca/transcarebc/surgery/gen-affirming  

Penis Enlargement

While many products claim to increase the size of the penis, no studies have shown that creams or supplements actually work.

Using a penis vacuum pump can temporarily enlarge the penis by increasing the flow of blood to the area, which makes the erection stronger.

There are surgical procedures that can be done to make the penis look longer. This is done by cutting ligaments in the groin, resulting in the penis hanging lower and appearing longer. After surgery, special care is needed to maintain the length of the penis. This surgery comes with the risk of side effects, however, including a change in the angle of erection so that the penis no longer points outward or upward. Talking to a plastic surgeon about these procedures can help decide if this is for you.

There are two proven ways to change the appearance of penis size without surgery:

  • Removing pubic hair will make the penis look longer by showing the part of the penis that is usually hidden behind the hair.
  • When a person gains weight, their penis will appear smaller because of increased fat distribution over the pubic area. If a person loses weight, the penis can look bigger as it is less covered by pubic fat and so is more visible.

Some people may choose to “pack”, meaning that they use a non-flesh penis.  Non-flesh penises are sometimes referred to as a packer or a prosthetic penis.  Some people view this part of their body as just their penis and choose to use it because they may like the way it feels, use it during sex, want to be able to stand to pee, or want to read as their gender.  

For more information on binding, packing, tucking and padding, please visit http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

Surgical Options for Changing Penile Anatomy

Phalloplasty is the term used for construction or reconstruction of a penis, or the artificial modification of the penis by surgery. The term phalloplasty can also refer to penis enlargement.

Complete construction or reconstruction of a penis can be performed for people who:

  • Have anatomical problems such as micropenis, epispadias and hypospadias
  • Have lost or damaged their penis through trauma, burns or explosion
  • Desire gender-affirming surgery as part of their gender transition

For more information on gender-affirming surgery, please visit http://www.phsa.ca/transcarebc/surgery/gen-affirming

Reduction of Penile Appearance

For larger-than-average penises, underwear choice can make a big difference in comfort. If penetrative sex is painful, consider changing position so that your partner can control the speed of entry and depth of penetration.

Reduction in the size of the penis and testicles is experienced as a side-effect of hormone enhancing treatment for trans feminine people and as a side-effect of hormone-blocking treatment for people with prostate cancer.

Some people may wish to completely hide their penis and testicles.  Tucking is a way of hiding the penis and testes between the legs or inside the body so that they are not visible.

For more information on binding, packing, tucking and padding, please visit http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

If you are experiencing pain or your genitals aren’t functioning the way they usually do, visit a healthcare provider.

Resources

Scarleteen.com – Information on penis anatomy and size

Young Men’s Health – Information on penis size

The Kinsey Institute – FAQs on penis size

Trans Care BC – Information on phalloplasty

Trans Care BC – Information on tucking

https://www.scarleteen.com/article/bodies/innies_outies_the_vagina_clitoris_uterus_and_more

https://www.scarleteen.com/article/advice/shown_actual_size_a_penis_shape_size_lowdown

Pap Screening

The Pap test is an important screening test that looks for changes in the cells of the cervix that can lead to cervical cancer. Cervical cancer is serious, but it usually develops slowly. If found and treated early, the chance of curing cervical cancer is very high. Cervical cancer is usually caused by a few types of Human Papillomavrus (HPV). The HPV strains that cause bumpy genital warts that you can see do not cause cervical cancer.

A Pap test is often done at the same time as sexually transmitted infection (STI) testing. Cells from the cervix are spread on a glass slide and sent to the Cervical Cancer Screening Laboratory (CCSL) in Vancouver. It generally takes four to six weeks for the results to come back to your health care provider.

The BC Cancer Agency recommends that cervical cancer screening should begin at age 25. In BC, a Pap test is done once a year for the first three years, then every three years if the results have been normal. Sometimes the Pap test is not included when people are tested for STIs. Ask your health care provider what tests are being done at the time of testing.

Downloadable Guides

Tips for a Healthy Vagina

Every person is different. Learn what is normal for you. Tips for a Healthy Vagina. This handout what developed by Vancouver Coastal Health.

Download

Resources and Related Pages