2. the canal in the female that extends from the external genitalia (
vulva) to the
cervix uteri. The adult vagina is normally about 8 cm (3 in) long and slopes upward and backward. Internally, the
bladder is in front of the vagina and the
rectum in back. The vagina receives the erect
penis in coitus; spermatozoa are discharged into it, swim through the cervical canal, and enter the
uterus. The vagina is also the passage for menstrual discharge, and it functions as the birth canal.
The interior lining of the vagina is mucous membrane; muscles and fibrous tissue form its walls. In pregnancy, changes occur in these tissues, enabling the vagina to stretch to many times its usual size during labor and childbirth. In a virgin, the opening of the vagina is usually, but not necessarily, partially closed by a membrane, the
hymen. Usually the hymen breaks at first intercourse; occasionally it ruptures during physical exercise.
In a normal state, the lining of the vagina secretes a fluid that is fermented to an acid by the bacteria that are usually present. This acidity probably helps to protect the vagina from invasion by other organisms. Douching as a regular practice should not be employed except when recommended by a health care provider.
Vaginal Examination. Since cancer of the female reproductive organs is a relatively common occurrence and is curable if detected early, physicians recommend that women of reproductive age and beyond have a periodic vaginal or pelvic examination. Such an examination is also necessary during pregnancy and labor and in the postpartum examination 6 to 8 weeks after childbirth. This is a simple procedure that is rarely uncomfortable if the woman understands its purpose.
The patient lies on her back on a special table with her legs raised and spread by stirrups. The examiner inserts a speculum to spread the vagina open and thus is able to observe the cervix and the lining of the vagina directly, and may take smears for microscopic examination to detect infection or cancer of the vagina or cervix. (See also
papanicolaou test.)
After removing the speculum the examiner inserts rubber-gloved fingers into the vagina and places the other hand on the abdomen. In this way it is possible to palpate the female reproductive organs, including the uterus and ovaries, between the hands. These organs are otherwise difficult or impossible to examine.
Patient Care. The patient should be prepared physically and emotionally for a vaginal examination. Since relaxation and cooperation of the patient are important to the success of the examination, she should be given a brief explanation of the procedure and encouraged to ask questions before the procedure is begun. The patient is draped with a top sheet so that the legs are covered and only the vulva is exposed. Privacy must be assured immediately before and during the examination. Equipment such as gloves, lubricant, vaginal speculum, and supplies needed for collecting specimens should be assembled before the examination is begun. After the examination is completed, the patient is assisted from the table.
Ideally, a vaginal examination should be done between menstrual periods; however, vaginal bleeding is not a contraindication to this procedure. Patients should be told this so that they will not postpone an appointment for examination when vaginal bleeding persists. They should not take over the counter medications or douche immediately before a vaginal examination; douching might remove secretions that could be useful in diagnosis.

Vaginal examination. From Jarvis, 2000.