I've just edited this having seen a link to a video posted today (8 October 2011) by camaguey (thanks camaguey) The link from 2m51s until 5m30s illustrates the vulva on the lines of the self examination described below, though in the link it is a doctor who performs the check. http://www.medicalvideos.us/play.php?vid=2448
I was asked to expand upon this subject after I had contributed to another thread. My comment was relevant at the time but to have said more about it there would have been too far off topic. I've done a sweep of threads but not found one suitable to attach my posting to, hence a new topic.
The question was 'What should women be looking for during vulvar self exams and any specific techniques they could/should use?'
Firstly my opinions are not to be taken as authoritative opinions backed by medical qualification and the measures detailed are merely commonsense checks any woman could and should make for herself. Any suspicion that something is wrong must be reported immediately to a medical practitioner.
Firstly, what are we looking for? Because vulvas (and other anatomical structures) vary so much I'm not going to describe a vulva from pubis to perineum. They vary in colour, in size, in position (some prominent to the front, some set to the back or underside). They vary in whether the outer lips (labia majora) enclose the inner lips (labia minora) or whether the inner lips protrude from within the outer - often, but not always, a consequence of childbearing.
We should, just as in breast self examination, be looking, and feeling, for changes. We have to assume when we first examine ourselves that all is well. Maybe we've had a Well Woman check and been given the all clear - what a good time to follow up with a monthly 5 minute check which might save your life. If you find some change that worries you then its not all bad, not as bad as not finding it maybe, go see your Gyn NOW. If you find nothing seems to have changed then congratulate yourself, pat yourself on the back. Maybe you're so relieved that your 5 minute check turns into a half hour treat for your vulva - but not till AFTER the check!
And how do we look in such an awkward area. A hand mirror? Maybe a gents magnifying shaving mirror on a telescopic arm? Maybe just move a mirrored wardrobe door. Get your lover to hold a mirror but keep his/her hands to themself. This is your vulva!
When we look into the mirror it should, in pre menopausal women be at the same time in the cycle. In post menopausal women the interval should be roughly equivalent to the menses, why not the first of the month? And why at the same time in the cycle? - because like our breasts our vulvas will change in shape, size and colour throughout the 28 days. It should be at the same time of day too , maybe before rising on the relevant day. Not to soon after sex. Examine yourself first reclining and then, if your mirror permits, standing.
You will first of all just do a visual check - think, what a wonderful structure this is. It stands guard at a place, protecting our 'nursery', our lovers 'play pen', capable of attracting our lovers into its embrace, capable of extracting and conveying what it needs - but I waffle! It can't do any of those things if its not healthy.
So, you'll first of all look at the symmetry or asymmetry of the vulva, particularly the outer labia. Are they as level, even, or uneven as usual? Look for swellings - stop! No touching yet, can't wait can you? Look at the colour, look for angry hotspots, weeping sores and other lesions. All OK? Well we can get on with it.
Close in with that mirror, part your pubic hair if you're not shaven, look under it, riffle through it. All OK? We'll move on. Getting nicer all the time isn't it?
Take your outer labia between the finger and thumb, near the bottom of your vulva, slide your fingers up, gentle now, use a little KY or similar but I'll bet most of you won't need any supplementry lubrication! 'Oh, its quite nice this, isn't it' 'Stop it now, this is serious'! We are feeling for any roughness or lesions maybe lying on the hidden underside of the labia. We repeat this on the other side. Then, just to prove we can handle this new experience we're going to do it all over again, this time palpating (lighly squeezing) the tissue from top to bottom. We're now on the hunt for suspicious lumps and we're going to be specially careful to check quite low down where the Bartholin glands are, one each side. These little chappies are there to secrete and exude a lubricating fluid, Mother Nature's KY. The fluid is fed to the outside by tiny ducts which can get blocked. It's not funny, its mighty painful and mighty dangerous.
Next - getting interested again are we? We move on to the inner lips - usually pinker or redder than the outer. Maybe even brown to purple - who knows - its change you're looking for remember! These tissues are a lot thinner than the outer labia, Take them, gently now, between that thumb and finger and check their whole surface.
Now then we come to the hardest part. Hardest for two reasons. One, because you'll be hard pressed to move your fingers slowly enough and two, because this part is going to get hard all on its own! Yes, the clitoris, clit, love button - you name it, you probably have!
Now, before it gets itself into a bit of a state, try to grasp this sometimes tiny sometimes large sometimes hidden sometimes proud but important bit between your finger and thumb. With a finger of the other hand try to ease back the 'hood' which covers most of it. Imagine an uncircumcised penis with its 'hood' foreskin. Never seen one? - go look but ask permission first!
Don't be too rough here - its sensitive! Is it sore, does it look inflamed maybe in patches. Move that mirror in. All OK? Well I'll leave it to you where you go from here - go on - you deserve it for giving yourself a five minute potentially life saving check - most often neglected - look forward to the next month!