The female intimate area is divided into external and internal reproductive organs.

The visible external area is collectively known as the vulva. It includes the mons pubis, the outer and inner labia (labia majora and labia minora) and the clitoris. The vaginal vestibule with the Bartholin glands and the vaginal opening (introitus vaginae) are also part of the external female genital organs.

The internal reproductive organs consist of the ovaries, the fallopian tubes and the uterus.

The labia surround the external female genital area. There are two pairs: the outer labia majora and the inner labia minora.

One of their main functions is to protect the vagina. The outer labia in particular help protect against drying out, pathogens and foreign bodies, while their fatty tissue also cushions mechanical pressure.

The inner labia surround the vaginal opening and clitoris. They are an erogenous area and become more swollen with blood during sexual arousal.

The labia majora are folds of skin containing connective tissue, fat, sebaceous and sweat glands, smooth muscle, nerves and blood vessels. Their outer surface is usually covered with hair, is comparatively dry and often more pigmented. Towards the inner surface, the skin is hairless and no longer contains the same sebaceous and sweat glands. This inner surface resembles a mucous membrane and is generally redder, softer and moister.

The sensitive clitoris lies between the front portions of the labia majora. Fine skin folds extend from its underside towards the labia minora.

Towards the perineum, the labia majora become flatter and merge in an arch. Immediately in front of this junction is a thin fold of skin known as the frenulum labiorum.

The labia minora consist of connective tissue, nerves, elastic fibres, blood vessels and a venous network that acts as erectile tissue. During sexual arousal, this tissue fills with blood and becomes thicker.

The labia minora contain no fat glands but numerous sebaceous glands and have a mucous-membrane-like structure. Their outer surface is covered by keratinised squamous epithelium, while the inner surface is covered by non-keratinised squamous epithelium.

The external female genital area is bordered and protected by the labia. From the outside, mainly the labia majora are usually visible, covering the inner labia minora.

In some women, the labia minora protrude beyond the outer labia. This is referred to as labial hypertrophy. Often this is purely an aesthetic variation. In more pronounced cases, however, it can cause discomfort such as pain during sport, sitting, wearing tight clothing or sexual intercourse. Because the inner labia are no longer fully protected by the outer labia, constant friction can also lead to irritation and inflammation.

In such cases, surgical labia reduction performed by an experienced specialist may be considered.

In most women, the skin around the vagina and anus is darker than the surrounding skin. This is related to melanocytes, the pigment-producing cells that form melanin. Melanin is also responsible for hair colour. In the intimate area, more pigment can accumulate within the skin and create patches or generally darker areas.

This pigmentation is often genetically determined. It can also be influenced by repeated friction, chronic inflammation or very intensive waxing or shaving.

Hormonal changes and the natural ageing process can also contribute to darker pigmentation in the intimate area.

No two women have identical labia. They vary in size, shape, surface texture and colour.

In many women, the labia are darker than the surrounding skin and often have a pinkish-brown tone.

The colour can also change temporarily. During pregnancy, for example, the labia may become darker purple-red because blood flow to the intimate area increases. Hormonal changes or varicose veins can also influence their colour.

After sexual intercourse, a temporary red “flush” may occur. This usually resolves on its own.

• Bikini line
  The bikini line is the area that is not covered by a bikini bottom.
• Intimate area
  The front intimate area includes the entire pubic region, including the mons pubis and labia. The rear intimate area includes the anal region.

Attitudes towards sexuality and intimate care have become more open, and the intimate area is no longer regarded as a taboo subject by many women. Body care, aesthetics and personal well-being may therefore also include the vulvar and bikini area.

With the widespread use of waxing and intimate shaving, differences in pigmentation can become more visible. Some women feel more comfortable when the colour of the skin in the intimate area appears more even and therefore wish to have darker areas lightened.

Lightening darker skin around the vagina and/or anus is an aesthetic choice. If a woman feels uncomfortable because of darker pigmentation in the intimate area, this concern does not need to be a source of embarrassment.

There are many aesthetic treatments for different types of pigmentation and appearance-related concerns, from tooth whitening to the treatment of pigmentation spots or melasma on the face and the brightening of darker areas in the intimate region.

As with any aesthetic treatment, the procedure should only be considered when it is medically appropriate and can be performed safely.

As in the front genital area, the skin around the anus naturally tends to be more strongly pigmented. This is related to the higher concentration and activity of melanocytes in the intimate region. Depending on whether a person has a lighter or darker overall skin type, the skin around the anal sphincter can also be correspondingly lighter or darker.

Anal bleaching is an aesthetic treatment intended to lighten darker skin around the anus. At our private practice for dermatology and aesthetics in Munich, we use the specially developed Pink Intimate peel for this purpose.

Some women prefer the skin around the anus to have a colour closer to the surrounding buttock skin. Darker pigmentation in this area can be perceived as aesthetically bothersome, and treatment is therefore requested for personal cosmetic reasons.

The bikini line is the area of skin covered by pubic hair but not covered by a bikini bottom or underwear. The exact boundary varies because there are many different styles of bikini bottoms and briefs, including shorts, Brazilian cuts, thongs, Rio briefs and micro-strings.

Many women regularly remove body hair from the legs, armpits and sometimes the face. Intimate shaving has also become common over recent years and reflects a broader cultural trend in body grooming.

The reasons differ. Some women feel more attractive with a hair-free intimate area or consider it part of their personal beauty ideal. Sexuality can also play a role, as some women feel more comfortable and confident with an intimate area that has been shaved or otherwise depilated.

• Brazilian cut / landing strip
  Almost all pubic hair is removed except for a narrow strip on the mons pubis. Some women leave hair on the outer labia; if this is also removed and only the central strip remains, the style is sometimes referred to as a complete Brazilian.
• Hollywood cut
  All hair in the intimate area is completely removed.
• Bikini cut
  Hair is removed mainly from the outer edges of the pubic triangle so that no hair is visible outside the underwear or bikini bottom.
• Freestyle
  Some women prefer individual patterns or shapes and use trimming or templates to create designs such as hearts or geometric triangles.

Menopause describes the transition from the reproductive phase of a woman’s life, in which pregnancy is possible, to the phase in which natural fertility has ended.

For many women, this transition begins from the mid-forties onwards. The ovaries gradually produce fewer sex hormones, ovulation becomes less frequent and fertility decreases. Menstrual cycles become more irregular; they may initially become shorter and later often longer. Eventually menstruation stops completely. The final menstrual period is referred to as the menopause. The hormonal transition usually continues for several years.

During and after menopause, many women experience dryness of the vaginal mucous membranes because of reduced hormone levels. The skin of the labia and vagina can become thinner and more parchment-like, and the vagina can lose some of its elasticity. Vaginal atrophy and vulvovaginal atrophy are common consequences of these changes.

Menopause and the associated decline in ovarian and uterine function cause a range of changes in the body. The urogenital tract is often particularly sensitive to the reduction in oestrogen. It is estimated that around half of women after menopause experience symptoms associated with vaginal or vulvovaginal atrophy.

Vaginal atrophy refers to thinning of the genital tissue and the vaginal lining. In vulvovaginal atrophy, not only the vaginal tissue but also the external vulvar tissue becomes thinner and changes in structure.

Vaginal or vulvovaginal atrophy can cause symptoms such as vaginal dryness, an increased vaginal pH, inflammation, itching and burning. It may also lead to pain during sexual intercourse and discomfort or pain when urinating.

Other possible signs include small capillary bleeds, vaginal discharge, recurrent urinary tract infections and stress-related urinary leakage when coughing, sneezing or exercising.

Thinning of tissue in the intimate area is not limited to women after menopause. Younger women can also develop vaginal or vulvovaginal atrophy.

Possible causes include medications with anti-oestrogenic effects, such as certain oral contraceptives or medicines used in breast-cancer treatment, including tamoxifen and aromatase inhibitors. In some women, these treatments can lead to symptoms similar to those seen around menopause.

Like all other parts of the body, the intimate area is affected by the natural ageing process. As collagen production decreases, the skin of the labia can become more lax. Pregnancy, especially repeated pregnancies, can intensify these changes.

The contours and proportions of the inner and outer labia may therefore change over time. At the same time, the body reduces subcutaneous fatty tissue, which can lead to a loss of volume. The outer labia may appear hollow or deflated, while comparatively more visible inner-labial tissue can alter the balance between the labia minora and labia majora.