The basics:

Who is this test for?

Cervical cancer screening can be done on anyone with a cervix.

What is this test for?

This test looks for signs of cervical cancer or early warning signs that cancer may develop in the future.

How is the test done?

A sample is taken of the cervix and cells are examined.

The details:

About Cervical Cancer:

Cervical cancer is of the most preventable forms of cancer. The key to this is early detection through a test known as a “Pap Smear”. This test is able to detect pre-cancerous changes, and action can then be taken to prevent cancer from developing. Or, if cancer is detected, there are treatments that may be able to address the situation before the cancer becomes life threatening. Because early detection can save lives, current medical guidelines generally recommend that anyone with a cervix get screened regularly, starting in their 20s.

Cervical cancer, as the name implies, is cancer of the cervix. Only people with a cervix are at risk of getting cervical cancer. The cervix is located at the end of the vagina and is a gateway to the uterus. If that’s not the anatomy you were born with, you are not at risk. If you have had surgery that removed your cervix, including some forms of hysterectomy, you are not at risk. If you’ve had surgery that constructed a cervix, you are likely not at risk, as the constructed cervix is made of different tissue.

According to the American Cancer Society, about 14500 cases of invasive cervical cancer are diagnosed each year in the US, and 4300 people will die from it. The screening test detects many cases and often successfully prevents them from turning into invasive, life threatening cancer.

Most cervical cancer is caused by HPV (Human Papilloma Virus), which is a very common sexually transmitted infection. Some estimates claim that most people who are sexually active will get infected at some point. Most HPV infections clear up without causing significant issues, some may cause things such as genital warts, and very few will cause cervical cancer. There is a vaccine for HPV, and using barriers such as condoms or dams during sex can help prevent its spread, but neither case is 100% effective. HPV can be spread by any kind of sexual interaction, including penis-in-vagina intercourse, manual sex/fingering (with or without penetration), anal sex, oral sex, or vulva-to-vulva contact, and contact with fluids is not required. To a lesser extent, HPV may be spread through any skin-to-skin contact, and there have been reports of cases where a person with an HPV infection in one area of the body has transmitted it to another part by simply touching both areas.

About the Test:

The most common screening test is known as a pap smear. This test involves taking cells from the cervix and examining them for signs of cancer or precancerous cells. The test only takes a few minutes, is performed without anesthesia, and is generally done in a doctor’s office. Often, it can be part of a larger exam.

The exact procedure may vary, but general goes something like this:

  1. The doctor will ask you to remove your clothing and put on a gown.
  2. The doctor will ask you to lie back and place your legs into what are called “stirrups”, which are designed to hold your legs apart for the pelvic examination.
  3. The doctor will insert a speculum into your vagina. A speculum is a duck bill like device that is inserted closed, then opened and locked into place. It is designed to hold the walls of the vagina apart so that the doctor can access your cervix. They come in different sizes, so if the one the doctor uses seems to big or is unbearably uncomfortable, ask that they try a smaller size.
  4. The doctor will scrape, brush, or swab the cervix in order to collect cells.
  5. The doctor will remove the speculum and the test is complete.
  6. Later, the cells will be examined and your results will be reported.


The pap smear is widely regarded as an uncomfortable, unpleasant, awkward, and invasive test, even among non-asexual people. But it’s also an important test, because it is highly effective at detecting and even preventing cancer while it is early enough to treat and eliminate.

It is common for asexual people, especially if they are penetration averse or uncomfortable with their genitals, to dread the thought of this test, and even avoid regular medical checkups out of fear that it will come up. This is a serious issue with serious implications that does not get enough attention. Fear of one procedure should not stop people from seeking other treatment, but the medical community is not doing enough to address this issue. Instead, doctors and nurses will often double down and insist and remind and cajole that you really oughta have this test. They’re expecting a patient who uses tampons and regularly engages in penetrative sexual activities. A patient who doesn’t want to deal with the time, expense, and hassle of the test. A patient who find the test embarrassing, but knows that a few minutes of embarrassment could save their life. They’re not expecting a patient who’s never had anything inserted in their vagina. They’re not expecting a patient with trauma. They’re not expecting a patient who’s dysphoric. They’re not expecting a patient with vaginismus. They’re not expecting a patient who is intensely uncomfortable with anyone doing anything in that area. They’re not expecting a patient who sees the exam as a violation. They’re not expecting a patient for whom the thought of the test causes paralyzing horror. And so they don’t respond properly to that situation, which means they don’t properly care for that patient.

First and foremost: You have a right to refuse any test or treatment. You can say no to a cervical cancer screening. Before you do, you should fully understand the risks that come with that decision and weigh them against the unpleasantness of the test itself. But you can say no, if that’s what you decide.

You can also talk to your doctor about ways to make the test less awful. Is there an alternative that can be done instead? Would a smaller speculum help? Would one made of a different material help? Would one that’s been warmed up a bit help? Would you be more comfortable inserting and removing the speculum yourself? Would it help if the doctor said more and explained what they were about to do at every step or said less and got it done with? Can they use lube on the speculum? Can you have someone you trust with you in the room or on the phone? Can it be done less frequently? Can they explain in advance and in detail what constitutes a “normal” level of discomfort, and what is pain that should be a signal to stop? If you’re not sexually active or you’re not comfortable with penetration or if you’ve never experienced penetration or nothing’s been inserted in your vagina before, tell them that. Can you put on a blind fold and pop in some earbuds and zone out for a bit? Whatever it is, they’ve probably had someone do it before. They can also adjust what they’re doing if they know how you’re feeling.

Stepping back a bit, as was mentioned earlier, most cervical cancer is caused by HPV, and most HPV infections are sexually transmitted. So there’s a natural question that arises from that, which is, “Do people who are not sexually active and never have been need to be screened?” Some doctors say no, while others say yes. The doctors who say no believe that the risk is so low that it is not worth the effort to screen. The doctors who say yes will point out that while the risk is low, it is not zero: HPV can be transmitted through non-sexual contact, and some cervical cancer is not caused by HPV.

There is a spectrum of risk, and you should honestly assess where you are on that spectrum and discuss with your doctor before refusing. On one end of the spectrum would be non-sexual contacts like handshakes, which have a very very low risk of transmitting HPV. Near the upper end would be things like frequent, unprotected penis-in-vagina sex with many partners. But again, the final decision is up to you. If you’re not sexually active and barely even shake hands with people (who does that anymore, anyway?), you can still decide to get screened, just in case. And if you’re at the other end of the risk spectrum, you’re still within your rights to say no.

It should be noted that the reason screening is universally recommended for anyone with a cervix over a certain age is because of the assumption that people over a certain age are sexually active, but may not be willing or safely able to admit it, or may be unwilling to take a test for an STI, no matter how common it is. By recommending universal screening, it removes the stigma around it. Taking the test isn’t an admission that you’ve had sex, it’s simply expected because of your age. And in some cases, if you refuse the test on the grounds that you’ve never been sexually active, the doctor may continue to push for it because they don’t believe you.

Bottom line: Routine cervical cancer screening saves lives. If you have no particular qualms about getting the test, then you probably should be screened as often as the guidelines recommend. However, if the thought of the test is overwhelmingly unpleasant, you should assess your risk and explore your options.

The vulva and its subcomponents have a number of uses. Here is a short list of some of the more common ones.

Nestled within the vulva is the endpoint of a liquid waste disposal system. The vast majority of the time when someone uses their vulva, it’s for urination.

Subsections within the vulva are often the primary source of sexual pleasure for people who have them. Certain components, such as the clitoris, can become particularly sensitive to stimulation in certain situations. Not everyone who owns a vulva will use it in this way.

For most vulva owners, a region located adjacent to the vagina will eventually begin redecorating itself as a nursery pretty much every month. If this nursery does not get a resident within that month, it will tear down what it built and throw it out, down the vagina. For many people, this is an annoying, unwanted process, but for others, it can be a welcome sign that a resident has not arrived, and for others, it can just be a thing that happens.

Some people who own a vulva enjoy using some or all of it with another person. On the other side, some people enjoy having a vulva they do not own used with them. Not everyone who owns a vulva will use it in this way.

Occasionally, often as a delayed reaction to certain activities with a partner (although that’s not always the case), the vulva will transform into a passageway by which a tiny human will be kicked out of the assembly floor where it had spent several months building itself. Not everyone who owns a vulva will use it in this way, not even everyone who hosts a self-assembling mass of cells known as a “baby”.

What Comes Out

It is important for a vulva owner to understand what sorts of things downstairs are common and “normal”, and which are potentially a bigger issue. This list cannot describe all possibilities, so please consult other resources or medical resources if there are concerns.

The vagina is the most common escape route for a baby looking to flee the uterus. There is typically ample advance warning (up to around nine months, in many cases) that a baby may be intending to use this passageway.

This is the most common thing to come out of a vulva. Usually happens to anyone who owns a vulva several times a day. Urine is a waste product of the biological processes of the body. It is usually released in a high pressure, high velocity stream. It is a flowing liquid in consistency and ranges from clear to deep yellow-brown in color. The exact volume varies, but it is typically a notable amount.

Urine is released from the urethra, which is located between the entrance to the vagina and the clitoris.

For a period of time, roughly once a month, there may be a flow of blood. This blood may be heavy, may be light, may be somewhat clotted and “chunky”. This flow is the result of the uterine lining breaking down and being discarded by the body. Vulva owners will often use a menstrual product, such as a tampon, pad, or cup to catch the blood flow.

It may be possible to lighten or even prevent menstruation from happening through the use of hormones sometimes called “birth control” for their ability to prevent pregnancy.

When aroused, the lining of the vagina may self-lubricate. This is generally a clear, slippery, viscous fluid. It’s similar in consistency to some kinds of liquid soap and a small string of fluid will bridge the gap if you pinch some of it between your fingers and slowly open them.

This natural lubrication may or may not be adequate for penetrative activities.

Throughout the month, there may be mucus that comes out of the vagina. The appearance can change from time to time, and these changes can be an indicator of the phase of the menstrual cycle. The mucus can range from clear to white to slightly yellowish, and may be reminiscent of snot. Sometimes it may be sticky.

Some other types of discharge may be signs of infection or other problems. If you notice a new type of discharge you’ve never seen before, it may be worth looking for more information or consulting a medical professional.

After penetrative intercourse that involves a penis ejaculating inside the vagina, a significant amount of the semen may drip out.

What Goes In

This is a non-exhaustive list of things that may potentially enter a vagina.

Nothing at all. Some people don’t want anything going in there, and that’s perfectly fine. The owner of the vagina gets to decide what to let in and what stays out.

As noted elsewhere on this site, it’s often possible for vulva owners to participate in sexual activities, masturbate, and experience orgasm without involving the vagina whatsoever.

Some menstrual products, like tampons or cups, may be inserted into the vagina to catch the blood during a period.

Certain medical procedures may require internal vaginal use of some sort of medical device. A speculum is a sort of metal duck bill-looking thing which is designed to hold the walls of the vagina apart. A swab, similar to a Q-tip may be used to take a sample. IUDs, or intra-uterine devices, are a form of birth control that is placed in the uterus, which will be accessed through the vagina. Sometimes dilators may be recommended to gradually stretch the vagina, if the vulva owner has a small vagina or a condition like vaginismus and wishes to take part in penetrative activities.

It is always your right to ask the doctor to explain a procedure beforehand and ask whether the procedure is necessary. Some procedures may not be warranted if you do not engage in penetrative intercourse. It is always your right to weigh the risks and decide not to proceed. If the procedure involves a speculum, you can typically ask the doctor to use a smaller size.

Sometimes body parts, such as fingers or penises, may be used inside a vagina. Lubrication might make this process more comfortable.

Sometimes toys, such as dildos, vibrators, or Kegel exercisers may be used inside a vagina. Lubrication might make this process more comfortable.

[Content Warning: This page has actual photos of actual vulvas.]

Beyond this point are photos of an actual vulva, with various parts labeled. These photos contain nudity. There is no text content outside of the image descriptions.

So if that’s not something you want to see, turn back now.

This image contains actual nudity. This image is a view of the front side of a fully nude standing person with a vulva, in order to provide a reference for location and size. The location of the vulva is highlighted by the blue circle, although it is mostly not visible. The person’s breasts are also visible.

Original Photograph: Public domain.

Filtering added.

This image contains actual nudity. This image is an angled view of the front side of a person with a vulva lying on a bed. Their legs are slightly open, allowing the vulva to be seen. The location of the vulva is highlighted by the blue circle, although only the outer labia are visible. The person’s breasts are visible in the background, but are blurry.

Original Photograph: peter klashorst / CC BY 2.0 (

Filtering added.

CC BY 2.0

This image contains actual nudity.  This image is a view of a vulva with closed labia, surrounded by pubic hair. The clitoris, vagina, and urethra are not visible in this image. The person’s front is towards the top of this photo. Several features are labeled.

Original Photograph: Viewmaster Stereoscopic Atlas of Human Anatomy, Section VI, Reel 156-6, Bassett/Gruber, 1961

Annotations Added.

This image contains actual nudity.  This image is a close-up view of a vulva being held open for visibility. The clitoris and vaginal entrance are visible. Pubic hair has been removed. The person’s front is towards the top of this photo. Several features are labeled.

Original Photograph: Public Domain

Annotations Added.

This image contains actual nudity. This image is a series of photos of a vulva in various stages of arousal, showing the inner labia expand. These images are not labeled.

Original Photograph: Fotomannforever / CC BY-SA 3.0 (

Filtering added.

CC BY-SA 3.0

This image contains actual nudity. This image is a series of photos of different vulvas, showing a variety of sizes, shapes, and styles of pubic hair. One of the images includes a piercing. These images are not labeled.

Original Photograph: Coupleabc / CC BY-SA 4.0 (

Filtering added.

CC BY-SA 4.0

This section describes some of the anatomical points of interest and neighborhoods within the vulva and its surrounding metro area.

The outer lips, also called the “labia majora”, are large, thick folds that make up the outer suburbs of the vulva. They are often covered with hair. When closed, these large folds often hide most of the rest of the areas of the vulva.

The inner lips, also called the “labia minora”, are thinner, hairless flaps that ring the central zone of the vulva. These lips are often folded and wrinkled in shape, and one side can be larger than the other.

This is the Central Park area of the vulva, a relatively smooth, soft, hairless zone, located inside the valley between the labia. At the north end are the foothills of the clitoris, and the southern end wraps around the urethra and the entrance to the vagina.

In the northern area of the vulva (towards the front of the body), where all the folds and flaps come together is nubby bit known as the clitoris. Because of its location and size, the clitoris tends to be overlooked and ignored. However, this is one of the most sensitive zones. Stimulating it is one of the more common ways vulva owners can get sexual pleasure and potentially reach orgasm. When aroused, the clitoris will often fill with blood and grow in size, and may come out of hiding. The external part of the clitoris is just the tip of the iceberg. Internally, the roots stretch along and around the vagina.

The clitoris is covered by a fold of skin known as the clitoral hood. The hood cushions and protects the sensitive skin of the clitoris. When aroused, the clitoris may come out from under the hood. The hood typically marks the northern extent of the vulva.

The urethra is a small hole, located near to the vaginal opening on the plains of the vestibule, between the vagina and the clitoris. Urine exits the body thorough this hole.

The vagina is a stretchy fleshy tube that extends several centimeters inside the body. Normally, the walls of the vagina are touching, but it can stretch to accommodate objects of varying sizes. It connects the northern neighbors, including the uterus and ovaries, with the outside world. For many people with a vulva, the vagina is one of the most prominent features of the vulva. So much so that many people erroneously refer to the entire vulva zone as the vagina. (Other people erroneously believe that the vagina is the primary, or even sole source of sexual pleasure in vulva-owners. Those people need to meet the clitoris, but that’s a story for another page…)

Pubic hair is a tuft of short, curled hairs located in front of and around the vulva. It usually covers the mons pubis and outer labia, but may extend beyond that range. For a variety of reasons, some people will shave or trim this hair, while others may find that process pointless and/or itchy.

The perineum is a zone between the legs, behind the southern extent of the vulva and in front of the anus.

The mons pubis, or pubic mound is a small, soft hill, located immediately above the vulva at the bottom end of the torso. This acts as a cushion for the pelvis during certain activities, and is often covered by pubic hair.

Along the front wall of the vagina (The same side the clitoris is on), a few centimeters inside, there is a small patch that feels harder and ridged, much like a small Ruffles potato chip under the skin. That is the location of the G-Spot. Some people who own one of these report that pressing and rubbing this area can be extremely pleasurable.

The vagina is a gateway to some interior features. At the inside end of the vagina is a thick ring called the cervix. Past the cervix is the uterus, which is where children spend months assembling themselves. Beyond that are some tubes and eventually the ovaries, which produce eggs, which are half of the material needed for children to begin assembling themselves in a uterus. With the exception of the cervix, none of these features are reachable from outside, without effort.

This page explores some of the more common variations on how a vulva may manifest itself.

All of the regions of the vulva can be vastly different sizes. The clitoris can be tiny and barely noticeable, or it can be large and distinctly prominent. The labia can be thin or thick or wrinkled or smooth. It is common for the labia on one side to be larger than the other. The size may change when aroused.

The vestibule area, vaginal skin, and inside of the labia are typically pinkish, reddish, or purplish in color. The outside of the labia may be the same color as the rest of the body, or may be pinkish, reddish, or purplish. It is common for some areas of the labia to appear darker than others. The color may change when aroused.

Hair down there varies wildly, if not removed. Hair usually covers at least the outer lips and the pubic mound, and is usually not present on the inner lips or clitoral hood. Some people have thick hair over a large area, extending up the stomach and down the legs, while others have thinner hair in a smaller area more immediately above and around the vulva, while others have something in between. Sometimes the hair extends to the perineum, sometimes it does not. The hair may be different thicknesses or lengths in different areas.

The vagina is usually a few inches deep and may be capable of stretching a little bit. I’m not going to get more specific than that because then people start to wonder how big theirs is in comparison to others and then might feel upset if they’re not in the 99th percentile because society is terrible like that. Some people with things like Androgen Insensitivity Syndrome may barely have any depth at all.

The tightness of a vagina is another thing society is terrible about. Penis-centered notions of an ideal vagina emphasize some mythical level of desirable tightness, and anything outside of that range is looked down on. However, most vaginas are stretchy and elastic and will form fit anything from a little finger to an entire baby, although discomfort may increase as the size of the object does. That said, if a vagina seems so tight that small or moderately sized objects (like a standard sized dildo or average-sized penis, or even a single finger or tampon) cause discomfort or pain it may be worth bringing this up with a doctor. Conditions such as vaginismus may lead to penetration difficulties, and anecdotally, they may be more common among asexual people.

The vulva and related areas may occasionally change between a number of different states. The transition between the states is not instant. The exact configuration will be different for different people, and the differences may be easier or harder to discern for different people. , as the size and shape of various parts may affectmake some things more or less apparent.

The vulva and friends spend most of their time in a default, unaroused state. The clitoris will often be relatively small, and the inner labia may be hidden completely by the outer labia.

Some of the time, the vulvar area will enter a state of arousal. Sometimes this is brought on by certain kinds of physical contact or sexual thoughts, while other times it can be random.

During arousal, several changes will take place. Blood will flow to the region, causing various tissues to expand. The labia may become fuller and more pronounced and change color. The inner labia may push open the outer labia and become more prominent. This clitoris will experience an erection. The glans will become larger and harder, but the clitoral hood may also expand at the same time, so even though the clitoris is getting larger, it may end up more hidden. In some cases, a hard shaft may become noticeable, connecting the glans to the body, and may cause the clitoris to stick out. The vagina may also begin producing lubrication.

Many of these changes may not be immediately apparent unless you closely watch the process, and even then they may be hard to detect. Feeling the wetness of the vaginal lubrication is one of the more commonly noticed signs. People also describe a feeling of “fullness”, “warmth”, or “tingling” downstairs.

Arousal also often makes the entire region more sensitive. Some areas, such as the clitoris, may become more sensitive than others. If stimulated in the right way for long enough, this can often lead to sexual pleasure and possibly orgasm.

Internally, there are changes that are even harder to notice. The vagina may lengthen, and the cervix and uterus may shift position. And the temperature of the entire area might increase slightly.

The menstrual cycle may impact how the vulva behaves. One of the more well-known effects is the period, where blood will come from the vagina for several days. Cervical mucus will change in amount, consistency, and color during the cycle. At some points during the month, arousal may be more common or easier to achieve, leading some people to describe a few days where they tend to feel more “horny”.

[Content Warning: This area discusses the anatomy of the vulva, including the clitoris and vagina. One of the pages in this section has photos.]


A vulva is one of the more common variations of human genitalia. It is located at the bottom of the torso, mostly between the legs. It consists of a number of flaps and folds of skin called labia. These flaps usually cover a nubby thing called a clitoris where some of the folds come together in the front, and a soft tube that reaches inside the body, called a vagina.

The vulva and everything else in that region vary wildly from person to person.

The following pages describes some common configurations, but it cannot possibly describe all possible variations.

These following pages explore what you are likely to encounter on your travels to the vulva and the area around it.

  • Asexual people can masturbate, if they want to.
  • Asexual people can use sex toys, if they want to.
  • Using an anatomical toy does not mean you’re secretly interested in that anatomy and does not invalidate asexuality.
  • There are toys of all types that are abstract/non-anatomical in design.
  • There are many toys for vulvas which do not require penetration.
  • There are a few toys for penises which do not require insertion.
  • There are many toys that can be used in a way where you do not have to touch your genitals directly.
  • There are many toys which can be used in a way where you do not have to come into contact with any fluids.
  • There are sex toy shops which focus on the toys and won’t fill your browser with sexual imagery.
  • If a toy looks cheap and sleazy, it probably is, so avoid it.
  • If any of the reviews mention a smell, avoid it.
  • Avoid jelly toys, as they disintegrate or melt and may be made with toxic chemicals.
  • Some stores make a point of not selling junk toys.
  • Most toy stores ship in plain boxes with an innocuous sounding company on the return address.
  • More expensive doesn’t necessarily mean better, but cheap almost always means worse.

And finally:

  • Use lube.

This is a brief rundown of some of the other types of toys that are out there.

Handheld Shower Head:  A handheld shower head with various massage options can be used to masturbate.  The spray can be directed against the vulva or clitoris.  They can also be used on the penis and testicles, but they are often less effective.  Handheld shower heads are a popular masturbation device because they are completely discreet and will immediately wash away any fluids produced.  (If you don’t have a handheld shower attachment, the water from a bathtub faucet can be used in much the same way, although in a much more limited position.) And even if you don’t use them to masturbate, they’re a useful upgrade to your shower, because you’ll no longer have to twist and contort to get the shower spray to rinse off that impossible spot on the back side of your knee.

Pillows:  A bunched up pillow can be grinded against for clitoral stimulation.  If you have a penis, a condom or plastic bag with a little bit of lube can be placed between pillows and thrusted into.  Place a towel over the pillow before use for easier cleanup.  Pillows are also a completely discreet option. (As long as you avoid wet spots…)

Cock Rings:  Cock rings are placed on the penis or around the testicles to aid with an erection and alter the sensations.  Some have vibrators attached.  Many times they come in packs of multiple sizes, so you can use the size that works best.  You want something that is roughly the diameter of the erect penis.  Too big and it will come right off, too small and it can start to hurt and you’ll end up with one of those four hour erections that you’re supposed to call a doctor about. Sometimes, the rings can be large enough to fit around both the penis and the testicles. Be careful with rings or you might end up with a trip to the ER having a metal ring buzzsawed off a part of your body that should never be near a buzzsaw.

Pumps:  Suction devices meant to draw blood into various areas to make it swell up and become larger or more sensitive.

Dolls:  Generally human-ish replicas used for intercourse simulation or carpool lane fraud.  Can be inflatable (like a beach ball), plush (like a stuffed toy), or metal and rubber (like a robot who’ll kill us all).

Partial Anatomy Replicas:  More than a sleeve/dildo, but less than a doll, these replicate parts of human anatomy.  Usually it’s just a section of the pelvis, with a labia and a vaginal hole, but others exist with a penis and testicles.  Butt (usually with an anal hole) and breast replicas also exist, as do full torso models.

Sex Machines:  These take many (large, noisy) forms, from a vibrating saddle with a dildo on the seat, to a reciprocating actuator with a dildo or sleeve on the end, to an alternating suction device.  On the smaller end, there are also some automatic strokers that might fit in this category.

Balls and Beads:  Sometimes sold for vaginal exercise (strengthen those Kegel muscles!), these are roughly ping-pong sized balls.  If they have a string, they can potentially be used anally (although put a condom on them if you do that, because strings are not easy to clean)  Beads are smaller variants on the balls, and are typically specifically for anal use.