“I don’t like oral sex. I just don’t feel comfortable with someone being that up close and personal with my vagina.” Origin physical therapist Dr. Alex Bertucci hears this sort of thing often. People may come to physical therapy for pelvic floor pain, but then reveal more — they think their labia are too long, their genitals have too strong an odor, or they just feel like things don’t look “normal.” There’s a name for how you feel about and value your genitals: genital self-esteem.
While having low genital self-esteem often feels private and isolating, it’s more common than you might think. According to a survey by tampon-maker Callaly “a quarter of people have negative feelings — including hatred, shame and disgust — towards their vulva.” Procedures like labiaplasty, clitoral hood reduction, and hymenectomy are on the rise, with some people turning to douches and scented products to smell “clean and fresh.” Low genital self-esteem can even lead people to avoid sex, relationships, and even solo pleasure.
According to Dr. Bertucci, genital self-esteem is not only how you feel about your genitals but also about how easily you’re able to enjoy sexual activity. It can be hard to lose yourself in the moment if you’re self-conscious about how you look, smell, or taste.
Why do so many people feel bad about their genitals?
Origin advisor Dr. Uchenna Ossai shares that just like our overall self-esteem, genital self-esteem can be influenced by the patriarchy, the information we’re given (and not given) about our bodies, how we were raised, pelvic floor function, illness, religion, culture, and more.
Birthworker and sex wellness educator Danellia "Dane Reál" Arechiga also shares that some birthing people may experience changes to the appearance or function of their genitals after giving birth. These changes can sometimes lead to feelings of insecurity, self-consciousness, and disconnection from their body, especially if the changes are unexpected.
It doesn’t help that people socialized as women are essentially told to avoid their genitals. The focus? Don’t get pregnant and don’t get an STI. Oh, and genitals should be odorless and tucked away. We’re not taught what different vulvas can look like and how to prioritize our own pleasure. As a result, many people have never even seen their own vulva.
And for those who have, they often have a picture in their head of what their genitals “should” look like and all the ways their anatomy doesn’t measure up. The vulvas we see in porn and in textbooks tend to be small, pale, and symmetrical, with small inner labia (and they're usually hairless). While some people’s bodies look like this, most do not.
Arechiga shares that identity can also play a big role in genital self-esteem. “Factors such as gender, race, and ethnicity can carry harmful stereotypes and assumptions. Also, someone who is transgender, non-binary, or gender non-conforming may feel disconnected from the genitals they were born with, which can have massive impacts on genital self-esteem. Feeling disconnected from the body you are living in and trying to navigate sexual relationships can cause confusion, self-hatred, and body dysmorphia.”
So, how can you improve your genital self-esteem?
First, Learn about the amazing variety of vulvas
As Dr. Bertucci says, “Vulvas are like faces –– no two are the same.” With our narrow view of what vulvas are “supposed” to look like, you might think something is odd about yours when, really, each vulva is unique. Start with The Vulva Gallery, the artist Lydia Reeves, the book A Celebration of Vulva Diversity, or Healthline’s ‘normal labia’ list. Dr. Ossai also recommends diversifying your social media feed when it comes to sex and sexuality and is a big fan of the book Finding VaJoyJoy, a story about a nonbinary vulva’s self-discovery.
Get to know your vulva
You might know how your vulva feels to the touch, but when was the last time you really looked? Dr. Bertucci recommends people use a hand mirror and get to know their unique vulva. (It’s totally normal if this feels a bit uncomfortable at first.) The more familiar you are with your genitals, the more likely you are to appreciate your own unique body over time.
Arechiga also recommends spending some time observing the color, shape, size, and details of your body. She offers the following practice.
Place a gentle hand or finger on your genitals, familiarizing yourself with the texture and temperature of your own hand on your body. Acknowledge that there is no other body just like yours, and speak affirming words as you look at and touch your genitals such as:
"I love and accept my body, including my vulva."
"My vulva is a natural and normal part of who I am."
"I am worthy of pleasure and sexual satisfaction."
"I am proud of my body and all that it is capable of."
"I am deserving of love, respect, and positive sexual experiences."
"I am grateful for the unique and beautiful qualities of my vulva."
"I choose to focus on my strengths and embrace my body, including my vulva."
Remember that bodies smell (and that’s okay)
There’s a big industry of douching and products that promise to make your body “odorless.” But the truth is that bodies have a smell — especially in sweatier areas, like armpits and genitals. There’s a whole market of things that are meant to “clean” your vagina or mask its scent, but Origin PTs say a little bit of soap on the outside with some warm water is all you need.
(Yes, some symptoms like discharge and strong odors can tip you off that something’s out of balance and you may want to get it checked out. The more you know about your natural scent, the easier it’ll be to tell when something has shifted!)
Let Your Creativity Flow
Get professional support
You might also consider seeking out an AASECT-certified sex therapist to explore genital self-esteem, sex, relationships, pleasure, and anything else that might come up — it’s often all connected. Sex counseling and PT can help you take control of your genital health, explore your desire, and see your genitals as a source of pleasure and strength.
Explore what genital self-esteem means to you with an Origin physical therapist.
At Origin, our pelvic floor PTs are experts at helping you get comfortable talking about all of your pelvic organs, and can address muscle and nerve issues like discomfort or pain, difficulty with orgasm, bladder / bowel leaks, prolapse, and many more conditions that can turn your life upside down and take a toll on genital self-esteem.
Within the first 5 minutes (whether in-person or online) you’ll quickly realize that a pelvic floor PT visit is nothing like a rushed gyno exam. There’s time for your PT to learn about your current relationship to your body and listen to any concerns you might have about your vagina and vulva.
While a hands-on pelvic floor physical therapy exam can be a fantastic way for a pelvic floor PT to learn more about this area of your body, it’s absolutely not required. “Your PT can learn so much just through conversation and evaluating your posture and how you move,” says Ashley Rawlins, PT, DPT, Origin’s Clinical Education and Development Lead. “And they can also teach you how to perform a pelvic self-exam that can be incredibly empowering.” If you do choose to have an in-person pelvic exam, your PT will ask for your consent, talk you through every step, and go at the pace that’s right for you.
If you’re looking for a stigma-free and supportive guide who will help you strengthen your connection and appreciation for your own body, don’t hesitate to book a visit with us.