Good Practice: Anatomy - The ‘v’ word

Bath time in Lorna Stewart’s home makes a bit of a splash. Lorna’s little girls, aged two and four, have a wash guided by their mum. Like many parents, Lorna checks they wash their faces, necks, hands and feet. Unlike many parents, she also asks, ‘Who’s ready to wash their vulva?’ (Inside Health, Radio 4, 10 August 2021).

How often do you say ‘vulva’? Can you name its different parts? Vulva is a rarely spoken thing, and not only during children’s bath time.

Fiona Reid, consultant uro-gynaecologist from St Mary’s hospital in Manchester, is worried that so many adults have a poor understanding of the external female genitalia. ‘Many people don’t realise that there are three holes: the vagina, the anus and also the urethra. Often they seem to think that the urethra and the vagina are one and the same. There is also considerable confusion about the clitoris and the urethra – and that can be among people who are training as medics, let alone the general public!’

This has to concern anyone working in education.

WHAT DO YOU KNOW ABOUT THE VULVA?

In light of this, it seems fitting to start by getting a few basics clear:

• The vulva is the term used for the outer part of the female genitalia.
• The hair-bearing area is the mons pubis.
• The labia majora are the larger outer lips with hair.
• Inside the labia majora are the labia minora, the smaller lips.
• Inside the labia minora is the vaginal opening – one of the three holes.
• The urethra, another of the three holes, is the hole above the vagina where we urinate from.
• Between the vagina and the anus is the perineum.
• The labia minora join together at the front and form the hood at the very front over the clitoris.

The anus is the third hole at the back but is not part of the vulva or genitalia. The diagram of the female ‘sexual’ anatomy in many text books is of the reproductive organs: a pair of ovaries, the fallopian tubes, a uterus and a vagina.

This internal or reproductive anatomy is not the same as the sexual anatomy.

USING ACCURATE TERMINOLOGY

The first question to ask is: Why wouldn’t we teach children proper names for all parts of their body? Year 1 is when children learn the body parts – neck, face, shoulders. It is not required to teach penis and vulva. In fact, teaching the different parts of the vulva is not on the curriculum at all. In Year 5 it might be taught as part of the Science National Curriculum: ‘Learn about the changes experienced in puberty.’

For children to be able to talk about their bodies, they need to be able to identify and label its different parts. Stewart continues, ‘It empowers children to say, “It’s my body and I get to choose”.’

In 2017, NHS Greater Glasgow and Clyde (NHSGGC) stated that using a variety of words to refer to the penis or vulva can be ‘really confusing for children’. The NHS Trust’s sexual health service in Sandyford encourages parents to ‘tell it like it is and use accurate terms from an early age’.

Jill Wilson, health improvement lead at Sandyford, says, ‘Many adults were not taught these words growing up and can feel uncomfortable using them as they can be thought of as “sexual” words. Young children do not have these associations and usually consider these words to be as normal as “hand” and “leg”.’

Emma Pobjoy, head teacher of Pastures Way Nursery School in Luton, says, ‘Using pet names for the genitalia has long been a concern of mine. I think my concern increased when we had a child refer to his penis as his “noo-noo”. Now, although that may sound completely innocent, I wonder what would happen if this child told one of the staff someone touched his noo-noo. Would they know what he meant and follow it up?’

Surely, it is nothing but absurd to teach a child that their face is called their face, their foot is called their foot, but their vulva is called their ‘woowoo’ and their penis is called their ‘noo-noo’?

MAKING A START IN THE EYFS

The early years are when children are developing an understanding about their bodies. This is why it is important to get off to a good start, enabling children to feel confidence and pride in themselves, not damaging feelings of shame. The Professional Association for Childcare and Early Years (PACEY) has shared an important blog by Maisie Yasmin Darling, ‘Teaching children about their private parts’.

She argues that, ‘When we don’t feel comfortable saying something, we tend to avoid it or make up colloquial terms or pet names in order to avoid any embarrassment. There are many such names – some bizarre and often non-recognisable as a description of private parts.’ (October 2019).

Embarrassment on the part of the adult can be the first hurdle to overcome. Darling continues, ‘When adults are clear, unashamed and upfront about all parts of the body, this teaches the child that all parts of their body are important, and no shame and stigma are attached to any part.’

It seems, then, that adults need to attend to their personal inhibitions or lack of ease. Rigorous self-reflection combined with the opportunity to talk openly as a team seem like necessary starting points in preventing the perpetuation of deep-seated taboos (some of which we are aware of, some not).

In terms of talking with children, the early years is fortunate in that there are many natural times to have such conversations, for instance during nappy-changing and potty training. The toilet and changing areas are ideal places to have displays and resources that support this learning.

Darling also points out the need for working with parents. Although this can be sensitive and tricky, it can reap long-term benefits for both adult and child. She says, ‘Teaching your child in this way can help increase the bond between parent and child, helping open communication become the norm. This is a very healthy and helpful dynamic to have as you grow up together. It’s also invaluable as your child approaches puberty.’

Pobjoy acknowledges parental involvement as key. ‘It is something I believe parents need more education on. Parents need to know the hard facts around the dangers of using pet names early on, so they are doing the right thing from the start, thus avoiding any confusion or potential safeguarding concern.’

SAFEGUARDING

The links with safeguarding are clear. A good knowledge and understanding of the anatomy supports children in owning their bodies. This helps equip them to speak out if their body is injured or mistreated.

Chelsea Watson, manager of Paint Pots Nursery in Southampton, says, ‘On the last DSL training I did, they said it was important for everyone, parents especially, to name children’s genitalia anatomically. This enables children to describe this area, and in cases of abuse it is more likely that people are prosecuted. Apparently, it can shock abusers if children use anatomical words.’

Pobjoy points out, ‘Using accurate terminology is not something I’ve seen addressed in safeguarding training, but it is something I believe needs highlighting to both practitioners and parents. We share the PANTS (NSPCC resource) with parents and children, but specifically doing some teaching about the use of correct terminology is something we have yet to introduce.’

KNOWLEDGE NEEDED

Silent ignorance about the anatomy leads to all sorts of problems. Knowledge is needed if young children are to grow up able to look after themselves and make choices, medically and sexually. It is time to break the silence. All children need to know about their bodies, the whole of their bodies. Vulva and penis should be as everyday to children as any other body part.

As Darling says, ‘They can take this invaluable knowledge with them into adulthood, respecting their bodies and those of others. What an amazing gift for a young adult and society to have more young people body-educated.’

Finally, we must not overlook a truth from the Inside Healthprogramme. The vulva is not part of the reproductive anatomy – it has a very different function. ‘The vulva is where the party’s at – that’s where all the nerve endings are!’

USEFUL RESOURCES

• Anatomically correct dolls
• The Great Big Body Book by Mary Hoffman and Ros Asquith
• PACEY’s safeguarding training
• The NSPCC’s PANTS campaign and resources