secretions. Another vaginal anomaly is a transverse vaginal septum, which partially or completely blocks the vaginal canal. The precise cause of an obstruction must be determined before it is repaired, since corrective surgery differs depending on the cause. In some cases, such as isolated vaginal agenesis, the external genitalia may appear normal. Abnormal openings known as fistulas can cause urine or feces to enter the vagina, resulting in incontinence. The vagina is susceptible to fistula formation because of its proximity to the urinary and gastrointestinal tracts. Specific causes are manifold and include obstructed labor, hysterectomy, malignancy, radiation, episiotomy, and bowel disorders. A small number of vaginal fistulas are congenital. Various surgical methods are employed to repair fistulas. Untreated, fistulas can result in significant disability and have a profound impact on quality of life. Vaginal evisceration is a serious complication of a vaginal hysterectomy and occurs when the vaginal cuff ruptures, allowing the small intestine to protrude from the vagina. Cysts may also affect the vagina. Various types of vaginal cysts can develop on the surface of the vaginal epithelium or in deeper layers of the vagina and can grow to be as large as 7 cm. Often, they are an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Cysts that can be present include Müllerian cysts, Gartner's duct cysts, and epidermoid cysts. A vaginal cyst is most likely to develop in women between the ages of 30 to 40. It is estimated that 1 out of 200 women has a vaginal cyst. The Bartholin's cyst is of vulvar rather than vaginal origin, but it presents as a lump at the vaginal opening. It is more common in younger women and is usually without symptoms, but it can cause pain if an abscess forms, block the entrance to the vulval vestibule if large, and impede walking or cause painful sexual intercourse. Society and culture Perceptions, symbolism and vulgarity Various perceptions of the vagina have existed throughout history, including the belief it is the center of sexual desire, a metaphor for life via birth, inferior to the penis, unappealing to sight or smell, or vulgar. These views can largely be attributed to sex differences, and how they are interpreted. David Buss, an evolutionary psychologist, stated that because a penis is significantly larger than a clitoris and