Vulvar Anatomy

Normal vulvar anatomy

Understanding the anatomy of the vulva is vital to an understanding of the wide variety of vulvar disorders.

The vulva is the group of external mucocutaneous structures making up the female genitalia. It is located between the thighs, bounded laterally by the labiocrural fold, anteriorly by the mons pubis, posteriorly by the posterior commissure and medially by the hymen and hymenal ring.

The main anatomic structures are: - mons pubis -urethral meatus - labia majora - hymen - labia minora - vestibular glands - clitoris - Bartholin's glands - vaginal vestibule

a. Mons pubis is the subcutaneous fat pad over the bony symphysis pubis. At puberty it becomes progressively thicker and is covered with pubic hair.

b. Labia: The labia are the lips of the vulva. Labia majora - These are the large outer lips covered with hair, containing sweat glands and sebaceous glands. Labia minora - These are the thin, inner, pigmented lips of the vulva, made of loose connective tissue. The fold between each labium majus and labium minus is called the interlabial sulcus. The junction of the labial squamous epithelium and vestibular transitional epithelium forms Hart's line on the inner aspect of the labia minora. The purpose of the labia is to protect the sexual organs, urinary opening, vestibule and vagina.

c. Clitoris: This is the erectile body of the vulva, corresponding to the penis in the male. This firm, rubbery, moveable shaft is connected to the pubic bone and is covered by a small hood. It is packed with thousands of nerve fibers and is vital for sexual arousal.

d. Vaginal (Vulvar) vestibule: This is the innermost area of the vulva just outside the hymen. It is a minimally keratinized oval epithelial area, extending from the inner aspect of the labia minora from just below the clitoris down and around the opening of the vagina to the posterior fossa. The tissue is responsive to estrogen and contains the urethra, minor vestibular glands and Bartholin's gland duct openings.

e. Urethral meatus: This is the opening of the urethra and is found just anterior to the vaginal introitus within the vestibule. The opening may be either star shaped or slit like. On either side of the meatus are the small openings of Skene's glands.

f. Hymen: This is the thin membrane of connective tissue separating the vestibule and the vagina. The shape pre-puberty is usually annular or crescentic but can take various shapes. It is prominent at birth, regresses during childhood, and disappears with sexual intercourse, leaving only remnants.

g. Vestibular (Skene's) glands are found around the hymenal ring and extend in two arcs up beside the urethra. All that is visible are the small openings to these minor, mucous glands. The largest of these are Bartholin's glands, one on each side, opening at 5 and 7 O'Clock positions just outside the hymenal ring. These glands are located deep in the musculature with ducts that can be up to 2-_ cm long.