The Vulva
The term
‘vulva’ applies to the external female gen ital organs. It consists of the
following structures:
The mons veneris (‘mount of venus’) or mons pubis.This is a
pad of fat lying over the symphysis pubis. It is covered with pubic hair from
the time of puberty.
The labia majora (‘greater lip’).Theses
are two foldsof fat and areolar tissue covered with skin and pubic hair on the
outer surface. They arise in the mons veneris and merge into the perineum
behind
The labia minora (‘lesser lip’) these are
two thin foldsof skin lying between the labia majora. Anteriorly they divide to
enclose the clitoris; posteriorly they fuse, forming the fourchette.
The clitoris This is a small rudimentary
organcorresponding to the male penis. It is extremely sensitive and highly
vascular and plays a part in the orgasm of sexual intercourse.
The vestibule This is the area enclosed by the
labiaminora in which are situated the openings of the urethra and the vagina
The urethral orifice this
orifice lies 2.5cm posterior tothe clitoris. On either side lie the openings of
Skene’s ducts, two small blind –ended tubules 0.5cm long running within the
urethral wall.
The vaginal orifice.This is
also known as the introitusof the vagina and occupies the posterior two thirds
of the vestibule. The orifice is partially closed by the hymen, a thin membrane
that tears during the first sexual intercourse or during the birth of the first
child. The remaining tags of hymen are known as the ‘carunculae myrtiformes’
because they are thought t o resemble the myrtle berries.
Bartholin’s glands there are
two small glands thatopen on either side of the vaginal orifice and lie in the
posterior part of the labia majora. They secrete mucus which lubricates the
vaginal opening
The Perineum
The
perineum is the area extending from the fourchette to the anus, and forms the
base of the perineal body – a triangular mass of connective tissue, muscle,
fat, measuring 4cm X 4cm. The perineal body fills the wedge shaped area between
the lower ends of the rectum and vagina, and forms a central attachment for the
muscles and fascia of pelvic floor. When, during the second stage of labor the
perineal body is flattened out by the descending fetal head, the perineum
elongates and becomes so thin that it is liable to tear.
·
First
degree tear the fourchette only is torn
·
Second
degree tear beyond the fourchette andnot involving the rectum
or anus
·
Third
degree tear the anal sphincter is torn, therectum occasionally
The Blood Supply
This
comes from the internal and external pudendal arteries. The blood drains
through corresponding veins
Lymphatic Drainage
This is
mainly via the inguinal glands
Nerve Supply
This is
derived from branches of pudendal nerve. The vaginal nerves supply the erectile
tissue of the vestibular bulbs and clitoris and their parasympathetic fibers
have a vasodilator effect.
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