The vulva is the female external genitalia. The vulva includes, among others labia major and minor, vestibule and clitoris. Find out what are your vulva discomforts and how you can prevent them.
Vulvastands forfemale external genitalia . The vulva includes the pubic mound, the vestibule of the vagina with the clitoris, the foreskin of the clitoris, the frenulum of the clitoris, the frenulum of the labia, the anterior and posterior commissure of the labia, the greater labia and the lesser labia.
Structure of the vulva
The vulva consists of the above-mentioned elements. The vestibule of the vagina is a shallow depression surrounded on the sides by the smaller lips, on the front by the frenulum of the clitoris, and on the back by the frenulum of the labia majora. It is usually torn open during the first birth. The urethra and the ducts of the vestibular glands also have openings in the vestibule of the vagina.
Vestibular glands are divided into smaller and larger ones. At the bottom of the atrium, smaller vestibular glands leave, producing mucus. The greater vestibular gland is located laterally from the vaginal vestibule in its posterior segment. It adheres to the perineal membrane from the outside, in its front part it is covered by the atrium bulb and the bulbar-spongy muscle. During sexual excitement it produces a profuse discharge. It is the equivalent of the bulbourethral gland in men.
The vestibule is an even creature hidden in the vestibule wall along the base of the labia minora. From the bottom, it is covered with the bulbar-spongy muscle. The vestibule is the equivalent of the penile spongy body.
The labia majora are longitudinal skin folds extending from the pubic mound towards the anus. They are separated by a skin-femoral furrow on the side. There is a vulva gap between the greater labia on the medial side. The larger labia are connected to the front with the anterior commissure of the lips, towards the back - with the posterior commissure.
The skin of the labia minora is thin, pigmented, has no sweat glands and no hair. They are visible after opening the labia majora. The front ends of the smaller lips are divided into two laths. The shorter ones end at the base of the clitoris, forming the frenulum of the clitoris.
The clitoris is a short, approximately two-centimeter long cylindrical bodyfrom the fusion of the two cavernous bodies of the clitoris. It lies below the pubic mound. Like the penis, it consists of legs, a shaft, and a glans.
The legs of the clitoris attach to the branches of the ischium and the pubic bone. The shaft of the clitoris is first drawn upwards and then bends at a sharp angle downwards. The glans of the clitoris forms its ventral bulge. The front ends of the labia minora, which go to the clitoris, form the foreskin of the clitoris at the front, and the frenulum at the rear.
The structure of the cavernous bodies of the clitoris is similar to that of the penis. This can lead to an erection of the clitoris. The clitoris, just like the lips, contains numerous sensory nerve endings.
Vulva functions
The vulva has many important functions. The large and smaller labia help to protect the inside of the vagina from external factors.
The clitoris, filling up with blood during intercourse, is responsible for the feeling of orgasm. Bartholin's glands are located symmetrically on both sides of the vestibule and secrete mucus that helps to moisten the vestibule and the vagina itself.
Vascular and innervation of the vulva
The arteries supply the vulva with oxygen-rich and nutrient-rich blood. They come mainly from the internal iliac artery and the femoral artery. The internal labia artery transfers the posterior labial branches to the labia, the vulva and the dorsal clitoral artery to the clitoris, and the vestibular artery supplies the vestibule. Branches of the external labia arteries - the anterior labial branches reach the labia.
Venous blood flows through the external vulva veins to the femoral vein, through the dorsal vein of the clitoris to the bladder plexus. The blood from the clitoris drains into the internal vulva through the deep veins of the clitoris.
The innervation of the vulva allows you to feel pain, other ailments, but also clitoral orgasm, which is mainly caused by the vulva nerve.
The clitoris is innervated by the dorsal nerve of the clitoris - one of the branches of the vulva nerve. Sensory innervation of the anterior part of the labia majora comes from the ilioinguinal nerve through the anterior labial nerves, and the posterior part from the labia nerve through the posterior labial nerves and from the posterior cutaneous nerve branch of the thigh. The sexual branch of the genitourinary nerve reaches the labia majora.
Diseases of the vulva
Mycosis
Mycosis of the vulva is an inflammation associated with a species of the genus Candidia. The same is the case with vaginal mycosis. Fungal vulvovaginitis often coexist. The characteristic symptoms are:
- redness,
- vulva swelling,
- swollen inguinal folds, often also in the perineum,
- severe burning and itching of the vulva.
There may be inflammatory foci beyond the erythema border, spreading to the skin of the adjacent areas of the body. Sometimes there are vesicles and pustules.
Mycosis of the genitals can lead to an ascending urinary tract infection. It is important to have a general urine test. Vulva mycosis should be differentiated from:
- mycosis caused by dermatophytes
- seborrheic vulvitis
- lichen planus
- allergic reactions
Diagnosis is based on mycological diagnosis.
Herpes
Vulvitis caused by herpes simplex viruses, the incubation period lasts 2-10 days. The disease causes ulceration within the vulva, the infection is characterized by numerous vesicles that develop into pustules, erosions and ulcers. There is also erythema of the external genitalia.
The infectivity is greatest when there are active lesions on the skin. When there is a secondary bacterial infection, there is burning, pain and dysuria. Severe general symptoms may also occur: fever, headache, abdominal pain, muscle pain.
Herpes in pregnant women is a significant problem because it is likely that the newborn will be infected perinatally. This can happen when the infection is symptomatic as well as during asymptomatic carrier.
Diagnosis is made on the basis of clinical symptoms, laboratory tests. One method is to cultivate the virus from vesicles. However, a more sensitive, but more expensive method - PCR, which allows detecting viral DNA in carriers with a small number of virions, is recommended.
Treatment consists of administration of antiviral drugs: aciclovir, valaciclovir, famciclovir.
Benign tumors
- fibroma - it consists of connective tissue fibroblasts, it is often pedunculated. The treatment consists in cutting out the lesion
- lipoma - the course of the disease is chronic, the lipoma grows slowly, for many years. The appearance of pain and tumor enlargement is alarming, as it may be a sign of malignancy. Treatment is based on the excision of the lesion.
- hemangioma - usually these are red, non-bleeding nodules, but when they reach larger sizes they can be painful. They should be removed
- cyst - arises from the mullerian (Muller) and intrarenal (Gaertner) ducts. Muller duct cysts are usually located in the lower 1/3 of the vagina, and Gaertner duct cysts in the vaginal vaults. Small,non-enlarging cysts do not require treatment. Surgical removal can be difficult as they sometimes penetrate deep into the pelvis.
- polyps - rare, usually small, but richly vascular
- condylomas - small and numerous changes, difficult to treat
Malignant neoplasms
- primary cancer of the vulva - initially, a small ulcer or lump can be observed, and itching caused by changes in the epithelium can also be an early symptom. It most often affects the elderly and is also associated with smoking.
There are two types of vulvar cancer:
- more common - developing in older women, usually as a hard, painless lump
- less common - occurring in younger women around 45-55. years of age, associated with infection of human papillomavirus. It presents with ulceration, flat or hard lesions of pink, red or white color.
- malignant melanoma - occurs very rarely on the vulva, usually in older women. There are epithelial and spindle cell melanomas. It happens that melanoma does not contain melanin. Cancer develops very quickly, it infiltrates the environment, metastases in the lymph nodes and through the bloodstream to the skin, lungs, liver, brain and bones. Treatment consists of removing the lesion with a large margin of he althy tissue and excision of the inguinal nodes.
- Paget's cancer - develops on the basis of Paget's disease, is an expression of disturbances in the differentiation of ectoderm cells. The disease manifests itself as sharply limited lesions accompanied by itching.
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