The vulva is a portal
for a variety of functions (reproductive and excretory) and has a unique
role in sexual feelings and function.
Because it is covered
with both dry, squamous skin and moist mucous membrane, it is subject to
diseases affecting both. Because of the close proximity of the rectum,
intestinal bacteria (anaerobes and coliforms) are more or less constantly
present to some degree. These may influence the type and course of
infections in this area.
The vulva may develop
conditions both benign and malignant, symptomless, annoying, or even
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The larger lips, labia
majora, extend from the mons pubis to the rectum. These are large, fleshy
pads that cover the bony pubic rami. They each contain a Bartholin gland,
which is usually not noticed but occasionally causes some problems.
Just inside the labia
majora are the smaller lips, the labia minora. In women who have not had a
baby, they are very thin and are usually hidden, to some extent, by the
labia majora. After a pregnancy, they are thicker and more prominent. They
are rich in nerve endings and are usually very sensitive to touch. During
sexual arousal, they swell and moisten with extracellular fluid. During
urination, the labia minora function to direct the urine stream in a more or
less single direction by forming a curtain on either side of the urethra.
The labia minora come
together at the top of the vulva to form the clitoral hood. This tissue
covers the clitoris, which lies just beneath the hood. The clitoris is
characteristically firmer than the surrounding tissues, with a rubbery
consistency. It has a high concentration of nerve endings and is extremely
sensitive to touch and vibration. It is usually, but not always, the area of
greatest sexual sensitivity. During the early stages of sexual arousal, it
swells and protrudes just beyond the clitoral hood. In the latter phases of
arousal, it generally flattens and retracts back beneath the clitoral hood.
The urethra lies
between the clitoris and the vagina. It conducts urine from the bladder to
the outside. It is normally non-tender to light or moderate touch. On each
side of the urethra are the pin-point Skene's ducts.
When the labia are
spread open, the hymen or remnants of the hymen are visualized. This
ring-like structure is usually torn at first intercourse, leading to a small
amount of bleeding. For some women, insertion of tampons or other objects
will lead to hymeneal rupture. After healing, only small bumps or flaps of
with hymens is considerable. Some are thin, stretchy, and so small as to be
largely unnoticed. Others are thick and nearly impenetrable. Rarely, the
hymen completely covers the vaginal opening, disallowing the passage of
Just inside the hymen
is the beginning of the vagina. In contrast to the smooth vulvar skin, the
vaginal skin has circumferential ridges (rugae). The vagina is not
cylindrical in shape, but more like a flattened cone, narrow at the vaginal
opening, and widening as the vagina approaches the cervix. Normally, the
anterior and posterior vaginal walls are in contact with each other, but
during intercourse or an examination, they separate. During sexual arousal,
the vaginal skin "sweats" small droplets of extracellular fluid, which is
the primary source of lubrication during intercourse.
fourchette is the area of mucous membrane between the rectum and the
Some women do not seem
to have any noticeable discharge, while others normally have a more or less
constant slight discharge that is odorless, clear to white and mucoid in