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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 disabling.
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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 skin remain.
Anatomic variation 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 menstrual
products.
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.
The posterior fourchette is the area of
mucous membrane between the rectum and the hymeneal ring.
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 nature.
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From:
Operational Obstetrics & Gynecology
2nd Edition
NAVMEDPUB 6300-2C
Bureau of Medicine and Surgery
Department of the Navy
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