The Anatomy of the Vulva

The vulva (pudendum) is the external female genitalia

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The external portion of female genital anatomy, the vulva—also known as the pudendum—protects a woman’s sexual organs, urethra, vestibule and vagina. The epicenter of sexual response, its inner and outer flaps are known as the labia majora and labia minora. As such, this organ can be subject to a range of health issues, including vulvar cancer, bacterial infections, as well as a number of sexually-transmitted diseases. It’s important to understand how this part of the body works, and how it’s connected to aspects of overall health.

Anatomy

Anatomically speaking, the vulva is a blanket term for all of the structures of the external female genitals. Here’s a quick breakdown of these structures:

  • Mons pubis: This structure made up of fatty tissue lies directly to the front of the pubic bones. It’s usually prominent, visible from the exterior, and where the pubic hair grows. The mons pubis helps cushion the area during sexual intercourse and houses the sebaceous glands, which secrete hormones associated with sexual attraction.
  • Labia majora: Named for the Latin terminology for “larger lips,” this feature consists of two prominent folds of skin that cover the labia minora, clitoris, vulva vestibule, vestibular bulbs, Bartholin’s and Skene’s glands, urethra, and vagina (see below). The front-facing (anterior) part of this feature forms what’s called the “labial commissure,” a fold just beneath the mons pubis. 
  • Labia minora: The “smaller lips” of the vulva, this pair of skin (cutaneous) folds arise at the clitoris, with its anterior portion encircling this feature and forming a clitoral hood and frenulum, before moving downward. In doing so, they form the borders of the vulva vestibule, and the rear portions of this feature link together to terminate between this feature and the labia majora. As these folds link together, they form what’s called the frenulum of the labia minora. This part of the body is engorged during sexual arousal.
  • Clitoris: This is an essential sex organ for women, and it’s divided into the glans clitoris and the body of the clitoris, both of which sit on an underlying tissue called the corpus cavernous. This tissue becomes flushed with blood during arousal; it merges together to protrude to the exterior of the vulva to form the glans clitoris. On the sides, the two ends of this tissue form the crus or “legs” of the clitoris and its body. In turn, the glans clitoris—which has many arteries and nerves—is the visible, protruding portion of the clitoris.
  • Vestibular bulbs: These two bulbs are formed of erectile tissue and arise near the back side of the body of the clitoris. Running along the middle edge of the crus of the clitoris, these features run towards the urethra and the vagina. At this point, the vestibular bulbs split and surround the side borders of these features. 
  • Vulva vestibule: This is the area between the two labia minora. Its upper end arises just beneath the clitoris and ends at the rear fold of the labia minora. This smooth surface contains the openings of both the urethra and the vagina. Its borders, called Hart’s lines, are formed by the edges of the labia minora. 
  • Bartholin’s glands: Sometimes referred to as the greater vestibular glands, these are two pea-sized structures that are found to the back and slightly to the side of the opening of the vagina.
  • Skene’s glands: Also known as the lesser vestibular glands, these sit on either side of the urethra.
  • Urethra: This extension of the bladder—which allows urine to exit the body—is a tube-like structure.
  • Vagina: Running from the cervix to the external surface via the vulva vestibule, the vagina is a muscular, elastic tube. The opening of this organ is partially covered by the hymen, a thin membrane of skin. This opening lies to the back of the opening of the urethra.

Anatomical Variations

Female external genitalia—particularly the sizes and colors of the mon pubis, clitoris, labia majora and minora, as well as the vaginal opening—can vary a great deal from person to person. Basically, these variations are associated with the amount of estrogen activity during puberty, with larger, thicker features associated with increased presence of this hormone during this time. The greatest differences are seen in the size, color, and structure of the labia majora and minora, with some women displaying more prominent folds. In other cases, the clitoris and clitoral hood are larger and more prominent. Largely, though, functionality is unaffected by these differences.

In addition, there are rarer cases of congenital variations of the vulva, involving the physiology of the uterus and vagina. There are four classes of this:

  • Class I: This is an abnormal development of ducts in the uterus and vagina. The most common such issue is Mayer-Rokinatsky-Kuster-Hauser syndrome, in which the uterus, cervix, and upper portion of the vagina do not develop properly.
  • Class II: This class refers to disorders of vertical fusion leading to malformation of the cervix, as well as either obstructive or nonobstructive transverse vaginal septa (walls). This can impact the functioning of the vulva.  
  • Class III: Lateral fusion disorders of this class describe situations where there is doubling of anatomical features of the vulva. Oftentimes, this will lead to the formation of multiple uteri, and can be obstructive—affecting function—or non-obstructive.
  • Class IV: The final category represents those that are combinations of the above defects.

Function

The vulva is primarily associated with sexual function—in addition to being directly involved during sexual intercourse, itself, it provides hormone production and protection of reproductive pathways—though it also is involved in the excretion of urine. In terms of the latter and as noted above, the vulva houses the urethra, which delivers urine from the bladder out of the body. 

During sexual activity, the vulva is particularly involved. During arousal, several parts become flushed with blood, including both the labia minora and majora, the clitoris, and the vestibular bulbs; this changes the shape of the vagina, stimulates sexual pleasure, and works to bolster lubrication for sexual intercourse. These physiological changes also work to promote chances of conception, secreting female hormones to mix with male semen deposited in the vagina to allow an opportunity to fertilize the egg.    

Associated Conditions

Among the many diseases or conditions that can impact the vulva, very many issues are due to sexually transmitted infections (STIs). These include:

  • Chlamydia: Among the more common STIs, chlamydia arises due to bacterial infection as a result of sexual contact. Though it can be asymptomatic, this disease can also lead to burning discharges, pain, and inflammation in the urethra and cervix. If untreated, this can lead to pelvic inflammatory disease, which can lead to discomfort, as well as ectopic pregnancy or infertility in women. Typically, treatment involves taking antibiotics like tetracyclines or macrolides.
  • Gonorrhea: Often present alongside chlamydia, gonorrhea is the result of infection by the Neisseria gonorrhoeae bacteria. Symptoms are also similar to the above and include discharges, inflammation, and pain in the cervix and urethra, as well as a risk of developing pelvic inflammatory disease. Antibiotics such as cephalosporins can be used to treat this condition.  
  • Syphilis: The result of infection by Treponema pallidum bacteria, syphilis, while often asymptomatic at first, can manifest as fever, skin rashes and sores, genital lesions (similar to warts), as well as inflammation and swelling of the lymph nodes. If untreated, further progression is alarming and includes lesions in the brain, and a cascade of other neurological symptoms. The antibiotic, penicillin, is used to treat this condition.
  • Herpes simplex 1 & 2: Also known as genital herpes, these conditions lead to the formation of lesions on the vulva. While these conditions are incurable, symptoms come and go, and flare-ups can be managed.  
  • Human papillomavirus (HPV): HPV flares up noticeably as cauliflower-shaped lesions—genital warts—on the vulva or genital region. These arise due to a viral infection, and typically resolve on their own. In some cases, though, the warts become chronic and can lead to cancer. 
  • Human immunodeficiency virus (HIV): This viral infection is asymptomatic at first but can become very dangerous because it attacks important aspects of the immune system and can compromise immune function. If it progresses, HIV becomes acquired immunodeficiency syndrome (AIDS), a condition characterized by the presence of other, opportunistic infections, many of which impact the vulva. There is, as yet, no cure for HIV; however, pharmaceutical therapies can keep the virus at bay.
  • Hepatitis B & C: Characterized by an inflammation of the liver, hepatitis is often asymptomatic on its own, though it can lead to cirrhosis or other dangerous conditions. While there exists a vaccine for hepatitis B, there is none for the other form, and there is no cure for this class of disease. Since sexual contact is a common cause of infection, prophylactic protection is recommended to stay safe.
  • Pubic lice (crabs): Though not strictly sexually transmitted, sexual contact is the most common mode of transmission of lice that affect the pubic hair that is on the outside of the vulva. These tiny, crab-like creatures cause severe itchiness, blood spotting on underwear, as well as small white dots in the pubic hair as well as pale bluish dots elsewhere on the body. Most are able to self-diagnose this condition, and treatment involves washing the area with a specialized soap and abstaining from sexual activity for about 14 days.

In addition, a range of other conditions can affect this part of the body, including:

  • Urinary tract infection (UTI): A very common condition, UTI is a bacterial infection of the urethra. This leads to symptoms like increased need to urinate, pain during urination, and cloudy and foul-smelling urine, among others. Highly treatable, this is often the result of the bacteria, Escherichia coil.
  • Bartholin cyst and abscess: Occasionally, a cyst can form in the Bartholin’s glands, affecting its ability to secrete necessary hormones. If this cyst is infected, it can continue to grow to form a abscess.  
  • Lichen sclerosus: This is an uncomfortable condition characterized by chronic itchiness of the vulva due to irritation. Due to scratching, this can lead to a thickening (or “lichenification”) of underlying tissues of the vulva alongside a thinning of the skin. Steroids can treat it.
  • Vulvitis: Also known as vulvar itching, this is a condition characterized by vaginal discharges as well as inflammation, itchiness, burning sensations, redness, swelling, and blisters on the vulva. It can occur to women at any age and is the result of either infection, allergic reaction, or injury. Treatment involves wearing looser clothing or taking sitz baths to ease discomfort. Doctors may also prescribe topical estrogen cream or application of cortisone ointment.
  • Vaginal Candidiasis: Also known as "vaginal yeast infection," this fungal infection causes vaginal itching and soreness, pain during sexual intercourse, pain or discomfort during urination, and/or abnormal discharges from the vagina. While most cases are relatively mild, some can develop into more serious infections and lead to cracking, bleeding, and inflammation. Cases are treated using special antifungal medicines prescribed by the doctor; these are either topical or are taken orally.
  • Imperforate hymen: This rare case is characterized by the hymen not allowing substances through. In girls who have started menstruating, this causes blood and other substances excreted during periods to get caught. Treatment involves perforating the region to drain it.
  • Vulvar carcinoma: Cancer of the vulva is rare, with the most common form being squamous cell carcinoma. It can arise due to HPV or the progression of lichen sclerosus.

Tests

Screening and examination of parts of the vulva are an essential aspect of female health. Prompt detection of health problems here, especially of cancer but certainly of STIs that may affect this part of the body will greatly improve outcomes. That said, testing and examination of this part of the body can be challenging, especially in absence of symptoms. Here's a quick breakdown:

  • Vulvar biopsy: In order to test for the presence of vulvar carcinoma, specialists will perform physical examination of the pelvis, and may call for a vulvar biopsy. This is a test in which a small portion of tissue is removed and examined for the presence of cancer or pre-cancerous cells under a very strong microscope. In selecting an area to examine, doctors may use a special device called a "colposcope" to magnify it, a procedure called "vulvoscopy." If results come up positive, other tests may be performed to assess for spread of cancer.
  • Darkfield microscopy: Though most syphilis cases are tested using blood samples, the definitive option is an assessment of a sample using a special darkfield microscope. If an open sore is found on the vulva, doctors may use that for assessment.
  • HPV testing: In cases of HPV that arise as genital warts on the vulva, doctors may need to perform testing for the presence of the virus in cell samples from the area. Most such tests are performed on samples taken from the cervix, however.
  • Genital herpes testing: If the sores from genital herpes appear on the vulva, they can be swabbed and tested. That said, this disease can be hard to diagnose between outbreaks.
  • Urinalysis: A wide range of health conditions are assessed using urine samples, including diabetes, liver health, and pregnancy. Women and girls who are providing a sample will need to spread the labia open and use a sterile wipe to clean the area, as well as a separate one for the urethra, before providing the sample. This is to ensure that an uncontaminated sample is assessed.
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Article Sources
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