Vulva

The vulva (lat. female shame) is the outer, visible area of the female genitals. It is subject to considerable morphological and functional changes in the course of life.

Anatomically, the vulva lies between the mons pubis and the anus. It is bordered by the labia majora, the large labia, which are strong, fatty skin folds.

The vestibulum is the part of the vulva that lies between the hymen and the small labia. The vestibulum vulvae begins at the front of the clitoris and extends to the posterior commissure (Fourchette posterior). From the vestibulum, the vagina leads to the uterus, and the short urethra to the bladder.

Laterally, the vestibulum is bordered by the hard line on the inside of the small labia. This is the border zone between the cornified and non-cornified squamous epithelium.

Physiologically, large areas of the vulva are covered by the pubic hair (pubes), which develops at the beginning of puberty as part of the body hair and thus as a secondary sexual characteristic.

Between the outer labia majora lie the two labia minora pudendi. In some women in a standing position they are completely covered by the labia majora, but they often protrude visibly beyond them. They begin at the front of the prepuce and/or clitoris and end at the front of the perineum. The labia minora are formations of the outer human skin, but resemble a mucous membrane. They are thin wrinkles rich in vessels and sebaceous glands, hairless and fatless. Size and shape vary greatly.

The paired bartholin glands open into the vestibulum between the small labia and the hymenal border. They produce a clear, spinnable secretion. The glandular outlet is not visible during normal examination.

A special epithelial feature in the introitus is the so-called papulosis, also called Hirsuties. It occurs in about 20% of women. Hirsuties are harmless, fine, hair-like epithelial sites, which are often confused with condylomata acuminata.

The clitoris, the "clitoris", is located at the anterior fold of the labia minora, commissura labiorum anterior. The clitoris, an organ homologous to the male corpus cavernosum, is a cylindrical, erectile structure formed by erectile tissue, which is interspersed with mechanoreceptors of the skin and is especially capable of reacting to touch. The clitoris consists of the glans clitoris and the two erectile clitoris legs.

The epithelium of the vestibule consists of a multi-layered and non-cornified squamous epithelium. In Caucasians it does not contain melanocytes and is therefore unpigmented. Atavistic pigmentation in the form of rounded or splatter-like melanocytic pigment spots (melanosis) may be present and, clinically not always easy to separate from malignant pigment lesions (malignant melanoma).

The frequently used term "mucosa" is rather historical. With the term "mucosa" this nomenclature discussion can be avoided. Furthermore, the mucosa of the genitals has goblet cells which, together with the cervical secretion, ensure the moistening of the vagina and vestibulum and (ectopic) sebaceous glands which form a protective film against the action of urine. It is also equipped with numerous sensitive nerve fibres and endings, including Meissner's corpuscles.

From the lower end of the vulva, the commissura labiorum posterior, the perineal suture or raphe perinei pulls clearly visible in the midline of the perineum in an anterio-posterior direction towards the anus.