FRS - Vulva

Question 1

What are the functions of the vulva (external female genitalia)?

Answer 1

1) Acts as sensory tissue during sexual intercourse
2) Assists in micturition
3) Protects the internale female genitalia from infection

Question 2

What are different features of the vulva?

Answer 2

1) Mons pubis - fat pad anterior to the pubis symphysis
2) Labia majora - two hair-bearing external skin folds - they extend from the mons pubis to a depression, known as the posterior commissure, overlying the perineal body.
3) Labia minora - two hairless folds of skin, which lies within the labia majora.
4) Vestibule - area enclosed by the labia minora - contains the openings of the vagina.
5) Bartholin’s glands - secrete lubricating mucus from small ducts during sexual arousal - located on either side of the vaginal orifice.
6) Clitoris - located under the clitoral hood - formed by the erectile corpus cavernosa - becomes engorged with sexual stimulation.

Question 3

Clinical relevance: infection of Bartholin’s glands

Answer 3

Bartholinitis

Treatment - antibiotics

Complications - formation of a cyst or abscess - this is treated by surgical drainage or exision of the lesion.

Question 4

Vascular supply and lymphatics?

Answer 4

Paired internal and external pudendal arteries (branches of the internal iliac and femoral artery respectively).

Venous drainage by the pudendal vein.

Lyymphatic fluid drains into the superficial inguinal lymph nodes.

Question 5

Innervation?

Answer 5

Sensory innervation of the vulva can be divided into anterior and posterior sections.

Anterior - ilioinguinal nerve + genital branch of the genitofemoral nerve.

Posterior - pudendal nerve + posterior cutaneous nerve of the thigh.

Clitoris and vestibule receives parasympathetic innervation from the cavernous nerves - derived from the uterovaginal plexus.

Question 6

Clinical relevance: vulval warts

Answer 6

Genital wart are benign epithelial growths caused by certain HPV types, such as 6 and 11. They are highly infectious and are easily transmitted between sexual partners through sexual or even physical contact.

They do not develop into cancerous lesions. Other strains of HPV (most commonly high-risk types 16 and 18) may predispose affected individuals to dysplastic changes in the cervix, vagina and/or anus which can potentially lead to carcinoma.

Recently developed HPV vaccines are safe and efficient in preventing high-risk HPV infection.