Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
Section I: ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM
2-10
2-10. FEMALE EXTERNAL GENITAL ORGANS (VULVA)
a. The external organs are referred to collectively as the vulva. The vulva is comprised of the paired labia majora, the paired labia minora, the clitoris and the vestibule. The vulva occupies the central portion of the perineal region. The mons veneris, urethra, and Skene's glands are in close proximity to the vulva.
b. The mons pubis (veneris) is a rounded elevation of tissue covered by skin and, after puberty, by hair. It is situated in front of the symphysis pubis.
c. The labia majora are two folds of skin that extend downward and backward. They unite below and behind to form the posterior commissure and in front to form the anterior commissure. They form the lateral boundaries of the vulva. A Bartholin gland is situated in each of the labium majus.
d. The labia minora are the two delicate folds of skin that lie within the labia majors. Anteriorly each labium minus splits into lateral and medial parts. The lateral part forms the prepuce of clitoris, and the medial part forms the frenulum. The posterior folds of the labia are united by a delicate fold extending between them. This forms the fourchette.
e. The clitoris is the homologue of the penis in the male. It hangs free and terminates in a rounded glans (small sensitive vascular body). Unlike the penis, the clitoris is not traversed by the urethra.
f. The vestibule is a smooth area surrounded by the labia minora, with the clitoris at its apex and the fourchette at its base. It contains openings for the urethra and the vagina.
g. The urethra, which is about 4 cm long, is in close relationship with the anterior vaginal wall and connects the bladder with the outside, acting as an excretory duct. At each side of the external urethral orifice (meatus) lie two small ducts, termed the paraurethral ducts, which drain small urethral glands (Skene's).
h. The vaginal opening lies behind the urethral orifice, and in the virgin it is almost closed by the hymen, a fold of vaginal mucosa.
i. The vestibular glands (Bartholin) lie one at each side of the lower end of the vagina. They are homologous of the bulbourethral glands of the male. The narrow gland duct opens into the vaginal orifice on the inner aspects of the labium minus.
