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2 The Normal Vulva
Fiona M. Lewis
CHAPTER MENU
Normal vulval anatomy Mons pubis Labia majora Labia minora Sebaceous glands (Fordyce spots) The clitoris The vestibule Hart’s line Bartholin’s glands Minor vestibular glands Vestibular papillae Hymen External urethral meatus and urethra
Associated structures Vagina Perineum The urogenital diaphragm Anal triangle Pelvic floor Ischiococcygeus muscle Iliococcygeus muscle Pubococcygeus muscle The Inguinofemoral region
Blood supply of the vulva Internal pudendal artery Femoral artery Venous drainage Microscopic anatomy
Lymphatic drainage of the vulva The external iliac lymph nodes Medial group Anterior group Lateral group Microscopic anatomy
Nerve supply of the vulva Somatic innervation Autonomic (visceral) innervation Pudendal nerve Microscopic anatomy
Normal microscopic anatomy and histological features Epithelia of the vulva Mons pubis Labia majora Labia minora Clitoris Vestibule Vagina Other epithelial cell types Melanocytes Langerhans cells Merkel cells The Basement membrane zone The dermis
Vulval lesions are not well described in the early medical literature, but first appear in the writings of Severinus Pineus in the sixteenth century and van den Spieghel in the seventeenth century. The terms used to describe the anatomical structures are often related to their function. The word vulva is derived from the Latin word for ‘wrapping’. The vagina (sheath) and mons veneris (hill of Venus) are obvious descriptions. The clitoris is usually thought to come from the Greek kleitoris, meaning ‘key’ or ‘gatekeeper’. Hymen is derived from the Greek hymen, meaning membrane. The labia are probably so called because they surround the vaginal opening like lips (Latin labium – lip).
There is a very wide variation in the appearance of the normal vulva, and this chapter looks at the normal anatomy, anatomical variants, and normal histological features at different sites. It is vital to understand the normal before the abnormal is diagnosed, thereby avoiding unnecessary treatment and worry for the patient.
Normal