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Lymphatic anatomy: lymphatics of the vulva
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Anca Chelariu-Raicu, Robert L. Coleman
The vulva comprises the mons pubis, the clitoris, the labia majora and minora, the vestibule (urethral meatus and hymenal remnant), the perineal body, the associated erectile tissues and muscles, and the supporting subcutaneous tissues (Figure 3.1). Superficially, these structures consist of, or are covered by, a keratinized, stratified, squamous epithelium to the level of the vestibule, where the epidermis becomes a nonkeratinized squamous mucous membrane. The vulvar structures are situated atop the superficial perineal fascia, a caudal continuation of the abdominal Scarpa’s layer. Support is given to the vulva through loose attachment to this fascia. Deep to this layer are the erectile and muscular contents of the genital floor (Figure 3.2). The deep or inferior fascia of the urogenital diaphragm, on which the clitoris and ischiocavernosus, bulbocavernosus, and deep transverse perineal muscles lie, is an important surgical landmark indicating the deep margin of locoregional resection. This fascial layer becomes continuous with the fascia lata laterally.
The immune system of the genitourinary tract
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
David A. MacIntyre, Kenneth W. Beagley
The female reproductive tract has upper and lower components. The lower female reproductive tract structures (ectocervix, vagina, and vulva) enable sperm to enter the body and protect the internal genital organs from potential pathogens. From the vulva to the vagina, the epidermis transitions from keratinized to stratified, nonkeratinized squamous epithelium. The vaginal mucosa consists of three distinct layers; (1) the outer surface layer, which is lubricated by mucus produced primarily by the cervix; (2) the intermediate layer, which acts as an active site of glycogen production; and (3) the basal layer, made up of actively dividing cells. Internal reproductive structures include the endocervix, uterus, and fallopian tubes (see Figure 20.1, left). The ovary produces both gametes (ova) and sex hormones (estradiol and progesterone). The fallopian tubes attached to the upper part of the uterus provide passage for the ovum from the ovary to the uterus. Following fertilization of an egg by a sperm in the fallopian tubes, the fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall. Each site in the female reproductive tract functions to insure passage of sperm to the site of fertilization, permit release of menstrual flow, as well as provide a route of passage of the baby at birth.
Miscellaneous conditions affecting the genitalia
Published in Shiv Shanker Pareek, The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Vulvitis may be a symptom of a sexually transmitted infection or a precancerous condition of the vulva. If these are suspected, the patient should be screened and biopsied as appropriate and treated accordingly.
The efficacy and safety of secondary focused ultrasound therapy for recurrence of non-neoplastic epithelial disorders of the vulva
Published in International Journal of Hyperthermia, 2022
Non-neoplastic epithelial disorders of the vulva (NNEDV) comprise a heterogeneous group of vulval lesions, including lichen sclerosus, lichen planus, and lichen simplex chronicus [1], and are one of the most common chronic vulvar skin disease problems. The true incidence and prevalence of this group of conditions are unknown and difficult to estimate because affected patients, if they choose to see a physician for their potentially embarrassing symptoms, present to various specialists [2]. Symptoms include chronic or recurrent vulvar itching, irritation, burning, and pain, which lead to significant physical discomfort and emotional distress that can affect mood and sexual relationships [3]. Moreover, lichen sclerosus not only affects quality of life, but is also associated with an increased risk of squamous cell carcinoma of the vulva [4]. Therefore, treatment of these vulvar conditions is not only helpful for symptomatic relief and prevention of progressive vulvar scarring, but it is also supportive of surveillance for associated vulvar cancers.
Management of non-obstetric traumatic vulvar haematoma: a retrospective review of 33 cases
Published in Journal of Obstetrics and Gynaecology, 2022
Mi Sun Kim, Hyun Jung Lee, Eunhui Joo, Sukho Kang, Mee-Hwa Lee, Hyeon Chul Kim
The vulva mostly consists of loose connective tissue and is well vascularised through branches of the pudendal, vaginal, haemorrhoid, and clitoral blood vessels (Benrubi et al. 1987). Vulvar masses, such as vulvar haematomas, can be observed in many conditions and are common in the obstetric population (Reder et al. 2020). However, non-obstetric traumatic vulvar haematomas are rare, and few cases have been reported in the literature to date (Propst and Thorp 1998; Sherer et al. 2006; Ernest and Knapp 2015; Lapresa Alcalde et al. 2019). Non-obstetric traumatic vulvar haematomas may arise secondary to straddle injury, penetrating injuries, foreign body insertion, and coitus (Lopez et al. 2018). Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) may need to be performed to further investigate the size, site, injury of adjacent organs, and haematoma expansion (Guerriero et al. 2004; Sherer et al. 2006).
Vulvodynia – an evolving disease
Published in Climacteric, 2022
Although vulvar pain symptoms can occur at any time over the lifespan and are more common in the reproductive years, the symptoms may begin for the first time after menopause. In fact, the prevalence of chronic vulvar pain in mid-life women has been estimated to be 8–38%, making chronic vulvar pain a major health concern for women in the menopausal age group [9]. Women presenting with vulvodynia quite commonly are in long-term relationships, have had the pain for several years and have been examined by multiple physicians before receiving the diagnosis [4,8,10]. The vestibule of the vulva extends from near the clitoris to the back of the vaginal introitus. During embryo development, the tissues outside the vestibule (outer labia) and inside the vestibule (vagina) arise from different embryo layers. Each zone therefore has different and unique tissue properties including different nerve sensitivity. As a special narrow portion of skin which forms the introitus of the vagina, the vestibule is supposed to be sensitive in a positive way, but has the capacity to develop localized exquisite tenderness, namely vulval vestibulodynia.