China
Africa
Explore chapters and articles related to this topic
Benign conditions of the vulva and vagina, psychosexual disorders and female genital mutilation
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
The vulva is the term used to describe the external female genitalia – the sexual organs. It includes the labia majora and minor, clitoris and fourchette. The vulval vestibule is defined anatomically as the area between the lower end of the vaginal canal at the hymenal ring and the labia minora. The different anatomical areas of the external genitalia have different histological characteristics and embryological origins. Both the labia minora and majora are covered with keratinized, pigmented, squamous epithelium. The labia majora are two large folds of adipose tissue covered by skin containing hair follicles and sebaceous and sweat glands. In contrast, the labia minora are devoid of adipose tissue and hair follicles, but contain sebaceous follicles. The normal vulval vestibule is covered with non-keratinized, non-pigmented squamous epithelium and is devoid of skin adnexa. Within the vulval vestibule are the ducts of the minor vestibular glands, the periurethral glands of Skene, the urethral meatus and the ducts of the Bartholin’s glands. The Bartholin’s glands (major vestibular glands) are the major glands of the vestibule and lie deep within the perineum. Both the major and the minor vestibular glands contain mucus-secreting acini with ducts lined by transitional epithelium. The ducts of the Bartholin’s glands exit at the introitus just above the fourchette at approximately five and seven o’clock on the perineum, and those of the minor vestibular glands are distributed throughout the vulval vestibule. The vagina and vulva are commonly known as the lower genital tract with the vagina leading to the upper genital tract (uterus, cervix, tubes and ovaries). The vagina has is a tubular structure but has anterior and posterior walls that lie in opposition.
Vulvodynia – an evolving disease
Published in Climacteric, 2022
Provoked vestibulodynia is the most prevalent subtype of vulvodynia [3]. The pain occurs in the vulval vestibule, most often triggered by attempted vaginal penetration, be it tampon insertion, sexual activity, speculum examination, direct touch, indirectly by walking or, rarely, even without provocation. It can be of such severity and intensity that sexual intercourse is not possible. The pain is often described as burning or raw, irritating, itchy, a feeling of pressure, sharp or tearing. Onset can be primary or secondary depending on whether pain has been present since first sexual activity or tampon use (primary) or after a period of pain-free sex (secondary). The importance of this distinction is that the pathophysiology, severity of symptoms and response to treatment may be different [4]. Pain is absent if there is no touch, and women may describe a feeling that something is blocking their vagina when they attempt sex. This is usually due to pelvic floor overactivity or spasm. Whilst incidence is higher in young women, there is a second peak of vulvar pain around menopause, in part due to vulvovaginal atrophy. It can also be new-onset or recurrent vulvodynia [5]. Localized vulvodynia refers to pain in the vestibule (vestibulodynia) or clitoris only (cliterodynia), whilst generalized refers to pain involving the whole vulva.