• Vulva:
  • Immediately external to vagina
  • Composed of: mons pubis, clitoris, labia minora, labia majora, vulvar vestibule, vestibulovaginal bulbs, urethral meatus, hymen, Bartholin's and Skene's glands and ducts, vaginal introitus
  
  
• Bartholin's glands:
  • Corresponds to bulbourethral glands in male
  
  
• Clitoris:
  • Erectile tissue similar to corpora cavernosa of penis
  • Lymphatics drain to deep inguinal nodes
  
  
• Hymen:
  • Nonkeratinized stratified squamous epithelium
  
  
• Labia majora:
  • Form the lateral boundaries of the vulva
  • Composed of folds of adipose and fibrous tissue
  • Fuse anteriorly into mons pubis
  • Posteriorly terminate 3-4 cm anterior to anus where they are united by posterior commissure or fourchette
  • Histologically, skin contains outer lining of stratified squamous epithelium, consisting of basal layer of cells (stratum malpighii), thin granular layer, and horny layer
  • Composed of keratinized stratified squamous epithelium with hair follicles and eccrine, apocrine and sebaceous glands
  
  
• Labia minora:
  • Consist of two folds of connective tissue which contain little or no adipose tissue
  • Anteriorly, labia minora divide into two parts
  • One part passes over clitoris to form prepuce
  • The other joins beneath clitoris and forms frenulum
  • Posteriorly, they blend with medial surfaces of labia majora
  • Skin and mucosa of labia minora are rich in sebaceous glands
  • Deeper area contains dense connective tissue
  • Composed of nonkeratinized stratified squamous epithelium, usually no adnexae
  
  
• Vestibule:
  • Area between the hymen and Hart's line
  • Lined by non-keratinized squamous epithelium
  • Structures found in vestibule include: major vestibular (Bartholin's) glands, minor vestibular glands, periurethral (Skene's) glands, urethra
  
  
• Minor vestibular gland:
  • Correspond to penile glands of Littre
  • Concentrically located within the vestibule
  • Shallow glands (extending no deeper than 3 mm into the underlying dermis) lined by single layer of mucin secreting columnar cells that merge with stratified squamous epithelium of vestibule
  • Open directly onto the surface
  
  
• Glands:
  • Apocrine glands (scent glands):
    • Develop secretory function at adrenarche
    • Identical to those of axillae, breast and perianal regions
    • Height of secretory cells varies
    • Lumina of glands are large compared to lumina of eccrine glands
  • Eccrine glands (sweat glands):
    • Primarily involved in heat regulation
    • Function before puberty
    • Lined by layer of epithelial cells that contain eosinophilic cytoplasm
  • Sebaceous glands:
    • Alveolar, holocrine glands which do not contain lumina
    • Each gland composed of several lobules
    • Cells in each lobule form delicate network filled with fat
  • Skene's glands:
    • Periurethral glands analogous to prostate
    • Mucus secreting columnar epithelium merges with duct urothelium, then stratified squamous epithelium of vestibule
  
  
• Vulvar lymphatics:
  • Drainage for all but clitoris is to superficial inguinal nodes

Regional anatomy #1

#2

Hart's line

Labia majora

Vestibule

Bartholin's gland

Sebaceous glands-hyperplasia

Vestibule-nonkeratinized squamous epithelium

Vestibule-minor vestibular glands

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