FEMALE EXTERNAL GENITAL ORGANS/ PUDENDUM OR VULVA

The synonymous terms vulva and pudendum refers to the female external genitalia; the term
pudendum is commonly used clinically. The vulva serves:
• As sensory and erectile tissue for sexual arousal and intercourse.
• To direct the flow of urine.
• To prevent entry of foreign material into the urogenital tract.

Pudendum includes: (1) The mons pubis; (2) the labia majora; (3) the labia minora; (4) the clitoris;
(5) the vestibule of the vagina; (6) the bulbs of the vestibule; and (7) the greater vestibular
glands.
Mons Pubis
The mons pubis is the rounded, fatty eminence anterior to the pubic symphysis, pubic tubercles,
and superior pubic rami. The eminence is formed by a mass of fatty subcutaneous tissue. The fat
in the mons pubis increases at puberty and decreases after menopause. The surface of the mons
is continuous with the anterior abdominal wall. After puberty, the mons pubis is covered with
coarse pubic hairs. The hair bearing area has a nearly horizontal upper limit.
Labia Majora
Labia majora are two thick folds of skin enclosing fat. They form the lateral boundaries of the
pudendal cleft. Their outer surfaces are covered with hair, and the inner surfaces are smooth, pink,
hairless and studded with large sebaceous glands. The larger anterior ends are connected to each
other below the mons pubis to form the anterior commissure. The skin connecting the less
prominent posterior ends of the labia is known as the posterior commissure. The area between
the posterior commissure and the anus which is about 2.5 cm long constitutes the gynaecological
perineum.

Labia Minora
Labia minora are two thin folds of skin, which lie within the pudendal cleft. Anteriorly, each
labium minus splits into two layers; the upper layer joins the corresponding layer of the opposite
side to form the prepuce of the clitoris. Similarly the lower layers of the two sides join to form the
frenulum of the clitoris. Posteriorly, the two labia minora meet to form the frenulum of the labia
minora. The inner surface of the labia minora contains numerous sebaceous glands.
Female external genitalia. A–C. Surface anatomy of vulva (pudendum) of vagina demonstrated in three positions. D. Illustration of vulva, similar to (C).
Moisture typically keeps the labia minora passively apposed, keeping the vestibule of vagina closed (B) unless spread apart as in (C)

Clitoris
The clitoris is an erectile organ, homologous with the penis. However, it is not traversed by the
urethra. It lies in the anterior part of the pudendal cleft. The body of the clitoris is made up of two
corpora cavemosa enclosed in a fibrous sheath and partly separated by an incomplete pectiniform
septum. corpus spongiosum is absent. Each corpus cavernosum is attached to the ischiopubic rami.
The down-turned free end of the clitoris is formed by a rounded tubercle, the glans clitoridis,
which caps the free ends of the corpora. The glans is made up of erectile tissue continuous
posteriorly with the commissural venous plexus uniting the right and left bulbs of the vestibule
called the bulbar commissure. The surface of the glans is highly sensitive and plays an important
role in sexual responses.
Clitoris. The surrounding soft tissues have been removed to reveal the parts of the clitoris.

Vestibule of the Vagina

Vestibule of the vagina is the space between the two labia minora. It presents the following
features. (1) The urethral orifice lies about 2.5 cm behind the clitoris and just in front of the vaginal
orifice. (2) The vaginal orifice or introitus lies in the posterior part of the vestibule, and is partly
closed, The size and appearance of the vaginal orifice vary with the condition of the hymen, a thin
anular fold of mucus membrane, which partially or wholly occludes the vaginal orifice. After its
rupture, only remnants of the hymen, hymenal caruncles (tags), are visible. These remnants
demarcate the vagina from the vestibule. The hymen has no established physiological function. It
is considered primarily a developmental vestige, but its condition (and that of the frenulum of the
labia minora) often provides critical evidence in cases of child abuse and rape. (3) The orifices of
the ducts of the greater vestibular glands lie one on each side of the vaginal orifice, between the
hymen and the labium minors. (4) Numerous lesser vestibular or mucous glands open on the
surface of the vestibule. (5) The posterior part of the vestibule between the vaginal orifice and
the frenulum of the labia minora forms a shallow depression known as the vestibular fossa.

Bulbs of the Vestibule

Bulbs of the vestibule are two oval bodies of erectile tissue that correspond to the two halves of
the bulb of the penis. The bulbs lie on either side of the vaginal and urethral orifices, superficial to
the perineal membrane. They are covered inferiorly and laterally by the bulbospongiosus muscles
extending along their length. The bulbs are homologous with the bulb of the penis. The tapering
anterior ends of the bulbs are united in front of the urethra by a venous plexus, called the bulbar
commissure. The expanded posterior ends of the bulbs partly overlap the greater vestibular
glands.

Vestibular Glands.
The greater vestibular glands (Bartholin glands), is approximately 0.5 cm in diameter, they are
located in the superficial perineal pouch. They lie on each side of the vestibule of the vagina,
posterolateral to the vaginal orifice and inferior to the perineal membrane. The greater vestibular
glands are round or oval and are partly overlapped posteriorly by the bulbs of the vestibule. Like
the bulbs, they are partially surrounded by the bulbospongiosus muscles. The slender ducts of
these glands pass deep to the bulbs of the vestibule and open into the vestibule on each side of
the vaginal orifice. These glands secrete mucus into the vestibule during sexual arousal.
The lesser vestibular glands are small glands on each side of the vestibule of the vagina that open
into it between the urethral and vaginal orifices. These glands secrete mucus into the vestibule,
which moistens the labia and vestibule.

Vessels and nerves of the perineum

Arterial Supply and Venous Drainage of Vulva.
The abundant arterial supply to the vulva is from the external and internal pudendal arteries. The
internal pudendal artery supplies most of the skin, external genitalia, and perineal muscles. The
labial arteries are branches of the internal pudendal artery, as are those of the clitoris. The labial
veins are tributaries of the internal pudendal veins and accompanying veins of the internal
pudendal artery. Venous engorgement during the excitement phase of the sexual response
causes an increase in the size and consistency of the clitoris and the bulbs of the vestibule of the
vagina.
Arteries of the perineum

Innervation of Vulva
The anterior aspect of the vulva (mons pubis, anterior labia) is supplied by derivatives of the
lumbar plexus: the anterior labial nerves, derived from the ilio-inguinal nerve, and the genital
branch of the genitofemoral nerve. The posterior aspect of the vulva is supplied by derivatives of
the sacral plexus: the perineal branch of the posterior cutaneous nerve of the thigh laterally, and
the pudendal nerve centrally. The latter is the primary nerve of the perineum. Its posterior labial
nerves (terminal superficial branches of the perineal nerve) supply the labia. Deep and muscular
branches of the perineal nerve supply the orifice of the vagina and superficial perineal muscles.
The dorsal nerve of the clitoris supplies deep perineal muscles and sensation to the clitoris.
The bulb of the vestibule and erectile bodies of the clitoris receive parasympathetic fibers via
cavernous nerves from the uterovaginal nerve plexus. Parasympathetic stimulation produces
increased vaginal secretion, erection of the clitoris, and engorgement of erectile tissue in the
bulbs of the vestibule.

Nerves of the perineum

LYMPHATIC DRAINAGE OF FEMALE PERINEUM

The vulva contains a rich network of lymphatic vessels. Lymph from the skin of the perineum,
including the anoderm inferior to the pectinate line of the anorectum and the inferiormost vagina,
vaginal orifice, and vestibule, drains initially to the superficial inguinal lymph nodes. Lymph from
the clitoris, vestibular bulb, and anterior labia minora drains to the deep inguinal lymph nodes, or
directly to the internal iliac lymph nodes, and that from the urethra drains to the internal iliac or
sacral lymph nodes.