ANATOMYANDPHYSIOLOGYI I

I
THEFEMALEREPRODUCTIVESYSTEM
(FI
RSTSEMESTER2021SET)

LECTURE2:
ANATOMYOFTHEEXTERNALSTRUCTURESOFTHE
FEMALEREPRODUCTIVESYSTEM

Learni
ng obj
ecti
ves:Afterstudyi
ng t
hissecti
on,“TheExternalSt
ruct
ureoftheAnatomyoft he
FemaleReproducti
veSystem,” st
udentsshoul
dbeabl et
odescri
bethestr
uctur
es,andfunct
ionsof
thefemaleexter
nalgenital
i
a;haveacl earknowledgeofpossi
blecl
ini
calanddiseaseconditi
ons
associ
atedwit
hit
sstruct
uresandfunct
ions.

Intr
oduction:
Thegener alfunct
ionsoft hef emalereproductiv
es ystem i
ncl
udetheformati
onofov a,r
ecepti
onof
spermatoz oa,provisi
onofs uit
abl eenvi
ronmentsforf er
ti
li
sat
ionandfetaldevelopment,part
uri
ti
on
(chil
dbi
rth),lact
ati
on,thepr oductionofbr
eas tmil
k,whichprovi
descompletenouris
hmentforthebaby
i
ni t
searlyl i
fe.Theex t
ernalgeni t
ali
asupportsthesefuncti
onsbyprov
idi
ngas ui
tableenvi
ronmentf
or
pleasur
abl etouch,arousal,secreti
onsoffl
uid,andprotect
ion.

Themai nexternalstr
ucturesoft hefemalereproducti
ves ys
tem (t
heVulva)i
ncl
ude:Labiamaj ora,
Labia minor
a,Bar t
holi
n’sgl ands ,Skene’sgl and,vesti
bule,and Cl
it
ori
scontai
ned withi
nt he
subst
anceoft heperi
neal r
egion,otherwi
seknownast hefemaleperi
neum.ThePer
ineumistheregion
below thepelvicdiaphragm;i tcons i
stsofvessels
,ner v
es,pouches,gl
ands,and muscle-f
ascial
for
mationsarr
angedt oclosethepel vi
cinf
eri
orl
y.

Descr ipt
ionoft hestructur esandf unctionsoft heVul va
Thev ulvai stheexternalgeni t
aliaofthef emaler eproducti
v etr
act,si
tuatedimmediatelyexternaltothe
genitalor i
fi
ce.Thes t
ructur esoft hev ulvaincludet helabiamaj or
a,labiaminora,monspubi s,cli
tori
s,
bulbofv esti
bule,v
ul vav es ti
bule,ves t
ibularglands ,andthegeni t
alorif
ice(oropeningoft hev agina).
Thev ulv
ai sri
chi nner vest hatar es t
imulateddur i
ngs exualacti
v i
tyandar ousal.Thev ulv
aal so
containst heopeni ngoft hef emaleur ethraandt huss er
v esthev i
talfunct
ionofpas singur i
ne.The
vul
vacons i
sti
ngoft heex ter nalgenitalorgansoft hef emalemammaldev el
opsdurings everalphas es,
chi
eflydur ingthefetal andpuber t
alper i
ods .

Thesoftmoundatthefrontofthevulv
a,themonspubi s,i
sformedbyf attytissuecoveri
ngthepubi c
bone.Themonspubi ss eparat
esint
ot wofoldsofs k
incal l
edthel abi
amaj ora,l
it
eral
ly“maj or(or
l
arge)li
ps.
” Thecleftbetweenthelabiamajoraiscall
edt hepudendalcl eft,orcl
eftofVenus,andit
cont
ainsandprot
ectstheother,moredeli
catestr
ucturesofthev ul
va.Thel abiamajorameetagai nat
theperi
neum,afl
atareabet weenthepudendalcl ef
tandt heanus .Thecol ouroftheoutsi
des ki
nof
thel
abiamajor
aisusuall
ycl osetot
heindiv
idual’sov eral
lskincol
ouralthought hereisconsi
derable

1
vari
ation.Thei nsi
deskinandmucusmembr aneareof t
enpi nkorbrowni sh.Af
tertheonsetofpuberty
,
themonspubi sandthelabiamaj orabecomecov eredbypubi chair.Thishairsometi
mesex tendsto
theinnert highsandper ineum, butthedens i
ty,
texture,
colour,andex tentofpubichaircoveragevary
considerabl yduet obothindi
v i
dual vari
ati
onandcul t
uralpracti
cesofhai rmodifi
cati
onorremov al
.
Thel abiami noraaretwos oftfoldsofs ki
nwi t
hinthelabiamaj ora,containi
ngnumer ouss ebaceous
andex ocrines weatglands.Thecl eftbetweent helabiami nor
aist hev esti
bule.Thevagina,uret
hra
andduct soft hegreat
erv est
ibularglandsopenintothevest i
bule.

Theclit
ori
sislocatedatthefr
ontofthev ul
vawher ethelabi
ami norameet .Thevis
ibleport
ionoft he
cli
tor
isi
stheclit
oralgl
ans,r
oughlythesizeands hapeofapea.Thecl i
tor
algl ansarehighl
ys ensi
ti
v e,
contai
ningasmanyner veendingsastheanalogousor ganinmales ,t
hegl anspenis.Thepointwher e
thelabi
ami nor
aat t
achestotheclit
ori
siscall
edt hefrenul
um cl
itori
dis.Apr epuce,thecli
toralhood,
normall
ycov er
sandpr ot
ectsthecli
tor
is;however,i
nwomenwi t
hpar ti
cularlylar
geclit
ori
sesors mal l
prepuces,t
heclit
orismaybepar t
ial
lyorwholl
yex posed.Thecli
toralhoodi sthefemaleequivalentof
themalefor
es ki
nandmaybepar t
ial
lyhi
ddeninsidethepudendal clef
t.

Thear eabetweent hel

abiami nor
aiscall
edt hevulv
alvest
ibul
e,andi
tcontai
nsthev agi
naland
uret
hralopenings.Theuret
hralopeni
ng(meatus)i
slocat
edbelowthecl
i
tor
isandjusti
nfrontoft
he
vagi
na.Thisi
swher euri
nepas sesf
romtheur
inarybl
adder.

Theopeningoft hevaginaisl ocat

edatt hebot tom oft hev ulvalvesti
bul
et owardtheper ineum.The
termint
roi
tusismor etechnicall
ycor r
ectthan“openi ng,”s incet hevaginaisusuall
ycol l
aps ed,wi
th
theopeningcl osedunl esss omethingisi nserted.Thei ntroit
usi ss ometimespar t
lycov eredbya
membr anecal l
edthehy men.Thehy menwi llr
upt ur
edur i
ngt hef i
rstepi
sodeofv i
gorouss ex ,andthe
bloodproducedbyt hisr upt
urehasbeent radit
ionall
ys eenasas ignofvirgi
nit
y.Howev er,thehymen
mayal sorupturespontaneous l
ydur i
ngex erci
seorbes tr
etchedbynor malactivi
ti
ess uchast heuse
oftampons .Sli
ghtl
ybel owandt othelef
tandr ightoft hev aginalopeningar etwoBar tholinglands
whichproduceawax y,pheromone- cont
ainingsubs tance,thepur pos eofwhichisnotyetfullyknown.

Inmammal s,i
ncl
udinghumans ,theprocessi soneofs exualreproducti
on,inwhichthemal eand
femal
eorgansdif
feranatomicall
yandphy si
ological
ly
, andthenewi ndivi
dualdevel
opsf r
omt hefusi
on
oftwodiff
erentsexcel ls(gametes)
.Themal egamet esarecal l
ed spermatozoaand t hefemale
gametesarecall
edov a.Noteagai nt
hattheex ter
nalgenital
iaisknowncol l
ecti
vel
yast heVulva,and
consi
stsoft
helabiamaj oraandlabiaminora,thecli
tori
s,thevaginalori
fi
ce,thevesti
bule,t
hehy men
andthevest
ibul
arglands( Bar
thol
in’sandSk ene’sgl ands).

Di am:Al
agr abel
edi
mageofavul
va,
showi
ngext
ernalandi
nter
nalst
ruct
uralvi
ews.

2
3
 Descr iptivesummar yoft heExt er nal Struct uresoft heFemal eGeni talia
MonsVener is
i. Themonsv ener isi sapadoff att issuesov erthes ymphy s ispubi s .
i
i. Ithasacov er i
ngofcoar se, cur lyhai r
s ,
andpubi c  hair .
i
i
i. Itprot ect sthepubi cbonef romt rauma.
Labi aMi nor a
i. Thel abiami nor ai sas preadoft woconnect iv
et iss uef oldst hatar epi nkishincol our.
i
i. Thei nternal s urfacei scompos edofmucousmembr anesandt heex ternal surfacei ssk i
n.
i
i
i. Itcont ainss ebaceousgl andsal l ov erthear ea.
Labi aMaj ora
i
. Later al tot hel abi ami nor aar et wof oldsoff att is suecov eredbyl oos econnect i
vet is
s ueand
epithel i
um, thel abi amaj ora.
i
i. Itsfunct ioni st opr otectt heex ter nal genital i
aandt hedi s t
al ur ethr aandv agi naf romt r
auma.
i
i
i. Itiscov er edi npubi chai rt hats er vesasaddi t
ionalpr otect ionagai ns tharmf ulbact eriathatmay
entert hes tructur e.
Vest ibul e
i
. Itisas moot h,f latteneds ur facei nsidet hel abiawher eint heopeni ngst ot heur ethraandt he
vagi naar ise.
Cl i
toris
i. Thecl it
or isisas mal l
, circularor ganofer ectil
et issueatt hef rontoft hel abiami nora.
i
i. Thepr epuce, af oldofs kin, ser vesasi t
scov ering.
i
i
i. Thisi st hecent ref ors ex ualar ous alandpl eas uref orf emal esbecaus ei tishi ghlys ens i
ti
ve
to t
ouch  andt emper atur e.
Skene’sGl ands
i
. Alsocal ledpar aur ethr alglands , t
heyar ef oundl ater altot heur et hralmeat usandhav educt sthat
openi nt otheur et hra.
i
i
. Thes ecr et i
onsf romt hisgl andl ubr icatet heex t
er nal geni tali
adur ingcoi tus.
Bar tholin’sGl and
i
. Alsocal led bul bov agi nalgl and,t hisisanot hergl and r es pons iblef ort hel ubri
cat i
onoft he
ex t
er nal geni tali
adur ingcoi tus .
i
i. Ithasduct st hatopeni ntot hedi stal vagina.
i
i
i. Bot hoft hes egl ands ' secr etionsar eal kalinet ohel pt hes per ms urvivei nthev agina.
Four chet te
i
. Thisi sar idgeoft issuewhi chi sf ormedbyt hepos ter i
orj oiningoft hel abiami nor aandMaj ora.
i
i
. Dur ing  epis i
otomy ,t
hi sist het i
s s uet hatiscutt oenl arget hev agi nal opening.
Per i
neal Body/ Ar ea
i
. Thisi samus cularar eat hats tretcheseas i
lydur ingchi ldbi rt
h.
i
i
. Mos tpr egnancyex erci sess uchasKegel ’sands quat t
ingar edonet os trengt hent heper i
neal
bodyt oal l
oweas ierex pans iondur ingchi l
dbi rt
handav oidt ear ingt het i
ssue.
Hymen
i
. Thiscov erst heopeni ngoft hev agi na.

4
i
i
. I
tist
ough,
elas
tic,
ands
emi
cir
clet
iss
uei
stor
ndur
ingt
hef
ir
sts
exual
int
ercour
se.

GENERALFunct i
onsoft heVul va
1. I
tissti
mulateddurings exualact
ivi
tyandar ousal
2. I
tservesthevit
al f
unctionofpassi
ngur i
ne
3. I
tpermitschil
dbirt
hthrought hevi
rginalopening
4. I
tproducesawax y,pheromone-containi
ngs ubst
anceasalubri
cant
5. I
tisex ter
nals upport,cover,andpr otect
ives t
ruct
urest
ot hestr
uct
uresoft
hef
emal
eint
ernal
geni
tali
a

Arteri
al Bloodsuppl y
Thebl oods upplytothefemaleex t
ernalgenitali
acomesf rom branchesfr
om theinter
nalpudendal
art
er i
est hatbr anchfromtheint
ernali
liacarter
iesandex t
ernalpudendalart
eri
esthatbranchfr
omthe
femor alarteries.
Venousdr ainage
TheVenousbl ooddrainsi
ntoal
argepl exuswhi chevent
uall
ydrainsint
otheint
ernali
li
acveins
.
Lymphat i
cdr ainage
Lymphdr ainagei st
hroughthesuperf
iciali
nguinalnodes.
Ner vesuppl y
Ner ves uppl ycomesf romthebr
anchesoft hepudendal nerves.

Clini
calCorrelati
onsoftheVulva
ThePat hophys i
ologyofacel l
,ti
ssue,organorsystem,i
sthes t
udyofitsdysfuncti
onalst
ateandits
pathologi
cals t
ate.Thi
si spredetermi
nedbyt hes t
udyandk nowledgeofthenor malarchi
tect
ureof
organs t
ruct
ures .Thef
ollowi
ngar ediseasecondi
ti
onsassoci
atedwitht
heVulva:
1.Vul vodyniaandVul varPain

Vulvodyniaisabr oadcl i
nicaltermt hatisus edtodes cr
ibeanytypeofchr onic,persist
entvulvar
painorv ulv
ars oreness .Thecondi ti
oni sdiagnos edi nwomenofal lagesandl i
festages.Women
experiencear angeofv ul
v arpain,suchasl abiamaj orathatar
es woll
enandi t
chy ,sorevulv
aar ea,
sharppai ninthev ul
va,v ulvarpaindur i
ngt heirperiod,vul
varpainduringintercourse,andmany
othertypesofdi scomf ort
.Thepai ni stypi
callydebilit
ati
ng,af
fecti
ngev er
yas pectoflif
ethrough
thephy si
calandemot i
onal s
y mptoms .

2.I
nfl
ammat
ionoft
heVul
var(
Vul
vi
ti
s):
Contactoral l
ergicvulvi
ti
sisv erycommonf oll
owingex posuret oirr
it
ants.Asmanyas54% of
sympt omat i
cwoment urnouttohav econtactv ul
vit
is.Vul
vit
isresult
ingfrom cont
actwit
hani rri
tant
i
smor ecommont hanall
ergi
cv ul
viti
s.Contactv ul
vit
isdoesnotneces sari
l
ycaus eery
thema, butit
canl eadt os ymptomsofbur ning,rawnes s,andi r
ri
tati
on.Infl
ammat i
onoft heVulvaisk nownas
vul
viti
s .Vulvi
ti
s i
sinfl
ammat i
oniny ourvulvaorgeni t
als.Vul
v i
ti
siscommonandcanr esultf
roman
all
ergicr eact
ion,aninfect
ionorani nj
ury.Sy mptomsi ncl
udei t
ching,rednessands well
i
ngi nyour

5
 vul va.
3.Vul varCyst :
i
. AGar tnercy st:is as malls olit
ar yuni l
ateralcy st 
on  thef r ontv agi nalwal ltowar ds  one si
de, whi ch
maybul get opr es entasani nterlabi almas si nlateadol es cence.Ci li
atedcy stoft hev ul
va.Att he
ninthweekofges t
ation,t hepar ames onephr icductdev el opsi nt othef all
opiant ube.Remnant sof
thisductcanf orm aci l
i
at ed,orpar ames onephr i
c,cy s tf oundi ncident allyont hel abi um maj orum
dur ingpr egnancy ,puber ty,orwi t
hot herhor monal i
nf l
uences .
i
i.Sebaceousv ulvarcy sts:Al socal leds ebaceousgl andorepi der mal inclusioncy stsar ethety pesof
beni gnv ul
varcy stst hatar ef ormedwhent hes ebum- pr oduci nggl ands( s ebaceousgl ands )oft he
vul vargetbl ock edf ollowinganumberofcondi t
ionsoff act or s
.Theyar ecommoni nagedwomen
butcanal soaf fecty ounggi r
lsaswel l
. Onei mpor tantpoi ntt onot e,cy stsar enotcancer ousand
cannotbet rans mitt
edt hr oughs ex ualact ivit
y. Caus esi ncl udeHor monaldi sorder s,Sk i
nt rauma,
shav i
ngoft hear easoft hev ul
v ar,andGenet iccondi tions .
i
ii
.Epi thelialincl usioncy st
sofv ulvar:Thi sist hemos tcommononet hatdev elopsi nt hev ulvaror
vagi na.J ustlikes ebaceousones , t
heyar es malls acst hatf ormont hes ur roundingepi t
hel
ial t
issue.
Ot hernamesf ort hiscondi ti
onar et hev ulvarepi thelial incl us ionors quamousi nclus ioncy st
soft he
vul va.Theyar eal s ocommoni nadul twomen.Caus esi ncl ude,Vul v artraumaex per ienceddur i
ng
chi l
dbi rthordur i
ngs urgicalpr ocedur esandunus ualcongeni talepi thelialremnant sduringf et al
gr owt handdev elopment .
i
v.Bar tholincy st:Thi sisak indofepi thelialv ulvarorv agi nalcy stt hati sf ormedwhent heBar t
hol i
n
glandi sbl ock ed.Us ually,theBar thol i
ngl andl ocatedonv agl i
pss ecretesas mal lamountoff luid
thatl ubr icat
est hev agl i
ps .Act ual l
y, therear enor mal lyi nv i
sibleandcan` tbef elt.Bar t
hol
ingl ands
are bl ock ed wi tht hi ngss uch ast hickmucusora v irginaldi schar ge,i nfection ( ors exual ly
trans mi t
teddi seas es )orduet ov ulvarorv agi naltrauma.
4.Vul varTumour :

Vul
varcancerisa ty
pe ofcancerthatoccurs on t
he out
ers ur
face area ofthe f
emale
geni
tal
i
a. 
Vul
vart
umour
s ar
ethos
eneopl
asmsofthevul
va.Vul
varandvaginalneopl
asmsmak eup

6
 as mall percentageoff emalegenitalcancer s
.Theycanbebeni gnormalignant.
5. Vul varVar icosit
ies
Vulvarv ari
cositi
esar e v
ari
cos ev ei
ns  
thatappearony ourv ul
va.Theyus uall
ys how updur ing
pregnancy ,whent hechangesi ny ourbodyt hatsupportagr owi
ngf etuscaus ey ourvei
nst o
becomes tres
s edands wollen.Thesev ei
nscanlookuns i
ghtl
yandf eeluncomf or
table.Butthey
usuallygoawaywi thoutt r
eatmentabouts ixweeksaft
ery ourbabyisbor n.Youcanhav ethem
withouthav inganys y
mpt oms .Or,youmaynot i
cesi
gnsthatthey’rethere,l
ikepainoraf eel
i
ngof
ful
lnessi ny ourv ul
va.Theyus ual
lygoawayoncey ourbabyi sborn.Inthemeant ime,ther
ear e
eas yl
ifes t
yleadjust
ment sy oucanmak et omanagesymptoms .

6.Endomet riosis
Endomet r
ios i
si soneoft hemos tcommonv ul
varpai ncaus es.Itdev elopswhent i
ssues imilarto
thatf oundi nt hewombbegi nstogr owi not herar easofy ourbody .Theabnor maltissuei soften
foundi nt
heov ariesandf al
lopiantubes .Properdi agnos i
sofendomet ri
osisinv olv
esdi ff
erentiat
ing
i
tf rom othert ypesofpel v i
cmas ses,s uchasenl argementors welli
ngi nthepel vicareat hatcan
caus ev ul
v arpai n.
7.Pel vicInf
lammat oryDisease
Pelv i
ci nf
lammat orydisease,orPI D,isat y
peofi nfecti
ont hatmaycaus ear angeofv ul
varpai n
sy mpt oms, suchass t
abbingv ulv
arpainandv ulvarburnings ens ati
on.Thef i
rststepforv ul
v arpain
treatmentr elat
edt oPIDi st oreceiveanaccur atediagnos isandper sonal i
zedt reatmentpl anat
Vulv arPainCl i
nici nLondon.
8.Femal eChr onicPel vi
cPai n
Ifyouhav ev ul
v ars or
enes scoupledwi t
hpel vicpai nthatlas t
sformor ethans ixmonths ,youmay
hav ef emal echr onicpel vi
cpai n.Thisty peofpai ni nthev ulvarr egi
oni sty picall
ycat egorizedas
funct i
onals omat icpains yndromeorchr onicr egionalpains yndrome.Tr eatmentatVul varPai n

7
 Clinictypi
call
ybegi nswithimagi ngt es
tst oruleoutabnor
mal i
ti
es,suchasgrowths,thatmaybe
caus i
ngyourvulvarpai
ns ymptoms .
9.Acommonnor malv ari
antthatisoftenmi sdiagnosedaspapil
lomatosis,
whi
chischar acter
izedby
papi ll
arygrowthoft hev est
ibul
armucos al ocatedwit
hinHar t
’sl i
ne.Thesegr owthsareof t
en
mis ident
if
ied as condylomas ar is
ing from i nf
ecti
ons wi
tht he human papil
lomav i
rus (HPV).
Inappr opr
iat
et r
eatmentofpapi ll
omasascondy l
omascanleadt oacuteorchronics ymptomsof
bur ningorpaininthevulvaandt hev est
ibule.
I
nConcl usi
on:Anat
omi cal
lyspeaki
ng,t
hev ul
vai 
sablankett
ermf orallofthestr
ucturesofthe
ext
ernalfemal
egeni
tals. 
TheVulvaI
sNottheSameAstheVagina.Vulv
asComei nDiff
erentShapes
,
Si
zes,andColor
s.Notwov ulv
asarethes
ame.YourVul
vaCanChangeAf terPr
egnancy.
REFERENCE
KelliL. 
Boy d.,Kather i
ne N. Gibson-Corl
ey,in Comparative Anatomy and Hist
ology
(SecondEdi ti
on),2018
Nationalcancerinsti
tuteSEERt rai
ningmodule
Kumarandcl arkcli
nicalmedicinefif
thedit
ion
BDChaur asi
a’shumananat omyf if
thedit
ion
HumanAnat omyat l
asofor gans
14th-edi
ti
on-Brunner-Suddarths-Textbook
-of-
Medi cal-
sur
gical-
Nursi
ng-by-
Janice-
L.-
HinkleKerry
-H.-Cheev er
_compr essed
12th-edi
ti
on-Ros s-
Wilson-Anatomy -
and-Physi
ology -
in-
Healt
h-and-I
ll
ness-
E-Book

Lecturer
Ukwuoma Ifeanyi S.
Neurosciencist.