ANATOMY &

PHYSIOLOGY VULVA

MWMS 4013
MEMBER’S
• NORHAFIFAH BINTI SUPARMAN
• ROZANA BTE ABD WAHAB
 0BJECTIVE

• Knowing the structure of the vulva

• Knowing the structure of the vulva that will
occur during the pregnancy & peuperium
• Knowing the injuries that will occur during the
birth process
Stucture of vulva:

1.Mon’s pubis
2.Labia majora
3.Labia minora
4.Clitoris
5.Vestibule
6.Hymen
7.Perineum
ANATOMY & PHYSIOLOGY VULVA
MON’S PUBIS
• The mons pubis is a tissue mound made up of fat located directly anterior to the
pubic bones.
• This mound of tissue is prominent in females and is usually covered in pubic hair.
• The mons pubis functions as a source of cushioning during sexual intercourse.
• The mons pubis also contains sebaceous glands that secrete pheromones to induce
sexual attraction.
• Labia Majora
-The word "labia majora" is defined as the larger lips.
-The labia majora are a prominent pair of cutaneous skin folds that will form the lateral
longitudinal borders of the vulval clefts.
-The labia majora forms the folds that cover the labia minora, clitoris, vulva, vestibule,
vestibular bulbs, Bartholin's glands, Skene's glands, urethra, and the vaginal opening.
The anterior part of the labia majora folds comes together to form the anterior labia
commissure directly beneath the mons pubis.
Labia Minora 
• The "labia minora" is defined as the smaller lips.
• The labia minora are a pair of small cutaneous folds that begins at the clitoris and
extends downward.
• The anterior folds of the labia minora encircle the clitoris forming the clitoral
hood and the frenulum of the clitoris.
• Then the labia minora descends obliquely and downward
forming the borders of the vestibule.
• Eventually, posterior ends of the labia minora terminate
as they become linked together by a skin fold called the
frenulum of the labia minora. The labia minora will
encircle the vulva vestibule and terminating between the
labia majora and the vulva vestibule. With sexual arousal,
the labia minora will become engorged with blood and
appear edematous.(#PENTING#)
Clitoris
• The clitoris is a sex organ in females that functions as a sensory organ.
• The clitoris can be divided into the glans clitoris and the body of the
clitoris.
• The glans clitoris is the only visible part of the clitoris. The glans clitoris
is highly innervated by nerves and perfused by many blood vessels.
• It is estimated that glans clitoris is innervated by roughly eight thousand
nerve endings. Since the glans clitoris is so highly innervated, it
becomes erected and engorged with blood during sexual arousal and
stimulation.
Vestibule
• The area between the labia minora is the vulva vestibule.
• This is a smooth surface that begins superiorly just below
the clitoris and ends inferiorly at the posterior commissure
of the labia minora.
• The vulva vestibule contains the opening to the urethra and
the vaginal opening.
• The borders of the vulva vestibule are formed from the edge of the labia
minora.
• There is a demarcation between the vulva vestibule and the labia minora
called Hart's lines. Hart's lines identify the change from the vulva vestibule to
the labia minora.
• This change of skin appearance is visible by the smoother transitional skin
appearance of the vulva vestibule to the vulvar appearance of the labia
minora.
• PERINEUM
-The perineum is the area skin between the opening of the
vagina and the anus.
- Typically between 2 and 5cm long,the perineum connects
with the muscle in the lower pelvic(as the pelvic floor
muscle)
- During child birth,the perineum stretch to make space for
the baby .
• HYMEN
-The hymen is a piece of tissue covering or surrounding part of vaginal
opening.
-Formed during development and present during birth,Some people will feel
pain or bleed when their hymen breaks
MICROSCOPIC STRUCTURE OF THE
VULVA
• Bartholin's Glands
• The Bartholin's glands also known as the greater vestibular glands
(homologous to the bulbourethral glands in males) are two pea-sized glands
located slightly lateral and posterior to the vagina opening.
• These two glands function to secrete a mucus-like substance into the vagina
and within the borders of the labia minora.
• This mucus functions as a lubricant to decrease friction during intercourse
and a moisturizer for the vulva.
BLOOD SUPPLY
• Blood supply –
• supplied by internal pudendal artery from the
internal branch iliac/hypogastric femoral artery
• . Venous flow – it flows inwards internal and
external Pudendal Veins, during sexual activity
these veins will swelling or swelling and increase
the size of the clitoris.
• Lymphatic channels on the vulva are superficial
inguinal lymph nodes
 SENSORY & NERVE VULVA
• Divided into front and back:
• The anterior part of the vulva is supplied by the ilioinginal
nerve and the genital branch of the genitofemoral nerve.
• The posterior part of the vulva is supplied by the pudendal
nerve from the posterior cutaneous nerve.
• The clitoris and vestibule receive parasympathetic than
cavernous nerves, which are obtained from the uterovaginal
plexus
STATE THE CHANGES IN THE STRUCTURE
WHICH OCCURS DURING PREGNANCY &
THE PEUPERIUM
• DURING PREGNANCY

1. -Vulvar varicose veins

- Vulvar varicose veins are caused by an increase in blood volume, and a
decrease in how fast blood flows from lower extremities.
• 2. Increased vaginal swelling
-The swelling and increased blood flow may also increase libido and make
feel easily aroused.
-Hormonal changes and increased blood flow may also cause vagina and labia
to darken and take on a bluish tint.
-If vaginal swelling is accompanied by redness, burning, and itching, contact
your doctor.
• Vaginal bleeding

-It may also be caused by increased blood volume.

-In some cases, vaginal bleeding is a sign of miscarriage, especially if it’s
accompanied by severe, menstrual-like cramping, and the passing of tissue
through your vagina.
• Vaginal bleeding during second and third trimesters is concerning,if vaginal
bleeding is caused by:
-placenta abruptio
-premature opening of the cervix
-preterm labor
-uterine rupture
• -DURING PEUPERIUM

-The vagina and vulva will initially be edematous, and

enlarged but return to their usual state over the first few
weeks of the puerperium. 
STATE THE INJURIES THAT MAY OCCUR
DURING LABOUR

• Large babies. Birth weight over 4kg-

• Prematurity. Babies born before 37 weeks (premature babies
have more fragile bodies and may be more easily injured).
• Cephalo pelvic disproportion. The size and shape of the
mother's pelvis is not adequate for the baby to be born vaginally.
 STATE THE INJURIES THAT MAY OCCUR
DURING LABOUR
Types of tear Muscles Involve Example

1st tear -Laceration involve fourchette -primid

and skin -wt baby 2.5kg to <4kg

2nd tear Skin,mucous -Instumental delivery(vaccum)

membrane,superficial pelvic
floor muscle,laceration vagina
wall and labia,if deep levator
ani involve.
3rd tear -Deep muscle but tear Shoulder dystocia
extended posteriorly whereby
anterior area,external and
sphinter involved
4th tear -Tear interior wall of
rectum,internal anal sphinter of -Weakness management
anus. during conduct.
 SIGNIFICANT LANDMARKS SUTURING
TEAR/EPISIOTOMY
MEDIOLATERAL -Starting at the mid point
fourchette
-Directed to 45' to the middle midline between
the ischial tuberosity and the anus which is 7
o'clock and the length is 2-3cm
- Can damage the anus sphincter and
Bartholin's gland
MEDIAN -Starting in the middle of the fourchette towards the posterior 2.5cm of the
midline of the perineum
-Mid line incision is made according to the perineal muscle incision. It can reduce
bleeding but high damage to the anus sphincter (3rd tear)
- Easy to sew, less pain and dyspareunia.
J-Shape
- Rarely done, difficult to sew.
-Starting in the middle of the fourchette
. -Directing towards the posterior in the middle line (midline) by 2cm
. -Pointing towards 7.00 o'clock to avoid the anus.
- Done for certain cases such as instrumental delivery such as forceps and vaccum.
THANK YOU
REFERENCES

• Text Book for midviwes 14th edition

• Text Book Anathomy & physiology applied to obstetrics
• Website https://www.mayoclinic.vulva
• Website https://.cancer.org
• Websites https//:www.Britannica.com