Female reproductive system

Clinical anatomy of the vulva

The female external genitalia or vulva include the mons pubis, labia majora, labia minora, clitoris, vestibule, vestibular bulbs and the greater vestibular glands ( Fig. 74.1 ). The appearance of these structures changes throughout the female reproductive cycle from infancy through puberty, pregnancy and the menopause.

The mons pubis is the rounded, hair-bearing area of skin and adipose tissue over the pubic symphysis and adjacent pubic bone. Before puberty, it is relatively flat and hairless; through adolescence and into adult life, it becomes prominent with coarse hair; and after menopause, it atrophies slightly. The labia majora are two folds of skin that extend from the mons pubis to the perineum, forming the lateral boundaries of the vulva. Each labium has an external surface covered with hairs and a smooth, pink internal surface that contains large sebaceous follicles. The labia minora are thin folds of skin, devoid of fat, that extend from the clitoris anteriorly to the fourchette posteriorly. The anterior parts of each lip meet above the clitoris to form the clitoral hood or prepuce, and the lower parts pass below the clitoris to form the frenulum of the clitoris. The space between the labia minora is the vestibule; it contains the openings of the vagina, the external urethra, the greater vestibular glands (Bartholin's glands) and the para-urethral glands (Skene's glands). The urethra opens 2.5 cm below the clitoris at the urethral meatus. The openings of Skene's glands are located on each side of the urethral meatus.