Rejuvenation of the External Female Genitalia

Labia majora

The labia majora are two prominent skin folds that extend from the mons pubis to the perineum, being wider in the front and thinner in the rear. They define an opening; the rima vulvae. In these, one can describe a lateral face, a medial face, a base, an inferior free margin and two extremities, anterior and posterior. The lateral face, convex in a latero-medial sense, is separated from the medial aspect of the thigh by the genito-femoral groove. As it thins posteriorly, it coincides with the inferior margin and with that of the opposite side to demarcate the rima vulvar surface. The medial face follows the external in a concave fashion and is in contact with the labia minora from which it is separated by the interlabial groove. The base is not visible from the outside, but represents the part that, by means of connective tissue bundles, attaches the ischio-pubic branches.

The anterior extremity in the outer part flows together with the contralateral, within the mons pubis (or veneris), while the innermost part delimits the anterior vulvar commissure. The mons pubis is a pad of fatty tissue that covers the pubic bone below the abdomen but above the labia. It has the function to protect the pubic bone from the impact of sexual intercourse.

The posterior extremity may be thin until it becomes flat with the skin of the perineum or if it encounters the contralateral part at the perineal raphe, it can define the limits of the posterior vulvar commissure.

The labia majora are composed essentially of two layers: skin and subcutaneous tissue. The skin that covers the lateral face is thick with hyperpigmentation and thick curly hair, with numerous sebaceous and sweat glands. The medial surface is instead covered by a thinner skin, translucent with a minor presence of hairs, of rosy color until it becomes a mucosa.

The distribution of the subcutaneous tissue is very similar to the anterior abdominal wall. In fact, it distinguishes itself as a superficial layer represented by a thick layer of adipose tissue that reduces in thickness in the anteroposterior sense, and which is replaced in the posterior part by smooth muscle cells, constituting the female dartos. The two layers are separated by a fibro-elastic membrane, originating at the subcutaneous ring of the inguinal canal. This is the band corresponding to the fasciae of Colles-abdominal Scarpa. The thicker Colles fascia is attached inferiorly to the ischiopubic rami, posteriorly to the urogenital diagram, but lacks anterior attachment. This anatomical structure prevents infections and hematomas that go toward the legs but may spread to the anterior abdominal wall.

Labia minora

The labia minora are two skin folds, flattened, free of fat, medial in respect to the labia majora, and delimiting the vaginal vestibule, and they are separated from the interlabial grooves. Each labia minora has two parts: the medial, also called internal or mucosal, and the lateral or external part. The anterior extremity runs anteriorly towards the clitoris and the posterior extremity runs towards the perineum. The lateral parts are joined medially forming the prepuce of the clitoris, the inferior side instead forming the frenulum. Posteriorly, they form the frenulum of the labia minora but can also be separated. The navicular fossa is located between the frenulum and the vaginal fornix. They greatly vary in shape and size. They may be poorly represented and protrude beyond the labia major, or can be asymmetrical, and duplicated on one side only, or on both.

Lloyd and colleagues studied 50 premenopausal women, aged between 18 and 50 years. They found an average length of labia minora of 6.0 ± 1.7 cm (2–10) and an average amplitude of 2.1 ± 0.9 cm. Measurements greater than 4 cm from the base to the free margin in its maximum height are considered a parameter of correction.

The labia minora consist of a thin stratum corneum, hyperpigmented, with absence of hair and sweat glands. Sebaceous glands are present and secrete hormones under the stimulus of a white substance, similar to male smegma. The subcutaneous tissue is dense, mainly composed of elastic fibers, and is traversed by an erectile vascular tissue, in which terminate numerous sensitive nerve endings. The genital corpuscles are very important for the perception of erogenous sensitivity, but also present are the Pacinian and Meissner corpuscles.

The vestibule of the vagina

The vaginal vestibule is an area that extends from the clitoris to the posterior fourchette of the labia minora, posteriorly it can be non-delimited and end directly in the perineum or be delimited by the frenulum of the labia minora; laterally it is delimited by labia minora. Its roof is made anteriorly from the clitoris, mucosa and then the urethral orifice and vaginal orifice.

The amplitude of the vaginal orifice can be variable and is reduced in virgin women by a mucous membrane called the hymen. It may have numerous shapes: circular, lunate, bilabiate, fimbriate, cribrose. After the first sexual acts it becomes torn, breaking up into different and irregular edges called wattles.

The vestibule of the vagina is covered by a skin similar to that of the labia minora, as is the hymen wall that protrudes toward the vestibule, but the wall of the hymen that faces the vagina is covered by an epithelium with the same characteristics of vaginal mucosa. Between the two layers, the mucous and the cutaneous, lies a dense connective tissue, in which are immersed smooth muscle cells, free nerve endings and blood vessels.