Anatomy

Many women are uncertain about their genital anatomy and may present complaining of vaginal itching or simply itching "down there.'' The vulva comprises the entire external genitalia from the mons pubis anteriorly to the anus posteriorly and laterally to the genito-crural folds. Included in this area are the labia majora, labia minora, clitoris, urethral meatus, vestibule, posterior fourchette, hymen, and the Bartholin's, Skene's, and minor vestibular glands and the vestibular bulbs.

The labia majora and mons contain adipose and fibrous tissue, covered by skin with numerous sebaceous and hair follicles. The labia minora do not contain adipose tissue, and their skin has sebaceous glands but not hair follicles. On the inner aspect of the labia minora is Hart's line, which delineates the junction between skin and the mucous membrane. The boundaries of the vulvar vestibule are Hart's line laterally and the hymenal ring medially, and this area contains numerous glands that secrete mucus. The vestibular bulbs are located within the bulbocavernosus muscles on either side of the vestibule and contain erectile tissue. The clitoris contains both erectile tissue and a very high density of nerve fibers.

The blood supply of the vulva is from branches of the internal and external pudendal arteries, and lymphatic drainage is primarily to the external and internal iliac nodes via the groins. Branches of the pudendal nerve provide most of the motor and sensory innervation to the vulva.

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