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Figure 19-1 The external female genitalia.

Labia majora Labia minora

Vaginal introitus Hymen

Labia majora Labia minora

Figure 19-1 The external female genitalia.

Inferiorly, the labia minora unite at the posterior commissure to form the fourchette. The perineum is the area between the fourchette and the anus.

The hymen is a circular fold of tissue that partially occludes the vaginal introitus. There are marked variations in its size, as well as in the number of openings in it. The vaginal introitus is the border between the external and internal genitalia and is located in the lower portion of the vestibule.

The blood supply to the external genitalia and perineum is predominantly from the internal pudendal arteries. The lymphatic drainage is into the superficial and deep inguinal nodes.

The internal genitalia are shown in Figure 19-2. The vagina is a muscularly walled, hollow canal that passes upward and slightly backward, at a right angle to the uterus. The vagina lies between the urinary bladder anteriorly and the rectum posteriorly. The vaginal walls are lined by transverse rugae, or folds. The lower portion of the cervix projects into the upper portion of the vagina and divides it into four fornices. The anterior fornix is shallow and is just posterior to the bladder. The posterior fornix is deep and is just anterior to the rectovaginal pouch, known as the cul-de-sac (pouch) of Douglas, and the pelvic viscera lie immediately above this pouch. The lateral fornices contain the broad ligaments. The fallopian tubes and ovaries may be palpated in the lateral fornices. The superficial cells of the vagina contain glycogen, which is acted on by the normal vaginal flora to produce lactic acid. This is in part responsible for the resistance of the vagina to infection.

The arterial supply to the vagina is derived from the internal iliac, uterine, and middle hemorrhoidal arteries. The lymphatic channels of the lower third of the vagina drain into the inguinal nodes. The lymphatic channels of the upper two thirds enter the hypogastric and sacral nodes.

The uterus is a hollow muscular organ with a small central cavity. The lower end is the cervix, and the upper portion is the fundus. The size of the uterus is different during various stages of life. At birth, the uterus is only 3 to 4 cm long. The adult uterus is 7 to 8 cm long and 3.5 cm wide, with an average wall thickness of 2 to 3 cm. The growth of the uterus and the relationship of the size of the fundus to the size of the cervix are shown in Figure 19-3.

Figure 19-2 A, Cross-sectional view of the internal female genitalia. B, Frontal view of the uterus, fallopian tubes, and ovaries.

Fundus-cervix ratio

8-month-old Newborn 1 year 5 years 9 years 12 years 15 years fetus

Figure 19-3 Growth of the uterus and changes in the fundus-cervix ratio with development. The darker red area represents the length of the cervix.

Vagina

Fallopian tube

Ovary

Fallopian tube

Vagina

Ovary

Figure 19-4 Anatomy of the uterus.

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