Labia and pudendal cleft
The pudendal cleft (rima pudendi) occupies the central part of the region and is bounded by skin folds.
- Labia majora (labia majora pudendi) are covered with hair on their outer margin, and their thickness contains adipose tissue and dense venous plexuses. Anteriorly, they join at the anterior commissure (commissura labiorum anterior) in the mons pubis area (mons pubis), and posteriorly they form the posterior commissure (commissura labiorum posterior) at the border with the perineum.
- Labia minora (labia minora pudendi) lie medial to the labia majora and serve as the lateral boundaries of the vaginal vestibule. In their upper part, they converge above the clitoris, forming its prepuce (preputium clitoridis) and frenulum (frenulum clitoridis).
Clitoris and vestibular bulb
Clitoris (clitoris) is an unpaired structure consisting of right and left corpora cavernosa (corpora cavernosa dextrum et sinistrum). Its crura (crura clitoridis) firmly fuse with the inferior rami of the pubic bones and are covered by the ischiocavernosus muscles. At the lower margin of the symphysis, the corpora cavernosa merge into a single body that terminates in the glans clitoridis (glans clitoridis).
Vestibular bulb (bulbus vestibuli) is an erectile tissue (bluish spongy layer) covered by the bulbospongiosus muscles. Topographically, it corresponds to the folds of the labia majora. Its narrowed upper parts embrace the urethra from above, while the thickened lower (posterior) ends closely adjoin the greater vestibular glands.
Vestibule of the vagina and female urethra
Vestibule of the vagina (vestibulum vaginae) is bounded laterally by the inner surfaces of the labia minora, superiorly by the clitoris, and inferiorly by the frenulum of the labia minora. The hymen or its remnants serves as the boundary separating it from the vagina proper.
Two important openings open into the vestibule:
- External urethral orifice (ostium urethrae externum) is located posteriorly and slightly inferiorly to the clitoris.
- Vaginal opening is located below the urethral orifice and is narrowed by the hymen.
The female urethra (urethra feminina) originates at the level of the inferior margin of the pubic symphysis (1.5–2.0 cm posterior to it), to which it is securely fixed. The canal runs downward and forward, piercing the urogenital diaphragm. Its posterior surface is firmly fused with the anterior vaginal wall.
Greater vestibular glands (Bartholin's)
The greater vestibular gland appears as a reddish-yellow body the size of a large pea. It is located at the base of the labia majora at the level of the posterior commissure.
The gland lies quite deep — 1.0–1.5 cm within the depth of the deep transverse perineal muscle, where it is partially covered by the bulbospongiosus muscle. To locate the excretory duct of Bartholin's gland, it is necessary to pull the labia minora outward. The opening of the duct opens medially, precisely at the border of the middle and posterior thirds of the labia minora (or near the remnants of the hymen).
Briefly: answers to topical questions
Which vessels supply blood to the labia majora and minora?
Blood supply to the labia majora and minora is provided by branches of the internal iliac and femoral arteries, while venous drainage occurs into the corresponding veins and the great saphenous vein of the leg.
Arterial blood supply is provided by:
- Internal pudendal artery (a. pudenda interna) supplies the perineum, including the labia majora and minora.
- Superficial external pudendal artery (r. pudenda, s. superficialis) supplies the labia majora and vagina.
Venous drainage is carried out by:
- Internal iliac veins receive the perineal veins accompanying the corresponding arteries.
- External pudendal veins drain blood from the labia majora, running laterally and emptying into the great saphenous vein of the leg.
Where does lymphatic drainage from the female external genitalia go?
Lymphatic drainage from the female external genitalia goes to the superficial inguinal lymph nodes.
This process is provided by the following groups of regional nodes:
- Superomedial superficial inguinal nodes (nodi inguinales superficiales superomediales) lie medially along the projection line of the inguinal ligament.
- Superolateral superficial inguinal nodes (nodi inguinales superficiales superolaterales) are located along the inguinal ligament.
These nodes act as the primary collector for lymph from the external genitalia, after which efferent vessels direct it to deeper structures.
To memorize the boundaries of the vaginal vestibule, imagine a rhombus: the upper angle is the clitoris, the lower angle is the frenulum of the labia minora, and the lateral sides are the inner surfaces of the labia minora. Inside this "rhombus", sequentially from top to bottom, are the external urethral orifice and the vaginal opening.
Class and exam questions
Where does the female urethra begin?
The urethra begins at the level of the inferior margin of the pubic symphysis, stepping back posteriorly by 1.5–2.0 centimeters.
Which muscles cover the crura of the clitoris and the vestibular bulb?
The crura of the clitoris are covered by the ischiocavernosus muscles, and the vestibular bulb by the bulbospongiosus muscles.
How to clinically find the excretory duct of Bartholin's gland?
It is necessary to pull the labia minora outward. The duct opens on the medial side at the border of the middle and posterior thirds of the labia minora (or at the remnants of the hymen).
What else to study on this topic
- Topography of the deep transverse perineal muscle
- Structure and functions of the urogenital diaphragm
- Syntopy of the female urethra and anterior vaginal wall
- Perineal fasciae and their connection with the external genitalia
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