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TheVagina

is an organ of the female reproductive tract. It is a distensible muscular tube which extends posterosuperiorly from the external vaginal orifice to the cervix.

It has several roles within the female reproductive system:

receives the penis and ejaculate, assisting in its transport to the uterus.

expands to provide a channel for delivery of a newborn from the uterus.

serves as a canal for menstrual fluid and tissue to leave the body.

In this article, we will look at the anatomy of the vagina its structure, innervation, vascular and lymphatic supply.

Fig 1 Overview of the female reproductive tract.

The vagina is closely related to many of the organs in the pelvic region:

Fig 2 Sagittal section of the female pelvis, showing the anatomical relations of the vagina.

The vagina is afibromuscular tubewith anterior and posterior walls these are normally collapsed and thus in contact with one another.

The shape of the vagina is not a round tunnel. In the transverse plane it is more like anHlying on the side. At the upper ending, the vagina surrounds the cervix, creating two domes (fornices or vaults): an anterior and a (deeper) posterior one.

Theposterior fornixis important as it acts like a natural reservoir for semen after intravaginal ejaculation. The semen retained in the fornix liquefies in the next 20-30 mins, allowing for easier permeation through the cervical canal.

Fig 3 The anterior and posterior vaginal fornices

The vagina is composed of four histological layers (internal to external):

this layer provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).

a dense connective tissue layer which projects papillae into the overlying epithelium. The larger veins are located here.

comprising two layers of smooth muscle; an inner circular and an outer longitudinal layer.

a fibrous layer, which provides additional strength to the vagina whilst also binding it to surrounding structures.

The arterial supply to the vagina is via the uterine and vaginal arteries both branches of theinternal iliac artery.

Venous return is by the vaginal venous plexus, which drains into theinternal iliac veinsvia the uterine vein.

Lymphatic drainage is divided into three sections:

Superior drains to external iliac nodes

Middle drains to internal iliac nodes

Inferior drains to superficial inguinal lymph nodes.

Fig 4 Posterior view of the arterial supply to the female reproductive tract.

Innervation is predominantly from the autonomic nervous system. Parasympathetic and sympathetic nerves arise from theuterovaginal nerve plexus(in turn a subsidiary of the inferior hypogastric plexus).

Only the inferior 1/5 of the vagina receives somatic innervation. This is via a branch of thepudendal nerve, thedeep perineal nerve.

Avaginal fistulais an open communication between the vagina and one of the adjacent pelvic organs.

It typically occurs as a result ofprolonged labour(where a Caesarean section is not available). As the fetus slowly progresses down the vaginal wall, it exerts pressure obstructing the blood supply and causing tissue necrosis.

There are three main types of vaginal fistulae:

abnormal communication with the bladder. Urine enters the vagina.

abnormal communication with the urethra. Urine only enters the vagina during urination.

abnormal communication with the rectum. Faecal matter can enter the vagina.

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Thevaginais an organ of the female reproductive tract. It is a distensible muscular tube which extends posterosuperiorly from the external vaginal orifice to the cervix.

It has several roles within the female reproductive system:

– receives the penis and ejaculate, assisting in its transport to the uterus.

– expands to provide a channel for delivery of a newborn from the uterus.

– serves as a canal for menstrual fluid and tissue to leave the body.

In this article, we will look at the anatomy of the vagina – its structure, innervation, vascular and lymphatic supply.

caption id=attachment_6527 align=aligncenter width=379Fig 1 – Overview of the female reproductive tract./caption

The vagina is closely related to many of the organs in the pelvic region:

caption id=attachment_6625 align=aligncenter width=566Fig 2 – Sagittal section of the female pelvis, showing the anatomical relations of the vagina./caption

The vagina is afibromuscular tubewith anterior and posterior walls – these are normally collapsed and thus in contact with one another.

The shape of the vagina is not a round tunnel. In the transverse plane it is more like anHlying on the side. At the upper ending, the vagina surrounds the cervix, creating two domes (fornices or vaults): an anterior and a (deeper) posterior one.

Theposterior fornixis important as it acts like a natural reservoir for semen after intravaginal ejaculation. The semen retained in the fornix liquefies in the next 20-30 mins, allowing for easier permeation through the cervical canal.

caption id=attachment_47760 align=aligncenter width=512Fig 3 – The anterior and posterior vaginal fornices/caption

The vagina is composed of four histological layers (internal to external):

– this layer provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).

– a dense connective tissue layer which projects papillae into the overlying epithelium. The larger veins are located here.

– comprising two layers of smooth muscle; an inner circular and an outer longitudinal layer.

– a fibrous layer, which provides additional strength to the vagina whilst also binding it to surrounding structures.

The arterial supply to the vagina is via the uterine and vaginal arteries – both branches of theinternal iliac artery.

Venous return is by the vaginal venous plexus, which drains into theinternal iliac veinsvia the uterine vein.

Lymphatic drainage is divided into three sections:

Superior – drains to external iliac nodes

Middle – drains to internal iliac nodes

Inferior – drains to superficial inguinal lymph nodes.

caption id=attachment_6541 align=aligncenter width=556Fig 4 – Posterior view of the arterial supply to the female reproductive tract./caption

Innervation is predominantly from the autonomic nervous system. Parasympathetic and sympathetic nerves arise from theuterovaginal nerve plexus(in turn a subsidiary of the inferior hypogastric plexus).

Only the inferior 1/5 of the vagina receives somatic innervation. This is via a branch of thepudendal nerve, thedeep perineal nerve.

Avaginal fistulais an open communication between the vagina and one of the adjacent pelvic organs.

It typically occurs as a result ofprolonged labour(where a Caesarean section is not available). As the fetus slowly progresses down the vaginal wall, it exerts pressure – obstructing the blood supply and causing tissue necrosis.

There are three main types of vaginal fistulae:

– abnormal communication with the bladder. Urine enters the vagina.

– abnormal communication with the urethra. Urine only enters the vagina during urination.

– abnormal communication with the rectum. Faecal matter can enter the vagina.

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