I. External Generative Structures
A. The pudenda—commonly designated the vulva—includes all structures visible externally from the pubis to the perineal body (Cunningham et al., 2001):
1. Structures:
a. mons pubis
b. Labia majora and minora,
c. Clitoris
d. Hymen
e. Vestibule
i. Greater vestibular or Bartholin glands
ii. Minor vestibular glands / paraurethral glands or Skene’s gland
iii. Urethral opening
iv. Vaginal introitus
f. Perineum
2. The vulva serves (Moore et al., 2010):
a. As sensory and erectile tissue for sexual arousal and intercourse.
b. To direct the flow of urine.
c. To prevent the entry of foreign material into the urogenital tract
A. Mons pubis/mons veneris: rounded, soft, fat-filled cushion and loose connective tissue overlie the symphysis pubis.
1. It is not an organ but a region or a landmark (Cunningham et al., 2001).
2. Contains sudoriferous glands and sebaceous glands.
3. After puberty- it is covered by a curly hair pattern called escutcheon.
a. In women, Coarse, dark, curly pubic hair growth begins here 1 to 2 years before the onset of menstruation. During reproductive life, pubic hair is abundant, but after menopause, it becomes sparse (Cunningham et al., 2005).
i. It is distributed in a triangular area the base of which is formed by the upper margin of the symphysis pubis.
b. In men and in some hirsute women, the escutcheon is not so well-circumscribed and extends onto the anterior abdominal wall toward the umbilicus (Cunningham et al., 2005).
4. Innervation: ilioinguinal and genitofemoral nerves (Pernoll, 2001). Blood Supply: external pudendal artery and vein (Pernoll, 2001).
5. FUNCTION: Act as cushions & protect the bone from trauma during coitus (Cunningham et al., 2005).
6. Clinical Importance: Clinical Importance: Dermatitis and infestation with Phthirus pubis (lice, crabs) are common. Cancer from the nearby reproductive structure can involve mons and edema can occur secondary to infections, vulvar varicosities, trauma, or carcinomatous infiltration of the lymphatics (Pernoll, 2001).
7. Medical Vocabulary:
a. Escutcheon /eskuch″ən/ [L, scutum, shield] à the pattern of distribution of coarse, adult pubic hair, rhomboid in the male and triangular in the female (O’Toole, 2017).
b. Sebaceous Gland à one of the many small sacculated organs in the dermis. They are located throughout the body in close association with all types of body hair but are especially abundant in the scalp, face, anus, nose, mouth, and external ear. They are rare in the palms of the hands and the soles of the feet. Each gland consists of a single duct that emerges from a cluster of oval alveoli. The ducts from most sebaceous glands open into the hair follicles, but some open onto the skin surface, as in the labia minora and the free margin of the lips. The sebum secreted by the glands oils the hair and the surrounding skin helps prevent evaporation of sweat, and aids in the retention of body heat. The sebaceous glands in the nose and face are large and lobulated and often swell with accumulated secretion (O’Toole, 2017).
c. Sudoriferous Glands à one of about 2 million tiny structures within the dermis that produce perspiration and secrete it via a sudoriferous duct to the skin’s surface. The average quantity of perspiration secreted in 24 hours varies from 700 to 900 g. Each sudoriferous gland consists of a single tube with a deeply coiled body and a superficial duct. The number of glands per square centimeter of skin varies in different parts of the body. The sudoriferous glands are very plentiful on the palms of the hands and on the soles of the feet, least numerous in the neck and the back, and completely absent in the deeper parts of the external auditory meatus, the prepuce, and the glans penis. Most are eccrine glands, producing perspiration that carries away sodium chloride, the waste products urea and lactic acid, and the breakdown products from garlic, spices, and other substances. Apocrine sweat glands associated with the coarse hair of the armpits and the pubic region are larger and secrete fluid that is much thicker than that secreted by the eccrine glands. Also called the sweat gland (O’Toole, 2017).
d. Symphysis Pubis / pubic symphysis à the slightly movable interpubic joint of the pelvis, consisting of two pubic bones separated by a disk of fibrocartilage and connected by two ligaments (O’Toole, 2017).
B. Labia majora: lengthwise fatty folds of skin extending from the mons to the perineum that protects the labia minora, the urinary meatus, and the vaginal introitus.
1. Embryological homology in male: the scrotum
2. Dimension:
a. 7 to 8 cm in length
b. 2 to 3 cm in width
c. 1 to 1.5 cm in thickness
3. Grooves (Moore et al., 2010):
a. anterior commissure à the labia majora are thicker anteriorly where they join to form the anterior commissure
b. the posterior commissure à in nulliparous women merge to form a ridge, which overlies the perineal body and is the posterior limit of the vulva. This commissure disappears after the first vaginal birth.
4. The cleft between the 2 labia is the rima pudenda;
a. Borders:
i. Superiorly, labia majora is continuous directly with the mons pubis, to form an anterior commissure
(I) The round ligament of the uterus passes through the inguinal canal (canal of Nuck) to end in a fibrous insertion in the anterior portion of the labia majora
ii. Posteriorly it tapers and merges into the area overlying the perineal body to form the posterior commissure.
(I) The outer surface is covered with hair.
(II) Inner surface, hair is absent.
5. The fluid secretion of small coiled (eccrine) sweat glands, which have no relationship to hairs, has no odor. Large coiled (apocrine) sweat glands that open into hair follicles are found over the mons, the labia majora, and the perineum as well as the axilla. These glands, which begin to secrete an odorous fluid at puberty, are more active during menstruation and pregnancy. The sweat glands are controlled by the sympathetic nervous system.
6. Innervation
a. Anteriorly: ilioinguinal and pudendal nerves.
b. Laterally and posteriorly: posterior femoral cutaneous nerve
7. Blood Supply:
a. Artery: internal pudendal artery (derived from the anterior parietal division of the internal iliac or hypogastric artery) and by the external pudendal artery (from the femoral artery)
b. Drainage (Vein): via the internal and external pudendal veins.
8. Developmental characteristics of labia majora (Cunningham et al., 2001, 2005, 2009):
a. Before puberty: the outer surface – similar to the adjacent skin
b. After puberty: the labia are covered with hair
c. Nulliparous: inner surface - moist and resembles a mucous membrane
d. Multiparous: inner surface - more skin-like.
e. During pregnancy, the vasculature commonly develops varicosities, especially in parous women associated with increased venous pressure created by advancing uterine weight.
f. Children and nulliparous women: the labia majora usually lie in close apposition.
g. multiparous women: may gape widely and less prominent
h. Menopause: thin and atrophic with sparse hair
9. Clinical Importance:
a. Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased heterogenization of the vaginal tissue. Symptoms include dryness, irritation, soreness, and dyspareunia with urinary frequency, urgency, and urge incontinence. It can occur at any time in a woman's life cycle, although more commonly in the postmenopausal phase, during which the prevalence is close to 50%. Clinical findings include the presence of pale and dry vulvovaginal mucosa with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. A vaginal pH of 4.6 or more supports the diagnosis of VVA (Mac Bride, et al., 2010).
b. Vulvar hematomas are collections of blood that are bounded from the extension of bleeding, thereby causing an obvious collection of blood protruding to the vulvar skin. These may be located in one of two anatomic areas, often referred to as the anterior and posterior triangles. When the hematoma occurs anterior to the superficial transverse perineal muscles, the perineal membrane (previously called the urogenital diaphragm) and Colles’ fascia prevent the extension of bleeding (Butler, 2019).
c. Elephantiasis is caused by obstruction of the lymphatic system and has varied etiology as filariasis, a complication of tubercular lymphadenitis, and idiopathic. It results in accumulation of lymph in the affected area leading to massive swelling and gross enlargement of the limbs and rarely external genitals called esthiomene (Sharma, et al., 2010) a rough estimate of its incidence would not be more than 1-2% of total cases of filarial elephantiasis (Chaudhary, et al., 2013).;
d. The round ligament of the uterus originates at the uterine cornu of the uterus and blends with the tissue of the mons pubis and labia majora (Chaudhry & Chaudhry, 2020). During pregnancy, it undergoes considerable hypertrophy and increases appreciably in both length and diameter which eventually leads to developing sharp pain or jabbing feeling on the right side of the groin and abdomen due to tightening or spasm of the ligaments or irritation of nearby nerve fibers (WebMD, 2012). This occurs in the second and third trimesters of pregnancy.
10. Medical Vocabulary
a. Connective Tissue à tissue that supports and binds other body tissue and parts. It derives from the mesoderm of the embryo and is dense, containing large numbers of cells and large amounts of intercellular material. The intercellular material is composed of fibers in a matrix or ground substance that may be liquid, gelatinous, or solid, such as in bone and cartilage. Connective tissue fibers may be collagenous or elastic. The matrix or ground material surrounding fibers and cells is a dynamic substance, susceptible to its own special diseases. Kinds include bone tissue, dense connective tissue, fibrous tissue, loose connective tissue, cartilage tissue (O’Toole, 2017).
b. Hematoma à /hē′mətō″mə, hem′-/ pl. hematomas, hematomata [Gk, haima + oma, tumor], a collection of extravasated blood trapped in the tissues of the skin or in an organ, resulting from trauma or incomplete hemostasis after surgery. Initially, there is frank bleeding into space; if the space is limited, pressure
slows and eventually stops the flow of blood. The blood clots, serum collects, the clot hardens, and the mass becomes palpable to the examiner and is often painful to the patient. A hematoma may be drained early in the process and bleeding arrested with pressure or, if necessary, with surgical ligation of the bleeding vessel. Considerable blood may be lost, and infection is a serious
complication. Also spelled hematoma (O’Toole, 2017).
c. Homology, in biology, the similarity of the structure, physiology, or development of different species of organisms based upon their descent from a common evolutionary ancestor (Encyclopaedia Britannica, 2020).
d. Inguinal Canal/Canal of Nuck à the tubular passage through the lower muscular layers of the abdominal wall that contains the spermatic cord in the male and the round ligament in the female. It is a common site for hernias (O’Toole, 2017).
e. Menopause à menopause /men″əpôz/ [L, men, month; Gk, pauses, to cease], strictly, the cessation of menses, but commonly referring to the period of the female climacteric. Menses stop naturally with the decline of cyclic hormonal production and function, usually between 45 and 55 years of age, but may stop earlier in life as a result of illness or surgery or for unknown reasons. As the production of ovarian estrogen and pituitary gonadotropins decreases, ovulation and menstruation becomes less frequent and eventually stop. Fluctuations in the circulating levels of these hormones occur as the levels decline. Compare andropause. See also artificial menopause (O’Toole, 2017).
i. OBSERVATIONS: Symptoms commonly associated with menopause include hot flashes, night sweats, and sleep disturbances. Vaginal dryness and mood swings are also experienced by some women.
ii. INTERVENTIONS: The symptoms of menopause may be relieved by hormone therapy. This can involve the use of either estrogen alone for women who have had a hysterectomy or estrogen with progesterone or progestin in its synthetic form for women who have not had a hysterectomy. Nonhormonal approaches include changes in lifestyle or diet; the use of dietary supplements may also relieve symptoms.
iii. PATIENT CARE CONSIDERATIONS: Symptoms associated with menopause vary greatly in severity and the length of time they persist
f. Scrotum à scrotum (skro¯tu˘m) pl. scrota, -ums [L., a bag] /skrō″təm/; .−scrotal, adj; the pouch of skin containing the testes and parts of the spermatic cords. It is divided on the surface into two lateral parts by a ridge that continues ventrally to the undersurface of the penis and dorsally along the middle line of the perineum to the anus. In young, robust individuals the scrotum is short and corrugated and closely wraps the testes. In older people and debilitated individuals and in warm environments the scrotum becomes elongated and flaccid. The two layers of the scrotum are the skin and the dartos tunic. The skin is brownish and very thin, is usually wrinkled, and has thinly scattered kinky hairs. The dartos tunic is composed of a thin layer of unstriated muscular fibers around the base of the scrotum. The tunic projects an internal septum that divides the pouch into two cavities for the testes, extending between the scrotal ridge and the root of the penis. The scrotum is highly vascular and contains no fat (O’Toole, 2017).
g. Sympathetic Nervous System à The thoracolumbar division of the autonomic nervous system. Preganglionic fibers originate in the thoracic and lumbar segments of the spinal cord and synapse with postganglionic neurons in the sympathetic ganglia. Most of these ganglia are in two chains lateral to the backbone, and others are within the trunk; postganglionic fibers extend to the organs innervated. Some effects of sympathetic stimulation are increased
heart rate, dilation of the bronchioles, dilation of the pupils, vasoconstriction in the skin and viscera, vasodilation in the skeletal muscles, slowing of peristalsis, conversion of glycogen to glucose by the liver, and secretion of epinephrine and norepinephrine by the adrenal medulla. Sympathetic effects are general rather than specific and prepare the body to cope with stressful situations (Venes, 2005).
C. Labia minora aka nymphae: lies medial to each labia majora; The lateral and anterior surfaces are pigmented, and the inner aspect is pink and moist, resembling the vaginal mucosa. It does not contain hair follicles nor sweat glands but is rich in sebaceous glands (Pernoll, 2001).
1. Embryological homology in male: the ventral shaft of the penis
2. Developmental characteristics of labia majora:
a. Nulliparous women: not visible behind the nonseparated labia majora concealing the introitus (Pernoll, 2001).
b. Multiparas: project beyond the labia majora.
3. The tissues of the labia minora converge:
a. Superiorly, where each is divided into two lamellae to enclose the clitoris:
i. the upper pair (larger lateral fold) merge/ unite across the midline to form the clitoral hood or the prepuce that covers the glans clitoris and distal parts of the body of the clitoris (Moore et al., 2010).
ii. the lower pair (smaller medial fold) fuse/unite across the midline to form the frenulum of the clitoris (Moore et al., 2010).
b. Inferiorly, the labia minora extend to approach the midline as low ridges of tissue that fuse to form the fourchette (Pernoll, 2001).
i. Fourchette (Cunningham et al., 2001, 2005, 2009):
(I) Thin fold of tissue formed by merging of the labia majora and labia minora below the vaginal orifice.
(II) The site of an initial incision during episiotomy
4. Nerve supply (Pernoll, 2001).: ilioinguinal, pudendal, and hemorrhoidal nerves.
5. Blood Supply (Pernoll, 2001).: external and internal pudendal arteries and veins.
D. Vestibule: An almond-shaped area that is enclosed by the labia minora laterally and extends from the clitoris to the fourchette. It is derived from the embryonic urogenital sinus membrane. The posterior portion of the vestibule between the fourchette and the vaginal opening is called the fossa navicularis. It is usually observed only in nulliparous women (Cunningham et al., 2005).
1. Borders:
a. Laterally- an almond-shaped area that is enclosed by Hart line
b. Medially- the external surface of the hymen
c. Anteriorly- the clitoral frenulum
d. Posteriorly- fourchette and the vaginal opening is called the fossa navicularis, and it is usually observed only in nulliparous women.
2. Perforated by six openings:
a. Urethral meatus - The lower 2/3 of the urethra lie immediately above the anterior vaginal wall.
i. Located in the midline of the vestibule: 1 to 1.5 cm below the pubic arch, a short distance above the vaginal opening.
ii. Clinical Significance:
(I) Foley Catheter: One common procedure that is routinely due in healthcare is the catheterization of the female urethra. This procedure involves the introduction of a flexible tube into the urethra and securing it in place with a saline-filled balloon. This procedure is done to assist in the excretion of urine from the bladder. This method can be used to collect urine for surveillance monitoring of the amount of urine produced or to collect urine used for the analysis of other pathologies.
(II) Urinary Tract Infection: One common pathology that involves the urethra is a urinary tract infection (UTI). In urinary tract infections, the patient classically complains of dysuria, increased urination, foul-smelling urination, and cloudy urine. This condition commonly affects females due to their urethrae is shorter than males' urethrae. The short urethra in females allows the bacteria to ascend the urethra more readily, and the anatomical location of the urethra, vagina, and anus allows for cross-contamination between the vaginal and anal bacteria into the urethra. The most common bacteriologic etiology of urinary tract infections is gram-negative rods, with the most common bacteria being Escherichia coli.
b. Two (2) ducts of Skene’s glands (also called paraurethral glands / minor vestibular gland):
i. Homologous to the prostate gland
ii. Are collectively an arborization of glands whose ducts open predominantly along the entire distal inferior aspect of the urethra. The two largest: skene glands, and their ducts typically lie distally near the urethral meatus. Inflammation and duct obstruction of any of the paraurethral glands can lead to urethral diverticulum formation. These ducts are about 0.5 mm in diameter, and of variable length.
iii. The minor vestibular glands are shallow glands lined by simple mucin-secreting epithelium and open along the Hart line.
iv. Ducts of these glands open on either side of the urethral orifice.
(I) Secrete a small amount of mucus
(II) Susceptible to infections
(III) Skene’s and Bartholin’s glands; easily irritated by chemicals, discharges, or friction
c. Vaginal Orifice Aka Vaginal Opening/ Vaginal Introitus
i. Hidden by the overlapping labia minora.
ii. Composed of elastic and collagenous connective tissue
iii. Outer and inner surfaces are covered by stratified squamous epithelium.
iv. External opening of the vagina covered by a thin membrane (hymen) in virgins.
v. Located lateral to the vaginal opening on both sides are the BARTHOLIN’S GLANDS
vi. The GRAFENBERG or G-SPOT is an overly sensitive area located at the inner anterior aspect of the vagina
d. The Pair Greater/ Major Vestibular Glands, Aka Bartholin’s Glands / Vulvovaginal Glands. Located at 4 o’clock and 8 o’clock of the vaginal orifice and are typically nonpalpable.
i. Homologues of the bulbourethral glands (Cowper’s glands) in the male. Two small, roundish, reddish-yellow bodies Histologically, composed of cuboidal epithelium.
ii. 0.5 to 1 cm in diameter/ducts: 1.5 to 2 cm long and open distal to the hymenal ring at 5 and 7 o'clock
iii. Situated: posterolateral aspect of the vaginal orifice; in contact with the posterior end of each lateral mass of the bulb of the vestibule; lateral to the hymen
iv. During sexual arousal- They produce mucus and participate in lubrication during sexual intercourse. The alkaline pH of their secretion helps to improve sperm survival in the vagina.
v. May harbor Neisseria gonorrhoeae or other bacteria = bartholinitis and Bartholin gland abscess. Secrete clear mucous to provide vaginal lubrication during sexual arousal. Susceptible to infection and gland blockage which may cause Abscesses (Painful) or Cysts (Asymptomatic)
vi. Clinical Significance:
(I) Bartholin cyst and abscess: Bartholin's glands are glands that produce secretions to lubricate the vulva and vagina. This gland can become obstructed and form a cyst containing the buildup of lubricant. If the cyst becomes infected, it then progresses to become an abscess. This condition tends to affect females of reproductive age. Bartholin cyst/abscess presents as a swelling located posterolateral to the vaginal orifice. This infection may result from infection with Escherichia coli, Chlamydia trachomatis, and Neisseria gonorrhoeae.
E. Hymen
1. Tissue component:
a. elastic and collagenous connective tissue.
b. the outer and inner surfaces are covered by stratified squamous epithelium.
2. no glandular or muscular elements in the hymen, and it is not richly supplied with nerve fibers.
3. A thin vascularized, Non-glandular, non-muscular, and non-innervated membrane that separates the vagina from the vestibule
4. It shows great variations in thickness and in the size and shape of the hymenal openings (e.g., annular, septate, cribriform, crescentic, fimbriate).
5. Developmental characteristics of Hymen
a. Newborn: the hymen is very vascular and redundant.
b. Pregnant women: epithelium is thick, and the tissue is rich in glycogen.
c. Menopause: the epithelium is thin, and focal cornification may develop.
d. Adult women: the hymen - aperture varies in diameter from pinpoint size to one that admits the tip of one or even two fingers.
6. After tampon usage, coitus, and childbirth, the shrunken remnants of the hymen became nodules of various sizes known as Carunculae Hymenales or Hymenal Caruncles.
a. Fimbriated type of hymen in virginal women may be indistinguishable from one that has been penetrated during intercourse.
b. Torn at several sites during first coitus, usually in the posterior portion. The edges of the torn tissue soon cicatrize, and the hymen becomes divided permanently into two or more portions that are separated by narrow sulci.
7. Clinical significance:
a. Imperforate hymen: In pubertal females that reach the age of menarche, but do not have menses is called primary amenorrhea. One cause of primary amenorrhea is the imperforate hymen. These females present with monthly pain and pressure in the lower abdomen, but not excretion of menses. On physical examination, there will be a blue, brown round bulging mass protruding from the vagina. The mass protruding from the vagina is a collection of menstrual products getting trapped due to an imperforate hymen. The treatment for this condition is incision and drainage of the mass.
CHARACTERISTICS:
- Lack of opening in the vaginal hymen
- No menstrual bleeding
- Enlarged uterus
- Amenorrhea
- Cryptomenorrhea -A condition where menstrual products are prevented from exiting the body by a partial or complete obstruction.
- Dyspareunia
- Female infertility
- Hematocolpos- An accumulation of menstrual blood in the vagina
- Hematometra -An accumulation of blood in the uterus
- Hydrometrocolpos -accumulation of secretions in the vagina and uterus
TREATMENT
Medical therapy has no role in the management of imperforate hymen
SURGICAL MANAGEMENT
Hymen incision
F. Clitoris: small erectile organ located beneath the arch of the pubis Rarely exceeds 2 cm in length and 0.5 cm normal diameter.
1. Embryological homology in male: the penis
2. Principal female erogenous organ - containing more nerve endings than the glans penis; sensitive to temperature and touch
3. Location: beneath the prepuce and above the urethra.
4. The free endpoint of the clitoris projects downward and inward toward the vaginal opening between the branched extremities of the labia minora
5. Secretes a fatty substance called smegma.
6. Anatomical Parts:
a. Glans
i. Made up of spindle-shaped cells
ii. Less than 0.5 cm in diameter/ covered by stratified squamous epithelium
iii. Richly supplied with nerve endings.
b. Corpus / corpora / clitoral body
i. Two corpora cavernosa, in the walls of which are smooth muscle fibers
ii. Beneath the ventral surface of this body, homologs of the corpora spongiosa unite to form a commissure.
iii. These homologs are anterior extensions of the vestibular bulbs
c. They are homologous to the single bulb of the penis, corpus spongiosum in the male.
d. Two crura = long, narrow crura arise from the inferior surface of the ischiopubic rami and deep to the ischiocavernosus muscle fuse just below the middle of the pubic arch
7. Nerve Tissues:
a. Tactile discs - a delicate network of free nerve endings in the labia majora, labia minora, and clitoris
b. Genital corpuscles - mediators of erotic sensation; abundant in the labia minora and glans clitoris
c. Vessels of the erectile clitoris: connected with the vestibular bulbs.
G. Perineum:
1. The perineum is a diamond-shaped region positioned inferiorly to the pelvic floor between the thighs.
2. The perineum is divided into an anterior urogenital triangle and a posterior anal triangle.
a. The anterior urogenital triangle is associated with the openings of the urinary systems and the reproductive systems and functions to anchor the external genitalia.
i. Boundaries:
(I) Superiorly: pubic rami
(II) Laterally: ischial tuberosities
(III) Posteriorly: superficial transverse perineal muscle.
ii. It is composed of Superficial and Deep Structures:
(I) Superficial
(A) the root of the clitoris
(B) muscles that cover: bulbospongiosus muscles and ischiocavernosus muscles;
(C) Superficial Transverse muscle
(II) Deep
(A) contains part of the urethra
(B) part of the vagina
(C) the sphincter urethrae
(D) the deep transverse perineal muscles
(E) the internal pudendal vessels and their branches
(F) the dorsal nerves of the clitoris
b. The posterior anal triangle contains the anus and the external anal sphincter.
i. anal triangle is bounded behind by the tip of the coccyx and on each side by the ischial tuberosity and the sacrotuberous ligament, overlapped by the border of the gluteus maximus muscle
3. The pudendal nerve (S2 to S4) and the internal pudendal artery are th
4. e major nerve and artery of the region
H. Clinical Significance:
1. Episiotomy à In episiotomies, the vaginal opening is enlarged by an incision that is done either midline or laterally during delivery of a child that risks tearing and damaging the vaginal opening. If the incision is performed midline, the perineal body will be the target of the incision. While the lateral episiotomy targets the transverse perineal muscle. The reason for performing episiotomies is that an incision can be easily repaired and decrease healing time, in contrast with a torn vaginal opening that could potentially involve the perineum muscles and the rectum. The repair of a torn vaginal opening due to a large child delivery has a longer healing time. Episiotomies are done as procedures to aid in vaginal delivery of large offsprings and the prevention of vaginal tearing into other perineum structures.
2. Labioplasty à Labioplasty is a surgical procedure with an emphasis on altering the size and shape of the labia majora and labia minora. Indications for labioplasty include multiple reasons, such as congenital defects, aging, cancers, and cosmetics. The focus of this procedure is to create a more desirable appearance of the labial folds.
3. Vaginoplasty à Vaginoplasty is a surgical procedure used to reconstruct or construct the vagina. Vaginoplasties are necessary for several reasons, such as pelvic organ prolapse, congenital defects, neoplasms, sex reassignments, and cosmetics. The goal of the vaginoplasty is to surgically make a vagina that is desirable for the patient.
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