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Vulva

In mammals, the vulva comprises mostly external, visible structures of the female genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, labia minora, clitoris, vestibule, urinary meatus, vaginal introitus, hymen, and openings of the vestibular glands. The folds of the outer and inner labia provide a double layer of protection for the vagina. While the vagina is a separate part of the anatomy, colloquially the term has often been used synonymously with vulva. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

Structure
The human vulva is made up of the following: Mons pubis The mons pubis is a soft mound of fatty tissue in the pubic region covering the pubic bone. is Latin for "pubic mound" and is present in both sexes to act as a cushion during sexual intercourse, and is more pronounced in the female. Labia The large outer pair of folds are the labia majora, which contain and protect the labia minora and other structures of the vulva. The labia minora are the small inner pair of skin folds that protect the openings. The labia minora are often pink or brownish black, relevant to the person's skin color. The grooves between the labia majora and minora are called the interlabial sulci, or interlabial folds. The labia minora meet posteriorly as the frenulum (fourchette). Clitoris Located at the anterior junction of the labia minora is the clitoris, a highly erogenous sexual organ. The visible portions of the clitoris are the glans and frenulum. Typically, the glans is roughly the size and shape of a pea, and can vary in size from about 6 mm to 25 mm (less than an inch). The size can also vary when the clitoris is erect, fill with blood, making the shaft engorged. The glans contains many nerve endings, which makes it highly sensitive. The hood may be partially or completely hidden within the pudendal cleft. Vestibule The area between the labia minora where the vaginal introitus and the urinary meatus (openings of the vagina and urethra respectively) are located is the vestibule. The meatus is below the clitoris and atop the introitus. The introitus is sometimes partly covered by a membrane called the hymen. The hymen will usually rupture during the first episode of vigorous sex, and the blood produced by this rupture has been seen to signify virginity. However, the hymen may also rupture spontaneously during exercise or be stretched by normal activities such as the use of tampons and menstrual cups, or be so minor as to be unnoticeable, or be absent. Two greater vestibular glands known as Bartholin's glands open into either side of the introitus and secrete a mucous vaginal lubricant. The openings of the lesser vestibular glands, known as Skene's glands, are found on either side of the urethral meatus. Muscles Pelvic floor muscles help to support the vulvar structures. The voluntary, pubococcygeus muscle, part of the levator ani muscle partially constricts the vaginal opening. Other muscles of the urogenital triangle support the vulvar area and they include the transverse perineal muscles, the bulbospongiosus, and the ischiocavernosus muscles. The bulbospongiosus muscle decreases the vaginal opening. Blood, lymph and nerve supply The tissues of the vulva are highly vascularised and blood supply is provided by the three pudendal arteries. Venous return is via the external and internal pudendal veins. The organs and tissues of the vulva are drained by a chain of superficial inguinal lymph nodes located along the blood vessels. The ilioinguinal nerve originates from the first lumbar nerve and gives branches that include the anterior labial nerves, which supply the skin of the mons pubis and the labia majora. The perineal nerve is one of the terminal branches of the pudendal nerve and this branches into the posterior labial nerves to supply the labia. The density of nerves at the glans indicates that it is the center of heightened sensation. These are joined underneath the pubic arch by the dorsal nerve of the clitoris. The pudendal nerve enters the pelvis through the lesser sciatic foramen and continues medial to the internal pudendal artery. The point where the nerve circles the ischial spine is the location where a pudendal block of local anesthetic can be administered to inhibit sensation to the vulva. A number of smaller nerves split off from the pudendal nerve. The deep branch of the perineal nerve supplies the muscles of the perineum and a branch of this supplies the bulb of the vestibule. Variations There is a great deal of variation in the appearance of the vulva. ==Development==
Development
Prenatal development from indifferent to both sexes—female on right In week three of the development of the embryo, mesenchyme cells from the primitive streak migrate around the cloacal membrane. Early in the fifth week, the cells form two swellings called the cloacal folds. The cloacal folds meet in front of the cloacal membrane and form a raised area known as the genital tubercle. The area between the vulva and the anus is known as the clinical perineum. The uterovaginal canal or genital canal, forms in the third month of the development of the urogenital system. The lower part of the canal is blocked off by a plate of tissue, the vaginal plate. This tissue develops and lengthens during the third to fifth months and the lower part of the vaginal canal is formed by a process of desquamation or cell shedding. The end of the vaginal canal is blocked off by an endodermal membrane, which separates the opening from the vestibule. In the fifth month, the membrane degenerates but leaves a remnant called the hymen. The labia majora are closed. These changes disappear over the first few months. The structures of the vulva become proportionately larger and may become more pronounced. Pubarche can occur independently of puberty. Premature pubarche may sometimes indicate a later metabolic-endocrine disorder seen at adolescence. The disorder sometimes known as a polyendocrine disorder is marked by elevated levels of androgen, insulin, and lipids, and may originate in the fetus. Instead of being seen as a normal variant it is proposed that premature pubarche may be seen as a marker for these later endocrine disorders. Apocrine sweat glands secrete sweat into the pubic hair follicles. This is broken down by bacteria on the skin and produces an odor, which some consider to act as an attractant sex pheromone. In prepubertal girls, the skin of the vulva is thin and delicate, and its neutral pH makes it prone to irritation. The production of the female sex hormone estradiol (an estrogen) at puberty, causes the perineal skin to thicken by keratinising, and this reduces the risk of infection. Estrogen also causes the laying down of fat in the development of the secondary sex characteristics. This contributes to the maturation of the vulva with increases in the size of the mons pubis, and the labia majora and the enlargement of the labia minora. Pregnancy In pregnancy, the vulva and vagina take on a bluish coloring due to venous congestion. This appears between the eighth and twelfth week and continues to darken as the pregnancy continues. After childbirth, a vaginal discharge known as lochia is produced and continues for about ten days. ==Function and physiology==
Function and physiology
The vulva has a major role to play in the reproductive system. It provides entry to, and protection for the uterus, and the right conditions in terms of warmth and moisture that aids in its sexual and reproductive functions. The vulva is richly innervated and provides pleasure when properly stimulated. The mons pubis provides cushioning against the pubic bone during intercourse. In females, this thickened secretion collects around the clitoris and labial folds. It can cause discomfort during sexual activity as it can cause the clitoral glans to stick to the hood, and is easily removed by bathing. Sexual stimulation and arousal The clitoris and the labia minora are both the most erogenous areas of the vulva. The labia majora are also somewhat erogenous. Local stimulation can involve the clitoris, vagina and other perineal regions. The clitoris (especially the glans) is the human female's most sensitive erogenous zone and generally the primary anatomical source of human female sexual pleasure. Sexual stimulation of the clitoris (by a number of means) can result in widespread sexual arousal and, if maintained, can result in orgasm. Stimulation to vulvar orgasm is optimally achieved by a massaging sensation, so that the clitoris and labia minora increase in size. Increased vasocongestion in the vagina causes it to swell, decreasing the size of the vaginal opening by about 30%. Clitoral erection takes place, which retracts the clitoral hood, causing the glans to appear. The labia majora have swollen from blood flow, and slightly separated, revealing a thick and engorged labia minora. The labia minora sometimes change considerably in color, going from pink to red in lighter skinned women who have not borne a child, or red to dark red in those who have. During orgasm, rhythmic muscle contractions occur in the outer third of the vagina, as well as the uterus and anus. Contractions become less intense and more randomly spaced as the orgasm continues. The number of contractions that accompany an orgasm vary depending on its intensity. An orgasm may be accompanied by female ejaculation, causing liquid from the Skene's glands to be expelled through the urethra. The pooled blood begins to dissipate, although at a much slower rate if an orgasm has not occurred. The vagina and its opening return to their normal relaxed state, and the rest of the vulva returns to its normal size, position and color. ==Clinical significance==
Clinical significance
Irritation Irritation and itching of the vulva is called pruritus vulvae. This can be a symptom of many disorders, some of which may be determined by a patch test. The most common cause of irritation is thrush, a fungal infection. Vulvovaginal health measures can help to prevent many disorders including thrush. Infections of the vagina such as vaginosis and of the uterus may produce vaginal discharge, which can be an irritant when it comes into contact with the vulvar tissue. Inflammation as vaginitis, vulvovaginitis and vulvitis can result from this causing irritation and pain. Ingrown hairs resulting from pubic hair shaving can cause folliculitis where the hair follicle becomes infected; or give rise to an inflammatory response known as pseudofolliculitis pubis. A less common cause of irritation is genital lichen planus, another inflammatory disorder. A severe variant of this is vulvovaginal gingival syndrome, which can lead to narrowing of the vagina, or vulva destruction. Many types of infection and other diseases including some cancers may cause irritation. The practice of safe sex can greatly reduce the risk of infection from many sexually transmitted pathogens. The use of condoms (either male or female condoms) is one of the most effective methods of protection. and gonorrhea that very often presents no symptoms but can result in discharge. Viral infections include human papillomavirus infection (HPV) – this is the most common STI and has many types. Genital HPV can cause genital warts. There have been links made between HPV and vulvar cancer, though HPV most often causes cervical cancer. Genital herpes is mostly asymptomatic but can present with small blisters that break open into ulcers. HIV/AIDS is mostly transmitted through sexual activity, and the vulva in some cases can be affected by sores. A highly contagious viral infection is molluscum contagiosum, which is transmissible on close contact and causes water warts. Parasitic infections include trichomoniasis, pediculosis pubis, and scabies. Trichomoniasis is transmitted by a parasitic protozoan and is the most common non-viral STI. Most cases are asymptomatic but may present symptoms of irritation and a discharge of unusual odor. Pediculosis pubis, commonly called crabs, is a disease caused by the crab louse an ectoparasite. Scabies, also known as the "seven year itch", is caused by another ectoparasite, the mite Sarcoptes scabiei, giving intense irritation. Based on the cellular origin and histology, vulvar cancers are classified into squamous cell carcinomas, melanomas, basal cell carcinomas, adenocarcinomas, sarcomas and invasive extramammary Paget's disease. The second most common vulvar cancer is basal cell carcinoma, which rarely spreads to regional lymph nodes or distant organs. Signs and symptoms of vulvar cancer can include: itching, or bleeding; skin changes including rashes, sores, lumps or ulcers, and changes in vulvar skin coloration. Pelvic pain might also occur especially during urinating and sex. However, a significant proportion remains asymptomatic in early disease stages, often delaying its diagnosis. Advanced-stage melanomas can be treated with checkpoint inhibitors. Other Labial fusion, also called labial adhesion, is the fusion of the labia minora. This affects a number of young girls and is not considered unduly problematic. The condition can usually be treated using creams, or it may right itself with the release of hormones at the onset of puberty. Clitoromegaly is an enlarged clitoris caused by either anabolic steroids or an intersex condition. Vulvodynia is chronic pain in the vulvar region. There is no single identifiable cause. A subtype of this is vulvar vestibulitis but since this is not thought to be an inflammatory condition it is more usually referred to as vestibulodynia. Vulvar vestibulitis usually affects pre-menopausal women. Papillary hidradenomas are nodules that can ulcerate and are mostly found on the skin of the labia or of the interlabial folds. Another more complex ulcerative condition is hidradenitis suppurativa, which is characterised by painful cysts that can ulcerate, and recur, and can become chronic lasting for many years. Chronic cases can develop into squamous cell carcinomas. A subtype of psoriasis, an autoimmune disease, is inverse psoriasis in which red patches can appear in the skin folds of the labia. Childbirth The vulvar region is at risk for trauma during childbirth. During childbirth, the vagina and vulva must stretch to accommodate the baby's head (approximately ). This can result in tears known as perineal tears in the vaginal opening, and other structures within the perineum. An episiotomy (a pre-emptive surgical cutting of the perineum) is sometimes performed to facilitate delivery and limit tearing. A tear takes longer to heal than an incision. No advantages have been demonstrated in the routine shaving of pubic hair prior to childbirth. Surgery Genitoplasties are plastic surgeries that can be carried out to repair, restore or alter vulvar tissues, particularly following damage caused by injury or cancer treatment. These procedures include vaginoplasty and vulvoplasty, which can also be performed as a cosmetic surgery. Other cosmetic surgeries to change the appearance of external structures include labiaplasties. Some of these procedures, vaginoplasties and vulvoplasties, are also carried out as gender-affirming surgeries. The use of cosmetic surgeries has been criticized by clinicians. The American College of Obstetricians and Gynecologists recommends that women be informed of the risks of these surgeries. They refer to the lack of data relevant to their safety and effectiveness and to the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring.{{cite journal ==Society and culture==
Society and culture
Altering the female genitalia and clitoral hood reduction movement opposes the ideals of female cosmetic genital surgeries: The Muff March in London, 2011 In some cultural practices, particularly in the African Khoikhoi and Rwanda cultures, the labia minora are purposefully stretched by repeated pulling on them and sometimes by attaching weights. This is a desired and encouraged practice by the women (starting at puberty) in order to promote better sexual satisfaction for both parties. The girls are subject to familial and social pressure to conform. In some cultures, including modern Western culture, women have shaved or otherwise removed the hair from part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would remove the hair on either side of their pubic triangles, to avoid exhibiting pubic hair. Other women prefer to retain their vulva hair. The removal of hair from the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, usually in the form of bikini waxing or Brazilian waxing, but has been prevalent in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography. Hair removal may include all, most, or some of the hair. French waxing leaves a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft called a landing strip. above and the labia piercing Several forms of genital piercings can be made in the vulva, and include the Christina, Princess Albertina, Isabella, Nefertiti, fourchette, and labia piercings. Piercings are usually performed for aesthetic purposes, but some forms like the clitoral hood piercing (or rarely glans piercing) might also enhance pleasure during sex. Though they are common in traditional cultures, intimate piercings are a fairly recent trend in Western society. Other forms of permanent modifications of the vulva for cultural, decorative or aesthetic reasons are genital tattoos or scarification (so-called "Hanabira"). Female genital surgery includes laser resurfacing of the labia to remove wrinkles, labiaplasty (reducing the size of the labia) and vaginoplasty. In September 2007, the American College of Obstetricians and Gynecologists (ACOG) issued a committee opinion on these and other female genital surgeries, including "vaginal rejuvenation", "designer vaginoplasty", "revirgination", and "G-spot amplification". This opinion states that the safety of these procedures has not been documented. The ACOG and the ISSVD recommend that women seeking these surgeries need to be informed about the lack of data supporting these procedures and the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring. With the growing popularity of female cosmetic genital surgeries, the practice increasingly draws criticism from an opposition movement of cyberfeminist activist groups and platforms, called the labia pride movement. The major point of contention is that heavy advertising for these procedures, in combination with a lack of public education, fosters body insecurities in women with larger labia in spite of the fact that there is normal and pronounced individual variation in the size of labia. The preference for smaller labia is a matter of a fashion fad and is without clinical or functional significance. Female genital mutilation The most prevalent form of non-consensual genital alteration is that of female genital mutilation. This mostly involves the partial or complete removal of the vulva. Female genital mutilation is carried out in thirty countries in Africa and Asia with more than 200 million girls being affected, and some women (as of 2018). FGM/C can have harmful effects on their physical and mental health. Various official and unofficial research reports also confirm these complications. In its various reports, the World Health Organization has considered FGM/C as an action that endangers women's health in various ways. This organization stated in a report published in January 2023 that FGM/C has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and it interferes with the natural functions of girls' and women's bodies. Although all forms of FGM/C are associated with increased risk of health complications, the risk is greater with more severe forms of FGM/C. The American National Library of Medicine also stated in an article in 2018 that the consequences of FGM/C have both physiological and psychological complications, including short- and long-term complications. The method in which the procedure is performed may determine the extent of the short-term complications. If the process was completed using unsterile equipment, no antiseptics, and no antibiotics, the victim may have increased risk of complications. Primary infections include staphylococcus infections, urinary tract infections, excessive and uncontrollable pain, and hemorrhaging. Infections such as human immunodeficiency virus (HIV), Chlamydia trachomatis, Clostridium tetani, and herpes simplex virus (HSV) 2 are significantly more common among women who underwent Type 3 mutilation compared with other categories. Etymology The word vulva is Latin for "womb". It derives from the 1540s in referring to the womb and female sexual organs, from the earlier volvere meaning to turn, roll or revolve, with further derivatives such as used in volvox, and volvulus (twisted bowel). The naming of the female (and male) genitals as , meaning parts to be ashamed of, dates from the mid-17th century. The naming influenced the general perception of the vulva and this is shown in depicted gynaecological procedures. The examiner shown in the Obstetrical examination dated 1822, is adopting the compromise procedure where the woman's genitals cannot be seen. Terminology In 2021, a study in the UK showed that few are able to label the structure of the vulva correctly. There are many sexual slang terms used for the vulva. "Cunt", a medieval word for the vulva and once the standard term, has become a vulgarism, and in other uses one of the strongest offensive and abusive swear words in English-speaking cultures. The word has been replaced in normal usage by a few euphemisms including "pussy" (vulgar slang) and "fanny" (UK), which used to be a common pet name. In North American informal use, the term "pussy" can also refer to a weak or effeminate man, and "fanny" is a term used for the buttocks. "Vagina" is often incorrectly used as a synonym for vulva since it is separate from that anatomy. and a vast number of Sumerian poems praising the vulva of Inanna, the goddess of love, sex, and fertility, have survived. Vaginal fluid is always described in Sumerian texts as tasting "sweet" Some major Hindu traditions such as Shaktism, a goddess-centered tradition, revere the vulva and vagina under the name yoni. The goddess as Devi is worshipped as the supreme deity. The yoni is a representation of the female deity and is found in many temples as a focus for prayer and offerings. Sheela na gigs are figurative carvings of naked women displaying an exaggerated vulva. They are found in ancient and medieval European contexts. They are displayed on many churches, but their origin and significance is debatable. A main line of thinking is that they were used to ward off evil spirits. Another view is that the sheela na gig was a divine assistant in childbirth. Starr Goode explores the image and possible meanings of the Sheela na gig and Baubo images in particular, but writes also about the recurring image worldwide. Through hundreds of photographs, she demonstrates that the image of a female displaying her vulva is not specific to European religious art or architecture, but that similar images are found in the visual arts and in mythical narratives of goddesses and heroines parting their thighs to reveal what she calls, "sacred powers". Her theory is that "the image is so rooted in our psyches that it seems as if the icon is the original cosmological center of the human imagination". (Origin of the World), painted by Gustave Courbet in 1866, was an early Realist painting of a vulva that only became exhibited many years later. The painting was commissioned by Ottoman diplomat Halil Şerif Paşa. The woman used as the model for the painting was probably Halil's lover Constance Quéniaux. However, another potential model is Marie-Anne Detourbay, who was also a lover of Halil Şerif Pasha. Japanese sculptor and manga artist Megumi Igarashi has focused much of her work on painting and modelling vulvas and vulva-themed works. She has used molds to create dioramas – three-dimensional models of her vulva with the hope of demystifying the female genitals. An art installation called The Dinner Party by feminist artist, Judy Chicago, portrays a symbolic history of famous women. The dinner plates each depict an elaborate vulval form and they are arranged in a triangular vulva shape. Another installation was made by British artist Jamie McCartney who used the casts of four hundred vulvas to create The Great Wall of Vagina in 2011. The casts are life-size. Explanations written by the project's sexual health adviser accompany these. The purpose of the artist was to "address some of the stigmas and misconceptions that are commonplace". ==Other animals==
Other animals
Vulve d'éléphante.jpg|Vulva of an Asian elephant German Shepherd vulva.jpg|Vulva of a dog (German Shepherd) Vulva of a horse.jpg|Vulva of a horse Vulva of a domestic cat.jpg|Vulva of a cat Orangutan vulva.jpg|Vulva of a Bornean orangutan As a rule, only the external female genitals of placental mammals are referred to as the "vulva", although the term is also used in the scientific literature for functionally comparable structures in other animal groups such as marsupials and roundworms (Nematoda). For comparison, birds, reptiles, amphibians, and monotremes have a cloaca. An organ system like a vulva does not exist. The vulva of a placental consists of the following along with its variations: • Clitoris: Made up of the root, glans and body and is usually retracted into a prepuce. Inside the clitoris of many non-human placentals is the baubellum, a small bone that possibly has origins in copulation. In horses and dogs, the clitoris is contained in clitoral fossa, which is a small pouch of tissue. • Labia: A small, thin pair of lip-like structures that protect the vestibule. They are known as the labia vulvae in carnivorans and ungulates and as the labia minora in primates. The labia majora only exist in primates (including humans). Afrotherians do not have distinguishable labia. • Vestibule/vulvar opening: In humans, other great apes, and some rodents, the vestibule is a flat and short external space that contains separate urethral and vaginal openings. In most other placentals, the urethra and vagina join as an internal vestibule (urogenital sinus), hence both urine and offspring exit through an orifice called the vulvar opening. During estrus, the clitoris of a mare (female horse) everts as the labia contracts by opening and closing. This is colloquially known as "winking". Throughout the menstrual cycle, some female primates' vulvar and anal regions will swell (sexual swelling) to attract a male, though the fundamental reason for this function is up for debate. The vulva of a spotted hyena has a large clitoris known as a pseudo-penis for copulating, giving birth and urinating, as well as fused labia (pseudo-scrotum). This can make it difficult to correctly sex the species. ==Additional images==
Additional images
File:Vulva-handsign-Yoni-mudra.svg|Vulva hand sign used as a yogic mudra File:NAMA Phallus ailé.jpg|Attic red-figure lid depicting three vulvae and a winged penis ==See also==
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