PUDENDUM

• Aka, vulva, refers to the external genitalia
• Comprises structures that are sexually responsive and/or protect the vaginal opening.

Key features:

• Vaginal orifice (aka, opening).
• Hymen caruncles surround vaginal orifice; they are remnants of the hymen, which, at birth, partially closes the vaginal orifice and over time is stretched and/or torn by physical activity, tampon use, intercourse, etc.
• Ducts of greater vestibular glands release lubricating secretions upon sexual arousal.
• Urethral opening
• Ducts of the paraurethral glands vary in number (aka, lesser vestibular glands, Skene’s glands, female prostate gland); release mucous secretions, which may be a lubricating fluid, or may be involved in female ejaculation (which itself is a contentious topic).
• Glans clitoris is the “free” portion of the clitoris; the majority of the clitoris is deep to the skin.
• Labia minora:
  Medial and lateral folds.
  • Comprise erectile tissues and rich vasculature.
  • The right and left medial folds meet to form the frenulum of the clitoris; recall that a frenulum is a small fold of tissue that connects structures.
  • The lateral folds meet at the prepuce (aka hood), which covers the body of the clitoris.
  • Posteriorly, the folds merge to form the frenulum of the labia minora (aka, forchette).
• The area between the labia minora is the vestibule of the vagina.
• Labia majora:
  • Comprise adipose and smooth muscle tissue; the overlying skin has hair follicles and sebaceous glands.
  • Meet anteriorly at the mons pubis, which is the mound of fatty tissue superficial to the pubic symphysis.
  • Posteriorly, the labia majora are separated by the posterior commissure, which overlies the perineal body.

Superficial perineal pouch

• Potential space deep to the skin of the pudendum.
• Lies between the superficial perineal fascia and the perineal membrane.
• Contains erectile tissues and their overlying muscles.
• Pubic rami anchor the soft tissues.
• Perineal membrane has openings through which the vagina and urethra pass
• Clitoris:
  • Comprises the paired corpora cavernosa, which are erectile tissues.
  • Anchored to the pubic symphysis via the suspensory ligament.
  • Crus (plural = crura) the lateral “leg” that attaches to the pubic rami and perineal membrane.
  • Body is the “free part” where the corpora cavernosa meet medially.
  • Glans is the exposed end of the body.
  • Average clitoral length is between 2-5 cm, with significant interindividual variation.
• Bulbs of the vestibule lie lateral to the opening of the vagina (deep to the labia minora) and are connected to the glans of the clitoris:
  • They comprise erectile tissues and are rich in vasculature; in fact, some authors classify them as corpus spongiosum and/or as components of the clitoral root.
• Greater vestibular glands (aka, Bartholins’ glands); they release lubricating secretions during sexual arousal
• Muscles that overlie the erectile tissues:
  • Ischiocavernosus overlies the crura of the clitoris.
  • Bulbospongiosus overlies the bulb of the vestibule and the greater vestibular gland.
  • Force blood into the body and glans of the clitoris during sexual arousal.
• Superficial transverse perineal muscles arise from the ischial bones and meet at the perineal body, which they help to stabilize.

Clinical Correlation:

• Episiotomies are surgical cuts through the perineum between the vagina and the anus to widen the vaginal opening during childbirth.
• Current research shows that most women do not need episiotomies and that the risks, which include infection, increased tearing, and, therefore, longer recovery times, outweigh the benefits in many cases.