Vagina
Updates to Article Attributes
The vagina is a midline fibromuscular tubular structure positioned in the female perineum extending superiorly to the cervix and uterus in the pelvis.
Gross morphology and relationsanatomy
The vagina is 8-10 cm in length, extending posterosuperiorlyposterosuperior from the vestibule through the urogentialurogenital diaphragm to the uterus. The vagina forms a 90° angle with the uterus.
The vagina can be divided into the following parts:
- vestibule: between labia minora
- vault: upper end of the vagina
- fornices (anterior, posterior, lateral): recesses formed as the vagina surrounds the cervix
The anterior and posterior vaginal walls are usually closely applied to each other, diverging at the vaginal vault and fornices.
The vagina is supported by various structures:
- levator ani
- transverse cervical ligament
- pubocervical ligament
- uterosacral ligament
- perineal membrane and perineal body
After menopause, the vagina shortens in length and the fornices almost completely disappear.
Relations3
- anteriorly: cervix, bladder, urethra
- posteriorly: pouch of Douglas, Denonvillier's fascia, perineal body
- laterally: levator ani, pelvic fascia, ureters3
Blood supply
- arterial supply: vaginal, uterine, internal pudendal and middle rectal arteries (branches of internal iliac arteries)
- venous supply: vaginal venous plexus draining into internal iliac veins
Lymphatic drainage
- upper three
quarters-quarters: internal and external iliac nodes - lower quarter: superficial inguinal nodes
Innervation
- upper vagina: parasympathetic fibres from pelvic splanchnic nerves (S2-S4)
- lower 2-3 cm vagina: pudendal nerve
Histology
Three layers:
- Mucosa (non-keratinised stratified squamous epithelium): is hormonally sensitive, and lubricated from the Cervical and Bartholin's glands
- Muscularis: connective tissue and smooth muscle (outer longitudinal and inner circular)
- Adventitia: endopelvic fascia that connects the vagina to surrounding pelvic structures to maintain support
Embryology
Embryological derivation of the vagina is from two parts, which is important for deriving congenital anomalies:
-
Upperupper twothirds-thirds of the vagina, cervix and uterus-: all derived from the paired Mullerian / paramesonephric ducts. -
Lowerlower onethird-third of the vagina-: derived from the bilateral sinovaginal bulbs which arise from the urogenital sinus.
Radiographic features
Ultrasound
During trans-abdominaltransabdominal scanning the distended bladder, which acts as an acoustic window, does not affect vaginal position. The vagina can, therefore, be used as an effective landmark, even if the uterus does not occupy its familiar position in the pelvis. The vagina is best seen midsagittal TA approach, with a partially filled bladder. The vagina is hypoechoic and the mucosa is echogenic. The echogenicity of the mucosa diminishes in menopause, with the loss of estrogenoestrogen stimulation.
Related pathology
-<p>The <strong>vagina</strong> is a midline fibromuscular tubular structure positioned in the female <a href="/articles/perineum">perineum</a> extending superiorly to the <a href="/articles/cervix">cervix</a> and <a href="/articles/uterus">uterus</a> in the <a href="/articles/pelvis-1">pelvis</a>. </p><h4>Gross morphology and relations</h4><p>The vagina is 8-10 cm in length, extending posterosuperiorly from the vestibule through the urogential diaphragm to the <a href="/articles/uterus">uterus</a>. The vagina forms a 90° angle with the uterus. </p><p>The vagina can be divided into the following parts:</p><ul>- +<p>The <strong>vagina</strong> is a midline fibromuscular tubular structure positioned in the female <a href="/articles/perineum">perineum</a> extending superiorly to the <a href="/articles/cervix">cervix</a> and <a href="/articles/uterus">uterus</a> in the <a href="/articles/pelvis-1">pelvis</a>. </p><h4>Gross anatomy</h4><p>The vagina is 8-10 cm in length, extending posterosuperior from the vestibule through the urogenital diaphragm to the <a href="/articles/uterus">uterus</a>. The vagina forms a 90° angle with the uterus. </p><p>The vagina can be divided into the following parts:</p><ul>
-</ul><p><strong>After menopause</strong>, the vagina shortens in length and the fornices almost completely disappear. </p><h5>Relations <sup>3</sup>-</h5><ul>- +</ul><p>After menopause, the vagina shortens in length and the fornices almost completely disappear. </p><h5>Relations</h5><ul>
-<li>laterally: <a href="/articles/levator-ani-1">levator ani</a>, pelvic fascia, <a href="/articles/ureters">ureters</a>- +<li>laterally: <a href="/articles/levator-ani-1">levator ani</a>, pelvic fascia, <a href="/articles/ureters">ureters</a> <sup>3</sup>
-<li>upper three quarters: internal and external iliac nodes</li>- +<li>upper three-quarters: internal and external iliac nodes</li>
-</ol><h4>Embryology</h4><p>Embryological derivation of the vagina is from two parts, which is important for deriving congenital anomalies:</p><ol>-<li>Upper two thirds of the vagina, cervix and uterus - all derived from the paired Mullerian / paramesonephric ducts.</li>-<li>Lower one third of the vagina - derived from the bilateral sinovaginal bulbs which arise from the urogenital sinus.</li>-</ol><h4>Radiographic features</h4><h5>Ultrasound</h5><p>During trans-abdominal scanning the distended bladder, which acts as an acoustic window, does not affect vaginal position. The vagina can therefore be used as an effective landmark, even if the uterus does not occupy its familiar position in the pelvis. The vagina is best seen midsagittal TA approach, with a partially filled bladder. The vagina is hypoechoic and the mucosa is echogenic. The echogenicity of the mucosa diminishes in menopause, with loss of estrogen stimulation.</p><h4>Related pathology</h4><ul>- +</ol><h4>Embryology</h4><p>Embryological derivation of the vagina is from two parts, which is important for deriving congenital anomalies:</p><ul>
- +<li>upper two-thirds of the vagina, cervix and uterus: all derived from the paired Mullerian / paramesonephric ducts.</li>
- +<li>lower one-third of the vagina: derived from the bilateral sinovaginal bulbs which arise from the urogenital sinus</li>
- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>During transabdominal scanning the distended bladder, which acts as an acoustic window, does not affect vaginal position. The vagina can, therefore, be used as an effective landmark, even if the uterus does not occupy its familiar position in the pelvis. The vagina is best seen midsagittal TA approach, with a partially filled bladder. The vagina is hypoechoic and the mucosa is echogenic. The echogenicity of the mucosa diminishes in menopause, with the loss of oestrogen stimulation.</p><h4>Related pathology</h4><ul>