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VAGINA

The vagina is a fibromuscular tube lined by non-keratinized stratified epithelium. It extends from the vestibule (the opening between the labia minora) to the uterus. The upper end of the vagina surrounds the vaginal projection of the uterine cervix. The annular recess between the cervix and vagina is the fornix: the different parts of this recess are given separate names, i.e. anterior, posterior and right and left lateral, but they are continuous.

The vagina ascends posteriorly and superiorly at an angle of over 90° to the uterine axis: this angle varies with the contents of the bladder and rectum. The width of the vagina increases as it ascends. Above the level of the hymen, the inner surfaces of the anterior and posterior vaginal walls are ordinarily in contact with each other forming a transverse slit. The vaginal mucosa is attached to the uterine cervix higher on the posterior cervical wall than on the anterior: the anterior wall is approximately 7.5 cm long and the posterior wall is approximately 9 cm long. The anterior wall of the vagina is related to the base of the bladder in its middle and upper portions and to the urethra (which is embedded in it) inferiorly. The posterior wall is covered by peritoneum in its upper quarter. It is separated from the rectum by the recto-uterine pouch superiorly, and by moderately loose connective tissue (Denonvillier's fascia) in its middle half. In its lower quarter it is separated from the anal canal by the musculofibrous perineal body. Laterally are levator ani and pelvic fascia. As the ureters pass anteromedially to reach the fundus of the bladder, they pass close to the lateral fornices. As they enter the bladder the ureters are usually anterior to the vagina, and at this point, each ureter is crossed transversely by a uterine artery.

The vagina opens externally via a sagittal introitus positioned below the urethral meatus. The size of the introitus varies: it is capable of great distension during childbirth and to a lesser degree during sexual intercourse. The hymen is a thin fold of mucous membrane situated just within the vaginal orifice. The internal surfaces of the folds are normally in contact each other and the vaginal opening appears as a cleft between them. The hymen varies greatly in shape and dimensions. When stretched, it is annular and widest posteriorly; it may also be semilunar and concave towards the mons pubis, cribriform, fringed, absent or complete and imperforate. The hymenal ring normally ruptures after first sexual intercourse, but can rupture earlier during non-sexual physical activity. Small round carunculae hymenales (also known as carunculae myrtiformis) are its remnants after it has been ruptured. It has no established function.

Remnants of the duct of Gartner (embryologically the caudal end of the mesonephric duct), are occasionally seen protruding through the lateral fornices or lateral parts of the vagina; these can cause cysts (Gartner's cysts).