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2.1.

Anatomi vagina

Vagina
From Wikipedia, the free encyclopedia
This article is about the body part. For other uses, see Vagina (disambiguation).

It has been suggested that Human vaginal size be merged into this article.
(Discuss) Proposed since May 2013.
Vagina

Vagina in the female human reproductive system.

Vulva with vaginal opening
Latin Vagina
Gray's subject #269 1264
Artery superior part to uterine artery, middle and inferior
parts to vaginal artery
Vein uterovaginal venous plexus, vaginal vein
Nerve Sympathetic: lumbar splanchnic plexus
Parasympathetic: pelvic splanchnic plexus
Lymph upper part to internal iliac lymph nodes, lower part
tosuperficial inguinal lymph nodes
Precursor urogenital sinus andparamesonephric ducts
MeSH Vagina
Dorlands/Elsevier Vagina
The vagina (from Latin vgna, literally "sheath" or "scabbard") is a fibromuscular elastic tubular tract which
is a sex organ and has two main functions: sexual intercourse and childbirth. In humans, this passage
leads from the opening of the vulva to the uterus (womb), but the vaginal tract ends at the cervix. Unlike
men, who have only one genital orifice, women have two, the urethra and the vagina. The vaginal opening
is much larger than the urethral opening, and both openings are protected by the labia.
[1][2]
The inner mould
of the vagina has a foldy texture which can create friction for the penis during intercourse. During arousal,
the vagina gets moist to facilitate the entrance of the penis.
The Latinate plural "vaginae" is rarely used in English. Colloquially, the word vagina is often used to refer to
the vulva or to the female genitals in general.
[3]
However, by its dictionary and anatomical
definitions, vagina refers exclusively to the specific internal structure.
Contents
[hide]
1 Location and structure
o 1.1 General structure
o 1.2 Vaginal ecosystem and acidity
1.2.1 Microflora and possible role in acidification
1.2.2 Estrogen vs. lactobacilli
1.2.3 Immune system
2 Function
o 2.1 Sexual activity
o 2.2 Childbirth
o 2.3 Uterine secretions
3 Clinical relevance
o 3.1 pH
o 3.2 Vaginismus
o 3.3 Signs of disease
3.3.1 Lumps
3.3.2 Discharge
3.3.3 Sores
o 3.4 Route of administration
4 Other animals
5 See also
6 References
7 External links
Location and structure
General structure
The human vagina is an elastic muscular canal that extends from the cervix to the vulva.
[4]
The internal
lining of the vagina consists of stratified squamous epithelium. Beneath this lining is a layer of smooth
muscle, which may contract during sexual intercourse and when giving birth. Beneath the muscle is a layer
of connective tissue called adventitia.
[5]

Although there is wide anatomical variation, the length of the unaroused vagina of a woman of child-
bearing age is approximately 6 to 7.5 cm (2.5 to 3 in) across the anterior wall (front), and 9 cm (3.5 in) long
across the posterior wall (rear), making posterior fornix deeper than anterior. During sexual arousal the
vagina expands in both length and width. Its elasticity allows it to stretch during sexual intercourse and
during birth of offspring. The vagina connects the superficial vulva to the cervix of the deep uterus.
If the woman stands upright, the vaginal tube points in an upward-backward direction and forms an angle of
slightly more than 45 degrees with the uterus and of about 60 degrees to horizon.
[6]
The vaginal opening is
at the caudal end of the vulva, behind the opening of the urethra. The upper one-fourth of the vagina is
separated from the rectum by the recto-uterine pouch. Above the vagina is a cushion of fat called the mons
pubis which surrounds the pubic bone and provides protective support during intercourse. The vagina,
along with the inside of the vulva, is reddish pink in color, as are most healthy internal mucous membranes
in mammals. A series of ridges produced by folding of the wall of the outer third of the vagina is called the
vaginal rugae. They are transverse epithelial ridges and their function is to provide the vagina with
increased surface area for extension and stretching.


Organs of the female reproductive system, with vagina seen in center
The Bartholin's glands, located near the vaginal opening and cervix, were originally thought to be the
primary source for vaginal lubrication, but they provide only a few drops ofmucus for vaginal
lubrication;
[7]
the significant majority of vaginal lubrication is now believed to be provided by plasma
seepage from the vaginal walls, which is called vaginal transudation. Vaginal transudation, which initially
forms as sweat-like droplets, is caused by vascular engorgement of the vagina (vasocongestion); this
results in the pressure inside the capillaries increasing the transudation of plasma through the vaginal
epithelium.
[7][8][9]

Before and during ovulation, the cervix's mucus glands secrete different variations of mucus, which
provides an alkaline environment in the vaginal canal that is favorable to the survival of sperm. "Vaginal
lubrication typically decreases as women age, but this is a natural physical change that does not normally
mean there is any physical or psychological problem. After menopause, the body produces less estrogen,
which, unless compensated for with estrogen replacement therapy, causes the vaginal walls to thin out
significantly."
[10]

The hymen is a membrane of tissue that surrounds or partially covers the external vaginal opening. The
effects of sexual intercourse and childbirth on the hymen are variable. If the hymen is sufficiently elastic, it
may return to nearly its original condition. In other cases, there may be remnants (carunculae myrtiformes),
or it may appear completely absent after repeated penetration.
[11][12]
Additionally, the hymen may be
lacerated by disease, injury, medical examination, masturbation or even physical exercise. For these
reasons, it is not possible to definitively determine whether or not a girl or woman is a virgin by examining
her hymen.
[11][12][13][14]

The vagina in its full length - not only its upper part as had been thought for a long time - is a derivative of
the embryonal Mullerian duct.
[15]
The upper 1/3 of vagina is supported by cardinal ligaments laterally
and uterosacral ligamentsposterolaterally. The middle 1/3 is supported by paracolpos and pelvic
diaphragm. The lower 1/3 is supported by the pelvic diaphragm, urogenital diaphragm and perineal body.
[6]

Vaginal ecosystem and acidity
The vagina is a nutrient rich environment that harbors a unique and complex microflora. It is a dynamic
ecosystem that undergoes long term changes, from neonate to puberty and from the reproductive period
(menarche) to menopause. Moreover, under the influence of hormones, such as estrogen (estradiol),
progesterone and follicle stimulating hormone (FSH), the vaginal ecosystem undergoes cyclic or periodic
changes, i.e. during menses and pregnancy.
[16][17][18][19]

One important variable parameter is the vaginal pH, which varies significantly during a womans lifespan,
from 7.0 in premenarchal girls, to 3.8-4.4 in women of reproductive age to 6.5-7.0 during menopause
without hormone therapy and 4.5-5.0 with hormone replacement therapy.
[16]
Estrogen, glycogen and
lactobacilli are important factors in this variation.
[16]

Microflora and possible role in acidification
The vagina of a newborn is affected by the residual maternal estrogen still present. At birth, the vaginal
mucosa is rich in glycogen and the vagina becomes colonized by lactic-acid producing bacteria, such as
Lactobacillus spp., within the first day after birth.
[20]
These estrogen effects will slowly disappear by the
fourth week after birth and the glycogen content will diminish. The vaginal pH becomes neutral or alkaline,
likely due to the almost absence of lactic-acid producing microorganisms.
[17][21]
In premenarchal girls,
the vaginal microflora is composed of anaerobic and aerobic cocci and rods with low loads of lactobacilli,
Gardnerella vaginalis and Mobiluncus spp.
[16][21]
During puberty, the estrogen levels rise until they reach the
concentrations found in adult women. The estrogen causes the vaginal epithelium to thicken and the
intracellular glycogen production to rise,
[22]
which consequently causes a shift in the composition of the
vaginal microflora.
[21]
At this moment, lactobacilli, probably from the rectum,
[23][24]
become the most
important inhabitants colonizing the vaginal econiche, utilizing the available glycogen, which is converted to
lactic acid, resulting in the acidification (pH < 4.4) of the vagina.
[16][23][24][25]
In addition, besides lactic acid,
the principal vaginal acidifier, other organic acids, i.e. acetic and linoleic acid, are also normally found in
vaginal fluid.
[26]

Estrogen vs. lactobacilli
The source of the lactic acid has been a matter of debate. Some studies suggest that the presence of
estrogen and not Lactobacillus is primarily related to acidification of the vagina,
[27]
and even that lactobacilli
cannot produce lactic acid from glycogen. The overall vaginal pH can be attributed to the total of estrogen
mediated lactic acid production by the epithelial cells (producing only the L-isomer of lactate) and the lactic
acid contribution by the endogenous vaginal bacteria (producing both D- and L-isomers of
lactate).
[26][28]
Boskey et al.,
[29]
studying vaginal lactate production in 11 women, found that D-lactate
(bacterial origin) in vaginal secretions ranged from 6% to 75%, with a mean of 55%. They concluded that
these findings supported the role of Lactobacillus as the primary source for vaginal acidification, although
the wide range found was not indicative for a dominant bacterial source of lactate in all women. Moreover,
the midportion of the vagina has a higher pH than the vaginal fornix, although the lactobacilli concentration
is uniform throughout the vaginal canal.
[26]
This is indicative for the fact that the vaginal mucosal
metabolism may be more dominant in determining the final pH.
[26]

However, in a pyrosequencing study by Ravel et al.
[30]
of the vaginal microflora of 396 asymptomatic North
American women, representing four ethnic groups (white, black, Hispanic, and Asian), the higher median
pH values in Hispanic (pH 5.0 0.59) and black (pH 4.7 1.04) women reflected a higher prevalence of
communities not dominated by Lactobacillus spp. in these two ethnic groups, when compared with Asian
(pH 4.4 0.59) and white (pH 4.2 0.3) women. Ravel et al.
[30]
found that the lowest pH values were
associated with vaginal ecosystems dominated by L. iners and L. crispatus, and the highest pH values
were associated with vaginal ecosystems not dominated by species of Lactobacillus.
[30][31]
The results of
Ravel may be controversial for L.iners, which was strongly associated with Bacterial vaginosis-like vaginal
microflora, which is characterized by alkaline pH.
[32][33]
Hummelen et al.
[31]
stated in their pyrosequencing
study that L. crispatus is associated with a low pH, but when L. crispatus is not present, a large fraction of
L. iners is required to predict a low pH.
[31]
Nevertheless, these results indicate that bacteria play an
important role in the acidification of the vagina and more research, e.g. regarding the resource of glycogen,
used to produce lactic acid and regarding the bacterial species that can metabolize glycogen, is needed to
understand the various factors that govern vaginal pH.
Immune system
Next to the protective effects of pH and the endogenous vaginal microflora, pathogen colonization is also
prevented by the local components of the innate and acquired immune systems.
[34]
The innate immune
system recognizes pathogen-associated molecular patterns (PAMPs) on microbial pathogens and includes
soluble factors (e.g. mannose-binding lectin, complement components, defensins, secretory leukocyte
protease inhibitor (SLPI) and nitric oxide), membrane-associated components (e.g. Toll-like receptors) and
tissue-associated phagocytes (macrophages and neutrophils).
[26][34][35][36]
The vaginal adaptive (acquired)
immunity produces locally IgG and IgA, which will recognize and bind to specific antigens on
microorganisms in the vagina.
[37]
For instance, an IgA response against G. vaginalis vaginolysin has been
reported and a correlation between this response and BV has been shown.
[38][39]

Finally, after the reproductive years, women enter the menopause, which is characterized by the cessation
of menstruation because of the loss of follicular activity.
[18]
The circulating estrogen levels are low and the
glycogen content is low to absent, resulting in a rise of the vaginal pH, and consequently the vagina is
colonized by bacteria associated with intermediate/disturbed vaginal microflora.
[17][18][40][41]
It has been
shown that estrogen therapy can augment the loads of lactobacilli, which in turn can diminish the increased
risk for BV and urinary tract infections.
[40][42]
However, the absence of lactobacilli by itself is not related to an
elevated prevalence of BV,
[43]
and estrogen replacement may merely potentiate the effect of lactobacilli
present on the vaginal pH.
[44]

The vaginal ecosystem is under the influence of many factors, endogenous (hormonal, innate immunity,
ethnicity), as well as exogenous (behavioral factors, such as sexual activity, cigarette smoking, douching
and antibiotic treatment in general),
[45][46][47]
that are determinative for the vaginal health. The endogenous
susceptibility for disturbance of the vaginal microflora and for infections is determined by the genetic
characteristics of each individual woman,
[30][34]
the specific composition of her vaginal microflora at a certain
point in time and the genotypic differences between the vaginal lactobacilli present (at species and strain
level).
[48][49]

Function
The vagina has several biological functions.
Sexual activity
Further information: Human sexual activity and Human female sexuality
The concentration of the nerve endings that lie close to the entrance of a woman's vagina (the lower third)
can provide pleasurable sensation during sexual activity when stimulated in a way that the particular
woman enjoys. However, the vagina as a whole has insufficient nerve endings for sexual stimulation
and orgasm,
[50][51][52][53]
which is considered to make the process of child birth significantly less
painful.
[51]
The outer one-third of the vagina, especially near the opening, contains the majority of the
vaginal nerve endings, making it more sensitive to touch than the inner two-thirds of the vaginal
barrel.
[51][52][53]

The clitoris contains an abundance of nerve endings and is a sex organ of multiplanar structure with a
broad attachment to the pubic arch and via extensive supporting tissue to the mons pubis and labia,
centrally attached to the urethraand vagina. Clitoral tissue forms a tissue cluster with the vagina. The tissue
is more extensive in some women than in others, which may contribute to orgasms experienced
vaginally.
[50][52][54]
During sexual arousal, and particularly the stimulation of the clitoris, the walls of the
vagina lubricate. This reduces friction that can be caused by various sexual activities.
[10]
With arousal, the
vagina lengthens rapidly,
[10]
to an average of about 4 in.(10 cm), but can continue to lengthen in response
to pressure. As the woman becomes fully aroused, the vagina tents (last ) expands in length and width,
while the cervix retracts. The walls of the vagina are composed of soft elastic folds of mucous membrane
which stretch or contract (with support from pelvic muscles) to the size of the inserted penis or other
object,
[10]
stimulating the penis and helping to cause the male to experience orgasm and ejaculation, thus
enabling fertilization.


Structure of the wall of vagina
An erogenous zone commonly referred to as the G-Spot (also known as the Grfenberg Spot) is typically
defined as being located at the anterior wall of the vagina, about five centimeters in from the entrance.
Some women experience intense pleasure if the G-Spot is stimulated appropriately during sexual activity. A
G-Spot orgasm may be responsible for female ejaculation, leading some doctors and researchers to
believe that G-Spot pleasure comes from the Skene's glands, a female homologue of the prostate, rather
than any particular spot on the vaginal wall.
[55][56][57]
Other researchers consider the connection between the
Skene's glands and the G-Spot to be weak.
[58][59][60]
They contend that the Skene's glands do not appear to
have receptors for touch stimulation, and that there is no direct evidence for their involvement.
[60]
The G-
Spot's existence, and existence as a distinct structure, is still under dispute, as its location can vary from
woman to woman and appears to be nonexistent in some women,
[54][58][61][62]
and it is hypothesized to be an
extension of the clitoris and therefore the reason for vaginal orgasms.
[50][54][63][64]

Childbirth
During childbirth, the vagina provides the channel to deliver the newborn from the uterus to its independent
life outside the body of the mother. During birth, the elasticity of the vagina allows it to stretch to many
times its normal diameter. The vagina is often referred to as the birth canal in the context of pregnancy and
childbirth, though the term is, by definition, the area between the outside of the vagina and the fully dilated
uterus.
[65]

Uterine secretions
The vagina provides a path for menstrual blood and tissue to leave the body. In industrial
societies, tampons, menstrual cups and sanitary napkins may be used to absorb or capture these fluids.
Clinical relevance


An ultrasound showing the urinary bladder (1), uterus (2), and vagina (3)
Further information: Vulvovaginal health
The vagina is self-cleansing and therefore usually needs no special treatment. Doctors generally
discourage the practice of douching.
[66]
Since a healthy vagina is colonized by a mutuallysymbiotic flora of
microorganisms that protect its host from disease-causing microbes, any attempt to upset this balance may
cause many undesirable outcomes, including but not limited to abnormal discharge and yeast infection.
The vagina is examined during gynecological exams, often using a speculum, which holds the vagina open
for visual inspection of the cervix or taking of samples (see pap smear). Medical activities involving the
vagina, including examinations, administration of medicine, and inspection of discharges, are also referred
to as being per vaginam (or p.v.).
[67]

pH
The healthy vagina of a woman of child-bearing age is acidic, with a pH normally ranging between 3.8 and
4.5.
[68]
This is due to the degradation of glycogen to the lactic acid by enzymes secreted by the Dderlein's
bacillus. This is a normal commensal of the vagina. The acidity retards the growth of many strains
of pathogenic microbes.
[69]

An increased pH of the vagina (with a commonly used cut-off of pH 4.5 or higher), can be caused by
bacterial overgrowth, as occurs in bacterial vaginosis and trichomoniasis, or rupture of membranes in
pregnancy.
[68]

Vaginismus
Main article: Vaginismus
Vaginismus, not to be confused with vaginitis (an inflammation of the vagina), refers to an involuntary
tightening of the vagina due to a conditioned reflex of the muscles in the area. It can affect any form of
vaginal penetration, including sexual intercourse, insertion of tampons and menstrual cups, and the
penetration involved in gynecological examinations. Various psychological and physical treatments are
possible to help alleviate it.
Signs of disease
Common signs of vaginal disease are lumps, discharge and sores:
Lumps
The presence of unusual lumps in the wall or base of the vagina is always abnormal. The most common of
these is Bartholin's cyst.
[70]
The cyst, which can feel like a pea, is formed by a blockage in glands which
normally supply the opening of the vagina. This condition is easily treated with minor surgery or silver
nitrate. Other less common causes of small lumps or vesicles are herpes simplex. They are usually multiple
and very painful with a clear fluid leaving a crust. They may be associated with generalized swelling and
are very tender. Lumps associated with cancer of the vaginal wall are very rare and the average age of
onset is seventy years.
[71]
The most common form is squamous cell carcinoma, then cancer of the glands
or adenocarcinoma and finally, and even more rarely, melanoma.
Discharge
Main article: Vaginal discharge
Most vaginal discharges occur due to normal bodily functions such as menstruation or sexual arousal.
Abnormal discharges, however, can indicate disease.
Normal vaginal discharges include blood or menses (from the uterus), the most common, and clear fluid
either as a result of sexual arousal or secretions from the cervix. Other non-infective causes
include dermatitis. Non-sexually transmitted discharges occur from bacterial vaginosis and thrush
or candidiasis. The final group of discharges include the sexually transmitted
diseases gonorrhea, chlamydia, and trichomoniasis. The discharge from thrush is slightly pungent and
white, that from trichomoniasis more foul and greenish, and that from foreign bodies resembling the
discharge of gonorrhea, greyish or yellow and purulent (pus-like).
[72]

Sores
All sores involve a breakdown in the walls of the fine membrane of the vaginal wall. The most common of
these are abrasions and small ulcers caused by trauma. While these can be inflicted during rape most are
actually caused by excessive rubbing from clothing or improper insertion of a sanitary tampon. The typical
ulcer or sore caused by syphilis is painless with raised edges. These are often undetected because they
occur mostly inside the vagina. The sores of herpes which occur with vesicles are extremely tender and
may cause such swelling that passing urine is difficult. In the developing world a group of parasitic diseases
also cause vaginal ulceration such as Leishmaniasis but these are rarely encountered in the
west. HIV/AIDS can be contracted through the vagina during intercourse but is not associated with any
local vaginal or vulval disease.
[73]
All the above local vulvovaginal diseases are easily treated. Often only
shame prevents patients from presenting for treatment.
[74]

Route of administration
Intravaginal administration is a route of administration where the substance is applied to the inside of the
vagina. Pharmacologically, it has the potential advantage to result in effects primarily in the vagina or
nearby structures (such as the vaginal portion of cervix) with limited systemic adverse effects compared to
other routes of administration.
Other animals

This section does not cite any references or sources. Please help improve
this section by adding citations to reliable sources. Unsourced material
may be challenged andremoved. (March 2013)
See also: Mammal female reproductive system
The vagina (along with the penis) is a general feature of animals in which the female is internally
fertilised (other than by traumatic insemination). The shape of the vagina varies among different animals.
In placental mammals and marsupials, the vagina leads from the uterus to the exterior of the female body.
In birds, monotremes, and some reptiles, an homologous part of the oviduct leads from the shell gland to
thecloaca.
[citation needed]
In some jawless fish, there is neither oviduct nor vagina and instead the egg travels
directly through the body cavity (and is fertilised externally as in most fish and amphibians). In insects and
other invertebrates the vagina is part of the oviduct (see insect reproductive system).
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