Anatomy

and 07 march
Physiology 2019

Applied to Obstetrics
Kumpulan 10
ADMW 3/2019
 Hasnizah Abdul Rahman
 Nicoletta Ali
TOPIC : VAGINA  Sitti Effarizah Bakar
 Sukmawati Mohd Saidi

1
 2 07 march 2019

LEARNING OUTCOMES
 Describe the structures of the vagina.
 Recognize the changes in the structure during
Pregnancy, Labour and Puerperium.
 Recognize injuries during Labour and take
appropriate action.
 Apply the above knowledge when giving care to the
mother.
 3 07 march 2019

Definition of Vagina
 Is a muscular canal lined
with nerves and mucus
membranes.It connects the
uterus and cervix to the
outside of the body,allowing
for menstruation,intercourse
and childbirth.

By Debra Sullivan,
PhD,MSN,RN,CNE,COI
on September 6,2018
 4 07 march 2019

ANATOMY AND PHYSIOLOGY OF VAGINA

The vagina is closely

related to many of the
organs in the pelvic region:

Anterior to the vagina is

the bladder and urethra.

Posterior to the vagina is

the rectum and anus.

Laterally located are the

ureters and uterine arteries.
 5 07 march 2019

STRUCTURE OF THE VAGINA

 The vagina is composed of 4 histological layers (internal to

external):

1. Stratified squamous epithelium – this layer provides

protection and is lubricated by cervical mucus (the vagina
itself does not contain any glands).
 Oestrogen stimulates the epithelial cells to secrete
glycogen. The glycogen is digested by the natural flora of
the vagina to produce lactic acid, and maintain a low
vaginal pH of ~4.5. This prevents infection by other
organisms.
 6 07 march 2019

Cont…
2. Elastic lamina propria – a dense connective tissue layer
which projects papillae into the overlying epithelium. The
larger veins are located here.
 Together, the lamina propria and epithelium comprise the
vaginal mucosa.

3. Fibromuscular layer – comprising two layers of smooth

muscle; an inner circular and an outer longitudinal layer.

4. Adventitia – a fibrous layer, which provides additional

strength to the vagina whilst also binding it to surrounding
structures.
7 07 march 2019
 8 07 march 2019

Cont…
 The muscular canal that
extends from the cervix to
the outside of the body. It is
usually 6 to 7 cm in length,
and its walls are lined with
mucous membrane.

 The cervix protrudes slightly

into the vagina, and
through a tiny hole in the
cervix (the os), sperm make
their way toward the
internal reproductive
organs.

 The vagina also includes

numerous tiny glands that
make vaginal secretions.
 9 07 march 2019

Microscopic Structure
 Squamous epithelium
-Type of modified skin
and forms the vaginal
lining.

 Vascular connective
tissue

 Muscle coat is arrange in

two layers
- inner circular fibres
- outer longitidinal fibres
 10 07 march 2019
Cont…
• Fascia is made up of
loose connective tissue Sectional view of stratified
which is part of the squamous epithelium of vagina
pelvic cellular tissue.

• The walls of the vagina

do not lie smoothly but
fall into transverse
folds, the rugea, which
allow for distention. In
patient who has borne
several children the
rugae have been
stretched several times,
and are therefore not so
obvious on inspection.
BLOOD SUPPLY 11 07 march 2019

Arterial supply to the

vagina is via the uterine and
vaginal arteries; both
branches of the internal
iliac artery.

Venous return is by the

vaginal venous plexus,
which drains into
the internal iliac veins via
the uterine vein.

Lymphatic drainage is via

the iliac and superficial
inguinal lymph nodes.
 12 07 march 2019

LYMPHATIC DRAINAGE

 Drainage of the lower

third of the vagina is
into the inguinal glands
, while the upper two
thirds is into the internal
and external iliac gland.
 13 07 march 2019

NERVE SUPPLY

 Sympathetic and para

sympathetic nerves from the
Lee-Frankerhauser (sacral)
plexus serve that portion of
the vagina which lies above
the levatores ani muscles.

 The pudendal nerve supplies

the lower vaginal area.
 14 07 march 2019

Cont…
 15 07 march 2019

FUNCTIONS
 Vaginal opening (vaginal vestibule @ introitus)
- during sexual intercourse or introitus
- serves as a conduit for menstrual flow the uterus
- during childbirth the baby passes through the
vagina (birth canal).

 Vaginal wall contains muscle and layers of tissue

with many elastic fibers for support uterus and to
prevent infection.
 16 07 march 2019

Changes in the structure

 Pregnancy

 Muscle layer hypertrophies and oestrigen causes the vaginal

epithelium to become thicker and more vascular.

 The altered composition of the surrounding connective

tissue increases the elasticity of the vagina

 Increasedrate of desquamation of the superficial vaginal

mucosa cells.
 17 07 march 2019

Cont…

 Labour
 Dilate to about 10 cm to accommodate the baby during
its trip from the uterus to the real world.

 Puerperium
 The vagina may get looser after having a baby as a result
of the pelvic floor muscles around the vagina getting
stretched out.

 This change can be more pronounced based on several

factor , such as how large your baby is, any complication
during delivery , and how many babies you have already
delivered.
 18 07 march 2019

Injuries during labour and appropriate

action
 Injuries

 Tears
 Episiotomy Action
Suturing
 Instrumental Delivery
 19 07 march 2019

VAGINAL HEALTH
 Avoiddouching. The vagina naturally cleanses itself.
This action can upset the natural balance of bacteria
and fungi, leading to an infection.

 Avoid scented soaps and feminine hygiene products.

Perfumes in scented hygiene products, such as soaps,
pads, and wipes, can irritate the skin and disrupt the
pH balance of the vagina.

 Avoid using pad or panty liner in the whole

day.Change as often or when wet.
 20 07 march 2019

Cont…

 Avoid wearing the same underwear within a few

days.

 Avoid watering directly in to the vagina.This action

can upset the natural bacteria (Lactobacillus).

 Avoid applied tissue and wet tissue for clean after

pass urine (PU) and bowel open (BO).
 21 07 march 2019

Cont…

 Be sexually responsible. Always use protection with

new partners and make sure to follow up with regular
sexually transmitted infections (STI) testing.

 Wash before and after intercourse.

 Kegel exercises strengthen the pelvic floor

muscles,which support the uterus,bladder,small intestine
and rectum.

 High nutritional protein and high vitamin c for healing

process and prevent infection.
 22 07 march 2019

References
 https://www.healthline.com/human-body-
maps/vagina
 https://www.webmed.com/women/picture-0f-the-
vagina#1
 https://human.biodigital.com/widgets/healthline/?be
 https://teachmeanatomy.info/pelvis/female-
reproductive-tract/vagina/
 https://emedicine.Medscape.com/article/1949237-
overview#a2
 Myles 14th edition
 23 07 march 2019

THE END