The Vulva

Structures of the Vulva

The vulva is a collective term for several anatomical structures:

• Mons pubis – a subcutaneous fat pad located anterior to the pubic symphysis. It formed by the fusion of the labia majora.
• Labia majora – two hair-bearing external skin folds.
  • They extend from the mons pubis posteriorly to the posterior commissure (a depression overlying the perineal body).
  • Embryologically derived from labioscrotal swellings
• Labia minora – two hairless folds of skin, which lie within the labia majora.
  • They fuse anteriorly to form the hood of the clitoris and extend posteriorly either side of the vaginal opening.
  • They merge posteriorly, creating a fold of skin known as the fourchette.
  • Embryologically derived from urethral folds
• Vestibule – the area enclosed by the labia minora. It contains the openings of the vagina (external vaginal orifice, vaginal introitus) and urethra.
• Bartholin’s glands – secrete lubricating mucus from small ducts during sexual arousal. They are located either side of the vaginal orifice.
• Clitoris – located under the clitoral hood. It is formed of erectile corpora cavernosa tissue, which becomes engorged with blood during sexual stimulation.
  • Embryologically derived from the genital tubercle

Adapted from work by Cancer Research UK [CC BY-SA 4.0]

Fig 1
The major structures of the vulva (external female genitalia).

Kostis Gyftopoulos MD, PhD

Fig 2
The external female genitalia.

Clinical Relevance

Infection of Bartholin’s Glands

The Bartholin’s glands (also known as the greater vestibular glands) can become infected and inflamed – known as bartholinitis.

This is initially treated with antibiotics, but occasionally can be complicated by the formation of a cyst or abscess. In case of an infected cyst or abscess, the only effective treatment is surgical drainage or excision of the lesion.

By Medimage [CC-BY-SA-3.0], via Wikimedia Commons

Fig 3
Right sided Bartholin’s cyst, caused by blockage of the Bartholin’s gland ducts.

Vascular Supply and Lymphatics

The arterial supply to the vulva is from the paired internal and external pudendal arteries (branches of the internal iliac artery and femoral artery, respectively).

Venous drainage is achieved via the pudendal veins, with smaller labial veins contributing as tributaries.

Lymph drains to the nearby superficial inguinal lymph nodes.

Innervation

The vulva receives sensory and parasympathetic nervous supply.

To describe the sensory distribution, the vulva can be divided into anterior and posterior sections:

• Anterior – ilioinguinal nerve, genital branch of the genitofemoral nerve

• Posterior – pudendal nerve, posterior cutaneous nerve of the thigh.

The clitoris and the vestibule also receive parasympathetic innervation from the cavernous nerves – derived from the uterovaginal plexus.

By TeachMeSeries Ltd (2025)

Fig 4
Cutaneous innervation the skin of the vulva and perineum