Vaginal rugae

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Vaginal rugae are illustrated in this 1891 medical textbook image The science and art of midwifery (1891) (14579471209).jpg
Vaginal rugae are illustrated in this 1891 medical textbook image

Vaginal rugae are structures of the vagina that are transverse ridges formed out of the supporting tissues and vaginal epithelium in females. [1] Some conditions can cause the disappearance of vaginal rugae and are usually associated with childbirth and prolapse of pelvic structures. The rugae contribute to the resiliency and elasticity of the vagina and its ability to distend and return to its previous state. [2] [3] [4] These structures not only allow expansions and an increase in surface area of the vaginal epithelium, they provide the space necessary for the vaginal microbiota. The shape and structure of the rugae are supported and maintained by the lamina propria of the vagina and the anterior and posterior rugae. [5]

Contents

The anterior and posterior columnae rugae are transverse vaginal support structures between which the transverse rugae exist. The cross section of the vagina normally forms a shape that resembles the letter 'H' due to these structures. [6]

Vaginal rugae disappear in older women and those with an estrogen deficiency. [7] The rugae can disappear with anterior vaginal wall prolapse which can occur when supports to the portion located between the vagina and bladder are damaged and the bladder bulges into the vaginal lumen. Vaginal self-examination includes visualizing the presence of vaginal rugae. [8] Anatomists identified rugae of the vagina as early as 1824. [9]

Development

The appearance and presence of vaginal rugae change over the life span of females and are associated with hormonal cycles, estrogens, childbirth, puberty and menopause. During gynecological examination of prepubescent girls, rugae can be visualized. [10] The vaginal rugae change after menopause. In some older women the rugae are present but become flattened and difficult to see. [11] In others, the rugae tend to disappear. [1]

Clinical considerations

Other structures can be present on the vaginal wall though most of the time these can be differentiated from rugae. [12] [13] Vaginal cysts can be small protrusions into the vagina that can be felt or palpated by a clinician. Vaginal inclusion cysts can appear as small bumps and can develop after childbirth. [12] Other small structures or protrusions can be Gartner's duct cysts, patches of endometrial tissue, and benign tumors. [12] [14] These cystic structures can obliterate the rugae and is a clue to their presence. [15] The absence of vaginal rugae seen in the normal vagina of a healthy woman may be an indication of a prolapsed bladder (cystocele) or rectocele. [13] [12] An enterocele, or bulging of the bowel into the vagina can also cause vaginal rugae to disappear. [16] The absence of vaginal rugae may also be an indicator of pelvic organ prolapse. [17] [18] [19] Vaginal rugae disappear in those with an estrogen deficiency. [7] [20]

Childbirth

Vaginal rugae can disappear during the second stage of labor. [21] After a vaginal birth, the rugae are not visible and the walls of the vagina are smooth. By the third week postpartum, the vagina has become much smaller and the rugae begin to reform on the vaginal walls. Six weeks after birth, the rugae have returned to approximately the same size as they were before the birth. The number of rugae after childbirth decreases. [22] In women who have not given birth, the rugae are more prominent than in those who have given birth multiple times. [6]

Related Research Articles

<span class="mw-page-title-main">Vagina</span> Part of the female reproductive tract

In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen. At the deep end, the cervix bulges into the vagina. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.

<span class="mw-page-title-main">Pelvic floor</span> Anatomical structure

The pelvic floor or pelvic diaphragm is an anatomical location in the human body, which has an important role in urinary and anal continence, sexual function and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and smooth, ligaments and fascia. and separates between the pelvic cavity from above, and the perineum from below. It is formed by the levator ani muscle and coccygeus muscle, and associated connective tissue.

<span class="mw-page-title-main">Rectocele</span> Bulging of the rectum into the vaginal wall

In gynecology, a rectocele or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

An imperforate hymen is a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when menstrual blood accumulates in the vagina and sometimes also in the uterus. It is treated by surgical incision of the hymen.

<span class="mw-page-title-main">Cystocele</span> Medical condition

The cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.

<span class="mw-page-title-main">Pelvic organ prolapse</span> Descent of the pelvic organs from their normal positions

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.

<span class="mw-page-title-main">Uterine prolapse</span> Medical condition

Uterine prolapse is a form of pelvic organ prolapse in which the uterus and a portion of the upper vagina protrude into the vaginal canal and, in severe cases, through the opening of the vagina. It is most often caused by injury or damage to structures that hold the uterus in place within the pelvic cavity. Symptoms may include vaginal fullness, pain with sexual intercourse, difficulty urinating, and urinary incontinence. Risk factors include older age, pregnancy, vaginal childbirth, obesity, chronic constipation, and chronic cough. Prevalence, based on physical exam alone, is estimated to be approximately 14%.

A urethrocele is the prolapse of the female urethra into the vagina. Weakening of the tissues that hold the urethra in place may cause it to protrude into the vagina. Urethroceles often occur with cystoceles. In this case, the term used is cystourethrocele.

Urogynecology or urogynaecology is a surgical sub-specialty of urology and gynecology.

Genitoplasty is plastic surgery to the genitals. Genitoplasties may be reconstructive to repair injuries, and damage arising from cancer treatment, or congenital disorders, endocrine conditions, or they may be cosmetic.

The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings. This assessment is the most frequently used among research publications related to pelvic organ prolapse.

A urogenital fistula is an abnormal tract that exists between the urinary tract and bladder, ureters, or urethra. A urogenital fistula can occur between any of the organs and structures of the pelvic region. A fistula allows urine to continually exit through and out the urogenital tract. This can result in significant disability, interference with sexual activity, and other physical health issues, the effects of which may in turn have a negative impact on mental or emotional state, including an increase in social isolation. Urogenital fistulas vary in etiology. Fistulas are usually caused by injury or surgery, but they can also result from malignancy, infection, prolonged and obstructed labor and deliver in childbirth, hysterectomy, radiation therapy or inflammation. Of the fistulas that develop from difficult childbirth, 97 percent occur in developing countries. Congenital urogenital fistulas are rare; only ten cases have been documented. Abnormal passageways can also exist between the vagina and the organs of the gastrointestinal system, and these may also be termed fistulas.

<span class="mw-page-title-main">Vaginal anomalies</span> Congenital defect; abnormal or absent vagina

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina.

<span class="mw-page-title-main">Vaginal support structures</span> Structures that maintain the position of the vagina within the pelvic cavity

The vaginal support structures are those muscles, bones, ligaments, tendons, membranes and fascia, of the pelvic floor that maintain the position of the vagina within the pelvic cavity and allow the normal functioning of the vagina and other reproductive structures in the female. Defects or injuries to these support structures in the pelvic floor leads to pelvic organ prolapse. Anatomical and congenital variations of vaginal support structures can predispose a woman to further dysfunction and prolapse later in life. The urethra is part of the anterior wall of the vagina and damage to the support structures there can lead to incontinence and urinary retention.

<span class="mw-page-title-main">Vaginal epithelium</span> Inner lining of the vagina

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers of cells. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

<span class="mw-page-title-main">Vaginal cysts</span> Benign growths of the vaginal epithelium

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites. In most instances they do not cause symptoms and present with few or no complications. A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination. Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele. Some cysts can be distinguished visually but most will need a biopsy to determine the type. Vaginal cysts can vary in size and can grow as large as 7 cm. Other cysts can be present on the vaginal wall though mostly these can be differentiated. Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors. The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst. Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant. Growths that originate from the urethra and other tissue can present as cysts of the vagina.

Transvaginal mesh, also known as vaginal mesh implant, is a net-like surgical tool that is used to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI) among female patients. The surgical mesh is placed transvaginally to reconstruct weakened pelvic muscle walls and to support the urethra or bladder.

References

  1. 1 2 "Rugae of vagina". TheFreeDictionary.com. Retrieved 2018-02-17.
  2. ↑ "Stratified Squamous Epithelium: Vaginal Lining and Rugae". blausen.com. Blausen Medical . Retrieved 15 February 2018.
  3. ↑ Snell, Richard S. (2004). Clinical Anatomy: An Illustrated Review with Questions and Explanations. Lippincott Williams & Wilkins. ISBN   9780781743167.
  4. ↑ Heger, Astrid M.; Emans, S. Jean; Muram, David (2000-09-07). Evaluation of the Sexually Abused Child: A Medical Textbook and Photographic Atlas. Oxford University Press. ISBN   9780199747825.
  5. ↑ "Vaginal epithelium". www.dartmouth.edu. Dartmouth College. Retrieved 2018-02-15.
  6. 1 2 Hafez, E. S.; Kenemans, P. (2012-12-06). Atlas of Human Reproduction: By Scanning Electron Microscopy. Springer Science & Business Media. ISBN   9789401181402.
  7. 1 2 Whiteside JL, Barber MD, Paraiso MF, Walters MD (March 2005). "Vaginal rugae: measurement and significance". Climacteric. 8 (1): 71–5. doi:10.1080/13697130500042490. PMID   15804734. S2CID   25810681.
  8. ↑ "Vaginal Self-Examination (VSE): Healthwise Medical Information on eMedicineHealth". eMedicineHealth. Retrieved 2018-02-15.
  9. ↑ Clarke, Charles Mansfield (1824). Observations on those diseases of females which are attended by discharges : illustrated by copper-plates of the diseases, &c. U.S. National Library of Medicine. Philadelphia : Carey and Lea.
  10. ↑ Sugar, Naomi; Graham, Elinor (2006). "Common Gynecologic Problems in Prepubertal Girls" (PDF). Pediatrics in Review. 27 (6): 213–23. doi:10.1542/pir.27-6-213. PMID   16740805.
  11. ↑ Bent, Alfred E.; Cundiff, Geoffrey W.; Swift, Steven E. (2008). Ostergard's Urogynecology and Pelvic Floor Dysfunction. Lippincott Williams & Wilkins. ISBN   9780781770958.
  12. 1 2 3 4 "Vaginal cysts: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2018-02-17.
  13. 1 2 Zimmern, Philippe E.; Haab, Francois; Chapple, Christopher R. (2007-12-09). Vaginal Surgery for Incontinence and Prolapse. Springer Science & Business Media. ISBN   9781846283468.
  14. ↑ Kondi-Pafiti, A.; Grapsa, D.; Papakonstantinou, K.; Kairi-Vassilatou, E.; Xasiakos, D. (2008). "Vaginal cysts: a common pathologic entity revisited". Clinical and Experimental Obstetrics & Gynecology. 35 (1): 41–44. ISSN   0390-6663. PMID   18390079.
  15. ↑ Jayaprakash, Sheela; M, Lakshmidevi; G, Sampath Kumar (2011-07-04). "A rare case of posterior vaginal wall cyst". BMJ Case Reports. 2011: bcr0220113804. doi:10.1136/bcr.02.2011.3804. ISSN   1757-790X. PMC   3132834 . PMID   22693290.
  16. ↑ Craft, T. M.; Parr, M. J. A.; Nolan, Jerry P. (2004-11-10). Key Topics in Critical Care, Second Edition. CRC Press. ISBN   9781841843582.
  17. ↑ Zimmern, Philippe E.; Haab, Francois; Chapple, Christopher R. (9 December 2007). Vaginal Surgery for Incontinence and Prolapse. Springer Science & Business Media. ISBN   9781846283468 . Retrieved 15 February 2018– via Google Books.
  18. ↑ Walters, Mark D; Karram, Mickey M (2014). Urogynecology and Reconstructive Pelvic Surgery. Saunders. pp. 326–341. ISBN   978-0323113779.
  19. ↑ Graham, Sam D.; Keane, Thomas E.; Glenn, James Francis (2010). Glenn's Urologic Surgery. Lippincott Williams & Wilkins. p. 238. ISBN   9780781791410.
  20. ↑ Mac Bride MB, Rhodes DJ, Shuster LT (January 2010). "Vulvovaginal atrophy". Mayo Clin. Proc. 85 (1): 87–94. doi:10.4065/mcp.2009.0413. PMC   2800285 . PMID   20042564.
  21. ↑ Chapple, Christopher R. (2006-01-01). Multidisciplinary Management of Female Pelvic Floor Disorders. Elsevier Health Sciences. ISBN   0443072728.
  22. ↑ O'Connor, Vivienne; Kovacs, Gabor (2003-10-07). Obstetrics, Gynaecology and Women's Health. Cambridge University Press. ISBN   9780521818933.
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