The vagina ( medieval Latin vagina , vagina 'in the sense of "container for a blade", Greek κόλπος Kólpos , womb', originally, 'Bay' (from the sea); plural vaginas ) or vagina is a tubular primary sex organ of female mammals and thus also the woman . It connects the external cervix with the vaginal vestibule and protects the internal female sexual organs located deeper in the body. During intercourse , she can hit the penisa male partner ( vaginal intercourse ). It is also part of the birth canal . Usually the vaginal walls lie flat on top of each other, forming a gap-like shape similar to the letter "H".
The outer visible end of the woman's vagina belongs to the vulva . The vulva, together with the clitoris (the glans of the clitoris and the erectile tissue of the clitoris), play an important role in the sexual arousal of women, usually more than the vagina (see “ The woman's orgasm ”).
The term vagina is often used incorrectly in everyday language to denote the vulva as a whole (such as in the term " designer vagina "). In a broader sense, certain female reproductive organs when not in mammals as vagina are called, such as nematodes or insects .
Macroscopic anatomy in the woman
The vagina is a stretchable, muscular, connective tissue tube that is 8 to 12 cm long in adult women. The rear vaginal wall (pars posterior) is slightly longer than the front vaginal wall (pars anterior) due to the position of the uterus . The vagina lies roughly in the pelvic axis and crosses the pelvic floor here . In the unstretched state, it is flattened by the paracolpium , the anterior and posterior walls touch and enclose the lumen of the vagina, which forms an H-shaped gap and thus enables unfolding without great tension. There are also transverse folds on the anterior and posterior vaginal wall , which are known as vaginal wrinkles (rugae vaginales) and form an anterior and posterior wrinkle column (Columnae rugarum anterior et posterior) . These increase the irritant effect during sexual intercourse and at the same time represent a stretch reserve for childbirth.
The vagina opens with the vaginal opening (ostium vaginae or introitus vaginae) into the vaginal vestibule (vestibulum vaginae) of the vulva . Some women here there is a fold of skin, variously as a hymen ( Hymen ) is called. If the vaginal opening is normal, the menstrual blood can flow out.
On the uterus side , the portio vaginalis uteri of the cervix (cervix uteri) protrudes into the vagina. This is encompassed by the vagina so that it lies between the deep, posterior (dorsal) and the smaller lateral and anterior (ventral) flat vaginal vault (fornix vaginae) . The posterior vaginal vault extends to the Douglas space (Excavatio rectouterina) , a pocket-shaped bulge of the peritoneum ( peritoneum ) and thus the deepest part of the abdomen between the rectum and the uterus. The back wall (dorsal wall) of the vagina is connected to the rectum by connective tissue (septum rectovaginale) and the anterior wall is connected to the bladder and urethra via the septum vesicovaginale and the septum urethrovaginale . The cervix is bent forward by about 90 ° and therefore does not follow the direction given by the vagina.
Ultrasound image of 1: urinary bladder; 2: uterus; 3: vagina
External cervix (Portio vaginalis uteri) and rear end of the vagina of a breastfeeding woman after two births , Para 2 , view through a speculum.
Vulva vestibule (vestibulum vaginae) and vaginal
Muscles, blood supply and nerves
In addition to the smooth muscles in the vaginal wall, the vagina is surrounded by striated muscles that are arranged like a grid. The pubococcygeus muscle , part of the levator ani muscle, is a muscle of the pelvic floor . The muscles on both sides (levator thighs) encircle the vagina like a noose and allow the vagina to narrow at will.
The vagina is supplied with blood via the vaginal artery from the internal iliac artery , which arises below the uterine artery . There are also supply branches of the inferior vesical artery and the internal pudendal artery . The venous plexus surrounding the vagina ( plexus venosus vaginalis ) is drained through the vena uterina . The lymph in the upper part of the vagina flows via the internal lymph nodes into the lumbar lymph nodes (Nodi lymphatici lumbales), and from the lower part into the inguinal lymph nodes (Nodi lymphatici inguinales superficiales) .
Microscopic anatomy in women
The vaginal wall is very thin with a wall thickness of about three millimeters. The vaginal mucous membrane (tunica mucosa vaginae) has a multi-layered, uncornified squamous epithelium ( vaginal epithelium ) that shows only minimal preceratin formation. It is rich in glycogen and has no glands (cutaneous mucous membrane). The epithelium lies on a lamina propria , which is rich in elastic fibers and large-lumen veins. The epithelium is subject to constant restructuring processes in the course of the sexual cycle , which are controlled by estrogens and progesterone .
In cross-section, the vagina shows the following wall structure:
- Mucous membrane ( Tunica mucosa vaginae ): Determines the surface quality and ensures an acidic environment (pH around 4) through the dead cells of the vaginal epithelium, which, due to the very high glycogen content, represent a good substrate for lactic acid bacteria (Döderlein bacteria) and for the development of the special vaginal flora lead microbiome , which counteracts the colonization of bacteria. The actual vaginal epithelium and the underlying lamina propria are included in the tunica mucosa vaginae . The epithelium of the vagina is a multilayer, uncornified squamous epithelium that further differentiates into four layers:
- Basal cell layer ( stratum basale )
- Parabasal layer ( stratum parabasale )
- Intermediate layer ( stratum intermedium )
- Superficial layer ( stratum superficiale )
They sit on the lamina propria and consist of loose connective tissue that is rich in elastic fibers and lymphocytes . In the lamina propria there are capillaries and lymph vessels , from which a transudate is pressed through the epithelium into the vagina during sexual arousal , as well as the plexus venosus vaginalis . The vaginal nerve innervation or sensitivity is minimal. There are only a few free nerve endings , sensory fibers are completely absent.
- Muscle layer ( tunica muscularis vaginae ): On the inside one can see a circular musculature , on the outside a longitudinal musculature. They allow the vagina to contract in a ring-shaped and length-wise manner when it enlarges. These muscles are smooth muscles , embedded in a connective tissue framework. The mesh-like or lattice-like arrangement of the smooth muscle fiber strands has a circular course that is also longitudinal on the front wall. This musculature continues in the musculature of the cervix and the perineum. The existing connective tissue is arranged like a concertina and consists of collagen but also numerous elastic fibers. Due to this structure, an extensive stretching of the vagina is biomechanically possible.
- Connective tissue layer ( Tunica adventita vaginae ): It contains many elastic fibers and is connected to the connective tissue sheaths of the pelvic floor, urethra and urinary bladder. It is also known as the "paracolpium". The dense covering structure made of connective tissue connects the vagina with its surroundings, especially with the urethra. It contains numerous elastic fibers and borders on the head (cranial) to the parametrium.
Although the term vagina is mainly used in mammals, it is also used to describe analogous organs of other animal groups. For example, insects also have a vagina. This is located on the eighth segment of the abdomen and represents an unpaired structure lined with chitin , which absorbs the male's aedeagus (the analogue of the penis in insects) during mating.
Within the vertebrates, the vagina did not develop until the Theria , the systematic group that includes the marsupials and the higher mammals . In the case of reptiles and birds no vagina is formed in a narrow sense according to, but is in the bird anatomy of the last section of the countershaft intestine in which the Eioberhäutchen is formed, referred to as the vagina. In egg-laying monotones , the two uterus flow into a common urogenital sinus , which opens into a cloaca .
In the case of the marsupial mammals (Metatheria), the vagina is paired (vagina duplex), since the end section of the paired Müller's duct , from which the vagina arises in the embryo , does not merge in them. Both branches end in a common urogenital sinus and fuse there.
An undivided and therefore unpaired vagina is typical for all higher mammals, although many mammals have a two-part uterus. As with the aardvark , for example, this can be completely separate and open into the vagina via two separate mouths. Since the hymen in most non-primates is only formed as an indistinct ring fold, the urethral orifice is defined as the posterior border of the vagina and thus as the transition to the vaginal vestibule. In some mammals, such as pigs , no portio and therefore no vaginal vault is formed. Occasionally there are rudiments of Wolff's duct on both sides, shortly before the posterior border of the vagina , which are referred to as Gartner ducts (Ductus deferentes vestigiales) .
In elephants , the vaginal opening is still in front of the hind legs and has to be pulled back for copulation. In whales, the genitals are shifted very far into the back and are close to the kidneys , the vagina opens here in an elongated fold.
The vaginal secretion present in the vagina consists of the cervical mucus formed in the cervical glands of the uterus and the transudate emerging from the vaginal wall . In addition, there are dead cells of the vaginal epithelium, which, due to the very high glycogen content, represent a good substrate for lactic acid bacteria ( Döderlein bacteria ) and a special vaginal flora . The organisms convert the glycogen into lactic acid , which is present in a concentration of about 0.5%.
Because of the lactic acid bacteria, the woman's vaginal secretion is acidic ( pH value 4 to 4.5) and serves to protect the female genital tract from ascending infections . The vagina also acts as a drain for menstrual bleeding from the uterus. In young girls before puberty, on the other hand, they are mainly colonized by staphylococci and streptococci , which provide little protection against germs.
Sexual arousal and intercourse
During vaginal intercourse, the vagina receives the penis and the sperm it expels with the sperm it contains . The vaginal environment changes during sexual arousal . The secretion becomes pH-neutral through the lubrication and the production and secretion of thin mucus in the cervical glands. The Bartholin's glands, which open into the vaginal vestibule, also secrete a mucous secretion when excited and moisten the vestibule, which makes it easier for the penis to penetrate the vagina. After the man ejaculates , the sperm is transported through the cervix, into the uterus and further down the fallopian tubes. The same applies to all other primates , ruminants , rabbits and some rodents . In contrast, in horses , dogs and pigs, for example, the penis can penetrate behind the cervix and ejaculate the sperm directly into the uterus.
Vaginal intercourse, like other forms of sexual activity, can lead to orgasm . Since the vagina essentially consists of relatively nerve-poor tissue, however, it is controversial whether the vaginal orgasm is triggered by the irritation in the vagina or an irritation of the clitoris triggered by the movement . The Graefenberg zone (also known as the G-spot) discovered by Ernst Graefenberg , located about three to four centimeters from the vaginal entrance in the front wall of the vagina, is considered to be particularly sensitive and sexually excitable in this context. It is adjacent to the paraurethral glands , which release sexual secretions when stimulated ( female ejaculation ). In an orgasm triggered by the vagina, different sensory nerve conduits are involved than in an orgasm, which is mainly caused by irritation of the clitoris. In the vaginal orgasm, the hypogastric plexus and the pelvic nerves are mainly addressed; in the clitoral orgasm, the pudendal nerve is addressed .
Some women prefer a direct caress of the clitoris body, with others the sensitivity at the vaginal entrance and the small Venus lips is particularly pronounced and some women prefer deep penetration. The venous plexuses around the urethra and vagina are also part of the active, erogenous system of women.
Contrary to previous assumptions, more recent scientific studies suggest that 70–80% of women can achieve orgasm solely through direct clitoral stimulation. Although indirect stimulation of the clitoris can also be sufficient, empirically it can be assumed that the majority of women cannot orgasm simply by penetrating the penis into the vagina. In contrast, the vaginal opening or the vaginal entrance (introitus vaginae) is very richly innervated with mechanoreceptors .
Theory of the distance between the clitoris and the mouth of the urethra
In a study from 1924, the psychoanalyst Marie Bonaparte , also known under the pseudonym AE Narjani, examined the distance between the clitoris and the opening of the urethra (meatus urethrae) , also known as the clitoral-urinary meatus distance (CUMD), in a total of 43 women , and then asked the test subjects about their sexual experiences. The point of reference for their measurements was the junction of the paired frenula clitoridis with the meatus urethrae externus located in the introitus vaginae . It was shown for the examiner in her evaluations that there was a correlation between the CUMD and the ability to orgasm. In other words, the closer the clitoris was to the urethral orifice, the more often the affected women experienced orgasm. It is hypothesized that women whose clitoris is closer to the urethral opening have an orgasm more often than women whose distance is greater. Bonaparte went so far as to test her hypothesis on herself to the point that she underwent an operation to move her clitoris closer to the vaginal entrance. In three operations carried out between 1927 and 1932 by the Viennese gynecologist Josef von Halban , the ligaments of the corpus clitoridis were severed and the glans of the clitoris was placed next to the mouth of the urethra. However, the operation did not bring about the increase in vaginal pleasure that Bonaparte had hoped for.
These studies were repeated by Carney Landis (1897–1962) and his colleagues in 1940 and produced similar results. According to more recent studies, however, these results are interpreted more functionally. Accordingly, it would be important in vaginal intercourse that there should be a cohabitational approach between the introitus vaginae and the clitoris.
At birth , the vagina becomes part of the birth canal for the child. The contractions and the associated opening of the cervix and the birth canal (opening phase of childbirth) mainly lead to a softening of the vaginal muscles, which allow them to stretch during the later birth process (expulsion phase of birth). This strain also concerns the Vorhofschwellkörper and the tissue of the labia and the dam, which may crack under the strain ( laceration ) and is cut at birth may ( episiotomy ).
Ontogenetic development of the vagina
The vagina develops together with the uterus and fallopian tubes from the paired Müller duct (ductus paramesonephricus), which is created embryonically in the urogenital ridge next to the urinary duct (Wolff duct, ductus mesonephricus ) . While in the male embryos the development of the Müllerian duct is suppressed by the anti-Müllerian hormone (AMH) formed in the fetal testes and these are regressed, in the female embryo it is transformed into the internal genitals without this hormone.
Here, from the 7th week of development from the Müllerian duct without hormonal inhibition, the fallopian tubes are (fallopian), the uterus (womb) and the vagina formed during the Wolff-speed regresses.
While the upper, cranial part of Müller's duct runs vertically and forms the fallopian tubes together with the middle part, the uterus and vagina are formed from the lower part. The originally paired ducts merge and merge at the end of the third month of development to form a duct which, under the influence of estrogens, differentiates into the uterus, the cervix and the upper area of the vagina. The lower end of this canal forms the sinovaginal cusp and ends at the posterior wall of the urogenital sinus. A thickening of the cusp and the wall of the urogenital sinus forms an epithelial plate, the vaginal plate, which in the 5th month of development protrudes at its upper end and finally breaks through at the end of embryonic development and forms the vaginal outlet with the hymen.
The role of the Hox genes in vaginal development
Some animal models have already shown that Hox genes play an important role in the development of the urogenital system . HOX-A10 was important for the development of the uterus , HOX-A11 for the caudal part of the uterus, HOX-A13 for the cranial part of the vagina and HOX-A9 for the fallopian tube development . Disturbances in the expression of these Hox genes lead to corresponding developmental disorders. Thus, disturbances of that for the development of further portions of the vagina and the formation and regulation of Hox A13 genes were extracellular matrix is responsible, in the context of a pelvic floor weakness , (Engl. Pelvic organ prolapse, POP).
The vagina can be felt with the fingers. A speculum , vaginoscope or colposcope are used for visual assessment . Regardless of gynecology, women can also explore and examine the vagina themselves in the context of a vaginal self-examination .
To examine the vaginal skin and the vaginal environment, epithelial cells are obtained through a smear and examined under a microscope on a slide. The vaginal cytology provides information about the current cycle phase. Today, however, the determination of the cycle phase is expanded to include hormone examinations in order to provide sufficient diagnostic reliability. In addition, tissue samples can be taken using a vaginal biopsy .
Malformations and positional anomalies
Vaginal malformations include various congenital disorders in the ontogenetic development of the vagina. These can only affect the vagina in isolation or can also occur in combination with malformations of the uterus and urinary tract. There are also malformations in the area of the vaginal outlet and the vaginal vestibule.
In the case of vaginal aplasia , the lack of formation of vaginal buds and the vaginal plate in the ontogenetic development leads to a malformation of the inhibition of the vagina and thus the complete absence of the vagina, since the Müller ducts do not break through into the urogenital sinus. It occurs primarily as a symptom of Mayer-Rokitansky-Küster-Hauser syndrome , Swyer syndrome , complete androgen resistance or Turner syndrome and is then associated with other malformations, such as the absence of the uterus. The correction is usually carried out by what is known as colpopoiesis , in order to enable normal sexual intercourse.
Other malformations concern the complete or partial occlusion of the vagina in the upper part of the vagina, which is known as vaginal atresia . In the vaginal vestibule there are forms of the hymen that close the vaginal entrance over a large area or, in the case of hymenal atresia , completely. The result of this closure is a hydrocolpos with accumulation of fluid in the vagina or hydrometrocolpos with accumulation of fluid in the uterus in newborn or a Hämatokolpos with impoundment of menstrual blood in the vagina or a hematometra (Hämatokolpos) with damming also into the uterus.
In the vagina septa , a double malformation occurs as a result of disturbances in the fusion of the paired vaginal buds, in which the vagina consists of two parallel tubes. If this is limited to the upper area, it is called the vagina subsepta. The vagina septa is often associated with more complex malformations such as Herlyn-Werner-Wunderlich syndrome or Meacham syndrome .
In contrast to malformations, positional anomalies are usually not congenital but acquired. These are various decreases in the height of the vagina above the pelvic floor , which can be caused by a sagging of the vagina or a vaginal prolapse . A complete protrusion of the vagina, called inversio vaginae , is very rare and can occur together with the protrusion of the uterus ( inversio uteri ) as a birth complication .
Illnesses and injuries
Various diseases and injuries can occur in the vagina, some of which can also affect the vulva or lower-lying genital organs such as the cervix or uterus.
Inflammation and infection
Acute and chronic inflammation with itching, redness and altered discharge are among the most common diseases of the vagina, which are known as colpitis or vaginitis. There is often a common inflammation of the vulva and vagina called vulvovaginitis . Inflammation of the vagina is mainly caused by infections with viruses , bacteria or fungi . The most common bacterial infections ( bacterial vaginosis ) are caused by Gardnerella vaginalis , Escherichia coli , gonococci , enterococci , staphylococci , streptococci and chlamydia . Among the vaginal fungal infections , the so-called vaginal fungus Candida albicans is particularly important, as it can trigger candidiasis . Trichomonas vaginalis (single-celled organisms) and viruses can also cause vaginitis .
In addition to the infections, inflammation can also occur as a result of injuries and as a result of damage or loss of vaginal secretions and flora. This may include external factors such as the use of intimate sprays, vaginal douches , antibiotics , spermicides and organic causes such as estrogen deficiency , diabetes mellitus , secretion, menorrhagia , immune and tumor diseases lead. Vaginitis is more common in childhood and old age than between puberty and postmenopause due to the low level of estrogen production.
Acute and chronic diseases
In addition to infection and inflammation, the vagina can also be affected by various diseases such as vaginal fistulas or tumors. Vaginal fistulas are acute, open connections between the vagina and neighboring hollow organs such as the urinary bladder, urethra or rectum or to the surface of the perineum. You can, for example, by chronic pressure damage. during pregnancy, but also by surgery.
In endometriosis , the lining of the uterus (endometrium) can spread outside the uterine cavity (ectopic) and thus also affect the vaginal wall and the connective tissue between the vagina and the intestine.
Vaginal tumors can appear as both benign ( benign ) and malignant ( malignant ) tumors. Vaginal carcinoma , which occurs as a cancer primarily in the upper part of the vaginal region, should be mentioned among the latter . Since symptoms often appear late and the carcinoma often metastasizes very early via the regional lymphatics , the prognosis for larger tumors is usually poor.
The Vaginodynie long lasting causes pain in the area of Vaginalausgangs without a physical findings present. The reasons for these conditions are unclear, but a psychological background that triggers a chronic genital pain syndrome is suspected. Also of vaginismus , which is characterized by a strong sensitivity and pain in the vaginal orifice is classified as psychological factors.
Injuries and foreign bodies
Injuries to the vaginal wall, usually tears in the vagina or vagina, can have different causes. These can be injuries caused by foreign bodies in the vagina as so-called impaling injuries , or coitus injuries due to violent sexual intercourse. In addition, cracks in the vaginal wall can also occur during childbirth as a labor complication. Minor injuries lead to short-term bleeding and heal within a short time; if the bleeding is more severe, medical examinations or even operations are necessary. A particularly serious injury is the total or partial tearing of the vagina from the uterus, known as colporrhexis .
A foreign body in the vagina, also known as an intravaginal foreign body, is usually an object inserted through the vagina and located there. This can become clinically relevant if it cannot be easily removed by the patient in the intended manner. The most common cases concern children, where the foreign bodies are introduced with playful intent. In adults, foreign bodies may have been introduced for various reasons, for example for hygiene (such as tampons ), to prevent or sexual stimulation (z. B. masturbation ). In addition to injuries, foreign bodies can also cause inflammation or changes in the flow of mucus. Vaginal stones are concrements that can form, for example, from chronic urine congestion .
Contraception and medication through the vagina
Means to prevent pregnancy can also be used in the vagina.
A so-called diaphragm can be inserted into the vaginal vault and combined with the introduction of a chemical active substance against the seeds ( spermicide ). In the USA, so-called “contraceptive sponges” made of polyurethane are also offered instead of the diaphragm . Further barrier methods are the LEA contraceptive or the cervical cap , also in combination with the spermicides mentioned. As a counterpart to the condom for men, there is the femidom for women .
The vaginal ring has been on the market as a hormonal contraceptive method for several years . This flexible ring is inserted into the vagina and releases progestin derivatives there for 21 days . These have the same mechanism of action as oral contraceptives ( birth control pills ).
In addition to contraception, medication can also take place via the vagina using a suppository (vaginal suppository ). Vaginal suppositories are used to treat gynecological diseases such as thrush colpitis, but also to alleviate menstrual symptoms such as stress incontinence, which can result from a deficiency in estrogens (which can be treated by estrogen forms ) and the atrophy of the vaginal membrane and the connective tissue structures below it. Furthermore, spermicidal suppositories can be used for contraception.
In classical antiquity, the word vāgīna was not used in its anatomical meaning. In classical Latin , vāgīna meant "sheath of the sword, sleeve".
Colloquially, there are innumerable names for the vagina (for example "honey pots").
Vagina in art and culture
As an internal organ, the vagina does not play a central role in the performing arts; depictions of the female genitalia usually relate to the external sex, the vulva. It should be noted, however, that in the artistic representation of the vulva, the emphasis can be more or less focused on the vagina or the vaginal opening as a symbol of sexuality and birth. This is the case, for example, with the Sheela-na-Gig, which is particularly widespread in Ireland . These are stone sculptures that usually depict the vulva in an oversized manner and present the vaginal opening.
In psychology that finds vagina dentata , which dentulous vagina ', more attention. It reflects the fear of a toothed vagina that might bite off and devour the penis. The motif can be found in various Asian myths, where different forms of penis fear ( Koro ) can be found. The vagina dentata was named by Sigmund Freud , who put it in the context of castration anxiety .
In her play Vagina-Monologe , published as a book in 1998 , Eve Ensler gave the vagina a polyphonic voice based on 200 interviews. “Because the monologues are so funny and emotional, it's easy to overlook their intellectual content. In doing so, they build a bridge between popular entertainment and sophisticated thinking about sexuality. "
In 2016, Giulia Becker created the vagina with her music video for Verdammte Schei * e in Neo Magazine Royale, an anthem that went viral on YouTube with over a million views (as of 2019) and was commented on in numerous print and online media.
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- Hymeneal atresia. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 564.
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- see also pelvic floor training , Rin-no-tama balls
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- vaginitis. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 563.
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- vaginal tumor. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 565.
- Vaginodynia. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 565.
- Vaginismus. In: Pschyrembel Dictionary Sexuality. Berlin 2006, pp. 565-566.
- vagina. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 457.
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- Foreign body, intravaginal. In: Pschyrembel Dictionary Sexuality. Berlin 2006, p. 457.
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- www.mundmische.de: Honey pot
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- Don't do that! In: The time . 15th November 2017.
- Kathrin Hollmer: The one with the Scheiden song . In: Süddeutsche Zeitung . February 24, 2018.