Labia Minora

Lying between both labia minora is a crenel (the vestibule) that contains the openings of the vagina, the urethra, the Bartholin's glands, and the bottom vestibular glands.

From: Subfertility , 2021

Reproductive beefcake

Jaclyn D. Nunziato , Fidel A. Valea , in Comprehensive Gynecology (Eighth Edition), 2022

Labia minora

The labia minora, or nymphae, are two small, red cutaneous folds situated between the labia majora and the vaginal orifice. They are more frail, shorter, and thinner than the labia majora. Anteriorly they carve up at the clitoris to form superiorly the prepuce and inferiorly the frenulum of the clitoris. Histologically they are composed of dense connective tissue with erectile tissue and elastic fibers, rather than adipose tissue. The pare of the labia minora is less cornified and has many sebaceous glands but no hair follicles or sweat glands. The labia minora and the breasts are the just areas of the trunk rich in sebaceous glands but without hair follicles. Among women of reproductive historic period, in that location is considerable variation in the size of the labia minora, and they are relatively more than prominent in children and postmenopausal women. The labia minora are homologous to the penile urethra and role of the skin of the penis in men.

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Neurology of Sexual and Float Disorders

Alessandra Graziottin , Dania Gambini , in Handbook of Clinical Neurology, 2015

The labia minora

The labia minora are two small cutaneous folds iii–iv  cm long, situated between the labia majora and extending from the clitoris anteriorly to the fourchette posteriorly (Putz and Pabst, 2008). Anteriorly each labium is divided into two portions: the upper division passes in a higher place the glans of the clitoris to fuse with the opposite part and forms the preputium clitoridis; the lower division passes under the clitoris, forming the frenulum of the clitoris with its contralateral part. The labia minora are rich in sebaceous glands, connective tissue, and vascular erectile tissue, with a considerable number of sensory nerve endings and receptors (Netter, 2010).

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Vulva, vagina and cervix

Tanya Levine , Winifred Greyness , in Diagnostic Cytopathology (Third Edition), 2010

Vulva

The labia majora and minora of the vulva are covered past keratinising squamous epithelium (Fig. 21.2) which undergoes very piddling hormonal change during the menstrual cycle. The outer surfaces of the labia majora are hair-bearing. The inner surfaces have many sebaceous glands and apocrine sweat glands, the secretions of which provide protection against infection and local damage to the peel.

The labia show pigmentation from the historic period of puberty, diminishing on the inner aspect of the labia minora where merely a thin layer of keratin is present. This epithelium extends to encompass the vestibule as far every bit the hymen. The vagina and the urethra open up onto the lobby of the vulva. Mucin secreting glands are present on either side of the vaginal introitus, including Bartholin's glands, which are situated in the lower vaginal wall, providing protection and lubrication.

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Vaginal and Urethral Disorders

Beverly H. Bauman MD , Robert L. Cloutier MD , in Pediatric Emergency Medicine, 2008

Labial Adhesions (Labial Agglutination)

Fusion of the labia minora is a common status in infants and toddlers that may be institute incidentally on examination or during attempts to perform urinary catheterization. vii The delicate pare of the labia minora can be easily irritated and inflamed from mild local trauma, harsh soaps, or soiled diaper contents. Upon healing, the labial surfaces may become fused to one some other, resulting in labial agglutination. Usually the adhesions start in the surface area of the posterior forchette and slowly advance towards the clitoris. This fusion may prevent visualization of the hymen and urethral opening (Fig. 94-1).

Most immature children are asymptomatic with labial adhesions, and therefore treatment is not routinely necessary. The adhesions may spontaneously resolve or resolve later effectually puberty with endogenous estrogen. Withal, if the patient has dysuria or if the parents have a preference to care for the condition, information technology can be managed with a several-week grade of once- or twice-daily application of topical 0.i% conjugated estrogen foam (Premarin cream). Potential side effects from systemic assimilation of topical estrogen cream include chest tenderness. Therefore, parents should be cautioned to avoid excessive use of the topical estrogen cream and discontinue its employ after the adhesions accept resolved. Post-obit successful labial separation, the application of petrolatum jelly to the labial area at night for several weeks can aid forbid recurrence of adhesions. Routine rapid forceful separation of the adhesions is discouraged because it is painful and will likely consequence in bleeding. If the labial adhesions cause urinary obstruction, topical lidocaine may be used to decrease the hurting of manual separation in the emergency section, yet the procedure is nevertheless likely to be painful, so systemic analgesics are advised. 7, viii

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Pediatric Vulvar Disorders

Lynette J. Margesson , in Obstetric and Gynecologic Dermatology (3rd Edition), 2008

Labial adhesions

Superficial fusion of the labia minora occurs in 1–3% of prepubertal girls. It starts posteriorly and usually involves the posterior two-thirds of the labia minora. Only rarely is there almost consummate labial agglutination .This is an acquired condition seen by and large in children 2–3 years of historic period 4 . The cause is unknown, merely local irritation, poor hygiene, genital trauma, and lack of estrogen may all play a role v . The result is inflammation and adherence of peel surfaces on either side of the labia, giving the vulva a flat appearance. Localized posterior fusion is often minor and asymptomatic. Although this condition resolves spontaneously with pubertal estrogenization, extensive fusion leaving only a pinhole opening tin can result in urine retention, urinary infection, genital irritation, and burning. The get-go line of therapy is topical estrogen foam, used two or 3 times a twenty-four hour period with gentle traction for 2–3 weeks if needed 6 . If extensive, surgery may be required i,seven–ten .

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The Female Reproductive System

Richard E. Jones PhD , Kristin H. Lopez PhD , in Human Reproductive Biological science (Fourth Edition), 2014

Labia Minora

The labia minora ("minor lips") are paired folds of smooth tissue underlying the labia majora. They range from light pink to brownish black in color in different individuals. In a sexually unstimulated status, these tissues comprehend the vaginal and urethral openings, merely upon sexual arousal they become more than open. The hairless pare of the labia minora has oil glands (but no sweat glands) and a few touch and force per unit area receptors. In older women or in women who have low estrogen levels, the skin of the labia minora becomes thinner and loses surface moisture.

Vestibule

The crenel between the labia minora is the foyer. Almost of this cavity is occupied past the opening of the vagina, the vaginal introitus. In women who have not previously had coitus, the introitus often is covered partially past a membrane of connective tissue known as the hymen. This tissue often is torn during beginning coitus, accompanied by minor hurting and bleeding. Notwithstanding it also can be cleaved by a sudden fall or jolt, by insertion of a vaginal tampon, or by agile participation in such sports as horseback riding and bicycling. In some women, the hymen can persist even subsequently coitus, peculiarly if the tissue is flexible. Thus, the presence or absence of a hymen is non a reliable indicator of virginity or sexual experience. In rare cases, a wall of tissue completely blocks the introitus, a condition called imperforate hymen. The condition is present in about 1 out of 2000 young women. Because an imperforate hymen can block menstrual menses, surgery is required to convalesce the trouble.

Urethral Orifice

Anterior to the vaginal introitus is the urethral orifice. This is where urine passes from the trunk. Below and to either side of the urethral orifice are openings of two small ducts leading to the paired lesser vestibular glands (Skene'due south glands). These glands are homologous to the male prostate glands (i.e. the two gland types are derived from the same structure in the embryo; encounter Chapter 5) and secrete a small corporeality of fluid. At each side of the introitus are openings of another pair of glands, the greater vestibular glands (Bartholin's glands). These glands secrete mucus and are homologous to the bulbourethral glands of the male person. Sometimes, Bartholin's glands can grade a cyst or abscess as the outcome of infection.

Clitoris

The glans clitoris lies at the inductive junction of the two labia minora, above the urethral orifice and at the lower border of the pubic os. The glans is the externally visible portion of the clitoris. Its average length is about 1–1.5  cm (0.5   in) and it is most 0.5   cm in diameter. There is, still, considerable individual variation in clitoral size. This cylindrical structure has a shaft and glans (enlarged cease). It is partially homologous to the penis. The clitoral shaft, like the shaft of the penis (Chapter iv), contains a pair of corpora cavernosa, spongy cylinders of tissue that make full with claret and cause the clitoris to erect slightly during sexual arousal (see Affiliate 8). At the base of the glans clitoris, the corpus cavernosa tissue branches and each "leg" or crus extends under the surface of the labia minora. Another spongy cylinder present in the penis, the corpus spongiosum, is not found in the clitoris; this tissue in the female is represented by the labia minora (Affiliate 5). The clitoral glans is partially covered by the clitoral prepuce, which is homologous to a similar structure covering the glans of the penis (see Chapter iv). The clitoris is rich in sensory receptors. Chapter eight discusses the role of the clitoris and other structures of the female vulva in the female person sexual response.

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Female person SEXUAL Office AND DYSFUNCTION

Irwin Goldstein , in Female person Urology (Third Edition), 2008

Urethral Meatus

Gentle retraction of the labia minora should provide a total view of the urethral meatus. Prolapse of the urethral mucosa out the urethral lumen is highly associated with estrogen deficiency states such equally natural menopause, surgical menopause due to bilateral oophorectomy, or deficiency caused by chemotherapy for malignancy. Clinical symptoms include urgency, frequency, and discomfort on urination; as well, spotting of blood may be observed on the toilet paper after wiping following voiding. The abnormal voiding history is often accompanied by a unique sexual history. Women with urethral prolapse often have the ability to have full sexual pleasure and satisfaction during self-stimulation of the clitoris, only with a partner or with a mechanical device she experiences pain, urgency to urinate, and/or inability to take orgasm secondary to distracting pain. Conservative treatment options include topical or systemic estrogens, although the risks and benefits of estrogen treatment need to be fully discussed. 64, 69

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Children: Normal Anogenital Anatomy and Variants

Yard.P. Deye , A.G. Jackson , in Encyclopedia of Forensic and Legal Medicine (Second Edition), 2016

Posterior Fourchette/Fossa Navicularis

With pubertal development, the labia minora intersect dorsally with the posterior fourchette. This aforementioned area is referred to as the posterior commisure in prepubescent girls since the labia minora are small-scale and not fused posteriorly. The fossa navicularis is the depressed area that extends from dorsal aspect of the hymenal base to the posterior fourchette. The fossa navicularis tin can appear erythematous due to visible vascularity, or in prepubescent girls waning effects of estrogen resulting in deeper pink advent. Some females may have lymphoid follicles in the fossa navicularis ( McCann et al., 1990; Altchek et al., 2010; Figure x). Other females may have a pale line in the midline. This is non a scar, only a normal variant, called linea vestibularis or fractional linear vestibularis, which results from an avascular expanse (Kellogg and Parra, 1991, 1993; Effigy 11). Exposure of mucosa in the midline of the fossa navicularis and/or posterior fourchette may also correspond failure of midline fusion (Heger et al., 2002a), which is further described below (Figure 12). The mucosa of the fossa may not always be smooth. In some cases at that place may be papillae or papules. Different verrucous lesions from human papilloma virus (condyloma acuminatum), these papillae and papules are normal findings, usually symmetric consistent with vestibular papillomatosis (Chan and Chiu, 2008; McCann et al., 1990). Additionally, neither vestibular papillomatosis nor lymphoid follicles modify in color when 5% acerb acrid is applied.

Figure x. Estrogenized, redundant hymen with lymphoid follicles in the fossa navicularis.

Figure eleven. Non-estrogenized, crescentic hymen with linea vestibularis in the midline of the fossa navicularis.

Effigy 12. Typical appearance of a failure of midline fusion that extends from the fossa navicularis to the perineal body (a). Minor failure of midline fusion that appears as a blind fistula in the fossa navicularis (b).

 Both photographs courtesy of Kathi Makoroff, Doc, Cincinnati Children's Infirmary, Cincinnati, OH.

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Sexual differentiation and the evolution of gender identity

John Bancroft MD FRCP FRCPE FRCPsych , in Human Sexuality and Its Issues (Tertiary Edition), 2009

Vulva

Flanking the vaginal opening are the labia minora, which are folds of skin much thinner than the labia majora, devoid of fat but also highly vascular. Anteriorly, as the labia minora converge towards the clitoris, they each bifurcate into two smaller folds, the inner of which merge together in the midline to form the frenulum of the glans of the clitoris. The outer folds form a fold of skin or prepuce enveloping the clitoris near its tip. Posteriorly, the labia minora are joined behind the vaginal opening by a sharp fold of pare, the fourchette. The area divisional by the clitoris, labia minora and fourchette is termed the vestibule and is normally moist. During sexual arousal not only do the erectile tissues of the deeper clitoral structures become engorged, but so practice the labia minora, which consequently get a little everted, exposing their inner moist surfaces and farther preparing the vestibule for entry of the penis. If penile entry is attempted in the sexually unaroused female, the flaccid labia minora may exist carried into the vaginal opening, causing discomfort. In the aroused woman, reciprocal movement of the engorged labia minora during penile thrusting serves to stimulate the body and glans of the clitoris.

In multiparous women, the vascular engorgement of the labia minora, which occurs during pregnancy and childbirth, leads to a permanent enlargement due to a degree of varicosity of the contained vasculature. Every bit a result, the labia minora are often visible between the labia majora, fifty-fifty in the unaroused country. This accounts for the considerable variability in external appearance of the vulva in dissimilar women, many of whom are self-conscious about this appearance and may exist reassured to larn that such variation is usual after childbearing.

Between the clitoris and the vaginal opening — a altitude of nigh 2 cm — lies the urethral opening.

In the virginal land, the vaginal opening is partially occluded by a sparse fold of peel, the hymen. The size of the hymeneal orifice and the thickness and elasticity of the hymen are variable. Ordinarily after puberty the orifice volition acknowledge a finger. In a woman who has had intercourse (or other forms of vaginal penetration) the hymen is generally torn in several places and its retracted remnants are represented past a fringe of pare tags (carunculae myrtiformes) which surround the vaginal opening. Very occasionally, the hymen is sufficiently elastic to allow penetration without rupturing. The hymen of some women is divided by a strand (i.east. with two or more orifices). This may become stretched rather than broken so that although intercourse or tampon insertion is possible, the strand remains and may become caught or stretched farther, causing pain and sometimes vaginismus (Sarrel 1976).

Just external to the zipper of the hymen, on either side, are the openings of the ducts from the two greater vestibular (Bartholin'southward) glands. These discharge mucoid secretion tardily during sexual arousal.

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Pediatric and adolescent gynecology

Eduardo Lara-Torre , Fidel A. Valea , in Comprehensive Gynecology (Eighth Edition), 2022

Labial adhesions

Labial adhesions literally means the labia minora accept adhered or agglutinated together at the midline. Some other term sometimes used to describe this condition is adhesive vulvitis. Denuded epithelium of adjacent labia minora agglutinates and fuses the two labia together, creating a apartment appearance of the vulvar surface. A telltale somewhat translucent vertical midline line is visible on physical examination at the site of agglutination. This narrow vertical line is pathognomonic for labial adhesions (Fig. 12.v). Labial adhesions are often partial, merely involving the upper or lower aspects of the labia. Small adhesions are common in preschool children, and perhaps as many as twenty% will have some caste of labial adhesions on routine test (Salary, 2015).

Inexperienced examiners may confuse labial adhesions for an imperforate hymen or vaginal agenesis. Although the physical examination findings are significantly different, all these weather may occlude the visualization of the vaginal introitus. In the patient with an imperforate hymen, the labia minora normally announced similar an upside-downwards 5 and no hymeneal fringe is visible at the introitus. In vaginal agenesis the hymeneal fringe is typically normal but the vaginal canal ends blindly behind the hymeneal fringe.

Labial adhesions are nigh mutual in girls between two and six years of age, with upward to ninety% of cases occurring before age 6. Estrogen reaches a nadir during this time, predisposing the nonestrogenized labia to denudation.

At that place is considerable variation in the length of agglutination of the two labia minora. In the most advanced cases there is fusion over both the urethral and the vaginal orifices. It is extremely rare for this fusion to exist consummate, and most children urinate through openings at the top of the adhesions, fifty-fifty when the urethra cannot exist visualized (pinpoint opening). However, the partially fused labia may form a pouch in which urine is defenseless and later dribbled, presenting as incontinence. Associated urinary infections have besides been reported and may be the presenting symptom leading to the diagnosis. Most patients will be asymptomatic or present with intermittent dysuria.

The recommended handling in asymptomatic patients is observation (Bacon, 2015). Near of the time treatment requests are driven past the parental business concern of a closed vagina and their interpretation that this may pb to an disability to take children in the hereafter or engage in intercourse. Although they do not explicitly say this, on further questioning, many parents disclose this kind of concern. With appropriate counseling and reassurance of the benign and common nature of this condition, every bit well as the probable resolution during puberty, most parents are reassured and follow advice. The majority of patients volition fall into this category and can exist reassured and followed over fourth dimension to spontaneous resolution when they produce their own endogenous estrogen. If spontaneous separation does non occur at puberty and manual separation is required, the presence of improve estrogenized skin decreases the chances of recurrence, which in children can range from 25% to 65%.

Some children present with symptoms, which may include voiding difficulties, dysuria, frequent urinary infections, urine dribbling afterwards voiding, recurrent vulvovaginitis, discomfort from the labia pulling at the line of adhesions, and, in rare cases, bleeding from the line of adhesion pulling autonomously.

Practice non attempt to separate the adhesions in the office by pulling briskly on the labia minora. It is very painful, and the raw edges are likely to attach again because the kid will exist reticent to permit application of medication after being subjected to this degree of pain. Even with local anesthesia, such as lidocaine ointments or creams, the potential pain and traumatic experience for the kid should deter providers from this intervention except in the well-motivated, mature child.

The most common handling of this condition is topical estrogen cream applied to the labia two times per solar day at the site of fusion. This usually results in spontaneous separation, typically in approximately 2 to 8 weeks. In cases in which resolution takes longer than several weeks, the clinician can reexamine the patient. If increased pigmentation is noted lateral to the midline of agglutination, the caregiver should be reinstructed to apply the cream to the line because the lateral pigmentation indicates the estrogen is existence applied lateral to the bodily adhesion. The action of estrogen and the awarding over the adhesion line itself make the treatment more constructive. Care should exist taken to not administer topical estrogen for more than 6 to 8 weeks considering prolonged apply has been associated with breast budding and, less commonly, vaginal bleeding from the peripheral furnishings of the absorption of estrogen. Failure of separation inside the normal time frame should trigger an alternative handling.

When estrogen therapy fails and symptoms persist, the use of midpotency topical steroids, such as betamethasone, twice a solar day for 6 to viii weeks has also shown adequate results and can be considered equally a showtime- or second-line treatment.

Once the status has been resolved, recurrence can frequently exist prevented past applying a bland ointment (such as zinc oxide cream or petroleum jelly) to the raw epithelial edges for at to the lowest degree one month or even longer. As previously mentioned, recurrences are mutual.

McCann and colleagues reported the association between injuries of the posterior fourchette and labial adhesions in sexually abused children (McCann, 1988). Labial agglutination alone is and so common that firsthand suspicion of child abuse based solely on this finding in 2- to 6-year- olds is unwarranted. Notwithstanding, the combination of labial adhesions and scarring of the posterior fourchette, especially in children with new-onset labial adhesions after age half dozen, should prompt the clinician to consider sexual corruption in the differential diagnosis.

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