The vaginal vestibule: assessing the case for an anterior and posterior division

Abstract

The vaginal vestibule has not been the subject of a dedicated journal article. Recent terminology has suggested its division into anterior and posterior components. The case for this division has not yet been assessed. Both components extend laterally from the hymen to the junction with the labia minora. The posterior vaginal vestibule is proposed to extend from the posterior aspect of the hymen to the anterior edge of the perineum whilst the anterior vestibule extends from the posterior aspect of the hymen to just below the clitoris. Anatomical considerations (differing layers) might firstly support the above division. The posterior vestibule, by necessity, is far more flexible with the superficial aspect (approximately 1.5 cm), anatomically and histologically, comprising skin and subcutaneous tissue, with perineal musculature deep to this. In turn, it is more likely to be subject to obstetric and surgical considerations than the anterior vaginal vestibule. Obstetric trauma, in particular, would tend to create defects, particularly at its posterior margin. Many dermatological and microbiological considerations may be common to both anterior and posterior vestibule. Any dermatological condition of the vestibule can result in sexual dysfunction and can be complicated by secondary muscular spasm. Congenital anomalies will differ anteriorly and posteriorly. Multiple considerations can be identified to support the case for division of the vaginal vestibule into anterior and posterior components. Neurourol. Urodynam. 36:979-983, 2017. © 2016 Wiley Periodicals, Inc.

Surgical anatomy of the vaginal introitus

“…3 The lateral junction, Hart's line, is where the smoother and shinier transitional appearance of the nonkeratinized stratified squamous epithelium, similar to the vagina, changes to keratinized skin. 3 It contains the openings of the vagina, urethra, and the ducts of the greater vestibular glands. 3 The overall anatomy and the layers of the anterior vestibule differ significantly from those of the posterior vestibule.…”

“…3 The overall anatomy and the layers of the anterior vestibule differ significantly from those of the posterior vestibule. 3 The anterior vestibule is more fixed anatomically overall and contains the pyriform-shaped erectile bodies known as the vestibular bulbs. 3 These do not extend as far posteriorly as the posterior vestibule.…”

Joint Report on Terminology for Cosmetic Gynecology

“…[85][86][87] Women with vaginal laxity may experience sexual dysfunction that manifests as a dyspareunia, increased vaginal 'wind,' obstructed intercourse, or loss of or decreased libido. 85,88 They may also describe entrapment of bath or shower water in the vagina, which empties upon standing or difficulty retaining a tampon. Among 324 urogynecology patients, vaginal laxity was reported by 24% with a mean bother of 5.7 (on a 0-10 Likert scale).…”

“…Objective evaluation of vaginal laxity has not been standardized, but a variety of measurements have been proposed. Haylen and colleagues 85 describe the following measurements:…”

“…84 Vaginal laxity is a symptom that has broad associations including being a symptom of prolapse and a complaint of excessive vaginal looseness. [85][86][87] Women with vaginal laxity may experience sexual dysfunction that manifests as a dyspareunia, increased vaginal 'wind,' obstructed intercourse, or loss of or decreased libido. 85,88 They may also describe entrapment of bath or shower water in the vagina, which empties upon standing or difficulty retaining a tampon.…”