Vagina -brief

1. VAGINA

2. ANATOMY
 DEFINITION : IT IS A MUSCULO MEMBRANOUS TUBE EXTENDING FROM VULVA
OUTSIDE TO THE UTERUS
 SITUATION : Between bladder and rectum
 DIRECTION :In the erect position, vagina is directed upwards and backwards
.It is slightly curved posteriorly
 SIZE AND SHAPE : Vaginal canal is H shaped slit with lower end narrower
than upper end . anterior wall measures 6-8cm posterior wall 7-9 cm
respectively.

3. Vaginal furnices
 ANTERIOR FORNIX : Close in relation to bladder
 POSTERIOR FORNIX: Related to pouch of douglas & rectum
 RIGHT & LEFT FORNIX: Ureter and urinary artery

4. RELATIONS:
 ANTERIOR: bladder and urethra
 POSTERIOR: pouch of douglas, rectum, perineal body
 LATERAL: levator ani muscles

5. Blood supply:
venous drainage: venous plexusint.iliac veins and
lymphatic drainage: iliac, int.iliac, inguinal lymph nodes

6. VAGINAL EXAMINATION
 INSPECTION : vagina is first inspected by separating labia minora with left
hand and next the speculum examination is done to inspect the cervix and
vaginal vault
 PALPATION : by PV digital examination
• Anteriorly : urethra , bladder & pubic symphysis
• Posteriorly : rectum , pouch of douglas
• Laterally : ovary, tube , lat. Pelvic wall , thickened ligaments ,ureter
• Superiorly : cervix
 Bimanual examination : to assess size & position uterus, enlargement of
ovaries, f.tubes and other pelvic masses

7. CLINICAL MANIFESTATIONS
 VAGINAL DISCHARGE
 VAGINITIS
 VAGINAL PROLAPSE
 VAGINAL LACERATION
 VAGINAL CANCER

8.  Vaginitis
 Common in
 Vaginal pH - doderlein’s bacilli glucogon, oestrogen
 Causes: bacterial , fungal , protozoal , viral ..
 Symptoms : itching or burning malodourous discharge .
 Signs : vulvar erythema ,swollen and tender vagina, oliguria, dysuria

9.  Vaginal discharge
 Ask about colour , consistency, amount , foul smelling / not
i. Purulent discharge bacterial vaginosis
ii. Thick Curdy white discharge candida vulvovaginitis
iii. Profuse frothy yellowish discharge  trichomonas vaginitis
iv. Watery ,fishy smelling discharge  gardnerella vaginalis

10.  Vaginal prolapse
 Weakness of supports of uterus can give rise to different degree of prolapse.
 Causes : ligamentary weakness, multiparous women, prolong labour stress,
pudendal nerve damage, raised IAP, spinal deformity,
 Anterior wall drags bladder or urethra cystocoele or urethrocoele
 Posterior wall drags rectum rectocoele
Trauma to anterior & posterior walls of vagina vesicovaginal , urethrovaginal ,
rectovaginal fistula.
 Vaginal carcinoma
 Primary carcinoma of vagina
 Invasive carcinoma of vagina includes 2 main types
a) Squamous cell carcinoma
b) Adenocarcinoma  endometrial and mucinous type

11. Other inflammatory conditions of vagina
 Oestrogen deficiency vaginitis
 Senile vaginitis
 Secondary vaginitis
 Ulceration of vagina , granulations,cysts, stenosis and atresia
 amoebiasis

12.  Diagnostic tools
 KOH prep: pseudohyphae of candida
 Whiff test : fishy odour in bv
 pH : > 4.5 nitrazine paper
 Clue cells with fuzzy border  bv
 Hanging drop test : motile trichomonous org
 CULTURE
 Chocolate agar  gonococci
 Sabouraud’s medium  candida
 Special enriched medium  trichomonous
Vaginal smears  lateral vaginal smears : cytohormonal assessment
vaginal pool or vault smears: pfv –endometrial and ovarian cancer.

13.  bacterial vaginosis –metronidazole 500 mg orally BD for 7 days ,
clindamycin cream vaginally.
 Candida vaginitis – vaf –butaconazole ,clotrimazole & miconazole
oaf-fluconazole SD 150mg dose
 Trichomonas vaginitis – metronidazole
 Gardnerella vaginosis – metronidazole , tetracycline /doxycycline,
sulphafurazole
 management

14. Thank you