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  • My age:
  • 59
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  • I'm from China
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  • Libra
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About

A rash in your vaginal area vulva may be caused by irritation of the skin from many sources, such as clothes rubbing against the skin. Rashes that occur without other symptoms are usually minor and often go away with home treatment. A common cause of a rash is contact with a substance that causes irritation or an allergic reaction contact dermatitis.

Description

In Diagnostic Ultrasound: Abdomen and Pelvis Transverse transabdominal ultrasound shows the mid to lower vagina at the level of anal canal.

How life events and ageing can change your vagina

For transabdominal US of the vagina, caudal angulation of the US probe is needed on both longitudinal and transverse scans. Note that the vaginal canal is better demonstrated on transabdominal US because the angle of insonation is more favorable, approaching a right angle. Transverse transabdominal ultrasound of the mid vagina shows the levator ani muscles adjacent to the posterolateral aspect of vagina.

Upper vagina is shown at the level of the ureteric orifices. The ureters run lateral to the lateral fornices of the vagina, cross anteriorly, and then enter into the posterior wall of the bladder. This is a useful plane for investigation of the ureteric jets. The vagina is a fibromuscular, collapsed tube, when it is in a relaxed state.

The lateral walls of the vagina are more rigid than anterior and posterior walls. Because of this, the vagina has a H-shaped cross section in the central portion.

The length and shape of the vagina varies between women with an average length of 6. The vagina is located within the female pelvis, anterior to the rectum and the anus, posterior to the urinary bladder and the urethra and laterally to the ureter and uterine artery. It Local pussy Middle at a 45 degree angle in relation to the perineum, and 90 degree angle in relation to the uterus. The vagina is attached to the pelvic walls by ligaments and endopelvic fascia, a system of connective tissue. Protrusion of the cervix into vagina forms vaginal fornices, that is, recesses of vaginal vault, divided into two lateral fornices; anterior fornix and posterior fornix.

The posterior fornix is the deeper recess and is adjacent to the rectouterine pouch, whereas the smaller anterior fornix ads the vesico-uterine pouch Standring, Barbara S. Apgar, Gregory L. Colposcopic examination of the vagina is indicated for the evaluation of abnormal cytology whenever cervical colposcopy is negative or for the evaluation of abnormal cytology after hysterectomy for CIN 2,3 or invasive cervical cancer. Other indications for vaginal colposcopy may include a history of maternal DES exposure, following the identification of gross vaginal lesions by inspection or palpation, suspected VaIN, or for the evaluation of extensive HPV-associated lesions in the vagina.

The goal of the vaginal colposcopy is to identify the presence and extent of preinvasive or invasive vaginal disease and to select appropriate therapy Table Colposcopic examination of the vagina is more tedious and more technically challenging than colposcopy of the cervix. The speculum blades obscure the anterior and posterior walls of the vagina, and colposcopic grading of lesions in the vagina is undefined. Vaginal colposcopy is performed in the dorsal lithotomy position. If possible, the buttocks should be raised 5 to 10 degrees. A thorough inspection of the vulvar vestibule is completed before the vaginal examination.

Local pussy Middle appropriately sized speculum should be chosen and carefully inserted into the vagina. The size of the speculum should be deep enough to view the cranial portion of the vagina but allow easy rotation so that the entire vagina may be visualized. The vaginal mucosal folds are inspected for acetowhite changes by rotating and withdrawing the speculum and observing the epithelium as it rolls over the speculum blades during withdrawal of the speculum. The application of half-strength Lugol's iodine to the vaginal mucosa after examination for acetowhite changes is frequently helpful in identifying multifocal areas of epithelial change or areas that were ly undetected.

In well-estrogenized women, the normal vaginal epithelium is well glycogenated and will turn a dark mahogany brown color after the application of half-strength Lugol's iodine.

Abnormal vaginal epithelium will reject the iodine and appear yellow in color. Lugol's iodine will dehydrate the vaginal epithelium, and women should be warned of potential discomfort. If the vaginal speculum needs to be withdrawn and reinserted, a thin coating of lubricating jelly on the speculum can ease the process. The use of an iris hook can expose hidden areas by stretching the mucosa and flattening the rugae, thus enhancing the identification of abnormal areas.

Biopsy sites in the vagina should be selected at the time of colposcopic examination. The ancillary tools that may be helpful in vaginal colposcopy are listed in Table The use of diluted Lugol's iodine aids in selecting sites for biopsy, especially when the lesions are multifocal Figures and The vaginal epithelium should also be palpated to detect any indurated areas.

Cervical punch biopsy instruments are normally used to obtain the sample.

The vagina

It is helpful to elevate the biopsy site with an iris hook or a single-toothed tenaculum to ensure that the stroma is included in the specimen so that invasive cancer can be excluded. In performing a vaginal biopsy, the clinician must strike a balance between taking a biopsy that is too deep the vaginal epithelium may be only 1 mm thick, and a deep biopsy may go through the full thickness of the vaginal wall and taking one that is too superficial and will not exclude invasion.

When vaginal colposcopy with biopsy cannot be obtained in the office with the use of local anesthesia, an evaluation under conscious sedation may become necessary. It is rarely necessary to suture the vagina after a punch biopsy.

Bleeding is generally controlled with the application of thickened Monsel's solution ferric subsulfate and direct pressure. VaIN is usually asymptomatic and is usually identified following colposcopy and biopsy for evaluation of an abnormal Pap smear.

Women occasionally complain of abnormal vaginal bleeding or an unusual vaginal discharge, although these symptoms are uncommon. Nevertheless, identification of VaIN is challenging for the colposcopist because it does not produce a characteristic appearance, like CIN.

The colposcopic appearance and histology are more often disparate than in CIN. VaIN may occur in association with vaginal condylomata. VaIN lesions may be leukoplakic Figureerythematous, or ulcerated 42 Figures and These lesions may be multifocal and may show a micropapillary surface similar to subclinical condyloma Figure If lesions are present, the surface pattern tends to be irregular, possibly owing to the loose configuration of the vaginal mucosa.

What are the parts of the female sexual anatomy?

Atrophic changes of the vagina may mask the colposcopic appearance of VaIN. Topical estrogen cream may reverse these changes and allow a more thorough colposcopic examination. The colposcopic examination should be repeated after daily application of topical vaginal estrogen for 3 weeks Figure Colposcopic patterns of VaIN may reflect findings that are slightly more severe than the histologic diagnosis.

Prediction of histology from abnormal colposcopic appearances, especially the lower grades of VaIN, is more difficult in the vagina than on the cervix.

Iodine staining may show partial uptake or no staining in low-grade lesions but may be strongly nonstaining in VaIN 3 lesions. Lesions that are raised, exophytic, or nodular, along with those that exhibit atypical vessels, coarse punctation, or mosaic and ulceration must raise the Local pussy Middle for vaginal carcinoma.

Because there is not a strong correlation between vaginal colposcopy and histology, biopsy of all suspicious lesions may be necessary. The colposcopic appearances of clinical and subclinical HPV lesions are similar to those on the cervix. They may be grossly visible or seen only with the colposcope. They are frequently characterized by the presence of microspikes or exhibit a micropapillary appearance.

Flat condylomata may exist as multifocal lesions and be indistinguishable from VaIN, with which they may coexist. It may be difficult to distinguish VaIN 1 and flat condylomata by cytology, colposcopy, and histology.

The colposcopic features of vaginal squamous cancer are similar to those of other lower genital tract squamous carcinomas.

Vaginal dryness

Exophytic tumor and true erosions or ulcerations may be present. Examination of the vasculature may reveal atypical corkscrew-like or spaghetti-like vessels similar to those that might be seen on the cervix.

Vaginal lesions that may mimic invasive cancer include traumatic ulcers and erosions such as tampon ulcers and pessary injuries Figureatrophic and postirradiation changes, endometriosis, granulation tissue Figureand inflammatory disorders Figure Biopsy may be necessary for diagnosis. Matthew R. Lindberg MD, Laura W. Anteriorly, vagina is separated from bladder by fibroadipose tissue; urethra enters vaginal wall distally. Middle portion is separated from rectum by rectovaginal septum, layer of fibroadipose tissue. Distal portion is separated from anal canal predominantly by sphincter musculature.

Intermediate cell layer is most prominent with more abundant cytoplasm that is sometimes glycogenated.

Superficial cell layer appears flattened with cells showing pyknotic nuclei and dense eosinophilic cytoplasm with occasional keratohyalin granules. Scattered spindled to stellate stromal cells nuclei may be multilobated.

Vaginal rashes and sores

Outer loose connective tissue layer contains peripheral nerves, blood vessels, and lymphatics. Muscular tube formed by smooth muscle and elastic connective fibers. Serves as excretory duct for uterus, female organ for copulation, and part of birth canal. Extends up and back from vestibule of external genitalia to surround cervix of uterus.

Has anterior and posterior walls, normally in apposition, with longer posterior wall. Superiorly, cervix projects downward and backward into vagina and divides vagina into shallow anterior, deep posterior, and lateral fornices.

Thin mucosal fold called hymen surrounds entrance to vaginal orifice. Outer surface adventitial coat is thin fibrous layer continuous with surrounding endopelvic fascia. Branches of VA and UA anastomose to form 2 median longitudinal vessels: Azygos arteries, 1 in front and 1 behind vagina.

Venous drainage — Form venous plexus around vagina.

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