vulva

The vulva comprises: mons pubis (fatty tissue over pubic symphysis), labia majora (hair-bearing, homologous to scrotum, derived from labioscrotal swellings), labia minora (hairless, derived from urogenital folds), clitoris (erectile tissue homologous to penis, derived from genital tubercle), vestibule (contains urethral and vaginal openings, Bartholin's and Skene's glands), and the hymen. Blood supply is from internal and external pudendal arteries; innervation includes the pudendal nerve (S2-S4) and ilioinguinal/genitofemoral nerves anteriorly. Lymphatic drainage is primarily to superficial then deep inguinal lymph nodes—clinically important because vulvar carcinoma spreads to inguinal nodes first (unlike cervical cancer which spreads to pelvic nodes). Key pathologies tested: Lichen sclerosus (thin, white, parchment-like skin, increased risk of squamous cell carcinoma, common in postmenopausal women), Lichen simplex chronicus (thickened, leathery skin from chronic scratching), Vulvar intraepithelial neoplasia (VIN)—precursor to squamous cell carcinoma, associated with HPV 16/18. Vulvar carcinoma: most commonly squamous cell carcinoma (also can be melanoma, Paget disease, or basal cell), typically in older women, risk factors include HPV infection, lichen sclerosus, smoking. Bartholin gland cyst/abscess: from blocked Bartholin duct, presents as painful labial mass, may need incision and drainage or marsupialization. Condyloma acuminata (genital warts) caused by HPV 6/11 present as vulvar lesions. Understanding vulvar anatomy is essential for exams on gynecologic exams, obstetric lacerations (episiotomy), and STI presentations.