Fourchette of the vulva

Inspection of the vulva is an essential part of a complete pelvic examination, and yet the area is often overlooked or given only a very cursory examination by clinicians. For their part, patients can be confused by terminology and are often not aware of the difference between the vagina and the vulva when they are trying to report the location of a symptom or abnormality. A brief overview of the anatomy and diseases of the vulva may prove helpful for both clinicians and patients. A review of normal vulvar anatomy is critical before moving on to a discussion of evaluation, diagnosis and biopsy.

A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia.

The posterior fourchette is a fork-shaped fold of skin at the bottom of the entrance to the vagina. The posterior fourchette is a thin tissue designed to stretch. However, it sometimes fails to stretch properly, and instead splits. This is a cause of recurrent vulval pain. Pain from fissuring is often described as being 'like a paper-cut' or 'knife-like'.

The vulva pudendum refers to the external female genitalia. Its functions are threefold:. This is initially treated with antibiotics, but occasionally can be complicated by the formation of a cyst or abscess. In case of an infected cyst or abscess, the only effective treatment is surgical drainage or excision of the lesion.