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
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
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.