Objectives To describe and document the anatomical and histological architecture of the vaginal outlet wall. Design A prospective observational case series study. Setting International centers. Population Twelve fresh human female cadavers. Methods Female corpses were subjected to stratum-by-stratum, macro-, and micro-anatomical dissections in sagittal, transverse, and coronal planes. Multiple excisional biopsies were obtained from the vaginal outlet wall at 12, 3, 6, and 9 o’clock locations for histological examination. Digital photograms documented the anatomical and histological features. Primary Outcome measures gross, topographic anatomy and characteristic histologic features of the vaginal outlet wall. Results The vaginal outlet wall (VOW) was positioned in the vertical orientation and fused with horizontally located the vaginal wall at the hymeneal plate level. The hymeneal membrane and ring were not attached directly to the vaginal wall. VOW has three identifiable anatomical-histological layers a) the hymeneal membrane, b) the hymeneal ring (cartilage) with different anatomy and histology than the vaginal wall, and c) the hymeneal plate (the deep level of VOW), which connects to the vaginal wall. Conclusions The vaginal outlet wall is an anatomical structure consisting of the hymeneal membrane, hymeneal ring (cartilage), and hymeneal plate. This structure is in vertical topographic orientation. Anatomically and histologically, it differs from the vaginal wall, which fuses with the deep layer of the hymeneal plate.
The vaginal outlet wall anatomy: A prospective case series study Abstract Objectives To describe and document the anatomical and histological architecture of the vaginal outlet wall. Design A prospective observational case series study. Setting International centers. Population Twelve fresh human female cadavers. Methods Female corpses were subjected to stratum-by-stratum, macro-, and micro-anatomical dissections in sagittal, transverse, and coronal planes. The multiple excisional biopsies were obtained from the vaginal outlet wall at 12, 3, 6, and 9 o’clock locations for histological examination. Digital photograms documented the anatomical and histological features. Primary Outcome measures Gross, topographic anatomy, and characteristic histologic features of the vaginal outlet wall. Results The vaginal outlet wall (VOW) was positioned in the vertical orientation and fused with horizontally located the vaginal wall at the hymeneal plate level. The hymeneal membrane and ring were not attached directly to the vaginal wall. VOW had three identifiable anatomical-histological layers a) the hymeneal membrane, b) the hymeneal ring (cartilage) with different anatomy and histology than the vaginal wall, and c) the hymeneal plate (the deep level of VOW), which connects to the vaginal wall. Conclusions The vaginal outlet wall is an anatomical structure consisting of the hymeneal membrane, hymeneal ring (cartilage), and hymeneal plate. This structure is in vertical topographic orientation. Anatomically and histologically, it differs from the vaginal wall, which fuses with the deep layer of the hymeneal plate.
Objectives To establish anatomical structures responsible for a resistance force on a fetal head during vaginal delivery; assess the postpartum perception of perineal pain and superficial dyspareunia; develop a new episiotomy. Design A prospective observational case series study. Setting International sites. Population Eighteen pregnant women in labor Methods Small V-shape excision was made on the posterior-lateral vaginal outlet without incising the posterior perineum or vaginal wall. Simple interrupted sutures were used to repair the surgical defect (outlectorrhaphy). Histological examinations were performed on excised specimens. Main Outcome Measures The primary maternal outcome measured postpartum perineal pain; the secondary outcome measured occurrences of superficial dyspareunia, results of Ostrzenski’s vaginal outlectomy, and APGAR scores measured the neonatal outcome. Results The small V-shape excision widened the vaginal outlet sufficiently for a vaginal delivery. Outlectorrhaphy required two-three simple interrupted sutures. All subjects were delivered vaginally with median newborns’ weight of 3,550 gm ±250gm and median APGAR scores of 9 ±1 at 5 minutes. One patient experienced a grate II extension tear with bleeding heavier than an uncomplicated vaginal outlectomy. Postpartum patients reported no moderate or severe perineal pain and no superficial dyspareunia. Histology showed that the vaginal outlet was deferred from the vaginal walls. Conclusions The vaginal outlet is responsible for resistance force on a fetal head. No moderate or severe perineal pain or dyspareunia occurred in this study group. Ostrzenski’s vaginal outlectomy widens the vaginal outlet sufficiently for a fetal vaginal birth, and it is easy to repair.