Introduction
Dickinson pioneered wax cylinders for vaginal wall impression, and
later, Morgan introduced the material that dentists
use.1, 2 These three-dimensional vaginal impression
molds demonstrate gross-topographical anatomy and its potential
aberrations. Pendergrass verified these techniques and
findings.3 When analyzing these vaginal molds, one can
conclude there is a separate anatomical structure in vertical
orientation that fused with the vaginal wall being in the horizontal
orientation.1, 2 The vaginal casting method findings
were confirmed by magnetic resonance imaging (MRI) with gel contrast
filling the vaginal canal.4 MRI technology provides
more detailed information about the shape and strata of the vaginal
walls with three identifiable zones a) the “distal vaginal sphincteric
zone” (the vaginal outlet wall); b) the “transition zone”; c) the
“forniceal zone.” 4 Also, the dynamic
ultrasonographic investigation showed the sphincteric zone within the
distal vaginal wall.5 Furthermore, Hart documented
that the hymen wall was always present in the female newborn at term
without demonstrating the hymeneal anatomical wall
layers.6
The current variable terminology used for the vaginal entrance wall did
not reflect the vaginal outlet wall. Often terms are used such as
vaginal introitus (introitus vaginae), the vaginal vestibule (vestibulum
vaginalis), the vaginal opening, and the vaginal
orifice.2-5 These terminologies do not reflect a
specific anatomical architecture of the vaginal outlet. The analysis of
the current nomenclatures reveals that a) the “vaginal introitus” is a
vaginal atrium located in front of the hymen; b) “the vaginal
vestibule” is located between the posterior surface of the hymen and
the anterior border of the posterior perineum; anteriorly, it runs from
the posterior surface hymen to the inferior edge of the clitoral
frenulum; laterally, it extends from the inferior hymen to base of the
labia minora, and there is a small crease between
them6, 7; c) The “vaginal orifice “or vaginal
opening” is a space and isn’t an anatomical structure. These
terminologies do not represent the entry to the vaginal canal. The
electronic and manual medical literature searches failed to identify any
scientific-clinical article describing the vaginal outlet wall. The new
terminology suggested by the author adequately encompasses this part of
the vaginal ingress or egress, and the author suggests the term “the
vaginal outlet wall.” Therefore, the present study is the first
anatomical and H/E histological description of the vaginal outlet wall.
There is no description of the vaginal outlet wall in anatomy
educational textbooks or atlases of human anatomy.8-13To the best of this author’s knowledge, there is no anatomical
description of the vaginal outlet in the scientific-clinical articles.
The present study question is, “does the vaginal outlet wall have
different anatomical and histological architectures than the vaginal
wall?” The study’s objectives are to describe the vaginal outlet wall
gross, topographic, and microscopic anatomy and document findings by
digital photograms. The primary outcome measures gross, topographic
anatomy and characteristic histologic features of the vavinal outlet
wall.