Interpretation Anatomy
The present study findings show that the vaginal outlet wall and its tensile resistance are not directly connected to the posterior perineum; therefore, clinicians need to know that cutting the posterior perineum in traditional episiotomies is questionable. The current investigation shows that the hymeneal ring (cartilage) is the tissue responsible for the resistance during fetal vaginal delivery. Furthermore, there are several reports in the medical literature about gynecological entities that are specifically related to the vaginal outlet, such as “vulvar outlet stenosis” (vaginal stenosis), which is recognized as causing superficial dyspareunia.6-8Those authors postulated that the vulvar outlet participates in the pelvic organ prolapse; therefore, it should be evaluated when the posterior-distal vaginal wall relaxation is present. However, they did not present the gross, topographic, or surgical anatomy.6-8