Figure Legends
Figure 1. The gross and topographic anatomy of the vaginal outletA. The specimen of the 10-year-old subject depicts the vaginal outlet wall (the yellow arrow). The horizontal location of the vaginal wall and the vertical position of the vaginal outlet are noticeable.
B. Three anatomical architecture and orientation of the vaginal outlet in the vertical position are presented: a) the hymeneal membrane is the superficial soft tissue layer-the black arrow; b) the green arrow shows the hymeneal ring-cartilage; c) the yellow arrow indicates the hymeneal plate and the visible groove between the hymeneal ring and the hymeneal plate structures.
C. The V-shape excised fragment of the vaginal outlet anatomical structures. The black arrow indicates the soft tissue superficial layer (the hymeneal membrane) of the vaginal outlet; the green arrow represents the middle layer - the hymeneal ring (cartilage); the yellow arrow depicts the deep layer of the hymeneal plate.
Figure 2. Microscopic characteristic features of the vaginal outlet wall
The microscopic architecture of the vaginal outlet wall consists of three layers – superficial, intermediate, and deep. The superficial layer (the hymeneal membrane) is the mucosal type of tissue. The epithelium that covers the hymen membrane is a nonkeratinized striated squamous cell arranged in roses of epithelial cells, on an average of three roses. The elastic lamina propria consisted of a dense connective fibers layer projecting papillae into the overlying epithelium with the capillary blood vessel network and nerve endings. Beneath the lamina propria was a strip of columnar epithelial cells. In addition, the parabasal, basal cells, and basal lamina were identifiable. The intermediate-hymeneal ring was composed of dense connective fibers with a network of arterial blood vessels, veins, nerve endings, and muscle fibers. The deep layer of the vaginal outlet wall (the hymeneal plate) was composed of predominantly longitudinal smooth muscles and connective tissues. This stratum was connected to the longitudinal vaginal wall muscles.
Figure 3. The clinical function of the vaginal outlet wall selected examplesA. Resistance force of the hymeneal outlet wall structure on the anterior vaginal wall prolapse (prolapse cystocele),B. The vaginal outlet wall resists the fetal head passing during vaginal delivery,C. The defective vaginal outlet wall causes the posterior-distal vaginal wall to descend.