The vagina is a musculomembranous tube extending from the vulva to the uterus. It is located between the bladder and rectum and is curved posteriorly. The vaginal canal is H-shaped with the lower end narrower than the upper end. It has anterior, posterior, and lateral fornices. The vagina has relations anteriorly to the bladder and urethra, posteriorly to the pouch of Douglas and rectum, and laterally to the levator ani muscles. Common clinical manifestations of vaginal conditions include discharge, vaginitis, prolapse, and cancer. Bacterial vaginosis, candidiasis, and trichomoniasis are treated with antibiotics like

1. VAGINA

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

5. Blood supply:
venous drainage: venous plexusint.iliac veins and
lymphatic drainage: iliac, int.iliac, inguinal lymph nodes

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

7. CLINICAL MANIFESTATIONS
 VAGINAL DISCHARGE
 VAGINITIS
 VAGINAL PROLAPSE
 VAGINAL LACERATION
 VAGINAL CANCER

8.  Vaginitis
 Common in
 Vaginal pH - doderlein’s bacilli glucogon, oestrogen
 Causes: bacterial , fungal , protozoal , viral ..
 Symptoms : itching or burning malodourous discharge .
 Signs : vulvar erythema ,swollen and tender vagina, oliguria, dysuria

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.

13.  bacterial vaginosis –metronidazole 500 mg orally BD for 7 days ,
clindamycin cream vaginally.
 Candida vaginitis – vaf –butaconazole ,clotrimazole & miconazole
oaf-fluconazole SD 150mg dose
 Trichomonas vaginitis – metronidazole
 Gardnerella vaginosis – metronidazole , tetracycline /doxycycline,
sulphafurazole
 management

14. Thank you