The vagina is an elastic muscular-membranous conduit that connects the vulva to the uterus. It measures approximately 7 to 10 cm long and 2 to 3 cm in diameter in a woman of childbearing age. The vagina is located between the bladder at the front and the rectum at the back, in the small pelvis. It is held in place by supportive structures such as the pelvic floor, the pubovesical and uterosacral ligaments.
The vaginal wall consists of three layers: the mucosa, the muscle layer, and the adventitia. The vaginal mucosa is a non-keratinized stratified epithelium, very rich in glycogen. This epithelium is devoid of glands, but it is lubricated by the secretions of the vestibular glands (Bartholin’s and Skene’s glands) and by the transudation of fluid through the vaginal wall. The muscle layer is composed of smooth muscle fibers arranged in two layers: an inner longitudinal layer and an outer circular layer. This muscle layer gives the vagina its elasticity and its ability to stretch during sexual intercourse and childbirth. The adventitia is a layer of loose connective tissue that surrounds the muscle layer and contains the blood vessels and nerves.
The vagina has several essential functions. First of all, it plays an important role in sexuality by allowing penetration during sexual intercourse. The vaginal walls are richly innervated and vascularized, making them sensitive to sexual stimulation. During arousal, the vagina lubricates and widens to facilitate penetration. The rhythmic contractions of the vaginal muscle layer contribute to the female orgasm.
Next, the vagina provides the passage for menstruation. During menstruation, the uterine endometrium sheds and the menstrual debris are expelled by the vagina in the form of blood and clots. The menstrual flow also contains shed vaginal cells and cervical secretions.
The vagina also plays a crucial role in childbirth by allowing the passage of the fetus. During pregnancy, under the influence of hormones, the vagina lengthens, softens, and becomes more elastic to prepare the birth canal. During childbirth, the vagina stretches considerably to allow the expulsion of the baby. After childbirth, the vagina gradually regains its tone through perineal rehabilitation exercises.
The vagina also harbors a complex microbial ecosystem, called the vaginal microbiota. This microbiota is dominated by lactic bacteria, mainly of the Lactobacillus genus, which maintain an acidic vaginal pH (between 3.8 and 4.5). This acidity protects the vagina from infections by preventing the proliferation of pathogenic germs. Lactobacilli produce lactic acid and hydrogen peroxide from the glycogen present in the vaginal epithelial cells. Any disturbance of this balance, called vaginal dysbiosis, can favor the development of infections such as bacterial vaginosis or vulvo-vaginal candidosis.
Certain factors can disrupt the vaginal ecosystem, such as the intake of antibiotics, vaginal douching, stress, poor intimate hygiene, or menopause. After menopause, estrogen deficiency leads to vaginal atrophy, characterized by thinning of the mucosa, a decrease in elasticity and vaginal dryness. These changes can cause discomfort and pain during sexual intercourse (dyspareunia). Local hormonal treatment (estrogen-based suppositories or creams) can be offered to improve these symptoms.
It is important to maintain good intimate hygiene to preserve vaginal health. It is recommended to wash the vulva with water and gentle, fragrance-free soap once a day. Vaginal douches and the use of scented tampons are to be avoided as they disrupt the balance of the microbiota. In case of vaginal dryness, the use of intimate lubricants can be useful to improve comfort during sexual intercourse. Pain or abnormal vaginal discharge should lead to consulting a doctor to identify the cause and propose appropriate treatment.
Key points to remember:
– The vagina is an elastic muscular-membranous conduit that connects the vulva to the uterus, located between the bladder and the rectum in the small pelvis.
– The vaginal wall consists of three layers: the mucosa (non-keratinized stratified epithelium rich in glycogen), the muscle layer (smooth muscle fibers in two layers), and the adventitia (loose connective tissue).
– The vagina plays an important role in sexuality by allowing penetration during sexual intercourse and contributing to the female orgasm through its highly innervated and vascularized walls.
– The vagina serves as the passage for menstruation and plays a vital role during childbirth by allowing the passage of the fetus.
– The vagina is home to a microbiota dominated by lactic bacteria (Lactobacillus) that maintain an acidic pH which has protective properties against infections.
– After menopause, an estrogen deficiency can lead to vaginal atrophy causing discomfort and pain during sexual intercourse.
– Good intimate hygiene (washing with water and gentle, fragrance-free soap, avoiding vaginal douches and scented tampons) is vital to maintaining vaginal health. In case of dryness, intimate lubricants can enhance comfort.
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