The science and art of midwifery (1891) (14579471209)

Vaginal rugae are structures of the vagina that are transverse ridges formed out of the supporting tissues and

vaginal epithelium The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal ...

in females. Some conditions can cause the disappearance of vaginal rugae and are usually associated with childbirth and prolapse of pelvic structures. The rugae contribute to the resiliency and elasticity of the vagina and its ability to distend and return to its previous state. These structures not only allow expansions and an increase in surface area of the vaginal epithelium, they provide the space necessary for the vaginal microbiota. The shape and structure of the rugae are supported and maintained by the lamina propria of the vagina and the anterior and posterior rugae. The anterior and posterior columnae rugae are transverse vaginal support structures between which the transverse rugae exist. The cross section of the vagina normally forms a shape that resembles the letter 'H' due to these structures. Vaginal rugae disappear in those with an estrogen deficiency and those women who are older. The rugae can disappear with anterior vaginal wall prolapse which can occur when supports to the portion located between the vagina and bladder are damaged and the bladder bulges into the vaginal lumen. Vaginal self-examination includes visualizing the presence of vaginal rugae. Anatomists identified rugae of the vagina as early as 1824.

Development

The appearance and presence of vaginal rugae change over the life span of females and are associated with hormonal cycles,

estrogens Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal acti ...

, childbirth, puberty and menopause. During gynecological examination of

prepubescent Preadolescence is a stage of human development following middle childhood and preceding adolescence.New Oxford American Dictionary. 2nd Edition. 2005. Oxford University Press. It commonly ends with the beginning of puberty. Preadolescence is ...

girls, rugae can be visualized. The vaginal rugae change after

menopause Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often ...

. In some older women the rugae are present but become flattened and difficult to see. In others, the rugae tend to disappear.

Clinical considerations

Other structures can be present on the vaginal wall though most of the time these can be differentiated from rugae.

Vaginal cysts Vaginal cysts are uncommon benign cysts that develop in the vaginal wall. The type of epithelial tissue lining a cyst is used to classify these growths. They can be congenital. They can present in childhood and adulthood. The most common type is ...

can be small protrusions into the vagina that can be felt or palpated by a clinician. Vaginal inclusion cysts can appear as small bumps and can develop after childbirth. Other small structures or protrusions can be Gartner duct cysts, patches of endometrial tissue, and benign tumors. These cystic structures can obliterate the rugae and is a clue to their presence. The absence of vaginal rugae seen in the normal vagina of a healthy woman may be an indication of a prolapsed bladder (cystocele) or rectocele. An

enterocele An enterocele is a protrusion of the small intestines and peritoneum into the vaginal canal. It may be treated transvaginally or by laparoscopy. An enterocele may also obstruct the rectum, leading to symptoms of obstructed defecation. Enteroceles ...

, or bulging of the

bowel The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

into the vagina can also cause vaginal rugae to disappear. The absence of vaginal rugae may also be an indicator of

pelvic organ prolapse Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. In m ...

. Vaginal rugae disappear in those with an estrogen deficiency.

Childbirth

Vaginal rugae can disappear during the second stage of labor. After a vaginal birth the rugae are not visible and the walls of the vagina are smooth. By the third week postpartum the vagina has become much smaller and the rugae begin to reform on the vaginal walls. Six weeks after birth, the rugae have returned to approximately the same size as they were before the birth. The number of rugae after childbirth decreases. In women who have not given birth, the rugae are more prominent than in those who have given birth multiple times.

References

{{Epithelial types Human female reproductive system Women and sexuality Women's health Anatomy Gynaecology Epithelium