Archives of Gynecology and Obstetrics

, Volume 273, Issue 4, pp 195–202 | Cite as

Lifetime changes in the vulva and vagina



The morphology and physiology of the vulva and vagina change over a lifetime. The most salient changes are linked to puberty, the menstrual cycle, pregnancy, and menopause. The cutaneous epithelia of the mons pubis, labia, and clitoris originate from the embryonic ectoderm and exhibit a keratinized, stratified structure similar to the skin at other sites. The mucosa of the vulvar vestibule, which originates from the embryonic endoderm, is non-keratinized. The vagina, derived from the embryonic mesoderm, is responsive to estrogen cycling. At birth, the vulva and vagina exhibit the effects of residual maternal estrogens. During puberty, the vulva and vagina acquire mature characteristics in a sequential fashion in response to adrenal and gonadal maturation. A trend to earlier pubertal onset has been observed in Western developed countries. In women of reproductive age, the vaginal mucosa responds to steroid hormone cycling, exhibiting maximal thickness and intracellular glycogen content at mid-cycle. Vulvar skin thickness remains unchanged but menstrual cycle-associated changes in ortho- and parakeratosis occur at the cytological level. The vulva and vagina further adapt to the needs of pregnancy and delivery. After menopause, tissue atrophy ensues. Post-menopausal changes in skin barrier function, skin hydration, and irritant susceptibility have been observed on exposed skin but not on the vulva. Nevertheless, older women with incontinence are at increased risk for developing incontinence dermatitis. A combination of factors, such as tissue atrophy, slower dissipation of excess skin hydration, shear forces associated with limited mobility, and lower tissue regeneration capacity increase the risk of morbidity from incontinence dermatitis in older women.

Key words

Vulva Vagina Puberty Reproductive age Menopause 



The authors are grateful to Paula J. Adams Hillard, MD for her technical review of this manuscript and to Deborah Hutchins, Ph.D., of Hutchins and Associates, LLC (Cincinnati, OH), for her technical input.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.The Procter & Gamble CompanyFeminine Care Clinical Sciences, Winton Hill Technical CenterCincinnatiUSA
  2. 2.Dermatology DepartmentUniversity of California School of MedicineSan FranciscoUSA

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