{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:13:14Z","timestamp":1789776794625,"version":"4.0.1"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"published-print":{"date-parts":[[2022,8]]},"abstract":"Abstract<\/jats:title>\n \n Aim<\/jats:title>\n The vaginal introitus is the entrance to the vagina, encompassing the anterior and posterior vestibules and the perineum. The surgical anatomy of the vaginal introitus, the lowest level of the vagina, has not been subject to a recent comprehensive examination and description. Vaginal introital surgery (perineorrhaphy) should be a key part of surgery for a majority of pelvic organ prolapse.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Cadaver studies were performed on the anterior and posterior vestibules and the perineum. Histological studies were performed on the excised perineal specimens of a cohort of 50 women undergoing perineorrhaphy. Included are pre\u2010 and postoperative studies which were performed on 50 women to determine the anatomical and histological changes achieved with a simple (anterior) perineorrhaphy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The vaginal introitus is equivalent to the Level III section of the vagina, measured posteriorly from the clitoris to the anterior perineum then down the perineum to the anal verge. The anterior and posterior vestibules, with nonkeratinizing epithelium, extend laterally to the keratinized epithelium of the labia minora (Hart's line). The anterior vestibule has six anatomical layers while the posterior vestibule has three. The perineum has an inverse trapezoid shape. Perineorrhaphy specimens were a mean 2.9\u2009cm wide and 1.6\u2009cm deep. They show squamous epithelium with loose underlying connective tissue. There were no important structures seen histologically, for example,\u00a0ligaments or muscles. Microscopically, only 6 (12%) were completely normal with 44 (88%) showing minor changes including inflammation and scarring. Considerable anatomical benefits were achieved with such a perineorrhaphy including a 27.6% increase in the perineal length and a 30.8% reduction in the genital hiatus.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n An understanding of the anatomy and histology of the vaginal introitus can assist with performing a simple and effective perineorrhaphy, the main surgical intervention at the vaginal introitus.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/nau.24961","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T03:23:20Z","timestamp":1653017000000},"page":"1240-1247","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Surgical anatomy of the vaginal introitus"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5436-2435","authenticated-orcid":false,"given":"Bernard T.","family":"Haylen","sequence":"first","affiliation":[{"name":"Department of Gynecology University of New South Wales Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dzung","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Anatomy University of Notre Dame Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audris","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology Gold Coast University Hospital Southport Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Stedman's Medical Dictionary","author":"Stedman T","year":"2006"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","unstructured":"HaylenBT MaherCF BarberMD et al. An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for pelvic organ prolapse.Neurourol Urodyn.\u00a02016;35(2):137\u2010168;Int Urogynecol J. 27(2):165\u2010194. 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