Lifetime changes in the vulva and vagina
Lifetime changes in the vulva and vagina
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DOI：
10.1007/s00404-005-0079-x
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发表时间：
2006-01-01
影响因子：
2.6
通讯作者：
Maibach, Howard
中科院分区：
文献类型：
--
作者：
Farage, Miranda;Maibach, Howard
外阴和阴道的形态和生理学在一生中会发生变化。最显著的变化与青春期、月经周期、怀孕和更年期有关。阴阜、阴唇和阴蒂的皮肤上皮细胞起源于胚胎外胚层，并表现出类似于其他部位皮肤的角质化分层结构。外阴前庭的粘膜起源于胚胎内胚层，是非角化的。阴道起源于胚胎中胚层，对雌激素循环有反应。在出生时，外阴和阴道表现出残留的母体雌激素的影响。在青春期，随着肾上腺和性腺的成熟，外阴和阴道相继获得成熟特征。在西方发达国家已观察到青春期开始较早的趋势。在育龄妇女中，阴道粘膜对类固醇激素循环有反应，在周期中期表现出最大厚度和细胞内糖原含量。外阴皮肤厚度保持不变，但在细胞学水平上发生了与月经周期相关的正角化和角化不全的变化。外阴和阴道进一步适应怀孕和分娩的需要。绝经后，组织萎缩加剧。在暴露的皮肤上观察到绝经后技能屏障功能、皮肤水合作用和刺激物敏感性的变化，但在外阴上没有观察到。然而，患有失禁的老年妇女患失禁性皮炎的风险增加。多种因素的结合，如组织萎缩、多余皮肤水化的缓慢消散、与有限活动性相关的剪切力以及较低的组织再生能力，增加了老年妇女失禁皮炎的发病风险。
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 skill 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.