Anterior Vulva Anatomical Definition
The anterior vulva comprises the structures extending from the pubic arch inferiorly, including the mons pubis, clitoris (body, glans, and crura), anterior portions of the labia majora and labia minora, and the anterior vestibule containing the urethral opening. 1, 2
Anatomical Boundaries and Structures
The vulva extends inferiorly from the pubic arch and is divided into anterior and posterior regions based on anatomical landmarks 1, 2:
Anterior Vulvar Components
Mons pubis: The most superior anterior structure, overlying the pubic symphysis 2
Clitoris complex: The central anterior structure with multiple components 2, 3:
- Clitoral body (median length 29 mm, width 9 mm)
- Glans clitoris (median length 8 mm, width 4 mm)
- Clitoral crura (median length 50 mm), which extend laterally and posteriorly
- The clitoris sits approximately 29 mm from the mid-pubic arch 3
Anterior labia majora and minora: The lateral boundaries extending anteriorly from the posterior fourchette 2
Anterior vestibule: Includes the urethral opening, located approximately 25 mm posterior to the clitoral glans 3
Vestibular bulbs (bulbs of the clitoris): Erectile tissue surrounding the urethra anteriorly and laterally, though these are deep structures 4
Clinical Demarcation
Anterior perineal trauma is specifically defined as injury involving the labia, anterior vagina, urethra, or clitoris, distinguishing it from posterior perineal trauma. 1 This clinical definition provides the clearest functional boundary—structures anterior to the vaginal opening and perineal body constitute the anterior vulva.
Key Anatomical Relationships
The clitoral body sits 14-46 mm from the mid-pubic arch, with significant anatomic variation 3
The dorsal nerve and artery of the clitoris course adjacent to the medial surface of the inferior pubic ramus, making them vulnerable during anterior vulvar procedures 3
The urethra is embedded in the anterior vaginal wall and surrounded by erectile tissue in all directions except posteriorly 4
Clinical Relevance for Radiation Planning
When defining the anterior vulvar clinical target volume for radiation therapy, the vulvar CTV should include the GTV or tumor bed plus adjacent skin, mucosa, and subcutaneous tissue, with wire markers placed to define vulvar skin borders during CT simulation. 1, 5 The anterior extent naturally includes all structures from the clitoris to the mons pubis 1.