Anatomical dissection
The corpses were placed on the examining table in the supine position with the lower extremities separated laterally and bent in the knees-hip joints and the upper limbs along the body side. To stabilize the body in this position, a medical bandage was placed between the ankle and wrist to hold them together, and the knees were kept laterally by fixing them to IV poles. Dissection planes were in various directions a) vertical plane from front to back that splits the vaginal outlet wall into visible layers; b) coronal-vertical planes, which allow visualizing the front and back of the segments of the vaginal outlet wall and its variations among the subjects The author executed all the anatomical macro- and micro-dissection.
All macro- and micro-dissections were performed with a 3.5-4.0x magnification loupe. The labium minus was despised laterally from the midline, and traction 2-0 size sutures were used to secure the labia to the vulvar skin—this maneuver allowed access to the vaginal outlet. The vaginal outlet was marked with a dermo-marker at 12, 6, 3, and 9 o’clock for the future orientation of taking biopsies for histological examinations.
In the sulcus between the labia minora minora, the fossa navicularis, and under the inferior membraneous urethral sphincter, the incision was made to expose the outer surface of the vaginal outlet wall. To visualize the inner surface of the vaginal outlet wall, the incision was made at the junction of the vaginal wall and the vaginal outlet inner surface. The Bartholin’s duct orifice and membranous urethral sphincter were outside the incisions.
The subsequent step was to make the vertical incision on the posterior-midline hymeneal membrane with the number 15-blade of the surgical scalpel to dissect the soft tissue from the hymeneal ring to demonstrate a well-defined white color structure, resembling a cartilage appearance that fuses inferiorly with the hymeneal plate and superiorly with the hymeneal membrane. The dissection continued until the entire hymeneal plate was visualized. Consequently, the three anatomical layers of the vaginal outlet wall are identified. The vertical position vaginal outlet wall fuses with the vaginal wall that is in a horizontal position.