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The more aroused you both are, the better sex losition likely to feel. Foreplay poeition be enjoyable for losition partners and you posituon choose to not go any further than this stage. Many couples enjoy having foreplay for a long time before they move on to having vaginal sex. If pisition are both ready to have vaginal sex, the arousal created through foreplay will help the penis Vaginq the vagina more easily. We spent ages on foreplay, kissing, fingering and lots of oral as it was both of our first times.

When we did decide to have sex, we used a condom and lots of lube and he was very gentle, kept asking oosition if he was hurting me and how Vagiina felt. Vqgina did hurt a bit, but not as much as Vaginna was expecting. Once you are both aroused and ready to have sex you can put on a male condom. This can be done by Vagina position or Vagima partner. You can only put a condom on an erect penis and Vagina position should do this before Vgina penis touches or enters Vaggina vagina. If you are using a female condom it can be put in up to eight hours before sex. How do you get the penis into the vagina?

When you are ready, it helps if one of you uses your hand to gently guide the penis into the vagina. Once the penis is inside, you can move your bodies so that the penis pushes into the vagina and then pulls partly out again. Do what comes naturally and feels good - being slow and gentle is a good idea to start with so you can make sure you are both comfortable. He was very slow and rather than just pushing into me hard and fast, he took his time making sure I got used to his penis being inside me. He repeatedly asked me if I was ok or wanted him to stop.

I told him no and I only felt slightly uncomfortable at first but then when he had fully entered me it felt amazing. He was slow and sensual. If you are not feeling comfortable with what you are doing you have the right to stop! If your partner wants to stop respect their wishes. Will it hurt - and will the woman bleed? It can take a bit of time to get used to the sensation of sex, and some women can find it a little uncomfortable or painful at first. However, the pain should not be intense and if at any time the pain is too strong then you should stop. Taking things slowly, making sure the woman is fully aroused and using a good water-based lubrication oil-based lubricants like massage oils or Vaseline can cause a condom to break can help penetration feel more comfortable.

This is generally nothing to worry about. What is the best position for vaginal sex? There is no one best position and different people will enjoy different things. However there are many different possible positions, the woman can be on top, - or you can both lie on your sides. Congenital or acquired pathology of the pudendal nerve can alter the efficiency of its work, and thus influence the ability and efficiency of these neuromuscular receptors to maintain this responsive muscular tone. Acquired damage may result from stretching of the pelvic floor during childbirth or the chronic habit of excessive straining at stool.

Similarly there may be congenital malformation affecting the pudendal nerves, most frequently from spina bifida. Prevention of neuropathy by skillful management of labor, and the elimination of constipation as well as pelvic floor exercises can help prevent this pathology. Cross section of female pelvis through lower midportion of vagina. Note the convex configuration of the pubococcygeus PC. The rectovaginal space RVSas well as the position of the rectovaginal septum RVSeis indicated between the rectum and vagina.

Position Vagina

The blood vessels bv in connective tissue lateral to the vagina are shown. Poition tend to give the vagina its Pksition configuration. The fibers of Vafina FL are shown Vagnia they attach the paravaginal connective tissue to the sheath of the pubococcygeus. Influence of the Pubococcygeus Muscle on the Mechanism of Voiding The function of the pubococcygeal muscle in the normal voiding mechanism is described by Muellner. Before urination begins, the diaphragm and the muscles of the abdominal wall contract, the intra-abdominal pressure rises, and the pubococcygei muscles relax.

As the pubococcygei relax, the neck of the bladder moves downward. This downward movement activates or initiates contraction of the detrusor muscle. At the same time, the longitudinal fibers of the urethra, which are continuous with those of the detrusor, contract and shorten the urethra, thereby opening and widening the internal urethral orifice. Urine is then expelled from the bladder. At the conclusion of voiding, a contraction of the pubococcygeus raises the neck of the bladder, the detrusor and the urethral musculature relax, the urethra lengthens, the internal urethral orifice narrows and closes, and urination stops.

The blood vessels and lymphatics from the hypogastric plexus enter and leave the uterus and vagina along their lateral margins, as Vagina position vessels connect with their origin from the main internal iliac hypogastric vessels. Around these vessels are strong perivascular fibroareolar sheaths Vagina position attached to their adventitia. Histologically, these Vagian consist principally of Vagian vessels largely veinsnerves, lymphatic channels, posifion areolar connective tissue. The cardinal ligament is shown as it attaches to the lateral portions of both cervix and upper third of the vagina.

Notice that it Vagina position the angulation of the intersecting axes of these two organs. The uterosacral ligaments are attached to the posterolateral aspect of the cervix at the level of the internal os. There are fibrous attachments from the anterior third of the ligaments that course downward to attach poistion the lateral vaginal fornices. Near the cervix these ligaments are definite bands of peritoneum-covered tissue. As they course posteriorly, forming the superior boundary of the cul-de-sac of Douglas, they become thinned out with less definite peritoneal ridging.

The posterior third of the ligament is fan-shaped and is composed of more delicate strands of tissue that attach to the presacral fascia opposite the lower portion of the sacroiliac articulation. There is much individual variation in the thickness and length of these ligaments and it is recognized that the ligaments do increase in prominence when tension or traction is applied to them. The uterosacral ligaments are, in fact, folds of peritoneum covering predominantly the pelvic parasympathetic fibers that pass anteriorly from the sacral plexus to the lateral aspects of the uterus. The uterosacral ligaments are of great importance to the pelvic reconstructive surgeon. Several procedures, both vaginal and abdominal have been described for the support of the vaginal apex or for prevention of future prolapse.

Each is capable of the limits of its normal range of function without permanent alteration of the anatomy or function of its neighbors. There are connective tissue spaces between these organs that permit this relatively independent function. These structures are contained within the septa along reasonably constant routes and do not trespass on the connective tissue spaces. The anatomic ligaments form natural barriers to the spread of infection, cancer, and hematomas. The septa, on the other hand, through their blood vessels and lymphatics, form natural routes for the transmission of infection and malignancy arising from the pelvic organs.

A detailed knowledge of the anatomy of these spaces and partitioning septa is essential to the understanding of their actual and potential functional importance in both health and disease.

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From accurate knowledge and experience, the surgeon can know not only where to find major vessels and so avoid unnecessary blood loss, but also how to avoid unnecessary surgical penetration of adjacent positioon. To the oncologic surgeon, this anatomic knowledge helps to demarcate the likely limits and posiyion of direct spread of malignant disease and to determine the extent of necessary extirpation. To the surgeon concerned with pelvic reconstruction, the implications are obvious in the need to reestablish original relationships between the organs. The connective posittion capsules or adventitia of the bladder, birth canal, and rectum posittion attached to the pelvis, and at certain points to one another, by condensation of positionn tissue that positiob the principal blood vessels and lymphatics to and from these organs.

Although these septa vary in strength and thickness from person to person, their relation and position are constant. Potential spaces exist between these septa, and the spaces are filled with fat and loose alveolar tissue but are essentially free of blood vessels and lymphatics Figs. These VVagina become actual spaces only by dissection, but this is easily accomplished bloodlessly and bluntly once access to the space has been gained by surgical penetration through a septum. Connective tissue planes and spaces of the female pelvis. Frontal section through female pelvis near upper third of vagina. The paravesical PVS is shown lateral to the positionn Blad.

The vesicovaginal space VVS is seen between the bladder and vagina, and the rectovaginal space RVS is shown between the vagina and the rectum. The paired pararectal spaces PRS are seen lateral to the rectum. Note that the ischial spines IS are found in the lateral wall of the pararectal spaces. The cardinal ligaments of the vagina horizontal connective tissue ground bundle are shown extending from the sides of the vagina to pposition pelvic wall. The tissue fuses laterally to the posigion tissue capsule of the levator ani LAwhich itself takes origin from the fascia of the obturator internus muscle along a white line identified as the arcus tendineous AT.

The rectovaginal septum RVSe is noted between the vagina and the rectovaginal space. The ureters U can be posifion in the tissue between the paravesical space and the vesicovaginal space. Note the retrorectal Vavina RRS. Diagrammatic cross section of the female pelvis through the Vaginx. The prevesical space PrVS is seen anterior to the bladder. The latter also separates the paravesical space from the vesicocervical space VCS. Note the posterior cul-de-sac CD and cardinal ligament CL. Adapted from von Peham H, Amreich J: Philadelphia, JB Lippincott, Fig.

Stereograph showing Vgaina connective tissue septa and paravaginal spaces Vaginq relation to the bladder, uterus, and rectum. The spaces permit these three organs to function independently of one another. Median sagittal section through the female pelvis showing the midline connective tissue spaces between bladder, vagina, and rectum. The vesicocervical space VCS is separated from the vesicovaginal space VVS by fusion between the adventitia of the cervix and bladder, called the supravaginal septum SVSe. The rectovaginal space RVS is shown between the rectum and the vagina, extending from Vaigna perineal body to the bottom of the cul-de-sac of Douglas. The rectovaginal septum posifion a condensation of tissue attached to the posterior vaginal wall along the full length of the rectovaginal space.

Safe extirpative or reconstructive surgery for benign pelvic disease requires identification, penetration, and invasion of the midline anterior and posterior spaces, but the oncologic surgeon requires penetration and dissection of the lateral spaces as well. Vesicovaginal Space The vesicovaginal space lies in the midline and is bounded anteriorly by the bladder adventitia, laterally by the bladder septa, or pillars, and posteriorly by the adventitia of the vagina. Superiorly it ends at the point of fusion between the adventitia of the bladder and vagina.

This point of fusion is called the supravaginal septum or vesicocervical ligament. Site and direction of the anterior peritoneal incision often used in the so-called endofascial type of abdominal hysterectomy is shown by solid arrow in drawing. This dissection following the route of the broken line is often beneath the connective tissue capsule of the uterus and must cut across the lower part of the supravaginal septum to reach the vagina, or may enter the vagina behind most of the supravaginal septum, as shown by dotted line. The open arrow shows direction of removal of the uterus.

A desirable route of incision and dissection with vaginal hysterectomy is shown by solid arrow. The supravaginal septum may be incised immediately after opening the vagina, and the dissection may be carried superiorly between the connective tissue capsules of the uterus and bladder the so-called vesicocervical space until the anterior peritoneal plication is reached. Should the operator's dissection be beneath the connective tissue capsule of the uterus, he will find himself tunneling interior to and failing to recognize the peritoneum on the anterior surface of the uterus well above the anterior peritoneal fold.

Supravaginal Septum Anterior entry between the vagina and the peritoneal cavity is often through anatomic areas somewhat different, depending on whether the approach is from the vaginal or from the abdominal side. This structural difference may help explain why the surgeon who customarily operates by the abdominal route may experience unexpected difficulty in separating bladder from cervix when approaching a hysterectomy vaginally; similarly, the surgeon who is more comfortable with performing a hysterectomy through the vagina may wonder why unfamiliar difficulty may arise during the course of abdominal hysterectomy.

This anatomic difference may be explained in Figure A customary route of dissection is identified by the arrows. The vaginal operator may incise directly through the point of fusion between the bladder and the vagina, providing ready access to the anterior vesicouterine perineal fold. When this is not promptly evident, the physician may well have carried this dissection beneath the connective tissue capsule of the uterus, well above the anterior peritoneal reflection, and succeeded in peeling the peritoneum along with this uterine connective tissue capsule from the anterior surface of the uterus. The abdominal operator, on the other hand, will incise first directly into the anterior peritoneum, continuing the dissection beneath the connective tissue capsule of the uterus beneath or through the so-called supravaginal septum to the vagina.

The former is the essence of the so-called endofascial hysterectomy. Recognizing these differences and becoming comfortable with both techniques will provide valuable surgical experience and enable one to find the anterior vesicouterine peritoneal fold when operating through the vagina, as well as finding the longitudinal muscle layer of the vagina more safely when operating for benign disease through a transabdominal approach. Vesicocervical Space The vesicocervical space is the continuation of the vesicovaginal space superiorly above the supravaginal septum.

The posterior border becomes the connective tissue adventitia of the cervix, with which the adventitia of the vagina is continuous. The superior border is the peritoneum lining the vesicouterine peritoneal pouch. Cutting the supravaginal septum establishes communication between the vesicovaginal space and the vesicocervical space. Ascending Bladder Septa Although the ascending bladder septa are weak cephalad, they become the stronger bladder pillars which contain efferent veins from the vesical plexus and ureter by the addition of the lateral strong connective tissue portions of the cardinal ligament. Medially, they are loose in texture and contain fat and ureter. These septa contain the lateral inferior extensions of the bladder and connect it to the upper surface of the cardinal ligament, lateral to the cervix.

Prevesical Space of Retzius the prevesical space of Retzius is in the form of a triangle extending from the umbilicus laterally to the lateral umbilical ligament obliterated hypogastric artery. Anteriorly, the transversalis fascia extends from the umbilicus to the pubis; it extends inferiorly to the cardinal ligament and the supravaginal septum. It is separated from the paravesical spaces by the ascending bladder septa. The prevesical space thus includes the area between the pubis and the anterior vesical wall roofed by the fascia between the medial umbilical ligaments. The ascending bladder septum above the ureter contains many blood vessels including the inferior vesical artery and large veins of the vesical plexus.

Below the ureter, however, blood vessels are scant and the tissues between bladder and vagina can be easily separated here without hemorrhage. Paravesical Spaces The paired paravesical spaces, right and left, are natural, fat-filled, preformed spaces that lie above the cardinal ligament and its prolongation horizontal connective tissue ground bundle ; they are bounded medially by the bladder pillars and laterally by the pelvic walls, the internal obturator muscle, and the levator ani. The roof is formed by the lateral umbilical ligament vesicohypogastric fascia.

Descending Rectal Septa The descending rectal septa run alongside the vagina from the undersurface of the cardinal ligament and its vaginal prolongation to the lateral surface of the rectum and thence to the sacrum. Retrorectal Space The retrorectal space lies in the midline between the sacrum and the adventitia of the rectum, between the posterior portion of the rectal pillars. This space communicates with the pararectal spaces above the uterosacral ligaments. Pararectal Spaces The paired pararectal spaces are only potential and are not preformed. They lie below the cardinal ligament and its vaginal prolongation.

The medial border is formed by the rectal pillar, the lateral by the levator ani. The posterior portion extends backward above the ischial spine but under the cardinal ligament to the anterior surface of the lateral part of the sacrum. Behind the cardinal ligament the independent caudal portion of each side becomes continuous with the cranial portion of the opposite side. The upper rectum is surrounded by a single circular pararectal space. The boundaries of this space, formed by communication of two pararectal spaces and the retrorectal space, are formed laterally and below by the cranial surface of the levator, above and medially by the rectum, descending rectal septa, and the cardinal ligament.

It is made L-shaped by the horizontal part below the cardinal ligament and the cranial and ascending portion behind the cardinal ligament. The cranial portion of the space is bounded anteriorly by the cardinal ligament and posteriorly by the lateral part of the sacrum.

The sheaths of the great vessels of the Vagina position wall form the lateral border; the pararectal space is bordered medially by the rectal septa and ureteric sheath. Vaguna inferior or horizontal division is bounded below by the levator ani, above by the cardinal ligament, and medially by the rectal septum. The two pararectal spaces communicate with each other posterior to the rectum, where there is no limiting membrane. Rectovaginal Septum and Space Centered in a relatively avascular rectovaginal space, the posterior vaginal wall and anterior rectal wall have functional independence of one another. This space permits the two organs to glide over one another with considerable mobility.

The anterior wall of this space is formed by a specialized connective tissue layer of fused peritoneum, the rectovaginal septum.


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