Vaginal rugae

Other structures can be present on the vaginal wall though most of the time these can be differentiated from rugae.^[12][13] Vaginal cysts can be small protrusions into the vagina that can be felt or palpated by a clinician. Vaginal inclusion cysts can appear as small bumps and can develop after childbirth.^[12] Other small structures or protrusions can be Gartner's duct cysts, patches of endometrial tissue, and benign tumors.^[12][14] These cystic structures can obliterate the rugae and is a clue to their presence.^[15] The absence of vaginal rugae seen in the normal vagina of a healthy woman may be an indication of a prolapsed bladder (cystocele) or rectocele.^[13][12] An enterocele, or bulging of the bowel into the vagina can also cause vaginal rugae to disappear.^[16] The absence of vaginal rugae may also be an indicator of pelvic organ prolapse.^[17][18][19] Vaginal rugae disappear in those with an estrogen deficiency.^[7][20]

Vaginal rugae can disappear during the second stage of labor.^[21] After a vaginal birth, the rugae are not visible and the walls of the vagina are smooth. By the third week postpartum, the vagina has become much smaller and the rugae begin to reform on the vaginal walls. Six weeks after birth, the rugae have returned to approximately the same size as they were before the birth. The number of rugae after childbirth decreases.^[22] In women who have not given birth, the rugae are more prominent than in those who have given birth multiple times.^[6]