Diagram for lymphatic drainage of vulva

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Here is a complete overview of the lymphatic drainage of the vulva, supported by diagrams from authoritative textbooks.

Lymphatic Drainage of the Vulva

Diagram 1 - Inguinal Lymph Node Groups (Schwartz's Principles of Surgery, Fig. 41-17)

This diagram shows the superficial inguinal and superficial femoral lymph nodes clustered around the fossa ovalis, in relation to the inguinal ligament and great saphenous vein - the primary drainage basin for the vulva.

Diagram 2 - Female Pelvic Lymphatic Drainage (Berek & Novak's Gynecology, Fig. 5-11)

Female pelvic lymphatic drainage showing vulvar drainage pathway to inguinal, iliac, and para-aortic nodes

The arrows from the vulva (bottom) show the upward flow through inguinal nodes to external iliac, common iliac, and ultimately para-aortic nodes.

Drainage Pathway - Step by Step

Step	Station	Notes
1st	Superficial inguinal nodes	Primary drainage from most of the vulva - labia majora, labia minora, clitoral hood, perineal skin
2nd	Deep femoral (deep inguinal) nodes	Drain the superficial inguinal nodes; the most distal is Cloquet's node (just under inguinal ligament)
3rd	External iliac nodes	Drain the deep femoral nodes upward
4th	Common iliac nodes	Further upward drainage
5th	Para-aortic nodes	Final common pathway

Special Drainage Routes

Clitoris and labia minora: Drain directly to the deep inguinal nodes, bypassing the superficial nodes. The clitoris also has direct efferents to the internal iliac nodes via the dorsal vein.
Perineum and lower labia majora: Some drainage goes to the rectal lymphatic plexus.
Midline crossing: The lymphatics from either side of the vulva form rich midline anastomoses. Drainage from the clitoris, anterior labia minora, and perineum is bilateral - meaning metastases can appear contralaterally even without ipsilateral nodal involvement.

Clinical Relevance (Vulvar Cancer)

The primary sentinel/drainage nodes are the superficial inguinal nodes - this is why radical vulvectomy includes bilateral inguinal lymph node dissection.
Cloquet's node (deep femoral, beneath inguinal ligament) acts as a gateway to pelvic nodes.
Bilateral nodal spread is possible even for unilateral lesions when they involve midline structures (clitoris, anterior vulva, perineum).

Sources:

Campbell-Walsh-Wein Urology, "Vulva: Vascularization, Lymphatic Drainage, and Neuroanatomy"
Berek & Novak's Gynecology, Fig. 5-11 and Table 5-5
Schwartz's Principles of Surgery (11th ed.), Fig. 41-17

Simple diagram

Generating Image

Simple clean medical flowchart diagram showing lymphatic drainage of the vulva. Flow arrows going upward: Vulva (labia majora, labia minora, perineum) at the bottom draining to Superficial Inguinal Nodes, then to Deep Femoral Nodes (with a label for Cloquet's node), then to External Iliac Nodes, then to Common Iliac Nodes, then to Para-aortic Nodes at the top. A separate side arrow from Clitoris going directly to Deep Inguinal Nodes and also to Internal Iliac Nodes. Clean white background, simple boxes and arrows, medical textbook style.

Lymphatic drainage of the vulva - simple diagram

Key points to remember:

Main route: Vulva → Superficial Inguinal → Deep Femoral (Cloquet's node) → External Iliac → Common Iliac → Para-aortic
Clitoris has a direct bypass route to Internal Iliac nodes
Drainage is bilateral for midline structures (clitoris, anterior labia minora)

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