The vaginal epithelium contains lower levels of lipids. This allows the passage of water and water-soluble substances through the tissue. Keratinization happens when the epithelium is exposed to the dry external atmosphere. In abnormal circumstances, such as in pelvic organ prolapse, the mucosa may be exposed to air, becoming dry and keratinized. Blood and nerve supply Blood is supplied to the vagina mainly via the vaginal artery, which emerges from a branch of the internal iliac artery or the uterine artery. The vaginal arteries anastamose (are joined) along the side of the vagina with the cervical branch of the uterine artery; this forms the azygos artery, which lies on the midline of the anterior and posterior vagina. Other arteries which supply the vagina include the middle rectal artery and the internal pudendal artery, all branches of the internal iliac artery. Three groups of lymphatic vessels accompany these arteries; the upper group accompanies the vaginal branches of the uterine artery; a middle group accompanies the vaginal arteries; and the lower group, draining lymph from the area outside the hymen, drain to the inguinal lymph nodes. Ninety-five percent of the lymphatic channels of the vagina are within 3 mm of the surface of the vagina. Two main veins drain blood from the vagina, one on the left and one on the right. These form a network of smaller veins, the vaginal venous plexus, on the sides of the vagina, connecting with similar venous plexuses of the uterus, bladder, and rectum. These ultimately drain into the internal iliac veins. The nerve supply of the upper vagina is provided by the sympathetic and parasympathetic areas of the pelvic plexus. The lower vagina is supplied by the pudendal nerve. Function Secretions Vaginal secretions are primarily from the uterus, cervix, and vaginal epithelium in addition to minuscule vaginal lubrication from the Bartholin's glands upon sexual arousal. It takes little vaginal secretion to make the vagina moist; secretions may increase during sexual arousal, the middle of or a little prior to menstruation, or during pregnancy. Menstruation (also known as a "period" or "monthly") is the regular discharge of blood and mucosal tissue (known as menses) from the inner lining of the uterus through the vagina. The vaginal mucous membrane varies in thickness and composition during the menstrual cycle, which is the regular, natural change that occurs in the female reproductive system (specifically the uterus and ovaries) that