Gynecology Lecture (Dr. Olinger)

Question 1

Uterus

Answer 1

• Thick walled, hollow, distensible muscular Organ, location of embryo and fetus development

A). FUNDUS (rounded superior portion between Uterine Horns, furthest away from the Vaginal Opening)

B). BODY (upper 2/3 of Uterus)
1. UTERINE HORNS (superolateral region, entrance point for
the Uterine Tubes)

2. UTERINE CAVITY (internal space in the Body of the Uterus)
   a. INTERNAL Os of the UTERUS (passage from Uterine Cavity to Cervical Canal)

C). ISTHMUS (tapering region superior to the Cervix)

D). CERVIX (Cylindrical, narrow inferior region, protrudes into the
uppermost Vagina)
1. SUPRAVAGINAL PART (between Isthmus and Vaginal Part)

2. VAGINAL PART (part of the Cervix that extends into the
   Upper most Vagina, surrounded by Fornix)
3. CERVICAL CANAL (small fusiform space in the Cervix of
   the Uterus)
   a. EXTERNAL Os of the UTERUS (inferior opening of the Cervical Canal into the Vagina)

Question 2

Clinical Note: After Child Birth

Answer 2

• After child birth the female infant Uterus has adult proportions (2/3 Body to 1 /3 Cervix) due to maternal hormonal influence.
• POSTPARTUM the Uterus reduces to a 1 ⁄ 2 Body/ 1 ⁄ 2 Cervix ratio. During PUBERTY the body of the Uterus returns again to the 2/3 size until MENOPAUSE, where it again returns to a 1 ⁄ 2 to 1 ⁄ 2 ratio.

Question 3

Clinical Note: Cervical Cancer

Answer 3

• Cervical Cancer was the leading cause of death of North American women until the 1940’s with the advent of the PAPANICOLAOU SMEAR, which can detect premalignant Cervical conditions.

Question 4

Clinical Note: Hysterectomy

Answer 4

• Hysterectomy: Excision of the Uterus through the Anterior Abdominal Wall or Vagina.

Question 5

Layers of the Uterine Wall

Answer 5

1. PERIMETRIUM (outer layer, serous coat of Peritoneum)
2. MYOMETRIUM (middle muscular layer, most vascular layer)
3. ENDOMETRIUM (inner mucous layer, closely adherent to Myometrium)

Question 6

Uterine and Ovarian Ligamentous Structures

Answer 6

1. BROAD LIGAMENT of the UTERUS (see Arthrology)
2. SUSPENSORY L. of the OVARY (see Arthrology)
3. ROUND LIGAMENT of the UTERUS (fibrous remnant of the
   inferior part of the Ovarian Gubernaculum, extends from the lateral Uterus, through the Mesometrium to the Labia Majora via the Inguinal Canal)
4. LIGAMENT of the OVARY (fibrous remnant of the superior part of the Ovarian Gubernaculum, extends from the Lateral Uterine Wall to the Ovary through the Mesometrium)
5. TRANSVERSE CERVICAL L. (see Arthrology)
6. UTEROSACRAL L. (see Arthrology)

Question 7

UTERINE (Fallopian) TUBES

Answer 7

• Convey Oocytes from the Ovary to the Uterus

A). INFUNDIBULUM (funnel-shaped distal end open to the Peritoneal Cavity near the Ovaries)
1). ABDOMINAL OSTIUM (opening that leads from Peritoneal Cavity to the Infundibulum of the Uterine Tube)

2) . FIMBRIAE (finger-like projections from the end of the Infundibulum over the Ovaries)
a. OVARIAN FIMBRIA (one long Infundibular Fimbria that attaches to the superior end of the Ovary)

B). AMPULLA (longest portion, from the Infundibulum to the Isthmus)

C). ISTHMUS (thick-walled portion which enters the Uterus Horn)

D). UTERINE PART (short segment which passes through the Uterine Wall)
1. UTERINE OSTIUM (opening that leads from the Uterine tube to the Uterine Cavity)

Question 8

Clinical Note: Ligation of the Uterine Tubes

Answer 8

• Ligation of the Uterine tubes is done either abdominally or Laparoscopically through the umbilicus and involves ligating the Uterine Tubes so the Oocytes never reach the Uterine cavity.

Question 9

Ovaries

Answer 9

• Small, almond-shaped glands suspended by Mesovarium; responsible for the production and expulsion of Oocytes

Question 10

Vagina

Answer 10

• Musculomembranous tube from the Cervix of the Uterus to
  the Vestibule of the Vagina, between the Labia Minora, normally a collapsed tube except at the superior most part that surrounds the Cervix of the Uterus

A). VAGINAL FORNIX (short recess around the Cervix, typically
described as having a deep posterior part, a shallow anterior and lateral parts)

Question 11

Perineum (Shallow External Compartment, contains the Female Genitalia and Pudendum (Vulva))

Answer 11

1. Mons Pubis
2. Pudendal Cleft
3. Labia Majora
4. Labia Minora
5. Clitoris
6. Vaginal Vestibule

Question 12

Mons Pubis

Answer 12

• Rounded, fatty prominence anterior to the Pubic Symphysis

Question 13

Pudendal Cleft

Answer 13

• Anterior slit between Labia Majora

Question 14

Labia Majora

Answer 14

• Prominent skin folds, protect External Urethral and Vaginal Orifices
  a. ANTERIOR LABIAL COMMISSURE (junction of Right and Left Labia Majora, anterior to the Angle of the Clitoris)
  b. POSTERIOR LABIAL COMMISSURE (posterior Limit of the Pudendum, overlies the Perineal Body, usually not present after first Vaginal birth)

Question 15

Labia Minora

Answer 15

• Folds of fat-free, hairless Skin enclosed within the Pudendal Cleft and Labia Majora, surround the Vestibule of the Vagina
  a. FRENULUM OF THE LABIA MINORA (Fourchette; small posteriorly located transverse mucosal fold, exists pre-sexual activity)

Question 16

Clitoris

Answer 16

• Erectile organ extends from the anterior junction of the Labia
  Minora posteriorly to the Pubic Symphysis, branches into two Crura which associate with corresponding Inferior Pubic Rami

A). GLANS CLITORIS (distal anterior projection)

B) ANGLE OF THE CLITORIS (at the Pubic Symphysis, bend in the Clitoris at the junction of the Crura and the Body of the Clitoris, described as being comprised of two Corpora Cavernosa)

C) BODY OF THE CLITORIS (comprised of two corpora Cavernosa)

D) CRURA OF THE CLITORIS (associated with the corresponding Inferior Pubic Ramus, posterolateral projections of the Corpora Cavernosa)

1. RIGHT Crus of the Clitoris
2. LEFT Crus of the Clitoris

E). PREPUCE OF THE CLITORIS (anterior most junction of the Labia Minora which travels anterior to and variably covers the Glans Clitoris)

F). FRENULA OF THE CLITORIS (travel posteriorly from the Clitoris to the paired Labia Minora)

G). SUSPENSORY L. of the CLITORIS (extends from the Pubic Symphysis to the Body of the Clitoris)

Question 17

Vaginal Vestibule

Answer 17

• Between paired Labia Minora, contains the Vaginal and External Urethral Orifices

A). EXTERNAL URETHRAL ORIFICES (exit point of the Urethra)

B). VAGINAL ORIFICE (opening of the Vagina)
1. HYMEN (membranous structure surrounding the Vaginal
Orifice)

C). BULBS OF THE VESTIBULE (paired, elongated erectile tissue, surrounding the Vaginal Orifice, homologous to the Bulb and the Corpus Spongiosum of the Penis)

D). GREATER VESTIBULAR GLANDS (paired glands, posterior to the Bulbs of the Vestibule, on either side of the Vaginal Vestibule, secrete mucus upon sexual arousal)

E). LESSER VESTIBULAR GLANDS (paired glands on either side of the Vaginal Vestibule, secrete mucus between External
Urethral Orifice and Vaginal Orifice moistening Labia and Vaginal Vestibule)