Anatomy of the Female Reproductive System

Question 1

What three arteries (branches of the internal iliac) exit the pelvis? Through which foramen do they pass?

Answer 1

Greater sciatic foramen

Superior gluteal artery, inferior gluteal artery and the internal pudendal artery

Question 2

What muscles do the gluteal arteries supply?

Answer 2

Superior supplies gluteus medius and minimus

Inferior supplies gluteus maximus

Question 3

What are the three branches of the internal pudendal artery that supply the perineum?

Answer 3

Inferior rectal
Perineal
Dorsal clitoral/penis

Question 4

What are the arteries of the pelvic viscera? (7)

Answer 4

Umbilical artery (obliterates)
Superior vesical arteries
Obturator Artery
Inferior vesical artery
(Uterine Arteries)
(Vaginal Artery)
Middle rectal arteries

Question 5

What do the vesical arteries supply?

Answer 5

Bladder

Question 6

What level does the ovarian artery come off the abdominal aorta?

Answer 6

L2-3

Question 7

What is the most common area for ectopic pregnancy?

Answer 7

Ampulla of fallopian tube

Question 8

Ectopic pregnancy - where might pain be referred to?

Answer 8

Shoulder, neck, or rectum

Question 9

What ligaments are there that support the uterus? (3)

Answer 9

Transverse cervical (cardinal) ligaments
Pubocervical ligaments
Sacrocervical ligaments

Question 10

What is the normal position of the uterus?

Answer 10

Anteverted and anteflexed

Question 11

Levator ani - what are the four fibres/muscles that comprise this? The join together in the middle to form…?

Answer 11

Sphincter vaginae
Puborectalis
Pubococcygeus
Iliococcygeus

MIDLINE (LEVATOR) RAPHE

Question 12

What does sphincter vaginae do?

Answer 12

Forms a sling around prostate/vagina and inserts into the perineal body (supports constrict vagina).

Question 13

What does puborectalis do?

Answer 13

Forms sling from pubic bone around rectoanal junction.

Question 14

What are the pelvic splanchnic nerves?

Answer 14

Parasympathetic to inferior hypogastric plexus. Come from S2, S3 and S4.

Question 15

What are the nerve roots for the pudendal nerve?

Answer 15

S2-4

Question 16

After a difficult childbirth, the levator ani muscles may fail to recoil and take up their previous position.
What complications may occur? (3)

Answer 16

Prolapse (uterine, vaginal, rectal)
Herniation of the bladder (cytocele)
Stress incontinence

Question 17

What makes up the female superficial pouch?

Answer 17

3 masses of erectile tissue
3 muscles
Bartholin’s gland
Perineal body

Question 18

What are the three muscles of the female superficial pouch?

Answer 18

Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal muscle

Question 19

What are the three masses of erectile tissue of the female superficial pouch?

Answer 19

Bulb of vestibule (attached to urogenital diaphram, divided by vagina)
Crura of clitoris

Question 20

What are the contents of the pudendal canal?

Answer 20

Pudendal nerve

Internal pudendal artery/vein

Question 21

What are the branches of the pudendal nerve?

Answer 21

Inferior rectal nerve
Dorsal nerve of penis/clitoris
Perineal nerve

Question 22

What are the branches of the internal pudendal artery?

Answer 22

Inferior rectal

Branches to penis, labia + clitoris

Question 23

Nocioception in viscera can cause pain which is consciously experienced – particularly if…?

Answer 23

The GVA travels with sympathetic nerves

Question 24

GVA impulses reach the spinal cord through sympathetic pathways through ____ from the thoracic viscera and _____ for most of the abdomen.

Answer 24

T1-T5

T5-L2

Question 25

GVA impulses travel with parasympathetic splanchnic nerves in the pelvis. What are the nerve roots?

Answer 25

S2-S4

Question 26

For labour, what three types of anaesthesia/block can be done?

Answer 26

Spinal Anaesthesia Pudendal nerve block Caudal epidural block

Question 27

Where is spinal anaesthesia given? What is the effect of this?

Answer 27

Subarachnoid space L4-5 | Complete anaesthesia below the waist

Question 28

What is a common side effect of spinal anaesthesia?

Answer 28

Headache

Question 29

Where is a pudendal nerve block given? What is the effect of this?

Answer 29

``` Pudendal nerve (S2-4) Anaesthesia of perineum and lower 1/4 vagina - somatic, the nerve alone is affected. ```

Question 30

Where/how is a caudal epidural block given? What is the effect of this?

Answer 30

Anaesthetic administered to catheter in sacral canal. This blocks out visceral pain from the cervix and vagina AS WELL AS somatic pain. Limbs are still unaffected and the mother can bare down with her abdominal muscles to assist contractions.

Question 31

Where does the majority of lymphatic drainage from the vagina go to? What about the ovaries?

Answer 31

Iliac lymph nodes | Preaortic