Female pelvis

Question 1

List the female pelvic organs

Answer 1

Ovary, uterine (Fallopian) tubes
Uterus and cervix
Vagina
Ureter, bladder, urethra
Rectum and 
Caecum, appendix, parts of sigmoid colon and ileum
Vessels, nerves and lymphatics

Question 2

What is the key difference between the interaction between organs of different body systems in the female pelvis

Answer 2

Organs from several systems in the pelvic cavity. No sharing of reproductive and urinary passages in female.

Question 3

How long are the vagina and urethra in females

Answer 3

Vagina- 10 cm

Urethra- 4cm long

Question 4

Summarise the peritoneum and pelvic fascia in females

Answer 4

Parietal peritoneum continues into pelvic cavity but does not reach the pelvic floor.
Uterine tubes are completely enveloped by peritoneum – the broad ligament
Ovaries: suspended by mesovarium from posterior of broad ligament (not fully enveloped)
Pelvic fascial condensations form “ligaments” supporting viscera eg: cervix, vagina

Question 5

Summarise the broad ligament of the ovary

Answer 5

The broad ligaments are transverse mesenteries joining the uterus to the pelvic walls.
Their important contents are the uterine tubes and uterine arteries.

Question 6

Describe the descent of the ovaries

Answer 6

Like the testes, the ovaries develop high on the posterior abdominal wall and then descend, bringing their vessels, lymphatics and nerves with them
However, unlike the testes, the ovaries do not migrate through the inguinal canal into the perineum, but stop short and assume a position on the lateral wall of the pelvic cavity.

Question 7

Describe the position of the ovary

Answer 7

Each almond-shaped ovary lies adjacent to the lateral pelvic wall just inferior to the pelvic inlet and is suspended by a fold of peritoneum,  the mesovarium, from the posterior aspect of the broad ligament.
The open (fimbriated) end of the uterine (fallopian) tube lies nearby, so that discharged ova may enter it. Within the mesovarium and posterior aspect of the broad ligament lies the ligament of ovary, which is an embryological remnant of the descent of the ovary

Question 8

What ae the round ligaments and ovarian ligaments descendents of

Answer 8

Round ligament of uterus
Remnant of gubernaculum to inguinal canal

Ligament of ovary
Remnant of gubernaculum

Question 9

Describe the function of the ovarian ligament

Answer 9

The ovarian ligament is attached to the ovary inferiorly. It connects the ovary to the side of the uterus. Structurally, it is a fibrous band of tissue that lies within the broad ligament. It joins the uterus just below the origin of the fallopian tubes.

Question 10

Describe the function of the suspensory ligament of ovary

Answer 10

The suspensory ligament of ovary extends outwards from the ovary to the lateral abdominal wall. It consists of a fold of peritoneum, thus some sources consider it to be part of the broad ligament. The function of this ligament is to contain the ovarian vessels and nerves (ovarian artery, ovarian vein, ovarian nerve plexus and lymphatic vessels).

Question 11

What are the functions of the ovaries

Answer 11

Sites of egg production (oogenesis)- mature eggs are ovulated in the peritoneal cavity and normally directed into the adjacent openings of the uterine tubes by cilia on the ends of the uterine tubes

Question 12

Summarise the stability of the cervix and the vagina

Answer 12

3 sets of fibrous bands – the cervical ligaments – anchor the cervix in position within the pelvis. These prevent the uterus from prolapsing through the vagina.

Question 13

Describe the 3 ligaments that stabilise the cervix and vagina

Answer 13

Condensations of fascia form ligaments that extend from the cervix to the anterior (pubocervical), lateral (transverse cervical or cardinal) and posterior (uterosacral ligament) pelvic walls.
These ligaments together with the perineal membrane, levator ani muscles and the perineal body, are thought to stabilise the uterus in the pelvic cavity
The most important of these is the cardinal ligament, which extend laterally from each side of the cervix and vaginal vault to the related pelvic wall
Help to prevent prolapse and the positive pressures in the abdomen pushing these organs down

Question 14

Summarise the uterus and uterine tubes

Answer 14

Consists of fundus, body, lower segment and cervix
Uterine tubes consist of infundibulum, ampulla, isthmus and uterine parts
Potential communication between peritoneal cavity and exterior via the reproductive passage -abdominal ostium of uterine tube and vaginal opening. (None exists in males)

Question 15

Describe the uterus

Answer 15

The uterus is a thick-walled muscular organ in the midline between the bladder and the recutm.
It consist of a body and a cervix, inferiorly it joins the vagina
Superiorly, uterine tubes project laterally from the uterus and open into the peritoneal cavity immediately adjacent to the ovaries

Question 16

Describe the body of the uterus

Answer 16

Flattened anteroposteriorly and, above the level of the origin of the uterine tubes, has a rounded superior end (fundus).
the cavity of the body is a narrow slit, when viewed laterally, and is shaped like an inverted triangle when viewed anteriorly
each of the superior corners is continuous with the lumen of the uterine tubes; the inferior corner is continuous with the central canal of the cervix

Question 17

Describe the changes of the uterus during pregnancy

Answer 17

Implantation of the blastocyst- normally occurs in the body
The uterus expands dramatically expands superiorly into the abdominal cavity
can make breathing difficult in pregnancy

Question 18

What is the cavity of the uterus lined by

Answer 18

A specialised mucous membrane, the endometrium, which responds to cyclical hormone changes- although the lining of the cervix does not take part in these changes

Question 19

Describe the uterine tubes

Answer 19

The uterine tubes extend from each side of the superior end of the body of the uterus to the lateral pelvic wall and are enclosed within the upper margins of the mesoalpinx portions of the broad ligaments.
Because the ovaries are suspended from the posterior aspect of the broad ligaments, the uterine tubes pass superiorly and terminate laterally to the ovaries

Each uterine tube has an expanded trumpet-shaped head the infundibulum, which curves around the superolateral pole of the ovary- the margin of the infundibulum is rimmed with small finger like projections termed fimbriae (facilitating the collection of ovulated eggs)
the lumen of the uterine tube opens into the peritoneal cavity at the narrowed end of the infundibulum
medial to the infundibulum, the tube expands to form the ampulla and then narrows to form the isthmus, before joining the body of the uterus
fertilisation takes place in the ampulla

Question 20

Summarise the cervix

Answer 20

Fibro-muscular ‘cylinder’ with internal os and external os
Cervical canal lined by mucus-secreting simple columnar epithelium.
Vaginal surface (of cervix) covered in stratified squamous non-keratinized epithelium (cervical smear test)- no glands in the vaginal wall
Projects into anterior vaginal wall at right angle to vaginal axis
Held in position by strong cervical ligaments attached to pelvis and sacrum – these ligaments are part of pelvic fascia, not peritoneum.

Question 21

What is the cervix

Answer 21

inferior part of uterus and is shaped like a short, broad cylinder with a narrow central channel
Because the end of the cervix is domed shaped, it bulges into the vagina, and a gutter, or fornix is formed around the margin of the cervix where it joins the vaginal wall
the tubular central canal of the cervix opens, below, as the external os, into the vaginal cavity, and above, as the internal os, into the uterine cavity

Question 22

Describe the relationship between the uterus, cervix and vagina

Answer 22

The cervical canal enters the vagina through the upper part of its anterior wall, the two tubes forming an angle of around 90 degrees

The body of the uterus is folded anteriorly (anteflexed on cervix) over the superior surface of the emptied bladder
The cervix is angled forward (anteverted) on the vagina so the inferior end of the cervix projects into the upper anterior aspect of the vagina

Question 23

Summarise the vagina

Answer 23

Fibromuscular canal – 7 -9 cm
Vaginal fornices at upper end
Posterior fornix is important clinically
Urethra fused with the anterior wall

Question 24

Describe the vagina

Answer 24

Copulatory organ in women
It is a distensible fibromuscular tube that extends from the perineum in the pelvic floor and into the pelvic cavity
The internal end of the canal is enlarged to form the vaginal vault
anterior relation is the urethra
posterior relation is the rectum

inferiorly, the vagina opens into the vestibule of the perineum immediately posterior to the external opening of the urethra
from its external opening (the introitus), the vaginal course posterosuperiorly through the perineal membrane, where it is attached by its anterior wall to the circular margin of the cervix

Question 25

What are the vaginal fornices

Answer 25

the vaginal fornix is the recess formed between the margin of the cervix and the vaginal wall. Based on position, the fornix is subdivided into a posterior fornix, an anterior fornix and two lateral fornices.

Question 26

Why is the posterior fornix important clinically

Answer 26

The recto-uterine pouch is an extremely important clinical region situated between the rectum and uterus When the patient is in the supine position, it is the lowest part of the abdominopelvic cavity and is a site where infection and fluids typically collect If an abscess is suspected, it can be drained through the posterior fornix of the vagina or rectum without necessitating transabdominal surgery Can also use it to collect or place eggs in IVF

Question 27

What happens during intercourse

Answer 27

Semen is deposited in the vaginal vault Spermatozoa make their way through the external os of the cervical canal, pass through the cervical canal into the uterine cavity, and then continue through the uterine cavity into the uterine tube where fertilisation normally occurs in the ampulla

Question 28

List the structures palpable on vaginal examination

Answer 28

Cervix- deepest third with the recto-uterine pouch Ischial spine Sacral promontory Uterine artery pulse (lateral fornix) Ovary and uterine tube either side- especially if enlarged Some structures can be felt through rectal examination

Question 29

Where can you palpate the uterosacral ligaments

Answer 29

on rectal not vagina examinations | they press either side of the rectum

Question 30

Summarise the blood supply to the female pelvis and perineum

Answer 30

Main branches to pelvic viscera are superior vesical, uterine and middle rectal (from internal iliac) - from anterior trunk of internal iliac Walls of pelvis supplied by sacral, gluteal and obturator branches- from posterior trunk of internal iiac but obturator is from anterior Pudendal artery supplies perineum and recto-anal region (via inferior rectal branch)- anterior iliac artery

Question 31

What does each artery in the pelvis supply

Answer 31

Superior and inferior vesical (vaginal) arteries: supply the bladder and vagina respectively Middle rectal: supplies the rectum Uterine arteries: bifurcates, so ascending branch can supply the uterus, uterine tube and ovary while the descending branch supplies the cervix and vagina Vaginal artery is equivalent to inferior vesical a in men

Question 32

Describe the uterine artery

Answer 32

Courses medially and anteriorly in the base of the broad ligament to reach the cervix Along its course, it crosses the ureter and passes superiorly to the lateral vaginal fornix once the vessel reaches the uterus, it ascends along the lateral margin of the uterus to reach the uterine tube, where it curves laterally and anastomoses with the ovarian artery Main blood supply to uterus. Enlarges during pregnancy Crosses ureter about 1 cm from cervix Ascending branch supplies uterine tubes and ovary. (Ovary has ovarian artery from abdominal aorta) Descending branch supplies vagina

Question 33

Describe the orientation of the ovary

Answer 33

The ovary is on the posterior surface of broad ligament facing into the peritoneal cavity into which eggs are first released The ovaries lie close to the openings of the uterine tubes into the peritoneal cavity. Ovaries and adjacent tubes receive an ovarian artery from the upper abdominal aorta.

Question 34

What is a common disaster in hysterectomy

Answer 34

Ureters can be tied off accidentally with uterine arteries during hysterectomy – a classic disaster. Ureter is under uterine arteries

Question 35

Describe the fascia in the pelvic cavity

Answer 35

Lines the pelvic walls, surrounds the bases of the pelvic viscera, and forms sheaths around the vessels and nerves that course medially from the pelvic walls to reach the viscera in the midline This fascia is a continuation of the extraperitoneal connective tissue layer found in the abdomen

Question 36

Describe this fascia in women

Answer 36

Forms rectovaginal septum (separating posterior surface of vagina from rectum) Forms condensations that holds the cervix and vagina in place

Question 37

Describe the formation of the pouches formed by the peritoneum in women

Answer 37

In women the uterus lies between the bladder and rectum, and the uterine tubes extend from the superior aspect of the uterus to the lateral pelvic walls This forms a shallow vesico-uterine pouch anteriorly (between uterus and bladder) and a deeper recto-uterine pouch posteriorly between the bladder and rectum In addition a large fold of peritoneum (the broad ligament), with the uterine tube enclosed in its superior margin and an ovary attached posteriorly, is located on each side of the uterus and extends to the lateral pelvic walls.

Question 38

Describe the structure of the broad ligament

Answer 38

Sheet-like fold of peritoneum oriented in the coronal plane that runs from the lateral pelvic wall to the uterus and encloses the uterine tube in its superior margin and suspends the ovary from its posterior aspect The uterine arteries cross the ureters at the base of the broad ligaments, and the ligaments of ovary and round ligament of the uterus are enclosed within the parts of the broad ligament related to the ovary and the uterus respectively.

Question 39

What are the 3 parts of the broad ligament

Answer 39

mesometrium- largest part- extends from lateral pelvic walls to body of uterus mesoalpinx- most superior part- suspends uterine tube in the pelvic cavity mesovarium- posterior extension of the broad ligament, which attaches to the ovary

Question 40

What does the ligament of ovary give rise to

Answer 40

courses medially in the margin of the mesovarium to the uterus and then continues anterolaterally as the round ligament of uterus. The round ligament of the uterus passes over the pelvic inlet to reach the inguinal canal to end in the connective tissue related to the labium majus in the perineum Both the ligament of ovary and round ligament are remnants of the gubernaculum, which attaches the gonad to the labioscrotal swellings in the embryo