Identify the following structures in the female reproductive system:
Describe the clinical basis for a sharp pain at ovulation
- Mittelschmerz pain is pelvic/lower abdominal pain felt during ovulation
- Exact cause is unknown
Why do nuns tend to get ovarian cancer?
They have the maximum number of follicular ruptures, thus get repeated healing/scarring which predisposes them to cancer
What are ovarian cysts?
Ovarian cysts are large fluid filled lesions on the ovary
How might a patient with an ovarian cyst present?
- Lower abdominal pain (stretching of perineum, rupture / torsion of ovary)
- Back pain
Identify the following structures on the uterus:
- Uterine tube
What sort of structure is the cervix?
Fibrous or muscular?
Distinguish between the external Os of a cervix that has had a baby passed through and one that hasn’t
Why do pregnant women experience the following symptoms:
- Acid reflux
- Acid reflux: uterus pushes on stomach from below
- Constipation: uterus pushes backwards onto large intestine
- Polyuria: uterus pushes downwards onto bladder
In terms of fertilisation, what is the clinical significance of the uterine tubes?
Site of fertilisation
What is notable about the ampulla region of the fallopian tube?
Most common site for ectopic pregnancies
What is the most important investigation in women of reproductive age with abdominal pain?
Identify the peritoneal ligaments
- Broad ligament
- Round ligament
- Ovarian ligament
- Suspensory ligament of the ovary
Describe the structure of the broad ligament
Broad ligament – peritoneal fold
Describe the structure of the suspensory ligament of the ovary
Suspensory ligament of the ovary – neurovascular pathway bulging into peritoneum
Describe the origins of the round ligament and the ligament of ovary
Round ligament and ligament of ovary – remnants of the gubernaculum
What is the mesovarium?
Mesovarium is the portion of the broad ligament of the uterus that suspends the ovaries
What is the mesosalpinx?
Mesosalpinx is the portion of the broad ligament that stretches from the ovary to the level of the uterine tube
What is the mesometrium?
Mesometrium is the mesentery of the uterus, composing most of the broad ligament of the uterus, excluding only the mesosalpinx and the mesovarium
How does the uterus get its blood supply?
- Uterine artery
- Ovarian artery
What is significant about the axis of cervix?
- Axis of cervix to axis of vagina < 180o = cervix is anteverted (most common)
- Axis of cervix to axis of vagina >180o = cervix is retroverted
What is significant about the axis of uterine body?
- Axis of uterine body to axis of vagina < 180o = uterus is anteflexed (most common)
- Axis of uterine body to axis of vagina > 180o = uterus is retroflexed
How is anteversion/anteflexion maintained?
Describe the three different types of vaginal mutilation
- Removal of clitoris
- Removal of all except urethra and vagina
- Everything is removed, sewn up and leaving a tiny opening for urine
What is the origin of the blood supply to the ovary?
The ovarian artery arises from the abdominal aorta
Describe the venous drainage of the left and right ovaries
- Left ovarian vein (LOV) drains into left renal vein
- Right ovarian vein (ROV) drains into the inferior vena cava
To which lymph nodes does the ovary drain?
Para-aortic lymph nodes
Identify the following areas in the fallopian tube:
How might infection spread to the peritoneum from the female reproductive tract?
Via the fimbrae
Describe how the tissue structure of the Fallopian tube facilitates the transport of the ovum towards the uterus
- Peristalsis: muscular tube moves ovum in peristaltic waves
- Cilliary sweeps: unidirectional movement of ovum
What may be the consequence of infection in the uterine tubes?
- Ectopic pregnancy
- Infection could spread to peritoneum (peritonitis)
Where would pain be felt with an ectopic pregnancy implanted in the ampulla of the uterine tubes?
Why is shoulder tip pain associated with the rupture of an ectopic pregnancy?
Blood runs up paracolic recesses (spaces between abdominal wall and colon) which compresses the phrenic nerve
Describe the arterial supply to the uterine tubes
- Uterine arteries
- Ovarian arteries
Be able to identify the following structures:
- Ovarian artery
- Uterine artery
- Vagina artery
- Internal pudendal artery
Why is the ureter at risk of being damaged during a hysterectomy?
- When removing the uterus, the uterine artery is clamped
- The ureter is closely associated to the uterine artery (water under the bridge)
What are the posterior anatomical relations of the vagina?
What are the anterior anatomical relations of the vagina?
What are the lateral anatomical relations of the vagina?
- Uterine artery
In terms of lymphatic drainage, identify the structures below:
In terms of the vulva, label the following structures:
- Mons pubis
- Labia majora & minora
- Vestibule of the vagina
- External urethral orifice
Describe the structure of the recto-uterine pouch
- Aka pouch of Douglas
- It is an extension of peritoneum between the posterior wall of uterus and the rectum in females
Describe the structure of the vesico-uterine pouch
Vesico-uterine pouch is a second but shallower pouch formed from the peritoneum over the uterus and bladder
In a bimanual/pelvic examination, which structure can be palpated anteriorly from the fornix?
In a bimanual / pelvic examination, what structures can be palpated from the posterior fornix?