The Female Reproductive System

Question 1

What does ‘water under the bridge’ refer to in women?

Answer 1

Ureter passes under the uterine artery

Question 2

Where is fluid most likely to accumulate in the pelvic cavity of a woman?

Answer 2

Rectouterine pouch

Question 3

What is the angle of anteversion?

Answer 3

Position of cervix in relation to vagina

Vagina - Version

Question 4

How do you clinically test the angle of anteversion?
What are the results?

Answer 4

Insert fingers into the vagina + feel for a cervix:

• cervix is anteverted: cervix felt on fingertips
• cervix is retroverted: cervix felt on fingernails

Question 5

How do you work out the angle of anteversion in a cross section specimen?
What are the results?

Answer 5

Draw long axis of vagina + cervical canal

• cervix is anteverted: <180°
• cervix is retroverted: >180°

Question 6

What is the angle of anteflexion?

Answer 6

Position of uterus compared to cervix

Question 7

How do you clinically test the angle of anteflexion?
What are the results?

Answer 7

Place hand on abdominal wall, insert other fingers in vagina + press uterus:

• uterus is anteflexed: can feel fundus of uterus
• uterus is retroflexed:cannot feel fundus of uterus

Question 8

How do you work out the angle of anteflexion in a cross section specimen?
What are the results?

Answer 8

Draw long axis of cervical canal and uterus?

• uterus is anteflexed: <180°
• uterus is retroflexed: >180°

Question 9

Why is it important to know the angle of anteversion?

Answer 9

Insertion of IUD
- to prevent perforation of any structures + causing bleeding

Question 10

What is the venous drainage of the ovaries?

Answer 10

• right ovary: right ovarian vein > IVC
• left ovary: left ovarian vein > left renal vein > IVC

Question 11

Why do some women get a sharp pain during ovulation?

Answer 11

The egg bursts out of the ovary

Question 12

What can happen to a ovary with a cyst?

Answer 12

• can twist > ovarian torsion
• can disrupt the blood supply > ischaemia

Question 13

What are the fornices?

Answer 13

• the upper end of the vagina where it meets the cervix
• ‘bulges around the cervix’

Question 14

What is cervical ectropion?

Answer 14

• it is a normal occurrence in which the cells that line the cervical canal spread out onto the surface on the cervix
• can appear red as the cells in the canal are thinner

Question 15

What can cause cervical ectropion?

Answer 15

Hormonal contraceptions

Question 16

What cells are in the uterine tubes?

Answer 16

• Ciliated cells
• Peg cells

Question 17

Function of ciliated cells in the uterine tubes

Answer 17

Cilia waft the egg down the tube

Question 18

Function of peg cells in the uterine tubes

Answer 18

• nutrition for sperm + egg
• secrete mucus which aids the movement of the egg and sperm

Question 19

What is the vesicouterine pouch?

Answer 19

A fold of peritoneum over the bladder and the uterus forming a pelvic recess

Question 20

What is the rectouterine pouch?
What is its other name?

Answer 20

• A fold of peritoneum over the rectum and the uterus forming a pelvic recess
• pouch of Douglas

Question 21

What are the 4 peritoneal ligaments?

Answer 21

• broad ligament
• round ligament
• ligaments of ovary
• suspensory ligament of ovary

Question 22

What is the round ligament between?

Answer 22

• from the uterus to the labia majora through the inguinal canal (deep inguinal ring)
• sits under the peritoneal sheath

Question 23

What is the round ligament a remnant of?

Answer 23

Gubernaculum

Question 24

What is the ligament of ovary between?

Answer 24

Ovary and uterus

Question 25

What is the suspensory ligament of the ovary?

Answer 25

- attaches each ovary to the pelvic sidewall - the neurovascular pathway bulging into peritoneum

Question 26

What is the broad ligament?

Answer 26

A two layered fold of peritoneum that extends from the lateral pelvic walls + folds over the internal genitalia

Question 27

What is the ligament of ovary a remnant of?

Answer 27

Gubernaculum

Question 28

What is the remnant of the Gubernaculum in women?

Answer 28

- Round ligament - ligament of ovary

Question 29

What are the subdivisions of the broad ligament?

Answer 29

- mesometrium - mesovarium - mesosalpinx

Question 30

What are the divisions of the uterine tubes?

Answer 30

- fimbriae - infundibulum - ampulla - isthmus

Question 31

What is the lymphatic drainage of the ovaries?

Answer 31

Para-aortic nodes

Question 32

What is type of epithelia is inside the vagina?

Answer 32

Stratified squamous epithelium (withstands friction)

Question 33

What is the mesosalpinx?

Answer 33

A subdivision of the broad ligament which covers the fallopian tubes

Question 34

What is the mesovarian?

Answer 34

- a subdivision of the broad ligament which attaches to the hilum of the ovary + encloses the neurovascular bundle - does NOT cover the ovary

Question 35

What is the mesometrium?

Answer 35

- a subdivision of the broad ligament which surround the uterus + external iliac vessels - also encloses proximal part of the round ligament

Question 36

What is the most common location of a ectopic pregnancy?

Answer 36

Ampulla

Question 37

Compare the cervical os before and after childbirth

Answer 37

- **pre-childbirth**: small dot . - **post-childbirth**: linear shape -

Question 38

Where do the ovarian arteries arise from?

Answer 38

Abdominal aorta

Question 39

What is the blood supply to the vagina?

Answer 39

- vaginal arteries - branches of the internal iliac artery

Question 40

What does the vaginal artery arise from?

Answer 40

Internal iliac artery

Question 41

Why are there large granules of glycogen in the vagina?

Answer 41

For the natural bacteria (lactobacilli) which keep the vagina acidic

Question 42

What can a disruption in the natural bacteria of the vagina cause?

Answer 42

Bacterial vaginosis Thrush

Question 43

What is the venous drainage of the uterus?

Answer 43

Into the **uterine vein** via a plexus in the broad ligament > drains into the **internal iliac vein**

Question 44

What is the venous drainage of the vagina?

Answer 44

into the **vaginal vein** via a plexus > drains into **internal iliac vein**

Question 45

What is the lymphatic drainage of the uterus?

Answer 45

- **body**: external iliac - **fundus**: paraaortic + inguinal - **cervix**: external + internal iliac + sacral

Question 46

What is the lymphatic drainage of the vagina?

Answer 46

- **superior 1/3**: external iliac - **middle 1/3**: internal iliac - **inferior 1/3**: superficial inguinal EIS in alphabetic order

Question 47

What are the 4 types of FGM?

Answer 47

1- partial/total removal of clitoris 2- partial/total removal of clitoris + labia minora 3- removal of labia minora + sewing labia majora together only leaving a small hole for urine + menstrual blood 4- any other harmful procedure *e.g. piercing, cutting*

Question 48

What is type 1 FGM?

Answer 48

Partial or total removal of clitoris

Question 49

What is type 2 FGM?

Answer 49

Partial or total removal of clitoris + labia minora

Question 50

What is type 3 FGM?

Answer 50

removal of labia minora + sewing labia majora together only leaving a small hole for urine + menstrual blood

Question 51

What needs to be considering in transgender women?

Answer 51

They normally have a prostate so they could suffer from BPH or prostate cancer

Question 52

What are polycystic ovaries? What is it a common cause of?

Answer 52

>10 cysts Infertility

Question 53

What type of peritoneum covers the ovaries?

Answer 53

Parietal peritoneum

Question 54

What is endometriosis?

Answer 54

Ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity

Question 55

What is the most common site of pelvic endometriosis?

Answer 55

Pound of Douglas Recto-uterine pouch