6. Pelvis and perineum: Female Flashcards
What completely envelops the uterine tubes?
Broad ligament
What are the ovaries suspended by?
Mesovarium (from posterior of broad ligament)
What are the ligaments that support the pelvis viscera (e.g. cervix) made of?
Condensations of pelvic fascia
What is the role of the broad ligaments and what runs through them?
Broad ligaments are transverse mesenteries joining the uterus to the pelvic walls.
Contain uterine tubes and uterine arteries.
What is the top part of the uterus called?
Fundus
What are the parts of the uterine tube?
Fimbriae Infundibulum Ampulla Isthmus Uterine part
What are the 3 ligaments that hold the cervix in place? (passive support)
Transverse cervical (cardinal) Ligament
Pubocervical Ligament
Uterosacral Ligament
These prevent the cervix from prolapsing
How is there a potential communication between the peritoneal cavity and the exterior via the reproductive passage?
Via the reproductive passage: Abdominal ostium of uterine tube and vaginal opening
What does the uterus consist of?
Fundus
Body
Lower segment
Cervix
What are the 2 openings of the cervix?
Internal Os
External Os
What is the term for the opening of the fallopian tube into the uterus?
Uterine Ostium
Describe how the uterus changes in size throughout pregnancy.
The fundus rises up the abdomen.
In the 10th month the fundus is lower than in the 9th month.
Describe the epithelial lining of the cervical canal.
Simple columnar epithelium, with goblet cells
Describe the epithelial lining of the vaginal surface of the cervix.
Non-keratinising stratified squamous epithelium
tested in the smear test
Describe the orientation of the axis of the cervix in relation to the axis of the vagina.
Axis of the cervix is at 90 degrees to the axis of the vagina
What is the cervix held in place by?
Strong cervical ligaments attached to pelvis and sacrum (ligaments are part of pelvic fascia)
What is the normal arrangement of the uterine body, the cervix and the vagina?
Uterine body is anteflexed on the cervix
Cervix is anteverted on the vagina
How long is a normal vagina?
7-9 cm
Which fornix is important clinically?
Posterior fornix (deeper) In close relation to recto-uterine pouch
What can be felt in the digital examination through the vagina?
Ischial spine Ovaries Uterine artery pulse (lateral fornix) Cervix Sacral Promontory
What are the main branches of the internal iliac artery that supply the pelvic viscera?
Superior Vesical Artery
Uterine Artery
Middle Rectal Artery
Which branches of the internal iliac artery supply the walls of the pelvis?
Sacral, Gluteal and Obturator Branches
What artery supplies the perineum and the recto-anal region?
Pudendal Artery
What supplies blood to the ovaries?
Ovarian artery (Main supply, directly from aorta) Ascending Uterine artery
What are the 2 divisions of the uterine artery?
Ascending Branch: supplies the uterine tubes and ovary
Descending Branch: Vaginal Artery (equivalent of inferior vesical in men) supplies the vagina
What gives the main blood supply to the uterus and enlarges during pregnancy?
Uterine artery
Where are eggs from the ovary initially released into?
Into the peritoneal cavity because the ovary is on the posterior surface of the broad ligament
Which urethral sphincter is not well developed in women?
Internal urethral sphincter
Which urethral sphincter is crucial for maintaining urinary continence in women?
External urethral sphincter
Describe the arrangement of sphincters in the deep perineal pouch.
Part of the pelvic floor muscles form compressor urethrae (compresses urethra)
Parts of the fibres from here combine with the external urethral sphincter to for sphincter urethrovaginalis.
This wraps around the external urinary sphincter
How is the corpus spongiosum different in women?
It splits into 2 around the vestibule of the vagina to form vestibular bulbs
How are the corpora cavernosa arranged in women?
Paired cylinders attached to ischiopubic rami
What makes up the body and glans of the clitoris?
Body: corpora cavernosae
Glans: corpus spongiosum
What is the collective name for female external genitalia?
Vulva
What gland in women is the equivalent of the prostate gland in men?
Skene’s gland (Paraurethral gland/ Lesser vestibular gland)
What gland in women is the equivalent of the paraurethral gland in men? What is its role?
Greater vestibular gland (Bartholin’s)
Provide lubrication
Where do the greater and lesser paraurethral glands open into? Where do the peri-urethral glands open into?
G+L: Vaginal vestibule
P-U: Urethral lumen
What does the vaginal wall lack? How is the wall kept moist?
Mucosa has no glands
Kept moist by transudation
Describe the mucosa in the cervical canal
Has numerous mucous glands
These are active in pre-menopausal women
Describe the innervation of the pelvic contents
Sympathetic: T10-L2 via hypogastric plexus
Parasympathetic: S2-S4 outflow
Somatic (to perineum): Pudendal S2-S4
What is the pudendal nerve motor and sensory to in females?
M: Perineal muscles, anal and urethral sphincters, levanter ani
S: external genitalia
Which lymph nodes do the pelvic organs drain to?
External and internal iliac lymph nodes
Where do the ovaries and testes drain to?
Para-aortic lymph nodes
Where do the perineum and external genitalia drain to?
Superficial inguinal nodes
What is the role of the suspensory ligament of the ovary?
Supplies vessels (e.g. ovarian artery) and nerves from lateral walls to ovary
Where does fertilisation occur?
Ampulla
What is the significance of the cervix protruding into the vagina?
Forms fornices
Recesses
Why is breathing harder late in pregnancy?
Uterus occupies large part of abdominal cavity
Makes diaphragm movement difficult
Which structures may be accidentally tied off during a hysterectomy?
Ureters
What is the term for the space between the labia majora?
Vestibule of vagina
