ANATOMY

Question 1

Synonym of VULVA

Answer 1

PUDENDUM

Question 2

Female external genital organs/ Vulva includes

Answer 2

Mons veneris
Labia majora
Labia minora
Clitoris
Vestibule
Perineum

Question 3

Mons veneris/ pubis

Answer 3

Subcutaneous adipose connective tissue, adult: covered by hair

Question 4

Labia majora

Answer 4

Lateral boundary of vulva
Fold of skin and subcutaneous tissue
Squamous epithelium
Sebaceous glands, sweat glands and hair follicles
Beneath skin: adipose tissue richly supplied by venous plexus: HEMATOMA IF INJURED DURING CHILDBIRTH
Inner surface hairless
Homologous: scrotum
Round ligaments terminate at its anterior end
Join to form posterior commissure in front of anus

Question 5

Labia minora

Answer 5

Thick skin folds devoid of fat just inside the labia majora
Connective tissue, sebaceous glands, erectile muscle fibers, vessels and nerves
Devoid of hair follicles
Anteriorly divide to enclose clitoris, form prepuce and frenulum anteriorly and posteriorly respectively
Posteriorly fuse to form fourchette USUALLY INJURED DURING CHILDBIRTH
Homologous: ventral aspect of penis

Question 6

Clitoris

Answer 6

Cylindrical erectile body measuring 2.5 cm
Location: most anterior part of vulva
Consists: Glans( squamous epithelium+ nerves), body and two crura
Vessels: connected to vestibular bulb, LIABLE TO INJURY DURING CHILDBIRTH
Attached: undersurface of symphysis pubis by suspensory ligament
Analogous: penis

Question 7

Vestibule

Answer 7

Triangular area
Bounded Ant clitoris, Lat labia minora Post fourchette
4 openings
Urethral: anteriorly, 1-1.5 cm below pubic symphysis in the midline, paraurethral ducts open in post wall or directly onto vestibule
Vaginal: large, posterior, midline
Strat squam
Hymen guards opening
Virgin+ Nulliparous: covered by labia minora
Ruptures with sex, lacerated during childbirth and represented by cicatrized nodules CARUNCULAE MYRTIFORMIS
Bartholin gland ducts

Question 8

Bartholin Glands

Answer 8

2 pea-sized
Located in superficial perineal pouch close to posterior end of vestibular bulb
Secrete alkaline mucus when sexually aroused, helped by contraction of bulbocavernosus
Lined by columnar epi, racemose gland
Duct 2 cm opens at junction of ant 2/3 and post 1/3 of vestibule in groove between hymen and labia minora, lined by columnar epi and strat squam(near opening)
Homologous: bulbourethral gland

Question 9

Vestibular bulbs

Answer 9

2 elongated masses of erectile tissue within the mucous membrane of vestibule on either side of vaginal orifice
Incorporated within bulbocavernosus
Homologous with bulb of penis and corpus spongiosum

Question 10

Vagina

Answer 10

Fibromusculomembranous sheath
Communicates uterine cavity and vulva
Canal for copulation, menstrual flow and birth
Directed upwards and backwards, 45* with horizontal in erect position, parallel to plane of pelvic inlet
4 walls, ant 7 cm post 9 cm and 3 lateral, H shaped on transverse section
4 fornices due to projection of cervix through anterior wall

Question 11

Relations of Vagina

Answer 11

ANT
Upper 1/3 UB
Lower 2/3 Urethra

POST
Upper 1/3 Pouch of Douglas
Middle 1/3 Rectum separated by rectovaginal septum
Lower /3 Anal canal separated by perineal body

LAT
Upper 1/3 Pelvic cellular tissue
Middle 1/3 blended with Levator ani
Lower 1/3 (3B) Vestibular bulb, Bartholin glands and Bulbocavernosus

Question 12

Vaginal Epithelial changes

Answer 12

Birth-14 days: Strat squam due to maternal estrogen
Pre puberty to post menopause: Few layered
Puberty to menopause: Strat squam devoid of glands; basal cells, intermediate cells and superficial cornified cells. Intermediate and superficial cells have glycogen. Cells extend up to squamnocolumnar junction

Question 13

Vaginal Secretion

Answer 13

Acidic ph 4-5.5
Highest ph: upper vagina due to mixing of cervical fluid
More acidic: prior to menstruation or middle of menstrual cycle, pregnancy, sexual excitement
Contents
Epithelial debris, tissue fluid, leukocytes, proteins, lactic acid produced by Doderlein’s bacilli

Question 14

Doderlein’s bacilli

Answer 14

GP rods, Anaerobic in acidic media
Convert glycogen to lactic acid in the vagina
Presence depends on estrogen, comes from intestines
Present 3 days after birth- 14th day
Reappears in puberty

Question 15

Uterine changes with age

Answer 15

Birth: uterus in false pelvis + long cervix
Child: uterus:cervix= 2:1
Puberty: uterus:cervix= 1:2 to 1:3
Post menopause: uterus atrophies

Question 16

Uterus dimensions

Answer 16

Length 8cm
Breadth 5cm at fundus
Wall thickness 1.5 cm
Isthmus 0.5cm
Cervix 2.5 cm; supravaginaland vaginal parts each 1.25cm

Question 17

Uterine cavity dimensions

Answer 17

Fundus: no cavity
Body 3.5cm triangular on coronal section with apex downwards
Cervix 2.5 cm
Total 6-7cm

Question 19

Uterus

Answer 19

Perimetrium: serous coat absent on lateral borders
Myometrium: thick smooth muscles, outer longitudinal, middle interlacing and inner circular
Endometrium: lamina propria with stroma: glands (non ciliated secretory columnar epi), blood vessels and nerves AND surface epi (single layer of ciliated columnar epi)

Question 22

Cervix histology

Answer 22

EPITHELIAL LINING

1. ARBOR VITAE UTERI
   median ridge anteriorly and posteriorly from which transverse folds radiate
   Lined: columnar epi with basal nuclei single layer, ciliated at folds, reserve cuboidal cells
   Stroma with fibrous CT and complex racemose glands lined by secretory columnar epi
2. PORTIO VAGINALIS
   Lining: strat squam upto external os where changes to columnar
3. TRANSITIONAL ZONE
   1-10mm
   Endocervical stroma and glands, histology varies with estrogen, irritation from infection and trauma
   Susceptible to dysplasia, metaplasia and carcinoma