Clinical anatomy of female repro tract

Question 1

Name two major purposes of the ovary

Answer 1

1. produce mature ova for fertilization

2. Generate steroid hormones

Question 2

Name the four parts of the uterus from superior-inferior

Answer 2

1. Fundus
2. Uterine tubes
3. Body
4. Cervix

Question 3

Where is the vesicouterine and rectouterine pouch?

Answer 3

The vesicouterine pouch is anterior to the uterus

The rectouterine pouch/pouch of Douglas is a posterior extension of the peritoneum; between the posterior wall of the uterus and rectum in females

Question 4

What is the normal position for the uterus to be in?

Name the two terms that would describe an abnormally placed uterus

Answer 4

1. Anteverted (inclined forward, with respects to the vagina)
2. Anteflexed forward with respect to the cervix

Abnormal: retroverted (points upwards at the head), retroflexed (flexes backwards at the cervix so the body and fundus are pointing towards the back)

Question 5

Where is the cervix? What two gutters does it form?

Answer 5

Cervix: the inferior part of the uterus, forms the posterior and anterior fornix

*it’s a broad cylinder with a narrow central channel that produces a dome-shaped bulge into the vaginal canal

Question 6

Which age group is there a higher prevalence of cervical carcinomas and which disease does it have a strong link with?

Answer 6

Strong link with HPV and more common in younger women

Question 7

If the cervical carcinoma tumour were to spread into the lymphatic system which lymph nodes would be immediately affected?

Answer 7

The internal and common iliac nodes

Question 8

What is the function of the fallopian tubes? Where is the usual site of fertilization?

Answer 8

Conduct the oocyte into the uterine cavity, fertilization is usually in the ampulla

Question 9

How do the fallopian tubes communicate with the peritoneal cavity?

Answer 9

Via an opening in the infundibulum

Question 10

Compare a tubal ligation procedure and a salpingo-oophorectomy

Answer 10

Tubal ligation: severing and tying the fallopian tubes for female sterilization

Salpingo-oophorectomy: Removing the uterine tubes + ovaries (e.g; cancer risk, reproductive disorders)

Question 11

What is the primary job of the uterine ligaments?

Name the four major sets

Answer 11

To anchor/support the uterus and ovaries in the pelvis via CT

1. Broad ligament
2. Round ligament
3. Cardinal (transverse cervical ligament)
4. Uterosacral ligament

Question 12

What is the broad ligament? Name and briefly describe each of its three parts

Answer 12

A double fold of peritoneum that extends laterally to the sidewalls of the pelvis

Mesovarium: a portion of the broad ligament that suspends the ovaries

Mesosalpinx: part of the broad ligament between the fallopian tube and the mesovarium

Mesometrium: Surrounds the uterus and is the largest subsection of the broad ligament. It covers the external iliac vessels and encloses the proximal part of the round ligament of the uterus.

Question 13

Where did the round ligament originate from embryologically? What are its attachment points?

Answer 13

Derived from the caudal end of the gubernaculum.

Attaches from the ovary, through the inguinal canal and splays out on labia majora

Question 14

What and where is the cardinal (transverse cervical) ligament?

Answer 14

Fascia that extends from the cervix to the lateral pelvis walls

Question 15

What and where is the uterosacral ligament?

Answer 15

Fascia (bilateral) extending from the cervix to the posterior pelvic walls/sacrum

Question 16

What is the job of the ovarian ligament and the suspensory ligament of the ovary?

Answer 16

Ovarian: connects the ovary to the lateral surface of the uterus

The suspensory ligament extends from the ovary in the other direction and carries blood vessels and nerves from the abdomen into the pelvis!

Question 17

What do the pubocervical ligaments do?

Answer 17

Bilateral structures that attach the cervix to the posterior surface of the pubic symphysis, they support the uterus in the pelvic cavity

Question 18

What generally happens when the uterine ligaments fail?

Answer 18

Vaginal and/or uterine prolapse

Question 19

Which arteries supply the female repro tract and where do they branch off from?

Answer 19

The ovarian arteries, arising just below the renal arteries (L1) on the abdominal aorta

Question 20

Which veins supply the female repro tract? Where do they drain into?

Answer 20

Ovarian veins:
L ovarian vein -> drains into L renal vein
R ovarian vein -> drains into IVC

Question 21

Name the lymph nodes involved in drainage from the

a) ovary
b) the uterus’ fundus + upper body
c) the uterus’ body + Cervix

Answer 21

a) Lumbar para-aortic nodes
b) para-aortic nodes and superficial inguinal nodes
c) external + internal iliac nodes and sacral nodes

Question 22

What is the pudendal cleft and what does it come together to form?

Answer 22

The opening between the labia majora which comes together to form mons pubis

Question 23

What does the labia minora enclose?

Answer 23

Encloses the opening of the vagina, the vestibular bulbs/clitoral bulbs

*vestibular bulbs are two masses of erectile tissue on either side of the vaginal opening and the clitoris

Question 24

What are the major and lesser vestibular bulbs and what do they secrete?

Answer 24

Major: bartholin’s, slightly posterior and to the L and R of the vaginal opening, they secrete mucus to lubricate the vagina (homologous to bulbourethral glands in males)

Lesser: skene’s, secretes fluid that helps lubricate the urethral opening

Question 25

What are the four roles of the bulbospongiosus muscle?

Answer 25

Clitoral erection, orgasm contraction, closes the vagina, expels remaining urine from the urethra

Question 26

What is the role of the ischiocavernosus muscle in males and females

Answer 26

Stabilizes the erect penis, tenses the vagina during orgasm

Question 27

Where is the perineal body?

Answer 27

Between the junction of the urogenital triangle and anal triangle

Question 28

What is culdocentesis/how is it performed? When is it used?

Answer 28

When peritoneal fluid is aspirated from the pouch of Douglas (rectouterine pouch) through the posterior vaginal fornix. It is used to evaluate women with pain in the lower abdomen/pelvis to determine whether intraabdominal fluid is present

Question 29

What is the pelvic pain line? Which structures are above and below and how does it determine the course of visceral pain sensation?

Answer 29

It is a ‘threshold’ in the inferior peritoneum, a pelvic structure is “above” the pelvic pain line if it’s in contact with the peritoneum

Above the line: uterine fundus, body; visceral afferent fibres conducting pain follow sympathetic fibres

Below: uterine cervix, vagina; visceral afferent fibres conducting pain impulses follow parasympathetic fibres

Question 30

Describe the innervation to the vagina

Answer 30

Inferior 1/5: somatic innervation from the pudendal nerve

Superior 4/5: visceral innervation from uterovaginal plexus

Question 31

Describe the pathway of the pudendal nerve, what does it innervate?

Answer 31

1. Exits pelvis via the greater sciatic foramen (S2-4)
2. Crosses ischial spine (close to sacrospinous ligament)
3. Enters perineum via lesser sciatic foramen (with internal pudendal artery)
4. Travels through pudendal canal/Alcock’s canal (along the wall of the ischioanal fossa)
   Gives off branches

Innervates the perineum (between anus and scrotum/vulva) and the pelvic floor

Question 32

What two muscles is the greater sciatic foramen in between?

Answer 32

Piriformis and coccygeus muscle

Question 33

What three major branches does the pudendal nerve give off?

Answer 33

1. Perineal N: innervates perineum
2. Inferior rectal nerve
3. Dorsal nerve of penis/clitoris; purely sensory

Question 34

What forms the lowest point in the peritoneal cavity?

Answer 34

The rectouterine pouch

Question 35

Name three ways to diagnose a cervical carcinoma and a treatment option

Answer 35

Diagnosis: inspection, imaging, biopsy
Treatment: can include removal of cervix/uterus