Female pelvis and perineum

Question 1

how does the parietal peritoneum extend?

Answer 1

Parietal peritoneum continues into pelvic cavity but does not reach the pelvic floor.

Question 2

What completely envelops the uterine tubes?

Answer 2

Uterine tubes are completely enveloped by peritoneum – the broad ligament

Question 3

What are the ovaries suspended by?

Answer 3

Ovaries: suspended by mesovarium from posterior of broad ligament (not fully enveloped)

Question 4

What are the ligaments that support the pelvis viscera made of?

Answer 4

Pelvic fascial condensations form “ligaments” supporting viscera eg: cervix, vagina

Question 5

What is the role of the broad ligaments and what runs through them?

Answer 5

Broad ligaments are transverse mesenteries joining the uterus to the pelvic walls. They contains the uterine tubes and the uterine arteries.

Question 6

What is the top part of the uterus and the rest called?

Answer 6

Fundus of uterus.

body, lower segment and cervix

Question 7

What are the four parts of the fallopian tube/uterine tube?

Answer 7

Isthmus, Ampulla, Infundibulum, Fimbriae

Question 8

What are the three ligaments that hold the cervix in place?

Answer 8

3 sets of fibrous bands – the cervical ligaments – anchor the cervix in position within the pelvis. These prevent the uterus from prolapsing through the vagina.

• Pubocervical Ligament
• Transverse (cardinal) Ligament
• Uterosacral Ligament

Question 9

How is there a potential communication between the peritoneal cavity and the exterior via the reproductive passage?

Answer 9

The fallopian tubes open into the peritoneal cavity via the abdominal ostium of the uterine tube and vaginal opening. This forms a connection between the exterior and the peritoneal cavity through the abdominal ostium of the uterine tube.

Question 10

What are the two openings of the cervix?

Answer 10

Internal Orifice

External Orifice

Question 11

What is the term for the opening of the fallopian tube into the uterus?

Answer 11

Uterine Ostium

Question 12

Describe how the uterus changes in size throughout pregnancy.

Answer 12

The fundus rises up the abdomen. In the 10th month the fundus is lower than in the 9th month.

Question 13

Describe the epithelial lining of the cervical canal.

Answer 13

Simple columnar epithelium - with goblet cells

Question 14

Describe the epithelial lining of the vaginal surface of the cervix.

Answer 14

Non-keratinising stratified squamous epithelium - this is what is tested in the smear test

Question 15

Describe the orientation of the axis of the cervix in relation to the axis of the vagina.

Answer 15

The axis of the cervix is at 90 degrees to the axis of the vagina

Question 16

What is the normal arrangement of the uterine body, the cervix and the vagina?

Answer 16

Uterine body is anteflexed on the cervix

Cervix is anteverted on the vagina

Question 17

How long is a normal vagina?

Answer 17

7-9 cm

Question 18

Which fornix is important clinically?

Answer 18

Posterior fornix

Question 19

What can be felt in the digital examination through the vagina?

Answer 19

• Ischial spine
• Ovaries
• Uterine artery pulse
• Cervix
• Sacral Promontory

Question 20

What are the main branches of the internal iliac artery that supply the pelvic viscera?

Answer 20

Superior Vesical Artery
Uterine Artery
Middle Rectal Artery

Question 21

Which branches supply the walls of the pelvis?

Answer 21

Sacral, Gluteal and Obturator Branches

Question 22

What artery supplies the perineum and the recto-anal region?

Answer 22

Pudendal Artery

Question 23

Where is there an arterial anastomosis in the pelvic region?

Answer 23

Ovarian artery and the uterine artery both supply the ovaries and they anastomose.

Question 24

what is the function of the uterine artery ?

when does it cross the ureter?

Answer 24

Main blood supply to uterus. Enlarges during pregnancy

Crosses ureter about 1 cm from cervix

Question 25

What are the two divisions of the uterine artery?

Answer 25

Ascending branch supplies uterine tubes and ovary. (Ovary has ovarian artery from abdominal aorta)

Descending Branch - Vaginal Artery (equivalent of inferior vesical in men) - supplies the vagina

Question 26

Where are eggs from the ovary initially released into?

Answer 26

Into the peritoneal cavity because the ovary is on the posterior surface of the broad ligament

Question 27

Perineal spaces

Answer 27

Perineal membrane (PM): Thick triangular fascial structure attached to pubic arch. Posterioly free margin. Anteriorly a small gap.
Deep perineal space: is above the PM and below fascia of pelvic diaphragm.
Superficial perineal space: is below PM and perineal fascia (subcutaneous tissue)
These spaces are potential spaces and they become real only when for eg: fluid leaks into them

Question 28

what is the median erectile tissue masses (corpus spongiosum) ?

Answer 28

In females it divides around the vestibule to form vestibular bulbs. The glans of clitoris is derived from this.

Question 29

what is the lateral erectile (corpora cavernosa) tissue masses

Answer 29

Lateral erectile tissue masses (corpora cavernosa) Paired cylinders, attached to ischiopubic rami. The body of clitoris is derived from these.
These erectile tissues within perineum are surrounded by skeletal muscles

Question 30

How is the bulbospongiosus different in women?

Answer 30

It splits into two around the vestibule of the vagina

Question 31

What makes up the body and glans of the clitoris?

Answer 31

Body - corpora cavernosae

Glans - corpus spongiosum

Question 32

Describe the arrangement of sphincters in the deep perineal pouch.

Answer 32

Part of the pelvic floor muscles form compressor urethrae (compresses the urethra)
Parts of the fibres from here combine with the external urethral sphincter to for sphincter urethrovaginalis.
It wraps around the urethra and keeps it closed.

Question 33

What is the collective name for female external genitalia?

Answer 33

Vulva

Question 34

What gland in women is the equivalent of the prostate in men?

Answer 34

Skene’s gland (Paraurethral gland)
REMEMBER: nerve supply is the same in women
Greater vestibular gland (Bartholin’s) and lesser vestibular glands (Skene’s) open into the vaginal vestibule. Peri-urethral glands open into the urethral lumen.

Question 35

Which lymph nodes do the pelvic organs drain to?

Answer 35

External and internal iliac lymph nodes

Question 36

Where do the ovaries and testes drain to?

Answer 36

Para-aortic lymph nodes

Question 37

Where do the perineum and external genitalia drain to?

Answer 37

Superficial inguinal nodes

Question 38

describe the nerves of pelvis?

Answer 38

Pelvic and perineal nerves:

1) Pelvic sympathetic – T10 - L2 via hypogastric plexus;
2) Pelvic parasympathetic – sacral outflow from S2-S4
3) Perineum (somatic) – Pudendal nerve S2-S4

Question 39

Describe the nerves of the perineum?

Answer 39

1. Anterior labial N (from ilioinguinal L1)
2. Perineal br of post
   cutaneous N of thigh S1-S3
3. Pudendal N S2 – S4

Question 40

describe the lymphatic drainage of pelvis and perineum/

Answer 40

Pelvic organs drain mainly to external and internal iliac nodes (around the arteries)

Ovary and testis drain to para-aortic nodes

Perineum (including anal canal) and external genitalia drain to superficial inguinal nodes (subcutaneous below inguinal ligament).

Question 41

where do the perineal lymph drain to?

Answer 41

Perineal lymph drainage is to superficial inguinal nodes

Question 42

what is the floor of the female pelvic floor made of and what does it consist of?

Answer 42

Levator Ani

1. Iliococcygeus
2. Pubococcygeus
3. Puborectalis