Female pelvis and perineum Flashcards
how does the parietal peritoneum extend?
Parietal peritoneum continues into pelvic cavity but does not reach the pelvic floor.
What completely envelops the uterine tubes?
Uterine tubes are completely enveloped by peritoneum – the broad ligament
What are the ovaries suspended by?
Ovaries: suspended by mesovarium from posterior of broad ligament (not fully enveloped)
What are the ligaments that support the pelvis viscera made of?
Pelvic fascial condensations form “ligaments” supporting viscera eg: cervix, vagina
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. They contains the uterine tubes and the uterine arteries.
What is the top part of the uterus and the rest called?
Fundus of uterus.
body, lower segment and cervix
What are the four parts of the fallopian tube/uterine tube?
Isthmus, Ampulla, Infundibulum, Fimbriae
What are the three ligaments that hold the cervix in place?
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
How is there a potential communication between the peritoneal cavity and the exterior via the reproductive passage?
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.
What are the two openings of the cervix?
Internal Orifice
External Orifice
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 - this is what is tested in the smear test
Describe the orientation of the axis of the cervix in relation to the axis of the vagina.
The axis of the cervix is at 90 degrees to the axis of the vagina
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
What can be felt in the digital examination through the vagina?
- Ischial spine
- Ovaries
- Uterine artery pulse
- 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 supply the walls of the pelvis?
Sacral, Gluteal and Obturator Branches
What artery supplies the perineum and the recto-anal region?
Pudendal Artery
Where is there an arterial anastomosis in the pelvic region?
Ovarian artery and the uterine artery both supply the ovaries and they anastomose.
what is the function of the uterine artery ?
when does it cross the ureter?
Main blood supply to uterus. Enlarges during pregnancy
Crosses ureter about 1 cm from cervix
What are the two divisions of the uterine artery?
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
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
Perineal spaces
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
what is the median erectile tissue masses (corpus spongiosum) ?
In females it divides around the vestibule to form vestibular bulbs. The glans of clitoris is derived from this.
what is the lateral erectile (corpora cavernosa) tissue masses
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
How is the bulbospongiosus different in women?
It splits into two around the vestibule of the vagina
What makes up the body and glans of the clitoris?
Body - corpora cavernosae
Glans - corpus spongiosum
Describe the arrangement of sphincters in the deep perineal pouch.
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.
What is the collective name for female external genitalia?
Vulva
What gland in women is the equivalent of the prostate in men?
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.
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
describe the nerves of pelvis?
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
Describe the nerves of the perineum?
- Anterior labial N (from ilioinguinal L1)
- Perineal br of post
cutaneous N of thigh S1-S3 - Pudendal N S2 – S4
describe the lymphatic drainage of pelvis and perineum/
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).
where do the perineal lymph drain to?
Perineal lymph drainage is to superficial inguinal nodes
what is the floor of the female pelvic floor made of and what does it consist of?
Levator Ani
- Iliococcygeus
- Pubococcygeus
- Puborectalis
