Female Perineum & Reproductive Organs Flashcards by Geun Young Park

Diamond shaped region between the upper thighs and below the pelvic diaphragm

Perineum

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The Perineum is divided into what 2 “triangles”

Urogenital triangle (anterior)
Anal triangle (posterior)

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The Female perineum contains paired folds of skin called _________ that surround the urethral and vaginal orifices

Labia

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All of the external female genital structures are collectively known as the…

Vulva

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What structures compose the Vulva (7 total)

Mons pubis
Labia Majora
Labia Minora
Clitoris
Vestibule of the Vagina
Bulbs of the Vestibule
Greater Vestibular Glands

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Superficial mound of fatty subcutaneous tissues that lies anterior to the Pubic Symphysis

Mons Pubis

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Bilateral folds of fatty, hair covered tissue that surrounds the female genitalia; join anteriorly and posteriorly at commissures

Labia Majora

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Bilateral folds of hairless skin that flank the vestibule of the vagina

Labia Minora

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Fusion of the Labia Minora, forming a fold over the Clitoris

Prepuce of the Clitoris

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Fusion of the Labia Minora just POSTERIOR to the Clitoris

Frenulum of the Clitoris

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Area between the Labia Minora; contains the Urethral Orifice, Vaginal Orifice and openings for the Greater Vestibular Glands

Vestibule of vagina

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What Orifices are located in the Vestibule (3 total)

External Urethral
Vaginal
Greater Vestibular Glands (Bartholin’s)

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Orifice within the Vestibule; is POSTERIOR to the Clitoris and ANTERIOR to the vaginal opening

External Urethral Orifice

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The External Urethral Orifice is located (anterior/posterior) to the Clitoris and (anterior/posterior) to the Vaginal opening

Posterior to Clitoris

Anterior to Vaginal opening

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Largest orifice within the Vestibule; normally partially closed at birth by Hymen

Vaginal Orifice

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There are ______ openings for the Greater Vestibular Glands in the Vestibule

2 (one on each side of the vaginal orifice)

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Paired elongated masses of erectile tissue, one on each side of the vaginal orifice; covered by the Bulbospongiosus muscles; thin out anteriorly and fuse to form the Clitoris

Vestibular Bulbs

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Glands on either side of the Vestibule; function to secrete mucous to lubricate the vagina

Greater Vestibular Glands (Bartholin’s glands)

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Purpose of the Greater Vestibular Glands (Bartholin’s glands)

Secrete mucous to lubricate the vagina

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Fancy name for the Greater Vestibular Glands

Bartholin’s glands

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What are the 3 branches of the Pudendal nerve

Inferior Rectal
Perineal
Dorsal Clitoral

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Which ARTERY and NERVE supply the majority of the External Female Genitalia

Internal Pudendal Artery
Pudendal nerve

*both within the Pudendal Canal

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What approaches can an OB/GYN take to perform a Pudendal Nerve Block (2 total)

Transvaginal

Transcutaneous

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Which landmark do you need to identify in order to perform a Pudendal Nerve Block

Ischial spine

transvaginal or transcutaneous approach

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The Camper's fascia is continuous with the Colle's fascia in the Perineum (True or False)

False; the Scarpa's fascia is the one that is continuous with the Colle's fascia * Females don't have Darto's fascia.

Another name for the Colles' Fascia

Superficial Perineal Fascia *continuous with Scarpa's fascia

Tough fibrous sheet that extends between the Ischiopubic Rami within UROGENITAL TRIANGLE; located just deep to the Colles' fascia; separates the Superficial and Deep Perineal spaces; serves as a platform for the erectile tissues

Perineal Membrane

Function of the Perineal Membrane

Serve as base for Erectile tissue *also separate Superficial and Deep Perineal spaces

4 Muscles of the FEMALE Superficial Perineal space (space b/w colles' fascia and perineal membrane)

``` Bulbospongiosus muscles (1) Ischiocavernousus muscles (2) Superficial Transverse Perineal muscles (3) Perineal body (4) ``` *also have nerves, vessels, bulbs, glands, and clitoris.

4 structures of the FEMALE Deep Perineal space (space above the perineal membrane)

Membranous Urethra and Sphincter (1) Compressor urethrae and Urethrovaginal sphincter (2) Deep Transverse Perineal muscles (3) Perineal body (4)

Paired wedge-shaped spaces on either side of the anal canal; filled with fat and connective tissue to support anal canal; contains the Pudendal Canal with the arteries and nerves; extends anteriorly into urogenital triangle deep to the Perineal Membrane

Ischioanal Fossae

The Ischioanal Fossae extends anteriorly into the Urogenital Triangle deep to the Perineal Membrane (True or False)

True (see green arrows)

Contents of the Pudendal Canal (Alcock's canal)

Pudendal nerve | Internal Pudendal vessels

FEMALE pear-shaped muscular organ in the middle of the Pelvis; POSTERIOR to bladder and ANTERIOR to rectum

Uterus

Normal site of implantation of a fertilized egg and development of the fetus

Uterus

Top part of the Uterus

Fundus

Middle part of the Uterus

Body

Narrow, lowest part of the Uterus; is the least mobile part; has both a supravaginal and vaginal part

Cervix

What are the two parts of the Cervix

Supravaginal (above vagina) | Vaginal (protrudes into the upper vagina)

Recesses on either side created by the vaginal part of the Cervix

Vaginal Fornices (recesses/spaces)

Narrow space within the Uterus

Uterine cavity

Connection/fusion point between the Uterine Cavity and the Cervical canal

Internal os (orifice)

Connection/fusion point between the cervical canal and vaginal canal.

External os (orifice)

Recess between the Uterus and the Bladder

Vesicouterine pouch

Recess between the Uterus and the Rectum

Rectouterine pouch (Pouch of Douglas)

The ___________ of the Uterus is mobile

Body (changes with fullness of bladder and rectum)

Normal position of the Uterus

Anteflexed (body of uterus forward) and Anteverted (cervix of uterus forward)

Main blood supply for the Uterus

Uterine artery (a branch of anterior division of Internal Iliac) *some from Ovarian and Vaginal arteries too

The Uterine artery traverses through the ____________ ligament at the base of the Uterus. Ovarian artery traverses through _______ ligament.

Cardinal; IP (aka. suspensory ligament)

Autonomic innervation of the Uterus

Pelvic plexus (Inferior Hypogastric Plexus)

The important anastomosis of the uterine and ovarian arteries occurs at the ______ Ligament of the Uterus, forming the ___________

round; sampson artery

Very important anastomosis of the Uterine and Ovarian arteries; dissected during hysterectomies

Sampson artery

Female gonads; ovoid structures that produce eggs and reproductive hormones; reside on the lateral walls of the Pelvic cavity

Ovaries

Ligament that encloses the Ovarian artery/veins/nerves

infundibulopelvic "IP" ligament * aka suspensory ligament of ovary

Ovarian arteries arise from the...

Abdominal Aorta (much like the testes)

The Ovarian veins drain where (hint: not same place)

Left: Left Renal Vein Right: IVC *same pattern with testes

Ovaries are connected to the superolateral aspect of the Uterus by what ligament?

Ligament of the Ovary (rather simple)

Normal site of FERTILIZATION in the Uterus

Uterine Tubes (Fallopian, Oviducts)

Most common sites of Ectopic Pregnancies

Uterine Tubes (Fallopian, Oviducts)

4 parts of the Uterine Tubes

Uterine/intramural (1) Isthmus (2) Ampulla (3) Infundibulum (4)

Narrowest part of the Uterine tube

Isthmus

Longest and widest part of the Uterine tube; normal site for Fertilization

Ampulla

Trumpet-shaped terminal part of the Uterine Tube; OPEN TO PERITONEAL CAVITY; has finger-like fimbriae

Infundibulum

The Uterine Tube is open to the peritoneal cavity (True or False)

True (has fimbriae to propel eggs into tube) (fimbriae is actually pretty close to ovary)

The main blood supplies for the Uterine Tubes

Ovarian artery Uterine artery *remember the important anastomosis between the two, the Sampson artery

Ligaments of the Uterus that originate near the Fundus on either side; pass through the Deep Inguinal rings, traverse the Inguinal canal and insert into Labia Majoria

Round Ligament

The Cardinal Ligament of the Uterus traverses through the Deep Inguinal rings (True or False)

False; it's the Round Ligament

Ligament of the Uterus; a double fold of peritoneum that extends laterally from each side to the walls of the Pelvic Cavity

Broad Ligament

3 parts of the Broad Ligament of the Uterus

Mesosalpinx Mesovarium Mesometrium

Part of Broad Ligament of the Uterus; ensheaths the Uterine tube

Mesosalpinx

Part of Broad Ligament of the Uterus; suspends the Ovary

Mesovarium

Part of Broad Ligament of the Uterus; connects the Uterus to the sidewalls of the Pelvis

Mesometrium

Paired ligaments that connect the Cervix to the Sacrum; maintains the Anteverted position of the uterus

Uterosacral Ligaments

Ligament of the Uterus; connects Cervix to sidewalls; transmits the Uterine artery; Ureter passes underneath the uterine artery

Cardinal Ligaments * aka transverse cervical ligaments * aka Makenrodt's ligaments

The Ureter passes (over/under) the Cardinal Ligament and Uterine arteries

Under "water under the bridge"

Fibromuscular tube that connects the Cervix to the external os (Orifice); serves as inferior part of birth canal and conduit for the penis during intercourse

Vagina

The (Anterior/Posterior) Vaginal Fornix is in contact with the Rectouterine Pouch, allowing for access to peritoneal cavity and fluid

Posterior

Process of removing a sample of fluid/tissue through the Posterior Vaginal Fornix into the Rectouterine Pouch (pouch of douglas)

Culdocentesis

Fancy name for the Rectouterine Pouch

Pouch of Douglas

The Ureters are (intra/retro)peritoneal

Retroperitoneal

Muscular tubes around 25-30 cm long; convey urine from the kidneys to the bladder

Ureters

The Ureters go (over/under) the Gonadal artery and vein

Under

The Ureters go (over/under) the Iliac artery and vein

Over

Site of the junction of the Ureter and the Bladder

Uretero-vesical Junction

Muscular reservoir for the temporary storage of urine; lies UNDER the peritoneum

Bladder

The bladder is (intra/retro/sub)peritoneal

Subperitoneal

Top part of Bladder; near the Pubic Symphysis

Apex

Posterior part of the Bladder

Fundus

Inferior, narrow, least mobile portion of the Bladder

Neck

Smooth muscles that compose the walls of the Bladder

Detrusor muscle

The Internal Urethral Sphincter is under (somatic/autonomic) control

Autonomic

Triangular-shaped region of muscle within the Bladder; corners are formed by the 2 ureter and 1 urethral openings

Trigone

The External Urethral Sphincter is made of (smooth/skeletal) muscle and is under control of the (hypogastric plexus/ pudendal nerve)

Skeletal (voluntary); Pudendal nerve (somatic control)

The lymph of the Ovaries (and testes) drain into the ____ nodes

Lumbar (Aortic)

Lymph from the superficial perineal structures (skin of perineum) drains into the ________ nodes. Lymph from the deeper perineal structures (erectile tissues) drains into the ________ nodes. Lymph from the GLANS of clitoris/penis drains into the ________ nodes. Eventually they all drain into ______ ---> ______.

1. superficial Inguinal 2. internal iliac 3. deep inguinal 4. thoracic duct; left subclavian

Lymph from the upper 3/4 (close to pelvis) of the Vagina drains into the ________ nodes. Lymph from the lower 1/4 (close to perineum) of the Vagina drains into the ________ nodes.

1. Iliac | 2. inguinal

____________ or tear could disrupt the perineal body

midline episiotomy

Besides the pudendal nerve, what other nerves provide sensory innervation to some anterior portion of female perineum?

1. ilioinguinal nerve | 2. genitofemoral nerve

The pudendal nerve originates from

sacral plexus (s2-s4)

The pudendal canal (Alcock's canal) is located within

ischioanal fossae

Clogging and infection of Bartholin's gland can cause obstruction to the outflow resulting in a collection of fluid inside the duct called ______ cyst.

Bartholin's

Ligaments that arise from the body of uterus

round ligaments | broad ligaments

Ligaments that arise from the cervix of uterus

Uterosacral ligaments | cardinal (transverse cervical or Makenrodt's) ligaments