Female Reproductive System

Question 1

[2-minute video]: The Uterine Artery

Answer 1

🩸

Question 2

Name the three parts of the uterus.

Answer 2

(a) fundus
(b) body
(c) cervix [divided into two parts: supravaginal and vaginal parts]
[Diagram] [Diagram 2] [Diagram 3]

Question 3

Name the three layers of the wall of the uterus.

Answer 3

(a) Perimetrium [peritoneum/serosa]
(b) Myometrium
(c) Endometrium

Question 4

Describe the normal position and axes of the uterus.

Answer 4

Normally the uterus lies in position of anteversion and anteflexion.

Anteversion: The long axis of the cervix is normally bent forward on the long axis of vagina forming an angle of about 90°. This position is called the position of anteversion.
Anteflexion: The long axis of the body of uterus is bent forward at the level of isthmus (internal os) on the long axis of cervix forming an angle of 170°. This position of the uterus is known as anteflexion.
[Diagram]

Question 5

Describe the peritoneal organisation of the cervix.

Answer 5

It is completely covered with peritoneum except at the anterior surface of the cervix.

Question 6

The uterus is related to two pouches namely: ________.

Answer 6

uterovesical pouch and rectouterine pouch [pouch of Douglas]
[Diagram]

Question 7

Name the four parts of the broad ligament and give a brief description of each.

Answer 7

(a) Mesosalpinx: It is the part of broad ligament between the fallopian tube and the ligament of the ovary.
(b) Mesometrium: It is the part of broad ligament extending from the pelvic floor to the ovary, the ligament of ovary, and the body of uterus.
(c) Mesovarium: It is the fold of posterior (or upper) layer of broad ligament extending to the ovary to be attached with it. It lies just below and behind the ampullary part of the uterine tube.
(d) Infundibulopelvic ligament (also called suspensory ligament of ovary): It is that part of the broad ligament which:
– Extends from the infundibulum of the tube and the upper pole of the ovary to the lateral wall of the lesser pelvis.
– Contains the ovarian blood vessels, nerves, and lymph vessels.
– Is continued laterally over the external iliac vessels as a distinct fold.
[Diagram 1] [Diagram 2] [Diagram 3]

Question 8

State the contents of the broad ligament.

Answer 8

(a) uterine tube
(b) uterine and ovarian vessels
(c) round ligament of ovary and round ligament of uterus
(d) lymphatics, sympathetics [uterovaginal and ovarian plexuses] and fat
(e) embryological remnants [e.g. epoophoron and its duct, paroophoron, vesicular appendices]

Question 9

State the anterior relations of the uterus. [body, supravaginal part of cervix and vaginal part of cervix]

Answer 9

(a) The body of uterus is related to the uterovesical pouch and the superior surface of urinary bladder.
(b) The supravaginal portion of cervix is related to the posterior surface of urinary bladder.
(c) The vaginal portion of cervix is related to the anterior fornix of the vagina.
[Diagram] [Diagram 2] [Diagram 3]

Question 10

State the posterior relations of the uterus. [body of uterus, supravaginal part of cervix, vaginal part of cervix]

Answer 10

(a) The body of uterus is related to the rectouterine pouch with coils of ileum and sigmoid colon in it.
(b) The supravaginal portion of cervix is related to the rectouterine pouch with coils of ileum and sigmoid colon in it.
(c) The vaginal portion of cervix is related to posterior fornix of the vagina.
[Diagram] [Diagram 2] [Diagram 3]

Question 11

State the lateral relations of the uterus.

Answer 11

(a) The body of uterus is related to the broad ligament and uterine artery and vein.
(b) The supravaginal portion of cervix is related to the ureter and uterine artery.
(c) The vaginal portion of cervix is related to the lateral fornices of the vagina.
[Diagram]

Question 12

State the anterior relations of the vagina.

Answer 12

(a) The upper half is related to the base of urinary bladder.
(b) The lower half is related to the urethra which is actually embedded in it.
[Diagram 1] [Diagram 2]

Question 13

State the posterior relations of the vagina.

Answer 13

(a) The upper one-fourth is related to the rectouterine pouch (or pouch of Douglas).
(b) The middle two-fourth is related to the ampulla of rectum from which it is separated by loose connective tissue.
(c) The lower one-fourth is related to the perineal body separating it from the anal canal.
[Diagram 1] [Diagram 2]

Question 14

State the lateral relations of the vagina.

Answer 14

(a) The upper part is related to the ureters which are close to the lateral fornices and are crossed by the uterine artery.
(b) The middle part is related to the anterior fibres of levator ani (pubococcygeus part) and pelvic fascia.
(c) The lower part is related to urogenital diaphragm, bulb of vestibule, bulbospongiosus, and greater vestibular gland (of Bartholin).
[Diagram] [Diagram 2]

Question 15

List the four parts of the fallopian tube from medial to lateral and indicate the part where fertilization takes place.

Answer 15

(a) intramural part
(b) isthmus
(c) ampulla - fertilization takes place here
(d) infundibulum
[Diagram]

Question 16

Discuss the blood supply of the uterine/fallopian tube.

Answer 16

The fallopian tube is supplied by two arteries: ovarian and uterine arteries. Usually the medial two-third of the tube is supplied by the uterine artery and lateral one-third by the ovarian artery.

Further notes:
The veins correspond to the arteries.

Question 17

Into which lymph nodes does lymph from the uterine tubes drain into?

Answer 17

The lymph vessels follow the veins and drain into internal iliac lymph nodes, pre-aortic and para-aortic lymph nodes. [Diagram]

Question 18

Discuss the arterial supply of the vagina.

Answer 18

(a) Vaginal artery, a branch of the internal iliac artery (main artery)
(b) Vaginal branch of uterine artery
(c) Internal pudendal artery
(d) Middle rectal artery
(e) Inferior vesical artery

Question 19

Discuss the lymphatic drainage of the vagina in the:
(a) upper third
(b) middle third
(c) lower third

Answer 19

(a) upper third: lymphatics accompany the uterine artery to drain into internal and external iliac nodes
(b) middle third: lymphatics accompany the vaginal artery to drain into the internal iliac nodes
(c) lower third: lymphatics accompany those from the vulva to drain into the medial group of superficial inguinal lymph nodes

Question 20

The lower one-third of vagina, including region of vaginal orifice, is extremely sensitive to touch. State its nerve supply.

Answer 20

It is supplied by the pudendal nerve.

Question 21

(a) What is the vestibule of the vagina?
(b) Name the openings present in the vestibule of the vagina.

Answer 21

(a) This is the part of the vulva between the labia minora.
(b) It contains the urethral orifice anteriorly and the vaginal orifice posteriorly. Also present are the openings of greater vestibular glands (of Bartholin), lesser vestibular glands, and paraurethral glands (of Skene). [Diagram]

Question 22

State three ligaments that provide mechanical support to the uterus.

Answer 22

⚚ Transverse cervical ligament aka. cardinal ligament
⚚ Uterosacral ligament
⚚ Pubocervical ligament
[Diagram]

Question 23

List two dynamic support structures of the uterus.

Answer 23

☛ pelvic diaphragm
☛ urogenital diaphragm