Female Reproductive System

Question 1

How do the walls of the vagina differ, and what is their default state?

Answer 1

Posterior wall is longer than the anterior wall, and the walls are normally in contact

Question 2

Where does the vagina extend from and to?

Answer 2

Vestibule to the cervix of the uterus

Question 3

What forms the fibrous coat of the vagina and what is in it?

Answer 3

Fibrous coat is formed by pelvic fascia, contains an extensive nerve plexus

Question 4

What are the fornices of the vagina and what does it surround?

Answer 4

Openings which forms arches surrounding the cervix. Includes: anterior, posterior, and lateral fornices.

Question 5

What structures are anterior to the vagina?

Answer 5

Vesicouterine pouch, bladder, parts of ureter, urethra

Question 6

What structures are posterior to the vagina?

Answer 6

Rectouterine pouch, rectum, perineal body

Question 7

What structures are lateral to the vagina at the level of the fornix?

Answer 7

The broad ligament, ureter, and uterine vessels

Question 8

What structures are lateral to the vagina inferiorly?

Answer 8

Levator ani, greater vestibular glands, vestibular bulb, urogenital diaphragm

Question 9

How do the sensory components of the vagina differ from lower 1/3 to upper 2/3?

Answer 9

Lower 1/3 - Pudendal nerve, more sensitive to somatic sensory (pain, temp, touch, erotic)
Upper 2/3 - relatively insensitive to these stimuli

Question 10

What are the functions of the uterus?

Answer 10

Site of blastocyst implantation, environment for embryonic / fetal development, provides propulsive force during birth of fetus

Question 11

What is the perimetrium?

Answer 11

Outer serous coat derived from peritoneum

Question 12

What defines the body of the uterus and what are its three parts?

Answer 12

Upper 2/3 of uterus

1. Fundus - upper portion above entry of uterine tubes
2. Cornua / horns - region of body where uterine tubes enter; the uterine tube cavity
3. Cavity - main portion

Question 13

What is the isthmus of the uterus?

Answer 13

The transition zone between body and cervix, where the body of the uterus flexes relative to the cervix

Question 14

What defines the cervix and what are two important parts?

Answer 14

Lower 1/3 of uterus; extends into vagina

1. Cervical canal - connects uterine cavity to vagina; usually plugged with mucus
2. Cervical os (ostium) - opening of cervical canal into vagina

Question 15

What are the two important angles of the uterus measured by gynecologists and how are they defined?

Answer 15

Anteflexion - anterior angle between axis of cervix and axis of uterine body

Anteversion - anterior angle between axis of vagina and axis of cervix

Question 16

What structures are anterior and posterior to the uterus?

Answer 16

Anterior - bladder, vesicouterine pouch

Posterior - rectum, rectouterine pouch, rectouterine fold

Question 17

What structures are lateral to the uterus?

Answer 17

Ureters, uterine tubes / ovaries, broad ligament, transverse cervical / cardinal ligament (the base of the broad ligament)

Question 18

What is the suspensory ligament of the ovary and what travels in it?

Answer 18

The peritoneum surrounding the ovarian vessels and nerves; originates in abdomen and attaches to superior pole of ovary

Question 19

What is the broad ligament?

Answer 19

Doublewalled sheet of peritoneum (like a mesentery) originating from lateral pelvic wall enclosing uterus, uterine tubes, ovarian + round ligaments, part of uterine vessels, part of ureter, and part of vary

Question 20

What is the mesosalpinx?

Answer 20

The part of the broad ligament which surrounds and suspends the uterine tube

Question 21

What is the mesovarium?

Answer 21

The part of the broad ligament which suspends the ovary

Question 22

What is the round ligament + what is its attachment? Where does it terminate?

Answer 22

Ligament attaching near the cornua of the uterus, travels within broad ligament and enters the inguinal canal. Terminates in the labium majus, it is a homologue of the gubernaculum

Question 23

What is the (proper) ligament of the ovary?

Answer 23

Also a homologue of the gubernaculum, it attaches near the cornua of the uterus as well as in the inferior pole of the ovary, and travels in the mesovarium.

Question 24

What is the rectouterine fold and what ligament resides inside? What else does it contain?

Answer 24

A fold forming from the reflection of peritoneum from uterus onto the rectum. Underlying this is a fascial thickening called the uterosacral ligament.

Also contains part of the uterine vessels and ureter

Question 25

What is the pubocervical ligament?

Answer 25

Fascial thickening between anterior pelvic wall and cervix

Question 26

What is the transverse cervical / cardinal ligament and what does it contain?

Answer 26

Fascial thickening at the base of the broad ligament containing the uterine vessels and ureter (ureter going under vessels, water under the bridge) Cardinal because it is the main ligament stabilizing the uterus in the pelvis

Question 27

What part of the uterine tube does fertilization typically occur?

Answer 27

ampulla, which is the first part following the infundibulum which is serviced by fimbriae

Question 28

Where do the uterine tubes lie?

Answer 28

In the free edge of the broad ligament, allowing for communication between peritoneal cavity and the outside world. Extends from cornua of uterus to lateral infundibular opening

Question 29

What are the four parts of the uterine tube?

Answer 29

1. Infundibilum - funnel shaped distal end which embraces the superior pole of ovary next to suspensory ligament, draws ova into its ostium via fimbriae 2. Ampulla - widest and longest part of tube - site of fertilization 3. Isthmus - narrow and thick walled portion between ampulla and uterine cornua 4. Uterine part - Within uterine myometrium, contains uterine ostium

Question 30

What is the orientation of the ovary and what attaches to its anterior and posterior borders?

Answer 30

Nearly vertical, with upper portion relating to suspensory ligament + uterine tube Anterior: Attaches to mesovarium Posterior: not covered by peritoneum

Question 31

What is the course of the uterine artery and what does it anastomose with? What does it supply?

Answer 31

Travels in broad ligament on a tortuous route to lateral aspect of uterus. Travels over top of the ureter. Anastomoses with ovarian artery, also supplying uterine tubes and upper portion of vagina

Question 32

What does the uterine artery have a tortuous path?

Answer 32

Allows for expansion during pregnancy, much like splenic artery

Question 33

Where does the ovarian artery travel? What does it supply / anastomose with?

Answer 33

In the suspensory ligament of the ovary and mesovarium. Supplies ovary and uterine tubes, anastomoses with uterine artery.

Question 34

What does the internal pudendal artery supply?

Answer 34

The lower end of the vagina in the vestibular area

Question 35

Where does the vaginal artery arise and what does it supply?

Answer 35

Arises from internal iliac, uterine artery, or a common trunk with uterine artery. Supplies: Middle and lower vagina, bladder (replaces inferior vesical)

Question 36

What does the ovarian vein drain? Where is its plexus?

Answer 36

Ovary and distal part of uterine tubes (same thing that ovarian artery supplies). Actually forms a plexus around the mesovarium of the broad ligament

Question 37

What is the uterovaginal plexus and where does it drain?

Answer 37

Plexus of veins draining uterus, vagina, proximal part of uterine tubes. Empties into uterine veins which go to internal iliac vein.

Question 38

What is the clinical significance of the uterovaginal plexus?

Answer 38

It may have anastomoses with superior rectal vein to provide a portal-systemic connection.

Question 39

What is special about the lymphatic drainage of the lower vagina?

Answer 39

Does not follow vessels totally, and first drains into superficial inguinal nodes. All others follow corresponding vessels