female reproductive system inferior genital tract

Question 1

what is the vagina?

Answer 1

Unpaired hollow organ, fibromuscular canal, copulatory organ, birth canal during delivery.

Question 2

what is the location and trajectory of the vagina?

Answer 2

From pelvic cavity through pelvic floor into perineum, from roof (vaginal vault)
runs inferiorly + anteriorly.
Forms right angle with uterus
Travels through pelvic floor (levator ani and urogenital triangle)
opens into vestibule, between labia minora of vulva.

Question 3

What is the specificity of the angle it forms with the uterus?

Answer 3

angle varies with vesical + rectal movements

larger (obtuse) in nulliparas // smaller (acute) in multiparas

Question 4

Wht are the relations of the vagina?

Answer 4

Ant: base of bladder (sup) urethra (inf)
Post: rectum + rectouterine pouch
((Sup. 1/4: covered by peritoneum
Inf. 1/4: surrounded by muscles, and fascia of the perineal body ))
Lat: levator ani muscle + pelvic fascia
Inf: opens with sagittal orifice posterior to urethral external orifice in vestibule.

Question 5

What does the vaginal vault do?

Answer 5

surrounds vaginal portion of cervix forming annular recess

Question 6

What is the annular recess formed by the vaginal vault ?

Answer 6

anterior + posterior fornix

Question 7

What is the erectile structure of the female reproductive system?

Answer 7

clitoral bulbs: aggregations of erectile tissue in internal part of the clitoris. Can also be found throughout vestibule.

Question 8

What are the lymphatics draining the external genitalia of females?

Answer 8

Superficial and deep inguinal nodes

Question 9

Which veins drain the female external genitalia?

Answer 9

External pudendal veins drain from into great saphenous vein –>Superficial vulvar structures
Deep dorsal veins drain into internal pudendal vein + Superficial dorsal veins drain into external pudendal vein and great saphenous vein –>Clitoris

Question 10

Which arteries irrigate the female external genitalia?

Answer 10

Internal pudendal artery (from internal iliac artery) + External pudendal artery (from femoral artery)

Question 11

What does the femal external genitalia consist of?

Answer 11

Mons pubis, Labia majora, Labia minora, Clitoris, Vestibule, Bulbs of vestibule, Greater vestibular glands

Question 12

Where does the Superficial perineal pouch lie?

Answer 12

Lies between perineal membrane + membranous layer of superficial fascia (Colle’s fascia) of perineum

Question 13

What does the superficial perineal pouch contain?

Answer 13

Bulbs of vestibule (on each side of vaginal opening), Crura of clitoris, Superficial perineal muscles (Superficial transversus perineal muscle, Ischiocavernosus, Bulbospongiosus), Greater vestibular glands

Question 14

What is the Urogenital triangle?

Answer 14

Anterior half of perineum, contains the root of external genitalia and the orifices of the urogenital systems

Question 15

What are the boundaries of the urogenital triangle ?

Answer 15

Lat. ischiopubic rami
Post. imaginary line between ischial tuberosities
Ant. inferior margin of pubic symphysis
Roof: levator ani
Floor: perineal membrane and deep perineal pouch

Question 16

What does the Urogenital diaphragm contain?

Answer 16

Perineal membrane, Deep perineal pouch (muscles)

Question 17

What is the perineal membrane?

Answer 17

 Fascial thickening attached to the inferior pubic arches bilaterally
 Triangular shape with truncated apex (gap between anterior margin and pubic symphisis covered by the inferior pubic ligament)
 Free posterior margin, Openings for: vagina and urethra

Question 18

What is the deep perineal pouch?

Answer 18

 Above the membrane
 Muscles (External urethral sphyncter, Deep transverse perineal, Compressor urethrae (women), Uretrovaginalis sphyncter (women))

Question 19

What is the pelvic floor?

Answer 19

Separates the pelvic cavity from the perineum

Question 20

What is the pelvic diaphragm?

Answer 20

U-shaped, opened anteriorly
contains
• Levator ani (Pubococcygeus muscle, Iliococcygeus muscle, Puborectalis muscle)
• Coccygeus (ischiococcygeus) muscle

Question 21

What is the Levator ani (Pubococcygeus muscle, Iliococcygeus muscle, Puborectalis muscle) ?

Answer 21

o Originates bilaterally from the entire contour of the pelvic outlet
o Muscles from both sides blend along the midline (posterior to the vagina)
o Surround anal opening + form a raphe posterior to it: anococcygeal ligament (body) that attaches to coccyx.
o Anteriorly: U-shaped gap urogenital hiatus

Question 22

What is the Coccygeus (ischiococcygeus) muscle ?

Answer 22

o Triangular muscles overlying sacropinous ligaments on both sides
o Complete the posterior portion of the diaphragm

Question 23

What is a Colposcopy?

Answer 23

illuminated, magnified view of vagina + cervix

Question 24

What is a vaginal examination? and why do we perform them?

Answer 24

easier visualization of fornix: speculum used to detach anterior + posterior vaginal walls. Swabs and scrapes introduced to collect samples from ectocervix during “Pap test” : screening procedure for cervical cancer screening

Question 25

What is the lymphatic drainage of the vagina ?

Answer 25

Superior vessels travel with uterine artery –> drain in internal + external iliac nodes

Intermediate vessels travel with vaginal artery –> drain in internal iliac nodes.

Inferior vessels –> below the hymen level, drain in superficial inguinal nodes

Question 26

What performs the venous drainage of the vagina ?

Answer 26

Lateral venous plexa (connected with uterine plexa) drain into vaginal veins –> internal iliac vein.
Both uterine and vaginal plexa drain part of venous blood from lower limb

Question 27

What is the course fo the vaginal arteries?

Answer 27

from internal iliac artery (or internal pudendal artery)
descend on anterior + posterior surfaces
merge longitudinally on midline
form azygos artery of vagina
Anastomosis with uterine arteries

Question 28

What is located posterior to the vaginal opening?

Answer 28

Bartholin’s glands (greater vestibular glands)

Question 29

What do the Bartholin’s glands (greater vestibular glands) secrete?

Answer 29

secrete mucus that lubricates vagina.

Question 30

What happens afer hymen perforation?

Answer 30

residual excrescences around orifice (caruncles).

Question 31

How is the internal surface of the vagina?

Answer 31

wrinkled due to transverse ridges of mucosa (rugae) + londitudinal ridges (columns) on anterior + posterior midline surfaces.

Question 32

What does the wrinkage of the vagina allow?

Answer 32

Mostly on inferior third –> allow vagina to stretch during childbirth

Question 33

What is the hymen?

Answer 33

thin mucosal membrane –> external opening of vagina in vestibule partially closed

Question 34

junction between vagina + ectocervix is lower ______ than ______

Answer 34

anteriorly, posteriorly
posterior fornix is deeper
posterior vaginal wall is thinner.

Question 35

Through posterior fornix: _________ can be accessed using __________

Answer 35

Pouch of douglas, culdocentesis