lecture 6 female pelvis Flashcards by Michael Tomaschek

female pelvic organs

ovary, Fallopian (uterine) tubes; uterus and cervix; vagina, ureter, bladder, urethra; rectum; caecum, appendix, parts of sigmoid colon and ileum (all false pelvis); vessels, nerves, lymphatics

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difference between male and female reproductive and urinary passages

female reproductive and urinary passages are not shared

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what do vagina and urethra both meet

vesibule of vagina

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where does the parietal peritoneum descend into

pelvic cavity but doesn’t touch the pelvic floor

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what envelopes the uterine tubes completely

broad ligament (part of peritoneum)

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what suspends ovaries and relation to broad ligament

suspended by mesovarium (part of peritoneum) from posterior of broad ligament (not fully enveloped to allow egg release)

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what do pelvic fascial condensations form and what is their function

ligaments which support viscera e.g. cervix, vagina

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what are the broad ligaments and what do they join

transverse mesenteries which join uterus to pelvic walls

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important contents in broad ligaments

uterine tubes, uterine arteries

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pouch in between anterior wall of uterus and bladder

vesico-uterine pouch

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pouch between anterior wall of rectum and posterior wall of uterus and vagina

recto-uterine pouch - pouch of Douglas; posterior fornix to recto-uterine pouch in IVF

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where does round ligament of uterus connect to at the uterus

uterine horns (where uterus and uterine vessels meet)

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what are the round ligament of the uterus and ligament of ovary remnants of; what is function of ovarian ligament

gubernaculum to inguinal canal; connects ovary to lateral surface of uterus

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what are the 3 sections of the broad ligament of uterus peritoneum

mesovarium, mesosalpinx, mesometrium

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what does the suspensory ligament of ovaries contain

ovarian vessels from lateral walls (reflection of broad ligament)

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what are the 3 sets of fibrous bands which form cervical ligaments (fascia)

transverse cervical (cardinal) ligament (most important as stronger), uterosacral ligament, pubocervical ligament (anterior)

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function of cervical ligaments

anchor cervix in place within pelvis, preventing uterus from prolapsing through vagina by passive support (dynamic support by pelvic floor muscles - levator ani, and coccygeus muscle)

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what does the uterus (8-9 cm) consist of

fundus, body, lower segment, cervix; all made of smooth muscle

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what do uterine tubes consist of

infundibulum, ampulla, isthmus, uterine parts

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where is there potential communication between via reproductive passage

peritoneal cavity and exterior, so infection can travel into peritoneal cavity via uterine tubes

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what is the reproductive passage

abdominal ostium of uterine tube and vagina opening

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superior to posterior uterus sections

fundus (superior to uterine tube entry in uterine cavity), body of uterus (containing internal os), cervix (neck of uterus containing cervical canal; then external os to vagina)

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lateral to medial uterine tube sections (from ovaries)

ovary (ovarian vessels in suspensory ligament of ovary attached), abdominal ostium of uterine tubules (with 10-12 mobile fimbriae on inferior end which guard and causes egg to go into ostium of uterine tube), infundibulum, ampulla (fertilisation normally occurs here), isthmus (narrowing), uterine part (joining uterine cavity with uterine ostium above, and fundus of uterus above that)

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uterus changes in size during pregnancy (3 to 9 months)

3 is normal uterus size, then increases up to iliac creest at 5 months, goes past umbilicus between 5-6 months, and above costl margin at 9 months

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effect on breathing during late pregnancy

more difficult as less room for lung to expand into as diaphragm pushed higher

uterus changes in size during pregnancy (10 months)

lower than 9 months (in between 9 and 8 months) as uterus shrinks again after childbirth

cervical structures and length

fibro-muscular cylinder with internal os (towards uterine cavity) and external os (towards vagina); 2.5 cm - if insufficient length will give birth earlier

cells of cervical canal

mucus-secreting simple columnar epithelium

cells of vaginal surface of cervix (just below external os)

stratified squamous non-keratinising epithelium

use of cells of vaginal surface of cervix

cervical smear test - no glands in vaginal wall

what does cervix project into and relation to vaginal axis

into anterior vaginal wall at right angle to vaginal axis

what are the cervical ligaments holding the cervix in place attached to

pelvis and sacrum

what are the cervical ligaments part of

pelvic fascia (not peritoneum)

angle of axis of uterine body to axis of cervix

"anteflexed" - obtuse

angle of axis of cervix to axis of vagina

"anteverted" - right angle; uterus tilted anteriorly to vagina

length of fibro-muscular cervical canal

7-9 cm

what is at the upper end of the cervix which is clinically important

posterior fornix (depth > lateral fornix > anterior fornix); gutter from neck of uterus (cervix) into anterior vaginal wall); instrument from posterior fornix to recto-uterine pouch in IVF to remove eggs from ovary; drain pelvic abscess as most abscess fluid collect in recto-uterine pouch as lowest part

what does the urethra (4cm long) fuse with of the vagina

connective tissue fuses with anterior wall; herniation into vaginal cavity from urethra can occur if weak wall

structures palpable via vaginal wall

cervix, ischial spine (near where pudendal nerve runs), sacral promontory, uterine artery pulse (lateral fornix), ovary

main arterial branches to pelvic viscera

superior vesical (main artery to urinary bladder), uterine, middle rectal

what are the walls of the pelvis supplied by

sacral, gluteal, obturator branches

what supplies the perineum and recto-anal region

pudendal artery (supplies recto-anal region via inferior rectal branches)

what is the vaginal artery equivalent to in men

inferior vesical artery

what is the major artery that supplies the female pelvis

internal iliac

what does the anterior division of internal iliac bifurcate into more inferiorly

uterine artery and internal pudendal artery (bifurcates into internal pudendal and middle rectal)

what branches from the uterine artery more inferiorly

vaginal artery

what branches from the internal iliac more superiorly to bifurcation into uterine and internal pudendal

superior vesical arteries

what is the main blood supply to uterus

uterine artery

what happens to uterine artery during pregnancy

enlarges

where does the uterine artery run

medially towards cervix

how far away from the cervix does the uterine artery cross the ureter (from kidney)

about 1 cm

where does uterine branch run close to

uterus in broad ligament

what does ascending branch of uterine artery supply

body of uterus, uterine tubes, ovaries (ovaries and adjacent tubes have ovarian artery via suspensory ligament from upper abdominal aorta also - just below renal arteries)

what does descending branch of uterine artery supply

vagina

what do the ovaries lie close to

openings of uterine tubes into peritoneal cavity

during hysterectomy what can happen with ureters

tied off accidently with uterine arteries

where is the ovary on the broad ligament and what does it face

on posterior surface of broad ligament, facing into peritoneal cavity into which eggs are first released

2 triangles in female perineum, and what is in between

urogenital, anal; perineal body in front of anal canal and behind vaginal opening (most muscles anchor; lower 1/3 vaginal muscles anchor here also)

3 points of urogenital triangle

pubic symphysis, ischial tuberosities (gluteal folds just below ischial tuberosities)

3 points of anal triangle

ischial tuberosities, coccyx

structure of perineal membrane

thick triangular fascial structure

what is perineal membrane attached to

pubic arch

posterior and anterior of perineal membrane

posteriorly free margin, anteriorly small gap

where is deep perineal space located

above perineal membrane and below fascia of pelvic diaphragm

where is superficial perineal space located

below perineal membrane and perineal fascia (subcutaneous tissue)

when do the deep and superficial potential spaces become real

when fluid leaks into them

what is the external urinary sphincter crucial for in women

maintaining urinary contincence (internal urethral sphincter not as well developed)

modification of pelvic floor muscles which wraps around vagina and urethra which are developed better in female

sphincter urethrovaginalis (compressor urethrae) as compresses urethra

contents of superficial perineal pouch

median errectile tissue masses (corpus spongiosum), lateral erectile tissue masses (corpora cavernosa); urethra does not run through erectile tissues

where does corpus spongiosum divide around to form vestibular bulbs

vestibule

what is derived from corpus spongiosum

glans of clitoris

what are the paired corpora cavernosa attached to

ischiopubic rami

what is derived from corpora cavernosa

body of clitoris

what are the erectile tissues in perineum surrounded by

skeletal muscles

vulva (female external genitalia) contents of superficial perineal pouch

mons pubis (fatty tissue lying over pubic bones), labia majora (hairy) and minora (hairless skin), clitoris, vestibule of vagina (space between labia majora and minora), vestibular bulbs (lie under labia majora), vestibular glands

what fills urogenital triangle

perineal membrane

what are anchored to perineal membrane

erectile tissues and associated skeletal muscles

where does urethra emerge through perineal membrane

urethra orifice

where does vagina emerge through perineal membrane

vagital orifice

what are either side of cervix, urethra orifice and vagital orifice

bulbs of vestibule

what does the posterior part of corpus spongiousum form, which have openings either side of urethra orifice into the vaginal vestibule

lesser (Skene's) and greater (Bartholin's) vestibular glands surrounding vestibule and vagina

below bulb of vesituble

perineal body

what is the hymen

thin mucosal fold containing vaginal orifice, which is normally perforated at the centre

what happens to the hymen during intercourse and child birth

it is torn and only a few tags remain

what do peri-urtheral glands open into

urethral lumen

as the vaginal wall has no glands, how is it kept moist

transudation

what is present in cervical canal mucosa

numerous mucus glands

what is male equivalent of paraurethral gland (lesser Skene's)

prostate

what is male equivalent of greater vestibular gland (Bartholin's)

paraurethral

what nerves supplies pelvic contents

autonomic

where are sympathetic nerves to pelvis from

T10-L2 via hypogastric plexus

where are parasympathetic nerves from

S2-S4 (pudendal nerve)

where is pelvic visceral pain referred to

suprapubic region and perineum

what is pudendal nerve motor to

perineal muscles, anal and urethral sphincters, levator ani

what is pudendal nerve sensory to

external genitalia (vestibule, labia minora and part of labia majora, lower vagina, clitoris, lower anal canal)

where is anterior labial nerve from

ilioinguinal L1

where is perineal branch of post-cutaneous nerve of thigh from

S1-S3

where do pelvic organs mainly drain to

external and internal iliac nodes around arteries

where do ovary and testis drain to

para-aortic nodes (closer to renal nodes)

where do perineum (including anal canal) and external genitalia drain to

superficial inguinal nodes (subcutaneous below inguinal ligament)

true pelvic cavity wedge (narrow anterior, wide posterior)

line from S1 to pubic symphysis, and line from pubic symphysis to coccyx

brief structures of true pelvic cavity from anterior to posterior

urinary bladder; uterus, cervix and vagina; rectum