lecture 6 female pelvis Flashcards
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
difference between male and female reproductive and urinary passages
female reproductive and urinary passages are not shared
what do vagina and urethra both meet
vesibule of vagina
where does the parietal peritoneum descend into
pelvic cavity but doesn’t touch the pelvic floor
what envelopes the uterine tubes completely
broad ligament (part of peritoneum)
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)
what do pelvic fascial condensations form and what is their function
ligaments which support viscera e.g. cervix, vagina
what are the broad ligaments and what do they join
transverse mesenteries which join uterus to pelvic walls
important contents in broad ligaments
uterine tubes, uterine arteries
pouch in between anterior wall of uterus and bladder
vesico-uterine pouch
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
where does round ligament of uterus connect to at the uterus
uterine horns (where uterus and uterine vessels meet)
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
what are the 3 sections of the broad ligament of uterus peritoneum
mesovarium, mesosalpinx, mesometrium
what does the suspensory ligament of ovaries contain
ovarian vessels from lateral walls (reflection of broad ligament)
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)
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)
what does the uterus (8-9 cm) consist of
fundus, body, lower segment, cervix; all made of smooth muscle
what do uterine tubes consist of
infundibulum, ampulla, isthmus, uterine parts
where is there potential communication between via reproductive passage
peritoneal cavity and exterior, so infection can travel into peritoneal cavity via uterine tubes
what is the reproductive passage
abdominal ostium of uterine tube and vagina opening
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)
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)
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
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
