Lecture 6 - Female Pelvis and Perineum Flashcards
What are the female pelvic organs?
Ovary, uterine tubes, uterus, cervix, vagina, ureter, bladder, urethra, rectum, caecum, appendix, sigmoid colon and ileum, vessels, nerves and lymphatics
What is the structure of the female pelvic organs?
What are the boundaries of the peritoneum and pelvic fascia?
Parietal peritoneum continues into pelvic cavity without touching the pelvic floor; uterine tubes are completely enveloped by peritoneum (broad ligament). Pelvic fascial condensation form ‘ligaments’ supporting viscera (cervix, vagina)
How are the ovaries suspended?
By the mesovarium from posterior of broad ligament
How are the broad ligament, uterus, uterine tubes and ovary organised?
What are the broad ligaments?
Transverse mesentries joining the uterus to the pelvic walls -> contain the uterine tubes and uterine arteries
How are the ligaments arranged around the uterus?
How is the cervix and vagina maintained stable?
3 sets of fibrous bands (cervical ligaments) anchor the cervix in position with the pelvis -> prevent uterus from prolapsing through the vagina
What is the structure of the uterus and uterine tube?
Uterus consists of fundus, body, lower segment and cervix. Uterine tubes consist of infundibulum, ampulla, isthmus and uterine parts
Where is there potential communication between peritoneal cavity and exterior?
Via the reproductive passage -> abdominal ostium of uterine tube and vaginal opening
How is the uterus arranged?
How does the uterus change size in pregnancy?
What is the cervix?
Fibro-muscular cylinder with internal/external os -> projects into anterior vaginal wall at right angle to vaginal axis
What lines the cervical canal?
Mucus secreting simple columnar epithelium
What cells line the vaginal surface of the cervix?
Covered in stratified squamous non-keratinized epithelium -> no glands in vaginal wall
How is the cervix held up?
By strong cervical ligaments attached to the pelvis and sacrum -> part of pelvic fascia
What is the vagina?
Fibromuscular canal -> 7-9cm; vaginal fornices at upper end -> posterior fornix is important clinically and urethra is fused with the anterior wall
What structures can be palpated via the vagina wall?
Cervix, ischial spine, sacral promontory, uterine arterial pulse (lateral fornix), ovary [some can be felt through rectal examination]
What is the arterial supply to the female pelvic viscera?
Superior vesicle, uterine and middle rectal
What is the arterial blood supply to the walls of the pelvis?
Sacral, gluteal and obturator branches
What does the pudendal artery supply?
Perineum and recto-anal region (via inferior rectal branch)
How does the internal iliac artery divide to supply the pelvis in the female?
What does the uterine artery supply?
Main blood supply to the uterus and enlarges during pregnancy
Where does the uterine artery run from and close to?
Runs medially to cervix and crosses ureter about 1cm from cervix -> uterine segment runs close to uterus in broad ligament
What does the ascending branch of the uterine artery supply?
Uterine tubes and ovary (ovary also has ovarian artery from abdominal aorta)
What does the descending branch of the uterine artery supply?
Vagina
Where do the ovaries lie?
Close to openings of the uterine tubes into the peritoneal cavity; on the posterior surface of broad ligament facing into the peritoneal cavity into which eggs are first released -> supplied by ovarian artey
What is the structure of the ovaries?
What are the superficial perineal structures of the female?
Perineal membrane fills the urogenital triangle -> erectile tissues and associated skeletal muscles are anchored to this
What are the deep perineal structures of the female?
How do the urethral sphincters differ in females and males?
Females don’t have a well organised IUS but the EUS is more intricate in women than men and is crucial for maintaining urinary continence in women
What are the 3 perineal spaces or pouches present in females?
Perineal membrane, deep perineal space and superficial perineal space -> Potential spaces and are real only when fluid leaks into them
What is the perineal membrane?
Thick triangular fascial structure attached to pubic arch -> posteriorly free margin and a small gap anteriorly
What is the deep/superficial perineal space?
Deep: above the perineal membrane and below the fascia of pelvic diaphragm. Superficial: Below perineal membrane and perineal fascia (subcutaneous tissue)
What is in the superficial perineal pouch?
Median erectile tissue masses, lateral erectile tissue masses -> these erectile tissues within perineum are surrounded by skeletal muscles
What are median erectile tissue masses in females?
Corpus spongiosum -> divides around the vestibule to form 2 vestibular bulbs, surrounding the lower vestibule and vagina -> derives the glans of clitoris
What are the lateral erectile tissue masses in females?
Corpora cavernosum -> Paired cylinders, attached to ischipubic rami -> derives the body of clitoris
What is the vulva?
Collective name for female external genitalia -> mons pubis, labia majora/minora, clitoris, vestibule of vagina, vestibular bulbs and vestibular glands
What is the hymen?
The vaginal orifice in a virgin possesses a thin mucosal fold (hymen) which is normally perforated at the centre. Following intercourse and child birth the hymen is torn and only a few tags may remain
What is the arrangement of the urethra in a female?
What nerves supply the pelvis in females?
Autonomic nerves only -> SNS from lower thoracic and upper lumbar segments via hypogastric plexus; PSNS from S2-4 outflow; pudendal (somatic) S2-4
Where is pelvic pain referred to?
Visceral and poorly localised -> referred to suprapubic region and perineum
What does the pudendal nerve innervate?
Motor: to perineal muscles, anal/urethral sphincters, levator ani. Sensory: External genitalia (vestibule, labia minora and part of labia majora), lower vagina, clitoris, lower anal canal
How are the external genitalia of the female innervated?
How is the pelvic lymphatic drainage organised?
Pelvic organs: mainly to external/internal iliac nodes. Ovary/Testis: para-aortic nodes. Perineum (inc. anal canal) and external genitalia: superficial inguinal nodes [subcutaneous below inguinal ligament]
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