Reproductive Anatomy

Question 1

which nerve supply the thoracic, pelvic, and urogenital diaphragms?

Answer 1

thoracic: C3-C5 (phrenic nerve)

pelvic: S3-S5 (somatic nerves)

urogenital: S2-S4 (pudendal nerve)

Question 2

what are the three parts of the coxae/hip bones?

Answer 2

1. ilium: iliac crest (L4/ abdominal aorta bifurcation landmark) + iliac fossa + anterior superior iliac spine
2. ischium: spine serves as muscle/ligament attachment, pudendal nerve runs along spine
3. pubis (+ pubic symphysis)

Question 3

What is vertebral level does the abdominal aorta bifurcate into the common iliac arteries and what is the bony landmark of this?

Answer 3

L4 - iliac crest

Question 4

pelvic diaphragm/floor =…

Answer 4

levator ani muscle + ischiococcygeus muscle + fascia

note levator ani muscles attach to the pelvic bones AND muscular white line/tendinous arch (thickening of obturator internus fascia)

Question 5

What is contained in the deep versus superficial perineum?

Answer 5

perineum is inferior to the pelvic diaphragm

deep (superior), aka urogenital diaphragm: contains external urethral sphincter

superficial (inferior): contains erectile tissue/ skeletal muscle/ fascia of external genitalia

Question 6

Which nerve and artery supplies both the deep and superficial perineal pouch?

Answer 6

pudendal nerve + internal pudendal artery

do not go through pelvic diaphragm, rather, pass through openings in the posterior pelvic wall (greater and lesser sciatic foreman)

Question 7

from what do the gonadal arteries branch, and how do they reach the ovary and testis, respectively?

Answer 7

Gonadal arteries branch from the abdominal aorta at L2

Female – course through the suspensory ligament to reach ovary

Male – course through spermatic cord (in inguinal canal) to reach testes

Question 8

branches of which arteries supply the pelvic viscera, including the oviducts, uterus, vagina, prostate, urinary bladder, and urethra?

Answer 8

branches of the internal iliac arteries

Question 9

what kind of innervation does the aortic–gonadal plexus versus the inferior hypogastric plexus provide?

Answer 9

aortic-gonadal (autonomic, on gonadal artery): sympathetic splanchnic nerves with pain to T10-T11 DRG

inferior hypogastric (autonomic, in pelvis): sympathetic above pelvic pain line + parasympathetic below pelvic pain line

Question 10

Contrast the sympathetic versus parasympathetic innervation by the inferior hypogastric plexus

Answer 10

sympathetic (above pelvic pain line): vasoconstriction, smooth muscle sphincter contraction, ejaculation, nerves with pain to T11-L2 DRG

parasympathetic (below pelvic pain line): smooth muscle contraction, sphincter inhibition, erection (cavernous nerves in prostatic plexus), nerves with pain to S2-S4 DRG

Question 11

Where does visceral pain for the gonads refer to?

Answer 11

T10-T11 dermatomes, because the visceral afferent pain fibers from the ovaries/testes “piggyback” on the sympathetic splanchnic nerves originating from here to reach the DRG at this level

Question 12

which internal female organs lie in the greater versus lesser pelvis?

Answer 12

greater pelvis - ovaries, uterine tubes, uterine fundus + body

lesser pelvis - uterine cervix and upper vagina

[external genitalia are in the perineum]

Question 13

into which to the right versus left ovarian veins drain?

Answer 13

Right – IVC
Left – left renal vein

Question 14

What is the relation of the ureter to the uterine artery and why is this anatomical relation important?

Answer 14

“water under the bridge” - ureter courses inferior to the uterine artery

Important to know during hysterectomy

Question 15

From what are the suspensory ovarian ligament and proper ovarian ligament derived? what are their respective functions?

Answer 15

both are segments of the broad ligament, which is made of the inferolateral edges of the parietal peritoneum

Suspensory ovarian ligament (aka infundibulopelvic ligament) carries the ovarian arteries and vein, connects ovary to body wall

Proper ovarian ligament is a fibrous cord connecting the ovary to the uterine body

Question 16

vagina fornices

Answer 16

Recesses between the cervix and the vagina walls (anterior, posterior, lateral)

Question 17

Pouch of Douglas

Answer 17

A.k.a. rectouterine pouch – lowest point of peritoneal cavity where exudate or pelvic abscess pooling my occur

small space found between uterus and rectum

Question 18

adnexa

Answer 18

uterine tubes + ovaries

Question 19

what are the respective functions of the round ligament of the uterus and the cardinal/transverse cervical ligament?

Answer 19

round ligament - extends from the uterus to the anterior abdominal wall to pass through the inguinal canal and reach the labia majora

cardinal/transverse cervical - connects at the pericervical ring and carries the uterine vessels

Question 20

cystocele vs rectocele vs uterine prolapse

Answer 20

cystocele: bulge/herniation of urinary bladder into anterior vaginal wall

rectocele: bulge/herniation of rectum into posterior vaginal wall

uterine prolapse: bulge/herniation of uterus through vaginal canal

Question 21

leiomyomas

Answer 21

aka fibroids, benign smooth muscle tumors of the uterus

Question 22

episiotomy

Answer 22

surgical incision made during childbirth at the posterior edge of the vagina to widen the birth canal (no longer recommended)

previously done to prevent random tearing of the perineal structures, such as the perineal body (central tendon of the perineum and critical for maintaining the integrity of the pelvic floor)

Question 23

how is anesthesia of the perineum performed?

Answer 23

via pudendal nerve block, using the ischial spine as a landmark

Question 24

what is the most common zone of the prostate for benign prostate hyperplasia vs prostatic cancer to arise?

Answer 24

transitional zone - typical site of BPH

peripheral zone - where majority of prostatic cancers arise

Question 25

where are the 3 sites to which prostatic cancer typically metastasizes?

Answer 25

1. bone 2. lung 3. liver

Question 26

the ends of the ductus deferens dilate into an _____ that combines with the ________

Answer 26

ends of the ductus deferens dilate into an *ampulla* that combines with the *seminal vesicles*

Question 27

what are the 3 penile erectile bodies?

Answer 27

2 *corpora cavernosa* + 1 *corpus spongiosum* (contains penile/spongy urethra) fill with blood to elicit erection

Question 28

During erection, blood from the _______ leads to ______ arteries that fill the erectile tissues. Compression of the _______ vein against the thick Buck’s fascia of the penis stops venous return during erection.

Answer 28

During erection, blood from the *internal pudendal artery* leads to *helicine arteries* that fill the erectile tissues. Compression of the *deep dorsal vein* against the thick Buck’s fascia of the penis stops venous return during erection.

Question 29

contrast the nervous input driving erection vs emission/ejaculation

Answer 29

erection - parasympathetic ejaculation - sympathetic

Question 30

the _____ is located in the ______ and serves as attachment for the external genitalia

Answer 30

the *UG diaphragm* is located in the *deep perineum* and serves as attachment for the external genitalia

Question 31

The gonadal vessels branch from the _______. The ovarian vessels travel in the ________, while the testicular vessels travel in the _______ and inguinal canal.

Answer 31

The gonadal vessels branch from the *abdominal aorta*. The ovarian vessels travel in the *suspensory ligament of the ovary*, while the testicular vessels travel in the *spermatic cord* and inguinal canal.

Question 32

Fibroids are also known as ______ and are benign smooth muscle tumors of the uterus.

Answer 32

Fibroids are also known as *leiomyomas* and are benign smooth muscle tumors of the uterus.

Question 33

Sperm is formed in the _____, matured/stored in the _______, and travels through the ________ before reaching the ejaculatory ducts and prostatic urethra.

Answer 33

Sperm is formed in the *testes*, matured/stored in the *epididymis*, and travels through the *ductus deferens* before reaching the ejaculatory ducts and prostatic urethra.

Question 34

the _______ is smooth muscle that contracts under ______ innervation to maintain urinary continence and prevent sperm entry into the urinary bladder during ejaculation

Answer 34

the *internal urethral sphincter* is smooth muscle that contracts under *sympathetic* innervation to maintain urinary continence and prevent sperm entry into the urinary bladder during ejaculation

Question 35

the ________ supplies _____ motor innervation to the skeletal muscles of the perineum

Answer 35

the *pudendal nerve* supplies *somatic* motor innervation to the skeletal muscles of the perineum

Question 36

Which of the following nerves carries visceral pain sensation from the cervix? A. Sympathetic splanchnic nerves B. Parasympathetic splanchnic nerves C. Pudendal nerve

Answer 36

B. Parasympathetic splanchnic nerves Organs touching the peritoneum (“above the pelvic pain line”) follow *sympathetic* fibers - fundus/body of uterus, oviducts, ovaries Organs below the peritoneum (“below the pelvic pain line”) follow *parasympathetic* fibers - cervix

Question 37

A pediatrician examined a healthy newborn male and noticed no abnormalities other than an opening located on the ventral surface of the penis. This malformation is the result of defective

Answer 37

closure of urethral folds.

Question 38

Mesonephric ducts give rise to a. urethra b. ductus deferens c. testes d. kidney nephrons e. prostate gland

Answer 38

b. ductus deferens

Question 39

Which of the following organs contains epithelium that is endoderm-derived? a. epididymis b. ureters c. uterine tubes d. prostate e. upper vagina

Answer 39

d. prostate Prostate grows from the urethra, which is derived from the urogenital sinus.

Question 40

An occlusion of the umbilical artery in the pelvis may result in reduced perfusion of the a. anterior abdominal wall musculature b. urinary bladder c. prostate gland d. cervix

Answer 40

b. urinary bladder Prior to reaching the anterior abdominal wall where it becomes fibrotic postnatally, the umbilical artery gives off some superior vesicle branches to the bladder.

Question 41

Which of the following nerves synapse on neuronal cell bodies in the inferior hypogastric plexus? a. pelvic splanchnic nerves b. pudendal nerve c. greater thoracic splanchnic nerves d. vagus nerve

Answer 41

a. pelvic splanchnic nerves Preganglionic sympathetic and parasympathetic neurons synapse in the inferior hypogastric plexus. While the greater thoracic splanchnic and vagus nerves contain preganglionic axons neither reach the inferior hypogastric plexus. The pelvic splanchnic nerves contain preganglionic parasympathetic axons that synapse on neurons in the inferior hypogastric plexus.

Question 42

Your patient suffers from erectile dysfunction following his prostatectomy. This postoperative outcome is most likely the result of a surgical lesion of the

Answer 42

cavernous nerves. cavernous nerves carry postganglionic parasympathetic axons that stimulate relaxation of arteries to the erectile tissues. A lesion of these nerves frequently occurs during radical prostatectomy and lead to erectile dysfunction.

Question 43

In performing a mediolateral episiotomy which of the following muscles in the superficial perineal pouch would you cut? a. external anal sphincter b. pubococcygeus c. deep transverse perineal muscle d. bulbospongiosus muscle

Answer 43

d. bulbospongiosus muscle Of the choices the bulbospongiosus and the ischiocavernosus are the only muscles in the superficial perineal pouch. The bulbospongiosus muscle attaches to the perineal body which is cut during a mediolateral episiotomy.

Question 44

Your patient suffers from retrograde ejaculations into the urinary bladder following his prostatectomy. This postoperative outcome is most likely the result of a a. lesion of the cavernous nerves. b. lesion of the pelvic splanchnic nerves. c. relaxation of the detrusor muscle. d. relaxation of the internal urethral sphincter.

Answer 44

d. relaxation of the internal urethral sphincter. During ejaculation, sympathetic innervation stimulates contraction of the internal urethral sphincter muscle so that the ejaculate passes through the spongy urethra. Prostatectomy may disrupt the innervation to the internal urethral sphincter resulting the sphincter relaxing and the ejaculate passing retrograde into the urinary bladder.

Question 45

An endometrial mass located in the rectouterine pouch a. may be palpated through the posterior wall of the anal canal. b. may be palpated through the posterior wall of the rectum. c. may be palpated through the posterior fornix of the vagina. d. is likely to result in retroflexion of the uterus.

Answer 45

c. may be palpated through the posterior fornix of the vagina. Digital inspection of the rectouterine pouch is done via palpation of the posterior vaginal fornix.

Question 46

Structures from which painful stimuli are carried via parasympathetic afferent nerve fibers include the a. uterine fundus. b. cervix c. anal mucosa inferior to the pectinate line. d. ovary. e. uterine tube.

Answer 46

b. cervix Painful stimuli carried via parasympathetic innervation is limited to structures located below the pelvic pain line defined as subperitoneal structures. The cervix is the only structure in this list that is subperitoneal.

Question 47

Which of the following structures travel from the pelvis to the perineum by passing posteriorly and through both the greater and lesser sciatic foramina? a. pudendal nerve b. rectum c. urethra d. cavernous nerves

Answer 47

a. pudendal nerve The pudendal nerve is the only choice here that passes through both openings to reach the perineum from the pelvis.

Question 48

Your 30-year-old patient is in labor with her first child. Your patient's cervix is dilated 7 cm and causing her a great deal of pain. The afferent nerve fibers transmitting pain have cell bodies located in dorsal root ganglion associated with the _____ spinal nerve.

Answer 48

The cervix is below the pelvic pain line and thus afferent impulses travel in the pelvic splanchnic nerves which arise from ventral rami of S2-S4.

Question 49

During radical prostatectomy pelvic surgery, a surgeon notices severe bleeding from an internal iliac artery branch that supplies the prostate. Which of the following arteries is most likely injured? a. internal pudendal artery b. inferior rectal artery c. umbilical artery d. inferior vesicle artery e. obturator artery

Answer 49

d. inferior vesicle artery The prostate, seminal vesicle and proximal portions of the vas deferens receive their blood supply from branches of the inferior vesicle artery.