The Vageen

Question 1

Explain how the ovary releases the oocyte into the peritoneal cavity during ovulation. (3)

Answer 1

Visceral peritoneum covers the ovarian stalk, but not the ovary itself. This means when the oocyte ruptures through the ovarian wall, it is released into the peritoneal cavity because the parietal peritoneum is still adhered to the abdominal wall.

Question 2

Explain why nuns have a higher incidence of ovarian cancer than the average woman in the population. (4)

Answer 2

Nuns ovulate more than the average woman because they have never been pregnant or used contraception that would prevent ovulation like is common in the general population. Because ovulation is a traumatic event when the oocyte bursts through the wall of the ovary, increased ovulation requires higher rates of cell division to repair the repeated damage, which increases the risk of cancer.

Question 3

Describe the places that fluid can collect in a female pelvis. (2)

Answer 3

Rectouterine space - between rectum and uterus - also called Pouch of Douglas.
Vesicouterine space - between bladder and uterus.

Question 4

Describe the normal appearances of the cervix. (4)

Answer 4

Only the non-keratinised stratified squamous epithelium seen on the outside of the cervix. If never given birth, external os should be pinpoint, if they have it could be a slit shape. Has a pointed fornix between vagina and cervix.

Question 5

Describe abnormal appearances of the cervix. Indicate what that could show. (4)

Answer 5

Cervical eversion - showing the internal columnar epithelium and the line of the transition zone externally. Could be related to being on the combi pill, or with haemorrhage or spots of different colours, relating to cancer.

Question 6

Describe the ligaments of the female internal genitalia. (5)

Answer 6

Broad ligament - a double fold of peritoneum that can be subdivided relating to the structures it surrounds - mesovarium (ovary), mesometrium (pelvic wall and uterus), mesosalpinx (Fallopian tubes).
Round ligament and ligament of ovary - remnants of the gubernaculum that run uterus > labia majora or ovary > uterus.
Suspensory ligament of ovary - neurovascular pathway containing ovarian vessels.

Question 7

Describe the axis of the internal female genitalia. (4)

Answer 7

Axis of vagina > axis of cervix
This is the angle of antiversion - under 180 is antiverted, over 180 is retroverted.
Axis of cervix > axis of uterus
This is the angle of antiflexion - under 180 is antiflexed, over 180 is retroflexed.

Question 8

Explain why the epithelium in the vagina needs to be rich in glycogen. (2)

Answer 8

This glycogen can be broken down into lactic acid by lactobacilli, which maintains the low pH needed to help prevent infections in the vagina.

Question 9

Describe the vascular supply to the female internal genitalia. (5)

Answer 9

Arteries: ovarian and uterine.
Veins: right ovarian - IVC, left ovarian - left renal vein, uterus, cervix and vagina - plexus in the broad ligament
Lymphatic: ovaries - para-aortic, uterus+cervix - iliac, sacral, aortic, inguinal, vagina - iliac and superficial inguinal.

Question 10

Describe the parts of the Fallopian tube. (4)

Answer 10

Ovary > fimbrae > infundibulum > ampulla > isthmus > uterus.