Vagina

Question 1

Course

Answer 1

1. Fibromuscular tube extending from external genitalia vestibule
   to uterus
2. Ascend upwards and backwards at 90º angle to uterus long axis
3. Cervix pierces upper part of vagina anterior wall, so anterior wall is shorter (7.5 cm) than posterior wall (9 cm)
4. Vagina upper end surrounds cervix vaginal part in form of arched annular recess (vaginal fornices)
5. Vaginal orifice has thin mucosal fold (hymen) which has central opening

Question 2

Relations: anterior

Answer 2

1. Upper part: pierced by cervix
2. Middle part: In contact with bladder base
3. Lower part: Directly related to urethra
   (embedded in vagina anterior wall)

Question 3

Relations: lateral (on each side) upper and middle part

Answer 3

Upper part:
1. Related to ureter
2. Runs anteromedial close to lateral fornix
3. Uterine artery crosses ureter
Middle part:
related to levator ani anterior fibers (sphincter vaginae) supporting vagina

Question 4

Relations: lateral (on each side) lower part

Answer 4

Lower part:
1. Pass in deep perineal pouch
where it is related to sphincter urethrae
2. Then pierce perineal membrane to reach
superficial perineal pouch where it is related to vestibule bulb, bulbospongiosus muscle and greater vestibual glands
(Bartholin glands)

Question 5

Arterial supply

Answer 5

Receives following branches from internal iliac artery:
1. Vaginal artery
2. Uterine artery
3. Middle rectal artery
4. Internal pudendal artery
These branches anastomose with each other forming 2 longitudinal median arterial chains (anterior and posterior azygos arteries of vagina) on vagina anterior and posterior walls

Question 6

Venous drainage

Answer 6

Veins form vaginal venous plexuses along vagina sides, draining into internal iliac vein

Question 7

Lymph drainage

Answer 7

1. Upper part: into
   external iliac nodes
2. Middle part: into
   internal iliac nodes
3. Vagina below hymen: into superficial inguinal nodes

Question 8

Applied anatomy: per vaginal examination (P.V.)

Answer 8

Finger introduced in vaginal can feel:
1. Anterior:
- Urethra
- Bladder
- Symphysis pubis
2. Posterior:
- Perineal body
- Rectum
- Any fluid collection or masses in Douglas pouch
3. Lateral:
- Vagina lateral wall
- Ovary
- Uterine tube
- Ischial spine
- Levator ani
4. Above: Uterus cervix

Question 9

Applied anatomy: bimanual examination

Answer 9

1. Fingers of right hand are introduced in vagina while other hand presses on anterior abdominal wall just above symphysis pubis
2. It gives idea about uterus size and position, ovary or uterine tube enlargement and presence of other pelvic masses