Anatomy of the Female Reproductive Tract
Specify the male homologues of the following female structures: clitoris, vestibular bulbs, greater vestibular glands.
-Clitoris (Female) = Penis / Corpora Cavernosa (Male) o Vestibular Bulbs (Female) = Bulb of the Penis and the Corpus Spongiosum (Male) o Greater Vestibular Glands (Bartholin's Glands) (Female) = Bulbourethral Glands (Male)
Specify the bony features that determine the diagonal conjugate diameter
A surrogate, measurable estimate of the true conjugate diameter; measured as the chord distance between the sagittal midline of the sacral promontory (palpable from within the vagina) and the inferior margin of the pubic symphysis.
Proper Ligament of the Ovary
Also called the ovarian ligament. It connects the ovary to the body of the uterus. There are no vessels contained within the ligament.
Uterus Position
Anteverted and Anteflexed on top of the bladder.
Explain the surgical significance of the relationship between the uterine artery and the ureter.
By virtue of its proximity to the uterine artery in the pelvic cavity, the ureter is at risk of being clamped, tied off and severed during hysterectomies.
Relate the vaginal fornices to the following clinical procedures: palpation of the ovaries, palpation of pulsations of ureter, palpation of uterine arteries, draining the rectouterine pouch, harvesting oocytes.
Fluid collecting in the rectouterine pouch (of Douglas) can be drained by inserting an aspirating needle through the posterior part of the posterior vaginal fornix. Such an approach is also used to harvest oocytes from the ovaries for in vitro fertilization. A number of pelvic organs can be palpated through the lateral vaginal fornices. These include the ovaries, ureters, and uterine arteries.
Suspensory Ligament of the Ovary
Passing from the lateral pelvic wall to the lateral pole of the ovary within the broad ligament; the suspensory ligament of the ovary is the superior most component of the broad ligament complex; it is created by the underlying ovarian vessels. This ligament of the Broad Ligament complex contains the vessels supplying the uterus, cervix and vagina, and the ovarian vessels (Ovarian Artery). Additionally, the Ureters are located at the base of this ligament.
Relate the uterine artery to the blood supply of the ovaries, uterine cervix and vagina.
The Uterine Artery originates from the internal iliac artery. The ascending branch of the uterine artery, which ascends along the lateral aspect of the uterus to anastomose with the ovarian artery (a branch of the abdominal aorta), and the descending branches of the uterine artery that supply the uterine cervix and vagina and anastomose with branches of the vaginal artery. Note the vaginal artery is a branch of the uterine artery prior to the latter's course anterior and superior to the ureter.
Specify the bony features that determine the bispinous diameter
The distance between the right and left ischial spines. The Bispinous Diameter is the narrowest dimension of the pelvic outlet.
Specify the bony features that determine the obstetric conjugate diameter
The narrowest dimension of the entrance to the birth canal in the anterior/posterior plane; represented as the chord (straight-line) distance from the sagittal midline of the sacral promontory to the nearest point on the internal (posterior) surface of the pubic symphysis.
Explain the anatomical basis of the pain and numbness experienced in the lower limb during late pregnancy and childbirth.
The obturator nerves and branches of the sacral plexus are susceptible to compression during pregnancy and childbirth. This would result in pain in the lower limbs. The obturator nerve is also susceptible to injury during surgery on the hip joint, lateral pelvic walls, or bladder suspension procedures. Damage to the obturator nerve can cause medial thigh pain or numbness, and spasms of the adductor muscles.
ovaries location
The ovaries are located between the uterus and the lateral pelvic wall, where they are partially embedded within the fimbriated distal openings of the uterine tubes.
Transverse (Cardinal) Cervical ligament
The transverse cervical (cardinal) ligament of the female pelvis is the thickened endopelvic fascia that attaches the uterine cervix and vagina to the lateral wall of the pelvis The Uterine Artery, Uterine Vein, and Lymphatics are all embedded in the Transverse Cervical Ligament and are at risk of injury when it is transected.
Specify and explain the dynamic and passive support mechanisms that maintain the uterus in position in the pelvic cavity.
The uterus is supported in its position in the pelvic cavity through a variety of different mechanisms. Contraction of the pelvic diaphragm provides dynamic support to the uterus, whereas passive support is provided by both the "ligaments" of the endopelvic fascia (Transverse (Cardinal) Cervical Ligament, Broad Ligament, and Uterosacral Ligament) (some of which contain small amounts of smooth muscle), and its anteverted and anteflexed position on top of the bladder. Loss of support of the uterus may result in uterine prolapse into the vaginal canal. Mild uterine prolapse (generally asymptomatic) is not uncommon following vaginal deliveries. More severe cases are associated with a feeling of pressure within the vagina, and lower back and sacral pain.
Anteflexion
Uterus bent anteriorly relative to the cervix
Retroflexion
Uterus bent posteriorly relative to the cervix
Anteversion
Uterus tipped anterosuperior relative to the axis of the vagina
Retroversion
Uterus tipped more superiorly or posterosuperiorly relative to the axis of the vagina
uterus location
Within the pelvic cavity, the uterus is typically oriented in an anteverted (tipped anterosuperior relative to the axis of the vagina) and anteflexed (bent anteriorly relative to the cervix) position such that it rests on the empty urinary bladder and pubic bones. When in this position, increases in intra-abdominal pressure will press the uterus further against the superior surface of the urinary bladder, rather than through the vaginal canal.
