THE FEMALE PELVIS Recto-uterine pouch [of Douglas] / Vesico-uterine pouch o Dips down to touch the posterior fornix

ix of vagina o Between upper 1/3 of uterus and superior surface of urinary bladder Mesosalphinx o Fascia extended postero-laterally to cover the fallopian tubes o Thickens as the infundibulo-pelvic ligament / false suspensory ligament of ovary Encloses the ovarian vessels Broad ligament o Below fallopian tubes, hangs downwards as a double layered fold at sides of uterus and cervix o Encloses abundant fibro-areolar endopelvic fascia o Distinguished by Parametrium Supports the uterine vessels and nerves and the distal ends of the ureters o Posterior layer Enfolds the ovaries on each side differentiated by Mesovarium True ovarian ligament - Also includes a cord like condensation of fibrous tissue o Attached superiorly to the superior angle of the uterus below the utero-tubal junction Fold that is reflected to the rectum as Recto-uterine pouch [of Douglas] Parametrium o Condensations: Cardinal or McKenrodts Ligaments Thickened parts at the sides of the cervix Extended to the lateral pelvic walls Maintain the cervix and uterus in place Uterine arteries run along superior border on each side (lateral medial) Ureters pass under each artery to reach urinary bladder Utero-Sacral Ligaments Less distinct thickening Extends from back of cervix Attached posteriorly to the recto-uterine fold and last segments of sacrum Prevents the forward displacement of the uterus True ligament of the Ovary One on each side Attached at one end to the lower or uterine pole of each ovary Other end attached to superior angle of uterus

Female Reproductive Organs Uterus o Hollow muscular organ o 7-8 cms longitudinal axis o 5 cms across supero-lateral angles/utero-tubal junctions o 2-3 cms inferior cylindrical cervical segment o Parts Fundus Slightly arching; superior border; above level of utero-tubal junctions Directed forwards towards the symphysis pubis Body of Corpus Uteri Main part of the organ Broad below fundus Narrows inferiorly at isthmus o Differentiates lower cervical part Cervix Cylindrical lowest segment Invaginates into the upper end of vaginal canal Surround a narrow cervical canal Supravaginal portion o Upper segment rising about 1-1.5 cms above attachments of vaginal fornix Intravaginal portion o Inferior half enclosed by vaginal fornix at the upper end of vaginal canal o Palpable and visible during internal exams o Observed as pale, pinkish, firm, bluntly rounded protuberance o External os - small central opening; may be rounded or appear as a narrow slit o Internal os at the isthmus o Cervix color usually changes with physiological states (menstruation, ovulation, etc) o Upon uterine contractions, cervix is effaced Process which integrates the musculature into the lower uterine segment until it fully disappears Leaving a gradually widening aperture for passage of fetus

Uterine cavity Triangular on coronal section Narrowed by thick surrounding muscular wall Lined by special secretory mucosal membrane endometrium Characteristic folds resemble palm leaf in cervical canal plica palmatae Intrauterine openings of fallopian tubes located at superior angles of the cavity Involution after delivery, the uterus returns to its pre-gravid state o Includes restoration of over-stretched ligaments o Toning up of pelvic and perineal muscles Position Normally slightly antero-verso flexed by angulations along longitudinal axis Body of uterus is bent over postero-superior surface of urinary bladder Fundus is directed anteriorly Cervix points anteroinferiorly Maintained by tone of its musculature Supported by muscles of pelvic floor and surrounding pelvic fascia and ligaments attached to pelvic wall Ante-version angulation (90o) between long axis of entire uterus and vagina Ante-flexion more obtuse bending of corpus uteri on its cervix Ligaments that keep uterus in position: Cardinal and utero-sacral ligaments Pubo-vesical ligament (pubocervical, vesico-vaginal) o Extends from pelvic surface of symphysis pubis o Encircles neck of urinary bladder Broad ligament o With mesosalphinx and fallopian tubes o Fixed by attachments of infundibulo-pelvic ligament to area of sacro-iliac joint

Fallopian Tube / Uterine Tube / Oviduct o Pair of muscular tubes, extends laterally and posteriorly to lateral pelvic wall o Below the bifurcation of common iliac vessels o 10-12 cms long

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Enveloped by mesosalphinx Parts Intramural or interstitial segment Shortest, narrowest, and most fixed part Embedded in thickness of uterine muscle @ superior lateral angle of uterus Intrauterine opening = 1 mm in diameter Isthmus 2.5 cms Emerges from uterine wall and extends laterally Ampulla Gradually widening, longest sinuous part (2/3 of length) Lateral end is dilated, curved slightly downwards near superior or tubal pole of ovary Infundibulum Expanded end of ampulla Fimbriae - finger-like processes o Abdominal opening or ostium abdominae End of each tube, center of fimbriae Direct communication with external environment through utero-tubal and vaginal passages Peritoneal covering of fimbriae is not pierced, remains intact o Ovarian fimbria one of fimbriae is longer than others Conduit for extruded ovum Facilitates entry through ostium into ampulla of tube Ovaries o Paired glands; size and shape of almond seed o Younger individuals smooth surface o Older increasingly rough and irregular due to presence of scarred remnants of extruded ova o Fossa ovarica [of Waldeyer] ovary lodged in this shallow depression, covered by peritoneum Located below bifurcated external and internal iliac vessels o 2 Poles Superior or tubal pole postero-laterally False suspensory ligament attached to tubal pole Inferior or uterine pole antero-medially True ligament of ovary is attached to uterine pole Vagina o Musculo-membranous tube (7-8 cms long) o Lower/external end opens into vestibule of perineum o Upper end accommodate the invaginated lower half of cervix o Fornices small pouch; enfolded upper end of vaginal wall attached to cervix Anterior fornix shallowest, increasing in the 2 lateral fornices Posterior fornix largest, deepest, produced by insertion of posterior wall (receptaculum seminis) Superior part rises above pelvic diaphragm into pelvic cavity Dome is in contact with cul-de-sac of Douglas o Anterior vaginal wall - Shortest, lined by multi-folded mucosa (rugae) Closely related to neck of urinary bladder and urethra o Posterior vaginal wall smoother, longer Separated from rectal wall by thin fascial septum o Inferior [external[ 1/3 of vaginal canal surrounded by muscles Pubo-coccygeus fascicule of levator ani Sphincter urethra and deep transverse perineal muscles of urogenital diaphragm Bulbo-cavernosus and the superficial transverse perineal muscles Neurovascular Supply o Uterine arteries ORIGIN: internal iliac arteries Course downwards, forwards and medially towards lateral border of isthmus Ureter passes below the artery and vein At this point, vaginal branch is given off Ascends sinuously along lateral border of uterus utero-tubal junction Anastomoses with ends of tubal branch of ovarian artery Branches penetrate myometrium o Ovarian arteries ORIGIN: abdominal aorta, given off below origins of renal arteries Oblique course downwards crossing over structures of abdominal wall lateral to ureter At pelvic brim, artery and vein cross over common iliac vessels Dip into pelvic cavity into fold of infundibulo-pelvic ligament Tubal branch Enters mesosalphinx, courses medially below fallopian tube utero-tubal junction Anastomoses with uterine artery o Vaginal arteries ORIGIN: internal iliac artery Courses downwards and medially Branches to lowest part of urinary bladder to rectum At vaginal wall anterior and posterior branches Anastomose to form azygos artery on anterior vaginal wall o Lymphatic vessels along sides of uterus, join urethral, ovarian, and tubal channels nodes along veins nodes along internal and external iliac vessels o Innervations Derived from sacral ganglia of sympathetic trunk Perivascular plexuses around hemorrhoidal arteries branches from inferior hypogastric plexus S2,3,4 parasympathetic fibers conveyed by pelvic splanchnic nerve Innervate smooth muscles and glands in uterus and fallopian tubes