What happens to the ovary during development?
It descends in the pelvis
What does the descent of the ovary have implications for?
Venous and lymphatic drainage of the ovaries
Where do the gonads develop?
Within the mesonephric ridge, on the posterior abdominal wall
What is the inferior pole of the ovary attached to?
What is the inferior attachment of the gubernaculum?
What causes the descent of the ovary?
The relative shortening of the gubernaculum, which drags the ovary through the abdomen
Where does the ovary stop its descent?
In the pelvis
What is the arterial supply to the ovary?
Via direct branches of the abdominal aorta
What is the venous drainage of the ovary?
- The right ovarian vein into the inferior vena cava
- The left ovarian vein into the left renal vein
What are the parts of the uterus?
- Uterine tubes
Draw a labelled diagram of the uterus
What happens to the fundus as pregnancy proceeds?
It becomes palpable
What is the clinical importance of the fundus of the uterus?
It is an important clinical measurement in pregnancy
What is the function of the uterine tubes?
Duct system for the gamete
What does the cervix contain?
The endocervical canal
What is the endocervical canal?
A channel that runs through the cervix
What are the peritoneal pouches of the uterus?
- The uterovesical pouch anteriorly
- The rectouterine pounch posteriorly
Where is the uterovesical pouch?
Between the urinary bladder and uterus
What is the rectouterine pouch also known as?
The pouch of Douglas
Where is the rectouterine pouch?
Between the rectum and the uterus
How can the rectouterine pouch be accessed?
Through the posterior fornix of the vagina
What is the peritoneal pouch in a male?
The rectovesical pouch
Where is the rectovesical pouch found?
Between the bladder and the rectum
What does the uterus develop from?
The paramesonephric duct
What are the paramesonephric ducts?
A pair of ducts that are open cranially and caudally, and connect to the urogenital sinus
Why do the paramesonephric ducts need to be open?
To allow for the collection of gametes after ovulation
When do paramesonephric ducts persist in development?
In the absence of MIH, and therefore in the absense of testes
What happens to the paramesonephric ducts in female development?
They grow into the abdominal cavity, dragging the peritoneal membrane with it, then fuse in the midline
What does fusion of the paramesonephric ducts in the midline create?
A broad transverse fold draped by peritoneum, the broad ligament
What is the purpose of the broad ligament?
It is like a mesentery, in that it is a sheet of pertioneum that allows structures to enter and leave, including vasculature
What is the round ligament of the uterus embryologically derived from?
What is the round ligament of the uterus attached to?
The ovary and labium majus
Where does the round ligament of the uterus travel?
Through the inguinal canal
What does the pathway of the round ligament through the inguinal canal have consequences for?
What is the consequence of the round ligament running through the inguinal canal on the lymphatic drainage?
Lymphatics run with the round ligament through the inguinal canal, so sometimes pathologies of the fundus of the uterus present as enlargement of the inguinal lymph nodes
What position is the uterus in?
It is anteverted with respect to the vagina, and anteflexed with respect to the cervix.
Normally tipped anteriorly, lying on top of the bladder
What does the uterine tube consist of?
- Abdominal ostium (opening)
What is the clinical relevance of the abdominal ostium of the uterine tube?
Means that the peritoneal cavity is open, and so there is a pathway for infection to spread from the lower reproductive tract, then into the abdominal cavity
What is the function of the uterine tube?
- Conduct oocyte into the uterine cavity
- Normally the site of fertilisation
Is the lining of the uterine tube endometrium, as in the uterine cavity ?
What is the consequence of the lining of the uterine tube not being endometrium?
Has a consequence for ectopic implantation, as control of implantation is dependant on the presence of endometrium
What does the cervix consist of?
- Internal os (opening into vagina)
- Endocervical canal
- External os (to body of uterus)
What ligaments support the pelvic viscera?
- Transverse cervical ligament
- Uterosacral ligament
- Pubovesical ligament
What is the tranverse cervical ligament?
Thickening at the base of the broad ligament
What does the transverse cervical ligament do?
Provides lateral stability of the cervix
What does the uterosacral ligament do?
Opposes anterior pull of the round ligament, assisting in maintaining anteversion
What arteries supply blood to the female internal genitalia?
- Ovarian artery
- Uterine artery
- Internal pudendal
What is the ovarian artery a branch of?
The abdominal aorta
What is the uterine artery a branch of?
Anterior division of internal iliac
What does the uterine artery give branches to?
The vaginal artery
What is the internal pudendal artery a branch of?
Anterior division of internal iliac
What is true of the blood supply to the female internal genitalia?
It has lots of anastomoses
What is the purpose of the anastomoses of the blood supply to the female internal genitalia?
Ensures maintainance of blood supply
Why is the maintaince of the blood supply to the female internal genitalia of critical importance?
Because if pregancy should occur, there is massive growth of the myometrium which needs to be supported by blood supply
What is the uterine artery in important anatomical relationship with?
Where does the ureter run in relation to the uterine artery?
The ureter runs under the artery
When is it important to consider the close relationship between the ureter and the uterine artery?
During a hysterectomy
Why is it important to consider the close relationship between the ureter and the uterine artery during a hysterectomy?
Because it is at risk of iatrogenic damage
How could a surgeon differentiate between the ureter and the uterine artery?
The ureter has a peristaltic reflex
Why does the uterus have a complex pattern of lymphatic drainage?
Reflective of its complex development
What nodes does the uterus drain to?
- External iliac
- Internal iliac
By what route does the uterus drain to the para-aortic nodes?
Along suspensory ligament
What parts of the uterus drain into the para-aortic nodes?
- Body of uterus
What parts of the uterus drain into the external iliac nodes?
- Body of uterus
What parts of the uterus drain into the internal iliac nodes?
What parts of the uterus drain into the sacral nodes?
What parts of the uterus drain into the inguinal nodes?
What are the parts of the female external genitalia?
- Labia majora
- Labia minora
What does the labia majora do?
Encloses the pudendal cleft
What does the labia minora do?
Encloses the vestibule of the vagina
What does the vestible of the vagina contain?
- Greater and lesser vestibular glands, aka Bartholin glands
What are the potential pathologies of the Bartholin glands?
- Bartholin gland cyst
What is a Bartholin gland cyst?
An accumulation of fluid that is not related to infection
What does the vaginal oriface open into?
What does the vaginal oriface open into the vestible along with?
The external urethral oriface and the ducts of the greater and lesser vestibular glands
What are the vaginal fornices?
Superior recesses of the vagina around the cervix
What is the clinical significance of the vaginal fornices?
Because they are the site of culdocentesis
What is culdocentesis?
Sampling of abnormal fluid from pouch of Douglas
What innervates the vagina and uterus?
- Inferior 1/5 of vagina receives somatic innervation from pudendal nerve
- Superior 4/5 of vagina and uterus recieves innervation from uterovaginal plexus
What does the location of pain originating from the vagina and uterus depend on?
The pelvic pain line
Where does pain originating from the vagina and uterus travel back to?
- Inferior thoracic lumbar spine ganglia
- S2-4 spinal ganglia
What innervates the perineum?
- Pudendal nerve
- Ilioinguinal nerve
What course does the pudendal nerve take?