Female Reproductive AnatomyALEX HAMMANT AND PHIL COPEMAN

Defining stuff

Pelvic girdle = bony pelvis

Pelvis = the space bound by the pelvic girdle

Great pelvis = Upper abdominal region of pelvic girdle

Lesser pelvis = Lower region of pelvic girdle (pelvic cavity & perineum)

Pelvic cavity = Region between inlet and pelvic floor

Perineum = Region below the pelvic floor

What’s what2

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Even more what’s what

Labia majora

Clitoris

Labia minora

Vaginal orifice

Perineal bodyImportant structural support

Urethral orifice

Greater vestibular glandDrain into vestibule at 5 & 7 o’clock

Vestibule

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Guess what?

Fundus

Uterine body & cavity

Cervical canalConnects vagina and uterine cavity via the external and internal os

External os

Vagina

Ampulla

Infundibulum

IsthmusUterine tubesOpen into the abdominal cavity into which ovulation takes place

Internal os

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An 19 year old girl has had pain in the inside of her thigh for the last few days. The same thing happened last month, what could be the problem?

Ovulation/cysts/tumours can impinge the obturator nerve (L2-4) which results in pain in the medial thigh, hip or knee; leading to medial thigh weakness/wasting.

Did someone say more labelling?

Ovarian arteryForm aorta @ ~L2Ovarian, tubal & fundal lymph drainage is to para-aortic nodes

Uterine arteryHeads toward lateral cervix/fornixPasses superior to the ureter

Vaginal arteryOften a branch of the uterineCan arise independently from internal iliac

UreterPasses inferior to uterine artery (water under bridge).Very delicate and must not be ligated, crushed or moved too much

Uterine & cervical lymphaticsPass to external, internal iliac & sacral nodesSome go to palpable inguinal nodes via round ligament

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Lymph drainage summary table

Organ Lymph drainage

Ovaries Para-aortic nodes around L2 level

UterusFundus and upper bodyLower bodyCervix

Para-aortic nodesExternal iliacInternal and external iliac and sacral

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Can you describe the alignment of these uterus:cervix:vaginas?

Which is the most common?

Trick question: anteverted anteflexed is the most common alignment!

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RetrovertedAnteflexed

AntevertedRetroflexed

RetrovertedRetroflexed1 2 3

Surely not more labels?

The broad ligament is made up of the mesometrium, mesosalpinz and mesovarium.

Suspensory ligament of ovary

Round ligament of the uterus

Round ligament of the ovary

Broad ligamentLarge double layered fold of peritoneum1

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A 16 year old girl is bleeding heavily PV, she has been the subject of a ‘backstreet abortion’. Where is she most likely to be bleeding?

The recto-uterine pouch.

What is the name of the other pouch?

Vesico-uterine pouch

How are these pouches formed?

Peritoneum covers the bladder, uterus, cervix and upper rectum

What refers where?

Pelvic organs covered in peritoneum

Refer pain to T10-L1 (via Sympathetic nerves)

Pelvic organs not covered in peritoneum

Refer pain to S2-4 (via Parasympathetic nerves)

Pelvic pain line

How to anaesthetise?

Sensory Neurons run with Sympathetics (T10-T12)

Spinal Block @ L3/4 (inject into CSF) & an epidural at the same level (Combined spinal epidural – CES/CSE)

Sensory Neurons run with Parasympathetics (S2-4)

Caudal epidural (sacral hiatus & canal)

Somatic sensory innervation (S2-4 Pudendal nerve)

Pudendal Nerve Block

Where do you do a pudendal nerve block?

Ischial spine!

Where does the pudendal nerve run?

From S2-4 out of the greater sciatic foramen and then back into the pelvis via the lesser sciatic foramen.