Female Pelvis and Reproductive System

What are the components of the female external genitalia?

Clitoris, labia majora, labia minora, vestibule, mons pubis, vaginal orifice.

What are the internal reproductive organs of the female?

Ovaries, uterine tubes, uterus, cervix, vagina.

How do structures enter the pelvis from the posterior abdominal wall?

Through the greater sciatic foramen, under the piriformis muscle (e.g., sciatic nerve, pudendal nerve).

How do structures enter the pelvis from the anterior abdominal wall?

Through the inguinal canal (e.g., round ligament of uterus); via vascular and lymphatic routes.

What is the course of the pudendal nerve?

Exits pelvis via greater sciatic foramen, wraps around sacrospinous ligament, re-enters via lesser sciatic foramen.

What landmark is used for pudendal nerve block?

Ischial spine palpated transvaginally; needle inserted near sacrospinous ligament.

What are the folds of peritoneum in the female pelvis? (think of broad folds)

Broad ligament (mesometrium, mesosalpinx, mesovarium), suspensory ligament of ovary, round ligament.

What are the peritoneal pouches in the female pelvis?

Vesicouterine pouch (between bladder and uterus), rectouterine pouch (Pouch of Douglas, between uterus and rectum).

What is the clinical relevance of the rectouterine pouch?

Lowest point in female peritoneal cavity; site of fluid accumulation, accessed via posterior fornix.

What are retroperitoneal spaces in the female pelvis?

Prevesical, retrovesical, presacral spaces; contain vessels, nerves, and connective tissue.

What is the visceral relationship of the uterus?

Anterior: bladder; Posterior: rectum; Superior: loops of small intestine.

What is the visceral relationship of the ovaries?

Posterolateral to uterus; adjacent to lateral pelvic wall and ureters.

What is the pelvic diaphragm? (diaphrams need muscles)

Levator ani (puborectalis, pubococcygeus, iliococcygeus) + coccygeus; forms muscular hammock supporting pelvic organs.

What is the function of the pelvic diaphragm?

Supports pelvic viscera, maintains continence, resists intra-abdominal pressure.

What causes pelvic organ prolapse?

Weakening of pelvic diaphragm and connective tissue; leads to descent of uterus, bladder (cystocele), or rectum (rectocele).

What is the urogenital triangle?

Anterior half of perineum; bounded by pubic symphysis and ischial tuberosities.

How is the urogenital triangle divided?

Perineal membrane separates it into superficial pouch (inferior) and deep pouch (superior).

What structures are in the superficial perineal pouch?

Erectile tissues (bulb of vestibule, clitoris), superficial perineal muscles, Bartholin glands.

What structures are in the deep perineal pouch?

External urethral sphincter, compressor urethrae, deep transverse perineal muscle, neurovascular elements.

What muscles form the pelvic diaphragm? (Use my PPi’s in my pelvic diaphragm)

Levator ani group (puborectalis, pubococcygeus, iliococcygeus) and coccygeus.

What muscles are in the deep perineal pouch but not part of the pelvic diaphragm?

External urethral sphincter, deep transverse perineal muscle, compressor urethrae.

What is the main arterial supply to female pelvic organs?

Internal iliac artery and its branches: uterine, vaginal, ovarian, internal pudendal arteries.

What is the relationship between uterine artery and ureter?

Uterine artery crosses over ureter near cervix (“water under the bridge”).

Why is the uterine artery-ureter relationship clinically important?

At risk during hysterectomy; ureter injury can cause urine leakage or obstruction.

What is the blood supply to the ovaries?

Ovarian arteries from abdominal aorta; travel in suspensory ligament of ovary.

What is the venous drainage of the ovaries?

Right ovarian vein → IVC; Left ovarian vein → left renal vein.

Where does fertilization occur?

In the ampulla of the uterine tube.

What hormones sustain early pregnancy?

hCG from trophoblast maintains corpus luteum → progesterone production; later placenta produces progesterone and estrogen.

What is the role of progesterone in pregnancy?

Maintains endometrial lining, inhibits uterine contractions, supports placental development.

What is the role of estrogen in pregnancy?

Stimulates uterine growth, increases blood flow, prepares breasts for lactation.

What is the role of hCG?

Maintains corpus luteum in early pregnancy; used as marker in pregnancy tests.

What is the role of the corpus luteum?

Produces progesterone to maintain endometrium until placenta takes over hormone production.

What is the anatomical boundary between the false and true pelvis?

Pelvic brim (linea terminalis), formed by arcuate line, pectineal line, and sacral promontory.

What structures pass through the inguinal canal in females?

Round ligament of the uterus and ilioinguinal nerve.

What is the course of the round ligament of the uterus?

Originates at uterine horns, passes through inguinal canal, terminates in labia majora.

What structures are included in the vulva?

Mons pubis, labia majora, labia minora, clitoris, vestibule of vagina.

What is the vestibule of the vagina?

Space between labia minora containing urethral and vaginal orifices.

What is the frenulum of the labia minora?

Posterior union of labia minora, also called the fourchette.

What is the glans clitoris?

Visible portion of clitoris; covered by prepuce; homologous to glans penis.

What is the broad ligament and its subdivisions?

Double layer of peritoneum supporting uterus; includes mesometrium (uterus), mesosalpinx (uterine tube), mesovarium (ovary).

What is the suspensory ligament of the ovary?

Peritoneal fold containing ovarian vessels; connects ovary to lateral pelvic wall.

What is the cardinal (transverse cervical) ligament?

Thick connective tissue anchoring cervix to lateral pelvic wall; contains uterine vessels.

What is the uterosacral ligament?

Connects cervix to sacrum; provides posterior support to uterus.

What is the vesicouterine pouch?

Peritoneal reflection between bladder and uterus; shallow in females.

What is the rectouterine pouch (Pouch of Douglas)?

Deepest peritoneal space in females; between uterus and rectum; site of fluid accumulation.

What is the clinical significance of the posterior fornix?

Access point to rectouterine pouch via vaginal exam or culdocentesis.

What is the relationship of the ureter to the uterine artery?

Ureter passes inferior to uterine artery near lateral cervix (“water under the bridge”).

What is the relationship of the ureter to the vaginal artery?

Ureter passes superior to vaginal artery.

What is the relationship of the ovary to the ureter?

Ovarian vessels cross anterior to ureter in suspensory ligament; ureter lies posterior.

What is the pelvic diaphragm composed of?

Levator ani (puborectalis, pubococcygeus, iliococcygeus) and coccygeus muscles.

What is the function of puborectalis?

Forms sling around anorectal junction; maintains fecal continence.

What is the perineal body and its importance?

Fibromuscular node between vagina and anus; anchors pelvic floor muscles; critical for pelvic support.

What muscles attach to the perineal body?

Bulbospongiosus, superficial and deep transverse perineal, external anal sphincter, levator ani.

What is the urogenital diaphragm?

Layer of muscle and fascia in deep perineal pouch; includes external urethral sphincter and deep transverse perineal muscle.

What separates the superficial and deep perineal pouches?

Perineal membrane. Superificial (bottom=colles fascia, roof=perineal membrane) and Deep(bottom=perineal membrane, roof=pelvic diaphragm)

What structures are found in the superficial perineal pouch?

Clitoris, bulbs of vestibule, Bartholin glands, superficial perineal muscles.

What structures are found in the deep perineal pouch?

External urethral sphincter, compressor urethrae, deep transverse perineal muscle, dorsal neurovasculature of clitoris.

What is the difference between pelvic diaphragm and deep perineal muscles?

Pelvic diaphragm supports pelvic organs and spans pelvic outlet; deep perineal muscles regulate urethral and vaginal function.

What is cystocele?

Prolapse of bladder into anterior vaginal wall due to weakened pelvic support.

What is rectocele?

Prolapse of rectum into posterior vaginal wall.

What is uterine prolapse?

Descent of uterus into vaginal canal due to weakened cardinal and uterosacral ligaments.

What arteries supply the uterus?

Uterine artery (from internal iliac); anastomoses with ovarian artery.

What arteries supply the vagina?

Vaginal artery (from internal iliac or uterine artery); inferior vesical artery may contribute.

What arteries supply the ovaries?

Ovarian arteries from abdominal aorta; travel in suspensory ligament.

What arteries supply the external genitalia?

Internal pudendal artery → perineal branches, dorsal artery of clitoris.

What is the venous drainage of the uterus and vagina?

Uterine and vaginal venous plexuses → internal iliac vein.

What is the lymphatic drainage of the uterus?

Fundus → para-aortic nodes; body → external iliac nodes; cervix → internal iliac and sacral nodes.

What is the lymphatic drainage of the ovaries?

Para-aortic (lumbar) nodes.

What is the lymphatic drainage of the vagina?

Upper → internal iliac; middle → external iliac; lower → superficial inguinal nodes.

What is the lymphatic drainage of the vulva and clitoris?

Superficial inguinal nodes; deep inguinal for clitoris.

What is the pathway of sperm during fertilization?

Vagina → cervix → uterus → uterine tube (ampulla).

Where does fertilization typically occur?

Ampulla of the uterine tube.

What hormone maintains the corpus luteum after fertilization?

hCG secreted by syncytiotrophoblast.

What is the role of the corpus luteum in early pregnancy?

Produces progesterone to maintain endometrial lining until placenta takes over.

What is the role of estrogen during pregnancy?

Promotes uterine growth, increases uterine blood flow, prepares breasts for lactation.

What is the role of progesterone during pregnancy?

Maintains endometrial lining, inhibits uterine contractions, supports placental development.

What are the layers of the uterus?

Endometrium (mucosa), myometrium (smooth muscle), perimetrium (serosa).

What is the histological lining of the uterus?

Simple columnar epithelium with ciliated and secretory cells.

What is the histological lining of the vagina?

Non-keratinized stratified squamous epithelium.

What are the segments of the uterine tube? Fun In An Island Inlet

Fimbriae, infundibulum, ampulla, isthmus, intramural/intersitium portion. FIAII Fun In A Island Inlet

What is the function of the fimbriae?

Sweep ovum into infundibulum after ovulation.

What is the significance of the ampulla of the uterine tube?

Primary site of fertilization; lined with ciliated columnar epithelium.

What is the role of the isthmus of the uterine tube?

Narrow muscular segment; propels ovum toward uterus via peristalsis.

What is the role of the intramural portion of the uterine tube?

Segment embedded in uterine wall; connects to uterine cavity.

What is the normal position of the uterus?

Anteverted and anteflexed.

What are common uterine positional abnormalities?

Retroverted, retroflexed, excessive anteflexion.

What is the fornix of the vagina?

Recess surrounding cervix; divided into anterior, posterior, and lateral fornices.

What is the clinical relevance of the lateral fornix?

Adjacent to ureter and uterine artery; important in surgical procedures.

What is the pelvic pain line?

Boundary where visceral afferents switch from sympathetic (above) to parasympathetic (below) pathways.

What nerves carry pain from intraperitoneal pelvic organs?

Sympathetic fibers to T12–L2.

What nerves carry pain from subperitoneal pelvic organs?

Parasympathetic fibers to S2–S4.

What is the function of the pudendal nerve?

Somatic innervation to perineum; motor and sensory.

What is the course of the pudendal nerve?

Exits greater sciatic foramen, wraps around ischial spine, enters lesser sciatic foramen into Alcock’s canal.

What is the clinical use of a pudendal nerve block?

Anesthesia for childbirth; injected near ischial spine.

What is the significance of the perineal membrane?

Separates superficial and deep perineal pouches; supports urogenital structures.

What is the function of the greater vestibular glands (Bartholin glands)?

Secrete mucus for vaginal lubrication; located in superficial pouch.

What is the role of the external urethral sphincter in females?

Controls urinary continence; part of deep perineal pouch.

What is the difference in urethral length between males and females?

Female urethra is shorter, increasing risk of incontinence and infection.

What is the obstetric conjugate?

Distance from sacral promontory to pubic symphysis; narrowest fixed AP diameter of pelvic inlet.