female reproductive system

what are the two ligaments of the ovary?

• suspensory ligament of ovary

• round ovarian ligament

what is the angle between the uterus and the cervix?

anti-flexion

what is the angle between the uterus, vagina and the cervix?

ante-version

what are the two round ligaments in the female reproductive system?

one of ovary, one of uterus.

what ligament is at the tubo-uterine angle?

round ligament of the uterus

describe the course taken by the round ligament of uterus

Round ligament of uterus travels outside the pelvis, deep inguinal ring, superficial inguinal ring and through the inguinal canal and is attached in front of the pubic bone.

how does the inguinal canal differ in females vs males?

• Inguinal canal in males → spermatocord

• Inguinal canal in females → uterine round ligament

what is the function of the uterine round ligament? what is the clinical relevance?

pulls uterus anteriorly

when weak → uterus is retroverted

describe the peritoneal covering of the uterus

Peritonea covers superior surface of bladder and is reflected on the inferior and superior walls of the uterus itself. Posteriorly, it is reflected on the rectum.

what are the two pouches of the peritoneum?

• Utero-vesical: between bladder and uterus

• Recto-uterine: between rectum and uterus 

how are the uterine broad ligaments formed?

peritoneum covers posterior and anterior sides of uterus but they are hanging from the fallopian tubes. The parts that “hang” are called broad ligaments.

describe what can be seen at the tubo-uterine junction

Tubo-uterine junction has two ligaments and 3 attachments:

• Anteriorly there is broad ligament

• Posteriorly there is round ligament

• On the side there is a fallopian tube

what is the relation of the round ligament to the broad ligament?

Round ligament is located POSTERIOR to the broad ligament. Ovary and round ligament are located behind broad ligament

name the 5 ovarian relations

Surfaces

• Lateral surface: pelvic wall adherence + ovarian fossa is present

• Medial surface: related to the uterus

Poles:

• Superior pole of the ovary is related to the fimbriae

• Inferior pole is attached to tubo-uterine junction

Borders

• The anterior border of the ovary is directed towards posterior border of broad ligament by a double layer of peritone CALLED MESOVARIUM

• Posterior border is a free border 

describe the blood supply of the ovaries

• Ovarian artery originates from abdominal aorta at L2

• Ovarian artery travels between two layers of mesovarium to approach the hilum which is at the ANTERIOR border of the ovary

venous drainage of ovary?

• Right ovarian → IVC

• Left ovarian → Left renal

what happens during nutcracker syndrome?

aneurysm (in SMA/abdominal aorta) causing compression of LEFT renal vein → renal hypertension and will block drainage → pelvic congestion syndrome

what is the nerve supply of the ovaries?

inferior hypogastric plexus

what is the lymph drainage of the ovaries?

lateral aortic (para-aortic) lymph nodes

what are the two blood supplies of the fallopian tubes?

1.    Lateral 1/3 → ovarian artery

2.    Medical 2/3 → uterine artery

venous drainage of fallopian tubes?

ovarian and uterine venous plexuses

what is the cervix anchored by?

The cervix is anchored laterally by Mackenrodt’s (cardinal) ligament

what is the arterial blood supply of the uterus + cervix? and how is it clinically relevant?

1. The uterine artery arises from the anterior division of the internal iliac artery

2. It runs medially in the base of the broad ligament, crosses above/superior to the ureter near the cervix ("water under the bridge"), and ascends along the lateral uterine wall

what is the venous drainage of the uterus + cervix?

Uterine veins form the uterovaginal venous plexus, which drains into the internal iliac vein

How do pelvic malignancies metastasise directly into the spine?

Uterovaginal venous plexus communicates directly with the internal vertebral venous plexus (Batson's plexus)

what are the relations + attachments of the four broad ligaments?

1. Mesosalpinx → attached to fallopian tube

2. Mesometrium → attached to uterus

3. Mesovarium → attached to anterior border of ovary

4. Suspensory ligament of ovary → connects ovary to lateral pelvic wall

what type of cells are present in the vagina

non-keratinized stratified squamous epithelium

what are the three vaginal relations?

• Posteriorly, its upper 1/4 is related to the pouch of Douglas (rectouterine pouch)

• its middle 2/4 to the rectum

• its lower 1/4 is separated from the anal canal by the perineal body

arterial supply of the vagina?

• Upper & Middle Vagina: Superior and middle vaginal branches from the uterine artery

• Lower Vagina: Inferior vaginal artery from the internal pudendal artery

venous drainage of the vagina?

Vaginal veins drain into the internal iliac vein via the uterovaginal venous plexus

lymph drainage in vagina?

• Above internal vagina: Internal iliac, external iliac, and sacral lymph nodes

• Below vaginal entrance + vulva: Superficial inguinal lymph nodes and sacral nodes

what is the dual sensory pattern of the vagina?

• Upper Vagina: Innervated by autonomic fibres via the inferior hypogastric plexus (sensitive to pressure/stretch)

• Lower Vagina: Richly innervated by somatic sensory fibres via the pudendal nerve (superficial perineal branches, highly sensitive to touch)

why are upper ulcers relatively painless whilst child birth is painful?

lower → intense somatic pain carried by pudendal nerve

what is the external genitalia covered by?

stratified squamous epithelium

arterial and venous supply of external genitalia?

internal + external pudendal arteries/veins

lymph drainage of the vulva?

Drains primarily to superficial and deep inguinal lymph nodes, then to internal and external iliac nodes

nerve supply of the external genitalia? what are their locations?

• pudendal nerve → S2–S4

• ilioinguinal nerve → L1

what is meant by “water under the bridge”?

uterine artery crosses above ureter