THE  FEMALE  PELVIS  

 
x Recto-­‐uterine  pouch  [of  Douglas]  /  Vesico-­‐uterine  pouch  
o Dips  down  to  touch  the  posterior  fornix  of  vagina  
o Between  upper  1/3  of  uterus  and  superior  surface  of  urinary  bladder  
x Mesosalphinx  
o Fascia  extended  postero-­‐laterally  to  cover  the  fallopian  tubes  
o Thickens  as  the  infundibulo-­‐pelvic  ligament  /  false  suspensory  
ligament  of  ovary  
ƒ Encloses  the  ovarian  vessels  
x 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  
ƒ Supports  the  uterine  vessels  and  nerves  and  the  distal  ends  of  
the  ureters  
o Posterior  layer  
ƒ Enfolds  the  ovaries  on  each  side  differentiated  by  Mesovarium  
x 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  
ƒ Fold  that  is  reflected  to  the  rectum  as  Recto-­‐uterine  pouch  [of  Douglas]  
x Parametrium  
o Condensations:  
ƒ Cardinal  or  McKenrodt͛s  Ligaments  
x Thickened  parts  at  the  sides  of  the  cervix  
x Extended  to  the  lateral  pelvic  walls  
x Maintain  the  cervix  and  uterus  in  place  
x Uterine  arteries  run  along  superior  border  on  each  side  (lateral  Æ  medial)  
x Ureters  pass  under  each  artery  to  reach  urinary  bladder  
ƒ Utero-­‐Sacral  Ligaments  
x Less  distinct  thickening  
x Extends  from  back  of  cervix  
x Attached  posteriorly  to  the  recto-­‐uterine  fold  and  last  segments  of  sacrum  
x Prevents  the  forward  displacement  of  the  uterus  
ƒ True  ligament  of  the  Ovary  
x One  on  each  side  
x Attached  at  one  end  to  the  lower  or  uterine  pole  of  each  ovary  
x Other  end  attached  to  superior  angle  of  uterus  
 
Female  Reproductive  Organs  
x Uterus   ƒ Uterine  cavity  
o Hollow  muscular  organ   x Triangular  on  coronal  section  
o 7-­‐8  cms  longitudinal  axis   x Narrowed  by  thick  surrounding  muscular  wall  
o  5  cms  across  supero-­‐lateral  angles/utero-­‐tubal  junctions   x Lined  by  special  secretory  mucosal  membrane  ʹ  endometrium  
o 2-­‐3  cms  inferior  cylindrical  cervical  segment   x Characteristic  folds  resemble  palm  leaf  in  cervical  canal  ʹ  plica  
o Parts   palmatae  
ƒ Fundus   x Intrauterine  openings  ʹ  of  fallopian  tubes  located  at  superior  
x Slightly  arching;  superior  border;  above  level  of  utero-­‐tubal   angles  of  the  cavity  
junctions   x Involution  ʹ  after  delivery,  the  uterus  returns  to  its  pre-­‐gravid  
x Directed  forwards  towards  the  symphysis  pubis   state  
ƒ Body  of  Corpus  Uteri   o Includes  restoration  of  over-­‐stretched  ligaments  
x Main  part  of  the  organ   o Toning  up  of  pelvic  
x Broad  below  fundus   and  perineal  muscles  
x Narrows  inferiorly  at  isthmus   o Position  
o Differentiates  lower  cervical  part   ƒ Normally  slightly  antero-­‐verso  
ƒ Cervix   flexed  by  angulations  along  
x Cylindrical  lowest  segment   longitudinal  axis  
x Invaginates  into  the  upper  end  of  vaginal  canal   x Body  of  uterus  is  bent  
x Surround  a  narrow  cervical  canal   over  postero-­‐superior  
x Supravaginal  portion   surface  of  urinary  bladder  
o Upper  segment  rising  about  1-­‐1.5  cms  above  attachments   x Fundus  is  directed  
of  vaginal  fornix   anteriorly  
x Intravaginal  portion   x Cervix  points  antero-­‐
o Inferior  half  enclosed  by  vaginal  fornix  at  the  upper  end  of   inferiorly  
vaginal  canal   ƒ Maintained  by  tone  of  its  
o Palpable  and  visible  during  internal  exams   musculature  
o Observed  as  pale,  pinkish,  firm,  bluntly  rounded   ƒ Supported  by  muscles  of  pelvic  floor  and  surrounding  pelvic  fascia  
protuberance   and  ligaments  attached  to  pelvic  wall  
o External  os  -­‐  small  central  opening;  may  be  rounded  or   ƒ Ante-­‐version  ʹ  angulation  (90o)  between  long  axis  of  entire  uterus  
appear  as  a  narrow  slit   and  vagina  
o Internal  os  ʹ  at  the  isthmus   ƒ Ante-­‐flexion  ʹ  more  obtuse  bending  of  corpus  uteri  on  its  cervix  
o Cervix  color  usually  changes  with  physiological  states   ƒ Ligaments  that  keep  uterus  in  position:  
(menstruation,  ovulation,  etc)   x Cardinal  and  utero-­‐sacral  ligaments  
o Upon  uterine  contractions,  cervix  is  effaced   x Pubo-­‐vesical  ligament  (pubocervical,  vesico-­‐vaginal)  
ƒ Process  which  integrates  the  musculature  into  the   o Extends  from  pelvic  surface  of  symphysis  pubis  
lower  uterine  segment  until  it  fully  disappears   o Encircles  neck  of  urinary  bladder  
ƒ Leaving  a  gradually  widening  aperture  for  passage  of   x Broad  ligament  
fetus   o With  mesosalphinx  and  fallopian  tubes  
  o Fixed  by  attachments  of  infundibulo-­‐pelvic  ligament  to  area  
  of  sacro-­‐iliac  joint  
x 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  
 
 o Enveloped  by  mesosalphinx  
o Parts  
ƒ Intramural  or  interstitial  segment  
x Shortest,  narrowest,  and  most  fixed  part  
x Embedded  in  thickness  of  uterine  muscle  @  superior  lateral  angle  of  uterus  
x Intrauterine  opening  =  1  mm  in  diameter  
ƒ Isthmus  
x 2.5  cms  
x Emerges  from  uterine  wall  and  extends  laterally  
ƒ Ampulla  
x Gradually  widening,  longest  sinuous  part  (2/3  of  length)  
x Lateral  end  is  dilated,  curved  slightly  downwards  near  superior  or  tubal  pole  of  ovary  
ƒ Infundibulum  
x Expanded  end  of  ampulla  
x Fimbriae  -­‐  finger-­‐like  processes  
o Abdominal  opening  or  ostium  abdominae  
ƒ End  of  each  tube,  center  of  fimbriae  
ƒ Direct  communication  with  external  environment  through  utero-­‐tubal  and  vaginal  passages  
ƒ Peritoneal  covering  of  fimbriae  is  not  pierced,  remains  intact  
o Ovarian  fimbria  ʹ  one  of  fimbriae  is  longer  than  others  
ƒ Conduit  for  extruded  ovum  
ƒ Facilitates  entry  through  ostium  into  ampulla  of  tube  
x Ovaries  
o Paired  glands;  size  and  shape  of  almond  seed  
o Younger  individuals  ʹ  smooth  surface  
o Older  ʹ  increasingly  rough  and  irregular  due  to  presence  of  scarred  remnants  of  extruded  ova  
o Fossa  ovarica  [of  Waldeyer]  ʹ  ovary  lodged  in  this  shallow  depression,  covered  by  peritoneum  
ƒ Located  below  bifurcated  external  and  internal  iliac  vessels  
o 2  Poles  
ƒ Superior  or  tubal  pole  ʹ  postero-­‐laterally  
x False  suspensory  ligament  attached  to  tubal  pole  
ƒ Inferior  or  uterine  pole  ʹ  antero-­‐medially  
x True  ligament  of  ovary  is  attached  to  uterine  pole  
x 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  ʹ  small  pouch;  enfolded  upper  end  of  vaginal  wall  
attached  to  cervix  
ƒ Anterior  fornix  ʹ  shallowest,  increasing  in  the  2  lateral  
fornices  
ƒ Posterior  fornix  ʹ  largest,  deepest,  produced  by  insertion  
of  posterior  wall  (receptaculum  seminis)    
x Superior  part  rises  above  pelvic  diaphragm  into  pelvic  cavity  
x Dome  is  in  contact  with  cul-­‐de-­‐sac  of  Douglas  
o Anterior  vaginal  wall  -­‐  Shortest,  lined  by  multi-­‐folded  mucosa  (rugae)  
ƒ Closely  related  to  neck  of  urinary  bladder  and  urethra  
o Posterior  vaginal  wall  ʹ  smoother,  longer  
ƒ Separated  from  rectal  wall  by  thin  fascial  septum  
o Inferior  [external[  1/3  of  vaginal  canal  ʹ  surrounded  by  muscles  
ƒ Pubo-­‐coccygeus  fascicule  of  levator  ani  
ƒ Sphincter  urethra  and  deep  transverse  perineal  muscles  of  urogenital  diaphragm  
ƒ Bulbo-­‐cavernosus  and  the  superficial  transverse  perineal  muscles  
x Neurovascular  Supply  
o Uterine  arteries  
ƒ ORIGIN:  internal  iliac  arteries  
ƒ Course  downwards,  forwards  and  medially  towards  lateral  border  of  isthmus  
ƒ Ureter  passes  below  the  artery  and  vein  
x At  this  point,  vaginal  branch  is  given  off  
ƒ Ascends  sinuously  along  lateral  border  of  uterus  Æ  utero-­‐tubal  junction  
ƒ Anastomoses  with  ends  of  tubal  branch  of  ovarian  artery  
ƒ Branches  penetrate  myometrium  
o Ovarian  arteries  
ƒ ORIGIN:  abdominal  aorta,  given  off  below  origins  of  renal  arteries  
ƒ Oblique  course  downwards  crossing  over  structures  of  abdominal  wall  lateral  to  ureter  
ƒ At  pelvic  brim,  artery  and  vein  cross  over  common  iliac  vessels  
ƒ Dip  into  pelvic  cavity  into  fold  of  infundibulo-­‐pelvic  ligament  
ƒ Tubal  branch  
x Enters  mesosalphinx,  courses  medially  below  fallopian  tube  Æ  utero-­‐tubal  junction  
x Anastomoses  with  uterine  artery  
o Vaginal  arteries  
ƒ ORIGIN:  internal  iliac  artery  
ƒ Courses  downwards  and  medially  
ƒ Branches  to  lowest  part  of  urinary  bladder  to  rectum  
ƒ At  vaginal  wall  Æ  anterior  and  posterior  branches  
x Anastomose  to  form  azygos  artery  on  anterior  vaginal  wall  
o Lymphatic  vessels  ʹ  along  sides  of  uterus,  join  urethral,  ovarian,  and  tubal  channels  Æ  nodes  
along  veins  Æ  nodes  along  internal  and  external  iliac  vessels  
o Innervations  
ƒ Derived  from  sacral  ganglia  of  sympathetic  trunk  
ƒ Perivascular  plexuses  around  hemorrhoidal  arteries  branches  from  inferior  hypogastric  plexus  
ƒ S2,3,4  ʹ  parasympathetic  fibers  conveyed  by  pelvic  splanchnic  nerve  
ƒ Innervate  smooth  muscles  and  glands  in  uterus  and  fallopian  tubes