The prostate can be examined by a rectal examination (P.R).

The examiner ’ s
 gloved finger can feel the posterior surface of the prostate through the anterior wall of the rectum.

It is contained mainly in the
 pelvic cavity and perineum.
It consists of :

An ovary on each side.
A uterus , vagina and clitoris in the
 midline.


A pair of accessory glands ( greater vestibular glands).
During pregnancy, the uterus expands into the abdomen.



It is almond in shape.
It lies against the
 lateral pelvic wall in a depression (ovarian fossa).
It is bounded


Above : the external iliac vessels.
Behind : the internal iliac vessels and the ureter.



It lies in the back of the broad ligament.
It is attached to it by the mesovarium.



The ovary is kept in position by:
Broad ligament .
Mesovarium.

Laxation of the broad ligaments
 after pregnancy cause prolapse of the ovaries in the rectouterine pouch.



This causes:

Tenderness of the ovaries and
Deyspareunia
(discomfort during sexual intercourse).

(1) Suspensory ligament of the ovary:

It is the part of the broad ligament between the mesovarium and the lateral pelvic wall.


(2) Round ligament of the ovary :
It connects the
 ovary to the lateral margin of the uterus.
It represents the remains of the upper part of the gubernaculum



Arterial :

Ovarian artery from abdominal aorta (at L1).

Venous drainage:
Right vein to
IVC.

Left vein to left renal vein.



The ovarian vessels,
 lymphatics and nerve supply cross the external iliac vessels at the pelvic brim.

They pass through the suspensory ligament of the ovary.
They enter the
 hilum of the ovary through the mesovarium.


It is (10) cm.

It lies in the
 upper part of the broad ligament.
It connects the
 peritoneal cavity at the region of the pelvis with that of the uterus.

It is enclosed within portion of the broad ligament
(Mesosalpinx).


It is divided into
(4) parts:

1. Infundibulum:
It is the lateral part.


It curves around the supero-lateral
 margin of the related ovary.

Its margin has
 several finger like projections
(Fimbriae).
The uterine tube opens into the
 peritoneal cavity at the narrowest end of the infundibulum .

2. Ampulla :


It is the widest part where fertilization can take place.
3. Isthmus:

Narrowest part of the tube, just
 lateral to the uterus.

4. Intramural :

The part that pierces the uterine wall.
The uterine tube serves:
(1) A channel through which the spermatozoa
 can pass to reach the ovum.
(2) It gives nourishment to the fertilized ovum.
(3) It transports the fertilized ovum to the uterine cavity.





It is performed in
 women who already have children to obtain a birth control.
Ova degenerate in the tube proximal to the obstruction.
Restoration of the
 continuity of the tube can be performed by taking of the clip.


The infecting
 organisms enter the uterus and uterine tube through sexual intercourse (or after labor).
Salpingitis and
 accumulation of pus into the peritoneal cavity (pelvic peritonitis) later general peritonitis .

Arterial :

Uterine (internal iliac).
Ovarian

(abdominal aorta).
Venous :
 correspond to arteries.


It is a thick walled muscular organ.


It is pear shaped.

It lies in the midline between the bladder and rectum.
In the nulliparous young adult :
(8cm) long.


(5cm) wide.

(2.5 cm) thick.


(1) Fundus :


It is the round superior part
 above the entery of the uterine tubes.
(2) Body :
It is flattened anteroposteriorly.


When viewed laterally :
The cavity is a narrow slit.



When viewed anteriorly:

The cavity is shaped like an inverted triangle.
Each of the superior corners of the cavity is continuous with the lumen of the uterine tube.



The inferior corner is
 continuous with the central canal of the cervix.

(3) Cervix :
It is the part that pierces the anterior wall of the vagina.
It is divided into two parts :
Supravaginal.

Vaginal .





Internal os :
External os :

Site of
 communication between the cervical canal and the cavity of the body.

Site of
 communication between the cervical canal and vagina.

Before birth of the first child :
Circular in shape.
Parous women :


Transverse with an anterior and a posterior lip.



The body:

Uterovesical pouch.

Superior surface of the bladder.
Supravaginal cervix:


Superior surface of the bladder.
Vaginal cervix:
Anterior fornix of the vagina.




Body :

Rectouterine
 pouch (pouch of
Douglas) with coils of ileum and sigmoid colon.

Body :

Broad ligament.
Uterine vessels.


Supravaginal cervix:
Ureter.

Vaginal cervix:

Lateral fornix of vagina.



Anteversion :

The uterus is bent forward.
The long axis of the body is bent on the long axis of the vagina.



Anteflexion:

At the level of internal os, the long axis of the body bents forward with the long axis of the cervix.
In the erect position :


With the bladder
 empty, the uterus lies in a horizontal plane.

Retroverted :

The fundus and body of the uterus are bent backwards on the vagina.
They lie in the
 rectouterine pouch .
Retroflexed :

The body bent
 backwards on the cervix.


It runs in the
 base of the broad ligament.
It crosses
 superior to the ureter.
It reaches the cervix at the internal os.


It ascends within
 the broad ligament along the lateral margin of the uterus.
It terminates by
 anastomosing with the ovarian artery.

It supplies :


Uterus.

Uterine tubes.
Vagina.


From inferior hypogastric
 plexus
(sympathetic & parasympathetic

1. Fundus : with the
 ovarian artery to paraaortic nodes.
2. Body & cervix : to internal & external iliac nodes.

3. Vessels accompany the round ligament to:
Superficial inguinal nodes.



The uterus is supported mainly by:
(1) Tone of the levator ani muscles :
Together with the
 pelvic fascia on their upper surface they are effectively support the uterus.
Their medial ends are attached to the cervix through the pelvic fascia.




It is a
 fibromuscular structure.
It is situated in the perineum. between the vagina and anal canal.

It receives the insertion of the
 anterior fibers of the levator ani.

It is elevated up to the pelvic walls.
by the levator ani.

It supports the vagina and indirectly the uterus.



It is important in maintaining the integrity of the pelvic floor.
Its damage
 during child birth can cause prolapse of the pelvic viscera.


(2) Ligaments:

They are sub
 peritoneal fibromuscular condensation of the pelvic fascia on the upper surface of the levator ani muscles.
They are attached to the cervix and vagina
.They are important in keeping the cervix in its normal position.


(1) Transverse
 cervical (cardinal) ligaments:
They connect the
 lateral pelvic walls to the cervix and upper end of the vagina.
They contain the ureter and uterine
 artery.

They are two firm
 bands of connective tissue.
They connect the
 posterior surface of the pubis to the cervix.
They give support to the neck of the bladder
(pubovesical) ligaments.


They are two firm bands
 connecting the lower end of the sacrum to the cervix and upper end of the vagina.
They form two ridges on either
 side of the rectouterine pouch.

It extends between the superolateral angle of the uterus and the subcutaneous tissue of the labia majora.

It helps to maintain the ante verted, ante flexed position of the uterus.


It is a distensible fibromuscular tube
(8cm).

It is the female genital canal.

It is the excretory duct for the menstrual blood.

It is part of the birth canal.


It extends from the perineum
(lower part) through the
 pelvic floor and up into the pelvic cavity (upper part).

It has anterior and posterior walls which are normally in position.

The cervix
 pierces the upper end of the anterior wall.

The area of the vaginal lumen surrounding the cervix is divided into four regions
(fornices):

Anterior.

Posterior.

Lateral (right and left).


It is a thin mucosal fold which covers the external vaginal orifice in virgins.


It is perforated at its center .
After child birth, it consists of tags.



Anterior:
Bladder.

Urethra.

Posterior :


Upper 1/3:
 rectouterine pouch.
Middle 1/3 : ampulla of rectum.
Lower 1/3 : perineal body.



Lateral:

Upper part :ureter.

Middle part : anterior fibers of levator ani
(sphincter vaginae).
Lower part : urogenital diaphragm.



Arterial:

Vaginal artery from:
Internal iliac.

Uterine.
Venous :



Vaginal plexus .

It drains into the internal iliac vein.


Upper 1/3 : to external & internal iliac lymph nodes.
Middle 1/3 : to internal iliac nodes.

Lower 1/3 : to superficial inguinal nodes.



Upper part:

Levator ani muscles.
Transverse cervical,
Pubocervical and
Sacrocervical ligaments.

Middle part: urogenital diaphragm.
Lower part : perineal body.



They are double fold layers of peritoneum extending between the lateral margins of the uterus and the lateral pelvic walls.
Superiorly : the two layers are continuous and form the upper free edge.
Inferiorly (base) : they separate to cover the
 pelvic floor. The uterine artery crosses the ureter .



Mesovarium.

Suspensory
 ligament of the ovary.
Mesosalpinx:
Between the
 uterine tube and the mesovarium.

1. Uterine tube (upper free border).
2. Ligaments : ovarian
& round ligament of uterus.
3. Vessels (blood and lymphatic): uterine & ovarian.

4. Nerves .




5. Epoophoron :
It is a vestigial structure
 representing the remains of the mesonephros.
It lies above the mesovarium.



6. Paroophoron:
It is a
 mesonephric remnant.
It lies just lateral to the uterus.

