GROSS ANATOMY

Female Reproductive System | Dr. Aracelli Dizon | 11/16/20)

OUTLINE

I. INTRODUCTION
II. EXTERNAL GENITALIA
III. INTERNAL GENITALIA
IV. PELVIC SYMPATHETIC
V. MENSTRUAL CYCLE
VI. ACCESSORY REPRODUCTIVE GLANDS
VII. CLINICAL CORRELATIONS

I. INTRODUCTION

FEMALE REPRODUCTIVE SYSTEM

o Accessory organs
- Plays many vital functions that ensures the
 Mammary glands
continuation of the human race
 Placenta
II. EXTERNAL GENITALIA
 Divisions
o External Genitalia (Vulva)
 Mons pubis - Collectively known as “vulva”
 Labia majora & minora - Vulva runs from the pubic area
 Clitoris downward to the rectum
 Hymen o Blood Supply:
 Vestibule of the vagina  External & Internal
 Vestibular bulbs Pudendal Arteries in each
 Greater vestibular glands sides
o Lymphatic drainage:
 Medial group of Superficial
Lymph Nodes
o Nerve Supply:
 Ilioinguinal nerves &
Genital branch of
Genitofemoral nerve-
Anterior part of vulva
 Perineal nerve & Posterior
Cutaneous nerve of the
thigh- Posterior part of
vulva
 Mons pubis
o Internal Genitalia - A rounded prominence of fatty
 Vagina tissue or fatty cushion of flesh in
 Cervix humans
 Uterus - Located over the junction of the
 Fallopian tubes pubic bones
 Ovaries - Covered with hair after puberty

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- It is where sexual hair development  Clitoris
occurs at the time of puberty - An erectile structure found beneath
- This area may be described as the anterior joining of the labia
directly anterosuperior to the pubic minora
symphysis - Width in adult female= 1cm
- Average length= 1.5-2.0cm
 Labia majora - Made up of 2 crura, which attach to
- Are two large, longitudinal folds of the periosteum of the ischiopubic
adipose and fibrous tissue rami
- Vary in size and distribution from - A very sensitive structure, analogous
female to female to the male penis
- Size is dependent upon adipose - Innervated by the dorsal nerve of
content the clitoris, a terminal branch of the
- They extend from the mons pubis pudendal nerve
anteriorly to the perineal body
posteriorly
- They have hair follicles

 Labia minora
- Also known as nymphaea
- They are two small cutaneous folds
found between the labia majora and
the introitus or vaginal vestibule
- Anteriorly, it joins to form the
frenulum of the clitoris
 Hymen
- A thin membrane found at the
entrance to the vaginal orifice
- Often, this is perforate before the
onset of menstruation, allowing flow
of menses  Vestibule
- Varies greatly in shape - Between the clitoris and the vaginal
introitus (opening)
- It is a triangular area known as the
vestibule, which extends to the
posterior fourchette
- It is where the urethral meatus is
found, approximately 1cm anterior
to the vaginal orifice
- It also gives rise to the opening of
the Skene glands bilaterally
 Vestibular bulbs
- These are 2 masses of erectile tissue
- They lie deep to the
bulbocavernosus muscle bilaterally

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vagina and swell with blood during
sexual arousal

 Urethra
- A female urethra ranges in length
from 3.5-5.0cm
- It is composed of membranous  Bartholin’s glands
connective tissue and links the - The greater vestibular glands
urinary bladder to the vestibule - They are also responsible for
externally secreting lubrication to the vagina
- With openings just outside the
hymen, bilaterally, at the posterior
aspect of the vagina
- Each gland is small, similar in shape
to a kidney bean

 Skene’s gland
- They are the lesser vestibular
glands, periurethral glands or
paraurethral glands
- They secrete lubrication at the
opening of the urethra
- Homologous to male’s prostate
glands
- Located on the anterior wall of the
o Bartholin’s gland cyst
vagina, around the lower end of the
 A swollen fluid-filled lump that
urethra
develops from a blockage of
- They drain into the urethra and
one of the Bartholin’s gland
near the urethral opening
- These glands are surrounded with
tissue that reaches up inside the

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- The area of the vaginal lumen, which
surrounds the cervix, is divided into
4 regions or fornices:
 Anterior Fornix
 Posterior Fornix
 Right Lateral Fornix
 Left Lateral Fornix

III. INTERNAL GENITALIA

 Vagina
- A muscular tube that extends
upward and backward from the o Culdocentesis
vulva to the uterus  A procedure wherein the
- It measured about 3 in. (8cm) long peritoneal fluid is extracted or
and has anterior and posterior walls, obtained from the cul de sac of a
which are normally in apposition female patient
- At its upper end, the anterior wall is
pierced by the cervix, which projects
downward and backward into the
vagina

- The vaginal orifice in a virgin possesses a thin

mucosal fold called the hymen, which is
perforated at its center
- After childbirth, the hymen usually consists
only of tags
- Contraction of the fibers of levator ani
- The upper half of the vagina lies
compresses the walls of the vagina together
above the pelvic floor
- In its lower part, the vagina is related to the
- The lower half lies within the
urogenital diaphragm and the bulb of the
perineum
vestibule

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of the uterine artery
supply the vagina
 Veins
 Vaginal veins- from a
plexus around the
vagina that drains into
the internal iliac vein
o Lymphatic drainage
 External internal iliac nodes
 Upper 1/3
 Internal iliac nodes
 Middle 1/3
 Superficial inguinal nodes
 Lower 1/3
o Nerve Supply
o Relations of Vagina  Inferior Hypogastric Plexuses
 Anteriorly
 Closely related to the o Supports of the vagina
bladder above and to  Upper part
the urethra below  Levator ani muscle
 Posteriorly ligament
 Upper 1/3 is related to  Transverse cervical
the rectouterine pouch ligament
(Pouch of Douglas)  Pubocervical ligament
 Middle 1/3 is related to  Sacrocervical ligament
the ampulla of the  Middle part
rectum  Urogenital diaphragm
 Lower 1/3 is related to  Lower part
the perineal body,  Perineal body
which separates it from
the anal canal
 Lateraly
 In its upper part, the
vagina is related to the
ureter
 Middle part, it is related
to the anterior fibers of
the levator ani, as they
run backwards to reach
the perineal body and
hook around the
anorectal junction
o Blood Supply
 Arteries
 Vaginal artery- branch
of internal iliac artery
and the vaginal branch

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rectovaginal septum and this
structure can become thin and
weak overtime
 When rectocele are small, most
women have no symptoms

o Function of Vagina
 Acts as the female genital canal
 Serves as the excretory duct for
the menstrual flow
 Forms part of the birth canal

 Pelvic Organ Prolapse

o Cystocele
 Also known as Prolapsed
Bladder
 It is medical condition in which o Enterocele
woman’s urinary bladder bulges  Hernia of the pouch of Douglas
into her vagina  When the upper 1/3 of the
 Trouble starting urination, posterior wall descends lined by
urinary incontinence and the peritoneum of Douglas
urinary frequency pouch and containing loops of
intestine

o Rectocele
 When the anterior wall of the
o Uterine prolapse
rectum prolapsed with the
 Occurs when pelvic floor
middle 1/3 of the posterior
muscles and ligaments stretch
vaginal wall
and weakens and no longer
 The tissue between the rectum
and the vagina is known as the
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provide enough support for the • Intravaginal is surrounded by gutter fornices
uterus • Posterior portion is deeper & covered with
 The uterus slips down into or peritoneum.
protrudes out of the vagina External os
 But it often affects - The junction is lined by columnar epithelium in
postmenopausal women the cervical canal
- Stratified epithelium lined the intravaginal
who’ve had one or more vaginal
portion
deliveries
- Site of cancer of cervix

• At birth cervix is larger than the body

• Fully developed cervix is 1/3 of body
• Fornices surround cervix
• Anterior wall shorter than the posterior wall
• Walls in contact except superior
• External os opens into vestibule of vagina

CERVIX

• Spindle-shaped cavity
• Openings
1. Internal os - opening from the body NORMAL VS. CERVICAL CARCINOMA
2. External os - opening into the vagina
• Cervix lined columnar epithelium
• Arbor vitae in nullipara
• Intravaginal portion of cervix covered by
stratified epithelium.

UTERUS

• Fused portions of the paramesonephric

(Mullerian) ducts
• Supravaginal • Hollow, pear-shaped muscular organ with thick
• Isthmus is a circular borderline area between the muscular wall 8cm (3in) long X 5cm (2in) wide X
body & cervix 2.5cm (1in) thick & weighed about 60 gms in a
• Isthmus is the supravaginal portion of cervix non-pregnant state
lower uterine segment • Larger in a multiparous woman
• Pelvic organ.
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UTERUS

• It is anteverted i.e. anterior to vertical plane

going through the vagina
• Posterior fornix deeper LAYERS OF THE UTERUS
• Anteflexed
1. Perimetrium – tunica serosa
• Bent anteriorly at junction of body & cervix
2. Myometrium – tunica muscularis
3. Endometrium
• Myometrium- No submucous layer
• Myometrium makes up bulk of uterine wall
• Blood vessels more evident in middle layer

4 Regions/Parts:
o Fundus
o Body
o Cornua
o Cervix
• Cervix opens into vault or fornices of vagina
• Fundus - portion above entrance of uterine
tubes
• Covered with peritoneum
• Body – inferior to the cornua with a
Triangular cavity
• Cornua – point of entrance of a
uterine tube

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LAYERS OF ENDOMETRIUM LATERALLY:

- The body of the uterus is related laterally to the
1. Stratum functionalis broad ligament & the uterine artery & vein.
2. Stratum basalis - The supravaginal cervix is related to the ureter as
it passes forward to enter the bladder.
UTERUS - RELATIONS - The vaginal cervix is related to the lateral fornix
• ANTERIORLY: of the vagina.
- The body of the uterus is related anteriorly to the - The uterine tubes enter the superolateral angles
uterovesical pouch & the superior surface of the of the uterus & the round ligaments of the ovary
bladder & of the uterus are attached to the uterine wall
- The supravaginal cervix is related to the superior just below this level.
surface of the bladder
- The vaginal cervix is related to the anterior fornix of
the vagina

LAYERS OF THE ENDOMETRIUM

 POSTERIORLY:
- The body of the uterus is related posteriorly to
the rectouterine pouch (pouch of Douglas) with
coils of ileum or sigmoid colon within it.

SUPPORTS of UTERUS

Upper
• Round ligament
• Broad ligament

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Middle margin of the uterus within the broad ligament
• Transverse ligament & ends by anastomosing with the ovarian
• Pubocervical artery, which also assists in supplying the
• Uterosacral uterus.
Lower -The uterine artery gives off a small descending
• Levator ani, coccygeus branch that supplies the cervix & the vagina.
• Perineal body

UTERINE ARTERY
BLOOD SUPPLY of the LAYERS of the UTERUS • Uterine artery lies superior to the ureter at
lateral fornix of vagina
• Base of broad ligament

BLOOD SUPPLY OF THE UTERUS:

• ARTERIES
- It is mainly from the uterine
artery, a branch of the
internal iliac artery. VENOUS DRAINAGE OF THE UTERUS
- It reaches the uterus by • The UTERIAN VEIN follows the artery & drains
running medially in the base of into the INTERNAL ILIAC VEIN.
the broad ligament.
- It crosses above the ureter at
R angles & reaches the cervix at
the level of the internal os.
-The artery then ascends along the lateral

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• Junction of the supravaginal portion of the cervix
and the body of the uterus
• Uterovesical pouch
• Covers body, fundus
• Covers the posterior surface body and the
supravaginal portion of cervix
• Upper third of posterior surface of vagina

POUCH OF DOUGLAS
• Upper third of posterior surface of vagina
(posterior fornix)
• Peritoneum reflected on to junction of upper
two thirds and lower third of rectum
• Pouch of Douglas is most dependent part of
female peritoneal cavity
• Broad ligament is lateral
NERVE SUPPLY OF THE UTERUS
• Sympathetic & parasympathetic LIGAMENTS
nerves from branches of the INFERIOR
HYPOGASTRIC PLEXUS. ROUND LIGAMENT
• Pain from cervix via parasympathetic S2 & S3 • Round ligament &
• Pain from body via sympathetic to T11 & T12 Ligament of ovary
develop from the
LYMPHATIC DRAINAGE OF THE UTERUS gubernaculum
• The lymph vessels from the fundus of the uterus • Side of uterus, junction fundus & body
accompany the ovarian artery & drain into the • Inguinal canal to labium majus
para-aortic nodes at the level of the 1ST lumbar • Anteversion
vertebra.
• The vessels from the body & cervix drain into the
internal & external iliac lymph nodes.
• A few lymph vessels follow the round ligament of
the uterus through the inguinal canal & drain
into the superficial inguinal lymph nodes.

UTEROVESICAL and RECTOVAGINAL FOLDS

UTEROVESICAL FOLD
• Also called the anterior uterovesical fold
• Consists of peritoneum reflected unto the
bladder from the uterus at the junction of the
cervix & the body

RECTOVAGINAL FOLD
• Also known as the posterior rectovaginal fold BROAD LIGAMENT
• Consists of peritoneum reflected from the • Two layered folds of peritoneum from side of
posterior vaginal fornix on to the front of the uterus to side wall of pelvis
rectum creating a deep rectouterine pouch of • Framework of pelvic fascia
Douglas • Parametric fat
PERITONEUM • Anterior surface looks inferiorly
• Reflected from the superior surface of the • Free upper border
bladder
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• Base on pelvic floor • SUBSEROSAL/
• Mesosalpinx SUBSEROUS MYOMA
• Mesometrium • ENDOMETRIAL CARCINOMA
• Mesoovarian
• Epoophoron FALLOPIAN TUBES
• Parallel tubules • The paired uterine tubes, or oviducts, supported
• Gaertners duct remains mesonephric tubules & by ligaments & mesenteries that allow
duct, may form cysts considerable mobility.
• Each measure about 10-12 cm in length

PUBOCERVICAL LIGAMENT
• Attached anteriorly to posterior aspect of body
of body of pubis
• Passes to neck of bladder
• Anterior fornix of vagina
• When the tone is decreased may cause cystocele

TRANSVERSE LIGAMENT
• Transverse or cardinal or Mackenrodt ligament
• Thickening of visceral layer of pelvic fascia
around uterine artery
• Lateral to medial in base of broad ligament
•
UTEROSACRAL LIGAMENT
• Uterosacral contains fibrous tissue
• Nonstriated muscle
• Attached from the cervix to the middle of sacrum
• Contains lymphatics draining cervix to sacral
PARTS:
glands
1. Infundibulum
• Helps uterus to be anteverted
- Funnel-shaped opening
• If the uterus is anteverted, no prolapse
fringed with fingerlike
extensions called fimbriae
DISEASES OF THE UTERUS
next to the ovary
• LOCATION & TYPES OF MYOMA & FIBROIDS

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2. Ampulla
-The longest & expanded
region where fertilization
normally occurs

3. Isthmus
- A more narrow portion nearer
the uterus

4. Uterine or Intramural part

- Which passes through the
wall of the uterus & opens
into the interior of this organ.
-Line by ciliated columnar epithelium
-Beats toward the uterus OVARIES

LYMPHATIC DRAINAGE OF THE FALLOPIAN TUBE  Oval shaped

 Measuring 1.5 x 0.75 inches or 4 x 2cm
 Attached to the back of the broad ligament by
the mesovarium
 Covered with germinal epithelium
 Side wall of pelvies covered with peritoneum
 Obturator internus muscle
 Obturator nerves supplies the parietal
peritoneum
 Ureter posterior
 Ligament of ovary medially

BLOOD SUPPLY OF THE FALLOPIAN TUBES

• Uterine artery
• Ovarian artery
• Vaginal artery
• Anterior & posterior arcuate run in middle layer

DISEASE OF THE FALLOPIAN TUBES

 ECTOPIC PREGNANCY

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 Irritation of the peritoneum of the side  Hemorrhagic ovarian cyst
wall by bleeding at ovulation or by lesions
involving the ovary, may result in referred
pain to medial side of the thigh or the knee
 Mittleschmerz pain (ovulation pain or
midcycle pain) at the site of ovulation
 One ovarian artery from lateral aspects
of aorta L2
 R ovarian vein drains into IVC
 L ovarian vein drains into left renal vein
 Lymphatics into paraaortic glands L2

 Polycystic Ovary

DISEASES OF THE OVARY

 Ovarian Cyst

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IV. PELVIC SYMPATHETIC

PELVIC PLEXUSES

 Supply pelvic organs

SYMPATHETIC ENERVATION
 Contains
 Ejaculation is via sympathetic impulses from L1 -
- Sympathetic L2
- Preganglionic parasympathetic nerves  Contraction of sphincters of bladder & anal canal

- Lateral column S2,3,4 PELVIC PARASYMPATHETIC

 Preganglionic have cell bodies in lateral
column of segments S2,3,4
 Ganglia found close to or in wall of organ
 Supplies intestine from splenic flexure to
upper two thirds of anal canal
 Supplies
1. Urinary bladder
2. Rectum
3. Motor to walls inhibitory to sphincters
4. Male & female genitalia

 Parasympathetic causes erection

V. MENSTRUAL CYCLE

 Hypogastric plexus  Menstrual phase

 Lumbar splanchnic - Day 1 to day 5
 Presacral nerve  Follicular phase
 Anterior to body of L5 - Day 1 to day 13
 Divide into pelvic plexuses  Ovulation
 Postganglionic of sympathetic that relayed - Day 14
in lumbar and sacral ganglia  Luteal phase
- Day 15 to day 28

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PHASES OF MENSTRUAL CYCLE

 Types of Nipple
- Average
- Flat
- Long
- Inverted

VI. ACCESSORY REPRODUCTIVE GLANDS

1. Mammary Gland
 Breast

 Diseases of the breast

 Mastitis - is an inflammation of breast tissue that
sometimes involves an infection. The
inflammation results in breast pain, swelling,
warmth and redness. You might also have fever
and chills.
- most commonly affects women who are breast-
feeding (lactation mastitis). But mastitis - can
occur in women who aren't breast-feeding and
in men.

 Shape of the breast

- Round
- Relaxed
- Teardrop
- East west

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 Breast Cyst- are fluid-filled sacs inside the breast, *Stage IIb Cancer
which are usually not cancerous (benign).
- Consist of one or many breast cysts and they
can happen in one or both breasts.
- Often described as round or oval lumps with
distinct edges.
- Usually feels like a grape or a water-filled
balloon, but sometimes a breast cyst feels firm.

2. PLACENTA - An organ that connects the

developing fetus to the uterine wall
- It allows nutrient uptake, thermo-regulation,
waste elimination, & gas exchange via the
mother's blood supply; to fight against internal
infection & to produce hormones which support
pregnancy.
 Breast Cancer - is cancer that forms in the cells
of the breasts.
- is the most common cancer diagnosed in women
in the United States.
- can occur in both men and women, but it's far
more common in women.

*Ductal Carcinoma in Situ ( DCIS) - is the

presence of abnormal cells inside a milk duct in
the breast.
- DCIS is considered the earliest form of breast
cancer.
- Noninvasive - it hasn't spread out of the milk
duct and has a low risk of becoming invasive.
- It provides O2 & nutrients to growing fetuses &
removes waste products from the fetus's blood.
- It attaches to the wall of the uterus, & the fetus'
umbilical cord develops from the placenta.
- Also called the navel string, or birth cord or
funiculus umbilicalis
- A conduit between the developing embryo or
fetus & the placenta.
- During prenatal development, the umbilical cord
is physiologically & genetically part of the fetus
&, (in humans)
- Normally contains two (2) arteries (the umbilical
arteries) & one (1) vein (the umbilical vein),
buried within Wharton's jelly.

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- The umbilical vein supplies the fetus with  Diseases of the Placenta
oxygenated, nutrient-rich blood from the  Placenta Previa - Abnormal implantation site of
placenta. the placenta.
- Normal implantationsite: upper part of the body
of the uterus.
- More often on the posterior wall.

- Conversely,the fetal heart pumps deoxygenated,

nutrient-depleted blood through the umbilical  Abruptio Placenta - It is the premature
arteries back to the placenta. separation of the placenta from the uterus.
- Also called placental abruption, typically present
 Umbilical Cord with bleeding, uterine contractions, & fetal
distress.
- The cause of placental abruption is often
unknown.
- Possible causes include:
 Trauma or injury to the abdomen from
an auto accident or fall — or rapid loss of
the fluid that surrounds & cushions the
baby in the uterus (amniotic fluid).

 Variations of the Placenta

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 Tubal infection usually occurs due to upward
VII. CLINICAL CORRELATIONS spread of infection from vagina and uterus.
 The patency of tubal block is tested by the
OVARY following tests:
(a) Insufflation test (or Rubin’s test): Air is pushed
 Ovarian torsion into the uterus, and if tube is patent, the air leaks
 The torsion of an ovary may occur due to an into the peritoneal cavity. The leakage of air
abnormally long mesovarium and suspensory produces hissing or bubbling sound which can be
ligament of the ovary. heard by a stethoscope over the iliac fossa.
 Prolapse of ovaries (b) Hysterosalpingography: It is a radiological
 The ovaries are often prolapsed /displaced into technique in which a radiopaque substance (e.g.,
the pouch of Douglas where they can be Lipiodol) is injected into the uterus by a suitable
palpated on per vaginal (PV) examination. canula. It outlines the uterine cavity and uterine
 Ovarian cyst tubes, and if tubes are patent, the contrast medium
 One or more small ovarian cysts may be formed spills into the peritoneal cavity.
due to the developmental arrest of the ovarian
follicles.  Ectopic pregnancy
 A large ovarian cyst with an encysted fluid may  It is commonest in the uterine tube (tubal
be formed from the corpus luteum of the gestation) and is usually associated with
pregnancy. It causes an anteroposterior bulging intraperitoneal hemorrhage, one of the causes
of the abdomen but does not present shifting of acute abdominal emergency in women of
dullness. It should be differentiated from ascites childbearing age. The hemorrhage occurs due to
which presents with shifting dullness. rupture of the tube caused by enlarging
 Ovarian carcinoma conceptus.
 The carcinoma of an ovary is common and  Tubectomy - It is an operation for the female
accounts for about 15% of all cancers and 20% of sterilization.
gynecological cancers. - In this procedure, each fallopian tube is ligated
 Teratoma at two points and the segment of tube between
 The ovary may sometimes contain pluripotent the ligatures is resected.
cells, which may give rise to a teratoma - This prevents the meeting of male and female
 Ovarian dysgenesis gametes, hence no fertilization. This is the ideal
 Congenital absence of one or both ovaries is method of family planning in female.
found in Turner’s syndrome.
 Ectopic ovaries CERVIX
 The ovary may fail to descend into the pelvis or
 Cervical carcinoma
very rarely may be drawn downward with the
round ligament of the uterus into the inguinal  It is the most common cancer in females (11%).
canal or even into the labium majus. The second commonest cancer in females is
breast cancer (about 8%). It is rare before 20
UTERINE TUBES years of age and reaches its peak between the
ages 45 and 55 years. 80% cervical cancers are
 Salpingitis squamous cell carcinoma and are related to
sexual activity. Early sexual exposure and
 The inflammation of the uterine tube (or salpinx)
promiscuity are prominent factors.
is called salpingitis (salpinx: trumpet-like). It is
the commonest cause of tubal block leading to  It spreads directly to adjacent structures and
secondary sterility in female. In recent times, the metastasizes via lymphatics to pelvic lymph
incidence of tubal block has increased in modern nodes and then to the preaortic and para-aortic
females probably because they miss morning lymph nodes.
bath in order to report on duty in time and waste
time in make-up.
GROSS ANATOMY Cassie,Ann,Gab 19 of
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 GROSS ANATOMY
Female Reproductive System | Dr. Aracelli Dizon | 11/16/20)
Clinical features:  Prolapse
 The prolapse of anterior vaginal wall may drag
1. Abnormal vaginal bleeding particularly the urinary bladder (cystocele) or urethra
intermenstrual. (urethrocele).
2. Postcoital bleeding.  The prolapse of the posterior vaginal wall drags
3. Pain, anorexia, and weight loss. the rectum (rectocele).
4. Fibroids/fibromyomas of uterus
- These are benign tumors arising from  Culdocentesis
myometrial cells.  It is a clinical procedure in which a needle is
- They are found in about one fifth of women passed through the posterior fornix of vagina
above 35 years of age. into the rectouterine pouch (of Douglas) to drain
- They are usually multiple and may undergo the pus accumulated in this pouch in pelvic
degenerative charges. inflammatory disease or blood following rupture
- They undergo atrophy after menopause. of the fallopian tube due to ectopic tubal
- Clinically they present as abnormal bleeding pregnancy. Nowadays this procedure is used to
(hypermenorrhea) and irregular contour of the obtain a fluid sample for collecting oocytes for in
uterus on bimanual palpation. vitro fertilization.
- They are often asymptomatic. Small
asymptomatic fibroids require no treatment.
- If large, hysterectomy (removal of uterus) is the References:
treatment of choice. - Lecturer’s ppt
5. Caesarean section - Clinical Anatomy by Regions – Snell
- It is the surgical procedure for delivering the - Lecture Notes
baby by cutting open the abdomen and uterus in - Previous Transes
cases where vaginal delivery is not possible.
- The term caesarean section is so named because
the Roman Emperor Julius Caesar was
supposedly born by this surgical procedure.

VAGINA

- Per vaginal (PV) examination is done to estimate

the different pathological conditions by
palpating the pelvic organs.

 Vaginitis (infection of vagina)

 Is uncommon in healthy adult females because
the vagina is self-sterilizing in adult due to its
acidic medium (pH = 4.5) in which organisms are
unable to grow.
 In the child, the normal defense mechanism of
the vagina is absent.
 The acidic medium is due to the presence of
Döderlein’s bacilli producing lactic acid from
glycogen in the vaginal epithelial cells which is
dependent upon the activity of estrogen on the
cells causing growth and maturation. After
menopause the vaginal epithelium atrophies.
 Therefore, vaginitis is common in children and
old women (after menopause).
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