1. GYNECOLOGY Anatomy 0f female pelvis
د.ايناس الخياط

2. External genitalia The vulva: , include :
The vulva: , include :
*The mons pubis is composed of fibrofatty tissue , which covers the body of the public bones . In the adult , the skin that covers the mons pubis bears pubic hair .
*The labia majora are two folds of skin with underlying adipose tissue bounding either side of the vaginal opening . They contain sebaceous and sweat glands and a few specialized apocrine glands .  
*The labia minora are two thin folds of skin that lie between the labia majora . Anteriorly they divide into two to form the prepuce and frenulum of the clitoris . Posteriorly they fuse to form a fold of skin called the fourchette . They contain sebaceous glands but have no adipose tissue .

3. The vulva:
*The clitoris is a small erectile structure . The body of the clitoris contains two crura , the corpora cavernosa . The clitoris is about 1 cm long but has a highly developed nerve supply and is very sensitive during sexual arousal .
*The vestibule is the cleft between the labia minora . The urethra , the ducts of the Bartholin's glands and the vagina open in the vestibule .
*Bartholin's glands , each about the size of a small pea , lie at the base of each vestibular bulb and open via a 2 cm duct into the vestibule between hymen and the labia minora . These are mucus-secreting , producing copious amounts during intercourse to act as a lubricant .
*The hymen is a thin fold of mucous membrane across the entrance to the vagina . There are usually openings in to allow menses to escape .

5. Age Changes :
In infancy the vulva is devoid of hair and there is considerable adipose tissue in the labia majora and pubis that is lost during childhood but reappears during puberty , at which time hair grows . After menopause the skin atrophies and becomes thinner . The labia minora shrink , subcutaneous fat is lost and the vaginal orifice becomes smaller

6. The Internal reproductive organs :
I- The vagina
The vagina is a fibromuscular canal lined with stratified squamous epithelium that leads from the uterus to the vulva . It is longer in the posterior wall ( around 9 cm ) than anteriorly ( approximately 7 cm ) .
The vault of the vagina is divided into four fornices : Posterior , anterior and two lateral .
The vaginal walls are rugose , with transverse folds .
The vagina is kept moist by secretions from the uterine and cervical glands and by some transudation from its epithelial lining . It has no glands . The epithelium is think and rich in glycogen .
*Doderlein's bacillus is a normal commensal of the vagina that breaks down the glycogen to form lactic acid , producing a pH of around This has a protective role for the vagina in decreasing the growth of pathogenic organisms .

7. The vagina Age Changes :
At birth , the vagina is under the influence of maternal oestrogens , so the epithelium is well developed . After a couple of weeks , the effects of the oestrogens disappear and the pH rises to 7 and the epithelium atrophies . At puberty the reverse occurs , and finally , at the menopause , the vagina tends to shrink and the epithelium atrophies .

10. The uterus
The uterus is shaped like an inverted pear , tapering inferiorly to the cervix , and in the non-pregnant maximum external dimensions are approximately 7.5 cm long , 5 cm wide and 3 cm thick . state is situated entirely within the pelvis , It is hollow and has thick muscular walls
An adult uterus weighs about 70g

13. The uterus The uterus consists of three layers :
1. The outer serous layer ( peritoneum ) .
2. The middle muscular layer ( myometrium )
3. The inner mucous layer ( endometrium ) .

14. The cervix
The cervix is narrower than the body of the uterus and is approximately 2.5 cm in length . Due to anti-flexion or retroflexion , the long axis of the cervix is rarely the same as the long axis of the body of the uterus . Anterior and lateral to the supravaginal portion is the cellular connective tissue , the parametrium . The posterior aspect is covered by peritoneum of the pouch of Douglas . The ureter runs about 1cm laterally to the supravaginal cervix . The vaginal portion projects into the vagina to form the fornices .

15. The cervix
It has numerous deep glandular follicles that secrete a clear alkaline mucus , the main component of physiological vaginal discharge . The epithelium of the endocervix is cylindrical and is also ciliated in its upper two-thirds and changes to stratified squamous epithelium around the region of the external os . This squamocolumnar junction is also known as the transformation zone and is an area of rapid cell division ; approximately 90 per cent of cervical carcinoma arises in this area .

16. Age Changes :
The disappearance of maternal oestrogens after birth causes the uterus to decrease in length by around one-third and in weight by about one-half. The cervix is then twice the length of the uterus .
At puberty , however , the corpus grows much faster and the size ration reverses . After the menopause , the uterus atrophies .

17. The fallopian tubes ( oviducts )
Each fallopian tube extends outwards from the uterine cornu to end near the ovary . At the abdominal ostium , the tube opens into the peritoneal cavity , which is therefore in communication with the exterior of the body via the uterus and the vagina
*10 cm long

18. The fallopian tubes is described in four parts :
1. The interstitial portion .
2. The isthmus .
3. The ampulla .
4. The infundibulum , or fimbrial portion . .
The epithelium of the fallopian tubes contains two functioning cell types : the ciliated cells , and the secretory cells ,

20. The ovaries
*The size and appearance of the ovaries depend on both age and the stage of the menstrual cycle
* In the young adult they are almond shaped , solid , a greyishpink and approximately 3 cm long , 1.5 cm wide and 1cm thick .
*In the child , the ovaries are small structures , approximately 1.5 cm long . They have a smooth surface and at birth contain between 1 and 2 million primordial follicles .
*The ovary is the only intra-abdominal structure not to be covered by peritoneum

23. The pelvic ligaments& fascia:
*The cardinal ligaments ( transverse cervical ligaments ) provide the essential support of the uterus and vaginal vault . These are two strong , fan-shaped fibro-muscular expansions that pass from the cervix and vaginal vault to the side wall of the pelvis on either side .
*The uterosacral ligaments run from the cervix and vaginal vault to the sacrum . In the erect position they are almost vertical in direction and support the cervix .
The bladder is supported laterally by condensations of the vesical pelvic fascia one each side ; there is also a sheet of pubocervical fascia which lies beneath in anteriorly .
*Overian &round ligament:
The round ligament is the continuation of the same structure and runs forwards under the anterior leaf of peritioneum to enter the inguinal canal , ending in the subcutaneous tissue of the labium majus .

24. Arteries supplying the pelvic organs :
1. The ovarian artery :
The ovarian artery arises from the aorta just below the renal artery and runs downwards on the anterior surface of the psoas muscle to the pelvic brim , where it crosses in front of the ureter and then passes into the infundibulopelvic fold of the broad ligament ..
2. The superior rectal artery :
This artery is the continuation of the inferior mesenteric artery and descends in the base of the pelvic measocolon .

25. Arteries supplying the pelvic organs
3. The internal iliac ( hypogastric ) artery :
Beings at the bifurcation of the common iliac artery in front of the sacroiliac joint . It soon divides into anterior and posterior divisions , the branches that supply the pelvic viscera are all from the anterior division :.
The uterine artery provides the main blood supply to the uterus .
The vaginal artery is another branch of the internal iliac artery that runs at a lower level to supply the vagina.
The vesical arteries are variable in number . They supply the bladder and terminal ureter .
The middle rectal artery often arises in common with the lowest vesical artery .
The pudendal artery . It gives off the inferior rectal artery . It terminates in branches that supply the perineal and vulval structures .

26. The pelvic veins :
Venous drainage from the uterine , vaginal and vesical plexuses is chiefly into the internal iliac veins . The ovarian veins that on the light ends in the inferior vena cava and that on the left in the left renal vein .