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

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

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

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

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

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

7. POSITION OF THE OVARY This causes: Tenderness of the ovaries and Deyspareunia (discomfort during sexual intercourse). This causes: Tenderness of the ovaries and Deyspareunia (discomfort during sexual intercourse).

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

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

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

11. HOW THEY ENTER THE OVARY? The ovarian vessels, lymphatics and nerve supply cross the external iliac vessels at the pelvic brim. The ovarian vessels, lymphatics and nerve supply cross the external iliac vessels at the pelvic brim.

12. HOW THEY ENTER THE OVARY? They pass through the suspensory ligament of the ovary. They pass through the suspensory ligament of the ovary. They enter the hilum of the ovary through the mesovarium. They enter the hilum of the ovary through the mesovarium.

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

14. UTERINE TUBE It is enclosed within portion of the broad ligament (Mesosalpinx). It is enclosed within portion of the broad ligament (Mesosalpinx).

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

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

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

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

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

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

21. BLOOD SUPPLY Arterial : Arterial : Uterine (internal iliac). Uterine (internal iliac). Ovarian (abdominal aorta). Ovarian (abdominal aorta). Venous : correspond to arteries. Venous : correspond to arteries.

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

23. PARTS (1) Fundus : (1) Fundus : It is the round superior part above the entery of the uterine tubes. It is the round superior part above the entery of the uterine tubes. (2) Body : (2) Body : It is flattened antero- posteriorly. It is flattened antero- posteriorly.

24. PARTS When viewed laterally : When viewed laterally : The cavity is a narrow slit. The cavity is a narrow slit.

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

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

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

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

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

30. RELATIONS (ANTERIOR) The body: The body: Uterovesical pouch. Uterovesical pouch. Superior surface of the bladder. Superior surface of the bladder. Supravaginal cervix: Supravaginal cervix: Superior surface of the bladder. Superior surface of the bladder. Vaginal cervix: Vaginal cervix: Anterior fornix of the vagina. Anterior fornix of the vagina.

31. RELATIONS (POSTERIOR) Body : Body : Rectouterine pouch (pouch of Douglas) with coils of ileum and sigmoid colon. Rectouterine pouch (pouch of Douglas) with coils of ileum and sigmoid colon.

32. RELATIONS (LATERAL) Body : Body : Broad ligament. Broad ligament. Uterine vessels. Uterine vessels. Supravaginal cervix: Supravaginal cervix: Ureter. Ureter. Vaginal cervix: Vaginal cervix: Lateral fornix of vagina. Lateral fornix of vagina.

33. POSITION OF UTERUS Anteversion : Anteversion : The uterus is bent forward. The uterus is bent forward. The long axis of the body is bent on the long axis of the vagina. The long axis of the body is bent on the long axis of the vagina.

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

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

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

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

38. UTERINE ARTERY It supplies : It supplies : Uterus. Uterus. Uterine tubes. Uterine tubes. Vagina. Vagina.

39. NERVE SUPPLY From inferior hypogastric plexus (sympathetic & parasympathetic From inferior hypogastric plexus (sympathetic & parasympathetic

40. LYMPH DRAINAGE 1. Fundus : with the ovarian artery to para- aortic nodes. 1. Fundus : with the ovarian artery to para- aortic nodes. 2. Body & cervix : to internal & external iliac nodes. 2. Body & cervix : to internal & external iliac nodes. 3. Vessels accompany the round ligament to: 3. Vessels accompany the round ligament to: Superficial inguinal nodes. Superficial inguinal nodes.

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

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

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

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

45. SUPPORTS OF THE UTERUS (2) Ligaments: (2) Ligaments: They are sub peritoneal fibro- muscular condensation of the pelvic fascia on the upper surface of the levator ani muscles. They are sub peritoneal fibro- muscular 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. They are attached to the cervix and vagina.They are important in keeping the cervix in its normal position.

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

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

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

49. ROUND LIGAMENT OF UTERUS It extends between the superolateral angle of the uterus and the subcutaneous tissue of the labia majora. 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 helps to maintain the ante verted, ante flexed position of the uterus.

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

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

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

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

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

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

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

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

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

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

60. BROAD LIGAMENTS They are double fold layers of peritoneum extending between the lateral margins of the uterus and the lateral pelvic walls. 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. 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. Inferiorly (base) : they separate to cover the pelvic floor. The uterine artery crosses the ureter.

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

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

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

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