PRACTICAL CONSIDERATIONS : THE OVARY. 1995 



doubtful whether the latter ever undergo division. In certain cases it is also possible that the 

 delicate partition separating two closely applied follicles may disappear, the ova thence 

 occupying the common sac (Ebner. ) 



The changes in form and position which the ovary undergoes during life are 

 conspicuous. In the new-born child the organ is relatively long (from 12-18 mm.) 

 and narrow (from 4-5 mm.), triangular on cross section, and lies entirely above the 

 brim of the pelvis, with its long axis transversely placed and its inner pole close to 

 the fundus uteri. During the first two years, owing to the increasing capacity of the 

 pelvis and interabdominal pressure and its attachments to the uterus, it gradually 

 sinks into the pelvic cavity, during this descent the direction of its long axis becoming 

 more vertical. At birth the surface of the ovary is marked with furrows and folds, 

 inequalities that disappear as the organ expands in consequence of the rapid increase 

 in its stroma-tissue during the first year or two. Later the growth of the young 

 ovary is gradual and slow, until the advent of sexual maturity, from the twelfth to 

 the fifteenth year, when the organ undergoes sudden increase and acquires its definite 

 form and size. Further enlargement, however, usually takes place in women who 

 bear children, until towards the fortieth year. The repeated development and rupture 

 of the Graafian follicles and the formation of the corpora lutea produce irregularity 

 of the surface, which becomes knobbed and scarred and contrasts strongly with the 

 smooth organ of childhood. After the cessation of menstruation, about the forty- 

 fifth year, gradual decrease (involution) of the ovary follows, until the organ may be 

 reduced to a dense fibrous body of less than half of the original size. 



Variations. — Abnormalities in the sexual glands of the female are, for the most part, 

 referrible to developmental deviations. Incompleteness or modification of its descent affect 

 the position of the organ, so that it may retain its original suprapelvic position and lie above or 

 upon the psoas magnus muscle ; or it may follow the pull of the round ligament (the homologue 

 of the genito-inguinal ligament of the male, page 2006) and pass partly or entirely through the 

 inguinal canal into the labium majus. Variations of position in the adult are commonly asso- 

 ciated with diseased conditions of the peritoneum and adjacent organs and are therefore patho- 

 logical. The adult ovary may present marked deviations from its typical form, sometimes 

 being unusually long, spheroidal, flattened, triangular, crescentic, or irregular. 



Sttpermunerary ovaries, varying in size from a hempseed to a small hazelnut, are not in- 

 frequent, occurring in from over 2 (Beigel) to 4 (Rieffel) per cent. Their usual situation is 

 along the white line marking the transition of the peritoneum into the germinal epithelium. 

 Isolation of a portion of the ovarian anlage, often probably by a peritoneal band (Nagel), is 

 responsible for these bodies, which consist of normal follicle-bearing ovarian tissue. 



PRACTICAL CONSIDERATIONS : THE OVARY. 



Since the ovaries project below the Fallopian tubes from the posterior surface of 

 the broad ligaments, in seeking for them in abdominal operations the hand should be 

 passed outward from the posterior surface of the uterus along the broad ligament, on 

 each side. 



In its usual position the long axis of the ovary is approximately vertical, its 

 external surface lying against the pelvic wall close to the obturator vessels and nerve. 

 The ureter and uterine artery lie behind and below it. 



Prolapse of the ovary occurs most frequently as the result of subinvolution after 

 labor. If involution is in any way arrested or rendered incomplete, the conditions 

 favorable for prolapse of the ovary will be present, — increased weight of the ovary 

 and relaxation and lengthening of its attachments. 



The left ovary is more frequently prolapsed than the right, because it normally 

 becomes more enlarged during pregnancy, and therefore suffers more from subinvolu- 

 tion, and because the arrangement of the veins on the left side is such that venous 

 congestion is very liable to occur (Penrose). An analogous anatomical condition 

 exists to that which, in the male, favors left-sided varicocele, the left ovarian vein 

 emptying into the renal vein at a right angle, while the right ovarian vein empties 

 into the vena cava at an acute angle (page 1961). 



In complete prolapse the organ lies in Douglas's pouch between the rectum and 

 the posterior vaginal wall. There is apt to be pain on walking, because the ovary is 

 then compressed between the cervix and the sacrum, and on coitus or defecation. 



