THE VAGINA. 



457 



THE VAGINA. 



The vagina is about 7. 5 cm. (3 in. ) long; its posterior wall is longer than the ante- 

 rior, being 8.75 cm. (3^ in. ) long. It will thus be seen that if the uterus is slightly 

 depressed, as it often is, the cervix is within easy reach of the examining finger, if, how- 

 ever, it is drawn up, as by an abdominal growth, it may only be reached with difficulty. 

 The hollow formed by the anterior wall of the vagina blending with the anterior lip of 

 the cervix is called the anterior fornix . The depression behind the posterior lip is the 

 posterior fornix, behind which is Douglas 1 s pouch. At the vulvar outlet the lumen of 

 the vagina is anteroposterior in direction, it then changes to lateral and at the cervix 

 becomes round. Its walls are in contact. In nulliparae the tube is more uniform in 

 size, but in multiparae it is small at each end but large in the middle. It is much 

 more dilatable and larger in the latter, hence operations in nulliparse are compara- 

 tively rarely done through the vagina. Anteriorly the vagina in its upper portion is 

 in relation with the bladder. In its lower portion (about one-third) it is in intimate 



Ovarian artery 



Ureter 



Uterine artery 

 Cervix 



Vesical artery 

 Upper end of vagina 



Bladder 

 FIG. 460. The ureter, ovarian artery, and uterine artery; showing their relation to the pelvic organs. 



relation with the urethra except at the upper portion of the latter. Posteriorly its 

 upper i or 2 cm. (3^ to J^ in.) is in front of the peritoneum and Douglas's pouch, 

 below this lies the rectum, and between it and the surface is the perineal body. 

 Laterally the ureters are close to the vagina and about half way up they empty into 

 the bladder. In its lower portion the vagina is joined by the insertion of the levator 

 ani muscle. The connection of the vagina to the bladder in front and rectum behind 

 is loose, so that in performing operations it is readily separated from these organs. 



The Ureter in the Female. The pelvic portion of the ureter in the female 

 is about 10 cm. (4 in. ) long. It crosses the pelvic brim at a level with the first piece 

 of the sacrum and passes over either the common iliac artery at its bifurcation or the 

 external iliac at its commencement. It then follows the wall of the pelvis downward 

 just posterior to the ovary and, near the floor of the pelvis, bends forward to pass 

 through the base of the broad ligament, traversing the loose connective tissue (para- 

 metrium) and being about 1.5 to 2 cm. (^ to ^ in.) outside of the cervix. At that 



