1416 



THE URINOGENITAL ORGANS 



Relations (Figs. 1157 and 1175). The upper part of the anterior wall of the vagina is in 

 relation with the base of the bladder, being separated from that viscus by lax connective tissue. 

 Lower down the middle line of the anterior wall and closely joined to it is the urethra. The upper 

 part of the posterior wall, near the middle line, is covered for a quarter of an inch or more with 

 peritoneum, which forms the anterior wall of the depths of the rectovaginal pouch of peritoneum 

 or pouch of Douglas (excavatio rectouterina [Douglasi]) (Fig. 1165), between the uterus and 

 vagina and the rectum. The portion of the posterior wall below the level of the pouch of 

 Douglas is placed close to the rectum, a layer of pelvic fascia intervening. As the vaginal orifice 

 is approached, the rectum and vagina separate, and interposed between them is a mass of fibro- 

 fatty tissue called the perineum or perineal body. Its sides are enclosed between the Levatores 

 ani muscles. The ureter toward its termination (Fig. 1166) lies near the lateral wall of the 

 vagina, passing at this point in a direction downward, inward, and slightly forward to reach the 

 bladder. The vagina near its termination passes through the triangular ligament, and upon its 

 sides are the bulbs of the vestibule, the glands of Bartholin, and the Bulbocavernous muscle. 



Structure. The vagina consists of an internal mucous lining, a muscular coat, and a 

 fibrous coat; between the first two is found a layer of erectile tissue. 



EXTERNAL 

 ILIAC NODES 



INTERNAL 

 ILIAC NODES 



LATERAL 

 SACRALNODES 



AFFERENTS 



TO EXTERNAL 



ILIAC NODES 



AFFERENTS 

 TO INTERNAL 

 ILIAC NODES 



RTTROVAGINAL 

 NODULES 



FIG. 1172. The lymphatics of the vagina. Schematic. (Poirier and Charpy.) 



The mucous membrane (tunica mucosa) (Fig. 1162) is continuous above with that lining the 

 uterus. Its inner surface presents, along the anterior and posterior walls, a longitudinal ridge 

 or raphe", called the rugous columns of the vagina (columna ruganim, anterior et -posterior). 

 The anterior column extends downward as far as the external orifice of the urethra, forming the 

 carina urethralis vaginae. Numerous transverse ridges or rugae (rugae vaginales) extend out- 

 ward from the raphe" on either side. These rugje are divided by furrows of variable depth, 

 giving to the mucous membrane the appearance of being studded over with conical projections 

 or papillae; they are most numerous near the orifice of the vagina, especially in females before 

 parturition. The epithelium covering the mucous membrane is of the stratified squamous 

 variety. The subepithelial tissue is very loose and contains numerous large veins, which by 

 their anastomoses form a plexus, together with smooth muscle fibres from the muscular coat; it is 

 regarded by Gussenbauer as an erectile tissue. It contains a number of mucous crvpts, but no 

 true glands. 



The muscular coat (tunica muscularis) consists of two layers, an external longitudinal, which 

 is far the stronger, and an internal circular layer. The longitudinal fibres are continuous with 

 the superficial muscle fibres of the uterus. The strongest fasciculi are those attached to the recto- 

 vesical fascia on each side. The two layers are not distinctly separable from each other, but 



