344 PRACTICAL ANATOMY. 



It is limited inferiorly by the introitus vagina; at the vestibule, and superiorly 

 by its junction with the cervix uteri. 



Define and locate tlic ntcro-vaginal fornix. 



It is the highest part of the vagina ; a space surrounding that part of the 

 cervix uteri within the vagina, and formed by the reflexion of the vaginal 

 mucous membrane on to the cervix. The vaginal passage extends upward and 

 backward. Its long axis extended would pass through the upper segment of 

 the sacrum. 



W licit arc the anterior relations of the vagina .' 



It is in close relation with the urethra and bladder. The ureters open into 

 the posterior wall of the bladder, anterior to the vagina, and about an inch below 

 the lowest part of the cervix uteri. There is a large amount of connective tissue 

 between the anterior wall of the vagina and the bladder and urethra. 



Describe the posterior relations of the vagina. 



The vagina is inflation posteriorly with the rectum. Intervening between 

 the rectum and posterior wall of the vagina from above downward are (i) the 

 peritoneal cul-de-sac of Douglas ; (2) subperitoneal connective tissue ; (3) the 

 perineal body. 



Describe the lateral relations of the vagina. 



(i) The vaginal branch of the uterine artery the uterine being a branch of 

 the internal iliac ; (2) a plexus of veins, lying at the base of the broad ligament 

 of the uterus, communicating with the haemorrhoidal, and tributary to the internal 

 iliac vein. 



Hcnv is tlie vaginal inlet narrowed f 



By the action of the sphincter vaginae, the levator ani, and engorgement of 

 the erectile tissue of the inlet, called the bulbi vestibuli. 



Describe the struct tire of t lie vaginal wall. 



It is composed of three coats : (i) An outer fibrous coat, a derivative of the 

 recto-vesical fascia. In this coat you will find in some cases a beautiful plexus 

 of veins. (2) A muscular coat, consisting of outer longitudinal fibres and an 

 inner layer of circular fibres. The muscular coat consists of unstriped fibres. 

 (3) A mucous coat, highly elastic, and continuous above with the mucous mem- 

 brane of the uterus, and below with that of the vulva. 



Describe the blood-supply of the vagina. 



The arteries, derived from the internal iliac, from the inferior branch of the 

 uterine, and from the external pudic branch of the common femoral artery, lie 

 along the lateral part of the vagina and divide into anterior and posterior branches 

 for the supply of the anterior and posterior surfaces respectively. The veins follow 

 the course of the arteries, form a rich plexus between the inner and middle coats, 

 and finally become tributary to the internal iliac vein. The nerve-supply of the 

 vagina is from the hypogastric plexus, internal pudic nerve, and the fourth 

 sacral. 



