152 TOPOGRAPHIC AND APPLIED ANATOMY. 



fair-sized vesical calculi may be removed through the urethra in the female more easily than 

 in the male. Its coarse is almost directly forward and downward with an insignificant anterior 

 concavity. The urethra rests upon the lower portion of the anterior vaginal wall, from which 

 it is separated by the comparatively broad urethrovaginal septum. The narrowest place is at the 

 external orifice, where the urethra opens as a sagittal slit into the vestibulum vaginae. 



The Uterus. The body of the uterus projects toward the peritoneal cavity between 

 the bladder and the rectum; it is very movable and its position is continually influenced 

 by the degree of distention of the bladder and of the rectum. Disregarding its fixation 

 to the vagina, bladder, and peritoneum (ligamentum latum), the uterus is held in its 

 position chiefly anteriorly by the ligamentum teres passing into the inguinal canal and 

 posteriorly by the recto-uterine muscles situated within the folds of Douglas. The anterior 

 surface of the body of the uterus rests upon the bladder, although it is separated from 

 it by the vesico-uterine fold of peritoneum (excavatio vesico-uterina). When the bladder is 

 full, it raises the uterus to a vertical position; when the bladder is empty, the uterus sinks 

 anteriorly. The empty and the full rectum have a similar influence upon the position of the 

 uterus. The neck of the uterus is more fixed, and in such a way that the external os is usually 

 at the level of the upper margin of the symphysis and the longitudinal axis of the cervix corre- 

 sponds to the pelvic axis (see page 144). Since the highest point of the fundus uteri does not 

 extend to the plane of the pelvic inlet, it follows that the normal non-pregnant uterus is always 

 entirely within the true pelvis. The fixation of the cervix is due to its attachment to the vagina, 

 to the connective tissue between it and the bladder, and to the recto-uterine muscles, which are 

 enclosed in the recto-uterine folds of the peritoneum and run to the lateral walls of the rectum 

 and to the sacrum. The position of the uterus in the dead body is no criterion for that in the 

 living woman. The normal position is an inclination anteriorly with a more or less decided 

 angle between the cervix and the body (normal anteflexion) which is influenced by the distention 

 of the bladder. If no angulation is present, so that the longitudinal axes of the body and of 

 the cervix form a straight line, we speak of anteversion; this condition tends to be more or less 

 prevalent after repeated pregnancies. In the dead subject the uterus is usually displaced pos- 

 teriorly, chiefly because gravitation has a better chance to act on account of the relaxed mus- 

 culature and of the absence of the intra-abdominal tension. Retroversion and retroflexion are 

 always abnormal positions. 



The Peritoneum. The peritoneum is reflected from the bladder to the uterus at the level 

 of the internal os, forming the vesico-ulerine jold (excavatio vesico-uterina), passes over the fundus 

 and covers the posterior surface of the uterus as far as the upper portion of the vagina and is 

 reflected to the rectum, forming the recto-uterine jold (excavatio recto-uterina). The peritoneum 

 is firmly adherent to the posterior surface of the uterine body, but it is more loosely attached to 

 the cervix. This relation of the peritoneum is of great importance for operative procedures upon 

 the uterus and upon the vagina. It is clear that the anterior wall of the cervix may be incised 

 toward the bladder without danger of opening the peritoneal cavity, while an incision into the 

 posterior wall may easily open the peritoneal cavity. We may also incise the anterior vaginal 

 wall, work upward in the loose connective tissue between the cervix and the bladder, and open 

 the vesico-uterine pouch to reach the genital organs within the peritoneal cavity. For the same 



