THE PELVIC CAVITY IN THE FEMALE. 



J IG V ?i?'~ The lateral pdvi . Wal1 f the female ' The Posterior layer of the broad ligament has been incised al 

 UCh - ^ Uten * ** h anteriorly 



purpose the gynecologist opens the peritoneal cavity by incising the posterior vaginal fornix 

 and entering the recto-uterine pouch. In a general way this procedure is the easier one, since 

 it is not necessary to first separate the cervix from the bladder. 



The Vagina. The vagina runs from above and behind obliquely downward and forward. 

 Its course presents a slight concavity anteriorly and it forms an inconstant angle with the cervix, 

 which is usually a right angle in the virgin. The anterior vaginal wall is somewhat shorter than 

 the posterior one, chiefly because the posterior wall extends higher upon the cervix than does 

 the anterior one. The vaginal vault i. e., the circular portion of the vagina surrounding the 

 intravaginal cervix is lower anteriorly than posteriorly, where the fornix is deeper and where 

 the vaginal cervix is longer. Although the anterior lip of the cervix is shorter than the posterior 

 one, it is situated at a lower level. 



The anterior wall of the vagina borders upon the bladder (with the interposition of loose 

 connective tissue) and upon the urethra (where the connective tissue is firmer). It is conse- 

 quently easy to enter the bladder through the anterior vaginal wall. Upon the posterior vaginal 

 wall we differentiate three areas (Plate 22): 



1. A small superior one, the region of the posterior vaginal vault. This portion has a 

 peritoneal reflection and is in relation with the deepest point of the recto-uterine pouch. 



2. A middle area, the longest of the three, which borders upon the sacral curve of the rectum. 

 It is separated from the rectum by the recto-vaginal septum, which is composed of loose connective 

 tissue and favors the prolapse of the vagina and of the uterus. 



3. A short inferior area, where the rectum becomes more distant from the vagina on account 

 of its perineal curve. It is situated below the urogenital diaphragm, and the perineum separates 

 this portion of the vagina and its vestibule from the lower end of the rectum. In this situation 

 a slight perineal tear during delivery may lead to a laceration of the wall of the vestibule of the 

 vagina, together with a varying amount of trauma to the perineal tissue and to the skin. If 

 the tear is a complete one, the anterior wall of the rectum will also be lacerated. 



What is the result, however, of a greater dilatation with laceration or of ulcerative processes 

 higher up in the vagina ? They lead to the formation of fistulas or to abnormal communications 

 between the viscera. Anteriorly, there may be a urethrovaginal fistula between the urethra and 

 the vagina, higher up there will be a vesicovaginal fistula, and still higher a vesicocervical fistula. 

 In any of these conditions the urine will continually dribble from the vagina in a most troublesome 

 manner. Posteriorly, a rectovaginal fistula may develop and feces may be passed through the 

 vagina. Since the upper vaginal wall and the cervix are in relation with the ureters (see page 

 151), it is possible to have a uretero vaginal or a ureterocervical fistula. 



The Ovaries. The position of the ovaries in the true pelvis is partially disclosed by the 

 designation of the parts of these flat ellipsoidal bodies. We differentiate an external and an 

 internal surface, a superior and an inferior pole (extremitas tubaria and extremitas uterina), 

 and an anterior and a posterior margin (margo mesovaricus and margo liber). The anterior 

 margin corresponds to the hilus of the ovary, where the vessels make their entrance and exit. 



