1274 UROGENITAL SYSTEM 



of the uterus, immediately below the point of attachment of the ovarian ligament, 

 the ligamentum teres (round ligament) (fig. 1030), which is a fibrous cord con- 

 taining non-striped muscle tissue. It extends downward, laterally and forward 

 between the two layers of the mesometrium toward the abdominal inguinal ring, 

 and, traversing this and the inguinal canal, it terminates in the labium majus by 

 becoming continuous with its connective tissue. 



It is accompanied by a funicular branch of the ovarian artery and a branch from the ovarian 

 venous plexus, and in the lower part of its course by a branch from the inferior epigastric artery, 

 over which it passes as it enters the abdominal ring. In its course through the inguinal canal 

 it is accompanied by the ilio-inguinal nerve and the external spermatic branch of the genito- 

 femoral. 



The utero-sacral ligaments are flat fibro-muscular bands which extend, one on 

 each side, from the upper part of the cervix uteri to the sides of the sacrum op- 

 posite the lower border of the sacro-ihac articulation. They produce the recto- 

 uterine folds (fig. 1029) of peritoneum, which form the lateral boundaries of the 

 mouth of the recto-uterine pouch (of Douglas) and their muscle fibres [m. rec- 

 touterinus] are continuous at one extremity with the muscular tissue of the 

 uterus and at the other with that of the rectum. 



Structure. — The portion of the broad ligament that invests the uterus forms the serous 

 covering [tunica serosa] of the organ and is sometimes termed the 'perimetrium. Over the fundus 

 and the greater portion of the body it is thin and firmly adherent to the subjacent muscular 

 substance of the uterus, so that it cannot readily be separated from it. Over the posterior 

 surface of the cervix and the lower part of the anterior surface of the body, however, it is thicker, 

 and is separated from the muscular substance by a layer of loose connective tissue, the -para- 

 metrium, which also extends upward along the sides of the uterus between the two layers of the 

 broad hgament, with whose subserous areolar tissue it is continuous. Owing to this disposition 

 of the parametrium the whole of the cervix may be amputated without encroaching upon the 

 peritoneal cavity. 



The main mass of the uterus is formed by the muscle tissue [tunica muscularis] or myome- 

 trium, whose fibres have a very complicated arrangement. Two principal layers may be 

 distinguished, an outer, weak one, composed partly of longitudinal fibres continuous with those 

 of the tubse uterinse, and of the round and utero-sacral ligaments, and a much stronger inner 

 one, whose fibres run in various directions and have intermingled with them in the body of the 

 uterus large venous plexuses. The inner surface of the myometrium is Uned by a mucous 

 membrane [tunica mucosa] or endometrium, which has a thickness of from 0.5 to 1.0 mm. and 

 is composed of tissue resembhng embryonic connective tissue, bearing upon its free surface a 

 single layer of ciHated columnar epithehum. On account of its structure the tissue is rather 

 delicate and friable, and numerous simple tubular glands, which open into the cavity of the 

 uterus, traverse its entire thickness. In the cervix the mouths of some of the glands may 

 become occluded, producing retention cysts, which appear as minute vesicles projecting from 

 the surface between the plicae palmatse; they are known as ovula Nabothi, after the anatomist 

 who first described them. 



Vessels and nerves. — The principal artery of the uterus is the uterine, whose terminal 

 portion ascends along the lateral border of the uterus in a tortuous course through the para- 

 metrium, giving off as it goes lateral branches to both surfaces of the uterus. Above, it anasto- 

 mo.ses with the ovarian artery, which thus forms an accessory source of blood supply during 

 pregnancy. The veins form a plexus that is drained by the ovarian and uterine veins, a com- 

 munication with the inferior epigastric being also made by way of the vein accompanying the 

 round ligament. The lymphatics from the greater portion of the body pass to the iliac 

 nodes: those of the fundus accompany the ovarian vessels to the lumbar nodes. A vessel also 

 accompanies the round ligament to terminate in one of the superficial inguinal nodes. The 

 lymph-vessels from the cervix terminate in the external iliac, hypogastric and lateral 

 sacral nodes. 



The nerves of the uterus pass to it from two sympathetic ganglia, situated one on either 

 side of the cervix, whence they are termed the cervical ganglia, and forming part of the plexus 

 ulero-vaginalis . Branches pass to the ganglia from the h3^pogastric plexus and also from the 

 second, third and fourth sacral nerves. 



4. The Vagina 



The vagina (fig. 1034) is a muscular, highly dilatable canal lined by mucous 

 membrane, and extends from the uterus to the external genitalia, where it opens 

 to the exterior. Its long axis is practically parallel with that of the lower part 

 of the sacrum and it therefore meets the cervix uteri at a wide angle which is 

 open anteriorly. Its anterior wall is, accordingly, somewhat shorter than the 

 po.sterior, measuring 6.0-7.0 cm., while the posterior one is about 1.5 cm. longer. 

 It becomes continuous with the cervix uteri some distance above the lower 

 extremity of that .structure, which thus projects into the lumen of the vagina, and 

 there is so formed a narrow circular space between the wall of the vagina and 



