THE OVARY 



1393 



descending upon the posterior wall of the vagina, when the finger is placed here 

 it is only separated from the peritoneal sac by the vaginal wall and pelvic fascia. 

 In examination of the pelvic organs the bimanual method, b}^ which one hand 

 on the hypogastric region, pushes them down and steadies them as well, is always 

 to be employed to complete an examination. 



The uterus and appendages. — ^The normal non-gravid uterus is usually 

 anteflexed and anteverted so as to lie with its long axis approximately at right 

 angles to that of the vagina. Its position varies considerably \\dth the degree 

 of distention of the bladder in front and of the rectum behind. The distance 

 from external os to fundus, as estimated by the passage of a sound is in the 

 adult virgin uterus 5.5 cm. of which 3 cm. belong to the cervix and 2.5 cm. to the 

 body. In the empty multiparous uterus the total length of the cavity is 6 cm., 

 2.5 cm. comprising the neck and 3.5 cm. the bod}^ 



Peritoneal relations. — In front the peritoneum is reflected from the uterus to form the 

 utero-vesical pouch at the level of the isthmus. Behind it covers not only the uterus but the 

 posterior fornix of the vagina, before turning off onto the front of the rectum. Laterall}^ the 

 peritoneum leaves the uterus and passes on to the lateral pelvic wall as a large twofold partition 

 fig. 1118), the broad ligament. 



Fig. 1118. — Sagittal Section of the Broad Ligament. 



Mesosalpinx- 



Graafian follicles 

 of ovary 



Mesovarium 



Mesometrium 

 Posterior surface 



Ureter 



Fallopian tube 



Epoijphoron 



Round ligament with 

 funicular vessels 



Connective tissue and unstriped 

 muscle (utero-pelvic band) 



Uterine veins 



Uterine artery 



Base of ligament 



The broad ligament, bearing in its upper border the uterine tube, in front the round ligament 

 and behind the ovary, consists of (1) an upper thin part, the mesosalpinx lying above the 

 attachment of the mesovarium, and containing the ovarian vessels and the epoophoron, and 

 below this (2) the thicker mesometrium, between the layers of which is a dense mass of fibrous 

 tissue surrounding the uterine artery. 



The anterior aspect of the cervix below the utero-vesical pouch of peritoneum, is readily 

 separable from the bladder with which it lies in contact, and the peritoneum may be raised off 

 the uterus with ease in the lower part of its attachment both front and back. Over the upper 

 part of the body and fundus, however, the peritoneal covering is firmly adherent, and cannot 

 be dissected off. 



The ovary, attached by its hilum to the mesovarium, lies in a fossa at the 

 back of the lateral wall of the pelvis just between the diverging external iliac and 

 hypogastric vessels. To feel it the finger should be pushed well up in the side of 

 the vagina toward the lateral wall of the pelvis. On the abdominal surface its 

 position corresponds to the middle of a line drawn from the anterior superior 

 iliac spine of that side to the opposite pubic tubercle (Rawlings). 



