• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

41 Cards in this Set

  • Front
  • Back

What two compartments do the pelvic floor separate?

Main pelvic cavity superiorly and perineum inferiorly

What is the pelvic floor composed of?

The diaphragm is formed by levator ani
muscles, coccygeus muscles and their
covering fascia.

Incomplete anteriorly – urethra and vagina
in females

Remember this diagram

Remember the sacral plexus in relation to the pelvic floor.

What are the anatomical components of the levator ani and their origins and insertions?

• Sphincter vaginae
– Form a sling around prostate or vagina and insert into the perineal body (supports constrict vagina)
• Puborectalis
– sling from pubic bone around rectoanal junction
• Pubococcygeus
– pubis to anococcygeal body (a fibrous mass between tip of coccyx and the anal canal)
• Iliococcygeus
– Ilium to anococcygeal body and coccyx

Describe the female pelvic floor when viewed superiorly.

Be able to describe the order from superior to inferior of the pelvic floor muscles when viewed laterally - female.

What is the function of the levator ani?

• Supports and maintains pelvic viscera in
• Resist intrapelvic pressure and expulsive
efforts of abdominal muscles
• Assists sphinter urethrae (eus)
• Important sphincter action on the anorectal
junction (also sphincter of the vagina)

What are the anatomical features of the ureter?

• Retroperitoneal, muscular tubes
• Pass over the pelvic brim at bifurcation of common iliac arteries in front of the
sarcoilliac joint
• Run on lateral walls of pelvis
• Opposite ischial spine, curve anteromedially
• Oblique entrance into bladder
– one way flap valve
• posterosuperior angles of thebladder

What are the anatomical features of the bladder?

• Extraperitoneal
• Pyramidal
– Apex – median umbilical ligament (urachus)
– Trigone posteriorly, between 2 superior ureteric orifices
• Relations:
– Inferolaterally – fat filled retropubic space, levator ani muscle and obturator internus
– ♀ superior and posterior surface– uterus, inferiorly – urogenital diaphragm.
– ♂ superior surface – rectum, posteriorly - seminal vesicles and ducta deferentia, inferiorly - prostate

What is the clinical relevance of the pouch of Douglas?

– Accumulation of blood or pus
– Commonly violated by misguided instruments that pierce the posterior fornix

Describe the ligaments of the female reproductive system.

What are the remnants of the gubernaculum in females and what do they connect?

• Ovarian ligament (cranial gubernaculum)

– Ovary to uterus

• Round ligament of uterus - can be source of pain in pregnancy if tight - caudal gubernaculum).

– Uterus to labium majorum via inguinal canal

Describe the anatomy of the blood vessels supplying the uterus.

What supports does the uterus have?

• Levator ani muscles and the perineal body
• Transverse cervical (cardinal) ligaments
– Fibromusc from lat. Pelvic walls to cervix and upper vagina
• Pubocervical Ligaments
– 2 firm bands CT from pubis to cervix (either side of bladder
• Sacrocervical ligaments
– Fibro musc bands cervix to sacrum

What are anatomical features of the vagina?

• Thin muscular tube extending backwards from the vulva to the uterus
• Upper half above pelvic floor, lower perineum
• Upper end of vagina pierced by cervix. The lumen surrounding cervix divided into fornices – ant, post, and 2 lats

What are the anatomical relations of the vagina?

Relations of the Vagina
• Ant – bladder/urethra
• Post – pouch of douglas, ampulla of rectum, perineal body
• Lat – ureters,levator ani, urogenital
- diaphragm and bulb of vestibule

Describe the pelvic floor when viewed sagitally.

What is in the female superficial perineal pouch?

• 3 masses of erectile tissue
– Bulb of vestibule – attached to urogenital diaphragm - Divided by vagina
– Crura of clitoris (respond to crura of penis (corpus cavernosa)
• 3 muscles
– Bulbospongiosus – surrounds vaginal orifice and covers vestibular bulbs
– Ischiocavernosus
– Superficial transverse perineal muscle
• Greater Vestibular Gland (Bartholin’s gland)
• Perineal Body

Describe the deep and superficial dissections of the perineum.

What is the anatomical relevance of the perineal body in females?

• Perineal Body
– Larger than in male. Clinically very important. Wedge shaped mass fibrous tissue between vagina and anus. Supports vaginal wall
– Point of attachment of muscles that assist perineal body to support vaginal wall
• Levator ani
• External anal sphincter
• Bulbospongiosus
• Superficial transverse perineal

What occurs upon injury to the pevlic floor during pregnancy?

• Difficult childbirth – levator ani muscles fail
to recoil and take up previous position
– Uterine and vaginal prolapse
– Heriation of the bladder (cytocele)
– Alteration of position of bladder neck – stress
– Prolapse of the rectum

Describe first and second degree prolapse of the uterus and the muscles that resist this.

What enters the pudendal canal?

• Pudendal nerve branch of the sacral plexus
• Internal Pudendal artery/vein branch internal iliac artery
• Leave pelvis through greater sciatic foramen
• Enters the perineum through the lesser sciatic foramen
• Pudendal Nerve
– Inferior rectal nerve
– Dorsal nerve of penis/clitoris
– Perineal nerve
• Internal Pudendal Artery
– inferior rectal
– Branches to penis, labia + clitoris

Describe the nerves that cover the pubic area in women.

Remember ischial spine is site of pudendal nerve blockade

What are general visceral afferents?

• Visceral afferents conduct impulses from
organs, glands and blood vessels which
travel via sympathetic and parasympathetic
• We are not conscious of MOST of these
impulses (afferent part of most visceral
reflexes e.g. the brain sensing the need for
the secretion of bile

How do GVA impulses reach the spinal cord?

• GVA impulses reach the spinal cord through
sympathetic pathways through T1-5 from the
thoracic viscera, and T5-L2 for most of the
• GVA impulses travel with parasympathetic
splanchnic nerves in the pelvis S2-4

What are the characteristics of spinal anaesthesia?

– Subarachnoid space L4-5. Complete anaethesia
below waist monitoring of uterine contractions.
Commonly followed by headache

What are the characteristics of pudendal nerve block?

– Peripheral nerve block S2-4 – perineum and lower ¼ vagina – mother can feel/assist contractions

What are the characteristics of caudal epidural block?

– Anaesthetic administered to catheter in sacral

canal (but must be done in advance). More

anesthetic can be administered if necessary, limbs still unaffected

Affects the pelvic SPLANCHNIC nerves - during childbirth still have abdominal muscles and can move leg as legs - lumbar and upper sacral

Describe the sites of administration of the above mentioned anaesthetic blocks.

What is the function of the obturator internus?

Lateral rotation of the hip - attachment to greater troch

+ fascia allows attachment tendinous arch of levator ani to ischial spine - pelvic floor attachment

Where does the sciatic nerve emerge?

Inferior to the pirirformis

Where does the sciatic nerve emerge?

Inferior to the pirirformis

What is the route of the pudendal nerve?

Deep to the pelvic floor

What is the broad ligament?

Double folded sheet of peritoneum.

Aka mesometrium

Connects uterus to walls and floor of pelvis

What is the suspensory ligament of the ovary?

Carries ovarian vessels

Ovary to walls of pelvis

Describe the blood vessels of the pelvis.

Bifurcation of abdo aorta

Bifurcation int and ext iliac.

Lots of lumbar venous plexi cf sacral fracture

Where does the ovarian artery come from?

L2 near renal arteries

Nb anastomoses with uterine artery

What is the relevance of water under the bridge?

0.5-2% of hysterectomies/routine uterine surgeries damage Ureter - only covered by slight amount of peritoneum

Check for extravasation of urine

What is the clinical significance of a retroverted/retroflexed uterus?

Painful intercourse - cervix is directly facing vagina