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1.The vestibule is an area enclosed by the labia minora. Bartholin's glands, sometimes called the

major vestibular glands, open into the posterior vestibule. These glands are prone to infection with

resulting occlusion of the ducts and the formation of grossly enlarged tender cysts.

2. The hymen is a membrane that may cover all or part of the vaginal opening just above the

vestibule. It may vary frombeing only small integumental remnants (known as myrtiformcaruncles) to

being perforated with one or many openings of various sizes, to being completely closed (imperforate

hymen) and require surgical intervention to allow menstruumto drain. The presence of myrtiform

caruncles is not pathognomonic of prior vaginal penetration (e.g., intercourse or childbirth). They are

of no pathologic significance.

3. The clitoris consists of two crura, a short body, and the glans clitoris with overlying skin called

the prepuce. It is attached to the pubic bone by a suspensory ligament. Within the shaft are corpora

cavernosa consisting of erectile tissue (loose in structure) that engorges with blood, causing erection

and enlargement (two times usual size) during sexual excitement. The clitoris and prepuce are the

primary areas of erotic stimulation in most women. The prepuce has the most innervation, which

usually comes froma terminal branch of the pudendal nerve in most women. Some women, however,

have alternate innervations and, in a few, innervation is sparse.

4. The size of the cervix and corpus changes with age and hormonal status; so does the ratio of

cervix to corpus. The infant uterus is only 2.5 to 3 cmin total length, and the cervix is larger than the

corpus. With aging, the size of the uterus changes, as does the ratio of cervix to corpus length. The

normal adult uterus is 7 to 10 cmlong.5. (B) Nabothian cysts are also called retention cysts because they are full of mucus fromthe blocked

crypts. They are benign and need no specific therapy. Their appearance is characteristic both grossly

and through the colpo-scope. Seldomis there any need for biopsy. Wolffian duct remnants cause cystic

structures along the broad ligament under the fallopian tube (paraovarian cysts) or on the lateral aspect

of the vagina (Gartner's duct cysts). The parmesonephron becomes the female reproductive system.

6. The uterus has a body (corpus) composed mainly of smooth muscle, and a cervix composed

mainly of connective and elastic tissues that are joined by a transitional portion (isthmus). It is an

estrogen-dependent organ measuring about 7.5 cmlong x 5 cmwide, with a 4-cmanterior-to-posterior

diameter. After puberty, the uterus weighs about 50 g in the nullipara and 70 g in the multipara. It lies

between the bladder anteriorly and the pouch of Douglas in front of the rectumposteriorly, with the

cervical portion extending fromthe intraperitoneal area into the vagina. The opening at the distal tip of

the cervix is called the external os. It is connected by the cervical canal to the internal os, which is

located just below the endometrial cavity. This cavity is lined by an epithelium, the endometrium.7. (A) The cervix protrudes into the fornix of the vagina, and the ovaries are intraperitoneal; therefore,

they are found cephalad to the cervix. The round ligaments are attached to the uterus anterior to the

attachment of the fallopian tubes. Retroflexion implies a sharp angle between the cervix and the fundus

of the uterus, which is bent posteriorly. This is a less common position of the uterus, which can also,

more commonly, be midposition or anteflexed. These are all normal positions of the uterus. It is

important to recognize which way the uterine body is flexed so that you do not perforate the lower

uterine segment while sounding the uterus or dilating the cervix. The uterus is normally mobile and if it

is not, adhesions or tumor may be present. The cervix is normally palpated anterior to the rectumon

rectal examination.

8. The cardinal ligaments are also called the transverse cervical ligaments, or Mackenrodt's

ligaments, and are considered part of the uterosacral ligament complex. These ligaments serve as the

major support for the apex of the vagina and are severed at the time of hysterectomy. Once divided at

hysterectomy, vaginal vault prolapse becomes more likely. The broad ligaments are mainly peritoneum

and the round ligaments mainly muscle. Neither provides much support. The arcuate ligament is not

attached to the uterus.

9. Fallopian tubes are a conduit fromthe peritoneal to the uterine cavity, which can also allow

spermor bacteria fromthe vagina through the uterus to the peritoneal cavity. Each tube is covered by

peritoneumand consists of three layers: serosa, muscularis, and mucosa. They traverse the superior

portion of the broad ligament attached by a mesentery (mesosalpinx). It has four distinct areas in its 8-

to 12-cmlength: the portion that runs through the uterine wall (interstitial or cornual portion), the

portion immediately adjacent to the uterus (isthmic portion), the midportion of the tube (ampulla), and

the distal portion containing the finger-like fimbriae that sweep the ovuminto the infundibu-lumof the

tube. The fimbriae are intraperitoneal. The tubal lumen becomes increasingly more complex as it

approaches the ovary. In tubal reanastomoses, the greatest success is attained when isthmic-isthmic or

isthmic-ampullary regions can be reapproximated. The longest of the fimbriae (the fimbriae ovarica) is

attached to the ovary.

10. The urogenital diaphragmis immediately cephalad to the muscles of the external genitalia. It

consists of a tough fibrous fascial membrane inferiorly covering the triangular area under the pubic

arch and extending posteriorly to the ischial tuberosities. It is penetrated by the urethra and vagina in

the female. Just cephalad to this fascia are the deep transverse perineal muscle and the urethral

sphincter mechanism. The superior fascia of the urogenital diaphragmis attached tightly to these

muscles and is just caudad to the levator ani muscle. The urogenital diaphragmsupplies support for the

anterior vagina, urethra, and trigone of the bladder. The area encompassing the urogenital diaphragm

and the superficial and deep perineal spaces is referred to as the urogenital triangle