So in the next part of the tutorial, I'm going to take a look at some of the other details
of the female reproductive system.
So we're going to build on what we looked at before, but fill in some of the gaps.
So if you remember from the last tutorial, I mentioned that there were some ligaments
which support the viscera and attach from some of the pelvic organs to the pelvic side
walls.
So in this first part I'm going to talk about the fascia and the ligaments that are associated
with the female reproductive tract.
So in the pelvic cavity you've got fascia, which lines the pelvic walls and it surrounds
the pelvic cavity and it encapsulates the viscera, and it forms sheaths around the vessels,
and in various places this fascia actually condenses to form ligaments.
So it forms these ligaments which form slings around the viscera, and which also provide
attachment from the viscera to the walls of the pelvic cavity.
So if I just rotate this cross-section of the pelvis around, you can see we have the
bladder anteriorly, and then we've got the vagina, and then we've got the rectum and
the anal canal posteriorly.
So what I'd like to do is take a horizontal section through this level, and we'll take
a look at how the fascia forms ligaments around these viscera.
So I've just switched over to this quick sketch that I've made, and I'll just orientate you
briefly.
So posteriorly, we've got the sacrum here, and then anteriorly we've got the pubic symphysis,
and laterally we've got the pelvic side walls.
So posteriorly, we've got the rectum, anterior to the rectum we've got the uterus, and then
at the front we've got the bladder.
So the idea of this diagram is that it's a horizontal section of the pelvic viscera,
and I'm going to show you how the various ligaments attach to the uterus.
So you've got ligaments which attach posteriorly to the sacrum, you've got ligaments which
attach to the lateral side walls of the pelvic cavity, and you've got ligaments which attach
anteriorly to the front of the pelvic cavity.
So the bands of fascia which thicken to extend from the uterus to the sacrum are called the
uterosacral ligaments.
So I've drawn these on here in blue.
And then you've got the thickening of fascia which extends from the cervix to the lateral
side walls of the pelvic cavity, so these thickenings of fascia are called cardinal
ligaments, or the more descriptively named transverse cervical ligaments.
And then extending anteriorly, you've got the pubocervical fascia, which extends onto
the pubis of the pelvic cavity.
So this ligament extends forwards from the cardinal ligaments onto the pubis on either
side of the bladder.
So those three ligaments together with the levator ani muscle (which forms the bulk of
the pelvic floor) are responsible for supporting the cervix and uterus and also the vaginal
vault.
So coming back to this model here, I'd like to take a look at the relationship of the
broad ligament to the ovaries and the fallopian tubes, and some of the other ligaments which
are formed by its folds.
So the broad ligament itself, is this flat sheet of peritoneum which drapes over the
viscera, and it attaches from the side of the uterus to the pelvic side walls on either
side.
And within it, it contains the fallopian tube in its free, superior edge, which you can
see here.
It also attaches to the ovary via its posterior aspect, which is known as the mesovarium.
It contains the round ligament, the ovarian ligament, it also transmits the uterine vessels
and various branches of the ovarian vessels, and it also carries lymphatics and nerve fibres.
And if I rotate the model around, what you'll be able to see, is deep to this ligament,
you've got the ureters coming underneath it, to pass into the bladder.
Above the ureters at this point, you've got the uterine arteries being carried in the
broad ligament.
So a way to remember this relationship is the mnemonic, "water under the bridge", so
the water carried within the ureter refers to the water that's under the bridge, so the
bridge is the uterine artery.
So a ligament I mentioned just now was the round ligament.
So this ligament you can see here covered by the peritoneum, coming off the uterus.
So coming laterally off the uterus, you've got the round ligament, which passes in this,
underneath this anterior aspect of the broad ligament, and it actually passes through the
deep inguinal ring, to enter the inguinal canal.
It then runs along the entire length of the inguinal canal, just like the spermatic cord
in males, and it ends up in the labium majus in the perineum.
So that's the round ligament of the uterus.
So now moving onto the ovaries.
So I mentioned before that the ovaries are actually attached to the posterior aspect
of the broad ligament by something called the mesovarium, which is essentially a fold
of the broad ligament, which suspends the ovaries in the intraperitoneal space.
So the ovaries actually have two attachments, or two ligaments, so one ligament attaches
to the superior pole of the ovary, and the other attaches to the inferior pole.
So if I just rotate it slightly, you can see that there is a fold of peritoneum in the
broad ligament, on the lateral side of the broad ligament.
So this fold of peritoneum attaches to the superior pole of the ovary, and it's called
the infundibulopelvic ligament, or also the suspensory ligament of the ovary.
So this fold of peritoneum contains the ovarian vessels and the lymphatics, which pass from
the side walls of the pelvis and enter into the superior pole of the ovary.
And then if I just rotate the model so we can look from a superior view, you can see
that there's an attachment on the inferior pole of the ovary, which connects the ovary
to the uterus.
And this is called the ovarian ligament, and this ligament is a fibromuscular band of tissue,
which passes to the cornu of the uterus.
And upon attachment to the uterus, this ligament continues round anteriorly and laterally as
the round ligament which I just showed you.
So I've just outlined this in red.
So now you should have a good idea of the organisation of the ligaments which are involved
in the reproductive system