FEMALE PELVIS.

The contents of the female pelvis are the following:

Viscera.

Blood-vessels.

Nerves.

5.

Certain venous plexuses in connection with the viscera.

1. The sacral and sacro-coccygeal plexuses and their branches.

2. The obturator nerves.

3. The pelvic part of the sympathetic.

The peritoneum is continued into the pelvis, and clothes some of the viscera completely and others partially.

General Position of the Viscera.—The rectum, as in the male, occupies the posterior part of the pelvic cavity, and is adapted to the concavity of the sacrum and coccyx. The bladder and urethra are situated in front, the former lying against the posterior aspect of the pubic bones. The uterus and vagina are intermediate in position; whilst the uterine appendages are placed laterally. Three tubes or canals are thus directed downwards to open on the surface within the limits of the perineum, viz. (a) the urethra ; (b) the vagina; (c) the rectum. (Figs. 156 and 157).

Peritoneum. The peritoneum, as it proceeds downwards from the posterior abdominal wall into the pelvis, comes into relation with the rectum, and gives it a partial covering. The first part of the gut it clothes completely and connects by means of a distinct fold, called the mesorectum, to the anterior surface of the sacrum. Gradually it quits the rectum, leaving first its posterior surface, then its

lateral, and finally its anterior surface. The peritoneum is now reflected on to the posterior wall of the upper part

FIG. 156. Mesial section through the pelvis of a virgin (after Legendre). The uterus is smaller than usual.

BRAUNE'S Atlas of Topographical Anatomy.)

(From

of the vagina, upon which it ascends to the posterior surface of the uterus, which it covers completely. Reaching the

fundus of the uterus, it turns over this and descends upon the anterior aspect of the organ. This surface of the uterus it only invests in its upper three-fourths, and is then reflected on to the posterior aspect of the bladder. Whilst the vagina, there

fore, receives a partial investment from the peritoneum posteriorly, it is altogether destitute of it anteriorly; and, again, whilst the entire posterior surface of the uterus is covered, the lower fourth of its anterior surface is bare, in so far as this membrane is concerned. From each lateral border of the uterus the peritoneum stretches outwards in the form of a wide fold, called the broad ligament. This connects the organ to the lateral wall of the pelvis and the iliac fossa.

FIG. 157.-Horizontal section through the urethra, vagina, and anal canal, a short distance above their terminations. (Henle.)

Ua. Urethra.
Va. Vagina.

L. Levator ani.
R. Rectum.

Upon the bladder the peritoneum is carried upwards, and at its apex is conducted to the posterior aspect of the anterior abdominal wall by the urachus. On each side of the viscus it extends outwards as far as the obliterated hypogastric artery, along the line of which it quits the bladder, and is continued on to the pelvic wall. An important point to notice is, that the peritoneal membrane is much more adherent to the wall of the uterus than it is to the wall of the bladder.

Broad Ligament of the Uterus (ligamentum latum

uteri). This is a wide fold composed of two layers of peritoneum which stretches from each lateral border of the uterus to the opposite part of the pelvic wall and iliac fossa. The superior border of the ligament is occupied by the Fallopian tube, the fimbriated free outer extremity of which opens into the peritoneal cavity. Here, therefore, a continuity is established between the mucous lining of the tube and the peritoneal membrane. At a lower level than the Fallopian tube two secondary folds will be observed in

FIG. 158. The uterus, with the broad ligament stretch-
ing out from either side of it (from Gegenbaur). The line
which leads from LIGAM. OVARIO-PELV. on the left side

points to the round ligament of the uterus. The peritoneal
fold immediately beyond this is the ligamentum ovario-
pelvicum.

connection with the broad ligament. Of these one projects backwards, and contains between its layers the ovary and its ligament, whilst the other is directed forwards, and contains the round ligament of the uterus.

In addition to these more conspicuous objects, the two layers of the broad ligament include between them other structures, viz.-(1) the parovarium; (2) the uterine and ovarian vessels, nerves, and lymphatics.

The part of the broad ligament which extends from the

upper end of the ovary to the iliac fossa in the neighbourhood of the external iliac vessels receives the special name of the ovario-pelvic ligament, or the suspensory ligament of the ovary. It contains between its two layers the ovarian vessels and nerves.

Recto-Vaginal Pouch, or the Pouch of Douglas.-This corresponds with the recto-vesical pouch in the male. In front, it is bounded by the peritoneum clothing the vagina and uterus; behind, by the membrane investing the rectum; whilst, on each side, it is limited by a semilunar fold of peritoneum which proceeds forwards from the side of the rectum to the side of the uterus. Some importance is attached to the fact that this pouch is slightly deeper on the left than upon the right side.

The Utero-vesical Pouch is much shallower than the preceding. It is placed between the uterus and the bladder, and it is limited laterally by two slight anteroposterior folds of peritoneum, termed the utero-vesical folds, which pass between these viscera.

False Ligaments of the Bladder and Uterus.-The false ligaments of the bladder are five in number, viz., one superior, two lateral, and two posterior.

The two posterior false ligaments of the bladder are the utero-vesical folds, which extend between the uterus and bladder, and limit the utero-vesical pouch laterally.

The superior false ligament is that portion of the peritoneum which passes from the apex of the bladder on to the anterior wall of the abdomen. It is led away from the viscus by the urachus and the two impervious hypogastric arteries.

The lateral false ligament is the term applied to the peritoneum as it passes from each side of the bladder to the wall of the pelvis and the iliac fossa. This reflection has been seen to take place along the line of the obliterated hypogastric artery.

The false ligaments of the uterus are four in number— two anterior and two posterior. These are simply other names applied to the recto-uterine and utero-vesical folds.