Atlas of Human Anatomy by Netter

Anterior- Vesicouterine pouch, superior surface of bladder

Posterior- Rectouterine pouch and anterior surface of rectum, loops of intestine in pouch

Vascular supply of uterus (including cervix)

Arterial

Uterine arteries (branches of internal iliac arteries)

Vaginal arteries (branches of uterine arteries with anastomoses with internal pudendal arteries)

Venous drainage: via uterine venous plexus to internal iliac veins

Lymphatics drain to

External iliac nodes

Internal iliac and sacral nodes

Superficial inguinal nodes (along round ligament)

Innervation

From the uterovaginal plexus, a subdivision of the inferior hypogastric (pelvic) plexus

Sympathetic, parasympathetic, and visceral afferents to and from the uterus pass through this plexus

Sympathetic innervation from lower lumbar spinal cord segments via lumbar splanchnic nerves and intermediate plexuses

Parasympathetic innervation from pelvic splanchnic nerves (S2,3,4 spinal cord levels) via pelvic plexus

Afferent fibers with pain information from body and fundus ascend through plexuses to lumbar splanchnic nerves to reach upper

lumber/lower thoracic spinal cord segments

Afferent fibers with pain information from cervix and all information except for pain from body and fundus follow parasympathetic fibers back

to central nervous system

Vagina

Basic structure

Muscular tube, 8 to 10 cm long

Superior end surrounds the cervix: upper two thirds lie within pelvic cavity

Slopes downward and forward through the pelvic diaphragm

Opens inferiorly into vestibule between labia minora

Lining has multiple transverse folds-rugae

Recessed area of vagina around the cervix is called the vaginal fornix; composed of shallow anterior, deep posterior, and lateral fornices

Posterior fornix directly related to rectouterine pouch

Relationships of the vagina

Superior External os cervix

Inferior Vestibule between labia minora

Anterior Posterior wall bladder

Posterior Rectouterine pouch

Ampulla of rectum

Lateral Levator ani muscles

Blood supply

Uterine arteries supplies superior part

Vaginal arteries supply middle part

Lower part supplied by middle rectal and internal pudendal arteries

Venous drainage

Vaginal venous plexus to uterine venous plexus to internal iliac veins

Innervation

Upper three fourths same as uterus

Lower one fourth is somatic via the pudendal nerve

Visceral and sympathetic fibers reach the lower one fourth via the pudendal nerve; no parasympathetics

Variations in Position of the Uterus

When the bladder is empty, body of the uterus bent anteriorly on the cervix: anteflexion

Axis of cervix also bent forward relative to axis of vagina: anteversion

Thus the body of uterus lies on superior surface bladder

Full bladder reduces these angles

Reversal of these angles is called retroversion and retroflexion

Ligaments Associated with the Uterus

Broad ligament

Double layer of peritoneum that sweeps up and over the uterus, ovaries, and the uterine tubes

Thus has an anterior and a posterior lamina

Extends from the sides of the uterus to the lateral pelvic walls