The Ovary, ovoid in shape and about 1¼ inches long by ½ inch broad at its widest part, is situated nearly vertically, its upper pole being attached to the pelvic brim by the suspensory ligament, while the lower pole is connected to the uterus by the ligament of the ovary, which consists of a rounded fibro-muscular band, slightly over 1 inch in length, which is attached to the uterus just below and behind the point of entrance of the Fallopian tube. The outer end of the Fallopian tube arches round the upper pole of the ovary, to which the ovarian fimbria is frequently attached. Instead of lying directly in the plane between the layers of the triangular ligament, the ovary forms a projection on the posterior wall, pushing, of course, the posterior layer of the broad ligament before it as it does so, and thus forming a short mesentery, the mesovarium. Thus the ovary is said to possess a posterior free border (covered, however, by altered peritoneum), and an anterior border to which the two layers of the mesovarium are attached, and between the layers of which the ovarian vessels and nerves with some connective tissue and muscular fibres run. The ovary thus projecting from the posterior layer of the broad ligament is frequently accommodated in a depression in the pelvic peritoneum lining the posterior part of the obturator fossa, to which the name 'ovarian fossa ' is given. This fossa lies between the obliterated hypogastric artery in front and ureter and uterine vessels behind, which thus form relations of the ovary, while above the ovary lie the external iliac vessels, and below, the peritoneum covering the pelvic floor. The ovary may be palpated by the fore and middle finger of one hand in the posterior cul-de-sac of vagina pressing up and outwards, and the fingers of the other hand flat above the centre of Poupart pressing downwards. The ovary seldom leaves its normal position, save in uterine displacements, or when affected by tumour. Occasionally, it becomes prolapsed, and may occur in her nice.
Ovarian tumours are most frequently cystic, and generally originate from the cortical zone in the region of the Graafian follicles. Such tumours frequently attain an enormous size, and have a pedicle composed of ovarian ligament, Fallopian tube, broad ligament, etc. Dermoids occasionally occur, as also sarcomata. Removal of the ovary, or ovariotomy, is necessitated in such cases, the pedicle, which contains many large vessels, being carefully ligatured. Removal has also been suggested in carcinoma mammae as likely to retard the growth, but has not proved successful.
The peritoneum covering the surface of the ovary is altered, being nodular and covered by a layer of columnar cells. The ovary is supplied with blood by the ovarian artery-a branch of the aorta-and by the ovarian branch of the uterine artery, both of which pass to the ovary along the mesovarium. The ovarian veins emerge by the mesovarium, and form a plexus between the layers of the mesosalpinx. The lymphatics ascend by the suspensory ligament of the ovary to the lumbar glands, and the nerves are derived from the tenth dorsal segment of the cord through the ovarian plexus (a branch of the aortic plexus), and some branches of the uterine plexus.
The hydatids of Morgagni are small pedunculated cystic structures near the infundibulum of the Fallopian tube. One or more in number, they are supposed to represent the upper end of the Wolffian duct. Situated between the layers of the mesosalpinx and in its outer one-third, lying between the Fallopian tube and the ovary, is the parovarium (organ of Rosenmuller). This consists of over half a dozen tubes, lined with ciliated epithelium, one of which, running parallel to the Fallopian tube, is called the duct of Gartner, and represents the Wolffian duct. The remainder are homologous with the male vasa efferentia and epididymis. Also lying between the layers of the mesosalpinx, but internal to the parovarium, is the paroophoron. This consists in infancy of a series of coiled tubes, representing the mesonephros, and is homologous with the paradidymis of the male.
Parovarian cysts may arise from either the parovarium or paroophoron. They occur between the layers of the broad ligament, and are generally unilocular and filled with clear fluid.
The round ligament, a fibro-muscular band nearly 6 inches in length, extends from the lateral angle of the uterus in front, and a little below the opening of the Fallopian tube, horizontally outwards between the layers of the broad ligament to the lateral pelvic wall, whence it is directed upwards and forwards to the trigonum femorale, and, curving round the deep epigastric artery, enters the internal abdominal ring. In its pelvic stage it crosses the obturator vessels and nerve, obliterated hypogastric artery, and external iliac vessels, and in the inguinal canal it is accompanied by the ilio-inguinal nerve, a process of transversalis fascia, and sometimes by a process of peritoneum called the canal of Nuck. It ends in the subcutaneous tissue and skin of the labium majus. The presence of the canal of Nuck predisposes to congenital inguinal hernia, and occasionally it may become distended with fluid, causing a hydrocele of the canal of Nuck. The round ligaments are sometimes shortened in order to correct retroversion or flexion of the uterus (Alexander's operation). This is done by exposing them at the external abdominal ring, pulling the anterior portions forwards on both sides, and fixing them to the parietes.
The lower subdivision of the broad ligament, that below the line of attachment of the mesovarium, is called the meso-metrium, and becomes thick as it approaches the pelvic floor. Ultimately the peritoneum of the anterior layer is reflected on to the lateral pelvic wall and bladder, while posteriorly on either side it forms the sacro-genital fold (these folds being connected by a ridge on the posterior wall of the cervix, called the torus uterinus), and thence gains the lateral and posterior pelvic walls. The extraperitoneal tissue situated on either side of the cervix and upper part of the vagina, and which is continued for a considerable distance between the layers of the broad ligament, and is continuous with the extraperitoneal tissue lining the lateral pelvic wall, etc., is called the parametrium. In it run the uterine vessels, nerves, and lymphatics, and the ureter.
The ureter runs from the sacro-iliac articulation down and backwards to near the floor of the lateral pelvic wall, whence it enters the broad ligament. This portion is 3 inches long, and lies first in front of, or to the inner side of, the internal iliac vessels ; then forms the posterior boundary of the obturator fossa, and lies immediately behind the ovary. The second portion, 2 inches long, traverses the parametrium between the layers of the broad ligament, ½ inch above the lateral vaginal fornix, and separated from the supravaginal cervix by ¾ inch. Here it is closely enveloped in the venous plexuses, and is crossed above by the uterine artery. Thence it converges towards its neighbour of the other side, so that it is even nearer the cervix in front than laterally (and may be detected by palpation from the vagina), to enter the bladder at the basal angle of the trigone 1 inch below the level of the external os, and just above the roof of the vagina, its course through the bladder wall being very oblique, and measuring ¾ inch in length.
The term Vulva is applied to the female external genitals, including the labia majora and minora, clitoris, urethral and vaginal openings. The urethral orifice is immediately in front of that of the vagina, and an inch behind the clitoris, and is surrounded by slightly prominent margins. The vaginal opening is partially closed in the young by the hymen, and when this is imperforate, as it occasionally is, retention of the menses occurs. Bartholin s glands (equivalent to Cowper's), each about the size of a small bean, are situated low down on the lateral wall of the vagina, and open by slender ducts in the angle between the vagina and labium minus. Cystic dilatation, or even abscess of the duct, may occur. The laoia majora are similar to the scrotum in nerve and blood supply and pathological tendencies. They may become very oedematous, or present large extravasations of blood, and may be affected by elephantiasis.