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et revolution du tubercule genital chez le foetus humain dans les deux sexes, avec qutiques rcmarqucs
concernant le developpement des glandesprostatiqius, Journal de 1'anatomie, annee xxv., 1889.

Waldeyer, Ueber Bau u. Entwickl. d. Samenfaden, Anat. Anzeiger, 1887.

"Weil, Ueber den Descensus Testiculorum, <kc., Prager Zeitschr. f. Heilkunde. ]884.

Zieg-ler, Contribution a Vetude de la circulation veincuse de la prostate, These, Bordeaux, 1893.



THE EXTERNAL GENITALS.



253



REPRODUCTIVE ORGANS IN THE FEMALE.

THE genital organs in the female consist of a pair of glands called the ovaries,
and of certain passages leading from the peritoneal cavity to the exterior. These
passages may be divided into a pair of lateral ducts, the Fallopian tubes, and a single



FT.



A.




Fig. 266. DIAGRAM OF FEMALE GENITAL PASSAGES. Modified from Henle. (J. S.)

o., ovary ; p"., parovarium ; F.T., Fallopian tube ; p'., pavilion at fimbriated end of Fallopian tube ;
A., ampulla of Fallopian tube ; i., isthmus of Fallopian tube ; F.. fundus of uterus ; B., cavity of body of
uterus; i.o., os uteri internum ; c., cavity of cervix % of uterus ; E.G.. os uteri externum ; va., vagina. ;
H., hymen ; u., orifice of urethra ; v., vestibule ; N., labium minus ; L.M.. labiummajus ; p., pudendal
or vulval cleft. The passage from u. to p. constitutes the uro-genital space.

median passage, which consists of three main portions named from above downwards
the uterus, vagina, and uro-genital space, or vulval cleft. Fig. 266 shows diagram -
matically the general relations of these parts. The structures which bound the
uro-genital space constitute the external genitals, while those above the hymen are
the internal genitals.

THE EXTEKNAL GENITALS.

The vulva, or pudendum, is a general term for the external genitals
(fig. 268). It includes the inons Veneris, the Idbia majora and minora, the clitoris,
and the hymen. The ureihra may also be described in connection with these parts.

The moiis Veneris is an eminence formed by a mass of areolar and adipose
tissue covered by skin provided with numerous hairs. It is situated in front of the
upper part of the pubic symphysis.

The labia majora are two rounded folds of skin extending downwards and
backwards from the mons to within about an inch of the anus. Each labium
has an outer convex surface, resembling ordinary skin, covered with hairs, and an



254



FEMALE REPRODUCTIVE ORGANS.



inner smooth surface of a pinkish colour, which lies against the opposite labium.
Within the substance of the fold there is found, besides fat, vessels, nerves, and
glands, a tissue resembling that of the dartos in the scrotum of the male, to which
the labia majora correspond. The labia majora, by their contact, generally conceal
the other parts of the external genitals ; not unfrequently, however, in old persons




Fig. 267. VIEW OF THE FEMALE ORGANS OF GENERATION FROM BEHIND, THE VAGINA BEING CUT OPEN

AND ITS WALLS TURNED ASIDE. (Sappey.) .

1, ovaries ; 2, Fallopian tubes ; 3, 4, 5, their fimbriated extremities (4 points to the osthun abdomi-
nale) ; 6, ovarian fimbria ; 7, ligament of the ovary ; 8, 9, broad ligaments ; 10, uterus ; 11, its
vaginal portion ; 12, os uteri ; 13, lateral and posterior walls of vagina reflected ; 14, its anterior wall ;
15, edge of hymen ; 16, orifice of urethra ; 7, vestibule ; 18, nymphae ; 19, clitoris ; 20, labia majora.

the labia minora project forwards between the labia majora so as to be visible
externally.

The labia minora, or nymphae, are two narrow pendulous folds of skin, one
on the inner surface of each labium majus. From their attached borders they
extend downwards, having their outer surfaces in contact with the labia majora, and
their inner surfaces against one another. Anteriorly each labium divides into two
branches, the upper of which joins the prepuce of the clitoris, and the other its
glans. Posteriorly the labium minus may end by gradually blending with the inner
surface of the labium majus, but in some cases it can be traced backwards until it
becomes continuous with a transverse fold of skin situated at the anterior edge of
the perineum, and known as the fourchette. The nymphse and fourchette resemble
one another and differ from the labia majora in being devoid of fat. In young



THE EXTERNAL GENITALS.



255



subjects the labia minora are of a rosy- red colour, and look like a mucous membrane,
but as age advances they become darker in colour and more like skin.

The clitoris, the homologue of the penis, is an erectile organ composed of two
corpora cavernosa and a rudimentary glans. It differs from the penis in being
much smaller, and in not being traversed by a urethra. The corpora cavernosa are
separated behind where they constitute the crura of the clitoris, but they unite in
front to form its body. Each crus is firmly attached to tho inner aspect of the
pubic arch superficial to the triangular ligament, and is covered by the ischio-
cavernosus or erector clitoridis muscle. In the body of the clitoris the two corpora

Fig. 268. VIEW OF EXTERNAL GENITALS OF

ADULT FEMALE, WITH THIGHS ABDUCTED,
AND LABIA MAJORA AND MINORA SEPARATED.

(J. S.)

1, labium majus ; 2, labium minus ; 3, pre-
putium clitoridis ; 4, vestibule ; 5, hymen ; 6,
fourchette ; 7, vaginal orifice ; 8, base of perineal
body ; 9, opening of duct of gland of Bartholin ;
A., anus. Dotted line to show position of outlet
of Hgamentous pelvis ; G.S. , great sacro-sciatic
ligament ; p. A., pubic arch ; c., coccyx.

cavernosa are closely united by their
flattened inner surfaces, the fibrous
septum between them (septum pec-
tiniforme) being incomplete. The
body is fixed by a small suspensory
ligament to the front of the symphysis
pubis, from which point it extends
downwards and backwards for about an
inch and a half. Its extremity is sur-
mounted by a small glans composed of
spongy erectile tissue. The glans is
imperforate, highly sensitive, and sur-
rounded superiorly by a membranous <' ^ i$l ; . ; / '>
fold, like the prepuce of the penis, while ^ \
below it gives attachment to a small V
frasnum. The prepuce and frsenum \
are continuous with the labia minora. \?
Erectile tissue. All the parts of : :: , (&!
the vulva are abundantly supplied with i;SIII
blood-vessels, and in certain situations v %tliflfl
there are masses composed of venous
plexuses or erectile tissue, corresponding
to those found in the male. Besides the corpora cavernosa and glans clitoridis
just referred to, there are two oval masses of erectile tissue, the bulbi vestibuli (figs.
269 and 270, a). P^ach bulb is about an inch long, and lies in the side wall of the
uro-genital space a little above the nymphse and superficial to the triangular liga-
ment. The bulbs are rather pointed at their upper extremities and rounded below ;
their inner aspects are partially covered by mucous membrane, while on the outer
side they are embraced by the fibres of the bulbo-cavernosus muscle. Together
they are equivalent to the bulb of the urethra in the male, which, it will be remem-
bered, shows traces of a median division. In front of the bipartite buFb of the
vestibule is a smaller plexus on each side, the vessels of which are directly continuous
with those of the bulbi vestibuli behind, and of the glans clitoridis in front. This
is the pars intermedia of Kobelt, and is regarded by him as corresponding with the





256



FEMALE REPRODUCTIVE ORGANS.



part of the male corpus spongiosum urethrse which lies between the bulb and the
glans. It receives large veins coming direct from the nymphse.

The uro-genital space, or vulval cleft, is a median fissure, which opens below
on to the surface between the two labia majora, and receives at its upper part the
orifices of the urethra and vagina. A portion of this space bounded infront by the glans
clitoridis, behind by a transverse line at the level of the urethra, and at the sides by the
labia minora, is called the vestibule. At the posterior part of the space there is a recess
between the fourchette and the hymen, called the fossa navicularis. The more
superficial part of the space bounded by the labia majora and minora, is lined by




269. LATERAL VIEW OP THE ERECTILE STRUCTURES OF THE EXTERNAL ORGANS IN THE FEMALE.

(From Kobelt.) |.

The blood-vessels have been injected, and the skin and mucous membrane have been removed ;
a, bulbus vestibuli ; c, plexus of veins named pars intermedia ; e, glans clitoridis ; /, body of the
clitoris ; h, dorsal vein ; I, right crus clitoridis ; m, vestibule ; n, right gland of Bartholin.

Fig. 270. FRONT VIEW OF THE ERECTILE STRUCTURES OF THE EXTERNAL ORGANS IN THE FEMALE.

(From Kobelt. ) f.

, bulbus vestibuli ; 6, sphincter vaginae muscle ; e, e, venous plexus or pars intermedia ; /, glans
clitoridis ; .7, connecting veins ; h, dorsal vein of the clitoris ; k, veins passing beneath the pubes ;
/, the obturator vein.

skin, and the deeper part by mucous membrane, which is continuous with the
mucous membrane of the urethra and vagina. According to Berry Hart, the line
separating skin from mucous membrane runs from just below the prepuce of the
clitoris backwards on each side along the base of the inner aspect of the labiurn minus
to the outer aspect of the base of the hymen. The raucous membrane is smooth,
reddish in colour, is covered by a scaly epithelium, and is provided with a consider-
able number of mucous crypts or follicles, and with glands which secrete an unctuous
and odorous substance. Sebaceous glands are found beneath the prepuce and
upon the labia majora and minora. Fine, downy hairs can be seen on the inner
aspect of the labia majora, but none on the labia minora.

The glands of Bartholin, or of Duverney (fig. 2G9, w), corresponding to Cowper's
glands in the male, are two reddish-yellow, round or oval bodies, measuring about
half an inch in the longest diameter, lodged one on each side of the commencement
of the vagina and beneath the inferior layer of the triangular ligament. Their
ducts, which are long and simple, open one on each side a little in front of the fossa
navicularis, by the side of the vaginal orifice, in the groove between the attached
border of the hymen and the labium minus (Cullingworth). As a rule, the orifices
of these ducts are too small to be distinctly recognized with the naked eye.



THE EXTERNAL GENITALS.



257



Blood-vessels. Arteries. The outermost parts of the vulva are supplied by
the superficial pudic and perimal arteries ; the deeper parts and all the erectile tissues
receive branches from the internal pudic arteries as in the male. The veins also in a
great measure correspond ; there is a dorsal vein of the clitoris receiving branches
from the glaus and other parts as in the male ; the veins of the bulbus vestibuli pass
backwards into the vaginal plexuses, and are connected also with the obturator




v;



Fig. 271. TRANSVERSE SECTION PASSING FROM ABOVE DOWNWARDS AND SLIGHTLY BACKWARDS THROUGH

THE ANTERIOR PART OF THE PELVIS OF A WOMAN AGED 54 YEARS : SEEN FROM THE FRONT. (J. S.) \

B, Bladder, cut across about half-an-inch in front of urethral orifice, i ; E, external urinary meatus,
formed a vertical slit on a slight prominence ; A, opening of left ureter ; v.c., vulval cleft ; u, anterior
wall of urethra ; v. B., vestibular bulb ; c, crus clitoridis ; B.C., bulbo-cavernosus muscle ; i.e., ischio-
cavernosus muscle ; L.M. , labiuin majus ; L.HI., labium minus ; P. A., pubic arch ; o.i., obturator
interims muscle ; x., on triangular ligament ; p., pelvic fascia.



veins : above they communicate with the veins of the pars intermedia, those of the
corpora cavernosa and the glans of the clitoris, and also with the vena dorsalis. The
lymphatics accompany the blood-vessels.

Nerves. Besides sympathetic branches, which descend along the arteries,
especially for the erectile tissues, there are other nerves proceeding from the lumbar
and sacral plexuses ; those from the former being branches of the genito-crural, and
those from the latter of the inferior pudendal and internal pudic nerves, which last
sends comparatively large branches to the clitoris. They terminate in the clitoris in
peculiar tactile corpuscles (sec Vol. I., Part 2, p. 338).

VOL. III., PT. 4. S



258 FEMALE REPRODUCTIVE ORGANS.

THE FEMALE URETHRA.

The female urethra is short as compared with that of the male sex, and corre-
sponds to the part of the male urethra which extends from the bladder to the open-
ings of the ejaculatory ducts. It is about an inch and a half in length, and is
directed from above downwards and forwards anterior to and parallel with the
vagina, with Avhich its posterior wall is intimately blended. It is closed, except
during micturition, by the apposition of the anterior and posterior walls. The
transverse diameter of the closed tube is about a quarter of an inch, but the tube is
capable of great distension, so that the index finger can be passed through it without
causing any permanent incontinence (Berry Hart). The external orifice or meatus
urinarius appears as a vertical slit with slightly prominent edges (see fig. 268, E),
situated about an inch behind the glans clitoridis, immediately in front of the
entrance to the vagina and below the lower edge of the pubic symphysis. The upper
opening of the urethra is at the neck of the bladder.

Structure of the urethral wall. The mucous membrane is whitish, except
near the orifice ; it is raised into longitudinal folds, which are not entirely obliterated
by distension, especially one which is particularly marked on the lower or posterior
surface of the urethra. Near the bladder the membrane is soft and pulpy, with
many tubular mucous glands. Lower down these increase in size and lie in groups
between the longitudinal folds ; and immediately within and around the orifice, the
lips of which are elevated, are several larger and wider crypts.

The lining membrane is covered with a stratified scaly epithelium, but near the
bladder it becomes transitional. The submucous areolar tissue contains numerous
elastic fibres. Outside this there is a highly vascular structure, in which are many
large veins. Between layers of the triangular ligament, the female urethra is
embraced by the fibres of the compressor urethras muscle.

The vessels and nerves of the female urethra are very numerous, and are
derived from the same sources as those of the vagina.

THE HYMEN.

The hymen is a thin fold of mucous membrane, which is situated at the vulvo-
vaginal orifice, and narrows this opening so that it will usually only admit the little
finger. It is generally described as forming an annular fold, which is much broader
behind than in front ; but the fold is compressed from side to side, and has its free
edge directed downwards so that the opening is a vertical slit bounded by lateral
lips, the inner surfaces of which are in close apposition (Cullingworth). In rare
cases the hymen forms a complete partition between the vagina and vulva, giving
rise to the condition known as " imperforate hymen." It has been described as
occasionally cribriform, and even in some cases as entirely absent. The small
rounded elevations called carunculce myrtiformes, found in women who have borne
children, are probably the remains of the hymen. The vaginal surface of the
hymen shows a few folds continuous with the rugas of the vagina. This fact is
considered by Budin to favour his view that the hymen is vaginal in its origin.
Others hold that it is of vulval origin, as in various cases of absence of the vagina
the hymen has been found well developed.

THE VAGINA.

The vagina is a dilatable membranous and muscular passage, extending from the
vulva to the uterus, the neck of which is embraced by it. It passes with a slight
curve from above downwards and forwards, usually nearly parallel with the plane of
the pelvic inlet, but tending to become more horizontal with a distended bladder,
and more vertical when the lower part of the rectum is loaded. The ends of the
vagina are somewhat narrower than the middle part ; the lower end, which is the



THE UTERUS.



narrowest, is H-shaped on transverse section, the middle part is flattened from before
backwards, so that its anterior and posterior walls are ordinarily in_cojitact with
each other (see fig. 272). At its upper end it is rounded, and expands to receive the
vaginal part of the neck of the uterus. The vagina reaches higher up on the cervix
uteri behind than in front, so that the uterus appears to be inserted into its anterior
wall. The anterior wall of the vagina is about 2| inches (6 centimeters) in
length, and the posterior 3| inches (8'5 centimeters). In front the vagina is in
relation with the bladder and urethra, its anterior wall being connected by loose
areolar tissue with the bladder, but intimately blended with the urethra. The

Fig. 272. CORONAL SECTION OP PEL-
VIS OF FEMALE AGED 54 PASSING
THROUGH BLADDER, VAGINA,
AND PERINEAL BODY. (J. S. )

B., brim of true pelvis ; IT., ischial
tuberosity ; O.T.. obturator intern us ;
O.F., obturator fascia ; L.A., levator
ani ; P.B., perineal body; A.W.,
anterior vaginal wall; BL., trigone
of bladder. The transverse black
line below A.W. represents the cavity
of the vagina.

posterior vaginal wall is
usually covered in about its
upper fourth by the perito-
neum, and below this is
loosely attached to the ante-
rior wall of the rectum. At
the sides it is enclosed be-
tween the levatores ani
muscles (fig 272).

Structure. The walls
of the vagina are composed

from within outwards of a mucous membrane, a muscular and a fibrous coat. They
are thickest in front, in the vicinity of the urethra, which indeed may be said to be
imbedded in the anterior wall of the vaginal passage ; in other situations they are
thinner. The vagina is firmly connected by areolar tissue to the neck of the bladder,
and only loosely to the rectum and levatores ani muscles ; at the upper end as just
stated, for about a fourth part of its length, its posterior surface receives a covering
from the peritoneum, which descends in the form of a cul-de-sac thus far between
the vagina and the rectum.

Externally the vagina is covered by a coat of dense areolar tissue, and beneath
this its walls are composed of unstriped muscle, which is not distinctly separable
into strata, but is composed chiefly of fibres internally circular and externally longi-
tudinal. Round the tube a layer of loose erectile tissue is found, which is most
marked towards the vulva.

At its lower end, the vagina is embraced by striated muscular fibres, which con-
stitute the sphincter vagintn, already described.

On the inner surface of the vagina, anteriorly and posteriorly, a slightly elevated
ridge extends from the lower end upwards in the middle line, forming the columns
of the vagina, or columns rugarum. Numerous dentated transverse ridges, called
ruga}, are also observed, particularly in persons who have not b,rne children,
running at right angles from the columns. These columns and rugas are most
evident near the entrance of the vagina and on the anterior surface, and gradually
become less marked, and disappear towards its upper end.

s 2




260 FEMALE REPRODUCTIVE ORGANS.

The raucous membrane, besides the columns and rugae, is provided with
microscopic papillae, and is lined with a stratified scaly epithelium. Mucous glands
are stated by Veith to be usually absent altogether, but one or two may occasionally
be met with.

Vessels and nerves. The vagina is largely supplied with vessels and nerves.
The arteries are derived from branches of the internal iliac, viz. the vaginal, internal
pudic, W'sical, and uterine. The veins correspond ; but they first surround the
vagina with numerous branches, and form at each side a plexus named the vaginal
plexus. The nerves are derived from the hypogastric plexus of the sympathetic,
and from the fourth sacral and pudic nerves of the spinal system ; the former are
traceable to the erectile tissue.

THE UTEEUS.

The uterus or womb (matrix, wortpor), is a hollow muscular organ with very
thick walls situated in the pelvic cavity between the rectum and the urinary
bladder. The Fallopian tubes, extending from each upper angle of the uterus to
their ovarian opening, conduct the ovum from the ovary to the uterine cavity. In
the case of pregnancy the uterus receives the ovum, retains and supports it during
the development of the foetus, and expels it at the time of parturition. During
gestation the uterus undergoes a great enlargement in size and capacity, as well as
important structural changes.

In the fully developed virgin condition, which is that to which the following
description mainly applies, the uterus is a somewhat pear-shaped body flattened
from before backwards, free above, and connected below with the vagina into which
its lower extremity projects. Its average dimensions are three inches (7'5 centimeters)
in length, two inches (5 centimeters) in breadth at its upper and wider part, and
nearly an inch (2*5 centimeters) in thickness ; it weighs from 7 to 12 drachms
(33 to 41 grammes). It is usually described as possessing a fundus, body, and neck.

The fundus is the broad convex upper end of the body, which projects upwards
from between the points of attachment of the Fallopian tubes (fig. 274). The
body gradually narrows as it extends from the fundus to the neck ; its sides are
nearly straight ; its anterior and posterior surfaces are both somewhat convex, but
the latter more so than the former. At the points of union of the sides with the
rounded superior border are two projecting angles with which the Fallopian tubes
are connected, the round ligaments being attached a little before, and the ovarian
igaments behind and beneath them : these three parts are all included within the
peritoneal duplicature of the broad ligaments (fig. 274). The neck or cervix uleri,
narrower and more rounded than the rest of the organ, is about an inch in length ;
it is continuous above with the body, and becoming somewhat smaller towards its
lower extremity projects into the anterior part of the upper end of the tube of the
vagina, which is united all round with the substance of the uterus, but extends
upwards to a greater distance behind than in front. The cervix may be divided
into three parts, upper, middle, and lower, according to their relation to the vagina.
The upper and middle parts lie respectively above and opposite the attachments of
the vaginal walls, while the lower portion projects free towards the cavity of the
vagina being entirely below the line of union of the uterine and vaginal walls. The
lower end of this, the vaginal part of the cervix, has a transverse aperture by which
its cavity opens into the vagina (figs. 273, 274) ; this is variously named os uteri, os
uteri externum, and (from a supposed resemblance to the mouth of the tench fish)
os tincce. It is bounded by two thick lips, the posterior of which is the thinner
and longer of the two, while the anterior, although projecting less from its vaginal
attachments, is lower in position, so that when the tube is closed both lips come
into contact with the posterior wall of the vagina. These borders or lips are smooth



THE UTERUS.



Sttl








Fig. 273. MEDIAN SECTION OF THE PELVIS OF A FEMALE AGED ABOUT 30 YEARS. (J. S.) |

1st s., body of 1st sacral vertebra ; p.s. , pubic symphysis ; B., bladder ; u., urethra ; ut., uterus ;
K.O., external os uteri ; us., utero-sacral ligaments which are united with one another on posterior aspect
of uterus; V., vagina; A.F., anterior vaginal foruix ; P.F., posterior vaginal fornix ; H. , hymen:
R., rectum ; A.C., anal canal ; L.Min., labium minus; L.Maj., labium majus ; c., clitoiis ; M., fat of
mons Veneris ; p., peritoneum ; p. B., perineal body ; A.C. B. , ano-coccygeal body.

This section was made after hardening the body by the injection of a 1 p. c. solution of chromic acid,
and the distension of the abdominal vessels with this fluid probably depressed somewhat the pelvic viscera.



262



FEMALE REPRODUCTIVE ORGANS.



in the nullipara, but after parturition they frequently become irregular, and are
sometimes fissured or cleft.

The peritoneum covers the upper end or fundus of the uterus, and also the
anterior surface of the body. Anteriorly, at about the union of the body with the
cervix it is reflected on to the bladder, forming the utero-vesical pouch. The
anterior aspect of the cervix is thus uncovered by peritoneum, and it is connected
with the bladder by loose cellular tissue. The posterior surface of the body and



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