f. The vestibule is a smooth area surrounded by the labia minora, with the
clitoris at its apex and the fourchette at its base. It contains openings for the urethra
and the vagina.
g. The urethra, which is about 4 cm long, is in close relationship with the anterior
vaginal wall and connects the bladder with the outside, acting as an excretory duct. At
each side of the external urethral orifice (meatus) lie two small ducts, termed the
paraurethral ducts, which drain small urethral glands (Skene's).
h. The vaginal opening lies behind the urethral orifice, and in the virgin it is
almost closed by the hymen, a fold of vaginal mucosa.
i. The vestibular glands (Bartholin) lie one at each side of the lower end of the
vagina. They are homologous of the bulbourethral glands of the male. The narrow
gland duct opens into the vaginal orifice on the inner aspects of the labium minus.
2-11. VASCULAR, NERVE, AND LYMPHATIC SUPPLY
a. The blood supply of the female pelvis is derived from the internal iliac
branches of the common iliac arteries and is supplemented by the ovarian and median
sacral arteries, which are branches of the aorta.
b. The nerve supply of the female pelvis comes from the autonomic nerves,
which enter the pelvis in the superior hypogastric plexus (presacral nerve).
c. The lymphatics of the female pelvis either follow the course of the vessels to
the iliac and preaortic nodes or empty into the inguinal glands.
Section II. VAGINAL SURGERY
2-12. PATIENT PREPARATION
a. Surgery on the structures of the reproductive system in the female may be
done either for diagnostic purposes or as a form of therapy in the treatment of a pelvic
condition such as uterine bleeding or suspected cancer. Surgery is also done to
remove tumors or repair structures.
b. For vaginal and perineal surgery, the lithotomy position is generally used. For
abdominal surgery, the patient is placed in a modified or extreme Trendelenburg
position. Care should be taken to prevent the patient from nerve injury and provide for
circulatory and respiratory functioning.
c. Skin preparation and draping procedures are routine. A sterile lithotomy pack
is needed for vaginal surgery, a laparotomy pack for abdominal surgery.