Opinion ID: 1842640
Heading Depth: 1
Heading Rank: 2

Heading: female anatomy

Text: The uterus, or womb, is a hollow, thick-walled, muscular organ in the shape of an inverted pear situated between the bladder (anterior) and the rectum (posterior). In a non-pregnant woman it is about three inches in length, two inches wide, and an inch thick. The upper rounded portion is the fundus, at each extremity of which is the cornu or horn marking the part where the fallopian tube joins the uterus, and through which the ovum travels after leaving the ovary. The uterine (fallopian) tube connects with an ovary. The uterus is supported in the pelvic cavity by the broad ligaments, round ligaments, cardinal ligaments, and rectouterine and vesicouterine folds or ligaments. It is a constantly changing organ. The elongated lower part of the uterus is the cervix. The cervix is about an inch long and extends into the upper portion of the vagina. The tissue of the cervix has the consistency of the nose, and moves freely. The vagina extends from the vestibule to the uterus, and is situated behind the bladder and in front of the rectum. It is directed upward and backward. Normally it is about two and one-half to three inches long in front, and three and one-half inches long in back. Its base is approximately the size of a half dollar. Both the uterus and the vagina are susceptible to very large dilation. The uterus encloses the developing fetus, and the head, the largest part of the fetus, must pass through the vagina at childbirth. Aging, wear and tear, and especially childbirth, alone or in combination with their attendant stretching frequently cause the uterus and vagina and surrounding tissue to become weak, and unable to support encroachment from the rectum and bladder. This may result in one or more of the following conditions, namely: a stretching and distension of the bladder downward (cystocele); a rectocele, in which the rectum bulges anteriorly into the vagina; or a uterine prolapse, or descensus, which is a downward displacement of the uterus into the vagina. One or more of the above conditions (they frequently occur in some combination), may sufficiently develop to necessitate a hysterectomy, which is a surgical removal of the uterus (hyster). In a hysterectomy with anterior and posterior (A and P) repair, the vagina, and also surrounding tissue are surgically repaired to resist encroachment by the rectum and bladder. This in turn requires dissection and suturing of the vaginal mucosa (lining) and wall and surrounding muscle. A hysterectomy inevitably causes some alteration in the size of the vagina. In a vaginal hysterectomy, with which we are concerned in this case, the uterus is severed from surrounding tissue and removed by pulling it through the vagina. More about this surgical procedure will be explained in the course of this opinion.