Obstetric and Gynecologic Clinical Anatomy

GUTIERREZ, Carissa C.
2011-50263 - Block I
May 2020
Flash Review:
Obstetric & Gynecologic
Clinical Anatomy

Exploration of speciﬁc anatomic relationships continue.
The development of new clinical and surgical correlation
in turn evolve.
Basic facts of anatomy do not change, but
our understanding of it does.

Outline
The idea is:
If we were still in clinical rotation,
what would our residents be teaching us?
The following slides are best studied for compre but may apply to PLE also.
OUTLINE
◉ Sexual Development
◉ Gynecologic and obstetric anatomy
◉ Common ultrasound ﬁndings and structural cases
◉ Anatomy of common procedures

Sexual
Development
THIS IS ACTUALLY A VERY IMPORTANT TOPIC IN ANATOMY AND OB-GYNE
IN SEPT 2019 PLE BECAUSE THEY REALLY LIKE FUCKING WITH PEOPLE

Normal Sexual
Development
“GENDER IDENTITY” equals:
◉ Chromosomal Sex
◉ Gonadal Sex
◉ Phenotypic Sex
Internal and external genitalia
development ends at:
13 weeks AOG
and is bipotential
Reference: NELSON’S Essentials of Pediatrics - 7th Edition (International Edition)

Normal Sexual
Development
◉ XY chromosome has the SRY gene
◉ SRY determines development of testis
Testis:
◉ Sertoli cells = anti-mullerian hormone
◉ Leydig cells = testosterone
Testosterone:
◉ causes Wolfﬁan ducts to develop
responsible for seminiferous tubules
and prostate
◉ Converts to DHT (via 5a-reductase).
DHT responsible for scrotum and penile
urethra

Normal Sexual
Development
SRY Testis
AMH (Sertoli) (anti-mullerian hormone)
Mullerian Fallopian tubes, uterus
Testosterone/
Wolfﬁan (Leydig)
Seminiferous tubules, prostate
gland, vas deferens
DHT Scrotum, penile urethra

Disorders of Sexual
Development
3 WAYS OF LOOKING AT IT:
◉ Virilization of XX female
◉ Underdevelopment in XY male
◉ Neither: trisomy = Turner/Klinefelter
Diagnostics:
◉ Palpation for testis - parapelvic
◉ Identify urethra location
◉ Ultrasound for female internal genitalia
◉ Test adrenal hormones
◉ Karyotyping

Virilization
of XX female
Caused by excessive androgens
before 13 weeks AOG
- Seminiferous tubules, prostate gland, vas
deferens, scrotum, penile urethra
90% is cause by
CONGENITAL ADRENAL HYPERPLASIA
◉ 21-hydroxylase deﬁciency
◉ Precursor pregnenolone converts to:
- Androgens
- Cortisol
- Aldosterone
*No cortisol causes excessive ACTH thus adrenal
hyperplasia
*No aldosterone causes salt loss and possibly SHOCK
Progestin intake before 13 wk AOG also causes
virilization in XX females

Underdevelopment
in XY male
Caused by testosterone deﬁciency
via
◉ Receptor defect
◉ Enzyme deﬁciency
◉ Dysplasia
But MOST often presents as
cryptorchidism
- Location does not a testis
make. Testosterone
production (even a little) by
said gonad implies SRY gene.

Underdevelopment
in XY male
ANDROGEN INSENSITIVITY SYNDROME (46 XY)
Androgen receptor defect, so:
Has a normal testis but misplaced = (+) SRY
Without female internal genitalia = (+)AMH
With female external genitalia = (-) androgen
Presents as:
◉ Amenorrhea
◉ Breast development = (+) estrogen
- Testosterone is peripherally converted to
estrogen
SRY Testis
Testosterone/
Wolfﬁan
(Leydig)
Seminiferous tubules,
prostate gland, vas deferens

Underdevelopment
in XY male
5a- REDUCTASE DEFICIENCY
Testosterone is not converted to DHT, so:
Has a normal testis but misplaced = (+) SRY
Without female internal genitalia = (+)AMH
With male internal genitalia = (+) androgens
Without penile urethra or scrotum = (-) DHT
Puberty causes male 2’ characteristics
◉ Penile enlargement
◉ Amenorrhea
SRY Testis
Testosterone/
Wolfﬁan
(Leydig)
Seminiferous tubules,
prostate gland, vas deferens

Summary
Congenital Adrenal
Hyperplasia
46XX 21a-hydroxylase deficiency
- Excess androgens
- No cortisol
- No aldosterone
Ambiguous genitalia
Amenorrhea
Androgen
Insensitivity
Syndrome
46XY Testosterone deficiency
- Androgen receptor defect
Ambiguous genitalia
Amenorrhea
Breast development
No pubic hair
5a-reductase
Deficiency
46XY Testosterone is not converted DHT “Female” genitalia
Male pubertal changes

Anatomy
IT’S FUNNY WHEN YOU FIND YOURSELF
LOOKING FROM THE OUTSIDE

Abdominal Wall
Anterior abdominal wall layers:
◉ Skin
◉ Superﬁcial fascia
○ Camper’s Fascia - cont. w/ fat
○ Scarpa’s Fascia
◉ Deep fascia
◉ Muscles
○ External oblique
○ Internal oblique
○ Transversus abdominis
○ (Rectus abdominis - midline)
◉ Extraperitoneal fascia
◉ Parietal peritoneum

Vulva
Female Origin Male
Ovary Gonad Testis
Skene’s gland Urogenital sinus Prostate gland
Bartholin’s gland Urogenital sinus Cowper’s gland
Labia majora Labioscrotal fold Scrotum
Labia minora Urogenital folds Penile skin
Clitoris/hood Genital
tubercle/prepuce
Penis/foreskin
Round ligament Gubernaculum Gubernaculum

Vulva
6 openings of the vestibule
◉ Urethra
◉ Vagina
◉ 2 Bartholin glands
- 5 and 7 o’clock
◉ 2 skene glands
- Paraurethral

Perineum
ANTERIOR TRIANGLE
(see ﬁgure)
POSTERIOR TRIANGLE
◉ Ischioanal fossa
◉ Anal canal
◉ Puborectalis m.
◉ Anal sphincter complex
Internal sphincter - splanchnic n.
External sphincter - inf pudendal n.
Pubic symphysis
Coccyx
Ischial
Tuberosities

Pelvis
Cartilaginous symphysis joints:
◉ Sacroiliac joint
◉ Synchondroses
◉ Symphysis pubis
They are slightly movable

Pubic arch 90”
Diagonal conjugate 11.5 cm
True conjugate 11 cm
Obstetric conjugate 10 cm
Transverse DIameter 13.5 cm
Obliques Diameter <13 cm
Bispinous diameter 10 cm
Bituberous diameter >8 cm
Ischial spines Not
prominent
Sidewalls Divergent
Sacral notches Narrow
Sacral incline Backward
Normal Pelvimetry

Pelvic Spaces Information
Retropubic space Between pubis and bladder
Vesciovaginal space Between bladder and vagina
Paravesical fossa Continuous to the retropubic space
Medial to hypogastric arteries
Obturator fossa Where obturator nerve, artery vein and lymph nodes are found
Seen through paravesical fossa
Pararectal fossa Peritoneum forms around the sigmoid, folds behind on the pelvis and back to
the front of the rectum and continues to the bladder
Medial to internal iliac artery
Where uterine artery and vein are found
Pouch of Douglas/
Rectovaginal
Between the vagina and rectum

Clinical Stuff
POUCH OF DOUGLAS
Bound by broad lig., uterosacral lig,
uterus and rectum
Most dependent point in female
abdomen = ﬂuid collection
A perforating injury can occur through
the posterior fornix involving the
peritoneum

Fallopian tube
97% of ectopic pregnancies occur here
Ampullary 81%
Isthmic 12%
Fimbrial 5%
Cornual interstitial 2%
Ovary
Medial to the internal iliac artery
- to identify in surgery
3% occur in the ovary, cervix or peritoneal cavity
Isthmic ectopic
pregnancies have
the highest
correlation to tubal
rupture

Vagina
Developed from 3 germ layers
Upper 4/5 vagina Endoderm
Mesoderm:
mullerian ducts
Lower 1/5 vagina Endoderm
External genital oriﬁce Ectoderm
Supplied by vaginal a., uterine a., middle
rectal a., internal pudendal a.

Uterus
Anteversion, anteflexion, dextrorotated
Sinusoids are interspersed between
myometrium. Therefore inducing
contraction is management for uterine
hemorrhage.
Is composed of
- Inner circular muscle fibers
- Outer longitudinal muscle fibers
Allows regulation of luminal size (circular)
and uterine length (longitudinal)

Type 1
Extrafascial
hysterectomy
Type 2
Modiﬁed radical
hysterectomy
Type 3
Radical
hysterectomy
Type 4
Extended radical
hysterectomy
Type 5
Partial exenteration
hysterectomy
Minimal disturbance
of bladder and
ureter
Removal of cervix
Ureters freed but
not dissected
25% of vagina
removed
Medial cardinal
ligament removed
Uterosacral
ligament transected
midway
Ureter dissected
from pubovesical
ligament
25% of vagina
removed
Uterine artery
ligated
Uterosacral
ligament resected
Ureter completely
dissected
Up to 75% of vagina
removed
Uterine artery
ligated
Superior vesical
artery sacriﬁced
Distal ureter
removed
Up to 75% of vagina
removed
Uterine artery
ligated
Portion of the
bladder resected
Hysterectomy

SupportsoftheUterus
Muscle Supports
Uterine ligaments
Paracervical tissue
Broad ligament
Round ligament
Fascial Supports Upper supports
Middle supports
Lower supportsPelvic diaphragm
Perineal muscles
Cardinal
(Mackenrodt’s)
Ligaments
Uterosacral ligaments
Pubocervical
ligaments
Levator Ani
Coccygeal muscle
Supports
of the UterusLevator Ani: Pubococcygeus, Iliococcygeus, Ischiococcygeus

Structures within the broad
ligament:
- Ureter
- Ovarian ligament
- Round ligament
- Uterine NAV
- Ovarian NAV
therefore it is cut as lateral as
possible in cancer surgery

Levator Ani: Pubococcygeus,
Iliococcygeus,
Ischiococcygeus

Pelvic Organ
Support
Organ Supporting Structures
Ovary Ovarian ligament
Infundibulopelvic ligament (suspensory)
Fallopian tube Broad ligament
Infundibulopelvic ligament (suspensory)
Uterus Broad ligament
Round ligament
Cardinal ligament (Mackenrodt’s)
Uterosacral ligament
Pubocervical ligament
Levator Ani
Coccygeal muscle
Perineal body
Vagina Cardinal ligament (Mackenrodt’s)
Pubocervical ligament
Bladder Levator ani
Coccygeal muscle
Perineal body
Obturator internus
Medial umbilical ligament (derived from urachus)
Rectum Proximal 1/3: ﬁxed by peritoneum anteriorly and
laterally only
SURGICAL STUFF:
Inguinal ligament
- Important for repair of the inguinal
hernia
Cooper’s ligament
- Frequently used in bladder
suspension procedures
Sacrospinous ligament
- For vaginal suspension
- For pelvic organ prolapse

Pelvic Organ
Prolapse
Weakness of supportive structures of
pelvic organs can be from:
◉ Birth-induced injury to the
pubococcygeal
- 55% of women with prolapse
◉ Degeneration of connective tissue
(cardinal, uterosacral, pubocervical)
in elderly multigravids
Presents as:
◉ Sensation of fullness
◉ Urinary symptoms
◉ Soft bulging mass

Pelvic Organ
Prolapse
Aa
Fixed point on the
ant vaginal wall
3cm interior from
the hymen
(R: -3 to +3)
Ba
Leading part of
prolapsed ant
vaginal wall
(R: -3 to +TVL)
C
Leading edge of the
cervix from the
hymen
(R: -TVL to +TVL)
gh
Genital hiatus
Urethral meatus to
post hymen
pb
Perineal body
Post hymen to anal
opening
tvl
Total vaginal length
Depth of vagina
when D and C is
reduced to normal
position
Ap
Fixed point on the
post vaginal wall
3cm interior from
the hymen
(R: -3 to +3)
Bp
Leading part of
prolapsed post
vaginal wall
(R: -3 to +TVL)
D
Posterior fornix
(R: -TVL to +TVL)

Pelvic Organ
Prolapse
So, remember that we are measuring distances
from point A to B. break it down box by box
Assume GH = 3.5, PB = 4.0, TVL = 8
Aa
Fixed point on the
ant vaginal wall
3cm interior from
the hymen
(R: -3 to +3)
Ba
Leading part of
prolapsed ant
vaginal wall
(R: -3 to +TVL)
C
Leading edge of the
cervix from the
hymen
(R: -TVL to +TVL)
gh
Genital hiatus
Urethral meatus to
post hymen
pb
Perineal body
Post hymen to anal
opening
tvl
Total vaginal length
Depth of vagina
when D and C is
reduced to normal
position
Ap
Fixed point on the
post vaginal wall
3cm interior from
the hymen
(R: -3 to +3)
Bp
Leading part of
prolapsed post
vaginal wall
(R: -3 to +TVL)
D
Posterior fornix
(R: -TVL to +TVL)

Pelvic Organ
Prolapse
Stage 0 No prolapse
Stage 1 Most DISTAL prolapse is >1cm inside
hymen
Stage 2 Prolapse <=1cm inside hymen
(If any prolapse is between -1 to+1 then stage 2)
Stage 3 Prolapse is >1cm outside hymen but TVL is
-2cm
Stage 4 Complete eversion/procidentia
This is for any compartment

Arteries that enter the TRUE
PELVIS:
◉ Internal Iliac artery
◉ Ovary artery
◉ Median sacral artery
◉ Superior rectal artery
- Supplies the rectum and the
upper part of the anal canal
up to the dentate line

Pelvic Blood Supply
Mainly from the
INTERNAL ILIAC ARTERY
◉ Anterior division (better visualized in surgery)
◉ Posterior division
Anterior division branches:
◉ Uterine a.**
◉ Vaginal a.
◉ Superior** Middle and Inferior vesical a.
◉ Middle and inferior rectal a.
◉ Obturator a.**
◉ Inferior gluteal a.
◉ Internal pudendal a.
◉ Obliterated umbilical a.
** are retroperitoneal
The term pudendal
comes from Latin
pudenda, meaning
external genitals,
derived from
pudendum, meaning
"parts to be
ashamed of".

Pelvic Blood Supply
EXTERNAL ILIAC ARTERY
Lateral to the external iliac vein
2 branches
- Inf. epigastric artery
- Deep circumﬂex Iliac artery
OVARIAN ARTERIES
originate directly from the AORTA,
inferior to the renal artery
OVARIAN VEINS
◉ Left drains into the left renal vein
◉ Right drains into the inferior vena
cava

Clinical Stuff
WATER UNDER THE BRIDGE
◉ Uterine arteries branch from the
internal iliac arteries
◉ Ureter runs parallel with the
internal iliac artery.
◉ Uterine artery crosses over the
ureter and then passe through
the cardinal ligament into the
bladder
FUN FACT: 75% of iatrogenic injuries to
the ureter are from gynecologic
surgeries

Internal Iliac ligation
UTERINE ARTERY
is the ﬁrst branch of anterior division of
the internal iliac artery
6 inches distal to the bifurcation of
common iliac artery
- Therefore there is sufﬁcient length
of internal artery to ligate!

Pelvic Innervation
Innervation
◉ Sympathetic: T5 to L1
◉ Parasympathetic: S1, S2, S3 (in the ganglia of Frankenhauser)
◉ Somatic: T10 to L8
Cervix is insensitive to soft touch and heat
◉ Why? The cervix has very few nerve endings, so any discomfort will feel more
like pressure and cramping. Pelvic splanchnic nerves, emerging as (S2–S3)

Pelvic Lymph Drainage
Runs along the infundibulopelvic ligament
Correlation Drainage
Cervical cancer first drains into parametrial nodes > obturator nodes
> pelvic nodes > paraaortic nodes
Uterine cancer first drains to the pelvic nodes or paraaortic nodes
Ovarian cancer first drains to the pelvic nodes > paraaortic nodes

Hypothalamic-Pituitary-Gonadal Axis
GnRH from the hypothalamus stimulates
LH and FSH release from the anterior pituitary gland.
Luteinizing hormone Follicle stimulating hormone
Theca cells Granulosa cells
progesterone (+) aromatase
androstenedione estrogen
The menstrual cycle is controlled by feedback systems:
● Moderate estrogen levels: negative feedback on the HPG axis
● High estrogen levels (in the absence of progesterone): positively feedback on the HPG axis
● Estrogen in the presence of progesterone: negative feedback on the HPG axis
● Inhibin: selectively inhibits FSH at the anterior pituitary

Ovarian cycle
Follicular Phase
follicles begin to mature and prepare to release an oocyte.
- follicle begins to develop independently of gonadotropins or ovarian steroids.
- Due to the low steroid and inhibin levels, there is little negative feedback at the HPG axis resulting in an increase
in FSH and LH levels. These stimulate follicle growth and estrogen production.
Only one dominant follicle can continue to maturity and complete each menstrual cycle.
- As estrogen levels rise, negative feedback reduces FSH levels, to initiate positive feedback at the HPG axis,
increasing levels of GnRH and gonadotropins.
- Granulosa cells become luteinised and express receptors for LH.
Ovulation
In response to the LH surge, the follicle ruptures and the mature oocyte
Following ovulation, the follicle remains luteinised, secreting estrogen and now also progesterone. This, together with
inhibin (inhibits FSH) stalls the cycle in anticipation of fertilisation.
Luteal Phase
The corpus luteum forms at the site of a ruptured follicle following ovulation. It produces estrogens, progesterone and
inhibin to maintain conditions for fertilisation and implantation.
in the absence of fertilisation, the corpus luteum spontaneously regresses
If fertilisation occurs, the syncytiotrophoblast of the embryo produces human chorionic gonadotropin (HcG), maintaining
the corpus luteum.

Uterine cycle
Proliferative Phase
preparing the reproductive tract for fertilisation and implantation
- Estrogen initiates fallopian tube formation, thickening of the endometrium,
increased growth and motility of the myometrium and production of a thin
alkaline cervical mucus (to facilitate sperm transport).
Secretory Phase
- Progesterone stimulates further thickening of the endometrium into a glandular
secretory form, further thickening of the myometrium, reduction of motility of the
myometrium, thick acidic cervical mucus production (a hostile environment to
prevent polyspermy)

Ultrasound and
clinical cases
ETO TALAGA YUNG PAGKUKULANGAN NATIN PAG WALANG CLINICAL ROTATION

Gyne indications for ultrasound
Masses
◉ Investigation of adnexal masses on PE
◉ Screening for ovarian cancer
◉ Treatment of ovarian cyst or ectopic pregnancy
◉ Investigation pelvic pain or enlargement (ONG etc)
Heavy/irregular menstrual bleeding
◉ Diagnosis of polycystic ovaries (AUB-O)
◉ Investigation of postmenopausal bleeding (endometrial thickness)
◉ Investigation of HMB (ﬁbroids, adenomyosis, leiomyoma)
Infertility
◉ Monitoring follicle number and growth of IVF, recover egg for IVF (infertility)
◉ Saline hysterography for delineation of the uterine cavity
◉ Determining tubal patency in infertility
◉ Investigation of primary amenorrhea

Writing out ultrasound results
ALWAYS consent and full Hx and PE
IMPORTANT:
Transabdominal - bladder full
- A full bladder will push away
bowels from visual ﬁeld
(Acoustic window)
Transvaginal - full bladder not
necessary (but we always do both)
Bladder identify
Uterus size, position, cavity abnormalities,
myometrial/endometrial thickness, and
corresponding border
Cervix note growths if any
Ovary size and compare bilaterally,cystic changes if
any
Adnexal
masses
ovarian or fallopian tubal
masses/hydrosalpinx
Color
doppler
identify vessels
Pouch of
Douglas
identify ﬂuid/masses

Transvaginal
Endometrial Proliferative phase = 1-2mm
Endometrial Secretory phase = 8-14mm
Composed of two layers:
stratum basale (basal layer) 1/3
- after menstruation, the stratum basale remains to
regenerate the endometrium ready for the next cycle
stratum functionale (functional layer) 2/3
- proliferation of the functional layer of the endometrium is
predominantly stimulated by estrogen
If pregnancy occurs, the endometrium is not shed but remains
as the decidua.

AUB-P
Best time of
examination is
postmenstrual
Presents always as
solitary homogeneous
and echogenic lesion

AUB-P
Interrupted mucosa sign
May be pedunculated or broad-based
Bright edge sign
the appearance of one or two well-defined short echogenic
linear echoes at the polyp borders which are perpendicular
to the ultrasound beam
Pedicle artery sign on color flow doppler
visualization of a vascular pedicle is 76% sensitive and 95%
specific for endometrial polyps

AUB-A
Presents as:
Dysmenorrhea
Abdominal enlargement (diffuse)
Prolonged AUB
HMB
"adeno": ectopic endometrial glands
- subendometrial echogenic linear irregular striations and/or nodules tiny (1-5 mm)
- Anechoic cysts
"myosis": muscular hyperplasia +/- hypertrophy,
- Hypoechoic -asymmetrical myometrial thickening
- indistinct borders, compared to leiomyomas
- halo surrounding the endometrial layer of ≥12 mm thickness (less speciﬁc)
Increased vascularity ﬂow on color Doppler
Venetian blind or rain shower appearance (parallel shadowing)

AUB-L
Presents as:
HMB
Abdominal
enlargement (focal)
Well circumscribed
compared to
adenomyosis

Systematic approach
to AUB diagnosis
Reference: https://www.researchgate.net/publication/284797278_Abnormal_Uterine_Bleeding/ﬁgures?lo=1

Treatment for AUB
Reference: https://www.researchgate.net/publication/284797278_Abnormal_Uterine_Bleeding/ﬁgures?lo=1

Gestational Sac
ﬁrst sign of early pregnancy at 3-5 weeks AOG
(2-3 mm)
Features:
● eccentric in endometrium, rather than
centrally
● double decidual sign (4.0-6.5 weeks)
● yolk sac (5.5 weeks)*
Differential: pseudogestational sac
Pair with b-HCG results: >= 3000 IU/mL (viable
pregnancy)
If one cannot identify a yolk sac at a mean gestational sac
diameter of 16-24 mm, this is suspicious for, though not
diagnostic of a failed early pregnancy.

Ectopic Pregnancy
TUBULAR ECTOPIC PREGNANCY
Presents as simple adnexal cyst: 10% chance of an ectopic
Or complex extra-adnexal cyst/mass: 95% chance of a
tubal ectopic
Tubal ring sign
- bagel sign or blob sign, echogenic ring which
surrounds an unruptured ectopic pregnancy.
- 95% positive predictive value (PPV) for ectopic
pregnancy.
Ring of ﬁre sign
- can be seen on color Doppler in a tubal ectopic, but
can also be seen in a corpus luteum

PCOS
CRITERIA:
- follicle number per ovary (FNPO) ≥ 20, and/or
- ovarian volume ≥10 mL, ensuring no corpora
lutea, cysts or dominant follicles are present
Normal ovary volume: 8ml (source?)
This supersedes the initial Rotterdam criteria of ≥12
follicles and interim recommendations of 24 or 25
follicles per ovary. The presence of a single
multifollicular ovary is sufﬁcient to provide the
sonographic criterion for PCOS 2.

Procedures
I’LL KEEP IT CONCISE (HOPEFULLY)

Pudendal Nerve Block
Indicated on the SECOND stage
of labour, if using forceps
delivery or episiotomy
Landmark: Ischial spine
◉ Through the vaginal
mucosa and sacrospinous
ligament
Landmark: ischial tuberosity
◉ Through the pudendal
canal

Spinal Nerve Block
Landmark:
- Between L3 and L4-5
(cauda equina)
- In the intersection of both PSIS
Layers:
- Skin
- subcutaneous fat
- supraspinous ligament
- interspinous ligament
- ligamentum ﬂavum
- dura mater
- subdural space
- arachnoid mater
- subarachnoid space.

The most common minor
gynecologic procedure
It is both diagnostic and
therapeutic
Indications:
◉ AUB
◉ s/p abortion
◉ Molar pregnancy
◉ Retained placental tissue
◉ Endometrial hyperplasia
◉ Uterine polyps
◉ Uterine cancer
Dilation and curettage

Colposcopy
Done if
◉ pap smears are unusual
◉ postcloital bleeding
◉ abnormal internal exam
Treatment may be advised if results show
Cervical intraepithelial neoplasia
(precancerous cells)
- Large loop excision of the
transformation zone (loop biopsy)
- Cryocautery
- Laser treatment
Acetowhitening may be associated with VIN, HPV, and
hyperkeratotic areas due to trauma, scratching, or pressure.
Iodine staining Areas containing glycogen turn brown or black;
areas lacking glycogen remain colourless saffron yellow.

Marsupialization
BARTHOLIN CYST
Most common vulvar cyst
Cutting a slit into an abscess or cyst and
suturing the edges of the slit.
The site remains open and can drain
freely.
Other vaginal cysts:
- Vaginal inclusion cyst
- Gartner duct cyst

Obstetric and Gynecologic Clinical Anatomy

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