attaches the ovaries to the lateral pelvic walls

a region of the broad ligament

contains ovarian artery, vein, and nerve

NOT covered by peritoneum

covered by simple cuboidal epithelium -> germinal epithelium

ovarian arteries (female gonadal artery from L2) that arise from the abdominal aorta

ascending branches of the uterine arteries that arise from the internal iliac artery

right and left ovarian veins

right ovarian -> drains directly into IVC

left ovarian -> drains into left renal vein

*remember - left gonadal veins drain into left renal vein, so they do NOT have to cross the abd aorta*

infundibulum -> funnel shaped, fimbriated, opens into peritoneal cavity

ampulla -> longest and widest part, site of fertilization

isthmus -> smallest diameter (said in lecture)

intramural -> opens into uterine cavity, part of tube actually w/in uterine muscle

from the ovarian arteries, directly from the abd aorta

ascending branches of uterine arteries, off of the internal iliac

right ovarian vein -> drains directly into the IVC

left ovarain vein -> drains into the left renal vein which then drains into the IVC

and uterine veins -> drain into internal iliac vein

bacterial infection (N. gonorrhea or Chlamydia trachomatis) of uterine tube w/ acute or chronic inflammation

may lead to scarring of the tube

predisposing to ectopic tubal pregnancy

most common cause of female sterility

tube will look markedly distended, w/ poss hemorrhage on serosal surface

most often occurs in ampulla

risk factors -> salpingitis, PID, pelvic surgery, exposure to diethylstilbestrol (DES).

signs -> sudden onset of abd pain, may be confused with appendicitis, last menses >60 days ago, + human chorionic gonadotropin (hCG) test, culdocentesis showing intraperitoneal blood

fundus ->superior to cornua, and large portion of upper segment of uterus during pregnancy, @ term may extend to xiphoid process (T9)

cornu -> located near entry of uterine tubes

body -> between cornu and cervix, isthmus of uterus is part of the body

cervix -> inferior to the body of uterus, protrudes into vagina, contains internal os, cervical canal, external os

part of the body of the uterus

dividing line between the body and cervix

nulliparous female -> has not had a vaginal delivery; external os of cervix is round

parous female -> has had a vaginal delivery; external os of the cervix is transverse (looks like fish lips (from lecture))

from the uterine arteries (found in the transverse cervical ligament) -> branches from the internal iliac arteries

there is potential collateral supply from the ovarian arteries

pelvic diaphragm (levator ani muscles)

urogenital diaphragm

urinary bladder (inferior to it)

round ligament of uterus

transverse cervical ligament

uterosacral liagment

pubocervical ligament

broad ligament

cardinal ligament of Mackenrodt

extends laterally from cervix to side wall of pelvis

located at base of broad ligament and contains uterine artery

ureter travels posterior and inferior to uterine artery

extends posteriorly from cervix to sacrum

responsible for bracing the uterus in its normal anteverted position

extends anteriorly from the cervix to the pubic symphysis

helps to prevent (cystocele -> herniation of urinary bladder into anterior wall of vagina)

double fold of parietal peritoneum, extends laterally from uterus to the side wall of pelvis

mesosalpinx -> supports uterine tubes

mesovarium -> suports the ovaries

mesometrium -> supports the uterus

suspensory ligament of the ovaries

contains -> ovarian vessels, and nerves; uterine tubes; ovarian ligament; round ligament; epoophoron; paroophoron; gartner duct; ureter; uterine vessels, and nerves

ovarian ligament of the uterus

round ligament of the uterus

epoophoron

paroophoron

gartner duct

an anteflexed and anteverted position

placing the uterus is a neraly horizontal position lying on superior wall of the urinary bladder

most common gynecologic cancer in women

linked to prolonged estrogen stimulation of endometrium

risk factors -> exogenous estrogen treatment for menopause, obesity, diabetes, nulliparity, early menarche, late menopause

grows in diffuse or polypoid pattern, often involves multiple sites

most common histologic variant -> entirely glandular cells (pure endometrial adenocarcinoma)

clinical findings -> perimenopausal or postmenopausal women complaining of abnorm uterine bleeding

presence of endometrial glandular tissue in abnormal locations outside of the uterus

found on: ovaries (80%), uterine ligaments, rectovaginal septum, puch of douglas (rectouterine), pelivic peritoneum covering uterus, uterine tubes, rectosigmoid colon, bladder

early foci -> on ovary or peritoneal surface -> appear red or bluish nodules (mulberry nodules)

shows cyclic changes synchronus w/endometrium of uterus

repeated bleeding -> deposition of hemosiderin forming -> gunpowder lesions

in ovary -> repeated bleedings -> may lead to formation of cysts containing chocolate colored material

results in: infertility, dysmenorrhea, pelvic pain (mostly at time of menstruation)

common benign neoplasm from proliferation of smooth muscle cells of uterus, that may become calcified

fibroids may be located: w/in myometrium (intramural), beneath endometrium (submucosa) (can poss grow into uterine cavity)

results in infertility if fibroids block uterine tube or prevent implantation of conceptus

may be palpated -> irregular, nodular, masses protruding against anterior abd wall

in radiograph -> calcifications in fibroids have popcorn like appearance

supravaginal portion -> lying above the vaginal vault

vaginal portion -> portio vaginalis, protrudes into the vagina

cervical mucosa during proliferative phase of menstrual cycle -> watery

during secretory phase of menstrual cycle -> viscous

occurs during childbirth

cervix undergoes cervical softening where connective tissue become pliable due to the action of relaxin

lumen covered by epithelial surface lining called endocervix

simple columnar epithelium

connects the uterine cavity with the vaginal cavity and extends from the internal os to the external os

normally, the simple columnar epithelial cells of the endocervical canal extends onto the ectocervix at puberty

when these cells come into contact with the acidic environment of the vagina the cells are transformed into squamous epithelium (squamous metaplasia), forming transformation zone

transformation zone is most common site

usually preceded by epithelial changes -> intraepithelial neoplasias diagnosed by a pap smear

HPV also linked as an important factor in cervial oncogenesis

cervical carcinoma may spread to -> side wall of pelvis, where ureters may become obstructed leading to hydronephrosis

most common site to spread is to the obturator lymph nodes

vagina

general features

extends from cervix to vestibule of the vagina

longest part of the birth canal -> distension during childbirth is limited by ischial spine and sacrospinous ligaments

forms a recess around cervix -> fornix

three regoins

anterior fornix -> anterior to the cervix, related to vesicouterine pouch

lateral fornices -> lateral to the cervix

posterior fornix -> posterior to the cervix, related to the rectouterine pouch (of Douglas), site for culdocentesis

superior portion -> from the vaginal branches of uterine artery (off of the internal iliac artery)

middle and lower portions -> internal pudendal artery directly off of the internal iliac

needle is passed through the posterior fornix into the rectouterine pouch of peritoneal cavity to obtain a fluid sample for analysis or to collect oocytes for an IVF

provides diagnostic information for many gynecological conditions (PID, ectopic tubal pregnancy)

chronic infection most often caused by trichomonas vaginalis (15%), candida albicans (25%), or gardnerella vaginalis (30%)

the vaginal epithelium is resistant to bacteria, fungal, and protozoan invasion so that the pathogens remain within the lumen of the vagina

25% of vaginitis cases

flagellated protozoan, sexually transmitted

inflammatory vaginal smear with numerous neutrophils, fiery-red appearance of the vaginal and cervical mucosa and a thin, gray-white, frothy, purulent, malodorous discharge (pH > 4.5)

postcoital bleeding is a common complaint

organism best seen in fresh preparations diluted with warm saline where the tumbling motility of the organism can be observed

25% of vaginitis cases

yeast -> produces pseudohyphae and true hyphae in tissues

produces superficial white patches or large fluffy membranes that easily detach leaving a red, irritated underlying surface and a thich, white, cottage cheese discharge (pH > 4.5)

organism can be observed on KOH prep of the discharge

30% of vaginitis cases

gram negative bacillus bacterial infection -> bacterial vaginosis

higher levels than normal of bacteria are present

not sexually transmitted

no inflammatory vaginal smear, no changes in mucosa, and a thin homogenous, somewhat adherent, fishy-odor discharge (pH >4.5)

discharge gives a + amine test ("whiff" test smelling fishy) when mixed w/KOH

vaginal smear -> increased # of bacteria and clue cells (squamous cells w/ clumped nucleus and a folded cytoplasm) covered with bacteria

two folds of hairless skin located medial to labia majora that enclose the vestibule of the vagina

each one is continuous anteriorly with prepuce of clitoris and frenulum of the clitoris

each one is continuous posteriorly with the fourchette -> connects the labia minora with the vaginal introitus (entry)

space between the labia minora

contains" urethral orifice, paraurethral glands (of Skene), vanginal introitus incompletely covered by the hymen, greater vestibular glands (of Bartholin), and lesser vestibular glands

has no corpus spongiosum and does not transmit the urethra

body of clitoris -> formed by two corpora cavernosa, which are continuous with the crura of the clitoris

glands of the clitoris is formed by the fusion of the vestibular bulbs

pregang cell bodies -> gray matter of S2-4 spinal cord

pregang axons -> form the pelvic splanchnic nerves, which interact with the inferior hypogastric plexux

postgang cell bodies -> located near of within the female viscera

postgang axons -> terminate on smooth muscle and glands

pregang cell bodies -> in the IML cell column of the spinal cord

pregang axons -> form the sacral splanchnic nerves

postgang cell bodies -> in the inferior hypogastric plexus

postgang axons -> terminate on smooth muscle and glands

the sac of peritoneum that incompletely surrounds the testes -> tunica vaginalis (has a parietal and visceral layer)

not found on posterior side of testes, found only on medial, lateral, and anterior sides of the testest

tunica albuginea projectes connective tissue septae

the septae create about 250 lobules (divides testes)

the setpae are projected inward toward mediastinum

the septae of the testes that converge toward the midline on the posterior surface of the testes

they meet to form the ridgelike thickening -> the mediastinum

rich collateral blood supply to the testes from:

artery of the ductus deferens (from the internal iliac)

cremasteric artery (from the inferior epigastric)

external pudendal artery (from the femoral)

this collateral circulation is sufficient to allow ligation of the testicular artery during surgery

to the testicular veins

right testicular -> empties directly into the IVC

left testicular -> empties into the left renal vein

testes begin to descend along normal pathway but fail to reach scrotum

undescended testis generally found w/in inguinal canal or abd cavity near deep inguinal ring

bilateral -> results in sterility (b/c of increased testicular temp)

associated with increased incidence of cancer and torsion

cryptorchidism -> testes began to descend along normal pathway but didn't reach scrotum (therefore, found w/in inguinal canal or in abd cavity near deep inguinal ring)

ectopic testes -> testes have descended along an abnormal pathway

an abnormal dilation of the pampiniform plexus and testicular vein -> presents as a palpable "bag of worms" scrotal swelling

90% occurs on left side due to compression of left testicular vein by sigmoid colon which contains stored feces and is often associated with infertility

rotation of the testes about the spermatic cord, usually toward the penis (medial rotation)

increased incidence occurs in men w/testes in a horizontal position and a high attachment of the tunica vaginalis to spermatic cord ("bell clapper deformity")

a medical emergency -> b/c compression of testicular vessels results in ischemia necrosis w/in 6 hrs

sudden excruciating scrotal pain

continued resorption of testicular fluid that began in efferent ductules

phagocytosis of degenerating sperm or spermatic residual bodies not phagocytosed by sertoli cells

secretion of glycoproteins (which bind t surface of cell membrane of sperm), sialic acid, glycerophosphocholine (which inhibits capacitation, preventing sperm from fertilizing 2ndary oocyte until sperm enter female tract)

glycoproteins -> bind to surface of cell membrane of sperm (thats all HYGA says)

sialic acid (no function described)

glycerophosphocholine -> inhibits capacitation, thus preventing sperm from fertilizing a 2ndary oocyte until the sperm enter the female reproductive tract

muscle coat consists of three layers:

inner longitudinal later

middle circular layer

outer longitudinal layer of smooth muscle

the three layers contract due to neural stimulation during sexual excitation and force sperm from the tail of the epididymus to the ductus deferens

this is the initial muscular component that contributes to the force of emission

begins at the inferior pole of testes, as continuation of tail of the epididymus

ascends to enter the spermatic cord

transits the inguinal canal (going through superficial inguinal ring first)

enters abdominal cavity by passing through deep inguinal ring

crosses external iliac vessels

and enters pelvis

joins prostate on posterior side w/seminal vesicles at the ejaculatory ducts that open into the prostatic urethra

similar to the tail region of the epididymus -> inner longitudinal later, middle circular layer, and outer longitudinal layer of smooth muscle

also contributes to the force of emission

from the artery of the ductus deferens which comes from the internal iliac artery

anastomoses with the testicular artery

vasectomy

what layers will be cut

skin -> colles fascia and dartos muscle (superficial fascia) -> external spermatic fascia -> cremasteric fascia and muscle -> internal spermatic fascia -> extraperitoneal fat

tunica vaginalis is NOT cut

ductus deferens

testicular artery

artery of the ductus deferens

cremasteric artery

pampiniform venous plexus

sympathetic and parasympathetic nerves -> which form testicular plexus

genitofemoral nerve

lymphatics

the ampulla of the ductus deferens

the seminal vesicles

the duct passes through the prostate gland and opens into the prostatic urethra at the seminal colliculus of the urethral crest

duct has NO smooth muscular coat -> does NOT contribute t othe force of emission

contraction with discharge seminal fluid into the ejaculatory duct

contraction is during emission

whitish-yellow viscous material

contains fructose (principal metabolic substrate for sperm) and other sugars, choline, proteins, aa's, ascorbic acid, citric acid, prostaglandins

testing for the presence of fructose (which is not produced elsewhere in the body) and choline crystals

both determine the presence of semen

clear, mucuslike, slippery fluid

contains galactose, galactosamine, galacturonic acid, sialic acid, and methylpentose

makes up major portion of preseminal fluid (pre-ejaculate fluid) and probably serves to lubricate the penile urethra

anterior surface -> related to retropubic space (which contains the vesical/retropubic venous plexus)

posterior surface -> related to the seminal vesicles and rectum

right and left lateral lobes

right and left posterior lobes

middle lobe

prostate is collection of 30-50 compound tubuloalveolar glands that are arranged in three zones

peripheral zone -> contains largest glands and highest number of glands

central zone

transitional (periurethral) zone

two pathways:

prostatic venous plexus -> internal iliac veins -> IVC

prostatic venous plexus -> vertebral venous plexus -> cranial dural sinuses

to the heart and lungs -> prostatic venous plexus -> internal iliac veins -> IVC

to the vertebral column and brain -> prostatic venous plexus -> vertebral venous plexus -> cranial dural sinuses

hyperplasia of the transitional (periurethral) zone -> involving lateral and middle lobes

may be due to do increased sensitivity of prostate to dihydrotestosterone (DHT)

develops in all men, NOT pre-malignant

hyperplasia of epithelial and fibromuscular stromal cells leads to formation of soft, yellow-pink nodules

compresses prostatic urethra -> obstructing urine flow

signs -> increased freq of urination, nocturia, dysuria, difficulty starting and stopping urination, dribbling, sense of incomplete emptying of bladder

treatment -> block conversion of testosterone to DHT &/or inhibit prostate gland secretion

common in peripheral zone (contains the largest glands, and largest # of glands) -> involving posterior lobes (palpable on digital rectal exam)

neoplastic epithelial cells -> formation of yellow, firm, gritty tumors -> invade nearby structures

by time urethral blockage occurs -> carcinoma is in advanced stage

pt usualy asymptomatic until advanced stages

signs -> indurated mass on digital rectal exam, obstructive uropathy, low back or pelvic pain

metastasis to bone is frequent

treatment -> inhibit release of follicle-stimulating hormone and leuteinizing hormone, radiation, prostatectomy

three columns -> bound together by the tunica albuginea

corpus spongiosum (1)

corpora cavernosa (2)

begins as bulb of penis and ends as glans penis

ventrally situated in the penis and transmits the urethra

during erection, doesn't get as turgid as corpora cavernosa

begin as crura of the penis and end proximal to the glans penis

dorsally situated in the penis

found within the corpus spongiosum and corpora cavernosa

consists of vascular channels that are linked by endothelium

supports the penis

arises from the linea alba and inserts into the deep fascia (of Buck)

from the deep artery of the penis (involved in the erection of the penis), one in each corpora cavernosa

dorsal arteries of the penis from the internal pudendal artery off of the internal iliac artery (two, both superficial to the corpora cavernosa)

two pathways

deep dorsal vein of the penis -> prostatic venous plexus -> internal iliac -> IVC

superficial dorsal vein -> external pudendal vein -> great saphenous vein -> femoral vein -> external iliac -> IVC

pregang cell bodies -> gray matter of S2-4 spinal cord

pregang axons -> form pelvic splanchnic nerves, which interact with the inferior hypogastric plexus

postgang cell bodies -> located near or within male viscera

postgang axons -> terminate on smooth muscle and glands

pregang cell bodies -> IML cell column of spinal cord

pregang axons -> for the sacral splanchnic nerves

postgang cell bodies -> in the inferior hypogastric plexus

postgang axons -> terminate on smooth muscle and glands

controlled by parasympathetic nervous system via pelvic splanchnic S2-4 -> dilate blood vesles supplying the erectile tissue -> engored corpora cavernosa and corpus spongiosum with blood -> compresses veins -> impedes venous return -> full erection

also maintained by somatic nervous system via perineal branch of pudendal nerve -> contract bulbospongiosum muscles and ischiocavernosus muscles -> compresses erectile tissue of bulb and crura of penis -> helps maintain erection

deep transverse perineal muscle

external urethral sphincter, aka - sphincter urethra muscle

coxal (hip bone)

sarcum

coccyx

forms lateral part of hip bone (coxal)

composed of anterior-superior iliac spine, anterior-inferior iliac spine, posterior iliac spine (superior and inferior), greater sciatic notch, iliac fossa, and gluteal lines (anterior, posterior, inferior)

sacrum 

location in bony pelvis

contains what structures

the pedicles form the sacral cornua

important landmarks in locating the sacral hiatus for administration of caudal anesthesia

as exiting the pelvic cavity to enter gluteal and thigh regions, the greater sciatic foramen transmits:

superior gluteal vein, artery and nerve; piriformis muscle; inferior gluteal vein, artery, and nerve; sciatic nerve; internal pudendal vein and artery; pudendal nerve

as they re-enter the pelvic cavity and proceed to perineum, the lesser sciatic foramen trasnmits:

internal pudendal vein and artery and pudendal nerve

pubic crest, iliopectineal line, and arcuate line

(linea terminalis is part of pelvic inlet)

females -> oval shaped

males -> heart shaped

what are the two measurements of the pelvic inlet

and which can be measured clinically

true conjugate diameter

diagonal conjugate diameter (able to be measured during an obstetric exam)

describe the true conjugate diameter measurement

and how is it measured

distance from the sacral promontory to the supierior margin of the pubic symphysis

measured radiographically on a lateral projection

describe the diagonal conjugate diameter

and how is it measured

distance from the sacral promontory to the inferior margin of the pubic symphysis

measured during an obstetric digital examination

what defines the pelvic outlet

who is it closed

shape

divided into what

defined by the coccyx, ischial tuberosities, inferior pubic ramus, and pubic symphysis

closed by the pelvic diaphragm and urogenital diaphragm

diamond shaped in both males and females

anal triangle and urogenital triangle

the triangles make up the pelvic outlet

and they are made by a line passing through the ischial tuberosities

the measurements of the pelvic outlet

and which one might present a problem during childbirth

transverse diameter

interspinous diameter -> may present a barrier to fetus during childbirth if interspinous diameter < 9.5 cm

distance between the ischial spines

the spines may present a barrier to the fetus during childbirth if the interspinous diameter < 9.5 cm

major false pelvic cavity:

males -> cavity is deep

females -> cavity is shallow

minor (true) pelvic cavity:

males -> narrow, deep, tapering

females -> wide and shallow, cylindrical

subpubic angle, aka pubic arch

males: <70 degress, narrow

females: > 80 degrees, wide

greater sciatic notch

males -> narrow, about 70 degrees

females -> wide, about 90 degrees

sacrum

males -> long and narrow

females -> short and wide

obturator internus muscle

piriformis muscle

coccygeus muscle

levator ani muscles (iliococcygeus, pubococcygeus, puborectalis)

arterial supply of the pelvis

(the major suppliers, not the smaller branches)

internal iliac artery (anterior and posterior divisions)

median sacral artery

superior rectal artery

ovarian artery (female) or testicular artery (male)

inferior gluteal artery

internal pudendal artery

umbilical artery

obturator artery

vaginal artery (females) or inferior vesical artery (males)

uterine artery (female) or artery of the ductus deferens (male)

middle rectal artery

iliolumbar artery

lateral sacral artery

superior gluteal artery

inferior gluteal artery

branch of what artery

how does it exit or enter the pelvis

and supplies what structures

branch of the anterior division of the internal iliac artery

exits the pelvis via the infrapiriformis recess of the greater sciatic foramen (inferior to the piriformis muscle)

supplies:

pelvic diaphragm, piriformis, quadratus femoris, uppermost hamstrings, gluteus maximus, and sciatic nerve

internal pudendal artery

branch of what artery

course of travel

supplies what structures

branch of anterior division of internal iliac artery

exits pelvis via the infrapiriformis recess of the greater sciatic foramen (inferior to the piriformis muscle) -> enters perineum via lesser sciatic foramen -> courses to urogenital triangle via pudendal canal

supplies:

perineum (it is the main artery of the perineum), including skin and muscles of anal triangle and urogenital triangle and the erectile bodies

umbilical artery

branch of what artery

course of travel

supplies what structures

branch of the anterior division of the internal iliac artery

runs along lateral pelvic wall and alongside bladder for a short distance, then obliterates to form medial umbilical ligament

gives rise to superior vesical artery which supplies superior part of urinary bladder

obturator artery

branch of what artery

course of travel

supplies what structures

branch of anterior division of internal iliac artery

runs along the lateral pelvic wall and exits the pelvis via the obturator canal

supplies:

pelvic muscles, muscles of the medial compartment of the thigh, head of femur, and ilium

vaginal artery (female) or inferior vesical artery (male)

supplies what structures

vaginal artery in females -> anterior and posterior walls of the vagina, vestibular bulb, and adjacent rectum

inferior vesical artery in males ->  runs in lateral ligament of the bladder and supplies fundus of bladder, prostate gland, seminal vesicle, ductus deferens, and lower part of ureter

uterine artery (female) or artery of the ductus deferens (male)

branch of what artery

course of travel

supplies what structures

branch of anterior division of internal iliac artery

uterine artery in females -> run medially in the base of the broad ligament to reach junction of cervix and body of uterus and runs in front of and above ureter near lateral fornix of vagina

supplies:

uterus, ligaments of the uterus, uterine tube, ovary, cervix, and vagina

artery of the ductus deferens in males -> supplies the ductus deferens

middle rectal artery

branch of what artery

course of travel

supplies what structures

branch of anterior division of internal iliac artery

runs medially and descends in the pelvis

supplies lower part of rectum, upper part of anal canal, prostate gland, and seminal vesicles

iliolumbar artery

lateral sacral artery

superior gluteal artery

iliolumbar artery

branch of what artery

course of travel

supplies what structures

branch of posterior division of internal iliac artery

ascends anterior to sacroiliac joint and posterior to the psoas major muscle

supplies psoas major, iliacus, quadratus lumborum, and cauda equina in vertebral column

lateral sacral artery

branch of what artery

course of travel

supplies what structures

branch of the posterior division of internal iliac artery

runs medially in front of sacral plexus and gives rise to branches that enter anterior sacral foramina and then emerge from posterior sacral foramina

supplies the meninges, roots of sacral nerves, and muscles and skin overlying the sacrum

superior gluteal artery

branch of what artery

course of travel

supplies what structures

branch of posterior division of internal iliac artery

exits the pelvis via the suprapiriformis recess of the greater sciatic foramen (superior to the piriformis muscle)

supplies: piriformis, gluteal muscles, and tensor fascia lata

median sacral artery

branch of what artery

course of travel

supplies what structures

branch of aorta, on posterior aspect

runs close to midline over the L4 and L5 vertebrae, sacrum, and coccyx

gives rise to medial sacral arteries

median sacral artery supplies posterior part of rectum, lower lumbar vertebrae, sacrum, and coccyx

superior rectal artery

branch of what artery

course of travel

supplies what structures

continuation of inferior mesenteric artery

descends into pelvis between the layers of the sigmoid colon

supplies the superior part of the rectum

ovarian artery (female) or testicular artery (male)

branch of what artery

corse of travel

supplies what structures

ovarian artery in females -> arises from abd aorta and reaches ovary through the suspensory ligament of the ovary

supplies the ureter, ovary, and ampulla of the uterine tube

testicular artery in males -> arises from abd aorta and then runs in the inguinal canal to enter the scrotum

supplies the ureter, testis, and epididymis

pelvic venous plexuses within the minor (true) pelvic cavity are formed by intercommunicating veins surrounding the pelvic viscera and include:

rectal venous plexus

vesical venous plexus

prostatic venous plexus

uterine venous plexus

vaginal venous plexus

pelvic venous plexus (PVP) -> internal iliac veins -> common iliac veins -> IVC (this is the main venous drainage pathway)

PVP -> median sacral vein -> common iliac vein -> IVC

PVP -> ovarian veins -> IVC

PVP -> superior rectal vein -> inferior mesenteric vein -> portal vein

PVP -> lateral sacral veins -> internal vertebral venous plexus -> cranial dural sinuses