Where is the pelvic bone located on a female

Anatomy, Function of Bones, Muscles, Ligaments

What is the female pelvis?

The pelvis is the lower part of the torso. It’s located between the abdomen and the legs. This area provides support for the intestines and also contains the bladder and reproductive organs.

There are some structural differences between the female and the male pelvis. Most of these differences involve providing enough space for a baby to develop and pass through the birth canal of the female pelvis. As a result, the female pelvis is generally broader and wider than the male pelvis.

Below, learn more about the bones, muscles, and organs of the female pelvis.

Female pelvis anatomy and function

Female pelvis bones

Hip bones

There are two hip bones, one on the left side of the body and the other on the right. Together, they form the part of the pelvis called the pelvic girdle.

The hip bones join to the upper part of the skeleton through attachment at the sacrum. Each hip bone is made of three smaller bones that fuse together during adolescence:

Ilium. The largest part of the hip bone, the ilium, is broad and fan-shaped. You can feel the arches of these bones when you put your hands on your hips.
Pubis. The pubis bone of each hip bone connects to the other at a joint called the pubis symphysis.
Ischium. When you sit down, most of your body weight falls on these bones. This is why they’re sometimes called sit bones.

The ilium, pubis, and ischium of each hip bone come together to form the acetabulum, where the head of the thigh bone (femur) attaches.

Sacrum

The sacrum is connected to the lower part of the vertebrae. It’s actually made up of five vertebrae that have fused together. The sacrum is quite thick and helps to support body weight.

Coccyx

The coccyx is sometimes called the tailbone. It’s connected to the bottom of the sacrum supported by several ligaments.

The coccyx is made up of four vertebrae that have fused into a triangle-like shape.

Female pelvis muscles

Levator ani muscles

The levator ani muscles are the largest group of muscles in the pelvis. They have several functions, including helping to support the pelvic organs.

The levator ani muscles consist of three separate muscles:

Puborectalis. This muscle is responsible for holding in urine and feces. It relaxes when you urinate or have a bowel movement.
Pubococcygeus. This muscle makes up most of the levator ani muscles. It originates at the pubis bone and connects to the coccyx.
Iliococcygeus. The iliococcygeus has thinner fibers and serves to lift the pelvic floor as well as the anal canal.

Coccygeus

This small pelvic floor muscle originates at the ischium and connects to the sacrum and coccyx.

Female pelvis organs

Uterus

The uterus is a thick-walled, hollow organ where a baby develops during pregnancy.

During the reproductive years, the lining of the uterus sheds every month during menstruation if you don’t become pregnant.

Ovaries

There are two ovaries located on either side of the uterus. The ovaries produce eggs and also release hormones, such estrogen and progesterone.

Fallopian tubes

The fallopian tubes connect each ovary to the uterus. Specialized cells in the fallopian tubes use hair-like structures called cilia to help direct eggs from the ovaries toward the uterus.

Cervix

The cervix connects the uterus to the vagina. It’s able to widen, allowing sperm to pass into the uterus.

In addition, thick mucus produced in the cervix can help to prevent bacteria from reaching the uterus.

Vagina

The vagina connects the cervix to the exterior female genitalia. It’s also called the birth canal, as the baby passes through the vagina during delivery.

Rectum

The rectum is the lowest part of the large intestine. Feces collects here until exiting through the anus.

Bladder

The bladder is the organ that collects and stores urine until it’s released. Urine reaches the bladder through tubes called ureters that connect to the kidneys.

Urethra

The urethra is the tube that urine travels through to exit the body from the bladder. The female urethra is much shorter than the male urethra.

Female pelvis ligaments

Broad ligament

The broad ligament supports the uterus, fallopian tubes, and ovaries. It extends to both sides of the pelvic wall.

The broad ligament can be further divided into three components that are linked to different parts of the female reproductive organs:

mesometrium, which supports the uterus
mesovarium, which supports the ovaries
mesosalpinx, which supports the fallopian tubes

Uterine ligaments

Uterine ligaments provide additional support for the uterus. Some of the main uterine ligaments include:

the round ligament
cardinal ligaments
pubocervical ligaments
uterosacral ligaments

Ovarian ligaments

The ovarian ligaments support the ovaries. There are two main ovarian ligaments:

the ovarian ligament
the suspensory ligament of the ovary

Female pelvis diagram

Explore this interactive 3-D diagram to learn more about the female pelvis:

Female pelvis conditions

The pelvis contains a large number of organs, bones, muscles, and ligaments, so many conditions can affect the entire pelvis or parts within it.

Some conditions that can affect the female pelvis as a whole include:

Pelvic inflammatory disease (PID). PID is an infection that occurs in the female reproductive system. While it’s often caused by a sexually transmitted infection, other infections can also cause PID. Untreated PID can lead to complications, such as infertility or ectopic pregnancy.
Pelvic organ prolapse. Pelvic organ prolapse occurs when the muscles in the pelvis can no longer support its organs, such as the bladder, uterus, or rectum. This can cause one or more of these organs to press down on the vagina. In some cases, this can cause a bulge to form outside of the vagina.
Endometriosis. Endometriosis occurs when the tissue that lines the inside walls of the uterus (endometrium) begins to grow outside of the uterus. The ovaries, fallopian tubes, and other tissues in the pelvis are typically affected by the condition. Endometriosis can lead to complications, including infertility or ovarian cancer.

Symptoms of a pelvic condition

Some common symptoms of a pelvic condition can include:

pain in the lower abdomen or pelvis
a feeling of pressure or fullness in the pelvis
unusual or foul-smelling vaginal discharge
pain during sex
bleeding in between periods
painful cramping during or before periods
pain during bowel movements or when urinating
a burning feeling when urinating

Tips for a healthy pelvis

The female pelvis is a complex, important part of the body. Follow these tips to keep it in good health:

Stay on top of your reproductive health

See a gynecologist for a yearly health screen. Things like pelvic exams and Pap smears can aid in identifying pelvic conditions or infections early.

You can get a free or low-cost pelvic exam at your local Planned Parenthood clinic.

Practice safe sex

Use barriers — such as condoms or dental dams — during sexual activity, especially with a new partner, to avoid infections that could lead to PID.

Try pelvic floor exercises

These types of exercises can help to strengthen the muscles in the pelvis, including those around the bladder and vagina.

Stronger pelvic floor muscles can aid in preventing things like incontinence or organ prolapse. Here’s how to get started.

Never ignore unusual symptoms

If you’re experiencing anything unusual in your pelvic area, such as bleeding between periods or unexplained pelvic pain, make an appointment with your doctor. Left untreated, some pelvic conditions can have lasting impacts on your health and fertility.

Anatomy, Abdomen and Pelvis, Female Pelvic Cavity - StatPearls

Introduction

The pelvic cavity is a bowl-like structure that sits below the abdominal cavity. The true pelvis, or lesser pelvis, lies below the pelvic brim (Figure 1). This landmark begins at the level of the sacral promontory posteriorly and the pubic symphysis anteriorly. The space below contains the bladder, rectum, and part of the descending colon. In females, the pelvis also houses the uterus, fallopian tubes, and ovaries. Knowledge of anatomy unique to females is essential for all clinicians, especially those in the field of obstetrics and gynecology.

Structure and Function

The uterus sits in the center of the female pelvic cavity (Figure 2.) The most common position of the uterus in the pelvic cavity is anteverted and anteflexed.[1] "Version" refers to the angle between the cervix and the vagina. An anteverted uterus appears "tipped forward" in the pelvic cavity. A retroverted uterus is "tipped backward." Retroversion is a normal variant but can lead to dyspareunia. Additionally, retroversion of a gravid uterus correlates with higher rates of vaginal bleeding and spontaneous abortion.[2]

"Flexion" is the term for the angle between the cervix and uterine body. Anteflexed means the uterus is bent forward. Retroflexed means the uterus bends backward. Occasionally, retroflexion is seen after cesarean section and may be due to scar tissue that attaches the uterine body to the abdominal wall, causing the fundus to bend posteriorly.[3] However, the data supporting this theory is limited.

Anterior to the uterus is the bladder, with rectum located posteriorly. Between the uterus and the rectum is the recto-uterine space, also known as the posterior cul-de-sac. It is a potential space prone to fluid collection. Small amounts of physiologic fluid accumulate during ovulation and menses. Pathologic causes of fluid collection in the recto-uterine pouch include pelvic abscesses, drop metastasis from gastrointestinal malignancies, and endometriosis. In certain situations, if fluid accumulation is severe, this space can be drained by performing a culdocentesis, which is accomplished by inserting a needle through the posterior fornix of the upper vagina to access the posterior cul-de-sac.

The posterior cul-de-sac communicates with the retroperitoneal space of the abdomen via the right and left epiploic gutters. The right gutter leads to the hepatorenal space, also known as Morrison's pouch. The right epiploic gutter also allows the spread of pelvic pathogens into the subphrenic space. Occasionally infection of the subphrenic space can occur, leading to adhesions on the capsule of the liver. This pathology is known as Fitz-Curtis-Hugh syndrome or gonococcal perihepatitis.

The left epiploic gutter leads to the splenorenal pouch. Due to the leftward position of the rectum, pelvic pathology is less likely to spread to the abdomen via the left epiploic communication. [4]

Embryology

The organs of the female reproductive tract each have a unique embryological origin. The exact embryological timeline in which these organs develop is still open to debate because most embryologic studies use animal models with different gestational ages. However, there is a consensus that the ovaries are the first to develop. They arise from the surface of the mesonephros at the gonadal ridge.[5] Later in development, the ovaries descend into the pelvis with guidance from the gubernaculum. The inferior aspect of the gubernaculum subsequently becomes the round ligament of the uterus and terminates at the labia majora.

In females, the absence of a Y chromosome allows the uterus to form. It derives from the Müllerian ducts, also known as the paramesonephric ducts. These ducts fuse to form the uterus, fallopian tubes, and cervix. Some studies suggest that the paramesonephric ducts also give rise to the upper vagina while other studies indicate that the vagina exclusively derives from the urogenital sinus epithelium. [6] In males, a substance coded for on the Y chromosome, known as the anti-Mullerian hormone, prevents the formation of internal female reproductive organs.

Blood Supply and Lymphatics

Arterial

The anterior branch of the internal iliac artery supplies most of the female reproductive organs. The uterine artery supplies the majority of the uterus (Figure 3). The lower uterine segment has a dual blood supply that includes branches of the vaginal artery. The ovaries are an exception because they receive blood from the ovarian arteries, which descend from the abdominal aorta.

The superior vesicle artery supplies the upper bladder. In females, the vaginal artery supplies the lower bladder. Both arteries are also branches of the anterior branch of the internal iliac artery.

The rectum receives vascular supply via three vessels. The superior rectal artery is the terminal branch of the inferior mesenteric artery. The middle rectal is a branch of the internal iliac artery. The inferior rectal is a branch of the pudendal artery.

Venous

The venous supply of pelvic organs follows the arterial supply. The uterine vein receives blood from the uterus and drains into the internal iliac vein. The ovarian veins receive blood from the ovaries. The right ovarian vein drains its contents directly into the inferior vena cava, while the left ovarian vein drainage is into the left renal vein. The increased length of the left ovarian vein makes it more susceptible to compression, especially during pregnancy.[7] Ovarian vein compression can lead to pelvic venous compression syndrome. The resulting pelvic vasculature congestion is a cause of chronic pelvic pain and may occur in non-pregnant patients as well.

The left-sided venous supply is also unique because the left internal iliac artery travels from its right-sided origin at the inferior vena cava towards a leftward destination in the pelvis. The longer path makes the left internal iliac more prone to compression and may explain why venous thromboembolism in pregnancy most commonly occur in the left iliac and iliofemoral veins. [8] Additionally, the leftward position of the sigmoid colon causes a gravid uterus to tip toward the right, which is thought to increase the risk of iliac vessel compression further.

Lymphatics

The lymphatic network of the pelvis is complex but is essential to understand when staging and treating gynecologic malignancies. Generally, the pelvic organs drain into the internal and external iliac lymph nodes (Figure 5).

The lymphatic drainage of the uterus is more complicated and remains somewhat ambiguous.[9] Some researchers suggest it may involve pelvic and para-aortic lymph nodes.[10] A more recent study from 2017 suggests that the uterus has two primary routes of lymphatic drainage, an upper pathway that drains to the external iliac and/or obturator lymph nodes and a lower pathway that drains to the internal iliac and/or presacral lymph nodes.[11]

The ovaries are an exception to the other female pelvic organs because they do not drain to pelvic lymph nodes. Their lymphatic drainage follows their blood supply; therefore they drain directly to the paraaortic lymph nodes.

Nerves

The female reproductive organs have both autonomic and sensory innervation. Beginning with the autonomic nervous system, sympathetic fibers exit at the level of T10 to L2 to form the superior hypogastric plexus, which divides into the left and right hypogastric nerve at approximately the level of the sacral promontory. The parasympathetic nerve fibers exit at the level of S2 to 4 and meet up with the sympathetic nervous system at the right and left hypogastric nerves. The right and left hypogastric nerves then migrate inferiorly to form the inferior hypogastric plexus. After this point, the nerve fibers follow blood vessels to their target organs. The inferior hypogastric plexus also receives sensory information from the uterus.

The ovarian nerve innervates the ovary. Although previously thought only to contain sensory fibers, recent animal studies suggest this nerve also carries autonomic fibers that may play a role in hormone secretion and constriction of ovarian vessels. [12][13][14] Recent studies suggest that the cervix and upper vagina also have autonomic innervation; however, the role of autonomic innervation in this region remains unclear.[15][16] Sensory innervation to the cervix and upper vagina has been more widely studied and receives supply by the pelvic splanchnic nerves. The pudendal nerve supplies the sensory innervation of the lower vagina. Pudendal nerve blocks can be used to provide local pain relief to laboring women by using the ischial spines as landmarks. Although once the treatment of choice for labor pain, it is no longer commonly used due to the widespread use of epidural anesthesia.[17]

Muscles

The inferior border of the pelvic cavity is the pelvic diaphragm. It is made up of a group of muscles. From posterior to anterior, these muscles include:

Piriformis
Coccygeus
Iliococcygeus
Pubococcygeus
Puborectalis

The fibers of the iliococcygeus, pubococcygeus, and puborectalis make up the levator ani muscle. Because of its proximity to the vagina, the pubococcygeus and puborectalis are the most commonly injured muscles during vaginal deliveries.[18] The obturator internus muscles make up the peripheral borders of the pelvis but are not among the muscles of the pelvic floor.

Ligaments

Three ligaments anchor the uterus. The uterosacral ligament supports the uterus posteriorly, and the pubocervical ligament anchors the uterus anteriorly. The transverse cervical ligament supports the uterus laterally. Unlike the anterior and posterior planes that contain the bladder and rectum respectively, the lateral plane lacks supporting structures other than the transverse cervical ligament. It is for this reason that this ligament also has the name of the "cardinal" ligament. The transverse ligament also differs from other supporting ligaments of the uterus because it is the only ligament that contains a vasculature structure, the uterine artery.

The ovary also has ligamentous support. The utero-ovarian ligament, also known as the ovarian ligament, extends from the ovary to the uterine body. The ovary is supported superiorly by the infundibulopelvic ligament, also known as the suspensory ligament of the ovary. This ligament descends from the lateral aspect of the abdominal wall and contains the ovarian neurovascular bundle.

The broad ligament overlies the uterus, fallopian tubes, and ovaries. It is the inferior most extension of the parietal peritoneum and has three divisions based on location. The lateral most aspect of the broad ligament is the "mesovarium" and overlies the ovaries. The "mesosalpinx" covers the fallopian tubes. The largest portion of the broad ligament is the "mesometrium" and overlies the uterus.

Physiologic Variants

The uterine and ovarian arteries supply the majority of the female reproductive tract. The uterine artery, like many pelvic arteries, has a variable presentation. It most commonly arises from the anterior branch of the internal iliac artery and shares a common trunk with the obliterated umbilical artery. [19] One study that analyzed imaging from 218 patients reported this presentation in 80.7 % of cases.[20] The same study reported the uterine artery branched directly off of the internal iliac in 13.6% of cases, making this the most common variation. The second and third most common variations they found were direct branching from the superior gluteal artery and internal pudendal artery, respectively. These variations are necessary to be aware of during surgery as well as during uterine artery embolization.

Ovarian artery variants are less common, but case reports exist that detail unique aberrations. One case report found an aberrant ovarian artery arising from the external iliac artery.[21] Another study reported an ovarian artery that branched directly from the common iliac artery.[22] These variations are thought to be due to abnormal descent of the ovaries into the pelvis during embryological development and may also correlate to other differences.[23]

Surgical Considerations

Several anatomical relationships are essential for surgeons to be aware of when operating in the female pelvis. For example, during a cesarean section, the bladder should always be identified to avoid iatrogenic cystotomy. This cautionary measure is especially the case in patients that have had a prior cesarean section because scar tissue can cause the bladder to adhere to the anterior uterine wall.

During any uterine surgery, identification of the uterine artery is vital. If cut, massive bleeding can ensue. During abdominal hysterectomies, the uterine artery is typically “skeletonized” so that its path along the uterus is clearly identifiable to the operating team.

If hemorrhage does occur, knowledge of pelvic vasculature becomes crucial. If the bleeding vessel cannot be clearly identified, the internal iliac should be clamped below the origin of the superior gluteal artery. This method is preferred so that necrosis of the gluteal muscle does not occur.

When operating deeper in the female pelvis, identification of the ureter is also crucial. There are three major locations where this structure may exist. Beginning superiorly, the ureters descend into the pelvis posterior to the infundibulopelvic ligaments. The ureters maintain this relationship until approximately the level of the iliac vessels, where they begin to travel more medially.

As the ureters continue to travel inferiorly, the next important landmark is the transverse cervical ligament. The ureters dive under this structure. Awareness of this relationship is of considerable importance when performing a hysterectomy. A popular pneumonic used by medical students is, "water under the bridge."

After passing under the transverse cervical ligament, the ureters continue to travel medially toward the bladder. Their insertion into the inferior aspect of the bladder is the third major location they should undergo positive identification intraoperatively. The insertion points are also visible from inside the bladder itself, during cystoscopy; this is sometimes performed after pelvic surgery if an injury to the bladder is suspected.

Injury to the bladder can also occur during pelvic surgery from the vaginal approach. When operating in this plane, injury to the rectum is also a possibility because at this level the rectum is directly posterior to the vagina (Figure 6.) Avoiding bladder and rectal injury becomes increasingly difficult if the patient has pelvic organ prolapse, such as cystocele or rectocele.

When performing surgery on the fallopian tubes, such as during a tubal ligation or tubal anastomosis, the location of the round ligament should be determined. Due to the similarity in structure and location, the round ligament can be mistaken for a fallopian tube. Unlike the round ligaments, however, the fallopian tubes have fimbriae, a characteristic can be used to differentiate between these two structures intraoperatively.

Clinical Significance

Clinical correlates related to female pelvic anatomy can be summarized as follows:

The standard position of the uterus is anteverted and anteflexed. Abnormal positioning of the uterus is associated with pathology. Retroversion, for example, is a cause of dyspareunia. Additionally, retroversion of a gravid uterus is associated with higher rates of spontaneous abortion.
The posterior cul-de-sac, located between the uterus and the rectum, is a potential space prone to fluid collection. Physiologic fluid accumulates during menses and ovulation. If fluid collection is pathologic, this space can undergo drainage via culdocentesis.
The posterior cul-de-sac communicates with the abdomen via the left and right epiploic gutters, which allows the spread of pelvic pathogens into the abdominal cavity. Due to the leftward position of the rectum, infections usual take the path of the right epiploic gutter. The right epiploic gutter leads to potential spaces surrounding the liver. These include the hepatorenal space, also known as Morrison’s pouch, and the subphrenic space. Infection of the subphrenic space secondary to a gonococcal pelvic infection is termed Fitz-Curtis-Hugh syndrome or gonococcal perihepatitis.
The increased length of the left ovarian vein makes it more susceptible to compression, especially during pregnancy. Compression of this vessel sometimes leads to pelvic venous compression syndrome and is a cause of chronic pelvic pain in both pregnant and non-pregnant patients.
Venous thromboembolism in pregnancy is most commonly left-sided and occur in the iliofemoral vessels, which is thought to be because of pelvic vessel engorgement in combination with the increased path the left iliac vein takes across the pelvis. These factors make this vessel more susceptible to compression by a gravid uterus.
Understanding the lymphatic drainage of the female reproductive tract is important when tracking the spread of gynecologic malignancies. Generally, the female reproductive organs drain to the internal and external iliac lymph nodes. A notable exception is the ovaries, which drain to the paraaortic lymph nodes.
The pudendal nerve receives sensory innervation to the lower vagina. Historically, pudendal nerve blocks were used to alleviate labor pains. However, pudendal nerve blocks are no longer commonly practiced due to the wide-spread use of epidural anesthesia.
The muscles of the pelvic floor are susceptible to injury during vaginal deliveries. The most commonly injured muscles are the pubococcygeus and puborectalis muscles due to their proximity to the vagina.
The pelvic vasculature contains many physiologic variants that are important for surgeons to know. Interventional radiologists should also be knowledgeable of variants, particularly during uterine artery embolization to treat fibroids. The uterine artery most commonly arises from the anterior branch of the internal iliac and shares a trunk with the obliterated umbilical artery. The most common variation is direct branching from the internal iliac.

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Figure

Compilation of 6 images detailing anatomy of female pelvic cavity. Contributed by Gray's Anatomy Plates (Public Domain)

References

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5.: Yao HH. The pathway to femaleness: current knowledge on embryonic development of the ovary. Mol Cell Endocrinol. 2005 Jan 31;230(1-2):87-93. [PMC free article: PMC4073593] [PubMed: 15664455]
6.: Robboy SJ, Kurita T, Baskin L, Cunha GR. New insights into human female reproductive tract development. Differentiation. 2017 Sep-Oct;97:9-22. [PMC free article: PMC5712241] [PubMed: 28918284]
7.: Jeanneret C, Beier K, von Weymarn A, Traber J. Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches. Vasa. 2016;45(4):275-82. [PubMed: 27428495]
8.: American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018 Jul;132(1):e1-e17. [PubMed: 29939938]
9.: Coleman RL, Frumovitz M, Levenback CF. Current perspectives on lymphatic mapping in carcinomas of the uterine corpus and cervix. J Natl Compr Canc Netw. 2006 May;4(5):471-8. [PubMed: 16687095]
10.: Burke TW, Levenback C, Tornos C, Morris M, Wharton JT, Gershenson DM. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996 Aug;62(2):169-73. [PubMed: 8751545]
11.: Geppert B, Lönnerfors C, Bollino M, Arechvo A, Persson J. A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2017 May;145(2):256-261. [PubMed: 28196672]
12.: Uchida S, Kagitani F. Autonomic nervous regulation of ovarian function by noxious somatic afferent stimulation. J Physiol Sci. 2015 Jan;65(1):1-9. [PMC free article: PMC4276811] [PubMed: 24966153]
13.: Pastelín CF, Rosas NH, Morales-Ledesma L, Linares R, Domínguez R, Morán C. Anatomical organization and neural pathways of the ovarian plexus nerve in rats. J Ovarian Res. 2017 Mar 14;10(1):18. [PMC free article: PMC5351206] [PubMed: 28292315]
14.: Cruz G, Fernandois D, Paredes AH. Ovarian function and reproductive senescence in the rat: role of ovarian sympathetic innervation. Reproduction. 2017 Feb;153(2):R59-R68. [PubMed: 27799628]
15.: Mónica Brauer M, Smith PG. Estrogen and female reproductive tract innervation: cellular and molecular mechanisms of autonomic neuroplasticity. Auton Neurosci. 2015 Jan;187:1-17. [PMC free article: PMC4412365] [PubMed: 25530517]
16.: Mowa CN. Uterine Cervical Neurotransmission and Cervical Remodeling. Curr Protein Pept Sci. 2017;18(2):120-124. [PubMed: 27001061]
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18.: Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. Womens Health (Lond). 2013 May;9(3):265-77; quiz 276-7. [PMC free article: PMC3877300] [PubMed: 23638782]
19.: Peters A, Stuparich MA, Mansuria SM, Lee TT. Anatomic vascular considerations in uterine artery ligation at its origin during laparoscopic hysterectomies. Am J Obstet Gynecol. 2016 Sep;215(3):393.e1-3. [PubMed: 27287682]
20.: Chantalat E, Merigot O, Chaynes P, Lauwers F, Delchier MC, Rimailho J. Radiological anatomical study of the origin of the uterine artery. Surg Radiol Anat. 2014 Dec;36(10):1093-9. [PubMed: 24052200]
21.: Kwon JH, Kim MD, Lee KH, Lee M, Lee MS, Won JY, Park SI, Lee DY. Aberrant ovarian collateral originating from external iliac artery during uterine artery embolization. Cardiovasc Intervent Radiol. 2013 Feb;36(1):269-71. [PubMed: 22565531]
22.: Kim WK, Yang SB, Goo DE, Kim YJ, Chang YW, Lee JM. Aberrant ovarian artery arising from the common iliac artery: case report. Korean J Radiol. 2013 Jan-Feb;14(1):91-3. [PMC free article: PMC3542308] [PubMed: 23323036]
23.: Rahman HA, Dong K, Yamadori T. Unique course of the ovarian artery associated with other variations. J Anat. 1993 Apr;182 ( Pt 2)(Pt 2):287-90. [PMC free article: PMC1259840] [PubMed: 8376204]

treatment, diagnosis, causes — 8(495)120-02-05

nine0010

Obstetrics and Gynecology
Consultations of the Chief Physician
Primary obstetrician-gynecologist consultation (excellent student of health care, Khersonskaya E.B.)	8000.00
Repeated consultation with an obstetrician-gynecologist (excellent worker in public health, Khersonskaya E.B.)	7000.00
Consultation of an obstetrician-gynecologist under the WB contract (excellent worker in healthcare, Khersonskaya E.B.) 2022	6000.00
Head physician remote consultation	3000.00
Chief physician's consultation on the correction of prescribed treatment	4000. 00
Extended consultation with the chief physician (more than 60 min.)	9000.00
CITO consultation (off days and hours)	10000.00
Consulting
Consultation of an obstetrician-gynecologist (Dr. Mezhlumova N.A.)	3500.00
Obstetrician-gynecologist primary consultation (Dr. Fotina E.V.)	4500.00
Obstetrician-gynecologist repeated consultation (Dr. Fotina E.V.)	4000.00
Consultation of an obstetrician-gynecologist under the WB contract (Fotina E.V.) 2022	3800.00
Doctor's consultation on the correction of the prescribed treatment	2000.00
Obstetrician-gynecologist remote consultation	3000.00
Remote consultation of a doctor for the correction of prescribed treatment	1500. 00
Primary consultation with a gynecologist-reproductologist	5000.00
Repeated consultation with a gynecologist-reproductologist	4500.00
Consultation with a gynecologist-reproductologist and ultrasound to assess the ovarian reserve	6500.00
Extended consultation with a gynecologist-reproductologist and ultrasound to assess the ovarian reserve	7000.00
Obstetrician-gynecologist consultation (Dr. Egorova A.A., Muravina E.L.)	4000.00
Consultation of an obstetrician-gynecologist (Dr. Kozlovskaya I.A.)	4500.00
Consultation of an obstetrician-gynecologist (Honored Doctor of the Russian Federation Ivanova N.V., Professor Panina O.B.)	8000.00
Council of obstetricians-gynecologists (Honored Doctor of the Russian Federation Ivanova N. V. together with the chief physician Khersonskaya E.B.)	4000.00
Council of Obstetricians-Gynecologists (Chief Physician Khersonskaya E.B. together with Honored Doctor of the Russian Federation Ivanova N.V.)	4000.00
Obstetric invasions
Amniotest (test for amniotic fluid leakage)	800.00
Amnisure Rapid Test	4000.00
Pregnancy test	1000.00
Insertion of an unloading obstetric pessary (excluding the cost of the pessary)	2500.00
Removal of the unloading obstetric pessary (excluding cost of the pessary)	2500.00
Gynecological procedures
Gynecological smear collection (WB contract)	500.00
Collection of gynecological smear 1 category	800. 00
Collection of gynecological smear 2 category	1900.00
Procedure in a gynecological room, category 1	1500.00
Procedure in the gynecological room 2 category	2700.00
Colposcopy (video colposcopy)	3000.00
Colposcopy (video colposcopy) extended	4500.00
Introduction of intrauterine contraceptives (excluding the cost of the spiral)	2700.00
Introduction of intrauterine contraceptives II degree of complexity (excluding the cost of the spiral)	4500.00
Removal of intrauterine devices (coils)	1200.00
Removal of intrauterine contraceptives (spirals) II degree of difficulty	1700.00
Placement/removal of a contraceptive ring (excluding cost of the ring)	800. 00
Placement/removal of a contraceptive ring (without the cost of the ring) II degree of complexity	1100.00
Removal of a foreign body from the vagina	1000.00
Removal of a foreign body from the vagina II degree of complexity	1500.00
Radio wave removal of single (up to 3 units) genital warts or papillomas	2000.00
Radio wave removal of multiple (more than 3 units) genital warts or papillomas	4000.00
Treatment of cervical pathology by radio wave method (Surgitron device) I degree of complexity	7000.00
Treatment of cervical pathology by radio wave method (Surgitron device) II degree of complexity	12000.00
Treatment of cervical pathology by radio wave method (Surgitron device) III degree of complexity	19000.00
Cryogenic removal of single genital warts or papillomas (up to 5 units) (nitrogen price included)	2000. 00
Cryogenic removal of multiple condylomas or papillomas of the female genital organs (up to 10 units) (nitrogen price included)	3000.00
Chemical removal of single genital warts or papillomas (up to 5 units)	1000.00
Chemical removal of multiple warts or papillomas of the female genital organs (up to 10 units)	2000.00
Chemical destruction of cervical pathology (treatment of cervical diseases with Solkovagin)	2500.00
Opening of cervical cysts	2000.00
Opening of cervical cysts II degree of complexity	3000.00
Hysterosonography	10000.00
Hysterosonography II degree of complexity	13000.00
Uterine aspiration	3200.00
Aspiration of the contents of the uterus II degree of complexity	4700. 00
Arabin obstetric pessary	7500.00
Endometrial aspiration biopsy (Pipel biopsy)	3500.00
Endometrial aspiration biopsy (Pipel biopsy) II degree of complexity	4900.00
Loop biopsy of the cervix (1 position) using the Surgitron device	2700.00
Loop biopsy of the cervix (1 position) II degree of complexity using the apparatus Surgitron	3300.00
Curettage of the cervical canal	2200.00
Curettage of the cervical canal II degree of complexity	3200.00
Curettage of the cervical canal + loop biopsy of the cervix using the Surgitron apparatus	7000.00
Curettage of the cervical canal + loop biopsy of the cervix using the Surgitron apparatus II degree of complexity	10000.00
Curettage of the cervical canal + loop biopsy of the cervix using the Surgitron device III degree of complexity	15000. 00
Hysteroscopy, separate diagnostic curettage	16000.00
Hysteroscopy, separate diagnostic curettage II degree of complexity	19500.00
Hysteroscopy, separate diagnostic curettage, IUD removal	18000.00
Hysteroscopy, separate diagnostic curettage, removal of the IUD II degree of complexity	25500.00
Hysteroscopy, separate diagnostic curettage, loop biopsy of the cervix	18000.00
Hysteroscopy, separate diagnostic curettage, loop biopsy of the cervix II degree of complexity	27000.00
Hysteroscopy, separate diagnostic curettage, polypectomy	20000.00
Hysteroscopy, separate diagnostic curettage, polypectomy II degree of complexity	27500.00
Hysteroscopy, dissection of intrauterine synechiae	25000.00
Hysteroscopy, dissection of intrauterine synechia II degree of complexity	37500. 00
Curettage of the cervical canal, removal of the polyp of the cervical canal	10000.00
Curettage of the cervical canal, removal of the polyp of the cervical canal II degree of complexity	15000.00
Instrumental IUD removal	6000.00
Instrumental removal of the IUD II degree of complexity	9000.00
Cervical conization	22000.00
Cervical conization II degree of complexity	25000.00
Operations on the Bartholin's gland (marsupialization, removal of the Bartholin's gland)	15000.00
Operations on Bartholin's gland (marsupialization, removal of Bartholin's gland) II degree of complexity	22500.00
Removal of stitches from the cervix	3000.00
Removal of stitches from the cervix II degree of complexity	4500. 00
Removal of staples after caesarean section I category of complexity	2500.00
Removal of staples after caesarean section II category of complexity	3500.00
Removal of sutures of I category of complexity	3000.00
Removal of stitches II category of complexity	4500.00
Cervicoscopy II degree of complexity	12000.00
Cervicoscopy+cervical curettage	18000.00
Cervicoscopy + curettage of the cervical canal II degree of complexity	15000.00
Polypectomy II degree of complexity	9000.00
Vaginal mass removal	15000.00
Removal of a neoplasm of the labia minora	15000.00
Removal of a neoplasm of the labia minora II category of complexity	25000. 00
Contouring with hyaluronic acid fillers 3 ml	40000.00
Sling installation (without sling cost)	55000
Colporrhaphy, perineolevathoroplasty II level
Colporrhaphy, perineolevathoroplasty level I	70000
Colporrhaphy II level	70000
Colporrhaphy level I	50000
Hysteroresectoscopy + dissection in / uterine septum (Honored Doctor of Russia kmn Ivanova N.V.)	60000
Hysteroresectoscopy + incision in/uterine septum II level	55000
Hysteroresectoscopy + incision in/uterine septum I level	45000
Hysteroresectoscopy + myomresection (Honored Doctor of Russia kmn Ivanova N.V.)	60000
Hysteroresectoscopy + myomresection level II	50000
Hysteroresectoscopy + myomresection level I	40000
Hysteroresectoscopy + polypectomy (Honored Doctor of Russia kmn Ivanova N. V.)	50000
Hysteroresectoscopy + polypectomy Level II	40000
Hysteroresectoscopy + polypectomy Level I	30000

Article "Chronic pelvic pain in women"

The problem of chronic pelvic pain in women of reproductive age occupies a special place in gynecology. Almost half of the patients who turn to the specialists of the EMC Department of Gynecology and Oncogynecology have complaints of chronic pelvic pain - discomfort for a long time in the lower abdomen, in the area below the navel. Long-term, despite the fact that conventional painkillers are ineffective, pelvic pain changes the psyche, the behavior of women, reduces the ability to work and quality of life. nine0801

Pain may be constant or intermittent, even paroxysmal, may be cyclical or not at all related to the menstrual cycle. Pain impulses arising in the genitals and surrounding tissues as a result of irritation of nerve endings are transmitted to the central nervous system, which in most women is accompanied by general weakness, irritability, anxiety, excitability, emotional lability, attention disorders, memory loss, sleep disturbances. nine0801

Chronic pelvic pain is characterized by:

persistent pain in the lower abdomen and lower back of varying intensity and character (pulling, dull, burning, etc.), prone to irradiation, lasting more than 6 months;
periodic exacerbations - pain crises arising in connection with cooling, overwork, stress, etc.;
psycho-emotional disorders, manifested by insomnia, irritability, disability, anxiety and depression, decreased sexual function up to a complete lack of interest and sexual response; nine0801
no or little effect of conventional pain and antispasmodic therapy.

In some cases, it is not possible to identify its causes even with in-depth examination - this is the so-called "inexplicable" pain. For such patients, the “triangle” route - gynecologist-urologist-neurologist - becomes familiar, and pain and fear force them to turn to an oncologist. Often, for years, these patients have been treated for "inflammation of the uterus and appendages" with large doses of antibacterial drugs, and such irrational treatment aggravates the situation even more. nine0801

Pain is one of the most common symptoms in many gynecological diseases. External genital endometriosis, adhesions in the pelvic cavity, chronic inflammatory diseases of the internal genital organs, internal endometriosis of the uterine body, Allen-Masters syndrome, genital tuberculosis, uterine fibroids, benign and malignant ovarian tumors, malignant neoplasms of the body and cervix, developmental anomalies genital organs with a violation of the outflow of menstrual blood - this is not a complete list of diseases and conditions that may be accompanied by chronic pelvic pain. nine0801

The most common misconceptions about chronic pelvic pain

Chronic pelvic pain in women can only be caused by gynecological diseases

coccygeal articulation, primary tumors of the pelvic bones, metastases to the pelvic bones and spine, bone forms of tuberculosis, pathology of the symphysis), retroperitoneal neoplasms, diseases of the peripheral nervous system (plexitis), diseases of the gastrointestinal tract (chronic colitis, irritable bowel syndrome, nonspecific ulcerative colitis, proctitis, adhesive disease), diseases of the urinary system (chronic cystitis, urolithiasis, pelvic location of the kidney, prolapse of the kidney), vascular disease (varicose veins of the small pelvis). The causes of chronic pain syndrome can also be mental illness (abdominal epileptic seizures, depressive syndrome, schizophrenia). nine0801

Pain is usually caused by one factor, eliminating which, you can get rid of pain

In fact, in most gynecological diseases, the origin of pain is caused by several irritants at once, and it is often impossible to single out the leading factor. With uterine fibroids, pain can be caused by an increase in this organ, a violation of its blood supply and contractility of the uterine muscle, deformation of the uterine cavity by nodes, compression of the enlarged uterus or individual nodes of neighboring organs - the intestines, urinary tract, nerve plexuses, blood vessels. nine0801

In case of tumors and cysts of the ovaries, the tissues and ligaments of the ovaries are stretched (up to torsion), the maturation of the follicles is disturbed, micro-ruptures with inflammation and the formation of adhesions are possible, compression of neighboring organs by cysts

a functioning uterus with aplasia of the cervix or vagina, a rudimentary uterine horn, a closed cavity of a bicornuate or doubled uterus) and other conditions accompanied by a violation of the outflow of menstrual blood (intrauterine synechia, stenosis of the cervical canal or cicatricial changes in the vagina). In these cases, the onset of pain is due to the expansion of closed cavities with blood and irritation of the peritoneum with almost constant hemoperitoneum, inflammation, and adhesions. Incorrect positions of the internal genital organs (bends of the uterus, prolapse, prolapse) also cause pelvic pain. nine0801

As a rule, most patients have a combined gynecological pathology, and each of the diseases can cause pain. External endometriosis often accompanies any other gynecological disease, and uterine fibroids are combined with internal endometriosis of the uterine body. Often there is a prolapse of the uterus, affected by fibroids or adenomyosis. The presence of a combined gynecological and extragenital pathology (hernias, diseases of the gastrointestinal tract, urinary tract, osteochondrosis of the spine) can significantly complicate the determination of the true cause of pain. nine0801

Periodic pain in women is normal

This myth has been around since the 19th century. Doctors then explained menstrual pain by the instability and delicacy of the physiology of women and believed that pain during menstruation is the norm, which is very characteristic of the female body. Another "cause" of pain in women during menstruation is, according to some, a low pain threshold.

In fact, many women and girls experience pain during their periods. However, severe pain that disrupts the habitual lifestyle and level of activity cannot be the norm, and usually they are based on some kind of disease, for example, endometriosis, a hormone-dependent disease in which the lining of the uterus (endometrium) grows in other parts of the body. This is the third most common gynecological disease after uterine fibroids and various inflammatory processes in the genitals. nine0801

Therefore, every woman with severe pain during menstruation should be fully examined to identify their cause.

Early identification of the causes of pain determines the success of treatment. To establish the possible causes of pelvic pain, we work as a team with doctors of other specialties - general surgeons, oncologists, urologists, neurologists, psychologists.

For the treatment of chronic pelvic pain, EMC gynecologists-surgeons use an approach based on reducing the invasiveness of surgery, avoiding excessive radicalism, and expectant management in certain diseases of the genital area. nine0801

Laparoscopy and hysteroscopy provide us with unique diagnostic and therapeutic opportunities, which allow us to identify and eliminate possible causes of pain that are not diagnosed by other examination methods: endometriosis of the pelvic peritoneum, adhesions, anatomical disorders - hernia, peritoneal defects (Allen-Masters syndrome).

From the point of view of the patient, laparoscopic intervention, unlike laparotomy, is not perceived as a “big and difficult” operation, and the absence of intense and prolonged postoperative pain associated with the surgical wound of the anterior abdominal wall eliminates the aggravation of the initial pain due to layering on them operating rooms. And, finally, early activation and return to physical activity, the almost absence of cosmetic defects also contribute to a quick recovery. nine0801

The volume of surgical intervention is chosen by EMC gynecologists depending on the age of the patient, her plans for childbearing, the severity of the detected pathology, the severity of pain. In young women, organ-preserving surgeries are performed, warning patients about the likelihood of recurrence of diseases such as endometriosis and uterine fibroids. Patients of older age groups with adenomyosis, multiple uterine fibroids, accompanied by severe pain, bleeding and leading to anemia, tumor growth and its significant size, dysfunction of neighboring organs, are shown radical operations in the volume of removal of the uterus, which we perform by laparoscopy or from a vaginal access . nine0801

In case of prolapse and prolapse of the pelvic organs accompanied by pelvic pain, EMC gynecologists use surgical correction technologies that are fundamentally different from each other, depending on the age of the patient, to effectively eliminate gynecological pathology and restore the disturbed pelvic anatomy.