A simple and effective method of birth control is to surgically ligate (clip) the uterine tubes, preventing spermatozoa from reaching the ovum. This simple short procedure is performed under general anesthetic. A small laparoscope is passed into the peritoneal cavity and special equipment is used to identify the tubes.
In the clinic
Carcinoma of the cervix and uterus
Carcinoma of the cervix (Fig. 5.56) and uterus is a common disease. Diagnosis is by inspection, cytology (examination of the cervical cells), imaging, biopsy, and dilation and curettage (D&C) of the uterus.
Carcinoma of the cervix and uterus may be treated by local resection, removal of the uterus (hysterectomy), and adjuvant chemotherapy. The tumor spreads via lymphatics to the internal and common iliac lymph nodes. Many countries have introduced screening programs for cervical cancer where women are regularly called for smear tests. The age of women included in the screening population varies depending on the country.
In the clinic
The recto-uterine pouch
The recto-uterine pouch (pouch of Douglas) is an extremely important clinical region situated between the rectum and uterus. When the patient is in the supine position, the recto-uterine pouch is the lowest portion of the abdominopelvic cavity and is a site where infection and fluids typically collect. It is impossible to palpate this region transabdominally, but it can be examined by transvaginal and transrectal digital palpation. If an abscess is suspected, it may be drained through the vagina or the rectum without necessitating transabdominal surgery.
In the clinic
Pudendal block anesthesia is performed to relieve the pain associated with childbirth. Although the use of this procedure is less common since the widespread adoption of epidural anesthesia, it provides an excellent option for women who have a contraindication to neuraxial anesthesia (e.g., spinal anatomy, low platelets, too close to delivery). Pudendal blocks are also used for certain types of chronic pelvic pain and in some rectal or urological procedures. The injection is usually given where the pudendal nerve crosses the lateral aspect of the sacrospinous ligament near its attachment to the ischial spine. During childbirth, a finger inserted into the vagina can palpate the ischial spine. The needle is passed transcutaneously to the medial aspect of the ischial spine and around the sacrospinous ligament. Infiltration is performed and the perineum is anesthetized. Pudendal nerve blocks can also be performed with imaging guidance (using fluoroscopy, computed tomography, or ultrasound) to localize the nerve rather than relying purely on anatomical landmarks.
In the clinic
It may be necessary to perform radical surgery to cure cancer of the prostate. To do this, the prostate and its attachments around the base of the bladder, including the seminal vesicles, must be removed en masse. Parts of the inferior hypogastric plexus in this region give rise to nerves that innervate the erectile tissues of the penis. Impotence may occur if these nerves cannot be or are not preserved during removal of the prostate.
For the same reasons, women may experience sexual dysfunction if similar nerves are damaged during pelvic surgery, for example, during a total hysterectomy.
In the clinic