Structure and its disorders

Pelvic map

• Uterus lies between bladder and rectum; parts are fundus, body, isthmus and cervix.
• "Water under the bridge" means ureter under uterine artery near the cervix.
• Cardinal and uterosacral ligaments are key apical supports; round ligament maintains anteversion, not prolapse support.
• Posterior vaginal fornix is deepest and relates to the pouch of Douglas.

Müllerian anomalies

• Müllerian ducts must form, fuse and resorb the septum.
• Septate uterus has normal external contour; bicornuate uterus has external fundal cleft.
• HSG alone cannot distinguish septate from bicornuate because it cannot assess outer fundal contour.
• MRKH has 46,XX, normal ovaries and secondary sexual characters, absent uterus/upper vagina and primary amenorrhoea.

Prolapse

• POP is support failure by compartment: anterior cystocele/urethrocele, posterior rectocele/enterocele, apical uterine or vault.
• POP-Q uses the hymen as reference: negative above, zero at, positive beyond.
• Treat symptoms and goals, not anatomy alone: PFMT, pessary, vaginal estrogen for atrophy, then surgery when needed.
• Transvaginal synthetic mesh for primary prolapse repair is restricted and not routine first-line.