The sexual life of woman in its physiological, pathological and hygienic aspects

by E. Heinrich Kisch

The complex nervous network of the female sexual organs is supplied by spinal as well as by sympathetic fibres, the fibres from the two systems anastomosing in a very intimate manner.

Fig. [3].—The distribution of the pudic nerve, n. pudendus, in the female perineal and pubic regions. The trunk of the pubic nerve, n. pudendus, is covered by the gluteus maximus muscle. On the right side of the body the branches of the inferior pudendal nerve, rami perineales, nervi cutanei fermoris posterioris have been dissected out; but the branches of this nerve to the labium majus have been cut short. The formation of the anococcygeal or subcaudal nerves, nn. anococcygei, out of the posterior primary division of the coccygeal nerve and out of the perforating branches which arise from the anterior primary divisions of the fourth and fifth sacral nerves and the coccygeal nerve. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)

The greater number of the spinal nerves distributed to the genital organs arise from the lumbar portion of the spinal cord, pass as rami communicantes to the first four lumbar ganglia of the great sympathetic cord, whence they proceed to the series of symmetrical (paired) and asymmetrical (azygos) sympathetic plexuses in front of, and adjacent to the abdominal aorta, which already contain afferent and efferent spinal fibres derived from the pneumogastric, phrenic, and splanchnic nerves. A small number only of coarse nerve-filaments, a larger number of fine nerve-filaments, derived from the sacral nerves, proceed direct to the internal genital organs; many of these fibres enter the lower extremity of the pelvic or inferior hypogastric pleans, some pass to the cervical ganglia of the uterus. Below the bifurcation of the aorta and in front of the sacral promontory, a large number of the uterine nerves, both of spinal and of sympathetic origin, unite to form an azygos plexus which has been shown by experiment to possess great functional importance. Anatomically this constitutes the upper undivided portion of the hypogastric plexus, which is the downward continuation of the abdominal aortic sympathetic plexus; but inasmuch as it is the principal channel of nervous impulses to the uterus it is often known at the present day as the great uterine plexus (plexus uterinus magnus). The nerves to the ovary and Fallopian tube (ovarian nerves) are derived from the spermatic (ovarian) plexus, an offshoot of the renal plexus; as the spermatic plexus descends, it is reinforced by branches from the abdominal aortic plexus, these branches often arising from a small ganglion (spermatic ganglion). The hypogastric or great uterine plexus, single and median above, divides below into the paired pelvic or inferior hypogastric plexuses, which pass downward and forward on either side of the rectum; these plexuses are reinforced by spinal elements derived from the sacral nerves. Before the terminal expansions of the pelvic or inferior hypogastric plexus enter the tissues of the internal genital organs, the bladder, and the rectum, small masses of ganglionic matter are interspersed among the nerve fibres.

To the above general sketch, which has been based on the synoptical description of Chrobak von Rosthorn, must be added a more detailed account of the innervation of the ovaries, this branch of the subject being of especial importance. The nerves of the ovary are derived from the sympathetic system, in part from the spermatic ganglion, in part from the second renal ganglion, and in part from the superior mesenteric plexus. The nerves of the ovary are for the most part vascular nerves, which unite before entering the ovary to form the ovarian plexus, and then pass into the hilum with the vessels, envelop the vessels of the medullary layer, and thence pass to the follicular region; exceedingly numerous, they form a close-meshed network, surrounding all the vessels up to the finest capillary ramifications; those fibres which terminate in the capillary walls and those also which reach the follicles are regarded by Riese as sensory. The great trunks of the uterine nerves are transversely disposed in relation to the great lateral vessels of the uterus, and passing inward toward the mucous membrane they break up into pencils of filaments; the uterine nerves proper are distributed for the most part to the muscular substance. In the Fallopian tubes, the nerves form arches around the lumen of the tube; some fibres also pass to the longitudinal folds of the mucous membrane.

This expansion of the nerves of the cerebrospinal and sympathetic systems in the female reproductive organs manifests the multiple interconnection of the two systems in this region, and proves beyond doubt that the sensory nerves of the genital organs have manifold connections with the motor tracts of the whole organism on the one hand and with the sensory ganglia of the central nervous system on the other, and in addition with the vasomotor centres and with efferent motor and secretory fibres.

As regards the vascular system of the female genital organs, the latter are supplied by the internal iliac artery. One of the two terminal branches of the common iliac, the internal iliac artery, descends into the pelvis over the sacro-iliac synchondrosis. Its branches may be arranged in four groups: anterior group, the hypogastric, iliolumbar, and obturator arteries; posterior group, the lateral sacral, gluteal, and sciatic arteries; internal group, the inferior vesical, uterine, and middle haemorrhoidal arteries; inferior group, comprising a single artery only, the internal pudic; the uterine artery supplies the uterus and the vaginal fornices; the ovarian artery supplies the ovary, the Fallopian tube, and the broad ligament of the uterus; the vaginal, cervicovaginal, or vesico-vaginal artery supplies the vagina; the internal pudic artery supplies the vestibule and the clitoris; the superior and inferior external pudic arteries (branches of the femoral artery) supply the labia majora. The veins of the female genital organs correspond in general to the arteries in their course and nomenclature, and empty their blood into the internal iliac vein.

Fig. [4].—The distribution of the lateral sacral arteries, the superior haemorrhoidal or superior rectal artery, the uterine artery, the ovarian artery and the distal portion of the internal pudic artery. (From Toldt: Atlas of Human Anatomy.—Rebman Company, New York.)

Attention must also be paid to the extremely rich lymphatic vascular system of the female genital apparatus. The body of the uterus and the annexa of that organ, the neck of the uterus and the vaginal fornices, the middle segment of the vagina, the lower segment of the vagina, the vestibule and the external genital organs—each of these possesses an independent set of lymphatic vessels, leading moreover to independent groups of lymphatic glands. It may be said that the lymph from the vulva passes to the inguinal glands, that from the vagina and the neck of the uterus to the internal and the external iliac lympathic glands, that from the upper part of the uterus and also that from the ovaries and Fallopian tubes to the median group of lumbar lymphatic glands (also known, from their position in front of the aorta and the vena cava, as the aortic lymphatic glands) (Chrobak von Rosthorn).