DISEASES OF THE OVARIES.
=Anatomy.=--The ovaries vary a good deal in size, within the limits of
health, in different individuals. It is unusual to find the two ovaries
in the same person exactly alike in size, shape, and appearance.
[Illustration: FIG. 158.--Uterus, tube, and ovary of a child one month
old (Sutton).]
The size, shape, and appearance of the ovary change at the different
periods of life. In the new-born child the ovary is elongated and lies
parallel to the Fallopian tube (Fig. 158). In rare cases this infantile
shape of the ovary may persist throughout life.
The general shape of the mature ovary is oval. The average measurements
are--long axis, 3 to 5 centimeters; breadth, 2 to 3 centimeters;
thickness, 12 millimeters; weight, 100 grains. These measurements are
subject to great variations. Henning’s table of measurements shows that
the ovary of the multipara is no larger than that of the virgin.
After the menopause the ovaries shrink a great deal in size, sharing in
the general atrophy of all the reproductive organs. The ovary of an old
woman may weigh but 15 grains.
The healthy ovary is of a pinkish pearly color. On its surface are
seen small bluish areas that mark the position of unruptured or of
recently ruptured ovarian follicles. The ripening follicles project
somewhat from the surface of the ovary, and the old ruptured follicles
are marked by scars which in time cover and render irregular the whole
surface of the ovary (Fig. 159).
The surface of the ovary becomes more irregular and wrinkled after the
menopause. The follicles disappear, until finally nothing is left but a
mass of fibrous tissue and a few blood-vessels.
The ovary lies in the posterior layer of the broad ligament. It is
attached by this connection with the broad ligament and by the ovarian
and infundibulo-pelvic ligaments.
[Illustration: FIG. 159.--Ovary (natural size), with the Fallopian tube
in relative position (Sutton).]
The ovarian ligament extends from the inner end of the ovary to the
angle of the uterus immediately below the origin of the Fallopian tube.
This ligament varies in length from 3 to 5 centimeters. It is shortest
in the virgin, and longest in the multiparous woman. The ligament
consists of a fold of peritoneum containing unstriped muscular fiber
from the uterus.
The infundibulo-pelvic ligament is that part of the upper margin of
the broad ligament lying between the distal end of the Fallopian tube
and the pelvic wall. It is about 2 centimeters in length. The length is
greatest in the multiparous woman.
The position of the ovary is maintained by its attachments and by its
own specific gravity. The considerations that have been discussed in
regard to the position of the uterus also apply here.
The blood-vessels are the utero-ovarian arteries and the ovarian
arteries and veins. The ovarian artery is homologous to the spermatic
artery in the male. The course of the ovarian veins has an important
influence upon some pathological conditions of the ovaries.
[Illustration: FIG. 160.--View of the posterior surface of the uterus,
Fallopian tubes, ovaries, and broad ligaments. The infundibulo-pelvic
ligament is shown on the left (Dickinson).]
The right ovarian vein enters the inferior vena cava at an acute angle,
and at the junction of the two there is a very perfect valve.
The left ovarian vein enters the left renal vein at a right angle:
there is no valve on this side. This anatomical difference affords a
probable explanation of the greater tendency to congestion and prolapse
of the left ovary.
The ovary is composed of connective tissue which surrounds the Graafian
follicles, blood-vessels, lymphatics, nerves, and unstriped muscular
fibers. The posterior portion, or the free portion of the ovary, is
covered with the germinal epithelium, or modified peritoneum, which is
continuous with the peritoneum of the broad ligament.
The ovary is divided into two portions, which present distinct
anatomical, physiological, and pathological differences.
The _oöphoron_ is the egg-bearing portion of the ovary. It corresponds
to the free border of the gland.
The _paroöphoron_ corresponds to the hilum of the ovary--that portion
in relation with the broad ligament.
The paroöphoron contains no ovarian follicles. It is composed of
connective tissue and numerous blood-vessels. In the paroöphoron of
young ovaries remnants of gland-tubules--vestiges of the Wolffian
body--may be found.
_Accessory ovaries_ have been described by several writers, and their
existence has often been assumed to account for the persistence of
menstruation after a supposed complete salpingo-oöphorectomy. It is
very doubtful if a true accessory ovary has ever been found. Bland
Sutton says: “As the evidence at present stands, an accessory ovary
quite separate from the main gland, so as to form a distinct organ, has
yet to be described by a competent observer.” It is probable that the
bodies that have been described as accessory ovaries have been more or
less detached portions of a lobulated ovary, or small fibro-myomatous
tumors of the ovarian ligament. Abdominal surgeons have had opportunity
of examining thousands of ovaries at operation, and yet I know of no
one who has come across a third ovary.