Blockage of these ducts can lead to a Bartholin’s cyst. Infection may follow, leading to a painful abscess. Infection is typically polymicrobial, with E. coli, PVL-positive S. aureus, Streptococcus, P. aeruginosa, and Neisseria being common pathogens.
Adenocarcinoma and squamous cell carcinoma can occur in postmenopausal women.
Asymptomatic cysts can be left untreated. Treatment methods are:
Adjunctive antibiotic therapy with ceftriaxone, ciprofloxacin, doxycycline, or azithromycin is given.
Biopsy is recommended in postmenopausal women or when there is suspicion of carcinoma.
It’s normal to have a small amount of fluid (a few millilitres) in the pouch of Douglas, secondary to menstruation and ovulation. Pathological fluid collection, however, can be seen in pelvic abscesses, endometriosis, PID, ectopic pregnancy, metastasis from gastrointestinal malignancies, etc.
Diagnosis can be made by culdocentesis, where a needle is inserted through the posterior fornix of the vagina to reach the recto-uterine pouch.
Infections and malignancies can spread to the hepatorenal space (Morrison’s pouch) via communications between the recto-uterine and hepatorenal spaces, as seen in Fitz Hugh-Curtis syndrome. Morrison’s pouch is the most dependent area of the peritoneal cavity in the supine position.
Accidental ligation can present as urinary retention and lower abdominal pain.
i) Primordial follicles: These small follicles are found toward the outer edge of the cortex. They consist of an oocyte surrounded by a single layer of flattened follicular epithelial cells (granulosa cells). It is surrounded by a thick glycoprotein layer called the zona pellucida.
ii) Primary follicle: This follicle is larger than the primordial follicle. It has an oocyte surrounded by two or more layers of granulosa cells, the zona pellucida, and a capsule called theca.
iii) Secondary follicle: These follicles are larger than the primary follicle and show small intrafollicular spaces filled with fluid, which coalesce to form the antrum. The granulosa cells at this stage are called cumulus oophorus. The theca differentiates into an internal, rounded cell layer called theca interna and an external, fibrous, spindle cell layer called theca externa.
iv) Graffian follicle: It contains the secondary oocyte surrounded by the zona pellucida and corona radiata (seen after the ovum is released from the follicle), a prominent antrum surrounded by membrana granulosa, cumulus oophorus, theca interna, and theca externa.
v) Corpus luteum: After ovulation, the Graffian follicle collapses. The granulosa cells enlarge and become vesicular to form granulosa lutein cells. They form folds; between the folds, theca interna cells can be seen, which are now called theca lutein cells.
vi) Corpus albicans: If pregnancy does not occur, the corpus luteum degenerates and becomes a pale-looking, atretic corpus albicans.