Vaginal fornix !

The vaginal fornix is the recess at the top of the vagina around the cervix; its back part lies right against the lowest pouch of the abdomen.

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What it is

The recess around the cervix at the top of the vagina (front, back and sides).

What it does

The back part lies right against the pouch of Douglas; after a hysterectomy the top is closed as the vaginal vault.

Key facts

Where: Recess around the vaginal part of the cervix: anterior (shallow), posterior (deepest, against the rectouterine pouch) and lateral parts
Function: Posterior fornix gives access to the rectouterine pouch (culdocentesis); the ureter lies about 2 cm from the lateral fornix

Relations

In front: Anterior lip of the cervix and, beyond the vaginal wall, the base of the urinary bladder
Behind: Rectouterine pouch, with the rectum behind it
Lateral: Parametrium and cardinal ligament with the uterine vessels; the ureters pass about 2 cm away
Medial: The vaginal part of the cervix, which it surrounds

How to find it

In bimanual examination two gloved fingers push up into each lateral fornix while the abdominal hand presses down to trap the adnexa; a full or tender posterior fornix suggests fluid, blood or pus in the rectouterine pouch. With a speculum the fornices are seen around the cervix, and discharge pools in the posterior one.

Examination

Adnexal tenderness or a mass felt through a lateral fornix points to disease of the tube or ovary, such as pelvic inflammatory disease, an ectopic pregnancy or ovarian torsion

On imaging

The transvaginal ultrasound probe rests in the fornices, close to the uterus and ovaries, which gives sharp images; free fluid in the rectouterine pouch shows just behind the posterior fornix, and echogenic fluid suggests blood.

Common problems

Infections (vaginosis, yeast).
Prolapse of the front or back wall (cystocele, rectocele) or of the top (vault).
Dryness after menopause (genitourinary syndrome of menopause).

How it is diagnosed

Examination with a speculum; swabs; pelvic floor examination.

Treatment

Treatment of infections; local oestrogen for dryness.
Pessary or surgery for prolapse.

Clinical notes

Culdocentesis: needle aspiration of the rectouterine pouch through the posterior fornix; non-clotting blood indicated haemoperitoneum, as in a ruptured ectopic pregnancy; ultrasound has largely replaced it
Posterior colpotomy opens the posterior fornix to drain a pelvic abscess, to begin a vaginal hysterectomy or to remove specimens
High vaginal swabs are taken from the posterior fornix
After hysterectomy the fornices are closed to form the vaginal vault, which can later prolapse or, rarely, open up (dehiscence)

Development

The vaginal plate hollows out around the lower end of the uterus; the ring-shaped recess left around the projecting cervix becomes the fornices, which most texts trace to the paramesonephric ducts.

Test yourself

Think of the answer, then tap the question to see it.

Which part of the vaginal fornix is covered on its outer side by peritoneum, and why does it matter?

The posterior fornix (by the rectouterine pouch); a needle or incision here enters the peritoneal cavity.

What is culdocentesis, and what did non-clotting blood indicate?

Needle aspiration of the rectouterine pouch through the posterior fornix; non-clotting blood indicated haemoperitoneum, e.g. a ruptured ectopic.

What is felt through the lateral fornices on bimanual examination?

The ovaries and uterine tubes (adnexa); tenderness or a mass suggests PID, ectopic pregnancy or torsion.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): fornix vaginae TA2 3524
Official Spanish (DeCS): Fórnix de la vagina
English (TA2): Vaginal fornix
Also called: vault of vagina · vaginal vault

Sources: Terminologia Anatomica (TA2); Anatomy, Abdomen and Pelvis: Female Internal Genitals; 27.2 Anatomy and Physiology of the Ovarian Reproductive System (OpenStax (Rice University), 2022) · adapted, CC BY 4.0.

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Representative model, for educational purposes only.

Vaginal fornix highlighted on the Durgical 3D model