[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Pelvis · Female](https://durgical.com/en/anatomy/region/pelvis/) › Vaginal fornix [Reproductive system](https://durgical.com/en/anatomy/system/reproductive-system/) · [Pelvis · Female](https://durgical.com/en/anatomy/region/pelvis/) # 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](https://durgical.com/en/anatomy/region/abdomen/). [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=pelvis&variant=female&select=vaginal_fornix&side=r) Opens in the Durgical app, no sign-up needed. ## 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 points - The posterior [fornix](https://durgical.com/en/anatomy/fornix/) is the deepest and the only part of the [vagina](https://durgical.com/en/anatomy/vagina/) covered on its outer side by [peritoneum](https://durgical.com/en/anatomy/peritoneum/) (of the rectouterine pouch): a needle or incision here enters the peritoneal cavity - On bimanual examination the [ovaries](https://durgical.com/en/anatomy/ovary/) and tubes are felt through the lateral fornices, and the rectouterine pouch through the posterior fornix - Each lateral fornix lies close to the [uterine artery](https://durgical.com/en/anatomy/uterine-artery/) and the ureters at the base of the [broad ligament](https://durgical.com/en/anatomy/broad-ligament-of-uterus/) ## 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](https://durgical.com/en/anatomy/cervix-of-uterus/) and, beyond the vaginal wall, the base of the [urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) **Behind** [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/), with the [rectum](https://durgical.com/en/anatomy/rectum/) behind it **Lateral** Parametrium and [cardinal ligament](https://durgical.com/en/anatomy/cardinal-ligament/) with the uterine vessels; the [ureters](https://durgical.com/en/anatomy/ureter/) 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](https://durgical.com/en/anatomy/levator-ani/) 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. ## Related conditions - [Bacterial vaginosis](https://durgical.com/en/conditions/bacterial-vaginosis/) - [Cervical intraepithelial neoplasia (cervical dysplasia)](https://durgical.com/en/conditions/cervical-intraepithelial-neoplasia/) ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/anatomy/vaginal-fornix/) 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 ## Related - [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) - [Vagina](https://durgical.com/en/anatomy/vagina/) - [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/) Sources: Terminologia Anatomica (TA2); [Anatomy, Abdomen and Pelvis: Female Internal Genitals](https://www.ncbi.nlm.nih.gov/books/NBK554601/); [27.2 Anatomy and Physiology of the Ovarian Reproductive System](https://openstax.org/books/anatomy-and-physiology-2e/pages/27-2-anatomy-and-physiology-of-the-ovarian-reproductive-system) (OpenStax (Rice University), 2022) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/vaginal-fornix/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/vaginal-fornix/