Human Anatomy: Female Reproductive System
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Questions and Answers

Which major vessel gives rise to the ovarian artery that supplies blood to the ovary?

  • Internal iliac artery
  • Aorta (correct)
  • External iliac artery
  • Inferior mesenteric artery

    • At which ligament does the uterine artery cross the ureter superiorly?

  • Broad ligament
  • Cardinal ligament (correct)
  • Sacrospinous ligament
  • Round ligament

    • Which ligament is primarily responsible for providing passive support to the uterus, fixing it to the sacrum?

  • Pubovesical ligament
  • Uterosacral ligament (correct)
  • Round ligament
  • Broad ligament

    • The broad ligament of the uterus encloses which structure that connects the ovary to the lateral pelvic wall?

    <p>Suspensory ligament of the ovary</p> Signup and view all the answers

    Which pelvic structure bounds the ovarian fossa anteriorly?

    <p>External iliac artery</p> Signup and view all the answers

    Which layer of the endometrium is shed during menstruation?

    <p>Functional layer</p> Signup and view all the answers

    Which part of the broad ligament supports the uterine tubes?

    <p>Mesosalpinx</p> Signup and view all the answers

    Which ligament connects the ovary to the uterus?

    <p>Ovarian ligament</p> Signup and view all the answers

    Which artery supplies the cervix and branches from the uterine artery?

    <p>Vaginal artery</p> Signup and view all the answers

    What structure lies posterior to the ovary and is significant as a surgical landmark?

    <p>Rectum</p> Signup and view all the answers

    Which artery primarily supplies blood to the pelvic organs?

    <p>Internal iliac artery</p> Signup and view all the answers

    What is the primary function of the mesovarium?

    <p>Attaches the ovary to the broad ligament</p> Signup and view all the answers

    To which structure does the uterosacral ligament attach the uterus?

    <p>Sacrum</p> Signup and view all the answers

    Which ligament plays a significant role in maintaining the position of the cervix?

    <p>Cardinal ligament</p> Signup and view all the answers

    The infundibulum of the fallopian tube is characterized by the presence of which structures that help capture the oocyte?

    <p>Fimbriae</p> Signup and view all the answers

    Which structures are connected by the ovarian ligament?

    <p>Ovary and uterus</p> Signup and view all the answers

    Which two distinct openings does the cervix of the uterus contain?

    <p>Internal and external os</p> Signup and view all the answers

    What is the name of the peritoneal pouch located between the uterus and the rectum?

    <p>Rectouterine pouch</p> Signup and view all the answers

    Which layer of the uterus contracts during childbirth?

    <p>Myometrium</p> Signup and view all the answers

    The ovarian arteries reach the ovary by passing through which ligament?

    <p>Suspensory ligament of the ovary</p> Signup and view all the answers

    All women have a uterus.

    <p>False</p> Signup and view all the answers

    Not all people with breasts are women.

    <p>True</p> Signup and view all the answers

    Which among the following options are components of the pelvic floor muscles?

    <p>Iliococcygeus</p> Signup and view all the answers

    What is the function of the sciatic nerve?

    <p>Supplies the posterior thigh muscles and sensory innervation of most of the leg and foot.</p> Signup and view all the answers

    What shape is the male pelvis compared to the female pelvis?

    <p>Heart shaped</p> Signup and view all the answers

    What major ligaments are associated with the pelvis?

    <p>Sacrospinous ligament and sacrotuberous ligament.</p> Signup and view all the answers

    The external iliac vessels leave and become _____ vessels below the inguinal ligament.

    <p>femoral</p> Signup and view all the answers

    Name the two main nerves that innervate the pelvis.

    <p>Sciatic nerve and pudendal nerve.</p> Signup and view all the answers

    What is the 'obstetric conjugate'?

    <p>Narrowest fixed distance for a foetus to pass through.</p> Signup and view all the answers

    The pelvic inlet is separated by the pelvic brim.

    <p>True</p> Signup and view all the answers

    What is indicated by implantation in a bicornuate uterus?

    <p>Miscarriage likely due to insufficient space for baby growth.</p> Signup and view all the answers

    What are the types of hysterectomy surgeries?

    <p>Partial (sub-total)</p> Signup and view all the answers

    What structure is at greatest risk of being damaged during a total hysterectomy?

    <p>Ureter</p> Signup and view all the answers

    The cervix connects the vagina with the __________.

    <p>uterus</p> Signup and view all the answers

    What are the two regions of the cervix?

    <p>Both A and B</p> Signup and view all the answers

    The vagina facilitates only sexual intercourse.

    <p>False</p> Signup and view all the answers

    What is the function of Bartholin’s glands?

    <p>Secrete lubricating mucus during sexual arousal.</p> Signup and view all the answers

    What arteries supply the blood to the penis?

    <p>All of the above</p> Signup and view all the answers

    What structure connects the inferior side of the ovary to the uterus?

    <p>Ovarian ligament</p> Signup and view all the answers

    Match the following structures with their associated vessels.

    <p>Ovary = Ovarian artery Uterus = Uterine artery Vagina = Vaginal artery Penis = Dorsal and deep arteries of the penis</p> Signup and view all the answers

    What conducts oxygen and nutrient-deficient blood to the placenta?

    <p>Umbilical arteries</p> Signup and view all the answers

    What happens to the distal parts of the umbilical arteries when the umbilical cord is cut? (Select all that apply)

    <p>They become occluded</p> Signup and view all the answers

    The obturator artery is crossed by the _____ under the bridge.

    <p>ureter</p> Signup and view all the answers

    What are the contents of the superficial perineal pouch in males? (Select all that apply)

    <p>Superficial transverse perineal muscles</p> Signup and view all the answers

    What forms the deep perineal pouch boundaries? (Select all that apply)

    <p>Superior fascia of the pelvic diaphragm</p> Signup and view all the answers

    What is the anatomical term for the most inferior part of the peritoneal cavity in males?

    <p>Rectovesical pouch</p> Signup and view all the answers

    Females have two pouches in the abdominal viscera while males have only one.

    <p>True</p> Signup and view all the answers

    What is the normal anatomical position of the adult uterus?

    <p>Anteverted and anteflexed</p> Signup and view all the answers

    What are the functions of the female reproductive system? (Select all that apply)

    <p>Assist in the transportation of the ovum</p> Signup and view all the answers

    What is a cystocele?

    <p>Bladder bulging into the upper part of the vaginal wall</p> Signup and view all the answers

    Women are less susceptible to UTIs than men.

    <p>False</p> Signup and view all the answers

    The function of the fallopian tubes is to assist in the transfer and transport of the ovum from the _____ to the uterus.

    <p>ovary</p> Signup and view all the answers

    What is the primary muscle that aids in the descent of the testes?

    <p>Gubernaculum</p> Signup and view all the answers

    The processus vaginalis closes after the descent of the testes.

    <p>True</p> Signup and view all the answers

    What are the contents of the spermatic cord? (Select all that apply)

    <p>Vas deferens</p> Signup and view all the answers

    What condition arises from a dilated and tortuous pampiniform plexus?

    <p>Varicocele</p> Signup and view all the answers

    What is the most common solid malignancy in males aged 20-35?

    <p>Testicular cancer</p> Signup and view all the answers

    The ejaculatory duct is formed by the vas deferens and the __________.

    <p>seminal glands</p> Signup and view all the answers

    Benign prostatic hyperplasia typically occurs in the peripheral zone of the prostate.

    <p>False</p> Signup and view all the answers

    Which mechanisms control erection? (Select all that apply)

    <p>Sympathetic nervous system</p> Signup and view all the answers

    What is the result of testicular torsion?

    <p>Twisting of the spermatic cord</p> Signup and view all the answers

    What do Sertoli cells produce during spermatogenesis?

    <p>Nurse cells that support developing germ cells</p> Signup and view all the answers

    The prostate gland surrounds the __________.

    <p>prostatic urethra</p> Signup and view all the answers

    The bulbourethral glands are homologous to the female greater vestibular glands.

    <p>True</p> Signup and view all the answers

    What are some common causes of erectile dysfunction? (Select all that apply)

    <p>Hypertension</p> Signup and view all the answers

    Match the reproductive glands with their functions:

    <p>Seminal vesicles = Secrete alkaline fluid rich in fructose Prostate gland = Adds alkaline secretion to sperm Bulbourethral glands = Secretes lubrication Sertoli cells = Support and nourish germ cells</p> Signup and view all the answers

    Which cells in the testes are primarily responsible for the production of testosterone?

    <p>Leydig cells</p> Signup and view all the answers

    What hormone stimulates the Leydig cells to secrete testosterone?

    <p>Luteinizing hormone (LH)</p> Signup and view all the answers

    Spermatogenesis occurs in which part of the male reproductive system?

    <p>Seminiferous tubules</p> Signup and view all the answers

    Which hormone directly stimulates spermatogenesis by acting on the Sertoli cells?

    <p>Follicle-stimulating hormone (FSH)</p> Signup and view all the answers

    What is the function of inhibin, secreted by Sertoli cells, in the male reproductive system?

    <p>Inhibits FSH release</p> Signup and view all the answers

    Which of the following structures is the primary site of sperm maturation?

    <p>Epididymis</p> Signup and view all the answers

    Which enzyme is responsible for converting testosterone to dihydrotestosterone (DHT), the more potent form of testosterone?

    <p>5-alpha reductase</p> Signup and view all the answers

    What role does androgen-binding protein (ABP), produced by Sertoli cells, play in spermatogenesis?

    <p>Binds testosterone to maintain high local concentrations in the seminiferous tubules</p> Signup and view all the answers

    What is the role of the blood-testis barrier formed by Sertoli cells?

    <p>To protect developing sperm cells from the immune system</p> Signup and view all the answers

    During ejaculation, sperm are propelled from the epididymis into which structure?

    <p>Vas deferens</p> Signup and view all the answers

    Which hormone released from the hypothalamus is responsible for regulating the release of FSH and LH from the anterior pituitary?

    <p>Gonadotropin-releasing hormone (GnRH)</p> Signup and view all the answers

    The acrosome reaction, necessary for fertilization, occurs in which part of the sperm cell?

    <p>Head</p> Signup and view all the answers

    The fluid produced by which gland contributes fructose, which serves as an energy source for sperm?

    <p>Seminal vesicles</p> Signup and view all the answers

    Which neurotransmitter is primarily responsible for inducing vasodilation and thereby erection of the penis?

    <p>Nitric oxide</p> Signup and view all the answers

    Which hormone, produced by the anterior pituitary, helps maintain the male reproductive tract by supporting spermatogenesis indirectly?

    <p>Follicle-stimulating hormone (FSH)</p> Signup and view all the answers

    Study Notes

    Blood Supply to the Ovary

    • The ovarian artery is the direct branch of the aorta
    • The ovarian artery travels through the suspensory ligament to reach the ovary

    Uterine Ligaments

    • The cardinal ligament is the primary support for the uterus, anchoring it to the sacrum
    • The round ligament helps to keep the uterus anteverted and anteflexed
    • The uterosacral ligament is the most significant passive support for the uterus, anchoring it to the sacrum
    • The suspensory ligament supports the ovary and connects it to the lateral pelvic wall
    • The ovarian ligament connects the ovary to the uterus

    Uterine Structures

    • The broad ligament encloses the mesosalpinx, mesometrium, and mesovarium
    • The mesosalpinx supports the fallopian tubes
    • The mesovarium attaches the ovary to the broad ligament
    • The mesometrium supports the uterus
    • The functional layer of the endometrium is shed during menstruation
    • The myometrium is responsible for uterine contractions and is active during childbirth
    • The cervix contains the internal and external os
    • The infundibulum of the fallopian tube has fimbriae which help capture oocytes

    Uterine Artery

    • The uterine artery is a branch of the internal iliac artery
    • The vaginal artery supplies the cervix and is also a branch of the uterine artery

    Anatomical Landmarks

    • The ovarian fossa is located anteriorly to the external iliac artery
    • The round ligament of the uterus passes through the inguinal canal to terminate in the labia majora
    • The ureter crosses the uterine artery superiorly at the level of the cardinal ligament
    • The rectum lies posteriorly to the ovary

    Peritoneal Pouches

    • The rectouterine pouch lies between the uterus and rectum

    Venous Drainage

    • The uterine venous plexus drains into the internal iliac vein

    Perineum

    • The perineum is bordered posteriorly by the coccyx
    • The cervix is covered anteriorly by the bladder

    Bony Structures of the Pelvis

    • The pelvic girdle is a complex structure made up of the left and right hip bones, sacrum and coccyx.
    • The iliac crest is a significant bony landmark in the pelvic girdle.
    • The iliac spine is another significant bony landmark used for muscle attachment and is located in the pelvic girdle.
    • The ischial spine is a bony landmark in the pelvic girdle that is useful for muscle attachment and located on the inner surface of the pelvis.
    • The greater sciatic notch is a significant bony landmark used for the passage of the sciatic nerve.
    • The ischial tuberosity is the bony prominence that bears body weight when sitting, it's located in the pelvic girdle.
    • The pubic symphysis is a cartilaginous joint formed by the union of the left and right pubic bones, located in the pelvic girdle.

    Major Ligaments of the Pelvis

    • The sacrospinous ligament is a strong, triangular ligament extending from the sacrum to the ischial spine.
    • The sacrotuberous ligament is another strong, triangular ligament extending from the sacrum to the ischial tuberosity.

    True vs False Pelvis

    • The true pelvis is the lesser pelvis, which is the space between the bones of the pelvic girdle.
    • The false pelvis is the greater pelvis, which is the space superior to the pelvic inlet.
    • The true and false pelvis are separated by the pelvic brim, which is the border of the pelvic inlet.

    Pelvic Inlet and Pelvic Outlet

    • The pelvic inlet is the opening of the true pelvis, through which the fetus must pass during childbirth.
    • The pelvic outlet is the opening of the true pelvis, through which the fetus exits the birth canal.
    • The linea terminalis is a line that marks the boundary between the true and false pelvis.
    • The linea terminalis is formed by the arcuate line and the pectinate line.

    Pelvic Planes & Dimensions

    • The true conjugate, obstetric conjugate and the diagonal conjugate are measurements taken to assess the adequacy of the pelvis for childbirth.

    Male vs Female Pelvis

    • The male pelvis (android) is heart-shaped and narrow, while the female pelvis (gynecoid) is oval and wider.
    • The ischiopubic rami angle is narrower in males (~70 degrees) and wider in females (~90-100 degrees).
    • The obturator foramen is circular in males and oval in females.
    • The iliac crests are higher in males and shorter in females.
    • The ischial spines are more prominent and closer together in males, while they are less prominent and wider apart in females.
    • The sacrum is longer, narrower, straighter and more pronounced in males, while it’s shorter, wider, and more curved in females.

    Passageways In and Out of the Pelvis

    • The inguinal ligament is a strong, fibrous band that runs from the anterior superior iliac spine to the pubic tubercle.
    • The greater sciatic foramen is a large opening in the pelvis through which several important nerves and vessels pass.
    • The lesser sciatic foramen is a smaller opening in the pelvis through which the obturator internus muscle passes.
    • The obturator canal is a short, tubular passage that allows the passage of the obturator nerve and vessels.
    • The urogenital hiatus is an opening in the pelvic floor through which the urethra, vagina, and the rectum pass.

    Pelvic Floor Muscles

    • The levator ani is a complex muscle that forms a sling-like structure at the base of the pelvis and has three components: the pubococcygeus, puborectalis, and iliococcygeus.
    • The coccygeus (ischiococcygeus) is a small, triangular muscle located in the pelvic floor.

    Pelvic Wall Muscles

    • The obturator internus is located on the medial wall of the pelvis and rotates the thigh laterally.
    • The piriformis is a muscle located in the pelvis that helps to rotate the hip laterally and abduct the thigh.

    Innervation of the Pelvis

    • The sciatic nerve is the largest nerve in the body and innervates the posterior thigh muscles + sensory innervation of most of the leg + foot.
    • The pudendal nerve innervates the pelvic floor muscles and provides sensory innervation to the perineum.

    Other Nerves of the Perineum

    • The superior gluteal nerve helps to innervate gluteal muscles.
    • The inferior gluteal nerve innervates the gluteal muscles.

    Blood Supply Through the Pelvis

    • The common iliac artery bifurcates into the internal and external iliac arteries.

    • The internal iliac artery supplies blood to the pelvic viscera, the musculoskeletal part of the pelvis, the gluteal region, the medial thigh and the peritoneum.

    • The umbilical artery supplies blood to the fetus before birth.

    • The internal pudendal arteries are branches of the internal iliac artery and supply blood to the perineum and external genitalia.### Vagina

    • Lymphatic drainage:

      • Superior part: external iliac nodes
      • Middle part: internal iliac nodes
      • Inferior part: superficial inguinal nodes

    • Innervation:

      • Parasympathetic & sympathetic: uterovaginal nerve plexus (part of inferior hypogastric plexus)
      • Inferior 1/5th of vagina has somatic: deep perineal nerve (branch of pudendal n.)

    Fornices

    • Fornices are potential spaces between the vaginal part of the cervix and vaginal walls.
    • The posterior fornix is deeper than the anterior, lateral, and right and left fornices.

    Vulva

    • It is the collective term for the external female genitalia.
    • Mons pubis: fusion of labia majora, subcutaneous fat pad anterior to pubic symphysis.
    • Labia majora: two hair-bearing external skin folds.
    • Labia minora: two hairless skin folds, lie within labia majora.
    • Vestibule: area enclosed by labia minora, contains openings of the vagina and urethra.
    • Bartholin's glands: secrete lubricating mucus during sexual arousal, located either side of the vaginal orifice.
    • Clitoris: located under clitoral hood, formed of erectile corpora cavernosa tissue, which becomes engorged with blood during sexual stimulation.

    Vulva Function

    • Sensory tissue during sexual intercourse.
    • Directs flow of urine during micturition.
    • Protects internal female reproductive tract from infection.

    Vulva Vasculature

    • Arterial supply: paired internal and external pudendal aa. (branches of internal iliac a.).
    • Venous drainage: pudendal vv.
    • Lymphatic drainage: superficial inguinal nodes.
    • Innervation:
      • Parasympathetic (clitoris and vestibule): cavernous nerves from uterovaginal plexus.
      • Sensory nerves:
        • Anterior: ilioinguinal nerve, genital branch of genitofemoral nerve.
        • Posterior: pudendal nerve, posterior cutaneous nerve of thigh.

    Blood Supply Summary

    • Ovaries: ovarian artery + uterine artery & veins.
    • Fallopian tubes: ovarian artery + uterine artery & veins.
    • Uterus: uterine artery.
    • Cervix: uterine & vaginal aa.
    • Vagina: uterine & vaginal aa. & external pudendal aa.
    • Vulva: internal and external pudendal arteries.

    Ligaments

    • Broad ligament (three divisions):
      • Mesometrium: surrounds uterus and is largest subsection, runs laterally to cover external iliac vessels, forming distinct fold over them, encloses proximal part of round ligament of uterus.
      • Mesovarium: associated with ovaries, projects from posterior surface of broad ligament and attaches to hilum of ovary, enclosing neurovascular supply, doesn't cover surface of ovary itself.
      • Mesosalpinx: originates superiorly to mesovarium, encloses fallopian tubes.
    • Ovarian ligament: connects inferior side of ovary to side of uterus, just below origin of fallopian tubes, lies within broad ligament.
    • Suspensory ligament of ovary (aka infundibulopelvic ligament): extends outwards from ovary to lateral abdominal wall, consists of fold of peritoneum (located within broad ligament), contains ovarian vessels and nerves.
    • Round ligament: remnant of embryonic gubernaculum, originates at uterine horns (where fallopian tube enters uterus), passes through inguinal canal, attaches to labia majora, located inside broad ligament.
    • Cardinal ligaments: situated along inferior border of broad ligament, house uterine artery and uterine veins, travels from side of cervix to lateral pelvic wall at level of ischial spines.
    • Pubocervical ligaments: bilateral structures, attach cervix to posterior surface of pubic symphysis.
    • Uterosacral ligaments: bilateral fibrous bands, attach cervix to sacrum.

    Pathway of Sperm during Ejaculation

    • Seminiferous tubules
    • Epididymis
    • Vas deferens
    • Ejaculatory ducts
    • Urethra
    • Penis

    Penis

    • Common outlet for urine & semen.
    • Consists of: root, body, & glans.
    • Composed of 2 cylindrical cavernous bodies of erectile tissue:
      • 2 corpus cavernosa.
      • 1 corpus spongiosum.
    • Tunica albuginea: outer fibrous covering of each cavernous body.
    • Deep fascia of the penis/Buck’s fascia: superficial to outer covering, forms a strong membranous covering for the corpus cavernosa & corpus spongiosum binding them together.

    Penis Structure

    • Penis root: located in superficial perineal pouch, contains 3 erectile tissues: 2 crura + 1 bulb & 2 muscles (ischiocavernosus & bulbospongiosus).
    • Penis body: free part suspended from pubic symphysis, composed of 3 cylinders of erectile tissue.
    • Penis glans: formed from distal expansion of corpus spongiosum, contains external urethral orifice (opening of spongy urethra near penis tip).

    Penis Erectile Tissue

    • Corpus cavernosa: formed by 2 crura meeting at the midline.
    • Corpus spongiosum: is the tapered part of the bulb of the penis in the penis body.
    • Bulb of the penis: fuses midline into a single unilateral structure.
    • Glans penis: corpus spongiosum that has greatly expanded distally.

    Penis Ligaments

    • Suspensory ligament of the penis: condensation of deep fascia, attached to penis at junction of its root + body, arises from anterior surface of pubic symphysis.
    • Fundiform ligament of the penis: condensation of collagen & elastic fibres of subcutaneous tissue, surrounds the penis + unites with the dartos fascia.

    Penis Vasculature

    • Arterial supply: dorsal & deep arteries of the penis, arteries of the bulb of the penis (bulbourethral a.)
    • Venous drainage: blood from cavernous spaces is drained by venous plexuses, deep dorsal veins of penis → prostatic venous plexus → cavernous spaces, superficial dorsal veins drain skin + subcutaneous tissue → superficial external pudendal v.
    • Innervation:
      • Parasympathetic from S2-4 spinal cord segments via:
        • Pelvic splanchnic nn.
        • Pudendal nn.
      • Sensory + somatic innervation by:
        • Dorsal nerve of the penis
        • Pudendal n.

    Scrotum

    • Fibromuscular cutaneous sac located between the penis + anus.
    • Arterial supply: anterior + posterior scrotal arteries.
    • Venous drainage: scrotal v. (derivative of the external pudendal v.)
    • Lymphatic drainage: superficial inguinal lymph nodes.
    • Innervation:
      • Anterior scrotum: lumbar plexus derivatives (ilioinguinal n. & genital branch of genitofemoral n.)
      • Posterior scrotum: sacral plexus derivatives (posterior scrotal nn. & superficial branches of pudendal n.)
      • Sympathetic fibres: assist in thermoregulation of testes (stimulates contraction of dartos muscle or scrotal sweat glands).

    Testes & Epididymis

    • Paired structures within the scrotum, both are suspended from the abdomen by the spermatic cord.
    • Testes: site of sperm production + hormone synthesis.
    • Epididymis: storage of sperm, posterolateral on each teste.

    Testes

    • Functions: spermatogenesis + androgen (testosterone) production.
    • Has lobules containing seminiferous tubules supported by interstitial tissue.
    • Seminiferous tubules: lined by Sertoli cells that aid in sperm maturation, spermatozoa are produced here, developing sperm travels through the tubules and collect in the rete testis.
    • Inside the scrotum, testes are mostly covered by the tunica vaginalis, lubricates surface of testes + allows friction-free movement.
    • Testicular parenchyma is protected by tunica albuginea (fibrous capsule that encloses the testes + divides it into lobules).

    Testes Temperature Regulation

    • Optimal temperature: 34 degrees Celcius, which is maintained by a range of factors:
      • Embryological descent of the testes via the inguinal canal.
      • Cremaster muscle: raises the testes in response to cold, sex or fear, formed by the internal oblique muscle, innervated by genital branch of the genitofemoral nerve (L1-L2).
      • Dartos muscle: smooth muscle which changes surface area of scrotum to regulate temperature → wrinkles the testes, receives autonomic innervation.
      • Pampiniform plexus of testicular veins.

    Epididymis

    • Single heavily coiled duct.
    • Can be divided into:
      • Head: most proximal part.
      • Body.
      • Tail: marks the origin of the vas deferens.
    • Main roles: Sperm maturation + storage.
    • Common site of inflammation in males due to untreated infection by: Neisseria gonorrhoea & Chlamydia trachomatis.

    Testes + Epididymis Vasculature

    • Innervation: from the testicular plexus (derived from the renal + aortic plexi, receives autonomic + sensory fibres).
    • Vasculature supply: testicular arteries (arise directly from the abdominal aorta), descend down the abdomen and pass into the scrotum via the inguinal canal, are contained within the spermatic cord, also supplied by branches of cremasteric artery (from inferior epigastric a.)
    • Venous drainage: testicular veins, formed from the pampiniform plexus in the scrotum, pampiniform plexus is a network of veins around the testicular a.
    • Lymphatics: lumbar + para-aortic nodes.

    Testicular Vasculature

    • Arterial supply: testicular arteries which arise from the abdominal aorta inferior to the renal arteries.
    • Venous supply: pampiniform venous plexus that comes from the testicular vein (note that the LHS testicular vein comes from the left renal vein due to the IVC being on the RHS).
    • Lymphatic drainage: follows testicular a. & v. to the right and left lumbar & pre-aortic lymph nodes.

    Descent of the Testes

    • Timing: 7th-12th week.
    • Location: Posterior body wall & perineum.
    • Key outcomes: relocation and development of inguinal canal.
    • Testes originate as an indifferent gonad on the posterior abdominal wall.
    • As the abdominal cavity starts to grow, the testes descend closer to their pelvic location.
    • Testes push into the pelvic region partially via the gubernaculum.
      • The gubernaculum starts to shorten into the scrotal ligament (is what pulls the ligament down).
      • As it shortens, it pulls the testes from the posterior abdominal wall and pushes through the anterior abdominal wall so they sit retroperitoneally..

    Descent of the Testes

    • Testes will descend posterior to the processus vaginalis (an embryonic developmental outpouching of the peritoneum).
    • It precedes the testes and then closes (if it doesn’t close, potential for a hernia).

    Descent of the Testes - Layers

    • As the testes descend, they drag layers of peritoneum down with them. However, the transversus abdominis muscle arches too high for the testes to capture a layer of it (won't be dragged!). Every other layer will be dragged down.
      • Abdomen: Camper’s fascia (fatty layer of superficial fascia), Scarpa’s fascia (membranous layer of superficial fascia).
      • Perineum: Dartos m. (male), Labia majora (female), Colle’s fascia (membranous layer of superficial fascia).
      • Scrotum: Dartos muscle, External spermatic fascia (becomes Buck's fascia at the penis), Cremaster muscle, Internal spermatic fascia.

    Spermatic Cord

    • Formed at the opening of the inguinal canal (deep inguinal ring) → inguinal canal → superficial inguinal ring and continues into the scrotum.
    • Collection of vessels, nerve and ducts that run to and from the testes:
      • 3 arteries: testicular a., deferential a., cremasteric a..
      • 3 nerves: genitofemoral, cremasteric, deferential.
      • 3 fascia: cremasteric, external spermatic, internal spermatic.

    The Scrotum

    • The scrotum houses the testes and is comprised of skin, fascia, muscle, and nerves
    • The scrotal components include the:
      • Genital branch of the genitofemoral nerve
      • Cremasteric nerve
      • Sympathetic nerve fibers
      • External spermatic fascia
      • Cremasteric fascia
      • Internal spermatic fascia
      • Vas deferens
      • Pampiniform plexus
      • Lymphatic vessels

    Varicocele

    • A varicocele is the dilation of veins in the pampiniform plexus
    • It usually appears when standing or straining and disappears supine because gravity empties the veins
    • It can result from defective valves in the testicular region or kidney or renal vein problems
    • Varicoceles are more common on the left side because the left testicular vein enters the left renal vein at a 90-degree angle, making the venous flow more susceptible to obstruction

    Haematocele of Testes

    • A hematocele is a collection of blood in the tunica vaginalis
    • It results from the rupture of branches of the testicular artery caused by trauma

    Testicular Torsion

    • Testicular torsion is the twisting of the spermatic cord due to rotation of the testicle
    • It is a surgical emergency that can lead to necrosis of the testicle within 6-12 hours
    • The torsion obstructs venous drainage, leading to edema and hemorrhage
    • It also strangulates the testicular artery, leading to necrosis
    • Symptoms include severe testicular pain, pain in the lower abdomen, nausea, vomiting, high-riding testes, and absent cremasteric reflex

    Testicular Cancer

    • The most common solid malignancy in males aged 20-35
    • Risk factors include cryptorchidism, contralateral testicular cancer, and family history
    • Clinical features include gynecomastia, a painless testicular nodule or swelling, and a negative transillumination test

    Testicular, Scrotal, and Prostate Cancer Spread

    • Testicular cancer spreads to the lungs, lymph nodes of the chest, pelvis, and base of the neck
    • Scrotal cancer spreads to the superficial inguinal nodes
    • Prostate cancer spreads through the Batson's venous plexus, which includes the vertebral and brain

    Vas Deferens

    • A continuation of the epididymis duct
    • Has a thick muscular wall giving it a firm, cord-like texture
    • Begins in the tail of the epididymis at the inferior pole of the testes
    • Ascends posterior to the testes, medial to the epididymis
    • Crosses over the external iliac vessels to enter the pelvis, passing medial to the ureter
    • Ends by joining the duct of the seminal glands to form the ejaculatory duct
    • Supplied by the artery to the vas deferens
    • Drained by the testicular vein

    Seminal Glands/Vesicles

    • Elongated structures found between the bladder fundus and rectum
    • Do not store sperm
    • Secrete a thick, alkaline fluid containing fructose that mixes with sperm as it passes into the ejaculatory ducts and urethra
    • Lie posterior to the ureters
    • Supplied by arteries to the seminal glands
    • Drained by veins accompanying the arteries

    Ejaculatory Ducts

    • Formed by the vas deferens and seminal glands
    • Arise near the bladder neck
    • Supplied by arteries to the vas deferens
    • Drained by veins that join the prostatic and vesical venous plexuses

    The Prostate Gland

    • Surrounds the prostatic urethra
    • Has two parts: glandular and fibromuscular
    • Secretes a slightly alkaline fluid (rich in citrate, calcium, and enzymes) that adds to the sperm ejaculate

    Lobes of the Prostate

    • Isthmus: anterior to the urethra, contains little to no glandular tissue
    • Right and left lobes: can be subdivided into four lobes

    Zones of the Prostate

    • Central zone: surrounds the ejaculatory ducts
    • Transitional zone: surrounds the urethra, typically undergoes BPH
    • Peripheral zone: body of the gland, located posteriorly
    • Fibromuscular stroma: stimulated anteriorly and merges with tissue of the urogenital diaphragm

    Prostate Gland Arterial Supply and Venous Drainage

    • Supplied by prostatic arteries (branches of the internal iliac artery)
    • Drained by veins forming the prostatic venous plexus, connecting to the Batson venous plexus, the internal vertebral venous plexus, and the vesical venous plexus

    Prostate Gland Innervation

    • Innervated by the inferior hypogastric plexus (SNS, PNS, and sensory)
    • Flanked by neurovascular bundles supplying the penis for erection
    • Motor control of smooth muscles in the prostate and seminal vesicles in emission is sympathetic
    • Prostate gland secretion is parasympathetic (pelvic splanchnic)

    Benign Prostatic Hyperplasia

    • Benign growth of cells in the transitional zone of the prostate
    • Leads to the formation of a nodule that compresses the prostatic urethra
    • Causes bladder outlet obstruction
    • Prevalence increases with age
    • Bladder outlet obstruction leads to detrusor overactivity, weakening of the bladder wall, incomplete voiding, and predisposition to UTIs
    • Results in voiding problems (hesitancy, poor stream, and dribbling) and storage problems (frequency, urgency, and nocturia)
    • Diagnosis involves a digital rectal exam and prostate-specific antigen levels

    Bulbourethral Glands

    • Paired structures embedded within the external urethral sphincter that are homologous to the female greater vestibular glands
    • Secrete lubrication and neutralize acid from urine

    Erectile Tissue Innervation

    • Autonomic: parasympathetic and sympathetic
    • Somatic: pudendal nerve

    Erectile Dysfunction

    • Inability to achieve or sustain an erection sufficient in rigidity or duration for sexual intercourse
    • Driven by parasympathetic, sensory, and sympathetic nerves
    • Common causes include hypertension, cardiovascular disease, hyperlipidemia, diabetes mellitus, prostate surgery, hypogonadism, medications, and alcohol abuse

    Perineal Muscles

    • Muscles Covering Erectile Tissues
      • Bulbospongiosus: holds less blood, good for patency, thin connective tissue covering
      • Ischiocavernosus: holds more blood, good for turgidity/rigidity, thick connective tissue
    • Transverse Perineal Muscles
      • Deep and superficial muscles
      • Function: support the pelvic floor and viscera, maintain intra-abdominal pressure

    Perineal Muscle Function

    • Aid in maintaining erection
    • Stretch receptors trigger muscle contraction to pinch off veins during erection

    Female Infertility

    • Common causes include ovary disorders, fallopian tube issues, problems in or with the uterus, immune factors, and other causes (e.g., endometriosis, PCOS)

    Female Infertility - Diagnostics

    • Assess ovulatory function using body temperature, hormone tests, and endometrial biopsy
    • Assess patency of fallopian tubes and uterus using hysterosalpingography

    Male Infertility - Causes

    • Low levels of sex hormones including GnRH, gonadotropin-releasing hormone, and gonadotropins
    • This can be caused by anosmia (loss of smell) or a small pituitary gland

    Lab Investigations for Male Infertility

    • Semen analysis (oligospermia = low sperm density, azoospermia = no sperm seen)
    • Serum FSH
    • Testicular histology
    • Genetic testing

    Seminiferous tubules

    • Located in the testes
    • Composed of germ cells (spermatogonia) and Sertoli cells
    • Produce sperm through spermatogenesis
    • Surrounded by a basement membrane and a layer of myoid cells
    • Have a lumen through which sperm are released

    Sertoli Cells

    • Columnar cells with a distinct-shaped nucleus
    • Tall and thin cytoplasm extending from the basal lamina to the lumen
    • Act as "nurse" cells for developing germ cells
    • Stimulated by FSH to produce spermatogenesis
    • Form tight junctions to create the blood-testes barrier, which protects immature sperm from the immune system
    • Separate the epithelium into two compartments: one containing diploid germ cells and the other, an immune-privileged compartment
    • Functions: express SRY on the Y chromosome, produce AMH in early fetal life, ensure self-renewal of spermatogonial stem cells

    Interstitial Tissue

    • Loose connective tissue containing vessels, nerves, lymphocytes, lymphatic system, and Leydig cells
    • Leydig cells produce testosterone in response to LH from the anterior pituitary gland
    • Testosterone diffuses into seminiferous tubules and enters the bloodstream

    Rete Testes

    • Network of tubules connecting the seminiferous tubules to the vas deferens
    • Passageway for the exit of sperm from the testes into the duct system

    Epididymis

    • Coiled tubules containing immature sperm
    • Sperm maturation occurs in the epididymis
    • Inflammation can occur due to gonorrhoea and chlamydia

    Vas Deferens (histology)

    • Similar epithelium to the epididymal tubule
    • Contains a thick smooth muscle wall that contracts to force sperm along this space during ejaculation
    • After a vasectomy, sperm are phagocytosed by tissue adjacent to the lumen

    Seminal Vesicles (histology)

    • Contains pseudostratified columnar epithelium
    • Highly folded lamina propria and smooth muscle
    • Secretes a yellow, viscous fluid rich in proteins and prostaglandins

    Prostate Gland (histology)

    • Contains the ejaculatory duct and urethra
    • Has a capsule with fibromuscular septa forming lobules
    • Growth stimulated by testosterone

    Ovaries (histology)

    • Almond-shaped, contain ovarian follicles, tunica albuginea, cortex, and medulla
    • Outer epithelium: simple squamous or cuboidal
    • Tunica albuginea: thick connective tissue capsule
    • Cortex: mostly ovarian follicles in different stages of development
    • Medulla: loose connective tissue with a rich blood supply

    Folliculogenesis

    • Series of developmental stages of ovarian follicles: primordial, primary, secondary, antral, and Graafian follicles
    • Primordial follicle: single layer of flattened granulosa cells surrounding the oocyte
    • Primary follicle: granulosa cells become cuboidal
    • Secondary follicle: development of a fluid-filled antrum, zona pellucida surrounding the oocyte, and corona radiata bridging the antrum
    • Graafian (tertiary, pre-ovulatory) follicle: mature follicle

    After Ovulation

    • Corpus luteum: yellow body, forms if pregnancy occurs
    • Corpus albicans: white body, forms if pregnancy does not occur

    Fallopian Tubes (histology)

    • Composed of three layers: mucosa, lamina propria, and muscularis
    • Mucosa: simple columnar epithelium containing ciliated cells and secretory cells
    • Lamina propria: loose connective tissue
    • Muscularis: smooth muscle with inner circular and outer longitudinal layers

    Uterus (histology)

    • Composed of three layers: serosa/adventitia, myometrium, and endometrium
    • Serosa/adventitia: outer connective tissue layer
    • Myometrium: thick layer of smooth muscle
    • Endometrium: mucosa containing simple columnar epithelium with ciliated cells and simple tubular glands in the lamina propria
    • Endometrium is subdivided into functionalis (shed during menstruation) and basalis (retained during menstruation)

    Male Reproductive Anatomy

    • The penis is comprised of three main sections: the root, the body, and the glans.
    • The root is the base of the penis, anchored to the pelvic bone.
    • The body is the main shaft of the penis, containing three cylinders of erectile tissue: two corpora cavernosa and one corpus spongiosum.
    • The glans is the rounded head of the penis, an expansion of the corpus spongiosum.
    • The tunica albuginea is a fibrous sheath surrounding the corpora cavernosa, aiding in erection.
    • Fascia provides structural support: Colles' fascia is superficial, and Buck's fascia is deep, binding the corpora cavernosa.
    • Ejaculatory Muscles: Two erectile muscles support the penis: Ischiocavernosus and Bulbospongiosus.
    • Vascular supply is primarily through the arteries of the penis and bulbourethral artery, and drained by the venous plexus of the penis.
    • Innervation: The penis receives both parasympathetic and somatic innervation.
      • Parasympathetic nerves, originating in the S2-S4 spinal cord, contribute to erection.
      • Somatic nerves, like the dorsal nerve of the penis and pudendal nerve, provide sensation.

    Sex Determination

    • Sex differentiation is driven by the SRY gene on the Y chromosome.
    • Presence of the SRY gene leads to the production of the SRY protein, which triggers the development of testes from the bipotential gonads.
    • The absence of the SRY gene leads to the development of ovaries.
    • Testosterone, produced by the testes, promotes the development of the Wolffian duct into the male reproductive structures.
    • Anti-Müllerian hormone (AMH), secreted by the testes, causes the degeneration of the Müllerian duct.
    • In females, the absence of testosterone leads to the degeneration of the Wolffian duct, and the Müllerian duct develops into female reproductive structures.

    Disorders of Sex Development: 5 alpha-hydroxylase deficiency

    • 5 alpha-hydroxylase deficiency prevents the conversion of testosterone to dihydrotestosterone (DHT), a crucial hormone for external male genitalia development.
    • Individuals with this deficiency have internal male genitalia due to testosterone production, but external female genitalia due to lack of DHT.

    Congenital Adrenal Hyperplasia (CAH)

    • Congenital Adrenal Hyperplasia (CAH) is a group of disorders that affect the adrenal glands' ability to produce hormones, leading to an excess of androgens.
    • Classic CAH is further divided into salt-wasting (severe) and non-salt wasting forms (milder).
    • Classic CAH can lead to ambiguous genitalia in females and precocious puberty in males.
    • Nonclassic CAH is often diagnosed later in life and can manifest with hirsutism and menstrual irregularities in females, and sometimes asymptomatically in males.

    Most Common Cause of CAH: 21-Hydroxylase Deficiency

    • 21-Hydroxylase deficiency is the most common type of CAH, an autosomal recessive disorder.
    • 21-hydroxylase is an enzyme essential for cortisol and aldosterone production.
    • Its deficiency disrupts hormone production and leads to an accumulation of androgen precursors.

    CAH Treatment

    • Maintenance therapy involves replacing missing hormones:
      • Glucocorticoids (like hydrocortisone) replace cortisol and suppress ACTH production to decrease androgen production.
      • Salt-wasting forms also need fludrocortisone (mineralocorticoid) and sodium chloride supplementation.
    • Growth hormone therapy may be necessary in CAH children, as the condition can lead to short stature.
    • Reconstructive surgery is considered for females with ambiguous genitalia.

    Male Reproduction

    • The testes are responsible for spermatogenesis (sperm production) and testosterone production.
    • Fertility refers to the ability to reproduce, while virility encompasses the effects of testosterone on the body and psychology.

    Hypothalamic-pituitary Axis

    • The hypothalamic-pituitary axis regulates testicular function.
    • The hypothalamus releases gonadotropin-releasing hormone (GnRH).
    • The pituitary gland releases luteinising hormone (LH) and follicle-stimulating hormone (FSH).

    Hormones and Testicular Function

    • LH stimulates Leydig cells to produce testosterone.
    • FSH stimulates Sertoli cells to:
      • Produce inhibin, which inhibits FSH production.
      • Support sperm production.
    • Inhibin regulates sperm production via feedback loops.

    Spermatogenesis

    • Spermatogenesis is the process of sperm development in the seminiferous tubules of the testes.
    • Requires the coordinated development of Sertoli and germ cells under the influence of gonadotropins.
    • LH and FSH both act on Sertoli cells:
      • LH binds to androgen receptors.
      • FSH binds to surface receptors.

    Sperm Structure

    • Sperm consists of a head (containing the nucleus), a midpiece (containing mitochondria), and a tail (for motility).
    • Acrosome covers the head and contains enzymes for fertilization.

    Testicular Failure (Hypogonadism)

    • Hypogonadism is a condition of inadequate sex steroid production.
    • Primary testicular failure (hypergonadotropic hypogonadism) occurs when the testes are damaged and cannot produce testosterone properly.
    • Secondary testicular failure (hypogonadotropic hypogonadism) occurs when the hypothalamus or pituitary gland is not functioning properly, leading to low GnRH or gonadotropin release.

    Congenital GnRH Deficiency Therapy

    • Gonadotropin therapy aims to establish fertility by replacing LH and FSH.
    • Testosterone therapy is used to promote virilization.
    • Treatment aims to mimic normal puberty by administering LH followed by FSH to induce testosterone production and testicular growth.

    Onset of Puberty

    • GnRH release from the hypothalamus triggers the onset of puberty.
    • Initial GnRH pulses are nocturnal, later becoming continuous.
    • Rising LH levels stimulate Leydig cells to produce testosterone, leading to virilization and testicular growth.
    • Metabolites of testosterone, including estradiol and dihydrotestosterone (DHT), play important roles in development.

    Testosterone

    • Testosterone exerts its effects through three main pathways:
      • Amplification pathway: Testosterone is converted to DHT by 5α-reductase and binds to androgen receptors.
      • Diversification pathway: Testosterone is converted to estradiol by aromatase and binds to estrogen receptors.
      • Inactivation pathway: Testosterone is oxidized and excreted by the kidneys.
    • Male reproductive aging is associated with a gradual decline in serum testosterone.
    • The decline is variable, and there is no equivalent to female menopause.

    Ovarian & Menstrual Cycles

    • Ovaries are responsible for producing gametes and key hormones (estrogen, progesterone, inhibin).
    • Oogenesis begins prenatally, with the development of oocytes within follicles.
    • The ovarian cycle involves the maturation of a follicle, ovulation of an oocyte, and formation of the corpus luteum.

    Phases of the Ovarian Cycle

    • Follicular phase (days 1-14): follicle growth and maturation culminates in ovulation.
    • Luteal phase (days 15-28): period of corpus luteum activity, which produces progesterone.

    Stages of the Ovarian Cycle

    • Primordial follicle: the earliest follicle type, containing a primary oocyte arrested in prophase I.
    • Primary follicle: primordial follicle with a cuboidal cell layer surrounding the oocyte.
    • Preantral follicle: a growing follicle with a stratifiied epithelium around the oocyte.
    • Early antral follicle: a follicle containing a fluid-filled cavity called the antrum.
    • Dominant follicle: selected follicle that continues to develop and eventually ovulates.
    • Atresia: the process of follicular degeneration.
    • Ovulation: release of the secondary oocyte from the mature follicle.

    Corpus Luteum

    • The corpus luteum forms from the remnants of the ovulated follicle.
    • It produces progesterone and estrogen.
    • It degenerates after 10 days if pregnancy doesn't occur, forming the corpus albicans.

    Hormonal Control of Ovarian Function

    • The ovarian cycle is regulated by:
      • GnRH (gonadotropin-releasing hormone)
      • FSH (follicle-stimulating hormone)
      • LH (luteinizing hormone)
      • Estrogen
      • Inhibin
      • Progesterone

    The Uterine Cycle

    • The uterine cycle refers to the cyclic changes in the endometrium in response to ovarian hormones.
    • It is synchronized with the ovarian cycle.

    Menstrual Phase

    • Characterized by shedding of the endometrial lining.
    • Prostaglandins cause vasoconstriction of spiral arteries and uterine contractions, leading to endometrial cell death.
    • Stratum functionalis (superficial layer) sloughs off.
    • Endometrial tissue and blood are discharged through the vagina as menstrual flow.
    • Only the deepest layer of the endometrium, the stratum basalis, remains.
    • Estrogen and progesterone levels are low.

    Proliferative (Preovulatory) Phase

    • Rebuilds the functional layer of the endometrium through proliferation of glandular epithelial cells, stroma, and blood vessels.
    • The endometrium thickens and becomes well vascularized.
    • Rising estrogen levels:
      • Promote progesterone receptor expression on endometrial cells.
      • Thin the cervical mucus.
    • Ovulation occurs at the end of this phase.

    Secretory (Postovulatory) Phase

    • Progesterone levels rise, preparing the endometrium for implantation.
    • Glands and stroma enlarge, arterioles elongate, and nutritious glycogen is secreted into the uterine lumen.
    • Progesterone thickens cervical mucus and inhibits prostaglandin-induced contractions, promoting a favorable environment for implantation.
    • If fertilization doesn't occur, the corpus luteum degenerates, leading to a decline in progesterone levels.

    Estrogen Production

    • Granulosa cells and theca cells in the ovary contribute to estrogen production.
    • The enzyme aromatase converts androgens into estradiol.

    Polycystic Ovary Syndrome (PCOS)

    • A common disorder characterized by hyperandrogenism, ovulatory dysfunction, and/or polycystic ovarian morphology.
    • Key characteristic features:
      • Dermatological abnormalities: often present due to hyperandrogenism, such as acne.
      • Metabolic dysfunction: increased insulin resistance in muscle and liver, leading to hyperinsulinemia (increased insulin secretion).
      • Subfertility: infertility is higher in individuals with PCOS.

    Ovarian Axis

    • The hypothalamus releases GnRH (gonadotropin-releasing hormone).
    • GnRH stimulates the pituitary gland to release LH (luteinizing hormone) and FSH (follicle-stimulating hormone).
    • LH and FSH act on the ovary, stimulating estradiol, inhibin A, and inhibin B production.
    • Estradiol and inhibins provide negative feedback to the hypothalamus and pituitary, regulating GnRH, LH, and FSH levels.

    PCOS Pathophysiology

    • A possible mechanism is due to increased androgen production by the ovaries.
    • This leads to increased LH production, which may further stimulate androgen production, creating a cycle.

    Male Reproductive System

    • Leydig cells in the testes are responsible for producing testosterone.
    • Luteinizing hormone (LH) stimulates Leydig cells to secrete testosterone.
    • Spermatogenesis occurs in the seminiferous tubules of the testes.
    • Follicle-stimulating hormone (FSH) directly stimulates spermatogenesis by acting on Sertoli cells.
    • Sertoli cells also produce inhibin, which inhibits the release of FSH.
    • Epididymis is the primary site of sperm maturation.
    • 5-alpha reductase converts testosterone to dihydrotestosterone (DHT), the more potent form.
    • Androgen-binding protein (ABP), produced by Sertoli cells, binds testosterone and maintains a high local concentration in the seminiferous tubules.
    • Blood-testis barrier, formed by Sertoli cells, protects developing sperm cells from the immune system.
    • Vas deferens carries sperm from the epididymis during ejaculation.
    • Gonadotropin-releasing hormone (GnRH) released from the hypothalamus regulates the release of FSH and LH from the anterior pituitary.
    • Acrosome, located in the head of the sperm cell, plays a crucial role in fertilization.
    • Seminal vesicles contribute fructose, an energy source for sperm, to the ejaculatory fluid.
    • Nitric oxide stimulates vasodilation and erection of the penis.
    • Follicle-stimulating hormone (FSH) indirectly supports spermatogenesis by maintaining the male reproductive tract.

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    Description

    This quiz covers the blood supply to the ovary, uterine ligaments, and key uterine structures. It is designed to test your knowledge about the anatomy and physiology of the female reproductive system. Familiarize yourself with the various ligaments and their functions for a comprehensive understanding.

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