Female Genital System Anatomy PDF

FEMALEGENITAL SYSTEM Prof Dr Mohamed El-Badry Mohamed Professor and Head of Human Anatomy and Embryology Department, Head of Academic Departments Faculty of Medicine, Merit University Professor of Human Anatomy and Embryology Department, Fac...

FEMALEGENITAL SYSTEM Prof Dr Mohamed El-Badry Mohamed Professor and Head of Human Anatomy and Embryology Department, Head of Academic Departments Faculty of Medicine, Merit University Professor of Human Anatomy and Embryology Department, Faculty of Medicine, Assiut University  Objectives of the of the Lecture By the end of the lecture the student should be able to: Mention the organs forming the female genital system Describe anatomy of the ovary Describe anatomy of the uterine tube and its parts Describe anatomy of the uterus, parts and normal position Describe anatomy of the vagina Describe anatomy of the vulva  Female Genital System Consists of: I. Primary sex organ: Ovaries II. Secondary sex organs: 1. Uterine Tubes 2. Uterus 3. Vagina 4. Vulva  OVARY Each ovary: Almond- shaped organ. Measuring: 4 x 2 Cm. Attached to back of broad ligament by mesovarium Usually, ovary lies with its long axis vertical. But, shares in any movement of broad ligament and uterus. POSITION OF OVARY (OVARIAN FOSSA): Depression in lateral wall of the pelvis in which lies the ovary. Boundaries of the ovarian fossa: Above: External iliac vessels Behind: Internal iliac vessels and ureter. Obturator nerve: Crosses floor of the fossa. NOTE: Position of ovary: Extremely variable Often found hanging down in rectouterine pouch (pouch of Douglas). During pregnancy: Enlarging uterus pulls ovary up into abdominal cavity. After childbirth:When broad ligament lax, ovary takes up variable position in pelvis. Suspensory ligament of ovary: Part of broad ligament extending between attachment of mesovarium and lateral wall of pelvis. Round ligament of ovary: Remains of upper part of gubernaculum (round ligament of uterus: Remains of lower part of gubernaculum). Extends from upper end of lateral wall of uterus to medial margin of the ovary. COVERINGS OF THE OVARY: 1.Tunica albuginea:Thin fibrous capsule 2.Germinal epithelium: Covers the capsule externally Modified area of peritoneum Continuous with squamous mesothelial cells of general peritoneum at hilum of ovary where mesovarium attached Does not give rise to ova. (misnomer) Oogonia: Develop before birth from primordial germ cells. NOTE: Before puberty: Ovary is smooth After puberty: Ovary becomes progressively scarred as corpora lutea degenerate. After menopause: Ovary becomes shrunken and its surface is pitted with scars. FUNCTION OF THE OVARIES: Organs responsible for production of: 1. Female germ cells; ova 2. Female sex hormones; estrogen and progesterone in sexually mature female. BLOOD SUPPLY OF THE OVARY: ARTERIES: Ovarian artery: Branch of aorta at level of 1st lumbar vertebra VEINS: Right ovarian vein: Drains into inferior vena cava Left ovarian vein: Drains into left renal vein LYMPH DRAINAGE OF THE OVARY: Lymph vessels follow the ovarian artery Drain into: Para-aortic nodes at level of 1st lumbar vertebra. NERVE SUPPLY OF OVARY: Derived from aortic plexus Accompanies the ovarian artery Blood supply, lymph drainage and nerve supply: Pass over pelvic inlet Cross external iliac vessels Reach ovary by passing through suspensory ligament of ovary Enter hilum of ovary via mesovarium  UTERINE TUBES (2) Each tube: About 10 Cm long. Lies: in upper border of broad ligament. Connects peritoneal cavity in region of ovary with cavity of uterus. PARTS OF UTERINE TUBE: 1. Infundibulum: Funnel-shaped lateral end Projects beyond broad ligament and overlies ovary Free edge of the funnel is broken up into finger-like processes; fimbriae(draped over ovary). 2. Ampulla: Widest part of the tube 3. Isthmus: Narrowest part of the tube Lies just lateral to the uterus 4. Intramural part: Segment that pierce the uterine wall FUNCTION OF UTERINE TUBE: 1. Receives the ovum from the ovary 2. Serves as conduit along which the spermatozoa travel to reach the ovum 3. Provides site where fertilization of ovum can take place (usually in ampulla) 4. Provides nourishment for fertilized ovum 5. Transports fertilized ovum to the uterus BLOOD SUPPLY OF UTERINE TUBE: ARTERIES: 1.Uterine artery: Branch of internal iliac artery 2.Ovarian artery: Branch of aorta VEINS: 1.Uterine vein: Drains into internal iliac vein 2.Ovarian vein: Right drains into inferior vena cava and left drains into left renal vein LYMPH DRAINAGE OF UTERINE TUBES: Lymph vessels follow corresponding arteries Drain into: 1. Internal iliac nodes 2. Para-aortic nodes NERVE SUPPLY OF UTERINE TUBES: Inferior hypogastric plexuses Aortic plexus  UTERUS Hollow, pear-shaped organ with thick muscular walls. In young nulliparous adult: 3 inches (8 Cm) long, 2 inches (5 Cm) wide and 1 inch (2.5 Cm) thick. PARTS OF THE UTERUS: 1. Fundus: Part of the uterus above entrance of uterine tubes. 2. Body: Part of the uterus below entrance of uterine tubes. Narrows below to become continuous with cervix. 3. Cervix: Pierces anterior wall of the vagina. Divided into: a. Supra-vaginal part of the cervix. b. Vaginal part of the cervix. Cavity of the uterine body: Triangular in coronal section Cleft in sagittal section Cavity of the cervix (cervical canal): Spindle-shaped Communicates with cavity of the body through internal os. In nullipara: External os is circular. In parous woman: Vaginal part of the cervix is larger and external os is opened out transversely having anterior and posterior lips. RELATIONS OF THE UTERUS: Anteriorly: -Body of uterus: Uterovesical pouch Superior surface of the bladder -Supravaginal cervix: Superior surface of bladder. Vaginal cervix: Anterior fornix of vagina Posterior relations of the uterus: 1. Rectouterine pouch 2. Coils of ilium 3. Sigmoid colon Laterally: -Body of uterus: Broad ligament, uterine artery and vein. -Supravaginal cervix: Ureter. -Vaginal cervix: Lateral fornix of vagina. NOTES: Uterine tubes enter supero-lateral angles of uterus Round ligaments of ovary and of uterus are attached to uterine wall just below this level. FUNCTION OF UTERUS: Serves as site for: 1. Reception of the fertilized ovum 2. Retention (implantation) of the fertilized ovum 3. Nutrition of the fertilized ovum POSITIONS OF THE UTERUS: Normally, in majority of women, long axis of uterus is bent forward on long axis of vagina forming an angle of 90 degrees(anteversion of uterus). Long axis of body of uterus is bent forward at level of internal os with long axis of cervix forming an angle of about 170 degrees. (anteflexion of uterus) Thus, in erect position with empty urinary bladder, uterus lies in an almost horizontal plane. Note: In some women, fundus and body of uterus are bent backward on vagina, lie in rectouterine pouch (pouch of Douglas); retroverted. If body of uterus is bent backward on the cervix, it is said to be retroflexed. BLOOD SUPPLY OF UTERUS: ARTERIES: Uterine artery: Branch of internal iliac artery VEINS: Uterine vein: Drains into internal iliac vein LYMPH DRAINAGE OF THE UTERUS: Lymph vessels from fundus of uterus: Accompany ovarian artery and drain into para-aortic lymph nodes at level of 1st lumbar vertebra. Lymph vessels from body and cervix: Drain into internal and external iliac lymph nodes. Few lymph vessels follow round ligament of uterus: through inguinal canal: Drain into superficial inguinal lymph nodes. NERVE SUPPLY OF THE UTERUS: Sympathetic and parasympathetic nerves from inferior hypogastric plexuses. Supports of uterus: 1.Tone of levatores ani muscles 2. Condensations of pelvic fascia; ligaments: Transverse cervical (cardinal), pubocervical and sacrocervical ligaments 3. Round ligament of uterus  VAGINA Muscular tube. Extends upward and backward from the vulva to the uterus. Measures about 3 inches (7.5 Cm) long. Has anterior and posterior walls, normally in apposition. Upper end of anterior wall is pierced by the cervix. Upper half lies above pelvic floor and lower half lies within the perineum.  Vaginal orifice in virgin has thin mucosal fold; hymen (perforated at its centre) After childbirth the hymen usually consists only of tags Vulva. Note the different appearances of the hymen in a virgin (B), a woman who has had sexual intercourse (C), and a multiparous woman (D). Fornices of vagina (4): Area of vaginal lumen that surrounds the cervix 1. Anterior fornix 2. Posterior fornix 3. Right lateral fornix 4. Left lateral fornix RELATIONS OF VAGINA: ANTERIORLY: Bladder (above) Urethra (below) POSTERIOR RELATIONS OF VAGINA: Upper third of vagina: Rectouterine pouch Middle third of vagina: Ampulla of rectum Lower third of vagina: Perineal body, anal canal LATERALLY: Upper part: Ureter. Middle part: Anterior fibers of levator ani. Lower part: Urogenital diaphragm, bulb of vestibule. FUNCTION OF VAGINA: 1. Female genital canal 2. Serves as excretory duct for menstrual flow 3. Forms part of the birth canal BLOOD SUPPLY OF VAGINA: ARTERIES: 1. Vaginal artery 2. Uterine artery 3. Internal pudendal artery 4.VEINS: Vaginal veins form plexus around the vagina, drains into internal iliac vein LYMPH DRAINAGE OF VAGINA: Upper third: External and internal iliac nodes. Middle third: Internal iliac nodes. Lower third: Superficial inguinal lymph nodes. NERVE SUPPLY OF VAGINA: Inferior hypogastric plexuses Pudendal nerve (lower part) SUPPORTS OF VAGINA: I. Upper part of vagina: 1.Levatores ani muscles 2.Transverse cervical ligaments 3.Pubocervical ligaments 4.Sacrocervical ligaments II. Middle part of vagina: Urogenital diaphragm III. Lower part of vagina: Perineal body Culdocentesis: Draining a pelvic abcess through the posterior fornix of the vagina Identification of blood or pus in peritoneal cavity by passage of needle through posterior fornix of vagina. Perforation of posterior vaginal fornix: Result from abortionist’s thrusting non-sterile instruments through posterior fornix instead of through external os of the cervix Death from peritonitis Cystocele: Bulging of the anterior vaginal wall due to sagging of the bladder Rectocele: Bulging of the posterior vaginal wall due to sagging of the rectal ampulla  BROAD LIGAMENTS 2 layered folds of peritoneum Extend across pelvic cavity from lateral margins of uterus to lateral pelvic walls. Superiorly: The 2 layers are continuous and form upper free edge. Inferiorly: At base of the ligament, the layers separate to cover pelvic floor. Parts of broad ligament: 1. Mesovarium: Ovary is attached to posterior layer of broad ligament by it. 2. Suspensory ligament: Part of broad ligament lateral to attachment of mesovarium. 3. Mesosalpinx: Part of broad ligament between mesovarium and uterine tube. 4. Mesometrium: Rest of broad ligament. CONTENTS OF BROAD LIGAMENT: 1.Uterine tube: In its free upper border 2.Round ligament of ovary 3.Round ligament of uterus 4.Uterine vessels 5.Ovarian vessels 6.Lymph vessels 7.Nerves 8.Epoophoron: Vestigial structure, lies in broad ligament above attachment of mesovarium (remains of mesonephros). 9.Paroophoron: Vestigial structure, lies in broad ligament lateral to the uterus (mesonephric remnant). 10.Fat. Note: At base of the broad ligament, the uterine artery crosses the ureter  VULVA Collective name for female external genitalia. Includes: 1.Mons pubis 2.Labia majora 3.Labia minora 4.Clitoris 5.Vestibule of the vagina 6.Vestibular bulb 7.Greater vestibular glands MONS PUBIS: Rounded, hair-bearing elevation of skin found anterior to the pubis. Pubic hair: Has horizontal superior margin, whereas in male it extends upward to the umbilicus. LABIA MAJORA: Prominent, hair-bearing folds of skin Extend: From mons pubis to unite posteriorly in the midline. LABIA MINORA: 2 smaller, hairless folds of soft skin. Lie: Between the labia majora. Their posterior ends unite to form the fourchette. Anteriorly: Split to enclose the clitoris forming an anterior prepuce and a posterior frenulum. CLITORIS Corresponds to the penis in the male. Situated at apex of vestibule anteriorly. Has structure similar to the penis. Together, body and glans of the clitoris are about 2 cm in length and 1 cm in diameter. In contrast to the penis, the clitoris is not functionally related to urethra or to urination. It functions solely as an organ of sexual arousal. ROOT OF THE CLITORIS:(3 erectile tissues) 1. Bulb of the vestibule 2. Right crus of the clitoris 3. Left crus of the clitoris Bulb of vestibule: Corresponds to bulb of the penis. Divided into: 2 halves by presence of vagina. Attached to: Under surface of the urogenital diaphragm. Covered by: Bulbospongiosus muscles. Crura of the clitoris: Correspond to crura of the penis. Become: Corpora cavernosa anteriorly Each remains separate and covered by ischiocavernosus muscle. BODY OF THE CLITORIS: Consists of:2 corpora cavernosa. Corpus spongiosum of the male:Represented by small amount of erectile tissue leading from vestibular bulbs to glans. GLANS OF THE CLITORIS: Small mass of erectile tissue. Caps body of the clitoris. Provided with numerous sensory endings. Partly hidden by the prepuce. BLOOD SUPPLY OF THE CLITORIS: ARTERIES: (branches of internal pudendal) 1. Corpora cavernosa: Deep arteries of clitoris 2. Corpus spongiosum: Artery of bulb of vestibule 3. Dorsal artery of clitoris VEINS: These veins drain into internal pudendal veins LYMPH DRAINAGE OF THE CLITORIS: 1.Skin of clitoris: Medial group of superficial inguinal lymph nodes 2.Deep structures of clitoris: Internal iliac nodes NERVE SUPPLY OF THE CLITORIS: 1. Pudendal nerve 2. Pelvic plexuses Clitoris is highly sensitive and enlarges on tactile stimulation. Glans of the clitoris is the most highly innervated part of the clitoris and is densely supplied with sensory endings. VESTIBULE: Smooth triangular area. Boundaries of vestibule: Laterally: Labia minora. At its apex: Clitoris. At its base: Fourchette. Openings into the vestibule: 1.Urethral orifice 2.Ducts of paraurethral glands 3.Vagina 4.Ducts of greater vestibular glands VAGINAL ORIFICE: Protected in virgins by the hymen (thin mucosal fold), perforated at its centre. At the 1st coitus: Hymen tears, usually posteriorly or posterolaterally. After childbirth: Only few tags of hymen remain. Vulva. Note the different appearances of the hymen in a virgin (B), a woman who has had sexual intercourse (C), and a multiparous woman (D). PARAURETHRAL GLANDS Correspond to the prostate in male Open into the vestibule by small ducts on either side of urethral orifice. GREATER VESTIBULAR GLANDS Pair of small mucous-secreting glands. Lie:under cover of posterior parts of bulb of the vestibule and labia majora. Each gland: Drains its secretion into the vestibule by small duct, opens into the groove between hymen and posterior part of labium minus. Function of greater vestibular glands: Secrete a lubricating mucous during sexual intercourse. BLOOD SUPPLY OF VULVA: ARTERIES: 1.External pudendal arteries (superficial and deep), branches of femoral arteries 2.Internal pudendal arteries, branches of internal iliac arteries VEINS: 1.External pudendal veins: Tributaries of great saphenous and femoral veins 2.Labial veins: Tributaries of internal pudendal veins LYMPH DRAINAGE OF VULVA: Skin of vulva: Medial group of superficial inguinal group. NERVE SUPPLY OF VULVA: Anterior parts of vulva: 1.Ilioinguinal nerves. 2.Genital branch of genitofemoral nerves. Posterior parts of vulva: 1.Labial branches of perineal nerves 2.Labial branches of posterior cutaneous nerves of the thigh  VAGINAL EXAMINATION (Per Vagina= PV): 1. Anatomical relations of the vagina are of great clinical importance 2. Many pathological conditions occurring in female pelvis may be diagnosed by a simple vaginal examination. Structures can be palpated through vaginal walls from above downward: Anteriorly: 1.Bladder 2.Urethra Posteriorly: 1.Loops of ilium (in rectouterine pouch) 2.Sigmoid colon (in pouch of Douglas) 3.Rectal ampulla 4.Perineal body Ovaries: May prolapse in pouch of Douglas following pregnancy due to laxity of broad ligaments and can be palpated through posterior fornix of the vagina. Laterally: 1.Uterus 2.Pelvic fascia and anterior fibers of levatores ani muscles 3.Urogenital diaphragm. Clinical Anatomy of female genital system:  Thank You Prof Dr Mohamed El-Badry Mohamed