Anatomy of Female Reproductive Organs PDF

# Anatomy of Female Reproductive Organs ## Prepared By Dr. Afaf Mohammed Emam Assistant Professor of Obstetrics and Gynecological Nursing ### General Objective: At the end of this lecture, the student should be able to acquire essential knowledge and understand structure, function, and location...

# Anatomy of Female Reproductive Organs ## Prepared By Dr. Afaf Mohammed Emam Assistant Professor of Obstetrics and Gynecological Nursing ### General Objective: At the end of this lecture, the student should be able to acquire essential knowledge and understand structure, function, and location of external and internal female genital organs. ### Specific Objectives: At the end of this lecture, the student should be able to: - Identify external female genital organs - Identify internal female genital organs ### Outlines: - External female genital organs - Internal female genital organs ### Anatomy of Female Reproductive Organs: Anatomy of female reproductive organs consists of: - Bony pelvis & soft tissue - Soft tissue consists of: - External female genital organs (The Vulva) - Internal female genital organs ### Female Reproductive System: This is a picture of the female reproductive system, showing the following parts: - Fallopian tube - Ovary - Uterus - Cervix - Vagina - Endometrium - Myometrium ### External Anatomy of Female Genital Organs: This is a picture of the external anatomy of female genital organs, showing the following parts: - Mons pubis - External urethral orifice - Vaginal orifice - Bartholin glands (greater vestibular glands) - Prepuce - Citoris - Labia minora - Labia majora - Fourchette (frenulum of labia majora) - Anus ### External Anatomy: This is a picture of the external anatomy of female genital organs, showing the following parts: - Pubic area (Mons pubis) - Outer lips (Labia Majora) - Inner lips (Labia Minora) - Bartholin's gland - Clitoris - Bladder opening (Urethra) - Vaginal opening - Anus ### External Female Genital Organ {The Vulva} - Mons Pubis. - Labia Majora - Labia Minora - Clitoris. - Vestibule. - The urethral meatus - The vaginal introitus - Hymen - Bartholin's glands - Perineum ### The Vulva: The Vulva consists of the following structures: - **The mons pubis or monsveneris**: is a pad of fat, covered with pubic hair from the time of puberty, - **Location**: Over the symphysis pubis. - **Function**: Is the protection of the symphysis pubis during intercourse - **The labia majora**: are two folds of fat and areolar tissue (large lips), covered with skin and pubic hair on the outer surface, it contains sweat and sebaceous (oil-secreting) glands. - **Location**: Arise in the monsveneris and merge into the perineum behind. - **Function**: Is the protection of the vaginal introitus - **The labia minora**: (small lips) are two thin folds of hairless skin lying between the labia majora. Anteriorly, divide to enclose the clitoris, posteriorly, fuse forming the fourchette. - **Location**: Between the labia majora. - **Function**: Lubricate the vulva, swell in response to stimulation, and are highly sensitive. - **The clitoris**: (corresponding to the male penis). It is a small erectile organ, very sensitive and highly vascular - **Location**: Is located at the anterior junction of the labia minora. There are folds above and below the clitoris. The joining of the folds above the clitoris forms the prepuce - **Function**: Is sexual stimulation. (Plays a part in the orgasm of sexual intercourse.) - **The vestibule**: - **Location**: (region between labia minora) the areas in which the openings of the urethra and the vagina are situated & enclosed by the labia minora. It contain all the following: - *The urethral orifice* - **Location**: 2.5 cm posterior to the clitoris, the Skene's glands are located on either side of the opening to the urethra. They secrete a small amount of mucus to keep the opening moist and lubricated for the passage of urine. - *The Vaginal orifice (Vaginal introitus)* - **Location**: Occupies the posterior two-thirds of the vestibule. The orifice is partially closed by the hymen - *The Hymen*, a thin membrane is found intact (Virgo) (العذراء) and which tears during sexual intercourse or during the birth of the first child. It has one or more openings to allow escape of menstrual blood. - **Shape of Hymen**: Annular, cresentic, cribiform, Elastic, imperforate, rigid, torn hymen, irregular margin in an intact hymen. - *Bartholin's glands*: are two small glands which open on either side of the vaginal orifice - **Function**: These are mucus-secreting, producing copious amounts during intercourse to act as a lubricant. - **The perineal body** - **Location**: The perineum is the most posterior part of the external female reproductive organs. This external region is located between the vulva and the anus. It is made up of skin, muscle, and fascia. The perineum can become lacerated or incised during childbirth and may need to be repaired with sutures. Incising the perineum area to provide more space for the presenting part is called an episiotomy. - **Function**: The perineal body helps strengthen the pelvic floor. ### Types of Hymen: - Imperforate - Annular - Denticular - Cribriform - Dentate - Crescentic - Labial - Fimbriated - Septate - Lunar - Microperforate - Parous Introitus ### Internal Female Genital Organs: This is a picture of the internal anatomy of female genital organs, showing the following parts: - Ovary - Fallopian tubes - Uterus - Vaginal canal - Uterine tube - Ovary - Rectouterine pouch - Uterus - Fallopian tube - Vesicouterine pouch - Fornix - Vagina - Cervix - Clitoris - Labium minus - Labium majus - Greater vestibular gland ### The Ovaries: (Female gonads) The ovaries: (female) (gonads الغدة التناسلية الانثوية comparable to the testes in the male & similar to almonds in size& shape. Each ovary weights from 2 to 5 grams and is about 4 cm long, 2 cm wide and 1 cm thick. - **Location**: Are located on either side of the uterus, below and behind the fimbriated ends of the ova ducts. - **Structure**: The ovary is composed of a medulla and cortex, covered with germinal epithelium - **Functions**: The development and the release of the ovum and the secretion of the hormones estrogen, progesteron and androgen are the two primary functions of the ovary. ### The Ovary: (Figure 4): This is a picture of the structure of the ovary, showing the following parts: - Medulla (contains neurovascular structures) - Cuboidal epithelium - Hilum - Cortex (contains ovarian follicles) ### The Ovary Details: - **The medulla**: it is made of fibrous tissue and the ovarian blood vessels, lymphatic's and nerves travel through it. The hilum where these vessels enter lies just where the ovary is attached to the broad ligament and this area is called the mesovarium. - **The cortex**: It contains the ovarian follicles in different stages of development, surrounded by stroma. The outer layer is formed of a single layer of cuboidal cells, the germinal epithelium and fibrous tissue known as the tunica albuginea. The cortex is the functioning part of the ovary. ### The Ovary: (Figure 5) This is a picture of the ovary, showing the following parts: - Retractor - Suspensory ligament - Mesovarium - Broad ligament - Uterus - Uterine tube - Ovarian ligament - Fimbriae - Broad Ligament - Ovarian artery and vein - Suspensory ligament - Infundibulum - Ovary - Ureter - Uterosacral ligament - Cervix - Cervical os - Vaginal wall - Vaginal rugae ### The Ovary: - **Supports**: Supported from above by the ovarian ligament medially and the infundibulopelvic ligament laterally. - **Relations**: - Anterior: the broad ligaments. - Posterior: The intestines. - Lateral: The infundibulopelvic ligaments and the side wall of the pelvis. - Superior: The Fallopian tubes. - Medial: The uterus and the ovarian ligament. ### The Fallopian Tubes: - **The fallopian tubes or uterine tubes**: Open pass way extended from the cornua of the uterus towards the sidewalls of the pelvis. Each tube is 10cm in long. - **Parts of the tube**: - *Interstitial portion*: is 1 cm long and lies within the wall of the uterus. Its lumen is 1 mm wide. - *The isthmus*: is narrow part, which extends for 2 cm from the uterus - *The ampulla*: is the wider portion of the tube where fertilization usually occurs. It is 5 cm long. - *The infundibulum*: is 2 cm long is the funnel-shaped fringed ending which is composed of fimbriae. One fimbria is elongated to form the ovarian fimbria which is attached to the ovary. - **Location**: The fallopian tubes extend laterally from the cornua of the uterus towards the side walls of the pelvis. They arch over the ovaries; the fringed ends hovering near the ovaries in order to receive the ovum. - **Functions**: - Receives the spermatozoa as they travel upwards - Provides a site for fertilization. - Ovum transport and pick up. - Embryo transport and nourishment. - **Relations**: - Anterior, posterior and superior. The peritoneal cavity and the intestines. - Lateral. The sidewalls of the pelvis. - Inferior. The broad ligaments and ovaries lie below the tubes. - Medial. The uterus lies between the two fallopian tubes. - **Supports**: The fallopian tubes are held in place by their attachment to the uterus. The peritoneum folds over them, draping down below as the broad ligaments and extending at the sides to form the infundibulopelvic ligaments. - The peristaltic movement of the fallopian tube is due to the action of the smooth muscles. The tube is covered with peritoneum but the infundibulum passes through it to open into the peritoneal cavity. ### The Fallopian Tubes: (Figure 6) This is a picture of the fallopian tubes, showing the following parts: - Fundus - Isthmus - Ovarian Ligament - Uterine Cavity - Body - Cervix - Fornix - Vagina - Ampulla - Infundibulum - Ovary - Isthmus of Uterus - Internal Os - Fimbriae - External Os ### The Uterus: - **The uterus**: It is a hollow, muscular, pear -shaped organ in non-pregnant woman; it is 7.5 cm long, 5cm wide and 2.5cm in depth, each wall being 1.25 cm thick. - **The Uterus: (Figure 7):** This is a picture of the uterus, showing the following parts: - Fundus - Body - Cervix - **Location**: Situated in the true pelvis, between the bladder and rectum. (In pelvic cavity) - **Function**: Shelter the fetus during pregnancy. It prepares for this possibility each month and following pregnancy it expels the uterine contents. ### The Uterus: - The body or corpus makes up the upper two thirds of the uterus and is the greater part. - The fundus is the domed upper wall between the insertions of the fallopian tubes. - The cronua are the upper outer angles of the uterus where the fallopian tubes join. - The cavity is a potential space between the anterior and posterior walls. It is triangular in shape, the base of the triangle being upper most. - The isthmus is a narrow area between the cavity and the cervix, which is 7 mm long. It enlarges during pregnancy to form the lower uterine segment. ### The Uterus: - **The cervix or neck**: the cervix forms the lower third of the uterus and measures 2.5cm in each direction. It is narrow lower part of the uterus composed of fibrous connective tissue, projects into the vagina &is divided into two portions: - *Vaginal portion*: Below the attachment site that protrudes into the vagina. - *Supra vaginal portion*: Above the site of attachment of the cervix to the vaginal wall - **The internal os**: (mouth) is the narrow opening between the isthmus and the cervix. - **The external os**: is a small round opening at the lower end of the cervix. After childbirth this becomes a transverse slit. - **The cervical canal**: is a continuation of the uterine cavity, lies between the internal & the external os, and is narrow at each end &wider in the middle. ### The Uterus: - **Layers of the uterus**: The uterus has three layers: - *The perimetrium* (the outer layer, serous coat) double membrane drape over the uterus, an extension of the peritoneum covering all but narrow on either side. - *The myometrium* :( muscle coat), the muscular myometrium forms the main bulk of the uterus and comprises smooth muscle fibers with areolar tissue, blood vessels, nerves and lymphatic's which is thick in the upper part of the uterus and is more sparse in the isthmus and cervix. - *The endometrium* :( mucous membrane) the endometrial layer is covered by a single layer of columnar epithelium. This epithelium is mostly lost due to the effects of pregnancy and menstruation. The endometrium undergoes cyclical changes during menstruation and varies in thickness between 1 and 5mm. ### The Uterus: (Figure 8): This is a picture of the ligaments of the uterus, showing the following parts: - Bladder - Pubocervical ligament - Cervix - Transverse/cardinal ligament - Uterosacral ligament - Rectum ### The Uterus: - N.B: the broad ligament. This is not a ligament but a peritoneal fold, and it does not support the uterus. - *Round ligaments*: fibro muscular coat from upper, outer angles of uterus, through inguinal canal, terminating in labia majora. - *The ovarian ligaments*: also begin at the cornea of the uterus but behind the fallopian tubes and pass down between the folds of the broad ligament to the ovaries. It is helpful to note that the round ligament, fallopian tube and the ovarian ligament are very similar in appearance and arise from the same area of the uterus. This makes careful identification important when tubal surgery is undertaken. ### The Vagina: - **The Vagina**: passage as musculo-membranous canal situated in front of the rectum and behind the bladder, passing upwards and backwards into the pelvis along a line approximately parallel to the plane of the pelvic brim. - **The Vagina: (Figure 9)**: This is a picture of the vagina, showing the following parts: - Rugae (transverse ridges) - Cervix - Longitudinal fold - H-shape - **Structure**: The posterior wall is 10 cm long while the anterior wall is only 7.5 cm in length because the cervix projects at a right angle into its upper part. The vaginal walls stretch during intercourse and child birth due to transverse folds as rugae. In the nulliparous adult the vagina is H- shaped in section. - **Functions**: - Allows the escape of the menstruation and act as excretory duct for uterine secretion - Receives semen from the male during sexual intercourse - provides an exit for the fetus during delivery. - **Contents**: The vagina has an acidic environment, which protects it against ascending infections the fluid is strongly acid (pH 4.5) due to the presence of lactic acid formed by the action of dodelein's bacilli on glycogen found in the squamous epithelium of the lining. - **Layers**: The lining is made of squamous epithelium. Beneath the epithelium lies a layer of vascular connective tissues. - **Relations**: - Superior. Above the vagina lies the uterus. - Inferior. Below the vagina lie the external genitialia. - Lateral: Beside the upper two-thirds are the pelvic fascia and the ureters, which pass beside the cervix. - Anterior. Vaginal wall is related to bladder and urethra.. - Posterior. Behind, the pouch of Douglas, the rectum and the perineal body each occupy approximately one-third of the posterior vaginal wall. - N.B: The upper posterior vaginal wall forms the anterior peritoneal reflection of the pouch of Dougla. ### Female Bony Pelvis: - **The bony pelvis**: forms a bony ring that transmits body weight to the lower extremities. In women, the bony pelvis is structured to adapt to the demands of childbearing. The pelvis functions to support and protect the pelvic contents and to form a relatively fixed axis for the birth passage. - **The female bony pelvis is divided into**: - *False pelvis*: above the pelvic brim and has no obstetric importance. - *True pelvis*: below the pelvic brim and it has an obstetric importance related to the child -birth. ### The True Pelvis: - **The true pelvis**: It is composed of: - *The Pelvic Inlet (Brim)* - **Boundaries** - Sacral promontory. - Sacroiliac joints. - Iliopectineal lines of innominate bone. - Iliopectineal eminencies. - Upper border of the superior pubic ramus. - Pubic tubercles. - Pubic crests. - Upper border of symphysis pubis. - Upper border of the pubic bone -*Cavity* -*Outlet* ### The Pelvis: (Figure 10) This is a picture of the structure of the pelvis, showing the following parts: - Pelvic brim - Anterior sacral foramen - Ischial spine - Pectineal line of pubis - Sacral promontory - Sacrum - Coccyx - Ala if sacrum - Iliac fossa - Iliac crest - Anterior superior iliac spine - Anterior inferior iliac spine - Acetabulum - Obturator foramen - Pubic symphysis - Pubic crest - Pubic tubercle - Ischiopubic ramus ### The Pelvic Inlet: - **Diameters of pelvic inlet**: - *Antero -posterior diameters*: - Anatomical antero -posterior diameter (true conjugate) = 11cm, from the tip of the sacral promontory to the upper border of the symphysis pubis. - Obstetric antero -posterior diameter = Obstetric conjugate = 11.5 cm from the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero- posterior diameter. - Diagonal conjugate = 12.5 cm, 1.5 cm longer than the true conjugate. From the tip of sacral promontory to the lower border of symphysis pubis, it measured by vaginal examination. - External conjugate = 20 cm from the depression below the last 5th lumbar spine to the upper anterior margin of the symphysis pubis measured from outside by the pelvimeter. It has not a true obstetric importance - *Transverse diameters*: - Anatomical transverse diameter =13cm between the farthest two points on the iliopectineal lines. It lies 4cm in front of the sacral promontory, 7 cm behind the symphysis. It is the largest diameter in the pelvis. - Obstetric transverse diameter: It bisects the true conjugate and is slightly shorter than the anatomical transverse diameter. = 12.5cm - Oblique diameters: = 12cm from the sacroiliac joint. - Right oblique diameter =12 cm from the right sacroiliac joint to the left iliopectineal eminence. - Left oblique diameter = 12 cm from the left sacroiliac joint to the right iliopectineal eminence. - Sacro-cotyloid diameters = 9-9.5 cm from the promontory of the sacrum to the right and left iliopectineal eminence. - **II- II - pelvic cavity**: - **Boundaries**: - Above: pelvic brim - below: plane of least pelvic dimensions - Anteriorly: symphysis pubis - Posteriorly: sacrum. - Its plane is known as plane of greatest pelvic dimensions which passes through: - Anteriorly: the middle of posterior surface of symphysis pubis. - Posteriorly: Junction of 3nd and 3rd pieces of the sacrum. - Laterally; the center of acetabulum and upper part of greater sciatic notch. - It's rounded with all diameters = 12.5cm. - **III- pelvic outlet**: - The pelvic outlet is an approximately diamond-shaped space that marks the inferior margin of the true pelvis. This opening in the pelvis has boundaries that mirror the perineal triangle boundaries, as the two spaces share a common base. - **Diameter pelvic outlet**: The anteroposterior (AP) diameter, from the symphysis pubic to the sacrococcygeal joint, is the largest diameter of the pelvic outlet and typically measures between 9.5 to 12.5 cm. ### Types of Bony Pelvis: - **1-Gynecoid**: Typical female pelvis found in 50% of women - Rounded–slightly oval inlet - Straight pelvic sidewalls with roomy pelvic cavity - Good sacral curve - Ischial spines are not prominent - Pubic arch is wide. - **2-Andoroid**: Typical male pelvis found in 1/3 white women 1/6 non-white - Pelvic brim is heart shaped - Narrow pubic arch - **3-Anthropoid**: 25% white women & 50% nonwhite - Long & narrow pelvic canal with long sacrum - Straight pelvic sidewalls - **4-PLATYPELLOID**: 3% of women - Pelvic brim - kidney shape - Sacral promontory pushed forwards ### The Pelvis: (Figure 11) This is a picture of the types of pelvis, showing the following parts: - Android (male or funnel-shaped pelvis with a contracted outlet) - Gynecoid (41% of women Superior views) - Anthropoid (long, narrow, and ova shaped) - Platypelloid (wide pelvis 2% of women) ### Pelvic Ligaments: - **Ligaments**: - *Sacrospinous ligament* → lateral aspect of the sacrum to ischial spines - *Sacrotuberous ligament* → lateral aspect of the sacrum to inner aspect of ischial tuberosity - *Sacroiliac ligament* → medial surface of the ilium to sacrum - *Illiolumbar ligament* → iliac crest to trans lumbar vertebra ### Fetal Skull: - **The skull**: is formed of the face, the vault & the base. - **The bones that form the skull are**: two frontal bones, two parietal bones, two temporal bones wings of the sphenoid & occipital bone. The bones of the face & base are heavy & fused. The bones of the vault are 2 frontal, 2 parietal & occipital. - The bones of the vault are not joined thus changes in the shape of the fetal head during labor can occur due to molding ### Fetal Skull Sutures: - **Fetal skull sutures**: - *Frontal suture* → between 2 frontal bones - *Sagittal suture* → between 2 parietal bones - *Coronal suture* → between parietal & frontal - *Lambdoid suture* → between parietal & occipital - *Temporal suture* → between inferior margin of the parietal & temporal ### The Fetal Skull: (Figure 12) This is a picture of the normal skull of the newborn, showing the following parts: - Frontal bones - Anterior Fontanelle - Sagittal Suture - Posterior Fontanelle - Occipital bone - Metopic suture - Coronal suture - Parietal Bones - Lambdoid suture