Female Genital System (Internal Structures) Lecture Notes PDF

 Copyright notice Material which is made available by way of an electronic database may be subject to certain licensing conditions. These conditions normally entail that you may only use the material for your own private study and research at the University and...

 Copyright notice Material which is made available by way of an electronic database may be subject to certain licensing conditions. These conditions normally entail that you may only use the material for your own private study and research at the University and not for any other purpose. It is expected of you to adhere to these conditions at all times. Printed material is also only made available for class discussion, private study and research purposes. Further reproduction of such material is prohibited /Materiaal wat by wyse van elektroniese databasis aan u beskikbaar gestel is, mag onderhewig wees aan bepaalde lisensievoorwaardes. Sulke voorwaardes behels normaalweg dat u die materiaal slegs vir u eie private studie en navorsing aan die Universiteit kan gebruik en vir geen ander doeleindes hoegenaamd nie. Daar word van u verwag om te alle tye aan hierdie voorwaardes gehoor te gee. Gedrukte materiaal word eweneens slegs vir klasbespreking, private studie en navorsingsdoeleindes beskikbaar gestel. Die verdere reproduksie daarvan is ontoelaatbaar. 2  Outcomes Describe the structure and relations of the vagina in the pelvis. Describe the structure, composition and relations of the different parts of the uterus and uterine tubes. Describe and name the position of the ligaments of the uterus. Describe the position of and name the structure, relations and ligaments of the ovaries. Describe the blood & nerve supply and lymphatic drainage of the uterus, uterine tubes, vagina and ovaries. 3 FEMALE INTERNAL GENITAL STRUCTURES 4 OVERVIEW 5 Female Genital System Internal genital External genital organs organs Vagina Mons pubis Uterus Labia majora & minora Uterine tubes Clitoris Ovaries Vestibular bulbs Greater vestibular glands (of Bartholin) 6  Female internal genital organs oVagina o Uterus o Uterine tubes o Ovaries 7 VAGINA 8  Vagina Distensible fibromuscular tube. Copulatory organ of females. Courses posterosuperiorly from the perineum through the pelvic floor into the pelvic cavity. Superior end surrounds cervix. Internal end is enlarged: vaginal vault. Forms a recess around cervix - fornix – 4 parts: anterior, posterior, 2 lateral fornices. Vaginal canal: normally collapsed. Opens inferiorly into vestibule. Posterior to opening of urethra 9  Vagina Relations  Anterior: fundus of bladder and urethra  Lateral: Levator ani muscle, pelvic fascia, and ureters  Posterior: Rectouterine pouch, rectum, and anal canal 10  Vagina Transverse section of Sagittal section of vagina vagina 11 UTERUS 12  Uterus Thick-walled hollow muscular organ between bladder and rectum. Consists of body (including fundus) and cervix. Joins vagina inferiorly via cervix. Uterine tubes project laterally from superior part of uterus. Open into peritoneal cavity adjacent to ovaries. Uterine cavity is continuous with uterine tube lumen & central canal of cervix. Blastocyst implants into body of uterus. Uterus expands into abdominal cavity during pregnancy. 13  Uterus Position Anteverted (tipped anterosuperiorly to axis of vagina) and anteflexed (flexed anteriorly to cervix). Lies over the bladder. Body Fundus is rounded superior part of body above level of uterine tubes. Lies between the layers of the broad ligament (peritoneum). Two surfaces: vesical and intestinal. 14  Uterus Structure: Body wall consists of three layers: Perimetrium: peritoneum & thin layer of CT. Myometrium: middle smooth muscle layer. Distends during pregnancy. Contains blood vessels and nerves. Contracts during birth to push out fetus. Endometrium: inner mucous layer. shed during menstruation. blastocyst implants here in conception. 15  Uterus Cervix Separated from body by isthmus. Interior is called cervical canal. Internal os opens into uterine cavity. External os opens into vaginal cavity. Two parts: supravaginal – between isthmus and vagina. Vaginal – protrudes into vagina. 16  Relations Anterior – superior surface of bladder, Uterus vesicouterine pouch. Posterior – rectouterine pouch, anterior surface of rectum. Lateral – broad ligament, cardinal ligaments, ureters. Anterior 17 Posterior UTERINE TUBES 18  Uterine tubes Extend from superior end of uterus body to lateral pelvic wall. Approximately 10cm long. Enclosed within mesosalpinx (free anterosuperior edge of broad ligament). Infundibulum curves around ovary. Lumen of uterine tube opens into peritoneal cavity. Receives oocyte during ovulation. Site of fertilization of oocyte by spermatozoon. 19  Uterine tubes Parts ▪ Infundibulum with fimbriae: Funnel shaped distal end that opens into peritoneal cavity. Fimbriae spread over the medial surface of ovary. ▪ Ampulla Widest and longest part. fertilization occurs here. ▪ Isthmus Thick-walled part. ▪ Uterine part Passes through wall of uterus Opens via uterine ostium into uterine cavity. 20 LIGAMENTS OF THE UTERUS 21  Ligaments of female Ligament of ovary (ovarian ligament) Remnants of gubernaculum ovarii Round ligament of uterus Broad ligament (subdivided into three parts): Mesometrium (on uterus) Mesovarium (on ovary) Peritoneum Mesosalpinx (on uterine tube) Suspensory ligament of ovary (superior part of broad ligament) Transverse cervical ligament At level of cervix. Uterosacral ligament Condensations of endopelvic fascia May contain smooth muscle 22  Ligaments of female 23 Please watch this short video! https://www.youtube.com/watch?v=1Uvsf6kMtIg Ligaments of female 24  Ligaments associated with uterus Broad ligament = sheet-like fold of peritoneum covering uterus, uterine tubes, ovary. 3 parts: Mesometrium: attaches to uterus. Mesosalpinx: covers uterine tubes. Mesovarium: attaches to ovary. Please see https://teachmeanatomy.info/pelvis/female- reproductive-tract/ligaments/ for a really good diagram. 25  Ligaments of uterus & cervix Parts of broad ligament Derivatives of gubernaculum ovarii Round ligament Ligament of ovary Ligaments of the cervix Good video: 26 https://www.youtube.com/watch?v=Bf_sr2qRRWs OVARIES 27 Ovaries Site of oocyte development: reproductive function. Secrete hormones: endocrine function. Almond-shaped. Located between uterus and lateral pelvic walls, inferior to pelvic inlet. Attached by peritoneal folds: Suspensory ligaments (contains ovarian vessels) which becomes continuous with: Mesovarium. Ligament of ovary – attaches uterine end of ovary to lateral angle of uterus. Round ligament – runs from lateral angle of uterus through inguinal canal. Ovarian and round ligaments: located within the broad ligament. 28  Ovaries Develop on posterior abdominal wall and descend before birth – drag vessels, lymphatics & nerves with them. Site of egg production (oogenesis). Mature eggs ovulated into peritoneal cavity from puberty– directed by fimbria into uterine tubes. Surface of ovary becomes scarred. 29 https://www.youtube.com/watch?v=Ml29ezbvMuY BLOOD, NERVE & LYMPHATIC 30 Blood supply of internal female genitals  Arterial:  Uterus - mainly uterine, also ovarian arteries  Uterine tubes – branches of ovarian & Uterine artery uterine arteries. anastomoses with  Vagina - superior part by uterine artery, ovarian & vaginal middle and inferior parts by vaginal and arteries internal pudendal arteries.  Ovaries – branches of ovarian & uterine arteries.  Ovarian arteries: originate from abdominal aorta.  Travel in suspensory ligament.  Uterine, vaginal & internal pudendal originate from internal iliac artery. 31 Blood supply of internal female genitals  Venous drainage:  Veins draining ovaries & uterine tubes form pampiniform plexus in broad ligament near ovary & uterine tube → drain into ovarian vein (travels with ovarian artery in suspensory ligament) → right drains into inferior vena cava / left drains into left renal vein.  Uterovaginal venous plexus: Veins draining vagina and uterus form vaginal venous plexus, continuous with uterine venous plexus → drain into uterine vein →internal iliac vein. 32 Nerve supply 33  Innervation Sympathetic fibres: From preganglionic fibres (T10- L2). Innervate blood vessels. Contraction of smooth muscles in internal urethral & internal anal sphincters. Contraction of smooth muscles of the reproductive tract and accessory glands. 34  Innervation Parasympathetic fibres: Pelvic splanchnic nerves from S2 – S4. Vasodilatory. Stimulate bladder contraction. Erection of erectile tissues. Visceral afferent fibres: Follow the course of sympathetic & parasympathetic fibres. Carry pain info. 35  Innervation Deep perineal nerve from pudendal nerve – somatic innervation (touch, pain, temperature) from inferior one-fifth of vagina. 36  Nerve supply ovaries and uterine tubes Sympathetic: Ovarian & uterine plexuses. Preganglionic fibers mainly from T10-L1 (ovaries) and T11-L1 (uterine tubes), travel with ovarian vessels (in suspensory ligament) and lumbar splanchnic nerves Visceral afferent pain: ascend retrograde with descending sympathetic fibers. Parasympathetic fibers traverse pelvic plexuses and pelvic splanchnic nerves. 37  Lymphatic drainage of uterus, uterine tubes, ovaries and vagina Fundus of uterus, uterine tubes and ovaries lumbar lymph nodes. Body of uterus external iliac nodes. Cervix of uterus and vaginal fornices external and internal iliac nodes. Middle part vagina internal lymph nodes. Inferior part of vagina common iliac and sacral nodes. Vestibule of vagina superficial inguinal nodes. 38 THANK YOU FOR LISTENING 39