GAD L3 (Anatomy of FEMALE repoductive )_665e257bdc5c66fccf96fb5a4ebd5b7b.pdf

# Anatomy of Female Reproductive System ## Lecture 3 - Level 3 ### By: Dr. Sally Mohsen ### Assistant professor of Anatomy and Embryology ### Objectives: * At the end of this lecture, the students will be able to: * Describe the structure of the different components and function of the fem...

# Anatomy of Female Reproductive System ## Lecture 3 - Level 3 ### By: Dr. Sally Mohsen ### Assistant professor of Anatomy and Embryology ### Objectives: * At the end of this lecture, the students will be able to: * Describe the structure of the different components and function of the female reproductive system. * Describe the adaptation of each system to suit its function * Explain the major differences between male and female reproductive systems. ## The Female Reproductive System This image shows a cross-section of the female reproductive system. The following parts are labeled: * Uterine Tube * Ovary * Uterus * Retouterine Pouch * Vesicouterine Pouch * Vagina * Clitoris * Labium Minus * Labium Majus * Fornix * Cervix * Greater Vestibular Gland ## Components Of Female Reproductive System The female reproductive organs can be subdivided into: 1. Internal genitalia 2. External genitalia ### Internal Genitalia The internal genitalia are those organs that are within the true pelvis. These include the following: * Vagina * Cervix * Uterus * Uterine Tubes (oviducts or fallopian tubes) * Ovaries ### External Genitalia The external genitalia lie outside the true pelvis (vulva). These include the following: * Perineum * Mons Pubis * Clitoris * Urethral (urinary) meatus * Labia majora and minora * Vestibule * Greater vestibular (Bartholin) glands * Skene glands * Peri-urethral area ## THE OVARIES ### Shape The ovary is almond-shaped. ### Size The ovary is 4x2 cm. ### Site The ovary is located in the pelvis in a depression called the ovarian fossa. It is often found hanging down in the rectouterine pouch (pouch of Douglas). ### Function * Production of female germ cells * Secretion of female sex hormones The ovary is attached to the back of the broad ligament by a peritoneal fold (mesovarium). ## Ligaments of ovary * The suspensory ligament of the ovary is that part of the broad ligament extending between the attachment of the mesovarium and the lateral wall of the pelvis. Blood supply, lymph drainage and nerve supply reach the ovary here. * The round ligament of the ovary connects the lateral margin of the uterus to the ovary. ## Clinical Note The ovary is kept in position by the broad ligament and the mesovarium. After pregnancy, the broad ligament is lax, and the ovaries may prolapse into the rectouterine pouch (pouch of Douglas). In these circumstances, the ovary may be tender and cause discomfort on sexual intercourse (dyspareunia). An ovary situated in the rectouterine pouch may be palpated through the posterior fornix of the vagina. ## Blood Supply ### Arterial Supply The ovarian artery from abdominal aorta at L1 level. ### Venous Supply The ovarian vein. (Right vein drains to IVC and left vein drains into left renal vein). ### Lymph Drainage Drain into the para-aortic nodes. ### Nerve Supply The nerve supply is derived from the aortic plexus. ## THE UTERINE (FALLOPIAN TUBES) أنابيب الرحم ### Length 10 cm long. ### Site The uterine tube is enclosed in the upper border of the broad ligament of uterus. ### Parts 1. **The infundibulum**: The funnel-shaped lateral end. Its free edge show fingerlike processes, known as fimbriae, draped over the ovary. 2. **The ampulla**: Widest part. 3. **The isthmus**: Narrowest part. 4. **The intramural part**: Segment that pierces uterine wall. ## THE UTERINE (FALLOPIAN) TUBES (Continued...) ### Function * **Site of fertilization of ovum (ampulla)** * **Transport of fertilized ovum into the uterus** ## Clinical Notes ### Ectopic Tubal Pregnancy Occasionally, a fertilized ovum fails to reach the uterus and may implant in the mucosa of the uterine tube (most commonly the ampulla), producing an ectopic tubal pregnancy. On the right side, the appendix often lies close to the ovary and uterine tube. This close relationship explains why a ruptured tubal pregnancy and the resulting peritonitis may be misdiagnosed as acute appendicitis. Tubal rupture and severe hemorrhage, giving rise to severe abdominal pain, tenderness, and guarding and constitute a threat to the mother's life and result in death of the embryo. ### Tubal Ligation Ligation and division of the uterine tubes is a surgical method of birth control and is usually restricted to women who already have children. The ova that are discharged from the ovarian follicles degenerate in the tube proximal to the obstruction. If, later, the woman wishes to have an additional child, restoration of the continuity of the uterine tubes can be attempted and, in about 20% of women, fertilization occurs. ## THE UTERUS ### Description A hollow, pear-shaped muscular organ. ### Size In the young nulliparous adult, it measures 3x2x1 inches in size. ### Parts * **Fundus**: The part of the uterus that lies above the entrance of the uterine tubes. * **Body**: The part of the uterus that lies below the entrance of the uterine tubes (cavity is triangular). * **Cervix**: Narrow part of the uterus. It pierces the anterior wall of the vagina. The body of the uterus is related anteriorly to the uterovesical pouch and the superior surface of the bladder while posteriorly, it is related to the rectouterine pouch (pouch of Douglas) with coils of ileum or sigmoid colon within it. ## THE CERVICAL CANAL (cavity of the cervix) * **Cervix is divided into:** * Supravaginal part * Vaginal part (its cavity is fusiform) * **The cervical canal, communicates with the cavity of the body through the internal os and with that of the vagina through the external os.** * Before the birth of the first child, the external os is circular. * In a parous woman, the vaginal part of the cervix is larger, and the external os becomes a transverse slit so that it possesses an anterior lip and a posterior lip. ## RELATIONS OF UTERUS | **Location** | **Relation** | |---|---| | **Lateral** | Lateral fornices of vagina | | **Posterior** | Posterior fornix of vagina | | **Anterior** | Superior surface of urinary bladder | | **Lateral** | Uterine artery | | **Posterior** | Sigmoid colon | | **Vaginal Part of Cervix** | Surrounded by vaginal fornices | ## NORMAL POSITIONS OF UTERUS (المواقف الطبيعية للرحم) ### Normal Position The normal/usual position of the uterus is anteverted and anteflexed. ### Anteverted Uterus The long axis of the whole uterus is bent forward on the long axis of the vagina. ### Anteflexed Uterus The long axis of the body of the uterus is bent forward on the long axis of the cervix. ## POSITIONS OF UTERUS ### Retroverted Uterus * Fundus & body of uterus are bent backward on the vagina and lie in the rectouterine pouch ### Retroflexed Uterus * Long axis of body of uterus is bent backward on the long axis of cervix ## Blood Supply of uterus (إمداد الرحم بالدم) ### Arterial Supply The uterine arteries branch of internal iliac artery and anastomose with ovarian artery which also assist in supplying the uterus. ### Venous Drainage * The uterine veins (from Pampiniform plexus) that drain into internal iliac veins. ## Nerve supply of the Uterus * The cervix and body are relatively insensitive to touch, cutting and burning. * The cervix is sensitive to dilatation and the body is sensitive to distension. ### Innervations * Parasympathetic form S2,3,4 * Sympathetic from: * T5 and T6 (motor) * T10, T11, T12, and L1 (sensory). Both reach the uterus through branches of inferior hypogastric plexus. ## Supports of the Uterus * The uterus is supported mainly by the tone of the levator ani muscles and the condensations of pelvic fascia, which form three important ligaments. ### Important Ligaments * Transverse cervical ligament * Pubocervical ligament * Sacrocervical ligament ### Other Ligaments The broad ligaments and the round ligaments of the uterus are lax structures, clinically they are considered to play a minor role in supporting the uterus. ## UTERINE AND CERVICAL LIGAMENTS (أربطة الرحم (والعنق 1. Broad ligament 2. Round ligament 3. Ovarian ligament ## Vagina ### Description * It is a Fibro-muscular tube. ### Extent * From external os, along pelvis & perineum, to open in the vulva (female external genitalia), behind urethral opening ### Length * Its anterior wall (7.5 cm) * Its posterior wall (9 cm) ### Function * Copulatory organ * Birth canal ## Clinical Notes * Hysterectomy (excision of the uterus) is performed through the lower anterior abdominal wall or through the vagina. The uterine artery crosses anterior to the ureter near the lateral fornix of the vagina, the ureter is in danger of being injured when the uterine artery is tied off during a hysterectomy. The point of crossing of the artery and the ureter is approximately 2 cm superior to the ischial spine. * In carcinoma of the uterus, the ureter is readily infiltrated by lateral extension, patient frequently show bilateral hydronephrosis with uraemia. * The close relationship of ureter to the lateral fornix is best appreciated by realizing that a ureteric stone at this site can be palpated on vaginal examination. (When can a stone in the ureter be felt!!) * Note that the genital canal in the female is the only direct communication into the peritoneum from the exterior and is a potential pathway for infection (for example, in gonorrhoea). ## THE VULVA ### Mons Veneris * A pad of fat overlying the symphysis pubis and covered by skin & hairs. ### Clitoris * An erectile cavernous structure below the symphysis pubis. * Formed of a small glans and two corpora cavernosa. ### Labia Majora * The outer 2 skin folds, raised by underlying fat, and passing back from thr mons veneris to the perineum. The outer skin is covered by hairs while the inner medial surface is smooth, hairless and contains sebaceous and sweat glands. ### Labia Minora * 2 thin folds of modified skin situated medial to the labia majora. ### The Hymen * A membrane, situated about 2 cm from the vestibule that demarcates the external from the internal genital organs, and partially closes the vaginal orifice. ### Bartholin Glands (Greater Vestibular Glands) * Bilateral compound racemose glands * Secrete mucus during sexual excitement * Situated deep in the labia majora, at the junction of the posterior and the middle thirds * Its duct is 2 cm long and opens between the hymen and the labium minus. ### Vestibule * The area between the inner aspects of the labia minora and the fourchette. * Structures that open in the vestibule are: * Urethra * The Bartholin glands ducts. * The vagina. ### Vestibular bulbs * Oblong masses of erectile tissue that lie on each side of the vaginal introitus. ### External urethral meatus * A triangular slit in the anterior part of the vestibule below the clitoris in which the urethra opens. ### Skene's duct * 2 blindly ending para-urethral tubules which open in the floor of the urethra, few millimeters form the external urethral meatus. ## Reference Book (کتاب مرجعی * **SNELL'S CLINICAL ANATOMY BY REGIONS** * **by Dr. LAWRENCE E. WINESKI PhD** * **(Author) 10th Edition 2019** * **ISBN 978-1496345646** ## Thank You