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ANATOMY OF THE FEMALE REPRODUCTIVE SYSTEM. final2.pptx
- 1. ANATOMY OF THEFEMALE REPRODUCTIVE SYSTEM Dr Monika Jindal (Professor)
- 2. Welcome to theworld of no life……
- 3. ANATOMY OF FEMALE REPRODUCTIVE SYSTEM DR MONIKAJINDAL (PROFESSOR)
- 4. • EXTERNAL GENITALIA •INTERNAL GENITALIA • ACCESSORY REPRODUCTIVE ORGANS FEMALE GENITALIA
- 5.
- 6. Mons pubis…. pad ofsubcutaneous connective tissue lying over pubic bone and covered by hair in triangular fashion. EXTERNAL GENITALIA(VULVA or PUDENDUM)
- 7. outer surface coveredby hair and inner by sebaceous glands covered by squamous epithelium • homologous to scrotum . • Round ligament terminates at its upper border . • join medially to form posterior commisure in front of anus LABIA MAJORA
- 8. • devoid offat . • In front and behind clitoris form prepuce and frenulum respectively . • In lower portion form fourchette that is lacerated during child birth . • Homologus to male penile urethera and part of penile skin LABIA MINORA
- 9. • Cylindrical erectilebody anteriorly. • 1.5-2 cm long, consists of glans, body and two crura • Analogue to penis in male • Covered by squamous epithelium • Richly supplied with nerves, • plays important role in sexual responses. Clitoris
- 10. • Triangular spaceb/w two labia minora, • has four openings. -urethral orifice-1.5 cm below pubic arch -vaginal orifice and hymen-vaginal orifice lies in the posterior end of vestibule and hymen is an elastic epithelial fold: – that partially blocks entrance to vagina – ruptured by sexual intercourse or tampon usage. – After delivery hymen is extremely lacerated and is later represented by carunclae myrtiformes. – Imperforate hymen • -openings of Bartholin’s duct. .. • Skene`s glands Vestibule
- 11. • A/C/A greatervestibular glands homologus to bulb of penis in male • Pea sized, yellowish white in colour. • Lubrication during intercourse. • Compound racemose gland opens at the junction of anterior 2/3rd and posterior 1/3rd of labia minora. • Bartholins cyst-most common infection gonorrhoea • Skene`s glands-largest parauretheral glands homologus to prostate in male.Ducts open on either side of urethera • Vestibular bulb-bilateral elongated masses of erectile tissue, on each side of vaginal orifice.Homologus to bulb of penis and corpus spongiosum in male. Bartholin glands
- 12.
- 13. Arteries Internal pudendal-labial -transeverse perineal -artery to vestibular bulb -deep and dorsal artery to clitoris. Femoral artery -superficial and deep external pudendal Veins Form plexus-internal pudendal vein, vaginal venous plexus, long saphenous vein. May cause varicosities in pregnancy and may rupture spontaneously and form haematomas. Blood supply of vulva
- 14. • Antero -superiorpart - cutaneous branch of ilio inguinal - genital branch of genito-femoral • Postero -inferior part- pudendal branches of posterior cutaneous nerve of thigh • In between- Labial and perineal branches of pudendal nerve(S2,3,4) - Nerve supply of vulva
- 15. Bilateral drainage meansfreely communicate with each other and hardly cross beyond labio-crural fold. • Superficial inguinal nodes-T shaped-primary(sentinel) LN of vulva-drain in deep inguinal nodes(secondary nodes) • Intermediate group of inguinal LN-gland of cloquet/Rosenmuller(upper most deep femoral LN’s- absent in 50% cases). • External(those comm with vaginal lower 3rd) and internal iliac lymphnode from deeper tissues. Lymphatic drainage of vulva
- 16.
- 17. Pelvic muscles andfascia
- 18. • Muscular partitionseparates pelvic cavity from anatomical perineum. • Pubo-coccygeus, ilio-coccygeus, ischio- coccygeus-collectively k/a as levator ani. • Downward, backward and medially. • Above parietal layer of fascia and below anal fascia. • Muscles with covering fascia k/a as pelvic diaphragm. Pelvic floor
- 19.
- 20. • Origin- backof pubic rami, condensed fascia covering obturator internus (white line), inner surface of ischial spines. • Insertion- down, back and medially- to vagina (post and lateral wall), ano-coccygeal body, lateral border of coccyx, lower part of sacrum. • Hiatus uro-genitalis • Hiatus rectalis Levator ani
- 21. Superiorly • Pelvic organs-bladder, vagina, uterus and rectum. • Pelvic cellular tissue • Ureter • Pelvic nerves Inferiorly • Anatomical perineum • Nerve supply- 4th sacral nerve, inferior rectal, perineal branch of pudendal nerve. Structure
- 22. • Support thepelvic organs. • Maintain intra-abdominal pressure. • Facilitates internal rotation. During pregnancy- levator ani hypertrophy, are less rigid & more distensible, help in second stage of labor. • Stabilize sacrococcygeal and sacroiliac joints • Puborectalis-controls action of ext and int anal sphincter. • Steady perineal body. Functions
- 23. Diamond shapedspace b/w two thighs. Boundaries-superficial Anterior –mons pubis Posterior-buttocks Each side-upper part of medial side of thigh • ant PERINEUM
- 24. Deep boundaries • Anterior– upper part of pubic arch and arcuate pubic ligament • Posterior-tip of coccyx • Each side-conjoined ischiopubic rami. • -ischial tuberosity. • -sacro-tuberous ligament. PERINEUM
- 25.
- 26. • Female externalgenital organs • Superficial perineal space • Deep perineal space Urogenital region
- 27. Two layers • Superficialfatty layer • Deep Membranous layer (Colle’s fascia) • Contents-superficial transverse perinei, bulbo- spongiosus, ischio-cavernosus, bartholin’s glands. Superficial pouch
- 28. Two layers- • thickinferior fascia of uro-genital diaphragm (Perineal membrane) • Thin superior fascia Perineal membrane is a thick, triangular sheet of fascia, on each side attached to ischiopubic rami, anteriorly thickened to form transverse perineal ligament. DEEP
- 29. • Triangular sheetof voluntary muscle surrounding the membranous urethra and deep perineal pouch Uro-genital diaphragm
- 30. Contents • Urethra • Vagina •artery and nerve to the bulb of vestibule • Deep artery of clitoris • Dorsal artery of clitoris • Posterior labial arteries and nerves • Branches of perineal nerves • Deep transverse perinei, sphincter urethrae. Deep perineal pouch
- 31. Also calledas obstetrical perineum. Fibro-muscular node, pyramid shaped, about 1.25 cm in front of anal margin Muscles- 9 (3 paired and 3 unpaired) Paired-superficial transverse perinei -deep transverse perinei -levator ani Unpaired-external anal sphincter -bulbo-spongiosus -longitudinal muscle coat of rectal ampulla. PERINEAL BODY
- 32. • 4 x4 cm, base covered with perineal skin Importance • Support the levator ani • Supports vagina and bladder • Vulnerable to injury during childbirth • episiotomy Perineal body/ obstetric perineum
- 33.
- 34. • Vagina • Uterus •Fallopian tubes • Ovaries INTERNAL GENITALIA
- 35. • Is anelastic, muscular tube that extends between CERVIX and VESTIBULE/INTROITUS. • highly distensible • Angle of 45 degree with the horizontal in erect posture, directed upwards and backwards. Vagina(kolpos)
- 36. • Diameter 2.5cm, widest at upper part and narrowest at introitus. • 4 Walls- ant, post and two lateral. • 7.5–9 cm long • 4 Fornices- clefts d/t vaginal portion of cervix Vagina(kolpos)
- 37. Anterior -upper2/3rd -base of bladder. -lower1/3rd -urethra Posterior -upper 1/3rd -pouch of douglas -middle 1/3rd -anterior rectal wall -lower1/3rd -anal canal (perineal body) Lateral -upper1/3rd -pelvic cellular tissue -middle1/3rd -levator ani -lower 1/3rd -bulbocavernosus muscles, vestibular bulbs and bartholin glands Relations of vagina
- 38.
- 39.
- 40. • Mucosa- stratifiedsquamous without secreting glands-basal, intermediate, superficial cornified cells • Submuc0sa • Muscular • Fibrous coat Structure
- 41. • pH –acidicduring childbearing period(4 to5.5) • Glycogen in exfoliated sq. cells is converted to lactic acid by Doderleins bacilli. • Vaginal secretion-tissue fluid, epithelial debris, leukocytes, electrolytes, proteins and lactic acid. Vagina
- 43. Arterial supply -vaginal branchof internal iliac -cervico-vaginal branch of uterine artery. Venous drainage-vaginal veins Lymphatic drainage -upper 1/3rd -ext iliac -middle -int iliac -lower1/3rd -superficial inguinal nodes Vagina
- 44. Nerve supply lower1/3rd –pudendal nerve(pain sensitive) upper2/3rd -sympathtic L1 ,L2 -parasympathetic S2,S3 (pain insensitive)
- 45. Applied anatomy ofvagina Excretory channel for menstural blood and uterine secretions Organ of copulation Birth canal of parturition.
- 46. • Hollow pyriformmuscular organ situated in pelvis b/w bladder and rectum. • Child bearing organ, protects and provides nutrition • Size-7.5 cm/5cm/2.5cm. • Weight-30 to 40 gms • Parts-fundus, body and cervix • Position-anteversion (90 deg) and anteflexion(125 deg) UTERUS (womb/hystera)
- 47. • Fundus-lies aboveopening of fallopian tubes. Convex, covered with peritoneum, oocyte usually implants here. • Body –triangular,b/w openings of tubes and isthmus • Superolateral angles-cornua of uterus. • Isthmus-narrowest, 0.5cm b/w body and cervix. (anatomical and histological os) Body uterus
- 49. • 3 layers -perimetrium-serouscoat -myometrium-thick bundle-smooth muscle outer- longitudinal middle-interlacing inner- circular fibres. -endometrium-mucus lining (no submucus layer)decidua during pregnancy Body
- 50. 2.5 cmlong 2 parts-supravaginal and vaginal. Cervical canal-fusiform shape, mucosal folds k/a arbor vitae uteri. External os Consists of mainly fibrous tissue. Endocx- simple columnar epithelium Vaginal part of cx-stratified sq epithelium Squamocolumnar junction situated at external os CERVIX
- 51. • Meeting pointof endocervical columnar epithelium with ectocervical squamous epithelium • Dynamic point • Moves up and down-puberty, pregnancy, menopause. • Metaplasia extends from original SCJ to the newly physiologically active SCJ. This area is defined as Transformation zone. SCJ
- 52.
- 53. • Ant- posteriorwall of U-V pouch above int os -below by base of bladder . • Post- peritoneum, forms ant wall of pouch of douglas • Laterally-double fold of peritoneum of broad ligament(contains uterine artery- ureter and ureteric tunnel) Relations of uterus
- 54. Primary supports Muscular oractive supports -pelvic diaphragm -perineal body -urogenital diaphragm Supports of uterus
- 55. Fibromuscular or mechanicalsupports -uterine axis -pubocervical ligaments -transeverse cervical lig of Mackenrodt -uterosacral -round ligaments
- 57. Secondary supports- doubtfulvalue -Broad ligaments -Uterovesical fold of peritoneum -Rectovaginal fold of peritoneum Supports
- 58. • Broad ligament: –limits side-to-side movement and rotation • Other ligaments within mesentery sheet of broad ligament: – prevent superior–inferior movement Structural support
- 59. • Arterial- uterine(branch of internaliliac) ovarian Venous- into int iliac veins Blood supply
- 60. 1. Ureteric 2. Descendingcervical 3. Circular artery to cervix 4. Segmental arcuate arteries--radial--short basal 5. Vaginal --spiral 6. Fundal 7. Twigs to round ligament 8. Tubal branch 9. Ovarian anastomotic branch Uterine artery
- 62. • Fundus andupper part body- preaortic • Lateral cornua- superficial inguinal gland • Lower part of body- ext iliac • Cervix-ext iliac, obturator, internal iliac, sacral. LYMPHATICS
- 63. Lymphatic drainage ofuterus
- 64.
- 65. • Mainly sympathetic-T5,T6-(motor),T10,- L1 (sensory) • the somatic distribution of uterine pain is that area of abdomen supplied by T10-L1. • Parasymp contains both motor and sensory from S2,3,4 and ends in ganglia of Frankenhauser near cervix • Uterus and Cx- insensitive to touch, heat and grasping. NERVE SUPPLY
- 67. • 10 cm. •2 openings-uterine –1mm -abdominal ostium-2mm Parts-Intramural/interstitial-1.25 cm-1mm dia. - Isthmus-2.5 cm- 2.5mm in dia. -Ampulla-tortuous-5 cm -2.5 mm in dia. -Infundibulum-1.25 cm- 6mm wide(fimbria-one is long-ovarian fimbria.) FALLOPIAN TUBES
- 68.
- 69. • 3 layers-serous -muscular-outerlongitudinal -inner circular -mucous membrane-columnar epithelium-ciliated,non-ciliated secretary and peg cells. Structures
- 70. • Transport Fertilization • Survivalof zygote thr’ secretions • Site for ectopic pregnancy Functions
- 71. • Arterial- uterineand ovarian • Venous- pampiniform plexus into ovarian veins • Lymphatic- Para-aortic nodes • Nerve supply- Uterine and ovarian nerves, very sensitive to handling Blood supply
- 72. • Female gonads •Lie in ovarian-fossaa • Intra-peritoneal • Ovarian ligament-uterus • Meso-ovarium-broad lig • Infundibulo-pelvic ligament-lateral pelvic wall OVARIES
- 74. • Two ends-tubal and uterine • Two borders- mesovarium and free posterior • Two surfaces- medial and lateral Ovaries
- 75. • Meso-ovarium • Ovarianligament: – extends from uterus to ovary. • Suspensory ligament: – extends from ovary to pelvic wall – Contains major blood vessels of ovary – Vessels connect to ovary at ovarian hilum: where ovary attaches to mesovarium. Ovary Support
- 76. • Are small,almond- shaped organs: – 3-5 cm long, 2-3 cm wide, 0.8-1cm thick – weigh 6–8 g – Pinkish grey Ovaries FUNCTION 1. Production of immature female gametes (oocytes) 2. Secretion of female sex hormones (estrogens, progestins) 3. Secretion of inhibin: - feedback control of pituitary FSH
- 77. 1. Peritoneal relations Mesovarium or ant border Suspensory or infundibulo-pelvic ligament. 2. Visceral relations Upper or tubal pole(medial)-uterine tube and ext iliac vein. Lower or uterine pole(lateral)-related to pelvic floor-ligament of ovary. Relations of ovary
- 78. • Ovary iscovered with single layer of cubical epithelium k/a as germinal epithelium. • Substance - outer cortex - inner medulla Structure
- 79. - Stromal cellsthickened below germinal epithelium k/a tunica albugenia. - Studded with numerous follicular structures k/a functional units in various phases of development. Primordial follicles Maturing follicles Graafian follicles Corpus luteum sex hormone production & ovulation. Cortex
- 80. • Consists ofloose connetive tissues • Few unstriped muscles • Blood vessels • Nerves • Hilus cells- homologous to interstitial cells of testes. Medulla
- 81. Arterial supply Ovarian artery(Branch of abdominal aorta) Uterine artery Venous drainage • Pampiniform plexus to form ovarian vein. Drains into inferior vena cava on right side and left renal vein on left side. Lymphatics Para –aortic lymph nodes `Sympathetic through T10, sensitive to manual squeezing. Blood supply
- 82. • Pelvic brimto bladder • 13 cm long and diameter of 5mm • Enters at Bifurcation of common iliac • Anterior to internal iliac and behind ovary in ovarian fossa • Lie at Base of broad ligament • Crossed by uterine artery anteriorly at 1.5 cm from isthmus • Anterior to vagina enter Ureteric tunnel Pelvic ureter
- 83. At ant fxof vagina turns obliquely for 2 cm to enter in bladder Ischial spine-pelvic floor-forward and medially crosses broad ligament-crossed by uterine antrly Enters in ureteric tunnel-close to supravag part of cx -1.5 cm lat to it. Pelvis-in front of bifurcation of CIA over sacroiliac joint behind root of mesentary(R)apex of mesosigmoid(l) In contact with peritoneum-ant to IIA and behind ovary in fossa Course of ureter
- 84. • At entryinto brim • Crossing of uterine • In intravesical part HOW TO RECOGNISE URETER Pale glistening appearance Longitudinal vs on surface Peristalsis Constrictions
- 85. • Infundibulopelvic lig •Clamping cardinals • Vaginal angles • Peritonization in post peritoneum • FEMALE URETHRA • 4cm long • Puv angle-100 • prone for infection and injury. • Parauretheral glands-site for infection…. Ureteric injury
- 86. But I amnot one of those teachers…….
- 87.
Editor's Notes
- #46 Anteversion refers to the position of uterus in which its long axis is bent forward on the long axis of the vagina and anteflexion is the forward bending of the long axis of the uterine body over long axis of vagina at internal os.