REproductive system anat.pptx

• Pelvis
– part of the trunk inferoposterior to the abdomen
– area of transition between the trunk and the lower
limbs
– space or compartment surrounded by the pelvic girdle
(bony pelvis)
• bony pelvis is subdivided into greater and lesser
pelvis
–greater pelvis is the inferior part of
abdominal cavity between the alae of the
ilium
–lesser pelvis provides the skeletal framework
for the pelvic cavity and the perineum
2

• Pelvic cavity
– basin-shaped inferior part of abdominopelvic cavity
inferior to the plane of pelvic brim
– Pelvic brim: extends from superior border of pubic
symphysis to promontory of sacrum
– enclosed by true pelvis and consists of pelvic inlet,
outlet, walls, and floor
– continuous superiorly with the abdominal cavity
– Contains organs of the urinary, gastrointestinal, and
reproductive systems
• urinary bladder, terminal parts of ureters, pelvic
genital organs, rectum, blood vessels, lymphatics,
and nerves
3

PELVIS
Bones
 The bones of the pelvis consist of the right and left pelvic bones, the sacrum,
and the coccyx.
 The sacrum articulates superiorly with vertebra L5 at the lumbosacral joint.
 The pelvic bones articulate posteriorly with the sacrum at the sacro-iliac joints
and with each other anteriorly at the pubic symphysis.
Pelvic bone
• The pelvic bone is irregular in shape and has two major parts separated by an
oblique line on the medial surface of the bone :
• the pelvic bone above this line is the false pelvis, which is part of the abdomen;
• the pelvic bone below the line is the true pelvis, which contains the pelvic cavity.
• The linea terminalis is the lower two-thirds of this line and contributes to the
margin of the pelvic inlet.
5

Components of the pelvic bone
 Each pelvic bone is formed by three elements: the ilium, pubis, and
ischium.
 At birth, these bones are connected by cartilage in the area of the
acetabulum;
 later, at between 16 and 18 years of age, they fuse into a single bone
6

Ilium
Of the three components of the pelvic bone, the ilium
is the most superior in position.
The ilium is separated into upper and lower parts by a
ridge on the medial surface:
Posteriorly, the ridge is sharp and lies immediately
superior to the surface of the bone that articulates with
the sacrum.
Anteriorly, the ridge separating the upper and lower
parts of the ilium is rounded and termed the arcuate
line.
The arcuate line forms part of the linea terminalis and
the pelvic brim.
7

Pubis
 The anterior and inferior part of the pelvic bone is
the pubis .
 Anteriorly, this line is continuous with the pubic
crest, which also is part of the linea terminalis and
pelvic inlet.
 The superior pubic ramus is marked by the obturator
groove, which forms the upper margin of the
obturator canal.
 The inferior ramus projects laterally and
inferiorly to join with the ramus of the ischium.
8

Ischium
• The ischium is the posterior and inferior part of the
pelvic bone .
It has:
• a large body that projects superiorly to join with the
ilium and the superior ramus of the pubis;
• a ramus that projects anteriorly to join with the inferior
ramus of the pubis.
• The posterior margin of the bone is marked by a
prominent ischial spine that separates the lesser
sciatic notch, below, from the greater sciatic notch,
above.
• The most prominent feature of the ischium is a large
tuberosity (the ischial tuberosity) on the
posteroinferior aspect of the bone.
9

sacrum
• The sacrum, which has the appearance of an inverted
triangle, is formed by the fusion of the five sacral
vertebrae.
• The base of the sacrum articulates with vertebra LV,
and its apex articulates with the coccyx
Coccyx
• The small terminal part of the vertebral column is the
coccyx, which consists of four fused coccygeal
vertebrae and, like the sacrum, has the shape of an
inverted triangle
11

Gender differences
• The pelvises of women and men differ in a number of
ways:
The pelvic inlet in women is circular in shape
compared with the heart-shaped pelvic inlet in men.
 The more circular shape is partly caused by the less
distinct promontory and broader alae in women.
The angle formed by the two arms of the pubic arch is
larger in women (80-85°) than it is in men (50-60°).
The ischial spines generally do not project as far
medially into the pelvic cavity in women as they do in
men.
14

True pelvis
• is cylindrical in shape and has an inlet, a wall, and an outlet.
Pelvic inlet
 Is the circular opening between the abdominal cavity and the pelvic
cavity through which structures traverse between the abdomen and
pelvic cavity.
 It is completely surrounded by bones and joints .
 The promontory of the sacrum protrudes into the inlet forming its
posterior margin in the midline.
 On either side of the promontory, the margin is formed by the alae
of the sacrum.
 The margin of the pelvic inlet then crosses the sacro-iliac joint and
continues along the linea terminalis (i.e. the arcuate line, the
pecten pubis or pectineal line, and the pubic crest) to the pubic
symphysis.
16

Pelvic wall
• Consist of the sacrum, the coccyx, the pelvic bones inferior to
the linea terminalis, two ligaments, and two muscles
17

Levator ani
 The two levator ani muscles originate from each side of the pelvic
wall, course medially and inferiorly, and join together in the midline.
 The attachment to the pelvic wall follows the circular contour of the
wall and includes:
 the posterior aspect of the body of the pubic bone;
 a linear thickening called the tendinous arch, in the fascia covering the
obturator internus muscle; and the spine of the ischium.
19

• The levator ani muscles are divided into at least three collections of
muscle fibers, based on site of origin and relationship to viscera in
the midline:
 pubococcygeus,
 puborectalis, and
 iliococcygeus muscles
Function: Formetion of pelvic floor, mentains
angle b/n anal canal and rectum, reinforce external
anal sphincter,in womens as vaginal sphincter
20

Within the deep perineal pouch, a sheet of skeletal
muscle functions as a sphincter, mainly for the
urethra, and as a stabilizer of the posterior edge of the
membrane:
Anteriorly, a group of muscle fibers surround the
urethra and collectively form the external urethral
sphincter.
Two additional groups of muscle fibers are associated
with the urethra and vagina in women.
One group forms the sphincter urethrovaginalis,
which surrounds the urethra and vagina as a unit.
The second group forms the compressor urethrae, on
each side, which originate from the ischiopubic rami
and meet anterior to the urethra.
23

Perineal body
 is an ill-defined connective tissue structure into which
muscles of the pelvic floor and the perineum attach .
 It is positioned in the midline along the posterior border of
the perineal membrane, to which it attaches.
 The posterior end of the urogenital hiatus in the levator ani
muscles is also connected to it.
 The deep transverse perineal muscles intersect at the
perineal body; in women, the sphincter urethrovaginalis
also attaches to the perineal body.
 Other muscles that connect to the perineal body include the
external anal sphincter, the superficial transverse perineal
muscles and the bulbospongiosus muscles of the perineum.
26

Reproductive system
In men
• The reproductive system in men has components in the
abdomen, pelvis, and perineum .
• The major components are a testis, epididymis, ductus
deferens, and ejaculatory duct on each side, and the urethra
and penis in the midline.
• In addition, three types of accessory glands are associated with
the system:
• a single prostate;
• a pair of seminal vesicles; and
• a pair of bulbourethral glands.
30

Testes
• The testes originally develop high on the posterior abdominal wall
and then descend, normally before birth, through the inguinal canal
in the anterior abdominal wall and into the scrotum of the perineum.
• During descent, the testes carry their vessels, lymphatics, and
nerves, as well as their principal drainage ducts, the ductus deferens
(vas deferens) with them.
• The lymph drainage of the testes is therefore to the para-aortic lymph
nodes in the abdomen, and not to the inguinal or pelvic lymph nodes
31

 The spermatic cord is the tube-shaped connection between
the pouch in the scrotum and the abdominal wall.
 The sides and anterior aspect of the testis are covered by a
closed sac of peritoneum (the tunica vaginalis).
 Normally after testicular descent, the connection closes,
leaving a fibrous remnant.
 Each testis is composed of seminiferous tubules and
interstitial tissue surrounded by a thick connective tissue
capsule (the tunica albuginea).
 Spermatozoa are produced by the seminiferous tubules.
 The 400-600 highly coiled seminiferous tubules are
modified at each end to become straight tubules
32

Epididymis
• The epididymis is a single, long coiled duct that courses along the
posterolateral side of the testis.
It has two distinct components:
 the efferent ductules, which form an enlarged coiled mass that sits
on the posterior superior pole of the testis and forms the head of the
epididymis;
 the true epididymis, which is a single, long coiled duct into which
the efferent ductules all drain, and form the tail of epididymis at the
inferior pole of the testis.
33

 During passage through the epididymis, spermatozoa acquire the
ability to move and fertilize an egg.
 The epididymis also stores spermatozoa until ejaculation.
 The end of the epididymis is continuous with the ductus deferens.
34

Ductus deferens
 Is a long muscular duct that transports spermatozoa from
the tail of the epididymis in the scrotum to the ejaculatory
duct in the pelvic cavity .
 It ascends in the scrotum as a component of the spermatic
cord and passes through the inguinal canal in the anterior
abdominal wall.
 The duct descends medially on the pelvic wall, deep to the
peritoneum, and crosses the ureter posterior to the bladder.
35

Seminal vesicle
 Each seminal vesicle is an accessory gland of the male reproductive
system that develops as a blind-ended tubular outgrowth from the
ductus deferens .
 The tube is coiled with numerous pocket-like outgrowths and is
encapsulated by connective tissue
 The duct of the seminal vesicle joins the ductus deferens to form the
ejaculatory duct.
 Secretions from the seminal vesicle contribute significantly to the
volume of the ejaculate (semen).
Prostate
 The prostate is an unpaired accessory structure of the male
reproductive system that surrounds the urethra in the pelvic cavity.
 It lies immediately inferior to the bladder, posterior to the pubic
symphysis, and anterior to the rectum.
36

 The prostate develops as 30-40 individual complex glands, which
grow from the urethral epithelium into the surrounding wall of the
urethra.
Bulbourethral glands
 one on each side, are small, pea-shaped mucous glands situated
within the deep perineal pouch.
 They are lateral to the membranous part of the urethra and
occur among the fibers of the external urethral sphincter.
 The duct from each gland passes inferomedially through the
perineal membrane, to open into the bulb of the spongy urethra
at the root of the penis.
37

• In men Superficial components of the genital
organs consist of the scrotum and the penis
• The scrotum is the male homologue of the labia
majora in women.
• The penis consists of a root and body.
• The attached root of the penis is palpable
posterior to the scrotum in the urogenital triangle
of the perineum.
• The pendulous part of the penis (body of penis) is
entirely covered by skin; the tip of the body is
covered by the glans penis.
40

Erectile tissues
• Two sets of erectile structures join to form the penis
and the clitoris.
• A pair of cylindrically shaped corpora cavernosa, one
on each side of the urogenital triangle, are anchored
by their proximal ends to the pubic arch.
• These attached parts are often termed the crura
(from the Latin for 'legs') of the clitoris or the penis.
• The distal ends of the corpora, which are not
attached to bone, form the body of the clitoris in
women and the dorsal parts of the body of the penis
in men
41

Penis
• The penis is composed mainly of the two corpora
cavernosa and the single corpus spongiosum,
which contains the urethra
• It has an attached part (root) and a free part
(body)
• the body of penis, which is covered entirely by
skin, is formed by the tethering of the two
proximal free parts of the corpora cavernosa and
the related free part of the corpus spongiosum.
42

In women
• The reproductive tract in women is contained mainly in the
pelvic cavity and perineum, although, during pregnancy, the
uterus expands into the abdomen.
Major components of the system consist of:
 an ovary on each side; and
 a uterus, vagina, and clitoris in the midline
 In addition, a pair of accessory glands (the greater vestibular
glands) are associated with the tract.
45

Ovaries
Like the testes in men, the ovaries develop high on
the posterior abdominal wall and then descend
before birth, bringing with them their vessels,
lymphatics, and nerves.
The ovaries are the sites of egg production
(oogenesis).
Mature eggs are ovulated into the peritoneal cavity
and normally directed into the adjacent openings
of the uterine tubes by cilia on the ends of the
uterine tubes.
47

• The ovaries lie adjacent to the lateral pelvic wall
just inferior to the pelvic inlet.
• Each of the two almond-shaped ovaries is
about 3 cm long and is suspended by a
mesentery (the mesovarium) from the posterior
aspect of the broad ligament
48

Broad ligament
 is a sheet-like fold of peritoneum, oriented in the
coronal plane that runs from the lateral pelvic wall to
the uterus, and encloses the uterine tube in its superior
margin .
The part of the broad ligament between the origin of the
mesovarium and the uterine tube is the mesosalpinx.
The peritoneum of the mesovarium becomes firmly
attached to the ovary as the surface epithelium of the
ovary.

49

• The ovaries are positioned with their long axis in the
vertical plane.
• The ovarian vessels, nerves, and lymphatics enter the
superior pole of the ovary from a lateral position and are
covered by another raised fold of peritoneum, which with
the structures it contains forms the suspensory ligament of
ovary (infundibulopelvic ligament)
• The round ligament of uterus passes over the pelvic inlet to
reach the deep inguinal ring and then courses through the
inguinal canal to end in connective tissue related to the
labium majus in the perineum.
50

Uterus
 is a thick-walled muscular organ in the midline between the bladder and
rectum .
 It consists of a body and a cervix, and inferiorly it joins the vagina
 Superiorly, uterine tubes project laterally from the uterus and open into
the peritoneal cavity immediately adjacent to the ovaries.
 The body of the uterus is flattened anteroposteriorly and, above the level
of origin of the uterine tubes , has a rounded superior end (fundus of
uterus).
 The cavity of the body of the uterus is a narrow slit, when viewed
laterally, and is shaped like an inverted triangle, when viewed anteriorly.
 Each of the superior corners of the cavity is continuous with the lumen
of a uterine tube; the inferior corner is continuous with the central canal
of the cervix.
 Implantation of the blastocyst normally occurs in the body of the uterus.
During pregnancy, the uterus dramatically expands superiorly into the
abdomen.
52

Uterine tubes
 extend from each side of the superior end of the body of the uterus
to the lateral pelvic wall and are enclosed within the upper margins
of the mesosalpinx portions of the broad ligaments.
 Because the ovaries are suspended from the posterior aspect of the
broad ligaments, the uterine tubes pass superiorly over, and terminate
laterally to, the ovaries.
 Each uterine tube has an expanded trumpet-shaped end (the
infundibulum), which curves around the superolateral pole of the
related ovary.
53

 The margin of the infundibulum is rimmed with small finger-like
projections termed fimbriae.
 The lumen of the uterine tube opens into the peritoneal cavity at the
narrowed end of the infundibulum.
 Medial to the infundibulum, the tube expands to form the ampulla
and then narrows to form the isthmus, before joining with the body of
the uterus.
 The fimbriated infundibulum facilitates the collection of ovulated
eggs from the ovary.
 Fertilization normally occurs in the ampulla
54

 The cervix forms the inferior part of the uterus and is shaped like a
short, broad cylinder with a narrow central channel.
 The body of the uterus normally arches forward (anteflexed on the
cervix) over the superior surface of the emptied bladder .
 In addition, the cervix is angled forward (anteverted) on the vagina
so that the inferior end of the cervix projects into the upper anterior
aspect of the vagina.
 Because the end of the cervix is dome shaped, it bulges into the
vagina, and a gutter, or fornix, is formed around the margin of the
cervix where it joins the vaginal wall.
 The tubular central canal of the cervix opens, below, as the external
os, into the vaginal cavity and, above, as the internal os, into the
uterine cavity.
55

Vagina
 is the copulatory organ in women.
 It is a distensible fibromuscular tube that extends from the
perineum through the pelvic floor and into the pelvic cavity.
 The internal end of the canal is enlarged to form a region
called the vaginal vault.
 The anterior wall of the vagina is related to the base of the
bladder and to the urethra; in fact, the urethra is embedded
in, or fused to, the anterior vaginal wall.
 Posteriorly, the vagina is related principally to the rectum.
 Inferiorly, the vagina opens into the vestibule of the
perineum immediately posterior to the external opening of
the urethra.
60

• From its external opening (the introitus), the
vagina courses posterosuperiorly through the
perineal membrane and into the pelvic cavity,
where it is attached by its anterior wall to the
circular margin of the cervix.
• The vaginal fornix is the recess formed between
the margin of the cervix and the vaginal wall.
• Based on position, the fornix is subdivided into a
posterior fornix, an anterior fornix, and two lateral
fornices
61

Clitoris
• is composed of two corpora cavernosa and the glans clitoris
• As in the penis, it has an attached part (root) and a free part
(body):
• the root of clitoris technically consists only of the two crura
• The body of clitoris, which is formed only by the unattached
parts of the two corpora cavernosa, angles posteriorly, and
is embedded in the connective tissues of the perineum.
•
62

• The body of clitoris is supported by a suspensory
ligament that attaches superiorly to the pubic
symphysis.
• The glans clitoris is attached to the distal end of
the body and is connected to the bulbs of the
vestibule by small bands of erectile tissue.
• The glans clitoris is exposed in the perineum and
the body of the clitoris can be palpated through
skin
63

Greater vestibular glands
• The greater vestibular glands (Bartholin's glands)
are seen in women.
• They are small, pea-shaped mucous glands that
lie posterior to the bulbs of the vestibule on each
side of the vaginal opening and are the female
homologues of the bulbourethral glands in men .
• The duct of each greater vestibular gland opens
into the vestibule of the perineum along the
posterolateral margin of the vaginal opening
64

Superficial features of the external genitalia
 In women, the clitoris and vestibular apparatus, together with a
number of skin and tissue folds, form the vulva.
 On either side of the midline are two thin folds of skin termed the
labia minora.
 The region enclosed between them, and into which the urethra
and vagina open, is the vestibule.
 Posterior to the vestibule, the labia minora unite, forming a small
transverse fold, the frenulum of labia minora (the fourchette).
 Within the vestibule, the vaginal orifice is surrounded to varying
degrees by a ring-like fold of membrane, the hymen, which
may have a small central perforation or may completely close the
vaginal opening.
 Following rupture of the hymen (resulting from first sexual
intercourse or injury), irregular remnants of the hymen fringe the
vaginal opening.
66

 Lateral to the labia minora are two broad folds, the labia
majora, which unite anteriorly to form the mons pubis.
 The mons pubis overlies the inferior aspect of the pubic
symphysis and is anterior to the vestibule and the clitoris.
 Posteriorly, the labia majora do not unite and are separated
by a depression termed the posterior commissure, which
overlies the position of the perineal body.
67

Nerves
Somatic plexuses
 Sacral and coccygeal plexuses
 The sacral and coccygeal plexuses are situated on the posterolateral wall
of the pelvic cavity and generally occur in the plane between the muscles
and blood vessels.
 They are formed by the ventral rami of S1 to Co, with a significant
contribution from L4 and L5, which enter the pelvis from the lumbar
plexus .
 Nerves from these mainly somatic plexuses contribute to the innervation
of the lower limb and muscles of the pelvis and perineum.
 Cutaneous branches supply skin over the medial side of the foot, the
posterior aspect of the lower limb, and most of the perineum
72

Sacral plexus
 The sacral plexus on each side is formed by the anterior rami of
S1 to S4, and the lumbosacral trunk (L4 and L5).
 The plexus is formed in relation to the anterior surface of the
piriformis muscle, which is part of the posterolateral pelvic wall.
 Gray rami communicantes from ganglia of the sympathetic trunk
connect with each of the anterior rami and carry postganglionic
sympathetic fibers destined for the periphery to the somatic
nerves .
 In addition, special visceral nerves (pelvic splanchnic nerves)
originating from S2 to S4 deliver preganglionic parasympathetic
fibers to the pelvic part of the prevertebral plexus
74

 Branches of the sacral plexus include the sciatic nerve and
gluteal nerves, which are major nerves of the lower limb, and
the pudendal nerve, which is the nerve of the perineum .
 Numerous smaller branches supply the pelvic wall, floor, and
lower limb.
Coccygeal plexus
 The small coccygeal plexus has a minor contribution from S4
and is formed mainly by the anterior rami of S5 and Co, which
originate inferiorly to the pelvic floor.
 They penetrate the coccygeus muscle to enter the pelvic
cavity and join with the anterior ramus of S4 to form a single
trunk, from which small anococcygeal nerves originate
76

Blood vessels
Arteries
• The major artery of the pelvis and perineum is the internal iliac
artery on each side .
• In addition to providing a blood supply to most of the pelvic
viscera, pelvic walls and floor, and structures in the perineum,
including erectile tissues of the clitoris and the penis, this artery
gives rise to branches that follow nerves into the gluteal region of
the lower limb.
• Other vessels that originate in the abdomen and contribute to the
supply of pelvic structures include the median sacral artery and,
in women, the ovarian arteries.
77

Branches of the posterior trunk of the internal iliac artery are
 iliolumbar artery
 The lumbar branch contributes to the supply of the posterior
abdominal wall, psoas, quadratus lumborum muscles, and
cauda equina
 The iliac branch passes laterally into the iliac fossa to supply
muscle and bone
 The lateral sacral arteries- skin and muscle posterior to the
sacrum
 superior gluteal artery- is the largest branch of the internal iliac
artery
 supply of muscles and skin in the gluteal region and also supplies
branches to adjacent muscles and bones of the pelvic walls.
79

Ovarian arteries
 In women, the gonadal (ovarian) vessels originate from the
abdominal aorta and then descend to cross the pelvic inlet and
supply the ovaries.
 They anastomose with terminal parts of the uterine arteries
Median sacral artery
 The median sacral artery originates from the posterior surface of
the aorta just superior to the aortic bifurcation at vertebral level
LIV in the abdomen.
81

Veins
 Pelvic veins follow the course of all branches of the internal
iliac artery except for the umbilical artery and the iliolumbar
artery.
 On each side, the veins drain into internal iliac veins, which
leave the pelvic cavity to join common iliac veins situated just
superior and lateral to the pelvic inlet.
82

Somatic nerves
Pudendal nerve
 The major somatic nerve of the perineum is the pudendal nerve.
 originates from the sacral plexus and carries fibers from spinal
cord levels S2 to S4.
 It leaves the pelvic cavity through the greater sciatic foramen
inferior to the piriformis muscle,
 then enters the anal triangle of the perineum by passing
medially through the lesser sciatic foramen.
 has three major terminal branches
1.The inferior rectal nerve innervate the external anal sphincter
and related regions of the levator ani muscles.
 is also general sensory for the skin of the anal triangle.
84

2.The perineal nerve - motor branches supply skeletal muscles in
the superficial and deep perineal pouches.
 The largest of the sensory branches is the posterior scrotal nerve
in men and the posterior labial nerve in women.
3.The dorsal nerve of penis and clitoris enters the deep perineal
pouch
 Other somatic nerves that enter the perineum are mainly sensory
and include branches of the ilio-inguinal, genitofemoral, posterior
femoral cutaneous, and anococcygeal nerves.
85

Blood vessels
Arteries
 The most significant artery of the perineum is the internal
pudendal artery .
 Other arteries entering the area include the external pudendal,
the testicular, and the cremasteric arteries.
• Internal pudendal artery
 originates as a branch of the anterior trunk of the internal iliac
artery in the pelvis .
 Along with the pudendal nerve, it leaves the pelvis through the
greater sciatic foramen inferior to the piriformis muscle
88

The branches of the internal pudendal artery are
Inferior rectal arteries
 originate from the internal pudendal artery in the anal triangle and
cross the ischio-anal fossa medially to branch and supply muscle
and related skin.
 They anastomose with middle and superior rectal arteries from the
internal iliac artery and the inferior mesenteric artery, respectively,
to form a network of vessels that supply the rectum and anal canal.
 Perineal artery
 The perineal artery originates near the anterior end of the pudendal
canal and gives off a transverse perineal branch, and a posterior
scrotal or labial artery to surrounding tissues and skin.
 Terminal part of the internal pudendal artery
 accompanies the dorsal nerve of the penis or clitoris into the deep
perineal pouch and supplies branches to the tissues in the deep
perineal pouch and erectile tissues.
89

• the internal pudendal artery bifurcates into two terminal branches.
 A deep artery of penis penetrates the perineal membrane to enter the crus and
supply the crus and corpus cavernosum of the body.
 The dorsal artery of penis penetrates the anterior margin of the perineal
membrane to meet the dorsal surface of the body of the penis.
Branches that supply the erectile tissues in women are similar to those in men.
 Arteries of the bulb of vestibule supply the bulb of the vestibule and related
vagina.
 Deep arteries of the clitoris supply the crura and corpus cavernosum of the body.
 Dorsal arteries of the clitoris supply surrounding tissues and the glans
91

• Veins in the perineum generally accompany the arteries and
join the internal pudendal veins that connect with the internal
iliac vein in the pelvis.
• The exception is the deep dorsal vein of penis or clitoris that
drains mainly the glans and the corpora cavernosa
92

REproductive system anat.pptx

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