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18 Female Genitalia

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18 Female Genitalia HAND OUT FEMALE GENITALIA Dr. Yuliana, S. Ked, M.Biomed Bagian Anatomi Fakultas Kedokteran Universitas Udayana Denpasar DAFTAR ISI halaman Daftar isi 1 Tujuan pembelajaran 2 Genitalia wanita 3 Self assessment 39 Daftar pustaka 40 1 TUJUAN PEMBELAJARAN Mahasiswa diharapkan dapat memahami: 1. Anatomi genitalia interna wanita termasuk vaskularisasi dan inervasinya 2. Anatomi genitalia eksterna wanita termasuk vaskularisasi dan inervasinya 3. Anatomi payudara termasuk vaskularisasi dan inervasinya 2 GENITALIA INTERNA WANITA Organ reproduksi wanita internal terdiri dari 1. Vagina 2. uterus, 3. uterine tubes 4. ovarium. GENITALIA EXTERNA WANITA Terdiri dari: 1. mons pubis 2. labia majora (termasuk pudendal cleft) 3. labia minora (termasuk vestibule), 4. clitoris 5. bulbus vestibulum 6. glandula vestibularis major dan minor 7. vulva (pudendum). 3 Istilah pudendum sering digunakan secara klinis. Vulva berperan sebagai jaringan erektil dan sensoris untuk rangsangan seksual dan hubungan seksual, mengarahkan aliran urine, dan mencegah masuknya bahan asing ke dalam tractus urogenitalis. MONS PUBIS Mons pubis dikelilingi oleh lapisan lemak di sebelah anterior symphysis pubis, tuberculum pubicum, dan rami pubis superior. Jumlah lemak pada mons pubis meningkat saat pubertas dan menurun setelah menopause. Setelah pubertas, mons pubis dikelilingi dengan rambut pubis yang kasar. LABIA MAJORA Labia majora adalah lipatan kulit yang menonjol dan berguna untuk melindungi orificium vagina dan uretra. Masing-masing labium majus memiliki lapisan lemak subkutan yang mengandung otot polos dan ligament uterus, yang berjalan inferoposterior dari mons pubis ke arah anus. Aspectus external labia pada orang dewasa ditutupi dengan kulit berpigmen yang terdiri dari banyak sebaceous glands dan diselimuti oleh rambut pubis. 4 Aspectus internal labia licin, berwarna merah muda dan tidak berbulu. Labia lebih tebal di bagian anterior untuk membentuk commisura anterior. Labia bergabung untuk membentuk commisura posterior di bagian posterior, yang biasanya menghilang setelah kelahiran per vaginam pertama kalinya (Moore et al ., 2014). LABIA MINORA - Labia minora merupakan lipatan kulit bebas lemak dan tidak berambut. - Bagian ini memiliki jaringan ikat spongiosa yang terdiri dari jaringan erektil dan banyak pembuluh darah kecil. - Walaupun permukaan internal labium minus terdiri dari kulit lembab dan tipis, struktur ini memiliki warna merah muda dan banyak serat saraf sensoris. - Labia minora dibungkus dalam pudendal cleft di labia majora serta mengelilingi uretra externa dan muara orificium vagina. - Di bagian anterior, labia minora membentuk dua lamina, yaitu lamina medialis yang bersatu sebagai frenulum clitoris, dan lamina lateralis yang bersatu untuk membentuk preputium clitoris. - Pada wanita muda yang masih gadis (perawan), labia minora terhubung ke posterior oleh lipatan transversal kecil, frenulum labia minora (fourchette). 5 CLITORIS Clitoris adalah organ erektil yang ada di pertemuan labia minora di sebelah anterior. Clitoris terdiri dari root (radix) dan body (corpus) , yang terdiri dari dua crura, dua corpora cavernosa, serta glans clitoris . Glans ditutupi oleh prepusium clitoris. Clitoris sangat sensitif dan membesar pada stimulasi taktil. Bagian glans ini paling banyak sarafnya. VESTIBULE Vestibule adalah suatu ruangan yang dikelilingi oleh labia minora, yang terdiri dari orificium urethra, vagina, dan ductus glandula vestibularis major dan minor. Orificium urethra externum berada di sebelah posteroinferior glans clitoris serta di sebelah anterior orificium vagina. Ukuran orificium vagina bervariasi sesuai dengan kondisi hymen . Hymen adalah selapis membrane mukosa tipis yang mengelilingi lumen. Setelah hymen ruptur, maka tinggal sisa hymen yang disebut hymenal caruncles . 6 BULBUS VESTIBULUM Bulbus vestibulum adalah massa jaringan erektil berpasangan yang ada di sekitar orificium vagina dan diselimuti oleh musculus bulbospongiosus. Bulbus homolog dengan penis dan corpus spongiosum. GLANDULA VESTIBULARIS MAJOR - Glandula vestibularis major (Bartholin glands) ada di masing-masing sisi vestibulum, di sebelah posterior orificium vagina. - Kelenjar berbentuk bulat atau oval dan mengalami overlapping di bagian posterior karena adanya bulbus vestibulum, dan dikelilingi oleh bulbospongiosus muscles. - Kelenjar ini mensekresi mucus ke dalam vestibule saat terjadi rangsangan seksual. GLANDULA VESTIBULARIS MINOR Kelenjar ini berukuran lebih kecil, terletak di masing-masing sisi vestibulum, di antara urethra dan orificium vagina. Kelenjar ini menghasilkan mucus, yang berguna untuk melembabkan labia dan vestibulum. 7 VASKULARISASI VULVA Suplai arteri vulva berasal dari: a. external pudendal arteries b. internal pudendal artery Internal pudendal artery memberikan suplai darah untuk kulit, genitalia externa, dan musculus di daerah perineum. Internal pudendal artery bercabang menjadi labial arteries, untuk memberikan suplai darah pada clitoris. Vena labialis adalah cabang dari internal pudendal veins serta venae comitantes . Pelebaran vena saat terangsang secara seksual menyebabkan peningkatan ukuran dan konsistensi clitoris serta bulbus vestibulum. Akibatnya clitoris membengkak dan kaku. Vulva kaya akan pembuluh limfe yang akan bermuara ke superficial inguinal lymph nodes . Aliran limfe glans clitoris dan labia minora anterior mengalir ke deep inguinal nodes or internal iliac nodes. 8 INNERVASI VULVA - Aspectus anterior vulva disuplai oleh nervus labialis anterior, yang berasal dari ilioinguinal nerve dan cabang genital nervus genitofemoralis. - Aspectus posterior mendapatkan darah dari cabang perineal nervus cutaneous posterior dan nervus pudendalis. - Nervus pudendalis adalah saraf utama perineum. - Nervus labialis posterior mensuplai labia: cabang muscular dan profundus mensuplai orificium vagina dan superficial perineal muscles - Nervus dorsalis clitoris mensuplai deep perineal muscles dan sensasi clitoris. - Bulbus vestibulum dan badan erektil clitoris menerima serat parasimpatis melalui nervus cavernosus dari uterovaginal plexus. - Stimulasi parasimpatis menyebabkan peningkatan sekresi vagina, ereksi clitoris, dan pelebaran jaringan erektil pada bulbus vestibulum. 9 GENITALIA INTERNA VAGINA Vagina merupakan suatu bentukan tabung muculomembranous , yang memanjang dari bagian servikal uterus sampai ke bagian vestibulum, yaitu celah antara labia minora ke arah terbukanya vagina dan urethra. Pangkal vagina bagian superior mengelilingi bagian servikal dari uterus. Bagian dinding anterior dan posterior dari vagina biasanya berdekatan sehinga tampak menempel, kecuali di ujung akhir vagina bagian superior yang dipisahkan oleh bagian servikal uterus. Vagina memiliki fungsi sebagai berikut: a. sebagai saluran cairan menstruasi b. membentuk bagian inferior dari jalan lahir c. sebagai tempat penis dan proses ejakulasi saat proses hubungan intim. d. Berhubungan dengan canalis cervicalis di bagian superior e. Berbatasan dengan vestibulum di bagian inferior. Canalis cervicalis membentang dari isthmus uterus menuju bagian eksternal uterus. Vagina dalam keadaan normal kolaps, sehingga bagian anterior bersenthugan dengan bagian posterior, dengan perkecualian pada ujung superior, tempat cervix 10 Vaginal fornix , lekukan di dekat tonjolan cervix dibagi menjadi tiga bagian, yaitu anterior, posterior, dan lateral. Bagian posterior vaginal fornix adalah bagian yang paling dalam dan berhubungan erat dengan rectouterine pouch. Ada empat otot pada vagina yang berperan sebagai spinchter, yaitu: a. pubovaginalis, b. external urethral sphincter, c. urethrovaginal sphincter d. bulbospongiosus Batas vagina: a. Anterior: fundus vesica urinaria dan urethra. b. Lateral: levator ani, visceral pelvic fascia, dan ureters. c. Posterior (inferior sampai superior): anal canal, rectum, dan recto-uterine pouch. 11 VASCULARISASI VAGINA. - Arteri yang mensuplai bagian superior vagina berasal dari arteri uterina - Arteri yang mensuplai bagian medial dan inferior vagina berasal dari arteri vaginalis dan arteri pudendalis interna - Vena membentuk vaginal venous plexuses di sepanjang vagina dan dalam mukosa vaginal. Vena-vena ini berhubungan dengan uterine venous plexus dalam bentuk uterovaginal plexus dan bermuara ke internal iliac veins melalui uterine vein. PEMBULUH LIMFE VAGINA Pembuluh limfe vagina dibagi menjadi empat bagian: a. Superior: menuju internal and external iliac lymph nodes. b. Middle: menuju internal iliac lymph nodes. c. Inferior: mengalir ke sacral and common iliac nodes. d. External orifice : menuju superficial inguinal lymph nodes. 12 UTERUS Uterus merupakan organ muskular berongga, berdinding tebal, dan berbentuk seperti buah pir. Uterus non gravid biasanya terletak di daerah pelvis bagian bawah, di mana bagian badannya terletak di atas kandung kemih, dan bagian servikalnya terletak antara kandung kemih dan rektum. Posisi uterus dewasa biasanya anteversion (relatif anterosuperior terhadap aksis vagina) dan anteflexion (fleksi corpus uteri ke arah anterior secara relatif terhadap cervix) sehingga organ ini terletak di atas kandung kemih. Posisi uterus berubah sesuai penuh tidaknya vesica urinaria dan rectum. Uterus dibedakan menjadi 2 bagian, yaitu: a. Corpus uteri (body) , membentuk dua pertiga superior, meliputi fundus uteri, bagian bulat corpus yang ada di sebelah superior orificium tuba uterine dan isthmus uterus , yang merupakan bagian corpus yang sempit (sekitar 1 cm) di sebelah superior cervix. Cornu uterine adalah region superolateral tempat masuknya uterine tubes enter.
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