Anatomy of the Female Genital Tract

Anatomy of The Female Genital Tract

Perineum:

Anatomically: It’s a diamond shape of the pelvis and soft tissue that covers it. The anterior triangle is covered by Vulva in females. Gynecological perineum; imaginary region; a square area between the vagina and anus.

Vulva consists of:

Mon pubis: Fibro fatty tissue over the symphysis pubis, covered with pubic hair. Inferiorly it divides and continues with Labia Majora. It is formed by the fusion of the urogenital sinus. Labia Majora: Lateral folds, include sweat glands, spacious glands and is hairy, too. Corresponds to the Scrotum. Labia Minora: A thin skin fold around the orifice, not hairy, secretory and covers the vestibule. Vestibules  Orifice + Paraurethral (Seken’s) Glands, Bartholin (Vestibule) Gland, Hymen, Vestibule Bulb. 1- Bartholin Gland is located in the medial aspect of Labia Minora. Very small and not palpable. Very important in secretions  Vaginal lubricant. Never remove Bartholin Glands even incase of abscess or infection. Remove if recurrent or old age for the risk of cancer. Correspond to Corpus in males. 2- Hymen is very thin membrane covering the vagina, not completely closed. Imperforated Hymen is an abnormality; how will secretions and period come out!  It’s a cause of late puberty. Ruptures after sexual intercourse but remnants will be present until first delivery. 3- Seken’s Gland are not palpable. Correspond to the Prostate. Orifice  Urethra and Vagina (Covered with Hymen, not totally closed) United superiorly at the level of clitoris with the pubic area United Inferiorly at Fourchette; the site of vasectomy during delivery.

 If a girl came complaining of late menarche + Secondary features like; Pubic hair or breast grown  It’s a structural problem.  If a girl came complaining of late menarche + NO secondary features  something originally is wrong. Clitoris:

Corresponds to the Penis. The most sensitive organ, most vascular organ and most painful. If injured during delivery  massive bleeding. If there is a tear or abscess  very painful  give lots of analgesics. Inferiorly  Urethral Opening. Bilaterally  Seken’s glands.

Superficial Perineal Muscle:

Superficial perineal muscles lie superficially to the urogenital sinus.

The aorta  common iliac artery  at the pelvic level it branches into Internal and External iliac arteries. External  Limbs & External genitalia. Internal  The whole pelvic area.  Pudendal artery … Very important in postpartum hemorrhage  uterine artery ligation or internal iliac artery ligation (To stop the supply to the uterus).

External genital  most vascular (External Iliac) Supply  Internal iliac. Veins  The opposite pathway. Lymphatic  External  Superficial LN. (Inguinal) Internal  Para-aortic LN.

* You’re not suppose to memories the blood or venous supply, just to understand.

Vagina:

 It is a tubular, muscular, H shape  Not hairy but secretory  Anterior and posterior walls are apposition for protection. After delivery there will be space.  Rugea, maze area  To expand and stretch during delivery Protection Sperms hide behind from the bacteria and acidity  Landmarks to vagina  Anterior; Urethra Posterior; Rectum Inferior; Bladder  Vaginal Fornices:  Anterior, Posterior and Lateral.  The edges between the cervix and vagina  Induce labor by prostaglandin in posterior fornix  When you examine a patient with prolapse, if she has Cystocele (Bladder downward position)  Anterior vaginal wall egg like.  When you examine a patient with rectum prolapse  Posterior vaginal wall is lax

Ureter inferior to uterine artery  very important anatomical relation (Water under the bridge) In postpartum hemorrhage, we will ligate the uterine artery OR In hysterectomy, coming laterally to cute the ligaments attached to the uterus … You reach the cervix level ... BE CARFUL not to ligate the ureter instead of the uterine artery.

Cervix tear  3 and 9 O’clock position  most commonly in c- section

 Vaginal Secreations: 1- Bartholine Glands 2- Skene’s Gland 3- Mucosa

 Vaginal Support: Defect in pelvic fascia  Pelvic floor prolapse  Repair? Support pelvic fascia.

 Blood Supply:  Upper portion  Mullerian (like uterus)  Lower Portion  Ureogenital sinus (like external organs) Internal iliac artery  Anterior vaginal artery + Uterine artery

 Lymphatic:  Upper 2/3  Internal iliac + Para-aortic  Lower 1/3  Inferior gluteal, Superficial, inguinal

 Nerve Supply  Pudendal nerve

 Summary:

1- Origin  Upper Mullerian (Perineal membrane) Lower  Urogenital Sinus 2- It is a tubular, muscular, H shape Not hairy but secretory 3- Blood Supply  Upper (Mainly; Internal iliac), Lower (External iliac). 4- Anatomical parts: Walls and Fornix Uterine artery is near by, and superior to the ureter. Uterus:

 Hallow tubular structure; Body and cervix Fundus, Cornea, body, Internal Orifice – (Isthmus) - Cervix, External Orifice External OS  Pap smear (Transformational zone) Internal OS  Measure cervix dilation for delivery. Cervical canal: Endo cervix  Columnar epithelium (Adenoma) Ecto Cervix Squamous (Squamous cell carcinoma)  Changes with age: In early childhood  Cervix length > uterus body. During puberty  Uterus body will increase and cervix will shrink. Menopause  Cervix > uterus body. Uterus body Cervix Shape Pear Cylindrical Pelvic portion Parts Fundus, Isthmus, Cornea Vaginal Portion (till fornix) Cervix; Squamous Histology Columnar Vagina; Columnar Muscular tissue Elastic Tissue Mucus secretion and Secretions, Sphincter to keep the pregnancy Function carry the baby in, Delivery canal. Cervix has a transformational zone; between the two we take the pap -smear

 Function: Carry the baby Provide secretion  Alkaline mucus Open to allow delivery

 Ligaments: To support the uterus. Broad ligament Round ligament

 Histology: Glandular The build endometrium  No implantation  Period

 Uterus Relations: Anteriorly  Bladder Posteriorly  Rectum Laterally  Ureter (Inferior to the uterine artery)

 Blood Supply: Internal iliac artery Mesentery Ovarian Vaginal A lot of collateral circulation.

 Lymphatic: Mostly  Internal iliac & Para-aortic Few  External iliac

Ureter:

 Directly related to the uterine artery.  It also supports the uterus  Blood Supply: From internal iliac artery  Uterine artery Veins  The opposite pathway. Lymphatic  Para-aortic

Fallopian Tube:

 Originated  Mullarian duct  Function  Transfer the ovary and sperm Fertilization location Ciliated tube? To mobilize sperm and ova Cilia problem  Ectopic Pregnancy (Most common site)  Empirical end that covers the uterus Very important to know because of infertility; the tube could be blocked or has a problem  Adnexa  Tubes and Ovaries  Fallopian Tube Parts: Uterus               Ovary Narrow  Wider Diameter Early symptoms  Late presentation Very Painful  Any lady with abnormal bleeding is considered pregnant unless proven otherwise.  Any pregnant lady with abnormal bleeding is diagnosed with ectopic pregnancy unless proven otherwise.  Blood Supply: Internal Iliac

Ovaries:

 Origin  Hindgut germ cells  Function: Ovulation Hormone Secretions Play a role in menstrual cycle; controls the endometrium. Ovary agenesis  delayed puberty Ovarian dysgenics  late period Ovarian hormonal imbalance  irregular bleeding, amenorrhea  Blood Supply: Arterial: Right ovarian artery  Directly from the aorta Left ovarian artery  Left renal artery Venous: Right ovarian vein  IVC Left ovarian vein  left renal vein  Lymphatic: Aortic and para aortic LN  Structure: Cortex & Medulla At the embryonic stage  primordial follicle, arrested. Each ovary contains 7million ova At childhood stage  ova degenerate  at least 100,000 ova At puberty  at least 100,000 ova in each ovary Every month 100 ova will grow  1 or 2 ovulate Ovulation  Corpus leutium Follicular atresia  menopause  arrest again  Nerve Supply: Vaginal Pudendal nerve Ovary  Sympathetic