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Anatomy of Female Reproductive Tract

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Anatomy of Female Reproductive Tract Anatomy of Female Reproductive Tract R,D FIROUZABADI External Genital Organs mons pubis (Sp ,Distribution Of Hair) labia majora (Sp_perineum,round lig, scrotom,without mus,8,-2.5,1-2.5 mucous labia minora – prepuce (clitoral hood) – frenulum of the labia minora = fourchette – w/o hair follicle ,nervous corposcle,variable in size,shape, 2 flat, red ,urethral fold vestibule of the vagina (6 orifice)lab minor, fourchette,clitoris – external urethral orifice paraurethral glands (Skene’s glands) [prostate] Bartholin's gland Clitoris: Glans,corpus,crura(inf ischiopubic Pubic arch body),nerve,squamus – vaginal orifice hymen – greater vestibular glands Bartholin’s glands [bulbourethral glands] arterial supply – two external pudendal arteries – one internal pudendal artery venous drainage: internal pudendal veins PELVIC DIAPHRAGM levator ani ,coccygeus UROGENITAL DIAPHRAGM deep trns ,cons urth,int,ext Pelvic Viscera urinary organs – ureters pass medial to origin of uterine artery and continues to level of ischial spine, where is crossed superiorly by the uterine artery. Then passes close to lateral portion of vaginal fornix and enters posterosuperior angle of bladder – urinary bladder hollow viscus with strong muscular walls trigone of bladder – urethra - about 4 cm long, anterior to vagina rectum – Ligaments round ligament of uterus - attaches anterior- inferiorly to uterotubal junctions ligament of ovary - attached to uterus, posterior- inferior to uterotubal junctions broad ligament - encloses body of uterus, freely moveable transverse cervical ligaments - extend from cervix and lateral parts of vaginal fornix to lateral walls of pelvis uterosacral ligaments - pass superiorly and slightly posteriorly from sides of cervix to middle of sacrum, can be palpated through rectum as pass posteriorly at sides of rectum. Hold cervix in normal relationship to sacrum. Broad Ligament Contains between its layers the fallopian tube; the ovary and the round ligament; the uterine and ovarian blood vessels, nerves, lymphatics, and fibromuscular tissue; and a portion of the ureter as it passes lateral to the uterosacral ligaments over the lateral angles of the vagina and into the base of the bladder Internal Genital Organs vagina – fornix – rectouterine pouch (pouch of Douglas) – sphincters of vagina pubovaginalis muscle urogenital diaphragm bulbospongiosus muscle – lymphatic drainage superior part into internal and external iliac lymph nodes middle part into the internal iliac lymph nodes vestibule into superficial inguinal lymph nodes Uterus – 7-8 cm long, 5-7 cm wide, 2-3 cm thick – projects superior-anteriorly over urinary bladder – two major parts body (superior 2/3s) – fundus cervix (inferior 1/3) – internal os – external os – anterior lip – posterior lip – lined with columnar, mucus-secreting epithelium isthmus = a transitional zone between body – wall of uterus consists of 3 layers: Perimetrium/serosa - outer serous coat, peritoneum supported by thin layer of connective tissue myometrium - 12-15 mm smooth muscle, main branches of blood vessels and nerves of uterus are in this layer endometrium - inner mucous coat uterine tubes 10-12 cm long, 1 cm diameter – 4 parts – extend laterally from cornua of uterus infundibulum – distal end – abdominal ostium, about 2 mm in diameter – 20-30 fimbriae – ovarian fimbria is attached to ovary ampulla – tortuous part – widest and longest part, over 1/2 its length – fertilization occurs here – Most common site for ectopic OVARY Almond shape Syn & sec st hor Dev &extrusion of ovaWALDEYER FOSSA UT-OVA LIG CORTEX (AGE),MEDULLA(ART,) SYM(OVA PLX), PARASYMP Ovary By the fifth week of embryonic life, germ cells have formed the ovary Maximum # of eggs the ovary is able to produce is at 20 weeks of gestation… 6- 7 million! 1-2 million at birth 300,000 at the onset of puberty! Ovary The functional unit is the FOLLICLE Oocyte (frozen in the first stage of meiosis) surrounded by granulosa cells & adjacent stromal cells…Theca cells. FSH will target the granulosa cells LH will target the thecal & stromal cells Ovary, cont’d As the follicle matures, Antrum develops around the oocyte A bunch of follicles will develop around day 7 of cycle…a dominant follicle will win! Ovary cont’d Rising estrogen levels from the maturing follicle itself will ‘prime’ the follicle for the LH surge. When estrogen levels reach 200pg/ml or greater for longer than 48 hours, the LH surge occurs The granulosa cells become luteinized just prior to ovulation & begin to produce progesterone Progesterone rise is responsible for... Facilitates the positive feedback action of estradiol in initiating the LH surge – LH surge occurs about 36 hours prior to ovulation Responsible for the FSH peak Ovary An avascular area will develop on the wall of the follicle & with the help of proteolytic enzymes ovulation occurs. The oocyte is picked up by the fimbriae of the tube If not met by a sperm will degenerate in 12-24 hours! Ovary After ovulation, luteinization will transform the ruptured follicle into a corpus luteum which produces estrogen & progesterone for the next 12- 16 days If not aided by secretion of hCG, the corpus luteum will become the corpus albicans Lymph Drainage The external genitalia, anus, and anal canal drain to the superficial inguinal nodes. The lower one third of the vagina drains to the sacral nodes and the internal and common iliac nodes. The cervix drains to the external or internal iliac and sacral nodes Ut: common iliac ,Periaortic nodes. Lymph, cont’d The lower uterus drains to the external iliac nodes The upper uterus drains into the ovarian lymphatics to the lumbar nodes. The lymphatics of the ovaries drain out of the pelvis to the lumbar nodes NERVES SYMPATHIC : aortic plx ,int iliac,franken huser(ut,bllader,sup vagina) PARASYMPATHIC CEREBROSPINAL T11,T12,sensory nerves from ut transmit painful stimuli of ut cont to cent sys.sens nev cx,upper vag s2,3,4 lower through the pudendal n Innervation – ilioinguinal nerve – genital branch of the genitofemoral nerve – perineal branch of the femoral cutaneous nerve of thigh – perineal nerve isthmus short 2.5 cm, narrow, thick-walled part of tube that enters the uterine cornu uterine part – short segment that passes through thick myometrium of uterus – uterine ostium (smaller than abdominal ostium) Blood supply Ovarian Art Uterin Art Ut vein Acrcuate vein Ut vein Hypogastric vein common iliac Ovarian vein Sup of ut, ovary, Sup of large lig Pampiniform plexus Ovarian vein Ovaries oval, almond-shaped, 3 cm long, 1.5 cm wide, 1 cm thick – ligaments superior (tubal) end of ovary is connected to lateral wall of pelvis by suspensory ligament of the ovary – contains ovarian vessels and nerves ligament of ovary - connects inferior (uterine) end of ovary to lateral angle of uterus – surface of ovary is not covered by peritoneum Female Bony Pelvis wider, shallower, and has larger superior and inferior pelvic apertures than male pelvis hip bones farther apart ischial tuberosities are farther apart because of wider pubic arch sacrum is less curved, which increases the size of the inferior pelvic aperture and the diameter of the birth canal obturator foramina is oval Types of Bony Pelvis anthropoid = AP diameter > transverse diameter – 23% females platypelloid – uncommon android = wide transverse diameter, posterior part of aperture is narrow – 32% females gynecoid = most spacious obstetrically – 43% females Superior Pelvic Aperture AP diameter = measurement from the midpoint of the superior border of pubic symphysis to the midpoint of sacral promontory transverse diameter = greatest width, measured from linea terminalis on one side to this line on opposite side oblique diameter = measurement from one iliopubic eminence to the opposite sacroiliac joint midplane diameter = interspinous diameter or distance between ischial spines and cannot be measured. Is estimated by palpating the scarospinous ligament through the vagina. The length of this ligament = about half the midplane diameter. determine prominence of ischial spines – < 9.5 cm may prevent passage of fetus Physiology Hypothalamus Anterior Pituitary Ovary Endometrium & outflow tract Hypothalamus Release of GnRH (gonadotropin- releasing hormone), also called LHRH, into the pituitary portal circulation via the pituitary stalk The menstrual cycle does not ‘begin’ here!! All are inter-related ! Hypothalamus What triggers the release of GnRH? – Unclear but in animal studies dopamine is inhibitory & norepinephrine is stimulatory – For normal gonadotropin release, GnRH must be released in pulses. The pulse frequency & amplitude are critical for normal menses – Decrease in pulse frequency will decrease LH release & increase FSH – Increase pulse frequency will increase LH & decrease FSH Anterior Pituitary Gonadotrophs respond to the GnRH by producing FSH (follicle stimulating hormone) & LH (Luteinizing hormone) into the general circulation Release at this level is also controlled by circulating levels of estrogen & progesterone (gonadal steroids)…positive & negative feedback Anterior Pituitary Stores & releases FSH & LH Day 1-7, follicular phase: estrogen from the ovary will stimulate storage of FSH & LH(in the pituitary)…also inhibits secretion Later in follicular phase with increasing estrogen levels (enlarging follicle) effect on gonadotrophs changes to stimulatory allowing for a secretion of LH which triggers ovulation Under the influence
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