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Lecture 1 Part I -Female Reproductive Anatomy

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Female Reproductive System BY Dr. MAZENAH During this lecture you shall be introduced to the principle anatomical structures of the female reproductive system: the ovaries, peritoneal reflections, uterine tubes (Fallopian tubes, oviducts), uterus and cervix, vagina and perineum. Attention will be drawn to • the function of these tissues in reproduction • blood and nerve supply, lymphatic drainage • clinical investigation and assessment, e.g., imaging • clinically relevant conditions THE REPRODUCTIVE TRACT 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: a) An ovary on each side b)A uterus, vagina, and clitoris in the midline c) In addition, a pair of labia majora, minora & accessory glands (the greater vestibular glands ). OVARY the ovaries develop high on the posterior abdominal wall and then descend before birth, Uterine tube Ovary Deep inguinal Ligament of ovary bringing with them their Roird ligament of v e s s e l s , lymphatics, and uterus nerves. Unlike the testes, the ovaries Superficial iiguiial do not migrate through the inguinal canal into the Greater vestibular peripeum, but stop short and gland Gians clitoris assume a position on the lateral wall of the pelvic cavity OVARY Mature eggs are ovulated into the peritoneal cavity and normally directed into the adjacent openings of the uterine tubes by fimbriae on the ends of the uterine tubes. They 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. TUNICA ALBUGINEA OF THE OVARY Tunica Granulosa Secondary Mesovarium and The connective tissue capsule albuginea calls follicle ,, blood vessels Cortex Primary Degenerating corpus follicles of the ovary, the Tunica luteum (corpus albicans) Vesicular (Graafian) Germinal Albuginea of the Ovary, is follicle epithelium -■ Primordial follicles covered with a smooth layer Pj—Antrum — of ovarian mesothelium that Oocyte Zona pellucida Ovarian has adull greenish ligament Theca folliculi appearance. Medulla Ovulated oocyte This epithelium becomes Corona radiala Developing corpus progressively scarred and luteum distorted because of the repeated rupture of ovarian follicles and discharge of oocytes during ovulation. ARTERIAL SUPPLY OF THE OVARIES The Ovarian Arteries come directly off the Abdominal Aorta, just below the Renal Arteries. Abdominal Aorta Ovarian Artery VENOUS DRAINAGE OF THE OVARIES Venous drainage of the ovaries is asymmetrical, by the left and right ovarian veins. Right Ovarian Vein Inferior Vena Cava Left Ovarian Vein Left Renal Vein Inferior Vena Cava Lymphatic Drainage of the Ovaries Lymphatic Drainage of the Ovaries is to the Para- aortic nodes UTERUS the uterus is a thick-walled muscular organ covered for the most part by serous membrane, Opening of uterine tube the peritoneum. The greater part of the uterine wall is a mass of smooth muscle, the myometrium, the cells of which Uterine tube “Body undergoes considerable hypertrophy and hyperplasia during pregnancy “Cervix in preparation for the requirements to expel the foetus at birth. Internally the uterine cavity is lined Vagina by mucous membrane, the endometrium. ENDOMETRIUM The endometrium consists of tubular glands that extend from the surface Endometrial surface epithelium into the connective tissue (stroma). Most of the superficial part of the Endometrial glands (secretory phase) endometrium (Function layer) is subject to cyclical growth, degeneration and shedding of dead Wmt Endometrial stroma tissues. The deeper part of tne mm endometrium (Basal layer) in the vicinity of the myometrium does not exhibit the cyclical changes and is responsible for the regeneration of the upper endometrium. POSITION OF THE UTERUS Ante Verted -In relation to the Vagina AntifleXed - In relation to the Cervix CERVIX The cervix forms the inferior part of the uterus and is shaped Internal os like a short, broad cylinder with a narrow central channel the cervix is angled forward Posterior (anteverted) on the vagina so fomix Anterior fornix that the inferior end of the External os cervix projects into the upper Vaginal canal anterior aspect of the vagina. 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. LIGAMENTS OF THE UTERUS - Broad Ligament - Round Ligament Of uterine tube Fundus of uterus Ampulla Round ligament of uterus Isthmus Infundibulum leading to abdominal ostium Uterine tube of uterine tube Left ovary Fimbriae Ovarian fimbria Ligament of ovary Suspensory ligament Ovarian vessels Isthmus of uterus Mesovarium of ovary Mesosalpinx , Cervix of uterus' Broad ligament of uterus Mesometrium (A) Posterior view External os of uterus BROAD LIGAMENT The broad ligament of the uterus is a double layer of peritoneum (mesentery) that extends from the sides of the uterus to the lateral walls and floor of the pelvis and encloses the uterine tube in its superior margin. It is comprised of the mesentery of the uterus, uterine tube (mesosalpinx)and ovary (mesovarium). The broad ligament assists in keeping the uterus in position. ROUND LIGAMENT gubernaculum is a band of fibros tissue, asses descending of ovary in pelvic cavity during development It is the embryological remnant of the Lateral gubernaculum, and is therefore attached to the Anterior Posterior ovary and then passes over the Ampulla pelvic inlet to reach the deep Medial inguinal ring and then Ligament of ovary courses through the inguinal canal to end in connective tissue related to the labium majus in the perineum. Round ligament of uterus This gives consequences to the Isthmus of uterus lymphatic drainage of the uterus -The fundus drains to the aortic nodes (where it is embryologicaly derived from) Most common ectopic pregnancy site is ampulla UTERINE TUBES The uterine tube is a muscular Opening of the tube that is narrow medially and uterine tube has a funnel-shaped abdominal opening near the ovary, the Infundibulum ostium, the margins of which are drawn into finger-like projections called the fimbria, an extension of Fimbriae the infundibulum. The infundibulum continues lent of ovary medially into an expanded intermediate segment, the ampulla. The tube continues into the narrow isthmus and opens into the uterine cavity. The function of the tube is to assist in the transfer and transport of the ovum from the ovary to the Fundus of uterus uterus. The epithelium is not that of the uterine cavity, giving -■ consequences to ectopic pregnancies. Adhesion, infection, occlusion Cause ectopic pregnancy ARTERIAL SUPPLY OF THE UTERUS - The Uterine Artery arises from the Anterior Division of the I nter nal I liac Artery. The ureter passes Ovarian A inferiorly to the uterine artery, “water Uterine A under the bridge - Abdominal Aorta -> Common Iliac -> Internal Iliac -> Anterior Vaginal A Division of Internal Iliac ^ Uterine A Internal pudendal A VENOUS DRAINAGE OF THE UTERUS Venous drainage of the uterus is via the Uterine Venous Plexus, which merges to form the Ut eri n e Ve in s, which are tributaries of the Internal Iliac Vein Uterine Venous Plexus -> Uterine V -> Internal Iliac -> Common Iliac -> IVC LYMPHATIC DRAINAGE OF THE UTERUS Lymphatic drainage of the uterus is complex: Fundus -> Aortic nodes Body -> External iliac nodes Cervix-> External and internal iliac nodes and sacral nodes THE VAGINA The vagina is a distensible muscular tube extending from the vestibule of the female genitalia to the cervix of the uterus. The wall consists of three layers: the mucous membrane, the muscular coat and a fibrous connective tissue layer, the adventitia. THE VAGINA The mucous membrane consists of a stratified squamous epithelium with underlying lamina propria. The lamina propria becomes looser towards the muscular layer and in this region it contains large veins. There are no glands in the vagina; the mucus lubricating it originates from the cervical glands. The muscular layer contains smooth muscle bundles arranged circularly and longitudinally. The longitudinally arranged bundles are numerous in the outer half of the muscle layer. The organ is surrounded by a fibrous adventitia. The Vaginal Fornices are the recesses of vagina around the cervix. ARTERIAL SUPPLY OF THE VAGINA Uterine tube Ovarian artery Ligament of The arteries supplying the Pampiniform and vein plexus of veins superior part of the vagina Ampulla Islhmus Tubal branches Ovarian branches derive from the Uterine Infundibulum' Fimbriae' Cut edge of peritoneum Arteries. Ureter [Uterine plexus and vein Internal iliac Uterine ariery| The middle and inferior artery Vaginal artery Ascending branch of uterine artery and vein parts of the vagina are Vaginal branch of uterine artery vaginal venous plexus supplied by the Vaginal and Internal pudendal artery Posterior view vagina Internal Pudendal Water under the bridge Arteries, a branch off the Anterior Division of the Internal Iliac Artery. VENOUS DRAINAGE OF THE VAGINA The vaginal veins form the Vaginal Venous Plexuses along the sides of the vagina and within the vaginal mucosa. These veins merge to form the Vaginal Vein, which drains into the internal iliac veins via the uterine vein. The vaginal venous plexus also communicates with the vesical and rectal venous plexuses. INNERVATION OF THE UTERUS AND VAGINA Inferior 1/5th of the Vagina receives somatic innervation from the Pudendal Nerve (S2-4) Superior 4/5th of the Vagina and Uterus receives innervation from the Uterovaginal plexus Pain afferents vary depending on the pelvic pain line • Above line - Pain refers back up • Below line - Local pain FEMALE EXTERNAL GENITALIA Labia Majora • Enclsoing the pudendal cleft Labia Minora • Enclosing the vestibule of the vagina • Bulbs of vestibule • Clitoris Vestibule • Orifices of urethra, vagina and greater (Bartholin) and lesser vestibular glands <b) Thank you .
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