Male and Female Reproductive Systems

1. Male and female reproductive organs 2. Testis, , , spermatic ducts 3. and accessory glands – , gland, bulbourethral glands 4. Female internal reproductive organs 5. Female external reproductive organs 6. Mammary gland (breast) and perineum SPLANCHNOLOGY ° Male reproductive system, systema genitalia masculina: V a part of the human reproductive process ° Male reproductive organs, organa genitalia masculina: V internal genital organs: ‹ , testis ‹ epididymis, epididymis ‹ ductus deferens, ductus (vas) deferens ‹ seminal vesicle, vesicula seminalis ‹ , ductus ejaculatorius ‹ prostate gland, prostata V external genital organs: ‹ penis, penis ‹ scrotum, scrotum ‹ bulbourethral glands, glandulae bulbourethrales Prof. Dr. Nikolai Lazarov 2 SPLANCHNOLOGY Testicle, testis

° Testicle, testis (Gr. orchis, didymis): V a pair of oval-shaped organs V two basic functions: ‹ production of sperm () ‹ secretion of androgens (male sex hormones) ° Testis in situ: V within an extension of the abdomen, scrotum V size: ‹ 40-45 mm in length ‹ 25-35 mm in height ‹ 20-30 mm in breadth V weigth – 10-14 g V external appearance: ‹ extremitas superior et extremitas inferior ‹ facies lateralis et facies medialis ‹ margo anterior et margo posterior Ù epididymis Prof. Dr. Nikolai Lazarov 3 SPLANCHNOLOGY Macroscopic anatomy

° testis: V lamina parietalis V lamina visceralis ° : V testis V septula testis V lobuli testis – 200-300 ° tunica vasculosa

Prof. Dr. Nikolai Lazarov 4 SPLANCHNOLOGY Microscopic anatomy ° Testicular lobules, lobuli testis: V tubuli seminiferi contorti – 400-600 V tubuli seminiferi recti Ù V ductuli efferentes testis – 12-20 V lobuli epididymis (coni vasculosi) V ductus epididymidis ‹ head, body and tail of epididymis

Prof. Dr. Nikolai Lazarov 5 SPLANCHNOLOGY Microscopic anatomy ° Convoluted seminiferous tubules, tubuli seminiferi contorti: V seminiferous epithelium: ‹ cells of spermatogenic lineage ‹ supporting (Sertoli) cells – epitheliocyti sustentantes (Sertoli) V stratum myoideum – myoid cells V stratum fibrosum Enrico Sertoli (1842-1910)

Prof. Dr. Nikolai Lazarov 6 SPLANCHNOLOGY Microscopic anatomy ° Spermatogenic lineage cells, cellulae spermatogenicae: V spermatogonia V primary V secondary spermatocytes (prespermatids) V – early and late V spermatozoa

Prof. Dr. Nikolai Lazarov 7 SPLANCHNOLOGY Interstitial tissue of the testis ° Interstitial (Leydig) cells, endocrinocyti interstitiales (Leydig): V 12 % of the testicular volume V located in the interstitium testis: ‹ isolated or in small clusters ‹ fenestrated capillaries V crystals of Reinke V steroid-secreting cells – production of androgens (testosterone) V stimulation by the LH (ICSH) from adenohypophysis

Franz von Leydig (1821-1908) Prof. Dr. Nikolai Lazarov 8 SPLANCHNOLOGY Microscopic anatomy ° Rete testis: V straight seminiferous tubules, tubuli seminiferi recti: ‹ simple cuboidal epithelium ‹ transport of sperm V ductuli efferentes testis: ‹ pseudostratified columnar epithelium – cell types: o ciliated columnar cells o cuboidal secretory cells ‹ stratum fibromusculare

Prof. Dr. Nikolai Lazarov 9 SPLANCHNOLOGY Microscopic anatomy ° Duct of the epididymis, ductus epididymidis: V ~6 m in length V forms the body and tail of the epididymis V structure of the wall: ‹ pseudostratified columnar epithelium: o epitheliocyti microvilosi – stereocilia o epitheliocyti basales o lymphocytes , halo cells ‹ tunica fibromuscularia o smooth muscle and elastic fibers ‹ tunica adventitia Prof. Dr. Nikolai Lazarov 10 SPLANCHNOLOGY Ductus (vas) deferens ° Ductus (vas) deferens: V a straight thick-walled muscular tube V transports sperm cells from the epididymis V length 45-50 cm V diameter 2.5-3 mm ° Anatomical parts: V testicular part V funicular part V inguinal part – 4 cm V pelvic part ° Ampulla ductus deferentis: V length 3-4 cm; diameter 1 cm V ejaculatory duct, ductus ejaculatorius Prof. Dr. Nikolai Lazarov 11 SPLANCHNOLOGY Microscopic anatomy ° tunica mucosa – 5-6 longitudinal folds: V lamina epithelialis – bilayered columnar epithelium with stereocilia V lamina propria: ‹ dense connective tissue ‹ elastic fibers ° tunica muscularis – thick: V inner longitudinal layer – in the initial portion V circular layer V outer longitudinal layer ° tunica adventitia (serosa)

Prof. Dr. Nikolai Lazarov 12 SPLANCHNOLOGY Seminal vesicle, vesicula seminalis ° Seminal vesicle, vesicula (glandula) seminalis: V a pair of simple tubular glands – two highly tortuous tubes V posterior to the urinary bladder V length 4-5 (15) cm V diameter 1 cm ° Macroscopic anatomy: V anterior and posterior part V excretory duct

Prof. Dr. Nikolai Lazarov 13 SPLANCHNOLOGY Microscopic anatomy ° tunica mucosa – highly folded mucosa: V lamina epithelialis – cuboidal or pseudostratified columnar epithelium with secretory granules ‹ viscid, yellowish secretion – 50-80% of the semen ‹ fructose, prostaglandins V lamina propria – very thin ‹ rich in elastic fibers ° tunica muscularis – thick: V inner circular layer V outer longitudinal layer ° tunica adventitia (serosa)

Prof. Dr. Nikolai Lazarov 14 SPLANCHNOLOGY Prostate gland, prostata

° Prostate gland, prostata: V fibromuscular dense organ V tubuloalveolar exocrine gland V endocrine gland ° Macroscopic anatomy: V cone-shaped – chestnut-like V weigth ~ 8 g V anterior-posterior size ~2 cm V transverse size ~4 cm V vertical size ~3 cm V tip, apex prostatae V base, basis prostatae V facies anterior et facies posterior V facies inferolateralis V two parts – anterior and posterior ‹ colliculus seminalis; utriculus prostaticus ‹ crista urethralis; ductus ejaculatorii V three lobes: ‹ lobus prostatae dexter et sinister ‹ lobus medius ‹ isthmus prostatae Prof. Dr. Nikolai Lazarov 15 SPLANCHNOLOGY Microscopic anatomy ° fibroelastic capsule – thin: V fibromuscular septa Ù 30-40 lobes ° smooth muscle, stroma myoelasticum ° glandular tissue, parenchyma glandulare: ‹peripheral zone ‹transition zone ‹central zone – 25% of the volume V secretory portion: ‹exocrinocyti mucosi – milky prostatic fluid – 30% of the semen o cuboidal or columnar pseudostratified epithelium o prostatic concretions (corpora amylacea) V prostatic tubules ‹two layers of simple columnar epithelium V prostatic Prof. Dr. Nikolai Lazarov 16 SPLANCHNOLOGY Bulbourethral glands, glandulae bulbourethrales ° Glandulae bulbourethrales (Cowper): V brownish, spherical glands V in the urogenital diaphragma V tubuloalveolar glands ‹ simple cuboidal to columnar epithelium – clear mucus Ù acts as a lubricant V ductus glandulae bulbourethralis – 3-4 cm V fibroelastic and smooth muscle tissue V skeletal muscles of perineum

Prof. Dr. Nikolai Lazarov 17 SPLANCHNOLOGY Penis, penis

° Penis, penis (Gr. phallos): V a reproductive, intromittent organ – to deposit semen in the vagina V urinary duct ° Anatomical parts: V root, radix penis ‹ crura penis ‹ bulbus penis V shaft or body, corpus penis ‹ dorsum penis ‹ facies urethralis Ù raphe penis ‹ lig. fundiforme – elasic fibers ‹ lig. suspensorium penis V glans, ‹ collum glandis ‹ corona glandis ‹ preputium penis et frenulum preputii ‹ ostium urethrae externum

Prof. Dr. Nikolai Lazarov 18 SPLANCHNOLOGY Macroscopic anatomy

° Structure – erectile tissues: V corpus cavernosum of the penis, corpora cavernosa penis ‹ crura penis ‹ septum penis V corpus cavernosum of the urethra, ‹ bulbus penis ‹ glans penis ‹ urethra masculina V tunica albuginea, penis V subcutis V shaft skin ‹ , preputium penis ‹ glands of Littre Prof. Dr. Nikolai Lazarov 19 SPLANCHNOLOGY Microscopic anatomy ° skin V raphe penis Ù raphe scroti ° fascia penis ° tunica albuginea ° erectile tissue V a. profunda penis V urethra spongiosa

Prof. Dr. Nikolai Lazarov 20 SPLANCHNOLOGY Scrotum, scrotum ° Scrotal sac: V a dual-chambered pendulous pouch V between the penis and anus V divided by a septum and raphe scroti ° Macroscopic anatomy: V skin – hairy and pigmented ‹ lightly keratinized epithelium ‹ sebaceous and abundance of sweat glands V subcutaneous layer of smooth muscle ‹ tunica s. musculus – 1-2 mm V fascia spermatica externa V fascia cremasterica V m. cremaster V fascia spermatica interna V tunica vaginalis testis – cavum vaginale ‹ lamina parietalis (periorchium) ‹ lamina visceralis (epiorchium) Prof. Dr. Nikolai Lazarov 21 SPLANCHNOLOGY , funiculus spermaticus ° Spermatic cord, funiculus spermaticus: V a paired cord of connective tissue V length 15-20 cm V from annulus inguinalis profundus ° Content: V sperm duct, ductus (vas) deferens V a. testicularis V vv. testicularis, pampiniform plexu s V a. ductus deferentis (a. vesicalis sup. ) V v. ductus deferentis V a. cremasterica (a. epigastrica inf.) V lymphatic vessels V nerves, plexus testicularis V r. genitalis n. genitofemoralis

Prof. Dr. Nikolai Lazarov 22 SPLANCHNOLOGY Female reproductive system

° Female reproductive system, systema genitalia feminina: V located in the pelvis ° Female reproductive organs, organa genitalia feminina: V internal female genitalia: ‹ ovary, ovarium ‹ uterine tube, tuba uterina ‹ uterus, uterus ‹ vagina, vagina V external female genitalia (vulva): ‹ mons pubis, mons pubis ‹ fleshy lips, labia labia majora et minora pudendi ‹ clitoris, clitoris ‹ vestibule, vestibulum vaginae ‹ vestibular bulbs, bulbi vestibuli ‹ greater vestibular glands, gll. vestibulares majores ‹ (mammary gland), breast, mamma Prof. Dr. Nikolai Lazarov 23 SPLANCHNOLOGY Ovary, ovarium ° Ovary, ovarium (Gr. oophoron): V female gonad V produces egg cells (ova) V secretes female sex hormones ° Ovary in situ: V lateral part of the pelvis, fossa ovarica V almond-shaped organ V size: ‹ length – 3-4 cm ‹ width – 1.5-2 cm ‹ thickness – 1-1.5 cm V weigth – 6-14 g V macroscopic appearance: ‹ extremitas uterina et extremitas tubaria ‹ facies lateralis et facies medialis ‹ margo liber et margo mesovaricus Ù lig. latum uteri, mesovarium Prof. Dr. Nikolai Lazarov 24 SPLANCHNOLOGY Microscopic anatomy ° Main components: V simple squamous or cuboidal epithelium, the germinal epithelium V tunica albuginea – collagen fibers V cortical region (zona parenchymatosa) ‹ ovarian follicles V medullary region (zona vasculosa) ‹ stroma ovarii ‹ interstitium ovarii ‹ hilum ovarii

Prof. Dr. Nikolai Lazarov 25 SPLANCHNOLOGY Cortical region ° Ovarian follicles: V primordial follicles, folliculi ovarici primordiales V primary follicles, folliculi ovarici primarii V secondary, folliculi ovarici secundarii Regnier de Graaf V mature (graafian) follicles, (1641-1673) folliculi ovarici vesiculosi (Graafi)

Prof. Dr. Nikolai Lazarov 26 SPLANCHNOLOGY Uterine tube, tuba uterina ° Uterine tube (oviduct), tuba uterina (Gr. salpinx), Fallopian tube (Falloppio): V two muscular tubes V length 10-12 (5-20) cm V diameter 3-4 – 8-9 mm ° Anatomical parts: V pars uterina – 1 cm ‹ ostium uterinum tubae – d=1 mm V isthmus tubae uterinae – 3-5 cm V ampulla tubae uterinae – 6-8 cm V infundibulum tubae uterinae ‹ ostium abdominale tubae, d=2-3 mm ‹ fimbriae tubae; fimbria ovarica ‹ appendices vesiculosae

Prof. Dr. Nikolai Lazarov 27 SPLANCHNOLOGY Microscopic anatomy ° tunica mucosa – longitudinal mucosal folds: V lamina epithelialis – simple columnar ciliated ‹ epitheliocyti ciliati ‹ epitheliocyti microvilosi V lamina propria mucosae: ‹ blood and lymphatic vessels, nerves ° tunica muscularis – smooth muscle: V (stratum longitudinale int.) – in pars uterina V stratum circulare – 0.2 mm V stratum longitudinale ° tunica serosa – peritoneum

Prof. Dr. Nikolai Lazarov 28 SPLANCHNOLOGY Uterus, uterus ° Uterus, uterus (Gr. metra, hystera): V thick muscular chamber ° Topography and external appearance: V in the pelvis, between the urinary bladder and rectum ‹ excavatio rectouterina ‹ excavatio vesicouterina (cavum Douglassi) V pear-shaped organ V weight – 30-45 g V size: ‹ length – 7-8 cm ‹ width – 5 cm ‹ thickness – 2.5 cm V two surfaces: ‹ facies vesicalis ‹ facies intestinalis ‹ margo uteri, sinister and dexter ‹ uterine horns Prof. Dr. Nikolai Lazarov 29 SPLANCHNOLOGY Uterus, uterus ° Macroscopic anatomy: V anatomical parts: ‹body, corpus uteri – ⅔ o fundus, fundus uteri ‹isthmus, isthmus uteri ‹neck, cervix (collum) uteri – ⅓ o portio supravaginalis o portio vaginalis cervicis V uterine cavity, cavitas uteri: ‹canalis cervicis uteri ‹ostium uteri o labium anterius o labium posterius • fornix vaginae

Prof. Dr. Nikolai Lazarov 30 SPLANCHNOLOGY Uterine wall ° tunica serosa (perimetrium) V tela subserosa ° tunica muscularis (myometrium) – smooth muscle tissue V stratum subserosum V stratum supravasculosum – circular and longitudinal muscle fibers V stratum vasculosum – circular and spiral muscle fibers V stratum submucosum – absent in the cervix; longitudinal muscle fibers ° tunica mucosa (endometrium): V plicae palmatae – in the cervix V lamina epithelialis – simple columnar epithelium ‹ epitheliocyti ciliati ‹ epitheliocyti microvilosi stratified squamous nonkeratinized epithelium Ù portio vaginalis cervicis V lamina propria mucosae: ‹ deciduocyti, gll. uterinae et gll. cervicales Prof. Dr. Nikolai Lazarov 31 SPLANCHNOLOGY Microscopic anatomy ° Cyclic changes of the endometrium: V basal layer – 1 mm thick V functional layer ° Phases of the menstrual cycle: V desquamative, menstrual phase V proliferative or follicular (estrogenic) V secretory (luteal) V premenstrual phase

Prof. Dr. Nikolai Lazarov 32 SPLANCHNOLOGY Vagina, vagina

° Vagina, vagina (Gr. colpos): V muscular tube V allows for discharge of menstrual fluid V receipt of the penis and semen, and birth of a baby ° Topography and macroscopic anatomy: V dorsally from the urinary bladder and ventrally of the rectum V between the uterus and vestibule V length – 8-10 cm V external appearance: ‹ paries anterior et paries posterior ‹ fornix vaginae, o pars anterior et pars posterior o partes laterales ‹ ostium vaginae Ù hymen – forms o carunculae hymenales

Prof. Dr. Nikolai Lazarov 33 SPLANCHNOLOGY Microscopic anatomy ° Vaginal wall: V mucosa, tunica mucosa – 150-20 µm ‹ rugae vaginales ‹ columnae rugarum (posterior et anterior) ‹ carina urethralis vaginae V lamina epithelialis – estrogen stimulation ‹ stratified squamous nonkeratinized epithelium V lamina propria ‹ dense connective tissue with elastic fibers ‹ no glands, folliculi lymphatici solitarii V lamina (stratum) submucosum V muscular layer, tunica muscularis ‹ longitudinal (and some circular) bundles of smooth muscle fibers V tunica spongiosa

Prof. Dr. Nikolai Lazarov 34 SPLANCHNOLOGY External female genital organs, pudendum femininum ° External female genitalia, pudendum femininum (vulva): V mons pubis, mons pubis V major and minor fleshy lips , labia majora et minora pudendi V clitoris, clitoris V vaginal vestibule, vestibulum vaginae V vestibular bulbs, bulbi vestibuli V greater vestibular glands, gll. vestibulares majores

Prof. Dr. Nikolai Lazarov 35 SPLANCHNOLOGY External female genitalia, pudendum femininum ° Mons pubis, mons pubis (Veneris ): V a mound of adipose tissue – 2-3 cm V overlies the pubic symphysis ° Major fleshy lips, labia majora pudendi: V rima pudendi ~7 cm V commissura labiorum anterior et commissura labiorum posterior V bulbus vestibuli ° Minor fleshy lips, labia minora pudendi (nymphae): V prepuce, preputium clitoridis V genital frenulum, frenulum clitoridis

Prof. Dr. Nikolai Lazarov 36 SPLANCHNOLOGY Vaginal vestibule, vestibulum vaginae ° Clitoris: ‹ a pair of corpora cavernosa ‹ septum corporum cavernosum V glans clitoridis ° Greater vestibular glands , gll. vestibulares majores (Bartholini): V pea-sized structures ~10-12 mm V ductus glandulae ~2 cm ° Vestibular bulbs, bulbi vestibuli: V pars (commissura) intermedia V venous plexuses

Prof. Dr. Nikolai Lazarov 37 SPLANCHNOLOGY Perineum, perineum

° Pelvic floor – boundaries: V a diamond-shaped area between the pubic symphysis and the coccyx V inferior to the pelvic diaphragm V between the legs ° Two triangle parts: V pelvic diaphragm, diaphragma (trigonum) pelvis V urogenital diaphragm, diaphragma urogenitalis V content – muscles and

Prof. Dr. Nikolai Lazarov 38 SPLANCHNOLOGY Ischioanal fossa, fossa ischioanalis (ischiorectalis) ° boundaries: V lateral – tuber ischiadicum, fascia m. obturatorii interni V medial and superior – fascia diaphragmatis pelvis inferior ° content: V adipose tissue, corpus adiposum V neurovascular bundle – a. et v. pudenda interna, n. pudendus

Prof. Dr. Nikolai Lazarov 39 SPLANCHNOLOGY Breast Embryonic development

° modified sudoriferous glands ° begin – fourth week of gestation, growth of a basic milk streak ° formation of milk lines, "ventral epidermal ridges" – sixth week of the embryo's "life" ° embryonic origin: V ectodermal – parenchyma Ù mammary papilla (nipple), alveoli, lactiferous ducts V mesenchymal – stroma Ù adipose tissue ° persist of mammary ridges Ù polymastia (accessory breasts along the milk line from axillae to groin) polythelia (supernumerary nipple)

Artemis of Ephesus Prof. Dr. Nikolai Lazarov 40 with tier upon tier of breasts to highlight her ability to nurture SPLANCHNOLOGY Breast topography

Prof. Dr. Nikolai Lazarov 41 SPLANCHNOLOGY Breast Adult breast anatomy

° areola mammae: Vareolar glands (of Montgomery) Vpapilla mammaria (nipple)

° parenchyma mammae – glandular tissue of the tubuloalveolar type V15-20 lobes, lobi glandulae mammariae: ‹cluster of rounded alveoli – alveolar and myoepithelial cells ‹ducts and ductules – ductus lactiferus, sinus lactiferus, porus lactiferus ° stroma mammae – fibrous and adipose (fatty) tissue Vsuspensory ligaments (of Cooper ) NB: The ratio of glands to adipose tissues rises from 1:1 Prof. Dr. Nikolai Lazarov 42 in nonlactating women to 2:1 in lactating women ! SPLANCHNOLOGY Breast Microscopic structure

° functional stages: Vchildish breast (before puberty) Vjuvenile breast Vadult resting mammary gland Vmammary gland during pregnancy Vlactating mammary gland

Prof. Dr. Nikolai Lazarov 43 SPLANCHNOLOGY Breast Blood vessels and lymphatic drainage

° superficial plexus Ù nodi lymphoidei axillares (75% of the lymph) ° deep (fascial) plexus Ù nodi lymphoidei mediastinales V lymphatic pathway of Grossman Ù nodi lymphoidei apicales (infraclaviculares) V lymphatic pathway of Gerota Ù nodi lymphoidei hepatici et subdiaphragmatici Prof. Dr. Nikolai Lazarov 44 SPLANCHNOLOGY Breast Lymphatic drainage

Prof. Dr. Nikolai Lazarov 45 SPLANCHNOLOGY Breast Axillary lymph nodes

° 5 groups (20-40 nodes): V apical group – 6-12 nodes , nodi lymphatici apicales (infraclaviculares) V central group – 4-6 nodes , nodi lymphatici centrales V anterior (pectoral) group – 4-5 nodes , nodi lymphatici mediales (pectorales) V posterior (subscapular) group – 6-7 nodes, nodi lymphatici subscapulares V lateral group – 3-8 nodes , nodi lymphatici laterales

Prof. Dr. Nikolai Lazarov 46 Thank you ...