16. Female reproductive system Flashcards
refers to the external female genitalia
vulva (pudendum)
fx of the vulva
Acts as sensory tissue during sexual intercourse
Assists in micturition by directing the flow of urine
Protects the internal female reproductive tract from infection.
vulva is a collective term for several anatomical structures:
- mons pubis
- labia majora
- labia minora
- vestibule
- bartholin’s glands
- clitoris
a subcutaneous fat pad located anterior to the pubic symphysis. It formed by the fusion of the labia majora.
mons pubis
two hair-bearing external skin folds.
They extend from the mons pubis posteriorly to the posterior commissure
Labia majora
a depression overlying the perineal body
posterior commissure
labia major is embryologically derived from
labioscrotal swellings
two hairless folds of skin, which lie within the labia majora.
labia minora
They fuse anteriorly to form the hood of the clitoris and extend posteriorly either side of the vaginal opening
labia minora
labia minora merge posteriorly, creating a fold of skin known as the
fourchette
labia minora is
Embryologically derived from
urethral folds
the area enclosed by the labia minora. It contains the openings of the vagina (external vaginal orifice, vaginal introitus) and urethra.
vestibule
secrete lubricating mucus from small ducts during sexual arousal. They are located either side of the vaginal orifice.
Bartholin’s glands
Clitoris – located under the clitoral hood. It is formed of
erectile corpora cavernosa tissue
Clitoris
Embryologically derived from the
genital tubercle
The Bartholin’s glands (also known as the greater vestibular glands) can become infected and inflamed – known as
bartholinitis
bartholinitis
tx
antibiotics
cyst or abscess - surgical drainage or excision of the lesion
arterial supply to the vulva is from the
paired internal and external pudendal arteries (branches of the internal iliac artery and femoral artery, respectively).
Vulva
Lymph drains to the nearby
superficial inguinal lymph nodes.
Venous drainage of vulva is achieved via
pudendal veins, with smaller labial veins contributing as tributaries.
Innervation
vulva
sensory -
Anterior – ilioinguinal nerve, genital branch of the genitofemoral nerve
Posterior – pudendal nerve, posterior cutaneous nerve of the thigh.
clitoris and the vestibule also receive parasympathetic innervation from the cavernous nerves – derived from the uterovaginal plexus
Genital warts are benign growths of epithelium caused by
HPV types, such as 6 & 11.
HPV associated with cancerous lesions
type 16 and 18
It is a distensible muscular tube which extends posterosuperiorly from the external vaginal orifice to the cervix.
vagina
vagina has several roles in female reproductive system
Sexual intercourse – receives the penis and ejaculate, assisting in its transport to the uterus.
Childbirth – expands to provide a channel for delivery of a newborn from the uterus.
Menstruation – serves as a canal for menstrual fluid and tissue to leave the body.
is important as it acts like a natural reservoir for semen after intravaginal ejaculation
posterior fornix
vagina is composed of four histological layers (internal to external):
- Stratified squamous epithelium
- Elastic lamina propria
- Fibromuscular layer
- Adventitia
this layer of vagina provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).
Stratified squamous epithelium
a dense connective tissue layer of vagina which projects papillae into the overlying epithelium. The larger veins are located here.
elastic lamina propria
vagina
Fibromuscular layer – comprising two layers of smooth muscle:
an inner circular and an outer longitudinal layer.
ICOL
The arterial supply to the vagina is via the uterine and vaginal arteries – both branches of the
internal iliac artery.
Venous return is by the vaginal venous plexus, which drains into the
internal iliac veins via the uterine vein.
Lymphatic drainage of vagina
Superior – drains to external iliac nodes
Middle – drains to internal iliac nodes
Inferior – drains to superficial inguinal lymph nodes
Innervation of vagina
Parasympathetic and sympathetic nerves arise from the uterovaginal nerve plexus (in turn a subsidiary of the inferior hypogastric plexus).
inferior 1/5 of the vagina receives somatic innervation. This is via a branch of the pudendal nerve, the deep perineal nerve.
is an open communication between the vagina and one of the adjacent pelvic organs.
vaginal fistula
vagina fistula
common cause
prolonged labor
three main types of vaginal fistulae:
Vesicovaginal – abnormal communication with the bladder. Urine enters the vagina.
Urethrovaginal – abnormal communication with the urethra. Urine only enters the vagina during urination.
Rectovaginal – abnormal communication with the rectum. Faecal matter can enter the vagina.
is the lower portion of the uterus, an organ of the female reproductive tract.
cervix
The cervix is composed of two regions;
ectocervix
endocervix
is the portion of the cervix that projects into the vagina.
ectocervix
ectocervix lined by
stratified squamous non-keratinized epithelium.
marks the transition from the ectocervix to the endocervical canal.
external os
more proximal, and ‘inner’ part of the cervix.
endocervical canal (or endocervix)
lining of endocervical canal (or endocervix)
mucus-secreting simple columnar epithelium
endocervical canal ends, and the uterine cavity begins, at a narrowing called
internal os
cervix performs two main functions:
- facilitates the passage of sperm into the uterine cavity
2. Maintains sterility of the upper female reproductive tract.
The blood supply to the uterus is via the
uterine artery.
venous drainage of uterus
plexus in the broad ligament that drains into the uterine veins
Lymphatic drainage of the uterus is via the
iliac, sacral, aortic and inguinal lymph nodes.
hronic inflammation and infection of the cervix
cervicitis
Cervicitis is chronic inflammation and infection of the cervix, most commonly caused by
Chlamydia trachomatis or Neisseria gonorrhoeae.
Complications of cervicitis
pelvic inflammatory disease
infertility
two main classifications of cervical cancer:
Squamous cell carcinoma
Adenocarcinoma
cancer of the epithelial lining of the ectocervix.
Squamous cell carcinoma
are components of the reproductive tract that mature during puberty under the influence of sex hormones produced from primary sex organs (the ovaries in females and the testes in males).
secondary sex organ
parts of the uterus
fundus
body
cervix
UTERUS - it can be described as ______ with respect to the vagina, and ______ with respect to the cervix
UTERUS - it can be described as anteverted with respect to the vagina, and anteflexed with respect to the cervix
However, the retroverted uterus is positioned directly above the vagina. Thus in instances of increased abdominal pressure
uterus is more likely to prolapse into the vagina.
fundus and body of the uterus are composed of three tissue layer
Peritoneum
Myometrium
Endometrium
a double layered membrane, continuous with the abdominal peritoneum. Also known as the perimetrium.
Peritoneum
thick smooth muscle layer. Cells of this layer undergo hypertrophy and hyperplasia during pregnancy in preparation to expel the fetus at birth.
Myometrium
inner mucous membrane lining the uterus
Endometrium
Endometrium – inner mucous membrane lining the uterus. It can be further subdivided into 2 parts:
Deep stratum basalis:
Superficial stratum functionalis
layer of endometrium Changes little throughout the menstrual cycle and is not shed at menstruation.
Deep stratum basalis
Superficial stratum functionalis: Proliferates in response to
estrogens
Superficial stratum functionalis- becomes secretory in response to
progesterone
ligaments securing the uterus in place.
Broad Ligament
Round Ligament
Ovarian Ligament
Cardinal Ligament
Uterosacral Ligament
This is a double layer of peritoneum attaching the sides of the uterus to the pelvis.
Broad Ligament
It acts as a mesentery for the uterus and contributes to maintaining it in position.
Broad Ligament
A remnant of the gubernaculum extending from the uterine horns to the labia majora via the inguinal canal.
Round Ligament
It functions to maintain the anteverted position of the uterus.
Round Ligament
this logament Joins the ovaries to the uterus.
Ovarian Ligament
this ligament contains the uterine artery and vein in addition to providing support to the uterus.
Cardinal Ligament
this ligament extends from the cervix to the lateral pelvic walls
Located at the base of the broad ligament
Cardinal Ligament
this ligament Extends from the cervix to the sacrum. It provides support to the uterus.
Uterosacral Ligament
blood supply to the uterus is via the
uterine artery
The uterine artery crosses the ureters approximately 1 cm laterally to the
internal os.
Sympathetic nerve fibres of the uterus arise from the
uterovaginal plexus. -largely comprises the anterior and intermediate parts of the inferior hypogastric plexus (T10-T12 and L1 nerve fibres)
Parasympathetic fibres of the uterus are derived from the pelvic splanchnic nerves (S2-S4).
is the presence of ectopic endometrial tissue at sites outside the uterus, most commonly the ovaries and the ligaments of the uterus.
Endometriosis
are benign tumours of the myometrium which affect 20% of menopausal women. They are oestrogen dependent, enlarging during pregnancy and with use of the contraceptive pill but regressing after the menopause
Fibroids
is the most common malignancy of the female genital tract, most often found during, or after, the menopause, and characterised by abnormal uterine bleeding.
Endometrial carcinoma
are muscular ‘J-shaped’ tubes, found in the female reproductive tract.
uterine tubes (or fallopian tubes, oviducts, salpinx)
ultra-structure of the uterine tubes facilitates the movement of the female gamete:
inner mucosa is lined with ciliated columnar epithelial cells and peg cells (non-ciliated secretory cells).
Smooth muscle layer contracts to assist with transportation of the ova and sperm
fallopian tubes
peristalsis is greatest when
oestrogen levels are high.
fallopian tube is described as having four parts (lateral to medial);
Fimbriae – finger-like, ciliated projections which capture the ovum from the surface of the ovary.
Infundibulum – funnel-shaped opening near the ovary to which fimbriae are attached.
Ampulla – widest section of the uterine tubes. Fertilization usually occurs here.
Isthmus – narrow section of the uterine tubes connecting the ampulla to the uterine cavity.
The arterial supply to the uterine tubes and venous drainage
uterine and ovarian arteries. Venous drainage is via the uterine and ovarian veins.
Lymphatic drainage
uterine tubes
iliac, sacral and aortic lymph nodes.
uterine tubes Innervation
sympathetic and parasympathetic innervation via nerve fibres from the ovarian and uterine (pelvic) plexuses. Sensory afferent fibres run from T11- L1.
is inflammation of the uterine tubes that is usually caused by bacterial infection. It can cause adhesions of the mucosa which may partially or completely block the lumen of the uterine tubes
Salpingitis
salpingitis
can potentially result in
infertility
ectopic pregnancy
In both the males and females, the gonads develop within the
mesonephric ridge
The ovaries are paired, oval organs attached to the posterior surface of the broad ligament of the uterus by the
mesovarium (a fold of peritoneum, continuous with the outer surface of the ovaries).
Neurovascular structures enter the hilum of the ovary via
mesovarium
main functions of the ovaries are
To produce oocytes (female gametes) in preparation for fertilisation.
To produce the sex steroid hormones oestrogen and progesterone, in response to pituitary gonadotrophins (LH and FSH).
Components of the Ovary
surface
cortex
medulla
component of ovary formed by simple cuboidal epithelium (known as germinal epithelium).
surface
component of ovary comprised of a connective tissue stroma and numerous ovarian follicles. Each follicle contains an oocyte, surrounded by a single layer of follicular cells.
cortex
formed by loose connective tissue and a rich neurovascular network, which enters via the hilum of the ovary.
medulla
are fluid-filled masses that may develop in the ovary. They are most commonly derived from ovarian follicles, reaching approximately 2-2.5 cm.
ovarian cysts
Most ovarian cysts are
a. benign
b. malignant
a. benign
are characterized by hormone dysfunction and multiple (over 10) ovarian cysts. It is associated with infertility.
Polycystic ovaries
The most common cancers of the ovaries arise from
epithelial components or germ cells
90% of ovarian cancers are derived from epithelium, these are termed
ovarian adenocarcinomas.
tumours which comprise cells from all 3 germ cell layers and are usually benign.
teratomas
Two peritoneal ligaments attach to the ovary;
Suspensory ligament of ovary
Ligament of ovary
this ligament is a fold of peritoneum extending from the mesovarium to the pelvic wall. Contains neurovascular structures.
Suspensory ligament of ovary
extends from the ovary to the fundus of the uterus. It then continues from the uterus to the connective tissue of the labium majus, as the round ligament of uterus.
ligament of ovary
The main arterial supply to the ovary is via the
- ovarian arteries from abdominal aorta (inferior the renal arteries)
- uterine arteries
venous drainage of ovaries
ovarian veins. The left ovarian vein drains into the left renal vein, and the right ovarian vein drains directly into the inferior vena cava.
innervation of the ovaries
receive sympathetic and parasympathetic innervation from the ovarian and uterine (pelvic) plexuses
The nerves reach the ovaries via the ____ to enter the ovary at the hilum.
suspensory ligament of the ovary
ligaments of the female reproductive tract can be divided into three categories:
Broad ligament
uteirne ligaments
ovarian ligaments
flat sheet of peritoneum, associated with the uterus, fallopian tubes and ovaries. It extends from the lateral pelvic walls on both sides, and folds over the internal female genitalia, covering their surface anteriorly and posteriorly.
broad ligament
Anatomically, the broad ligament can be divided into three regions:
mesometrium
mesovarium
mesosalpinx
Surrounds the uterus and is the largest subsection of the broad ligament. I
mesometrium
Part of the broad ligament associated with the ovaries. It projects from the posterior surface of the broad ligament and attaches to the hilum of the ovary, enclosing its neurovascular supply. It does not, however, cover the surface of the ovary itself.
Mesovarium
this ligament runs laterally to cover the external iliac vessels, forming a distinct fold over them.
Mesometrium
this region of the broad ligament also encloses the proximal part of the round ligament of the uterus.
Mesometrium
this region of broad ligament originates superiorly to the mesovarium, enclosing the fallopian tubes.
Mesosalpinx
Three other ligaments of the female reproductive tract are located within the broad ligament:
Ovarian ligament.
Round ligament of uterus.
Suspensory ligament of ovary (also known as the infundibulopelvic ligament).
There are a number of ligamentous structures that attach to the uterus. They can be divided by where they attach to the uterus:
Superior aspect – supported by the broad ligament and the round ligaments.
Middle aspect – supported by the cardinal, pubocervical and uterosacral ligaments.
The inferior aspect of uterus is supported by the structures in the pelvic floor – the levator ani, perineal membrane and perineal body.
a remnant of the embryonic gubernaculum
Round Ligament
this ligament originates at the uterine horns (the points at which the fallopian tubes enter the uterus), and attaches to the labia majora, passing through the inguinal canal.
round ligament
this ligament can be a source of pain during pregnancy, due to the increased force placed on the ligament by the expanding uterus.
round ligament
The cardinal ligaments are also known as the
lateral, transverse cervical, or Mackenrodt’s ligaments.
these ligaments is situated along the inferior border of the broad ligament and house the uterine artery and uterine veins.
Cardinal Ligaments
These ligaments arise from the side of the cervix and the lateral fornix of the vagina. They provide an extensive attachment on the lateral pelvic wall at the level of the ischial spines.
cardinal ligaments
Some fibres of the cardinal ligaments interdigitate with fibres from the
uterosacral ligaments.
When a hysterectomy is being performed due to a malignancy, these ligaments are often removed as they are common reservoir of cancerous cells.
cardinal ligaments
ligaments are bilateral structures, which attach the cervix to the posterior surface of the pubic symphysis. They function to support the uterus within the pelvic cavity.
Pubocervical Ligaments
are also bilateral fibrous bands, which attach the cervix to the sacrum.
uterosacral ligaments
They are also known as the recto-uterine ligaments or sacrocervical ligaments. This supports the uterus and holds it in place
uterosacral ligaments
thin fibrous covering of the ovaries
tunica albuginea
the widest part of the fallopian tubes
ampulla
represents the remains of the UPPER part of the gubernculum; connects the lateral margin of the uterus to the ovary
round ligament of ovary
remains of the lower part of the gubernculum
extends between superlateral angle of the uterus through deep inguinal ring and inguinal canal to the subcutaneous tissue of the labia majora
round ligament of the uterus
