2 - Female Reproductive System

Question 1

Label the parts of the female reproductive system.

Answer 1

Question 2

What is the blood supply to the female reproductive system?

Answer 2

• Ovarian artery from abdominal aorta below renal artery.
• Anastomoses between uterine and vaginal so could be issues with bleeding in hysterectomy
• Also internal pudendal artery

Question 3

Why are nuns more likely to get ovarian cancer?

Answer 3

• Capsule of peritoneum that is damaged at ovulation by rupturing follicle
• Scarring and causes chance for mutation as proliferating
• Nuns don’t take OC pill so have more ovulations

Question 4

How might someone with an ovarian cyst present?

Answer 4

• Discomfort on intercourse
• Pain
• Bloating
• More likely to lead to torsion and occlusion of blood supply

Question 5

Label the different parts of the uterus and the uterine tubes?

Answer 5

Question 6

What can you feel in the fornices when doing a vaginal exam?

Answer 6

Lateral: levator ani

Question 7

What does a cervix look like if you were to put a camera up the vagina?

Answer 7

• Looks like glans penis, external os is like the wee hole. Os bigger if had a child.
• Os may be inside out due to pregnancy and OC pill
• Cervical cancer will look red and nasty on cervix

Question 8

Why might a pregnant woman feel pain?

Answer 8

Round ligament (remnant of gubernaculum) is being stretched and this attaches from the uterine horns to the labia majora

Question 9

What is the issue with the uterine tubes being open into the peritoneal cavity?

Answer 9

Bacteria can track up the vagina and uterine tubes and end up with peritonitis

Question 10

Explain the attachments of the main ligaments of the female reproductive system?

Answer 10

- Broad: Flat sheet of peritoneum, from lateral walls and folds over the internal female genitalia, covering their surface anteriorly and posteriorly. Split into three

- Round: Uterine horns to labia majora. Remnant of gubernaculum

- Suspensory: from ovary to wall. Neurovascular pathway and tents peritoneum

- Ligament of ovary: ovary to uterus

Question 11

How is the broad ligament split into three?

Answer 11

Mesometrium: mesentry of uterus

Mesovarium: mesentry of ovaries

Mesosalpinx: mesentry of tubes

Question 12

How can the bladder move up if it is constricted by the peritoneum?

Answer 12

Peritoneum does not cover the anterior bladder so it can move up

Question 13

What is the normal angle of the cervix with the vagina and the uterus?

Answer 13

• Anteverted, Anteflexed
• Round ligament pulls fundus forward

Question 14

When giving birth and a mother has a tear, what part of the vagina is tearing?

Answer 14

Fourchette

Question 15

What are the four types of femal genital mutilation?

Answer 15

Type 4 is things like piercings

Question 16

What are the health risks with FGM?

Answer 16

Female genital mutilation (FGM) is a procedure where the female genitals are deliberately cut, injured or changed, but there’s no medical reason for this to be done.

Question 17

Complete the following table.

Answer 17

Question 18

What is the general pathogenesis behind polycystic ovaries?

Answer 18

Ovarian cysts derived from follicles form. Can be asymptomatic or can cause torsion/rupture. To be polycystic have to have over 10 - common cause of infertility

Question 19

What is the common origin of tumours of the ovary?

Answer 19

From germinal epithelium (modified mesothelium cuboidal)

Question 20

How does the ova travel down the uterine tube and what are some causes of infertility due to dysfunction of this?

Answer 20

- Cilia and mucus secreting Peg cells

• Scarring from ectopic pregnancy or a chronic infection like chlamydia
• Adhesions from endometriosis

Question 21

What are some risk factors for an ectopic pregnancy?

Answer 21

• IUD
• Endometriosis
• PID
• Blocked fallopian tube
• Immotile cilia

Question 22

What is the clinical significance of the vesicouterine and the rectouterine pouch?

Answer 22

Fluid collection can occur here, e.g in haemorraghe or infection

Question 23

What are the layers of the uterus? And what is the type of cell in the innermost layer?

Answer 23

Endometrium is simple columnar, same as the cervix

Question 24

What is endometriosis?

Answer 24

Ectopic endometrial tissue is dispersed to different sites in peritoneal cavity.

Can attach to ovaries and uterus and associated with severe dysmennorhea and infertility

Question 25

What do the epithelia in the cervix do?

Answer 25

- Simple columnar - Secrete cervical mucus, changes in consistency and pH depending on menstraul cycle to help or hinder entry of sperm

Question 26

What is the purpose of the epithelia in the vagina?

Answer 26

**- Stratified squamous containing lots of glycogen** - Lactobacilli regulate pH and keep environment acidic so no thrush - Adapted to expand and resist friction but cannot lubricate so depends on cervix

Question 27

What are the common sites of ectopic implantation, with most common first?

Answer 27

- Ampulla - Isthmus - Fimbrae - Cornual

Question 28

Where would you mainly feel pain with ectopic pregnancy in ampulla?

Answer 28

**- Iliac fossa -** compression of structures **- Shoulder tip (on rupture):** irritation of phrenic nerve, referred pain

Question 29

Why is ectopic pregnancy a gynaelogical emergency?

Answer 29

Lots of anastomoses between vaginal and uterine arteries

Question 30

Why are the ureters at risk during a hysterectomy?

Answer 30

Ureters cross the uterine arteries which need to be ligated so may clamp them

Question 31

How might a retroverted retroflexed uterus present?

Answer 31

Painful sex or asymptomatic

Question 32

What is the innervation of the different parts of the female genitalia?

Answer 32

Question 33

What would the histology of the vagina be like?

Answer 33

- Mucosa, submucosa and muscular layer - Non-keratinised stratified squamous - Lots of glycogen (bright pink) for metabolism by lactobaccili to maintain acid pH - No glands as lubrication from cervix

Question 34

What would the histology of the cervix be like?

Answer 34

- Simple columanr with sharp change to vaginal epithelium at entrance to external os - Lots of mucosal glands - Transformation zone changes location in life

Question 35

What is the histology of the uterus?

Answer 35

Simple columnar

Question 36

How can the endometrium be split up into different areas?

Answer 36

**- Stratum Basalis** **- Stratum Functionalis:** outer compact and deeper spongy layers - Functional layer stripped away in menstruation and replaced by basal layer (cells next to the glands)

Question 37

Identify where in the menstrual cycle each of these histological slides are (endometrium).

Answer 37

**1 -** Proliferative stage under influence of oestrogen. Stratum functionalis ncrease in length as cells grown from the glands in basalis **2 -** Secretory phase where glands grow bigger and more coiled into the lamina propria. Saw tooth appearance. Empty spaces due to stromal oedema. Decidual cells where can only see nucleus **3 -** Menstraul phase where progesterone levels drop so endometrium breaks down. Spasm of coiled arteries in stratum functionalis so lack of nutrients so these cells die. Coiled arteries don;t go into the basalis

Question 38

What is the histology of the fallopian tubes?

Answer 38

- Inner mucosa and a serosal layer. Folding in the lumen - Ampulla has two muscle layers, isthmus has three and is bigger - Ampulla has lots of cilliated cells, increase in peg cells towards uterus

Question 39

What is a peg cell?

Answer 39

- Non-ciliated epithelial cell within the uterine tube. - Capacitate sperm - Give nutrients to the oocyte - Inhibits microorgansms getting into peritoneum

Question 40

What are the layers of the urogenital triangle?

Answer 40