2: Female Reproductive System & Pelvic Floor Flashcards
What are the main anatomical structures of the female pelvis? (5 things)
- Ovary
- Uterus
- Uterine tubes
- Vagina + external gentalia
- Pelvic bones, lig, musc, nerves and vessels
Where is the uterus located?
Between bladder and rectum
How is the uterus anchored to the pelvis
series of ligaments
What is the top muscle of the uterus called?
Fundus
What is anterior to the uterus?
Uterovesical pouch
What is posterior to the uterus?
Recto-uterine pouch (aka pouch of Douglas)
What is the lowest point in the peritoneal cavity?
Recto-uterine pouch (aka pouch of Douglas)
Where are the ovaries located? (2 points)
- Laterally and behind uterus
- Inferior to pelvic inlet
What is the purpose of the ovaries? (2 things)
- Produce mature ova for fertilisation
- Generate steroid hormones
What is the arterial supply of the ovaries?
Ovarian arteries (directly branch off from abdominal aorta)
What is the venous return from the ovaries?
R ovarian vein –> IVC
L ovarian vein –> L renal vein
What is the lymphatic drainage of the ovaries?
Via lumbar lymph nodes
What makes up the bulk of ovarian tissue?
Primordial follicles
What do primordial follicles consist of?
Large primary ooctye with nucleus surrounded by a single layer of follicular cells
How is the uterus divided functionally?
2 Main regions:
- Muscular body (upper 2/3rds)
- Fibrous Cervix (lower 1/3rd)
What are the 4 major uterine ligaments?
- Broad Ligament
- Round Ligament
- Cardinal (Transverse cervical) ligament
- Uterosacral Ligament
What are the 3 minor uterine ligaments?
- Pubocervical ligament
- Suspensory Ligament of Ovary
- Ligament of Ovary
Which is the largest ligament?
Broad ligament
What is the broad ligament?
Double layer of peritoneum that provides support to uterus
Where does the broad ligament extend do?
Laterally on each side of uterus onto the lateral pelvic walls
(Like a sheet of tissue draped over the uterus)
What are the 3 divisions of the broad ligament?
- Mesovarium
- Mesosalpinx
- Mesometrium
What is the mesovarium?
Broad ligament mesentry covering ovary
What is the mesosalpinx?
Broad ligament mesentry covering uterine tubes
What is the mesometrium?
Broad ligament mesentry covering uterus body itself
It is the largest part of ligament
Where does the round ligament of uterus extend to?
From ovary –> through inguinal canal –> labia majora
Where does the cardinal (transverse cervical) ligament extend to?
And what does it contain? (2 things)
From circular cervix –> lateral pelvic walls
Contains:
- Uterine artery
- Uterine veins
Where does the uterosacral ligament extend to?
From circular cervix –> posterior pelvic walls
What does the uterosacral ligament assist with?
Maintaining anteversion of uterus
What is the role of the minor uterine ligaments? (2 things)
- Provide support to pelvic viscera
- House vascular structures
Where does the pubocervical ligament extend to?
From cervix –> anterior pelvic wall
What is the role of the pubocervical ligament?
Supports uterus
Where does the suspensory ligament of the ovary extend to?
And what does it contain? (4 things)
Ovary –> lateral pelvic wall
Contains:
- Ovarian artery
- Ovarian vein
- Ovarian nerve plexus
- Lymphatic vessels
Where does the ligament of the ovary extend to?
Ovary –> uterus
Are the fallopian tubes open or closed ended tubes?
Open
Where do the fallopian tubes extend from?
From each side of superior end of uterus body?
Where are the fallopian tubes enclosed in?
Within mesosalpinx (broad ligament)
What are the functions of the fallopian tubes? (2 things)
- Conduct oocyte into uterine cavity
- Site of fertilisation
Where in the fallopian tube is the egg fertilized?
Ampulla (middle part of tube)
What are the layers of the fallopian tube? (3 layers)
- Mucous membrane
- Muscular layer
- Serous coat
What cells does the mucous membrane of the fallopian tube have?
- Ciliated simple columnar epithelium
- Non-ciliated (secretory) cells
What is the role of the ciliated cells in the fallopian tube?
Help transfer ovum from ovary surface –> fallopian tube
What is the purpose of the non-ciliated (secretory) cells in the fallopian tube?
Provide nutrients to early conceptus after fertilisation
What does contraction of the SMC in the muscular layer of the fallopian tubes transport? (2 things)
- Sperm –> fertilisation site
- Conceptus –> uterus
What is the cervix?
Fibromuscular neck of uterus
What are the functions of the cervix? (2 things)
- Allows sperm from vagina to enter uterine cavity –> site of fertilisaton
- Protect uterus + upper genital tract from bacteria
What are the 2 regions of the cervix?
- Endocervix
- Exocervix
What cells are in the endocervix?
Tall columnar epithelium (basally placed nuclei)
(most of cytoplasm filled w. mucus)
What are the 2 openings of the endocervical canal?
- External opening: opening from vagina to cervix
- Internal opening: opening from cervix to uterus
What cells are in the exocervix?
Stratified squamous non-K ciliated epithelia
What is the rest of the cervix composed of?
Circular arranged SM fibres in dense connective tissue
What is the vagina?
Distensible muscular tube (6-7.5cm) from middle cervix –> vaginal orifice
What are the functions of the vagina? (5 things)
- Canal for menstrual fluid
- Inferior portion of birth canal
- Receives penis and ejaculate
- Communicate w. cervical canal above
- Communicate w. vestibule (opening) of vagina below
What is the arterial supply of the superior portion of the vagina?
Uterine arteries
What is the arterial supply of the middle / inferior portion of the vagina?
Vaginal + Internal pudendal arteries
What is the innervation of the inferior 1/5th of the vagina?
Somatic (from pudendal nerve branch)
What is the innervation of the superior 4/5th of the vagina?
Visceral (from uterovaginal nerve plexus)
What are the 3 layers of the vaginal wall?
- Mucous membrane
- Muscular coat
- Adventitia (fibrous connective tissue layer)
What cells are in the mucous membrane of the vaginal wall?
Stratified squamous non-K epithelium
What is underneath the stratified squamous epithelium in the mucous membrane of the vaginal wall?
Lamina propria - Looser towards muscular layer + has large veins
Are there glands in the vagina? (why / why not)
No, the mucus lubricating the vagina comes from the cervical glands
What is the muscular coat of the vaginal wall composed of?
SM bundles arranged circularly and longitudinally
(lots of longitudinal in outer half of the layer)
What is endometriosis?
Ectopic endometrial tissue dispersed to different sites in peritoneal cavity
What are some signs / symptoms of endometriosis? (2 things)
- Dysmenorhoea (painful period)
- Infertility
What is endometrial carcinoma?
Uterus cancer mainly in post menopausal women
What sign/symptom is associated with endometrial carcinoma?
Abnormal uterine bleeding
What are ovarian cysts derived from?
Follicles
What are polycystic ovaries and what are the associated with?
10+ cysts
Associated with infertility
What can fallopian tube infection lead to?
Occlusion of fimbrial (ovary) end of tube
What can inflammation of fallopian tube (salpingitis) lead to?
Blockage of tube
What can clinical problems of the fallopian tube in general cause?
Infertility / ectopic pregnancy
(Cah the egg can’t get to where it needs to be)
How is a low pH environment maintained in the vagina?
Bacteria in the vagina use glycogen as substrate for lactic acid production
What is the normal pH of the vagina?
3.8 - 4.5
What is the pelvic floor?
Muscular layers that support pelvic viscera
What are the functions of the pelvic floor? (3 things)
- Exerts sphincteric action on rectum, urethra and vagina
- Resists increase in intra-abd pressure
- Helps in child birth, urinary and faecal continence
What causes an increase in intra-abdominal pressure? (3 things)
- Coughing
- Defecation
- Heavy lifting
What is the perineal body? (2 things)
- Fibromuscular junction @ intersection of anterior and posterior perineum
- Central fulcrum for pelvic support
What attaches at the perineal body?
Muscles of the pelvic floor and perineum
What muscle fibres (from pelvic floor –> perineum) attach at the perineal body? (5 muscles / muscle groups)
- Bulbospongiosus muscle
- External anal sphincter
- Levator ani (part of pelvic floor)
- Transverse perineal muscles (superficial and deep)
- Sphincter urethrae
BELTS for support
What does the perineal body act as in women?
Tear resistant body between vagina and external anal sphincter
(Supports posterior part of vaginal wall against prolapse)
What are the two main layers of the Pelvic Floor?
- Pelvic diaphragm (bowl shaped)
- Perineum
What is the pelvic diaphragm divided into? (2 things)
- Coccygeus
- Levator Ani (I,P,P)
(Could I Please Peek) (PD = pedo)
What are the 3 muscles of the Levator Ani?
- Iliococcygeus
- Pubococcygeus
- Puborectalis
(I Please Peek)
What is the perineum divided into? (2 things)
- Anterior (urogenital) Triangle (2 layers)
- Posterior (anal) Triangle
PeRineum like PyRamid so triangles
What are the 2 layers of the anterior (urogenital) triangle?
- Urogenital Diaphragm (2 layers)
- Superficial Perineal Pouch
What are the 2 layers of the urogenital diaphragm?
- Deep perineal pouch
- Perineal membrane
What is the posterial (anal) triangle composed of? (3 things)
- Anal aperture
- Levator ani parts
- Ischioanal fossa
Ali likes anal
What causes prolapse of the pelvic viscera (bladder and vagina)? (2 things)
- Trauma to pelvic floor
- Poor muscle fibre tone
What causes prolapse of the vagina?
Damage to the perineal body @ childbirth
What problems are causes by pelvic floor dysfunction?
Urinary and renal incontinence
What are the risk factors for pelvic floor dysfunction? (6 things)
- Age
- No. of vaginal deliveries
- Family history
- Weight
- Chronic coughing (from lung disorders)
- Menopause (atrophy of tissues after oestrogen withdrawal)
What are the treatments of pelvic floor dysfunction? (3 things)
- Surgically repaired
- Strengthen muscle w. pelvic floor exercises
- Do episiotomy @ childbirth
What is episiotomy?
Surgical incision of perineum and posterior vaginal wall @ 2nd stage of labour to enlarge opening and stop uncontrollable tearing
What are the differences between the female and male bony pelvis? (5 things)
- F: Circular pelvic inlet // M: Heart shaped
- F: Wide pubic arch angle // M: Narrow
- F: Less distinct sacral promontory (inward projecting ant. part of sacral vertabra) // M: More distinct
- F: Ischial spine project less medially into pelvic cavity // M: Project more medially
- F: Thinner bone // M: Thicker
Circular pelvic inlet… male or female?
Female
Heart shaped pelvic inlet… male or female?
Male (men don’t love but snm heart shape)
Wide pubic arch angle… male or female?
Female
Narrow pubic arch angle… male or female?
Male
Distinct sacral promontory (inward projecting ant. part of sacral vertabra) … male or female?
Male
Ischial spine project more medially into pelvic cavity… male or female?
Male
Thinner bone of bony pelvis… male or female?
Female
Thicker bone of bony pelvis… male or female?
Male
What is the pelvic inlet?
Junction between greater and lesser pelvis
What are the posterior borders of the pelvic inlet? (2 things)
- Sacral promontory (inward projecting ant. part of sacral vertabra)
- Sacral wings
What are the lateral borders of the pelvic inlet? (2 things)
- Arcuate line on inner surface of ilium
- Pectineal line on superior pubic ramus
What is the anterior border of the pelvic inlet?
Pubic symphysis
What is the posterior border of the pelvic outlet?
Tip of coccyx
What are the lateral borders of the pelvic outlet? (2 things)
- Ischial tuberosities
- Inferior margin of sacrotuberous ligament
What is the anterior border of the pelvic outlet?
Pubic arch (inferior border of ischiopubic rami)
What is the pelvic region divided into? (2 things)
- Greater (false) pelvis
- Lesser (true) pelvis
Where is the greater (false) pelvis located?
Superiorly
What is the greater (false) pelvis?
Space surrounded by upper portions of iliac bones and upper part of sacrum posteriorly
Where is the lesser (true) pelvis located?
Inferiorly
What is the lesser (true) pelvis?
Space surrounded by margins of obturator foramen, ischial spines, and lower portion of sacrum
