20-03-23 - Female reproductive organs Flashcards
Learning outcomes
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the ovary
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the uterine (Fallopian) tube
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the uterus and cervix
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the vagina
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the female urethra
- Describe the anatomy (position, structure, function, blood, nerve supply and lymph drainage) of the female external genital organs
- Discuss the clinical implications of the anatomy of the pelvic floor, and reproductive organs in the female
Describe the 3 parts of the internal female reproductive organs.
What is the purpose of each?
What are the 2 parts of the external female reproductive organs?
- 3 parts of the internal female reproductive organs:
1) Uterus
* Implantation
* Development and nourishment of fetus
* Childbirth
2) Uterine tubes
* Transport of oocyte
* Site of fertilization
3) Ovary
* Production of ovum
* Maintenance of menstrual cycle
- 2 parts of the external female reproductive organs:
1) Vulva
* External genitalia is collectively referred to as the vulva
2) Vagina
* Birth canal
* Sexual intercourse
What is another name for the ovary?
Describe the size/surface of the ovary? Where is the ovary located?
What 4 other structures are also located in the ovarian fossa?
Is the ovary intraperitoneal or retroperitoneal?
Which ligament is the ovary attached to?
What are the 2 supporting ligaments of the ovary?
- The ovary is also called the oophoron
- The ovary is almond shaped and 3x1.5x1 cm
- It has a smooth surface in young girls but scarred and pitted after puberty
- The position of the ovary is extremely variable, but is generally located in ovarian fossa (shallow depression in the lateral walls of pelvis)
- 4 other structures are also located in the ovarian fossa:
1) Internal iliac artery
2) Ureter
3) External iliac artery (umbilical a.)
4) Obturator nerve on the floor of the ovarian fossa - The ovaries are true intraperitoneal
- The ovary is attached to the back of the broad ligament by the mesovarium
- 2 supporting ligaments of the ovary:
1) Ovarian ligament
2) Suspensory ligaments
Where structure lies posterior to the ovary?
What structure lies laterally to the ovary?
Where can ovarian disease cause referred pain to be?
When can ureters be at risk?
- The ureter lies posteriorly to the ovary
- The obturator nerve lies laterally to the ovary - ovarian disease may cause referred pain to the medial thigh
- The ureter is at risk during surgical procedures of the ovary
What are the 3 Peritoneal and ligamentous supports of the ovary?
- 3 Peritoneal and ligamentous supports of the ovary:
1) Round ligament of ovary, Ovarian ligament
* Extends between cornu of the uterus and the inferior pole of the ovary
* The remnant of the upper part of gubernaculum
2) Suspensory ligament of ovary
* In the broad ligament
* Carries the ovarian blood vessels
3) Mesovarium
* Short peritoneal fold that attaches the ovary to the back of the broad ligament
What are 3 other names for the fallopian tube?
Where is the fallopian tube located?
What structures does the fimbriae surround? What does the fimbriae do?
Where does fertilisation usually take place?
What is this also the most common site of?
What structures aid in the transport of the ovum into the uterine cavity?
- 3 other names for the fallopian tube:
1) Fallopian tube
2) Oviduct
3) Salpinx - The fallopian tube is located In the free superior border of the broad ligament
- The ostium of the uterine tube in the infundibulum is surrounded by fimbriae which pick up the ovum
- Fertilisation usually takes place in the ampulla, which is also the most common site of ectopic pregnancies
- The fallopian tube has circular and longitudinal smooth muscle fibres on the wall (utilises peristaltic movement) and cilia inside, which can be used to transport the ovum into the uterine cavity
What type of organ is the uterus? What structures are around the uterus?
What structure is the uterus partially covered in?
Describe the how the peritoneum covers the uterus.
What are the 4 parts of the uterus?
- The uterus is a muscular, hollow, central pelvic organ
- The uterus is anterior to the rectum and posterosuperior to the urinary bladder
- The uterus is partially covered with peritoneum
- The peritoneum covers the anterior surface of the rectum, reflects on the posterior surface of the uterus, covers the uterus, and the reflects on the superior surface of the bladder
- 4 parts of the uterus:
1) Body
* Divided into the body proper and the fundus
* The fundus is part of the body that is superior to the entrance of the fallopian tubes into the uterus
2) Isthmus
* The opening into the uterus is termed internal os or internal orifice of the cervix uteri.
* It corresponds to the slight constriction referred to as the isthmus, which can be found on the surface of the uterus, midway from the apex and the base
* The isthmus forms the lower segment during pregnancy
* The isthmus is below the uterovesical reflection of peritoneum
3) Cervix
* Inserts into vagina through anterior wall
* Has Supravaginal (invisible) and Vaginal parts
* The cervical canal connects the uterine cavity to the vagina
4) Uterine cavity
Vaginal diagram
UTERUS: Cervix.
What is the consistency of the cervix like?
What are the 4 different parts of the cervix?
What are the different forms of epithelium seen in the cervix?
- UTERUS: Cervix
- The cervix has variable consistency, and becomes softer in pregnancy
- 4 different parts of the cervix:
1) Cervical canal
* Columnar epithelium
2) Internal os (orifice)
* Internal opening
3) External os (orifice)
* External opening
* Variable shape
* In nulliparous (never given birth), it is circular
* In multiparous (given vaginal birth several times), it is a slit
4) Ectocervix (vaginal cervix)
* Projects into vagina
* non-keratinizing stratified squamous epithelium, which contains glycogen
What is the squamocolumnar junction?
How does the position of the squamocolumnar junction vary with age?
What is the cervical transformation zone?
What condition can develop in this area?
What Is cervical ectropion?
- The squamocolumnar junction is the part of the cervix between columnar epithelium of the cervical canal and the squamous epithelium of the ectocervix
- The squamocolumnar junction varies with age – in children, it is in the endocervical canal, after puberty, it moves to the ectocervix, in adulthood, it moves back to its original position due to columnar epithelium being replaced with squamous epithelium (squamous metaplasia)
- The cervical transformation zone is the area between the 2 different squamocolumnar junctions
- Cervical intraepithelial neoplasia (CIN) is stage 0 of cervical cancer, and develops in the cervical transformation zone
- Cervical ectropion is the appearance given when there is visibility of the glandular columnar epithelium from the vagina
What are the 3 layers of the uterus?
What does each layer consist of?
What are the 3 layers of the myometrium?
What are the 2 layers of the endometrium?
- 3 layers of the uterus:
1) Perimetrium (Outermost)
* Thin visceral peritoneum
2) Myometrium (Middle layer)
* Smooth muscle fibres arranged in 3 layers
1) Longitudinal
2) Spiral (Figure of 8 around vessels)
3) Circular - forms sphincter around uterine tubes and internal orifice
3) Endometrium (Innermost) – the opening
* Mucous membrane and spiral arteries
* 2 layers:
1) Basal layer (regenerates the functional layer)
2) Functional layer (shed as menses)
What does anteflexion and anteversion of the uterus refer to?
How common is anteflexion of the uterus?
What can Retroversion and/or retroflexion of the uterus cause?
- Anteflexion of the uterus (flexion related to fundus):
- The adult uterus is bent forward on itself at about the level of the internal os to form an angle of 170°
- Flexion of the uterus is the relationship between the body of the uterus (fundus) and the cervix of the uterus
- Most women have anteflexion of the uterus
- Anteversion of the uterus (version related to vagina):
- The axis of the cervix forms an angle of 90-95° with the axis of the vagina
What are 2 other names for the round ligament of uterus?
What is the round ligament of the uterus a remnant of?
What structures does it pass through?
What is the role of the round ligament of the uterus?
- 2 other names for the round ligament of uterus:
1) Ligamentum teres
2) Ligamentum rotundum - The round ligament is a remnant of the lower part of gubernaculum
- It passes within the broad ligament from the cornu of the uterus through the inguinal canal to the labia majora
- Together with the broad ligament, round ligament of the uterus holds the uterus anteverted & anteflexed over the bladder
What are 2 other names for the round ligament of uterus?
What is the round ligament of the uterus a remnant of?
What structures does it pass through?
What is the role of the round ligament of the uterus?
- 2 other names for the round ligament of uterus:
1) Ligamentum teres
2) Ligamentum rotundum - The round ligament is a remnant of the lower part of gubernaculum
- It passes within the broad ligament from the cornu of the uterus through the inguinal canal to the labia majora
- Together with the broad ligament, round ligament of the uterus holds the uterus anteverted & anteflexed over the bladder
What is he broad ligament of the uterus formed by?
How is it formed?
What 6 structures are contained within the broad ligament of the uterus?
- The broad ligament of the uterus is formed by 2 layers of peritoneum
- The peritoneum drapes over the bladder & then the uterus, uterine tube & ovarian ligaments to form the broad ligament from the uterus to the lateral pelvic wall
- 6 structures are contained within the broad ligament of the uterus:
1) Ovarian ligament
2) Uterine tubes
3) Uterus
4) Round ligament of uterus
5) Ureter
6) Vessels and nerves of the ovaries and uterus
What are the 3 parts of the broad ligament of the uterus?
- 3 parts of the broad ligament of the uterus:
1) Mesosalpinx: Part of the broad ligament surrounding the uterine tube
2) Mesovarium: Part of the broad ligament suspending the ovaries
3) Mesometrium: Part of the broad ligament adjacent to the uterus
What structures is the uterus supported by?
What are the ligaments derived from?
What can weakness in these structures lead to?
- Since the uterus is above the pelvic floor, it is supported by muscles of the pelvic floor (especially levator ani) and ligaments
- These ligaments are derived from fascia
- Weakness of these ligaments & the pelvic floor muscles may lead uterus to prolapse
What does the fasciae that forms the supporting ligaments of the uterus collectively form together?
What are the 5 supporting ligaments of the uterus?
- The fasciae that forms the supporting ligaments of the uterus meet & fuse as the organs pierce the pelvic floor forming the tendinous arch of pelvic fascia adjacent to the organs & running from pubis to sacrum
- 5 supporting ligaments of the uterus:
1) Uterosacral
2) Cardinal
3) Uterocervical
4) Pubocervical
5) Sacrocervical
What is the length of the vagina?
Where does it extend between?
What structures does it lie anterior and posterior to?
What are its walls in contact with?
What structure is embedded in the vaginas anterior wall?
Does the vagina contain glands?
What are Döderlein bacilli?
Where are they found?
What substance do they act on?
What is the purpose of this?
What can happen to Döderlein bacilli when antibiotics are taken?
- The vagina is about 10cm in length
- It extends from the cervix to vaginal vestibule
- It lies anterior to the rectum, posterior to the bladder
- The vaginas anterior & posterior walls are in contact with each other
- The urethra is embedded in its anterior wall
- Vagina does not contain glands but has Döderlein bacilli
- Döderlein bacilli are lactobacilli that are found in the normal vaginal flora
- They convert glycogen stored in vaginal epithelial cells into lactic acid
- This allows for the vagina to be rid of other bacteria
- When antibiotics are taken, this can kill Döderlein bacilli, leading to vaginitis or thrush
How are fornices formed?
What is the posterior fornix related to?
What can the posterior fornix be used to access?
- The cervix pushes into the vagina forming the fornix (plural - fornices)
- The posterior fornix is related to the rectouterine pouch (of Douglas) – the deepest part of the pelvic cavity
- The fornices are distensible, and the peritoneal cavity may be accessed via the posterior fornix via a speculum
What 2 structures does the ureter pass in the vagina?
What can happen to the ureter in a hysterectomy?
- The ureter passes inferior to the uterine artery & lateral to the lateral fornix (water under the bridge analogy)
- In performing a hysterectomy, the ureter may be accidentally divided while clamping the uterine vessels
How large is the female urethra? What structures does the urethra pass through?
Where does the urethra open in relation to the vagina?
Where does the periurethral glands open into?
What structures are homologous to the prostate?
- The female urethra is 4 cm long & 6 mm wide
- The urethra Passes through deep perineal pouch (compartment) with external urethral sphincter around, then the perineal membrane & then the superficial perineal pouch (compartment)
- The urethra opens immediately anterior to the vagina
- The Periurethral glands opens into urethra
- Paraurethral glands & ducts in distal urethra are homologous to the prostate
What are the 2 types of para-urethral glands?
What do they secrete?
Where are they located?
What is their purpose?
What is para-urethral glands homologous to?
- 2 types of para-urethral glands:
1) Lesser vestibular glands
2) Skene glands - They are tiny mucous-secreting glands
- The para-urethral glands are located at either side of the urinary meatus
- Their purpose is to keep vestibule lubricated during intercourse
- They are homologous to the prostate
What is the arterial supply of the 3 female internal genital organs?
- Arterial supply of the 3 female internal genital organs:
1) Ovary
* Ovarian artery (arises from aorta at L2)
2) Uterine tube
* Tubal branches from the ovarian and uterine arteries
3) Uterus
* Uterine artery
What is the venous drainage of the 3 female internal genital organs?
- Venous drainage of the 3 female internal genital organs:
1) Ovary
* Ovarian plexus to ovarian veins to left renal vein or inferior vena cava
2) Uterine tube
* Ovarian veins and uterovaginal venous plexus
3) Uterus
* Uterovaginal plexus to uterine veins to internal iliac veins
Describe the lymphatic drainage of the following female internal genital organs:
1) Ovary
2) Uterine tube
3) Uterus & proximal vagina
4) Distal vagina
5) Urethra
- Lymphatic drainage of the following female internal genital organs:
1) Ovary
* The para-aortic (lumbar) lymph nodes
2) Uterine tube
* Para-aortic (lumbar) but may also pass to superficial inguinal
3) Uterus & proximal vagina
* Internal iliac nodes
4) Distal vagina
* Deep & superficial inguinal nodes
5) Urethra
* External & internal iliac + deep & superficial inguinal nodes
Describe the pain sensation supply in the following vaginal structures:
1) The ovary and distal uterine tube
2) Proximal uterine tube and uterine body
3) Uterine cervix & proximal vagina:
4) Distal vagina
Which structures are above and below the pelvic pain line?
Where is pain in each structure referred to?
- Pain sensation supply in the following vaginal structures:
- Above the pelvic pain line:
1) The ovary and distal uterine tube
* Sympathetics from T10-11
* Pain referred to the peri-umbilical region
2) Proximal uterine tube and uterine body
* Sympathetics from T12-L2
* Pain referred to the suprapubic region
- Below the pelvic pain line:
3) Uterine cervix & proximal vagina
* Parasympathetics from S2-4
* Pain felt deeply in the pelvis
4) Distal vagina
* Somatic pudendal nerve (S2-4)
What are the female external genitalia collectively referred to as?
What are the 9 parts of the external female genitalia?
- The female external genitalia are collectively referred to as the vulva
- 9 parts of the external female genitalia:
1) Surround the vaginal orifice
2) Mons pubis
3) Labia majora
4) Labia minora
5) Clitoris
6) Vaginal vestibule
7) Hymen
8) Vestibular bulbs
9) Greater vestibular gland
What are the labia majora made from?
Which layer of the perineum are they formed from?
What structure does it enclose?
Where ligament is attached?
What is the labia majora the homologue to?
- The labia majora is made from skin folds that stretch from the mons pubis to perineum
- The labia majora is mainly fatty (superficial) layer of subcutaneous tissue of the perineum
- It encloses the pudendal cleft
- The round ligament of uterus is attached to the labia majora
- It is the homologue of scrotum
Where is the labia minora (Nymphae) located?
What is it located posterior to?
What structure does it surround?
What is it a homologue to?
- The labia minora (Nymphae) is medial to the labia majora
- It is located posteriorly from the posterior labial commissure or fourchette
- The Labia minora (Nymphae) surrounds the vaginal vestibule
- It is the homologue of penis skin
What 2 structures are located on the vaginal vestibule?
What does the hymen consist of?
What are the 4 different ways the hymen can perforated?
Why is this perforation required?
- 2 structures are located on the vaginal vestibule:
1) Urethral opening
2) The vaginal opening - The hymen consists of a thin mucosal fold
- 4 different ways the hymen can be perforated
1) Annular
2) Semilunar
3) Septate
4) Cribriform - This perforation is required, otherwise menstrual blood wouldn’t be able to flow
What type of tissue is the clitoris?
Where is it located?
What 3 structures does the clitoris consist of?
What is it hooded by?
What is the clitoris the homologue of?
What type of tissue is the Bulb of the vestibule?
What muscle is it covered by?
- The clitoris is a cavernous tissue
- It is located at the anterior junction of the labia minora
- 3 structures the clitoris consists of:
1) 2 crura
2) Body
3) Glans (head) - The clitoris is hooded by the prepuce of the clitoris
- The clitoris is the homologue of penis, but without urethra
- The bulb of the vestibule is vascular erectile tissue
- It is covered by bulbospongiosus muscle
What is another name for the greater vestibular gland?
Where is it located? What muscle is it covered by?
Where does it drain into?
What is the function of the greater vestibular gland?
What is the for the greater vestibular gland the homologue of?
What pathologies can arise in the greater vestibular gland?
- The greater vestibular gland is also known as Bartholin’s gland
- It is located Posterior to the end of the vestibular bulb
- It is covered by the bulbospongiosus muscle
- The greater vestibular gland drains into the vestibule
- It secretes mucus for lubrication during sexual arousal
- The greater vestibular gland is the homologue of bulbourethral gland in males
- The greater vestibular gland May be the site of painful cyst or abscess formation
MRI scan of vagina
