5) The Female Reproductive System Flashcards
How do the ovaries arise?
Develop within mesonephric ridge
Female gonads
Describe the decent of the ovaries
Descend through abdomen, stop in pelvis
Inferior pole of ovary connected by gubernaculum to labioscrotal folds
Mesonephric ducts fuse to form uterus, stops ovaries descent
How large are the ovaries & what is their function?
Almond shaped & sized
Oocyte development
Production of reproductive hormones
How are the ovaries suspended?
Short ovarian ligament, tethers ovary to uterus
Lies medially within mesovarium (short peritoneal fold)
What surrounds the ovaries?
Tunica albuginea
which is covered by a smooth layer of ovarian mesothelium
What is the arterial supply of the ovaries?
Abdominal aorta > Ovarian artery
What is the venous drainage of the ovaries?
Asymmetrical
Right ovarian vein > Inferior vena cava
Left ovarian vein > Left renal vein > Inferior vena cava
What is the lymphatic drainage of the ovaries?
Para-aortic nodes
What are the 4 main components of the uterus
Uterine tubes
Fundus
Body
Cervix
What are the relationships of the uterus?
Uterovesical pouch anteriorly
Rectouterine (Pouch of Douglas) posteriorly
Posterior fornix of vagina
What are the layers of the uterus?
Peritoneum - serous membrane covers the uterus
Myometrium - smooth muscle uterine wall
Endometrium - internal mucous membrane, lines the uterine cavity
What are the differences between the two layers of endometrium in the uterine cavity?
Stratum functionalis - superficial layer, subject to cyclical growth, degeneration & shedding of dead tissues
Stratus basalis - deep layer, no cyclical changes, responsible for regeneration of upper endometrium
What happens during the proliferative phase of the endometrium?
Oestrogen secreted during folliculogenesis stimulates growth & proliferation of endometrium
What happens during the secretory phase of the endometrium?
After ovulation the CL secretes progesterone
Stimulates endometrial glands to secrete glycogen
Causes extensive coiling of glands, enriching vascular supply to mucous membrane
Describe the position of the uterus
AnteVerted in relation to the Vagina
AntefleXed in relation to the cerviX
What are the 4 main ligaments of the uterus and ovary?
Broad ligament
Round ligament of uterus
Ovarian ligament
Suspensory ligament of ovary
What is the broad ligament of the uterus?
Double layer of peritoneum (mesentery)
Extends from sides of uterus to lateral walls & floor of pelvis
Comprised of the mesentary of the uterus, uterine tube & ovary
Assists in keeping the uterus in position
What 3 regions can the broad ligament be divided into?
Mesometrium
Mesovarium
Mesosalpinx
What is the round ligament of the uterus?
Embryological remnant of the gubernaculum
Attached to ovary & labium majus
Travels through inguinal canal
What is the lymphatic drainage of the fundus of the uterus?
Aortic nodes
embryological derivation
Name the sections of the uterine (Fallopian) tubes
Ovary Fimbria (finger-like projections) Infundibulum Ampulla Isthmus (narrow) Uterine cavity
What is the function of the cervix?
Allow sperms to enter uterine cavity to proceed to site of fertilisation
Protect the uterus & upper genital tract from bacterial invasion
Describe the structure of the cervix
2 regions - endocervix & exocervix
Endocervix - tall columnar ep., basally placed nuclei, cytoplasm filled with mucus
Mucosa contains large glands with mucus-secreting columnar cells
Exocervix - stratified squamous non-keratinised ep.
Remainder of cervix smooth muscle & dense c.t.
What is the transformation zone in the cervix?
Abrupt change from columnar to stratified squamous non-keratinised epithelium
Majority of neoplasms form here
What is the arterial supply to the uterus?
Abdominal aorta > Common Iliac > Anterior division of Internal Iliac > Uterine artery
What does the saying “water under the bridge” refer to?
The ureter (water) passes inferiorly to the uterine artery (bridge)
What is the venous drainage of the uterus?
Uterine venous plexus > Uterine veins > Internal Iliac vein > Common Iliac vein > IVC
What is the lymphatic drainage of the uterus?
Fundus > Aortic nodes
Body > External iliac nodes
Cervix > External & Internal iliac nodes & sacral nodes
What are the 3 layers comprising the walls of the vagina?
Mucous membrane
Muscular coat
Fibrous connective tissue layer, adventitia
Describe the mucous membrane of the vagina
Stratified squamous epithelium
Underlying lamina propria - dense c.t. with papillae projecting into the covering ep.
Lamina propria becomes looser towards the muscular layer & has large veins here
How is the vagina lubricated?
No glands in the vagina
Mucus lubricating it originates from the cervical glands
Describe the muscular layer of the vagina?
Smooth muscle bundles arranged circularly & longitudinally
Longitudinal bundles are numerous in the outer half of the muscle layer
What are the vaginal fornices?
Anterior & posterior fornix
Recesses of vagina around the cervix
What is the arterial supply to the vagina?
Abdominal aorta > Common Iliac > Internal Iliac > Anterior division of Internal Iliac > Uterine > Vaginal artery
Middle & Inferior parts of vagina:
Abdominal aorta > Common Iliac > Internal Iliac > Anterior division of Internal Iliac > Pudendal artery
What is the venous drainage of the vagina?
Vaginal plexus > Vaginal vein > Uterine vein > Internal Iliac vein > Common Iliac vein > IVC
Describe the innervation of the uterus & vagina
Inferior 1/5 of vagina - somatic innervation, Pudendal nerve (S2-4)
Superior 4/5 vagina & uterus - innervation from uterovaginal plexus
How do pain afferents in the uterus & vagina vary?
Depend on pelvic pain line
Above line - Pain refers back up
Below line - Local pain
Where do tumours of the ovary usually arise from?
Epithelial components
Germ cells
What are ovarian cysts and how do they develop?
Fluid-filled sacs that develop on a woman's ovary Usually derived from follicles Polycystic ovaries (>10 cysts) usually associated with infertility
What is salpingitis?
Inflammation of the uterine tube causes by microorganisms
Fusions or adhesions of mucosa
Partially/Completely block lumen - infertility
May result in ectopic pregnancy
What is endometriosis?
Condition in which ectopic endometrial tissue is dispersed to various sites along peritoneal cavity & beyond (e.g. near umbilicus)
Ovaries/attachments of uterus associated
Dysmenorrhoea, infertility or both
What is an endometrial carcinoma and where can it take place?
Malignancy of the endometrium Cervix Usually postmenopausal women Junction - columnar cells of endocervix & squamous exocervix (transformation zone) Abnormal uterine bleeding
What happens during a cervical examination?
Use of a speculum to isolate the external os of cervix
What is a bimanual examination?
2 fingers inserted into vagina until they isolate the cervix
Test of cervical motion tenderness (sign of PID)
Examiner palpates uterus
What are the Bartholin glands (greater vestibular glands)?
Pea sized glands
Located slightly posterior and to the left and right of the opening of the vagina
Secrete mucus (slight vaginal lubrication)
What irregularites can happen to the greater vestibular glands?
Bartholinitis (infection/inflammation)
Bartholin Gland Cyst (duct of gland blocked)
What bacteria is present in the vagina & what is its function?
Lactobacillus
Normal vaginal flora
Utilise glycogen as a substrate for lactic acid production
Maintains low pH environment
What is the technical term for inflammation of the vagina?
Vaginitis
What is vaginismus?
Condition making any sort of vaginal penetration (sex, tampons) painful or impossible
Reflex of pubococcygeus muscle
Where can an ectopic pregnancy take place?
Anywhere but body of uterus
Describe the peritoneal cavity in the female
Peritoneal cavity is open via the ostium of the uterine tube
Potential route of infection
