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15. Reproductive > 5. The Female Reproductive System and Pelvic Floor > Flashcards

5. The Female Reproductive System and Pelvic Floor Flashcards

1
Q

How do the ovaries get to their anatomical location?

A

Develop within mesonephric ridge and descend through abdomen before stopping in the pelvis. The gubernaculum connects the inferior pole of ovary to labioscrotal folds and mesonephric ducts fuse to form uterus which stops descent of ovaries.

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2
Q

What are the ovaries?

A

Almond shaped and sized female gonads in which oocytes develop, they’re endocrine glands producing reproductive hormones.

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3
Q

What suspends the ovary?

A

A short peritoneal fold - mesoveraium.

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4
Q

What is within the mesovarium?

A

A short ovarian ligament which tethers the ovary to the uterus.

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5
Q

What is the ovarian ligament a remnant of?

A

Superior part of the ovarian gubernaculum.

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6
Q

Describe the capsule of the ovary.

A

The tunica albuginea of the ovary. It is covered with a smooth layer of ovarian mesothelium that has a dull, greyish appearance.

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7
Q

Why does the epithelium of the ovary become progressively scarred and distorted?

A

Repeated rupture of ovarian follicles and discharge of oocytes during ovulation.

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8
Q

What is the arterial supply of the ovaries?

A

Ovarian arteries which comes directly off the abdominal aorta.

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9
Q

What is the venous drainage of the ovaries?

A

It is asymmetrical by the left and right ovarian veins.
Right ovarian -> inferior vena cava.
Left ovarian -> left renal -> inferior vena cava.

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10
Q

What is the lymphatic drainage of the ovaries?

A

Para-aortic nodes.

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11
Q

What are the parts of the uterus?

A

Fundus, body, uterine tubes, and cervix.

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12
Q

What are the relationships of the uterus?

A

Uterovesical pouch anterior, rectouterine pouch/ pouch of Douglas posteriorly, posterior fornix of the vagina.

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13
Q

What is the uterus?

A

A thick-walled muscular organ covered by serous membrane - peritoneum.

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14
Q

What is the uterine cavity lined by internally?

A

Mucous membrane - the endometrium. This consists of tubular glands that extend from the surface into the stroma.

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15
Q

What is the stratum functionalis and what is its tissue cycle like?

A

It is the superficial part of the endometrium, function layer. It has cyclical growth, degeneration, and shedding of dead tissues, controlled by hormones.

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16
Q

What is the stratus basalis?

A

The deeper part of the endometrium, basal layer. It is responsible for regeneration of the stratum functionalis.

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17
Q

What is the action of oestrogen on the endometrium?

A

Stimulates growth and proliferation in the proliferative phase of endometrium.

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18
Q

What is the action of progesterone on the endometrium?

A

Stimulates endometrial glands to secrete glycogen and causes extensive coiling, enriching the vascular supply to the mucous membrane in the secretory phase.

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19
Q

What happens in the menstrual phase according to endometrium, hormones, and vascular supply?

A

Endometrium breaks down and there is degeneration of the upper endometrium, bleeding and shedding of dead tissues. The hormones withdraw as the luteolysis of the corpus luteum degenerates. Vascular changes lead to bleeding.

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20
Q

What is the position of the uterus?

A

Anteverted in relation to the vagina.

Antiflexed in relation to the cervix.

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21
Q

What is the broad ligament of the uterus?

A

A double layer of peritoneum that extends from the sides of the uterus to the lateral walls and floor of the pelvis.

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22
Q

What compromises the broad ligament?

A

Mesentery of the uterus, uterine tube, and ovary.

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23
Q

What does the broad ligament do?

A

Helps keep the uterus in position.

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24
Q

What is the round ligament?

A

The embryological remnant of the gubernaculum that is attached to the ovary and labium majus as well as travelling through the inguinal canal.

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25
Q

What is the lymphatic drainage of the fundus of the uterus and why?

A

To the aortic nodes, that’s where it’s embryologically derived from.

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26
Q

What is the uterine tube?

A

A muscular tube that is narrow medially and has a funnel-shaped abdominal opening near the ovary, the ostium. It’s margins are drawn into fimbria - extension of the infundibulum.

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27
Q

Where does the infundibulum extend?

A

Medially into an expanded intermediate segment - ampulla.

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28
Q

What is the function of the uterine tube?

A

Assists in transfer and transport of the ovum from the ovary to the uterus.

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29
Q

Why are ectopic pregnancies in the uterine tube a problem?

A

It has different epithelium from uterine cavity epithelium so doesn’t support pregnancy.

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30
Q

What is the cervix?

A

The fibromuscular neck which protrudes into the upper vagina and contains endocervical canal linking the uterine cavity with the vagina.

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31
Q

What is the function of the cervix?

A

To allow sperm deposited in the vagina at coitus to enter the uterine cavity to proceed to the site of fertilisation.

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32
Q

What are the two regions of cervix?

A

Endocervix and exocervix.

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33
Q

What is the endocervix lined with?

A

Tall columnar epithelium with basally placed nuclei and greater part of cytoplasm filled with mucus. Mucosa contain large glands lined with tall, mucus-secreting columnar cells.

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34
Q

What is the endocervix lined with?

A

Stratified squamous non-keratinised epithelium.

35
Q

What is the arterial supply to the uterus?

A

Uterine artery (abdominal aorta -> common iliac -> internal iliac -> anterior division -> uterine).

36
Q

How are the ureter and uterine artery anatomically related?

A

“Water under the bridge” - the ureter passes inferiorly to the uterine artery.

37
Q

What is the venous drainage of the uterus?

A

Via uterine venous plexus, merges to form uterine veins - tributaries of internal iliac vein.
Uterine venous plexus -> uterine -> internal iliac -> common iliac -> inferior vena cava.

38
Q

What is the lymphatic drainage of the uterus?

A

Fundus -> aortic nodes.
Body -> external iliac nodes.
Cervix -> external and internal iliac nodes and sacral nodes.

39
Q

What is the vagina?

A

Distensible muscular tube extending from vestibule of female genitalia to cervix of uterus.

40
Q

What are the layers in the wall of the vagina?

A

Mucous membrane, muscular coat, and fibrous connective tissue layer - adventitia.

41
Q

What does the mucous membrane of the vagina consist of?

A

Stratified squamous epithelium with underlying lamina propria composed of dense connective tissue which projects papillae in places covering epithelium.

42
Q

How does the lamina propria of the vagina change?

A

It gets looser towards the muscular layer and contains large veins here.

43
Q

Where does mucus lubricating the vagina come from?

A

Cervical glands.

44
Q

What is the structure of the muscular layer of the vagina?

A

Smooth muscle bundles arranged circularly and longitudinally.

45
Q

What are vaginal fornices?

A

Recesses of vagina around the cervix.

46
Q

What is the arterial supply of the vagina?

A

Superior part: arteries from uterine artery.
Middle and inferior parts: vaginal and internal pudendal arteries (branch off anterior division of internal iliac artery).

Abdominal aorta -> common iliac -> internal iliac -> anterior division -> uterine -> vaginal
Abdominal aorta -> common iliac -> internal iliac -> anterior division -> pudendal

47
Q

What is the venous drainage of the vagina?

A

Vaginal veins form vaginal venous plexus. Merge to form vaginal vein which drains into internal iliac veins via uterine vein.
Vaginal plexus -> vaginal -> uterine -> internal iliac -> common iliac -> inferior vena cava.

48
Q

What is the innervation of the uterus and vagina?

A

Inferior 1/5th of vagina - somatic innervation from pudendal nerve (S2,3,4)
Superior 4/5th of vagina and uterus - uterovaginal plexus.

49
Q

How does pain vary above and below the pelvic pain line?

A

Above - refers back up.

Below - local pain.

50
Q

What makes up female external genitalia?

A

Labia majora (encloses pudendal cleft), labia minora (encloses vestibule of vagina, bulbs of vestibule, clitoris), vestibule (orifices or urethra, vagina, and greater/Bartholin and lesser vestibular glands).

51
Q

What are two common clinical problems in the ovary?

A

Cysts from follicles - if 10+ then it’s polycystic ovaries -> infertility.
Tumours from epithelial components or germ cells.

52
Q

What is salpingitis?

A

Inflammation of the uterine tube from microorganisms causing fusions of adhesions of the mucosa so can partially/completely block its lumen -> infertility.

53
Q

What are the complications of salpingitis?

A

Infertility from blocked uterine tube lumen, ectopic pregnancy, implantation outside uterus.

54
Q

What is endometriosis?

A

Condition where ectopic endometrial tissue is dispersed to various sites along peritoneal cavity and beyond.

55
Q

What are the complications of endometriosis?

A

Severe period pain, infertility, or both.

56
Q

What is endometrial carcinoma?

A

Malignancy of the endometrium, usually in postmenopausal women and in transformation zone (between columnar cells of endocervix and squamous cells of exocervix).

57
Q

What is the major symptom of endometrial carcinoma?

A

Abnormal bleeding.

58
Q

What is bimanual examination?

A

Two fingers inserted into vagina until they isolate cervix then test cervical motion tenderness as examiner palpates uterus.

59
Q

What are two clinical problems in the greater vestibular glands/Bartholin glands?

A

Bartholinitis (infection/inflammation), and bartholin gland cyst (duct of gland becomes blocked -> cyst).

60
Q

What is lactobacillus?

A

Normal vaginal flora that utilises glycogen as a substrate for lactic acid production to keep a low pH environment in the vagina.

61
Q

What is vaginitis?

A

Inflammation of the vagina.

62
Q

What is vaginismus?

A

Painful vagina penetration due to reflex of pubococcygeus muscle.

63
Q

What is the relevance of peritoneal reflection in the female?

A

Peritoneal cavity is open via ostium of uterine tube so this is a potential route for infection to take.

64
Q

What forms the pelvic floor?

A

The pelvic diaphragm (bowel/funnel shaped, coccygeus and levator ani muscles, fascial covering on superior and inferior aspects of muscles) and superficial muscles/structures (anterior/urogenital perineum, posterior/anal perineum).

65
Q

Where is the pelvic diaphragm?

A

Within the lesser pelvis, separating the pelvic cavity from perineum.

66
Q

What is the urogenital diaphragm?

A

A triangular sandwich with striated muscle fibres between two layers of fascia - superior fascia, sphincter urethrae, inferior/superficial fascia.

67
Q

What is below the perineal membranes in males and both sexes?

A

Males: superficial transverse perineal membrane, bulbospongiosus muscle, ad ischiocavernosus muscle.
Both sexes: superficial perineal pouch (collection of urine if urethra ruptures).

68
Q

What is the posterior/anal perineum?

A

Compromises of anus, levator ani, and ischiorectal fossae. Forms a triangle between the ischial tuberosities and coccyx.

69
Q

What is the ischiorectal fossae?

A

A fatty fossa that can become infected. It has the pudendal nerve passing along the lateral wall.

70
Q

What are the levator ani?

A

Paired muscles forming three slings of muscles extending from the posterior aspect of the pubic bone, the fascia over obturator internus and ischial spines.

71
Q

What are the three slings of the levator ani?

A

Anterior fibres around the prostate or vagina, intermediate fibres around the rectum (puborectalis) and into the annococcygeal body (pubococcygeus), posterior fibres to the anococcygeal body and coccyn (iliococcygeus).

72
Q

Where is the coccygeus?

A

Posterior, overlying the sacrospinous ligament.

73
Q

What is the perineal body?

A

Pyramidal fibromuscular mass found at the junction between the urogenital and anal triangles.

74
Q

Where is the perineal body in males and females?

A

Males: between the bulb of the penis and anus.
Females: between the vagina and anus.

75
Q

What is the function of the perineal body?

A

For the integrity of the pelvic floor, anchors the perineal muscles and rectum.

76
Q

What attaches to the perineal body?

A

Anal sphincters, bulbospongiosus, superficial transverse perineal muscles, fibres of levator ani.

77
Q

What happens if the perineal body ruptures at birth?

A

It causes weakness in the pelvic floor, leading to prolapse of the vagina and uterus.

78
Q

How can perineal body rupture be avoided during labour?

A

Episiotomy (cut near the perineal body so it doesn’t rip itself).

79
Q

Which nerves, muscles, and ligaments can be stretched in pelvic floor damage?

A

Stretch pudendal nerve -> neuropraxia and muscle weakness.
Stretch and damage pelvic floor and perineal muscles -> muscle weakness.
Stretch/rupture of ligament support of muscles -> ineffective muscle action.

80
Q

What is a non-invasive way to treat pelvic floor dysfunction?

A

Pelvic floor muscle exercises, cures incontinence in 50-75% of patients.

81
Q

What is the purpose of continence surgeries?

A

Increase support to sphincter mechanism and prevent descent of bladder neck by colposuspension or tension-free vaginal tape.

82
Q

What are the side effects of continence surgeries?

A

Voiding difficulty/urinary retention, overactive bladder disease from obstruction.

83
Q

What are prolapse procedures?

A

They replace prolapsed organs and restore connective tissue support to maintain pelvic floor function.

84
Q

What are the side effects of prolapse procedures?

A

Recurrence, new incontinence, dyspareunia (painful sexual intercourse).

15. Reproductive (12 decks)

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