Female and Male genitalia Flashcards
greater pelvis
-includes:
-pelvic brim and
-ilium of the hip bones
lesser pelvis
-true pelvis
-inlet
-pelvic cavity
-obturator internus
pelvis structure: male vs female
-male:
-thicker and heavier
-greater pelvis is deeper
-lesser pelvis is narrow and deep
-pelvic inlet (superior pelvic aperture)- heart shaped
-pelvic outlet (inferior pelvic aperture)- comparatively small
-pubic arch and subpubic angle (degree)- narrow (<70 degrees)
-obturator foramen- round
-acetabulum- large
-female:
-thinner and lighter
-greater pelvis is shallow (child birth)
-lesser pelvis is wide and shallow
-pelvic inlet (superior pelvic aperture)- oval or rounded
-pelvic outlet (inferior pelvic aperture)- comparatively large
-pubic arch and subpubic angle (degree)- wide (>80 degrees)
-obturator foramen- oval
-acetabulum- small
female pouches
-vesico-uterine pouch
-recto-uterine pouch -> rectovesical pouch in males
pelvic floor muscles
-3 walls:
-antero-inferior wall
-lateral walls
-posterior (posterosuperior) walls
-pelvic floor:
-levator ani -> puboprostaticus, pubovaginalis, puborectalis, pubococcygeus, iliococcygeus
-coccygeus
-obturator internus
-piriformis
autonomic nerves of pelvis
-pelvis has 4 roots/routes
-sacral sympathetic trunks- sympathetic
-hypogastric plexuses- sympathetic
-pelvic splanchnic nerves- parasympathetic
-periarterial plexuses- sympathetic
pelvic arteries and veins
-arteries:
-internal iliac arteries: anterior and posterior division
-ovarian arteries- off aorta
-median sacral artery
-superior rectal artery
-veins:
-internal iliac veins
-ovarian veins- feeds back into left renal
-medium sacral vein
-superior rectal vein
-internal vertebral venous plexus
lymphatic drainage of pelvic
-4 primary groups:
-external iliac lymph nodes-
-internal iliac lymph nodes
-sacral lymph nodes
-common iliac lymph nodes
-highly interconnected -> many can be removed without disturbing drainage -> BUT can allow cancer to spread from pelvis and into abdomen
female lymphatic drainage
-lumbar nodes- gonads, common iliac nodes -> ovary, uterine tube, fundus of uterus
-inferior mesenteric- superior rectum, sigmoid, descending, pararectal nodes
-internal iliac- base of bladder, inferior pelvic ureter, anal canal above pectinate line, inferior rectum, middle and upper vagina, cervix, body of uterus
-externa iliac- anterosuperior pelvis -> superior bladder, upper vagina, cervix, lower body of uterus
-superficial inguinal- external genitalia/anus, outer skin, tip of uterus
-deep inguinal- clitoris
-sacral- inferior rectum and vagina
-pararectal- superior rectum
lymphatic drainage of male pelvis
-lumbar- urethra, testis, epididymis
-inferior mesenteric- top of rectum, sigmoid, descending, pararectal
-internal iliac- external and internal iliac lymph nodes
-external- prostatic urethra, prostate, base of bladder, inferior ureter, inferior seminal gland, cavernous bodies, anal canal above pectinate, inferior rectum
-superficial inguinal- perineum, skin of penis, scrotum, anus, anal canal inferior pectinate
-deep inguinal- glans penis, spongy urethra
-sacral- inferior rectum
-pararectal- superior rectum
male pelvis
-ductus (vas) deferens
-seminal glands
-ejaculatory ducts
-prostate
-bulbo-urethral glands- fluid production of mucous like secretion enters through urethra during arousal -> changes pH of urethra for fluid transmission
prostate
-walnut sized gland
-surrounds prostatic portion of urethra
-glandular portion- 2/3
-fibromuscular portion- 1/3
-dense fibrous capsule -> incorporates nerves and veins
-fibrous prostatic sheath
-ligaments that support prostate
-base that lies close to neck of bladder
-apex
-muscular anterior surface
-isthmus- lies anterior to urethra
-urethral sphincter muscle
-divided into right and left lobes
-prostatic ducts- lie on either side of seminal colliculus
-prostate produces fluid with 15-30% of volume being makeup of semen
manual exam of prostate
-for nodules or enlargement (hypertrophy)
-prostate palpated for changes in tissue consistency via rectum
autonomic innervation
-ductus deferens, seminal glands, ejaculatory ducts, and prostate -> richly innervated by sympathetic
-symp- ejaculation/orgasm
-parasympathetic- penile erection
-presynaptic parasympathetic fibers from S2-S4 spinal cord segments traverse pelvic splanchnic nerves which also join inferior hypogastric pelvic plexus
-somatic supply to musculature
female pelvis
-uterus - cervix
-walls of uterus (outer to inner)- perimetrium, myometrium, endometrium (lining)
-fallopian tubes
-ovaries
-vagina
ligament of ovary and round ligament of uterus
-ligament of ovary- attaches uterus posteroinferior to uterotubal junction
-round ligament of uterus- anteroinferiorly to uterotubal junction -> anchors anteriorly
-these ligaments are vestiges that have occurred during descent of ovary into developmental position
broad ligament of uterus and suspensory ligament
-broad ligament of uterus- double layer of peritoneum (mesentery) -> extends from sides of uterus to lateral wall and down to floor of pelvis -> centers uterus
-broad ligament gives lateral support*
-contain ovaries, uterine tubes, vasculature and related structures
-suspensory ligament of ovary- between layers of broad ligament and surrounds ovarian vessels
->conveys ovarian vessels, lymphatic and nerves that goes to ovary
cervix
-narrow inferior portion of uterus which protrudes into vagina and surrounds external os
-fibrous structure
-small amount of smooth and elastin
-uterus goes into cervix via internal os
relationships of the uterus
-peritoneum covers body of fundus of uterus anteriorly and superiorly BUT NOT cervix
-vesicouterine pouch- separates uterine body from urinary bladder (covered by peritoneum)
-no peritoneum between inferior uterus body (isthmus) / cervix and bladder -> direct connection -> cancer can spread
-rectouterine pouch- between uterine body, supravaginal part of cervix and rectum
blood supply to ovaries and uterine tubules
-arterial:
-ovarian arteries
-ascending branches of uterine arteries
-venous:
-pampiniform plexus of veins
-ovarian vein
uterine tubes
-fallopian tubes
-extend lateral from uterine horns
-open into peritoneal cavity near ovaries
-lies in the mesosalpinx of the free edges of the broad ligament
-position of tubes and ovaries is variable during stages of life
-often asymmetric
-4 parts:
-infundibulum- funnel shaped distal end, finger-like process called fimbriae, spread over medial surface of ovary
-ampulla- widest and longest part
-isthmus- thick walled, enters into uterine horn
-uterine- short intramural segment that passes through wall of uterus and opens through uterine ostium into uterine cavity
egg travel
-during follicular release the ovum or egg moves along fallopian tube -> enter into uterus
-fertilization - implantation into uterine wall
ovary
-almond shaped
-located near attachment of broad ligament to the lateral pelvic walls
-suspended from both by peritoneal folds -> mesovarium (posterosuperior aspect of broad ligament) and suspensory ligament of the ovary from the pelvic wall
-the ligament of ovary- attaches ovary to uterus
autonomic innervation of uterus, vagina, ovaries
-descend along the ovarian vessels from ovarian plexus and from uterine plexus
-visceral afferent pain fibers ascend retrogradely with sympathetic fibers of ovarian plexus and lumbar splanchnic nerves to cell bodies in T11-L1 spinal sensory ganglia
-visceral afferent reflex fibers follow parasympathetic fibers retrogradely through uterine and inferior hypogastric plexuses and pelvic splanchnic nerves to cell bodies in S2-S4 spinal sensory ganglia
male and female perineum artery supply
-internal iliac artery gives off -> internal pudendal ->
-internal pudendal -> inferior rectal and perineal
-terminal branch of perineal -> posterior scrotal or labial and artery of bulb of penis or vestibule
-terminal branches of internal pudendal -> deep artery of penis or clitoris and dorsal artery of penis or clitoris
-femoral artery -> external pudendal, superficial, and deep branches
muscle of perineum
-external anal sphincter muscle
-bulbospongiosus
-ischiocavernosus
-superficial transverse perineal
-deep transverse perineal
-external urethral sphincter
-pelvic outlet passes through perineum
anal triangle
-lies posterior to transverse line joining the anterior ends of ischial tuberosities
-contains anal canal and its orifice (anus)
urogenital triangle (UG)
-lies anterior to transverse line joining the anterior ends of ischial tuberosities
-contains the root of scrotum and penis in males
-contains vulva of females
perineal body
-irregular fibromuscular mass
-located in the medium plane between the anal canal and perineal membrane
-lies deep to skin with relatively little overlying subcutaneous tissue
-posterior to vestibule of vagina or bulb of penis
-anterior to anus and anal canal
-contains collagenous and elastic fibers and both skeletal and smooth muscle
-convergence of several muscles ->
-bulbospongiosus
-external anal sphincter
-superficial and deep transverse perineal
-smooth and voluntary slips of muscle from the externurethral sphincter
-levator ani
-muscular coats of the rectum
fascia of perineum
-perineal fascia -> consists of superficial and deep layers
-subcutaneous tissue of perineum = superficial perineal fascia -> consists of superficial fatty layer and membranous layer
-deep perineal fascia
superficial fatty layer of subcutaneous tissue of perineum
-female- fatty layer of subcutaneous tissue of perineum makes up labia majora and mons pubis -> continuation of the subcutaneous tissue through abdomen of campers fascia
-male- fatty layer is much less in the UG triangle replaced all together in the penis and scrotum with the smooth dartos muscle
membranous layer of perineal fascia
-aka colles fascia
-part of subq/superficial fascia
-continuous with membranous layer of subcutaneous tissue of abdomen continuous -> aka scarpas fascia
deep perineal fascia
-fused to suspensory ligament of penis or clitoris
-continuous with deep fascia covering the external oblique of the abdomen and rectus sheath
superficial perineal pouch- males
-contains:
-root of the penis (bulb and crura) and associated muscles
-proximal part of spongy urethra
-superficial transverse perineal muscles
-deep perineal branches of the internal pudendal vessels and pudendal nerves
superficial perineal pouch females
-contains:
-clitoris and associated muscles/neurovasculature
-bulbs of vestibule and surrounding muscle (bulbospongiosus)
-greater vestibular glands
-deep perineal branches of internal pudendal vessels and pudendal nerves
-superficial transverse perineal muscles
deep perineal pouch
-fat filled anterior recesses of the ischioanal fossa
-contains in both genders -> part of urethra and external urethral sphincter muscles
pudendal canal
-pudendal canal is passage within obturator fascia
-covers medial aspect of obturator internus muscle and lines lateral wall of ischioanal fossa
-internal pudendal artery, vein, pudendal nerve, and obturator internus nerve -> enter canal at lesser sciatic notch
-vasculature supply and drain the perineum
-pudendal nerve innervates most of the area
pudendal nerve
-2 branches -> superficial and deep
-superficial -> gives rise to posterior scrotal or labial branches
-deep -> supplies muscles of deep and superficial perineal pouches, skin of vestibule, and mucosa of inferiormost part of vagina
dorsal nerve of penis or clitoris
-primary sensory nerve serving the male or female organ
-especially the glans
scrotum
-fibromuscular sac
-contains testes and associated structures and inferior to pubic symphysis
-bilateral embryonic formation -> indicated by midline scrotal raphe
-scrotal raphe is continuous to ventral penis with penile raphe
-2 compartments- 1 for each testis by prolongated of dartos fascia -> septum of scrotum
-contents- testis and epididymis
scrotum blood supply, lymph, and innervation
-ANTERIOR scrotum- external scrotal arteries (terminal branches of external pudendal) AND posterior scrotal arteries (terminal branches of internal pudendal)
-also receives branches from cremasteric arteries (from inferior epigastric)
-drained by external pudendal veins
-superficial inguinal lymph nodes
-ANTERIOR- anterior scrotal nerves (from ilioinguinal) AND genital branches (from genitofemoral)
-POSTERIOR- posterior scrotal nerves (from superficial perineal branches of pudendal) AND perineal branch (of posterior femoral cutaneous)
male urethra
-starts at neck of bladder
-prostatic
-membranous- starts at apex of prostate and traverses deep perineal pouch -> which is surrounded by external urethral sphincter
-spongy urethra- begins at distal end of intermediate part of urethra and ends at the external urethral orifice
-lumen of spongy urethra expanded in bulb of penis to form intrabulbar fossa and in the glands of the penis to form navicular fossa
penis
-make organ of copulation
-outlet urine and semen
-root, body, glans penis
-3 cylindrical bodies of erectile cavernous tissue -> paired corpora cavernosa and single corpus spongiosum (ventral)
-corpus spongiosum- contains spongy urethra
-each cavernous body has fibrous outer covering-> tunica albuginea
-superficial to tunica albuginea is deep fascia of the penis -> aka buck fascia (continuation of deep perineal fascia that forms membranous covering of the corpora binding them together)
root of penis
-nonpendulous
-crura and bulb
-surrounded by ischiocavernosus and bulbospongiosus muscles
-in the superficial perineal pouch
-bulb of penis is penetrated by urethra
body of penis
-free part that is suspended from the pubic symphysis
-penis has no muscles (except for a few fibers of bulbospongiosus near root of penis and ischiocavernosus that embrace the crura of the penis)
-pendulous
-distal end- glans penis
-external urethral orifice- slit like opening of spongy urethra located near tip of glans
-thin skin and fascia of penis are prolonged as double layer of skin -> prepuce (foreskin)
-uncircumcised- covers glands to a variable extent
-frenulum of prepuce is median fold that passes from prepuce to urethral surface of glans
glans penis
-distal penis
-projects past the ends of corpora cavernosa to form -> corona of glans
-corona overhangs neck of glans
-neck of glans separates from body of penis
suspensory ligament of penis
-arises from deep fascia from pubic symphysis
-splits to form a sling that attaches to deep fascia of penis at junction of its root and body
-fibers are short and taught
vasculature and innervation of penis
-internal pudendal arteries
-erectile function
-blood from cavernous spaces of the corpora cavernosa is drained by venous plexus that becomes deep dorsal vein of penis
-S2-S4 innervation:
-dorsal nerve of penis (from pudendal)- sensory and sympathetic
-cavernous nerves- parasympathetic
mons pubis
-rounded, fatty eminence anterior to pubic symphysis, pubic tubercle and superior pubic rami
-pubic hairs are here
-fattiness varies throughout life
labia majora
-folds of skin that bound pudendal cleft (the slit between)
-each labium majus is filled with subcutaneous fat containing smooth muscle and termination of round ligament of uterus
-thicker anteriorly where they join to merge with anterior commissure
-posteriorly merge to form posterior commissure -> usually disappears after child birth
labia minora
-fat free, hairless
-core spongy connective tissue containing erectile tissue and many small blood vessels
-many sensory nerve ending
-enclosed in pudendal cleft within labial majora
-surround vestibule
-form 2 laminae: medial laminae unit to form frenulum of clitoris and lateral laminae unite to form prepuce of clitoris
-minora connect posteriorly by transverse fold -> frenulum of labia minora (fourchette)
clitoris
-erectile
-where minora meet anteriorly
-consists of root, cylindrical body, glans clitoris, tip of body
-root- 2 crura -> unite to form pendulous body that is attached to pubic symphysis by suspensory ligament
-crura are joined by anterior extensions of bulbs of vestibule -> form bulbo-clitoral erectile organ
-prepuce/hood of clitoris- covers
-supplied by dorsal arteries, veins, nerves
-glans clitoris- highly innervated with sensory nerve endings
vestibule
-surrounded by labia minora
-contains- urethra, vagina, ducts of greater and lesser vestibular glands
-paraurethral glands on either side of urethra
-hymencaruncles- remnants of hymen
bulbs of vestibule
-paired masses of elongated erectile tissue that lie along sides of vaginal orifice under bulbospongiosus muscles
-homologous with bulb of penis and corpus spongiosum
vestibular glands
-greater vestibular gland- bartholin gland -> bilaterally posterolateral to vagina -> secrete mucus into vestibule during sexual arousal
-lesser vestibular gland- smaller and between urethral and vaginal orifices -> secrete mucus into vestibule -> moistens labia and vestibule
supply to female genitals
-vulva- external and internal pudendal arteries / veins
-anterior labial nerves (from genital branch and ilioinguinal)
-pudendal nerve- perineum
-> posterior labial nerves
seminiferous tubules
-were sperm is created
-epididymis is where sperm is stored
-pampiniform plexus of veins
vas deferens
-meets with seminal vesicles (where semen is made)
-bulbourethral gland- makes alkaline environment for sperm survival
internal oblique/ Cremasteric muscle
-muscle that enters spermatic cord
-Cremasteric Reflex -stroke inside of thigh -> testes rise -> shows damage to cord
corpus cavernosus
-erection
-engorgement
-veins cant drain during erection
fornix
refers to the anterior (front) and posterior (back) recesses into which the upper vagina is divided. These vault like recesses are formed by protrusion of the cervix into the vagina.
fundus
-top of uterus
ovary
-maturation of ovum
-hormonal production
