Female Reproductive Anatomy Flashcards
development of female reproductive anatomy
*Mullerian ducts fuse to form uterus & top of vagina
note - urinary, reproductive, and GI tracts develop in close proximity; often pathophysiology in one organ produces symptoms in neighboring organs
female external genitalia: perineum
*the area between the anus and vulva, rich in sensory nerve endings & vascularity that are important in providing sexual arousal
*no valves in vulvar veins
*clinical implications:
-rapid healing
-common hematomas related to birth trauma
-infection is rare
female external genitalia: vulva
*collective term for the female external reproductive sex organs
*includes: mons pubis, labia majora, labia minora, clitoris, urethra, vaginal introitus, and surrounding glands
*boundaries extend from:
-mons pubis anteriorly to rectum posteriorly
-one lateral genitocrural fold to the other
female external genitalia: mons pubis
*a layer of fatty tissue over the pubic symphysis of the pubic bone
female external genitalia: clitoris
*a homologue of the dorsal part of the penis
*consists of 2 erectile corpora cavernosa that end in the glans
*surrounded by a hood/prepuce (extension of labia minora) and covered by stratified squamous epithelium
*highly sensitive and a source of sexual pleasure, enlarging in response to nerve stimulation
female external genitalia: vestibule
*contains the vaginal and urethral openings
*covered by stratified squamous epithelium
*includes 2 types of glands:
1. Bartholin’s glands
2. vestibular glands
female external genitalia: labia majora
*2 cutaneous folds that extend from the mons pubis to the perineum
*covered with squamous epithelial cells (like the rest of the body’s skin)
*made of adipose and fibrous tissue
*lined with hair follicles & sebaceous glands
*have to treat as deep as 3mm for VIN in this area, due to deep hair follicles
female external genitalia: labia minora
*2 flaps located on each side of the vaginal opening
*lined by squamous epithelium, but lack hair and sebaceous glands
*made of dense connective tissue, erectile tissue, and elastic fibers (no adipose tissue)
female external genitalia: hymen
*thin and typically perforated layer at entrance to vagina
*fibrous tissue with few small blood vessels
*small tags are remnants of hymen in adult/sexually active females
note - imperforate hymen = defect in vaginal canalization
female external genitalia: urethra
*extends from bladder to vestibule
*composed of stratified transitional epithelium proximally and stratified squamous epithelium distally
female external genitalia: lesser vestibular glands
*aka Skene glands
*open into distal urethra
*homologous to prostate in males
*smaller and more numerous mucous glands
female external genitalia: Bartholin Glands
*aka greater vestibular glands
*two tubuloalveolar mucous glands at 4 o’clock and 8 o’clock at vaginal orifice
*about the size of a pea
*homologous to Cowper glands in male
*most common large cyst of the vulva arises from this structure
female external genitalia: vestibular bulbs
*erectile tissue on either side of vaginal orifice
*homologous to bulb of the penis
female external genitalia: pelvic floor
*the levator ani is a collection of 3 muscles:
1. puborectalis
2. pubococcygeus
3. iliococcygeus
*physiologically, normal levator ani muscles are in a constant state of contraction
*with increases in intra-abdominal pressure, the levator ani contract more to support the pelvic viscera
*if they are not strong enough, the anatomic position of the urethra, vagina, and rectum are not maintained
female internal genitalia: vagina
*a muscular tube that connects the external female genitalia to the uterus
*line with non-keratinizing squamous epithelium
*goes posteriorly with the uterus laying almost horizontally and at least 90 degrees between uterus and vagina
female internal genitalia: vaginal arteries
*mostly symmetrical, coming in laterally and anastomosing in the center
*anterior divisions of the interior iliac arteries supply most of the blood to the uterus, cervix, and vagina
*vaginal artery is usually a branch of the uterine artery
female internal genitalia: lymphatic drainage of vagina
*drains to the internal iliac and superficial inguinal nodes
vagina - pH and lubrication
*vagina has low pH due to bacterial metabolism of glycogen in sloughed cells from walls, resulting in lactic acid accumulation
*lubrication: transudate from increased vascular flow of Bartholin’s glands, cervical glands during intercourse
vaginal support
*vagina does not have any intrinsic support; reliant on ligaments, organs, and muscles to hold it in place
*level 1: uterosacral ligaments to pelvic walls
*level 2: fascial support
*level 3: urethra, levator ani muscles, and perineal body
female internal genitalia: cervix
*the lowest, narrow portion of the uterus which attaches to the vagina
*portio vaginalis: the portion that sticks into the vagina; covered by squamous epithelium
*cervical canal:
1. external os: narrowing off the vagina, at the lower portion of the cervical canal
2. internal os: narrowing at the top of the cervical canal
*columnar epithelium covers glandular tissue (secretes mucus, facilitating sperm transport)
histology of the cervix
*transition from squamous (ectocervix) to columnar (endocervix) epithelium at the SCJ (squamo-columnar junction or transformation zone)
*squamocolumnar junction (transformation zone) is most common site for cervical cancer
*columnar epithelium is in the cervical canal; useful for secreting mucous and facilitating sperm transport
vascular supply of the cervix
*cervix has its major vessels at 3 and 9 o’clock
*uterine arteries → cervical arteries
*numerous anastomoses with vaginal and middle hemorrhoidal arteries
lymphatic drainage of the cervix
*lymph drainage nodes:
-internal iliac
-common iliac
-external iliac
-obturator
-visceral nodes of parametria
innervation of the cervix
*parasympathetic fibers of S2-S4
*exocervix has less pain sensors than endocervix
female internal genitalia: uterus
*shaped like an inverted pear
*the non-gravid uterus consists of body and cervix, demarcated by a relatively narrow isthmus
*fundus = portion above the uterine tubes
*uterus has a trilaminar wall consisting of:
1. inner vascular and secretory endometrium
2. a hormonally-stimulated intermediate smooth muscle myometrium
3. outer visceral peritoneum (perimetrium)
layers of the uterus: endometrium
*the inner layer of the uterus
*composed of simple columnar epithelium, endometrial glands, and stroma (connective tissue)
*vascular & secretory
*undergoes cyclical changes to prepare for implantation to occur; sheds with menstruation if implantation does not occur
layers of the uterus: myometrium
*a hormonally-stimulated intermediate smooth muscle layer
*dilates the cervical canal and expels the fetus during childbirth
layers of the uterus: perimetrium
*visceral peritoneum that covers the surface of most of the fundus and body of the uterus and continues bilaterally as the broad ligament (mesometrium)
uterus support
*uterus is normally anteverted and anteflexed, so that its weight is borne largely by the urinary bladder
*receives significant passive support from cardinal ligaments and uterosacral ligament
*receives active support from the muscles of the pelvic floor
vascular supply & drainage of the uterus
*blood supply: uterine arteries & ovarian arteries
*venous drainage: uterine & ovarian veins
lymphatic drainage of the uterus
*lymphatic drainage nodes:
-aortic
-lumbar
-pelvic
-internal iliac
innervation of the uterus
*afferent nerves: T11, T12
*sympathetic: ovarian and hypogastric plexus
*parasympathetic: pelvic nerve, S2-S4
relationships between rectum, uterus/vagina, and bladder
*vesicouterine pouch - anterior
*rectouterine pouch (of Douglas) - posterior; deepest point of peritoneal cavity
uterine (fallopian) tubes
*the conduits & sites of fertilization for oocytes discharged into the peritoneal cavity
*connect the ovaries to the uterus
*3 portions:
1. isthmus - closest to the uterus
2. ampulla
3. infundibulum (fimbriated, funnel-like) - closest to the ovary
vascular supply of uterine (fallopian) tubes
*ovarian and uterine arteries
uterine (fallopian) tubes - histology
*ciliated columnar to help transport oocyte
ovaries - overview
*sit at the end of each uterine (fallopian) tube
*within ovarian follicles, differentiation of an embryonic ovum into a mature ovum ready for fertilization takes place (oogenesis)
support of the ovaries
*suspended by peritoneal folds: the mesovarium from the posterosuperior aspect of the broad ligament, the ovarian ligament which connects it to the uterus, and the suspensory ligament
vascular supply of the ovaries
*ovarian arteries & uterine arteries
venous drainage of the ovaries
- right ovarian vein drains directly into IVC
- left ovarian vein drains into left renal vein before draining into IVC
lymphatic drainage of ovaries
*para-aortic lymph nodes
female pelvic ligaments: broad ligament
*connects: uterus to lateral pelvic wall
*structures contained: ovary, fallopian tube, round ligament
*notes: fold of peritoneum comprising the mesometrium, mesovarium, and mesosalpinx
female pelvic ligaments: round ligament
*connects: uterine horn to labia majora
*notes: travels through inguinal canal; derivative of gubernaculum
female pelvic ligaments: cardinal ligament
*connects: cervix to lateral pelvic wall
*structures contained: UTERINE VESSELS (uterine artery/vein)
*notes: condensation at the base of the broad ligament; uterine vessel ligation during hysterectomy risks damaging the URETER (water under the bridge)
female pelvic ligaments: uterosacral ligament
*connects: cervix to sacrum around each side of rectum
female pelvic ligaments: suspensory / infundibulopelvic ligament
*connects: ovary to lateral pelvic wall
*structures contains: ovarian vessels (ovarian artery)
*notes: ovarian vessel ligation during oophorectomy risks damaging the ureter
ureters - anatomically narrow sites
*sites that are anatomically narrowed (easier for stones to get caught):
1. ureteropelvic junction
2. crossing of the external iliac artery
3. passing through the bladder wall
ureters - at-risk surgical sites
- where the ovarian vessels lie just lateral to the ureter
- where the ureter passes inferior to the uterine vessels (water under the bridge)
- where the ureter lies 1 cm lateral to the cervix
female reproductive system - anatomic abnormalities
- absence of ovary
- ectopic ovarian tissue
- absence of uterus - due to degeneration of Mullerian ducts
- failure of Mullerian duct fusion
- absence of vagina - due to failure of vaginal plate development
- vaginal atresia - due to failure to canalize (source of imperforate hymen)
arterial supply of the female reproductive organs (general)
*anterior branch of the internal iliac artery supplies most of the female reproductive organs
*uterine artery (branch of anterior internal iliac) supplies most of the uterus
*ovarian arteries (descended from the abdominal aorta) supply the ovaries
which ligament in the female pelvis contains the UTERINE vessels (artery & vein)?
CARDINAL ligament
*connects cervix to lateral pelvic wall
note - uterine vessel ligation during hysterectomy risks damaging the URETER (water under the bridge)
which ligament in the female pelvis contains the OVARIAN vessels (artery & vein)?
SUSPENSORY ligament (aka infundibulopelvic ligament) of the ovary
*connects ovary to lateral pelvic wall
