Female Reproductive Organs Flashcards
What are the functions of the uterus?
- Implantation
- Development and nourishment of fetus
- Childbirth
What are the functions of the ovary?
- Production of ovum
- Maintenance of menstraul cycle
Describe the shape/structure of the ovary?
- Almond-shaped
- 3 x 1.5 x 1 cm
- Smooth surface in young girls but scarred and pitted after puberty
Where is the ovary located?
- True intraperitoneal
- Located in ovarian fossa
- Attached to the back of the broad ligament by the mesovarium, supported by the ovarian ligament and suspensory ligaments
What is at risk during surgery of the ovary?
The ureter is at risk as it lies posterior to the ovary
Where does the obturator nerve lie in relation to the ovary?
Lateral
What anchors the ovary?
- Round (ovarian) ligament
- Supsensory (infundibulopelvic) ligament of the ovary
- Mesovarium
What is the round ligament of the ovary?
- Extends between cornu of uterus and ovary
- Keeps ovary close to uterus
- Remnant of upper part of gubernaculum
Where can ovarian disease refer pain to due to the obturator nerve’s position?
Medial thigh
What happens to the ovary after pregnancy?
Less stable and position is more varibale
What is the suspensory (infundibulopelvic) ligament of ovary?
- In the broad ligament
- Carries the ovarian blood vessels
What is the mesovarium?
- Short peritoneal fold that attaches to the ovary to the back pf the broad ligament
What are the areas of the fallopian tube from ovary in towards the uterus?
- Infundibulum
- Ampulla
- Isthmus
What are the finger-like projections called that pick up the ovum and into the fallopian tubes?
Fimbria
Where does fertilisation usually take place?
Ampulla
What cause the ovum to move towards the uterus?
- Cilia
- Circular and longitudinal smooth muscle peristaltic movements
Where do ectopic pregnancys usually take place?
Ampulla
Where is the uterus located?
Anterior to the rectum and posterosuperior to the urinary bladder
What are the 3 main parts of the uterus?
- Body
- Isthmus
- Cervix
Where is the fundus of the uterus located?
Superior to the corner of the uterus at the top of the body
WHere is the internal os located?
Isthmus
How can the cervix be divided?
- Supravaginal cervix
- Vaginal cervix
What is the uterine cavity?
Inside of uterus (tringular shaped)
What is the consistancy of the cervix like?
Changes
- Unpregnant cervix = firm, softened during pregnancy
What are the 2 openings of the cervical canal?
- Internal os (orifice)
- External os
What is the epithelium of the cervical canal?
Columnar epithelium
What is the boundary between the supravaginal and vaginal cervix?
squamocolumnar junction, cervical transformation zone external os opens up and becomes exposed after puberty , can be seen when ooking into vagina
What is the vaginal cervix also known as?
Ectocervix
What is the epithelium of the ectocervix?
Non-keratinizing stratified squamus epithelium, which contains glycogen
When can the columnar epithelia of the cervix become squamus?
Metaplasia can devolp into cervical intraepithelial neoplasia
What happens to the external os after someone has given birth?
Becomes slit-like instead of circular
What are the layers of the uterus from the outer layer to the innermost layer?
- Perimetrium
- Myometrium
- Endometrium
What layer of the uterus is thin visceral peritoneum?
Perimetrium
What are the layers of the myometrium?
Smooth muscle fibres arranges in 3 layers
- Longitudinal
- Spiral (figure of 8 around vessels)
- Circular -> sphincter around uterine tubes and internal orifice
What is the endometrium and whar are the layers?
Innermost layer of uterus
Mucous membrane and spiral arteries
- Basal (deep) layer (regenerates the functional layer)
- Functional (superficial) layer (shed as menses)
What happens if the basal layer is destroyed (eg in abortion)?
Woman becomes infertile is it cannot produce the functional layer
At what angle does the adult uterus sit?
- Bent forward on itself at about the level of the internal os to form an angle of 170 degrees, lies on superior surface of uterus (anteflexion of the uterus)
- Axis of cervix forms an angle of 90 degrees with the axis of the vagina (antevertion of the uterus)
What can retroversion and/or retroflexion cause?
Backache and difficulty in conception
What are the other names for round ligament of the uterus?
- Ligamentum teres
- Ligamentum rotundum
What does the round ligament pass through and where does it go to?
Passes within the broad ligament from the cornu of the uterus through the inguinal canal to the labia majora
What is the round ligament of the ovary a remnant of?
Upper part of gubernaculum
What ligaments hold the uterus anteverted and anteflexed over the bladder?
Round ligament of uterus and broad ligament
What is the broad ligament formed by?
- 2 layers of the peritoneum
- Peritoneum drapes over the bladder and then the uterus, uterine tube and ovarian ligaments from the uterus to the lateral pelvic wall
What is contained within the broad ligament?
- Ovarian ligament
- Uterine tubes
- Uterus
- Round ligament of uterus
- Ureter
- Vessels and nerves of the ovaries and uterus
What is the part of the broad ligament surrounding the uterine tube called?
Mesosalpinx
What is the part of the broad ligament surrounding the ovaries called?
Mesovarium
What is the part of the broad ligament adjacent to the uterus called?
Mesometrium
What are the supportive structures of the uterus?
- Supported by muscles of the pelvic floor (esp. levator ani) and ligaments
- The visceral and parietal fasciae meet and fuse as the organs pierce the pelvic floor forming the tendinous arch of pelvic fascia adjacent to the organs and running from pubis to sacrum
What are the “ligaments” derived from?
Visceral and parietal fascia
What can weakness of the ligaments and pelvic floor muscles result in?
Prolapse, urinary incontinance (common in menapausal women)
What are the supportive ligaments of the uterus?
- Cardinal (transverse cervical) ligament
- Uterosacral ligament
- Uterovesical ligament
- Pubocervical ligament
- Sacrocervical ligament
How long is the vagina?
~ 10 cm in length
WHere does the vagina lie?
Anterior to the rectum and posterior to the bladder
Where is the urethra located in the vagina?
Embedded in anterior wall of vagina
What bacteria does the vagina house and what does this result in?
Doderlein bacilli (lactobacilli) converts glycogen into lactic acid (making it acidic)
What does the cervix pushing into the vagina form?
The fornix
How may the peritoneal cavity be accessed?
Via the posterior fornix (it is distensible)
What is the posterior fornix related to?
Rectouterine pouch (of Douglas)
What is the relationship between the ureter and the uterine artery and lateral fornix?
Passes inferior to the uterine artery and lateral to the lateral fornix (“water under the bridge”)
What can be at risk during a hysterectomy?
Ureter may be accidentally divided while clamping the uterine vessels
How long and wide is the urethra?
- 4 cm long
- 6 mm wide
What are the paraurethral glands and ducts homologous to?
Prostate
What does the female uretha pass through?
- Deep perineal pouch (compartment) with external urethral sphincter around
- Then the perineal membrane
- And then the superficial perineal pouch (compartment)
Where does the urethra open?
Immediatelt anterior to the vagina
Where is the external urethral sphincter found?
- Deep perineal pouch
- Surrounds membranous part of urethra and ur
What is the function of the para-urethral glands?
- Tiny mucous-secreting glands
- Located at either side of urinary meatus
- Keep vestibule lubricated during intercourse
Where do the peri-urethral glands open?
Into urethra
Where do the para-urethral glands open?
Vestibulum
What are para-urethral also known as?
Lesser vestibular or skene glands
Where do the ovarian arteries arise?
From aorta at L2
What artery is the uterine tube supplied by?
Tubal branches from the ovarian and uterine arteries
What artery is the uterus supplied by?
Uterine artery
What is the venous drainage of the ovary?
- Ovarian plexus
- > Ovarian veins
- > Left renal vein or IVC
What is the venous drainage of the uterine tube?
Ovarian veins and uterovaginal venous plexus
What is the venous drainage of the uterus?
- uterovaginal plexus
- > uterine veins
- > Internal iliac veins
What is the lymoh drainage of the ovary?
Para-aortic (lumbar) lymph nodes
WHat is the lymph drainage of the uterine tubes?
Para-aortic (lumbar) but may also pass to superficial inguinal
What is the lymph drainage of the uterus and proximal vagina?
INternal iliac nodes
What is the lymph drainage of the distal vagina?
Deep and superficial inguinal nodes
What is the lymph drainage of the urethra?
External and internal iliac + deep and superficial inguinal nodes
Where is pain from the ovary and distal uterine tube referred to?
- Sympathetics from T10-11
- Peri-umbilical region
Where is pain referred to from the proximal uterine tube and uterine body?
- Sympathetics from T12-L2
- Suprapubic region
Where is pain referred to from the uterine cervix and proximal vagina referred to?
- Parasympathetics from S2-4
- Deep pelvis
Where is pain referred to from the distal vagina?
Somatic pudendal nerve (S2-4)
What is the external female genitalia known as?
Vulva
What is the labia majora?
- Skin folds from mons pubis to perineum
- Mainly fatty (superficial) layer of the subcutaneous tissue of the perineum
- Encloses pudendal cleft
- Round ligament of uterus is attached
- Homologue of scrotum
What is the labia minora (nymphae)?
- Medial to the labia majora
- Posteriorly from the posterior labial commissure or fourchette
- Surround the vaginal vestibule
- Homologue of penis skin
What opens at the vaginal vestibule?
- Urethra
- Vagina
What is the hymen??
- Thin mucosal fold
- Partially closes vagina
- Perforated: Annular, semilunar, septate or cribriform
What is the clitoris?
- Cavernous tissue at the anterior junction of the labia minora
- Consists of 2 crura, body and glans (head), hooded by the prepuce of the clitoris
- Homologue of penis but w/o urethra
What is the bulb of the vestibule?
- Vascular erectile tissue
- Covered by bulbospongiosus muscle
What is the function of the greater vestibular gland?
- Secretes mucus for lubrication during sexual arousal
Where is the greater vestibular gland located?
Posterior to the end of the vestibular bulb
What is the greater vestibular gland also known as?
Bartholin’s gland
What covers the greater vestibular gland?
Bulbospongiosus muscle
What is the homologue of the greater vestibular gland?
Bulbourethral gland in males
Where can be the site of a painful cyst or abscess formation?
Greater vestibular gland
What is the arterial supply to the external genitalia?
Internal pudendal branches of the internal iliac arterues and external pudendal branches from the femoral arteries (venous return has corresponding names)
What is the parasympathetic, visceral and somatic sensory and somatic innervation to the external genitalia?
- Pudendal nerve
- Ilio-inguinal nevre
- Genital branch of the genitofemoral nerve
What is the lymphatic drainage of the external genitalia?
Mainly to superficial inguinal nodes, but also drains to deep inguinal and internal inguinal iliac nodes
What is an episiotomy?
- Surgical incsision that may be done during parturition to fascilitate delivery and accomodate the head of an emerging fetus
- Often used when baby too bigin relation to mother or shoulder dystocia
What are the 2 types of episiotomy and what are the advantages of each?
- Midline incision - advantage is that it heals more easily, disadvantage is that you can damage anal sphincter
- Mediolateral - protects spincter, more painful, more difficult to repair
