Female Reproductive Organs Flashcards
Describe the location of the ovaries
- suspended by mesentery
- supported by suspensory ligament of ovary and ovarian ligament
- lies in ovarian fossa
(superior: external iliac vessels
inferior: obturator nerve
anterior: broad ligament
posterior: ureter and internal iliac vessels)
Where is pain from the ovaries referred to?
- medial thigh
- due to obturator nerve
Describe the position of the uterine tubes and their function
- found enclosed within the mesosapinx (mesentery)
- converys the ovum from the ovaries to the uterine cavity through peristaltic movement and cilia
Describe the different parts of the uterine tubes
- infundibulum: most lateral part of tube, lumen opens into peritoneal cavity
- fimbriae (attached to infundibulum): finger-like projections, picks up ovum
- ampulla: site of fertilisation
- isthmus: has thickest wall, attaches ampulla to uterine horn
- intra-mural: running through uterine wall into the body and cavity of uterus
What are the functions and parts of the uterus?
Functions:
- development of embryo/foetus
- expulsion of foetus during childbirth
Parts:
- body (including fundus)
- isthmus
- cervix
Expand on the body of the uterus
- has a fundus
- has a uterine cornua (horns) where the uterine tubes enter
- has a cavity which is the site of implantation
- separated from cervix by isthmus
- 3 layers: perimetrium (visceral layer of peritoneum), myometrium (smooth muscle layer), endometrium (functional and basal layer)
What are the relationships of the uterus?
- sits between bladder and rectum
- lies in true pelvis
- uterine artery crosses over ureter
- separated from surrounding structures by the peritoneum forming pouches (vesicouterine (shallow) and rectouterine pouches (deep))
Expand on the cervix
- mostly fibrous
- small amount of elastin
- inferior aspect: dome shaped and bulges into vagina
- forms fornices
- internal and external os with canal in between
Describe the different areas of epithelium in the cervix
- endocervix: columnar epithelium
- ectocervix (extends into vagina): non-keratinising stratified squamous epithelium
- transformation zone: area where epithelium starts to change from columnar to stratified squamous
What are the normal angles of the uterus?
- axis of cervix is 90 degrees with angle of vagina (anteversion)
- if backwards then retroversion
- adult uterus is bent forward on itself at level of internal os to form 170 degree angle (anteflexion)
- if over 180 then retroflexion
What is the clinical significance of the uterine angles?
retroversion and/or retroflexion can cause backache and difficulty conceiving
What are the important features of the vagina?
- runs from cervix to the vestibule
- has a collapsed vaginal canal
- internal end is enlarged (forming vaginal vault)
- fornices open into internal end (1 anterior, 1 posterior, 2 lateral)
- contains lactobacilli (help maintain acidity in vagina)
What are the relations of the vagina?
- anterior: bladder and urethra
- posterior: rectum, posterior fornix related to rectouterine pouch
- latera: ureter passes lateral to lateral fornix, levator ani, pelvic fascia
What are the functions of the vagina?
- insertion of penis and receives ejaculate during sexual intercourse
- canal for menstrual fluid
- part of birth canal
Describe the positioning, parts and contents of the broad ligament
Positioning:
- from lateral pelvic wall to uterus
- keeps uterus in place but allows movement
Parts:
- mesometrium
- mesosalpinx
- mesovarium
Contents:
- uterine tube in superior margin
- suspensory ligament of ovary
- round ligament of uterus
What are the ligaments of the gubernaculum and where do they run?
- round ligament of uterus (remnant of lower gubernaculum): from cornua of uterus to labia majora
- round ligament of ovary (remnant of upper gubernaculum): from cornua of uterus to ovary
Describe the supporting muscles and fascia of the uterus
- muscles of pelvic floor support uterus
- condensation of fascia form supportive ligaments:
- pubocervical ligament (anteriorly)
- transverse cervical (cardinal) ligament (lateral)
- uterosacral ligament (posterior)
- rectovaginal septum: separates posterior vagina from rectum
Describe features of the urethra
- lies in anterior vaginal wall and opens in vestibule
- externally has paraurethral glands that open into vestibule
- one on each side of lateral margin of urethra
What are the parts of the external genitalia?
- mons pubis
- labia majora
- labia minora
- clitoris
- vestibule
- hymen
- bulbs of vestibule
- greater vestibular glands
Elaborate on mons pubis and labia majora
Mons pubis:
- fatty superficial tissue overlying pubic symphysis
- protection
Labia majora:
- continuation of mons pubis moving laterally and posteriorly
- fatty tissue with sebaceous glands
- where round ligament of uterus enters internally
- posterior commissure separates it from perineum
- pudendal cleft between each labia majora
Elaborate on the labia minora and the clitoris
Labia minora:
- surround vestibule and external urethral opening
- bifurcate anteriorly to form frenulum and hood of clitoris
- unite posteriorly at fourchette
Clitoris:
- anteriorly is cavernous tissue
- 2 crura, glans, hood and frenulum
Elaborate of the vestibule and hymen
Vestibule:
- between 2 labia minora
- contains external urethral sphincter and vaginal introitus opening
Hymen:
- surrounds vaginal introitus
- thin mucosal fold
- its structure varies from person to person and at different stages of life
Expand of the bulbs of the vestibule and the greater vestibular glands
Bulbs of vestibule:
- on either side of introitus and medial to labia minora
- paired masses of elongated erectile tissue
- covered in spongiosus tissue
Greater Vestibular Glands:
- posterior to bulbs
- drain into vestibule
- secrete mucus during sexual intercourse
- can become infected and form cysts or abscesses
Describe the arterial supply of the female repro system
- ovaries: ovarian artery (from aorta at L2)
- uterine tubes: tubal branches from ovarian and uterine arteries
- uterus: uterine artery (from internal iliac)
- vagina: vaginal artery (from internal iliac)
- external genitalia: internal pudendal branches from internal iliac, and external pudendal branches from femoral arteries
- urethra: internal pudendal and vaginal arteries
Describe the venous drainage of the female repro system
- ovaries: pampiniform plexus to ovarian vein to IVC on R/L renal vein
- uterine tube: tubal veins to ovarian veins to uterovaginal plexus
- uterus: uterovaginal plexus to uterine veins to internal iliac veins
- vagina: uterovaginal plexus to internal iliac veins
- external genitalia: internal pudendal to internal iliac, external pudendal to femoral, clitoris to deep dorsal vein to vesical plexus
- urethra: internal pudendal and vaginal veins
Describe the lymph drainage of the female repro system
- ovaries: para-aortic lumbar nodes
- uterine tubes: para-aortic, superficial inguinal nodes
- uterus and proximal vagina: internal iliac nodes
- distal vagina: deep and superficial inguinal nodes
- external genitalia: superficial inguinal nodes
- urethra: external and internal iliac nodes
Describe the nerve supply and referred pain of the female repro system
- ovary and distal uterine tube: sympathetics from T10-11 (referred peri-umbilical pain)
- proximal uterine tube and body above pelvic pain line: parasympathetics from S2-4 (referred pain suprapubic)
- uterine cervix and proximal vagina below pelvic pain line: parasympathetics from S2-4 (pain felt in deep pelvis)
- distal vagina: somatic pudendal nerve S2-4 and sympathetics (localised pain)
- urethra: vesical plexus and pudendal nerve
- external genitalia: pudendal, ilioinguinal and genital branch of genitofemoral nerves
