Gross anatomy of the reproductive tract

Question 1

What are the parts of the female reproductive tract?

Answer 1

paired gonads (Ovaries (left and right) where germ cells develop)

duct system
o paired uterine (fallopian) tubes
o single midline uterus
o single midline vagina
 Located in pelvis
 Vagina extends through pelvic floor

Question 2

Describe the ovary

Answer 2

Produces gametes and hormones, endocrine and exocrine function
o Oestrogen and progesterone
 Almond-shaped
o 3cm in younger women, often smaller in aged women (postmenopause – no longer
producing gametes)
o surface appears scarred and pitted > Ovaries go through wound healing process monthly when release an oocyte

 Variable in position, esp after childbirth
o Can be higher/lower depending on the number of children a woman has had
 Near lateral wall of pelvic cavity

 Position stabilised by ligaments – not in direct continuity with the rest of the reproductive tract
 Fimbriae extend over the ovaries

Question 3

What is the blood supply to the ovary

Answer 3

via ovarian artery –arises from aorta at level of renal artery
 Blood supply originates so high because the ovaries descend during development

Question 4

What is the venous drainage of the ovary

Answer 4

via ovarian vein
 drains to inferior vena cava on right side
 left renal vein on left side

Question 5

Describe the lymphatics of the oavry

Answer 5

o drain to aortic nodes at level of renal vessels
o Important to be aware of this because of cancer
o Drains into the abdominal cavity  rapid spread of ovarian cancer
o Position of ovaries can make it very difficult to pick up on ovarian cancer at an early stage

Question 6

What ligaments are associated with the ovaries?

Answer 6

Broad ligament
Ovarian ligament
Suspensory ligament

Question 7

Describe the broad ligament

Answer 7

o peritoneal sheet draped over uterus and uterine tubes
o ovaries attached to the posterior layer by short mesentery, ‘the mesovarium’
 Sort of like a shelf on the back of the peritoneum (broad ligament)
 Fixed onto the back of the broad ligament
 NB: position of the ovary is variable, especially after childbirth

Question 8

Describe the ovarian ligament

Answer 8

o fibrous cord, links ovary to uterus

Question 9

Describe the suspensory ligament of the ovary

Answer 9

o lateral wall of pelvis to ovary (attaches to the ovaries from above)
o carries ovarian artery and vein

Question 10

What is the round ligament?

Answer 10

holds the uterus in place

Question 11

What are the pouches in the peritoneum

Answer 11

o Rectouterine (pouch of Douglas)
o Uterovesical

Question 12

Why are the peritoneal pouches important clinically?

Answer 12

infection can accumulate here and be difficult to treat
o Common with back-street abortions
o Associated with endometriosis – blood and dead necrotic tissue accumulates

Question 13

What are the parts of the uterine tubes/fallopian tubes/oviducts

Answer 13

 Infundibulum
o funnel-shaped opening to peritoneal cavity
o fringed by finger like fimbriae

 Ampulla
o middle section where fertilisation occurs

 Isthmus
o short narrowed section
o connected to uterine wall

 Interstitial/uterine part
o Continuous with the uterus

 Approximately 13 cm long

NB: Not directly connected to ovary => Not a closed system => can allow infection to escape into the peritoneum (e.g. with STIs)

Question 14

Describe the uterus

Answer 14

 Pear-shaped (inverted)
 In resting state (non-pregnant) 7-8cm long, 5cm wide, 2.5cm thick, but very variable in the aged
 Flattened from front to back
o Slit-like space between the walls
o Necessary to keep the conceptus in place prior to implantation

Question 15

What are the parts of the uterus?

Answer 15

 Body
 Cervix (Latin for ‘neck’)
o cervical canal
o internal os and external os (opening)
 external faces into the vagina
 difference in appearance of external os in women who have or have not borne children
o Cervix can be felt through the rectouterine pouch
 Fundus
o rounded part, projects up above level of uterine tubes
 Isthmus
o narrowing between body and cervix

Question 16

What is a Bicornuate Uterus?

Answer 16

 most common congenital uterine anomaly, but fairly rare overall
 can impact a woman’s reproductive capabilities
o woman can carry two separate pregnancies
 commonly referred to as a ‘heart-shaped’ uterus
 uterus composed of two ‘horns’ separated by a septum.
 In humans =
malformation, but in some other species,
incl rodents and pigs = normal.

Question 17

Describe the position of the uterus

Answer 17

 Body of uterus is bent forwards on the cervix, a position termed “anteflexion”
 Whole uterus is bent forward at a right angle to the vagina, a position termed “anteversion”

 NB: 20% females show retroflexion and retroversion –no symptoms

Question 18

What is the blood supply to the uterus?

Answer 18

Uterine artery, branch of internal iliac artery

Question 19

What is the venous drainage of the uterus?

Answer 19

Uterine vein drains to internal iliac vein

Question 20

Describe the lymphatics of the uterus

Answer 20

o drainage of body and cervix differ
o body to para-aortic nodes
o cervix to internal iliac nodes

Question 21

Give an overview of the male reproductive system

Answer 21

 Two testes (singular = testis)
o Exocrine and endocrine glands

 Duct system
o closely associated with urinary system
o share final duct - urethra

 Accessory glands
o One prostate gland
o Two seminal vesicles
o Two bulbourethral glands

Question 22

What is the importance of the rectovesical pouch?

Answer 22

less risk of infection than in females because there is no communication with the
outside

Question 23

What is retrograde ejaculation

Answer 23

occurs when semen, which would, in most cases, beejaculatedvia the
urethra, is redirected to the urinary bladder

Question 24

Describe the scrotum

Answer 24

o Skin
o Dartos muscle  wrinkles skin of the scrotum
 Smooth muscle
o External spermatic fascia
o Cremasteric fascia
o Internal spermatic fascia
 These layers may be fused and hard to distinguish
 They are derived from layers of the abdominal wall

Question 25

Describe the testis

Answer 25

 Has to remain outside the body at slightly cooler temperature ```  Cremaster muscle o skeletal muscle o Lies deep to dermis o Runs in spermatic cord o Contracts to raise testis in cold weather ```  Cremasteric reflex  Not to be confused with DARTOS muscle –smooth muscle in dermis, causes wrinkling of scrotal skin

Question 26

Describe the covering of the testes

Answer 26

Tunica vaginalis of the testis o A closed sac of peritoneum:  visceral and parietal layers  space between containing film of peritoneal fluid

Question 27

What is a hydrocele?

Answer 27

excess fluid in the tunica vaginalis

Question 28

Describe the duct system of the testes

Answer 28

 The ends of a coiled seminiferous tubule join to form a straight tubule (or “tubulus rectus”)  All the straight tubules join to a network “rete testis”  From this network, efferent ductules leave and join the epididymis

Question 29

What is the epididymis?

Answer 29

 a very coiled tube – continuous with the ductus deferens  so tightly coiled that it has a gross form – head, body and tail  lined by pseudostratified columnar epithelium with stereocilia (long microvilli)  Stereocilia increase the area for absorption from fluid  can monitor and adjust the fluid composition  Sperm mature in the epididymis, need optimum conditions

Question 30

What is the blood supply of the testis

Answer 30

Testicular artery

Question 31

What is the venous drainage of the testis?

Answer 31

Pampiniform plexus (network, forms counter cooling system for testis) o Right  Drains to → testicular vein → IVC o Left  drains to renal vein

Question 32

What is the lymphatic drainage of the testes?

Answer 32

Different lymphatic drainage of testis and scrotum: o testis to para-aortic nodes o scrotum to inguinal nodes

Question 33

Describe the ductus deferens

Answer 33

Thick-walled => small lumen Smooth muscle in the wall contracts by peristalsis at emission Runs in spermatic cord, through inguinal canal Lies on side wall of pelvis, turns medially to base of bladder Enlarges at end –ampulla region Also attached here to seminal vesicle – outpouching of the ductus

Question 34

Describe the seminal vesicles

Answer 34

 Develops as an out-pouching of the ductus deferens  Coiled tubes  Secretes an alkaline viscous fluid which helps to neutralise the acid in the female tract.

Question 35

Describe the seminal fluid

Answer 35

alkaline viscous fluid which helps to neutralise the acid in the female tract. o Fructose - used for ATP production by sperm o Prostaglandins - aid sperm mobility and viability and may also stimulate muscle contraction in the female tract

Question 36

What is the ejaculatory duct?

Answer 36

 Duct of the seminal vesicle joins with the ductus deferens on each side to form the ejaculatory duct  Penetrates the prostate gland empties into the urethra runs through the penis => single exit point

Question 37

Describe the prostate gland

Answer 37

 Pyramidal in shape  Size and shape of a chestnut  Surrounds the beginning of the urethra  Secretes a slightly acidic fluid containing o citrate (used by sperm for ATP production) o acid phosphatase o proteolytic enzymes => liquefy coagulated semen  Passes its secretion to the urethra via many prostatic ducts

Question 38

What ate the bulbourethral glands

Answer 38

 Pea-sized  Produce a mucus-like secretion  Ducts open to spongy urethra