Pelvis: Male and Female Reproductive Anatomy Flashcards
Testis
- Produce sperm
Epididymis
- Storage and maturation of sperm
Vas deferens (ductus deferens)
- Transport of sperm from epididymis
Seminal vesicles
- Secrete seminal fluid added to sperm (about 60-70%)
Ejaculatory ducts
- Formed by the union of the ductus deferens and seminal vesicles
Prostate
- Secrete seminal fluid added to sperm (about 30%)
Bulbourethral glands
- Contribute small amounts of fluid to semen
Pathway of sperm
- Epididymis
- Vas deferens
- Ejaculatory ducts
- Prostatic urethra
- Membranous urethra
- Spongy urethra
Ductus deferens
- Thick, smooth muscle wall
- Sympathetics (cause contraction during ejaculation)
Seminal gland (seminal vesicles)
- Between bladder fundus and rectum
- Secrete thick alkaline fluid (fructose, coagulating agent)
Ejaculatory ducts
- Junction of the ampulla of ductus deferens and duct of the seminal vesicle
- Passes through prostate gland, opens on the seminal colliculus in the prostatic urethra
Prostate features
- Walnut size gland, anterior to rectum
- 2/3 glandular tissue
- 1/3 fibromuscular tissue
Prostatic ducts
Prostate location
- Base is superior (inferior to bladder neck )
- Apex is inferior
Prostatic ducts
- About 20-30
- Open into the prostatic sinuses
Bulborethral gland
- Posterior to membranous uretha
- Embedded in external urethral sphincter
- Ducts open proximal spongy urethra
Prostate anatomical lobes
- Anterior (Isthmus)
- Posterior
- Lateral (left & right)
- Median (Middle)
Prostate zones
- Peripheral
- Central
- Transitional
- Fibromuscular
Peripheral zone of prostate
- 70% of glandular volume
- Surrounds distal prostatic urethra
- Accessible by DRE
- Majority of prostate cancers
Central zone of prostate
- 25% of glandular volume
- Surrounds ejaculatory ducts
- Small % of cancers, but aggressive
Transitional zone of prostate
- 5% of glandular volume
- Surrounds proximal urethra
- BPH
Fibromuscular zone of prostate
- No glandular tissue
Male external genitalia
- Penis (and urethra)
- Scrotum
Penis
- Part of the urinary and reproductive systems
- 3 cylinders of erectile tissue
3 cylinders of erectile tissue of penis
- Paired corpora cavernosa
- Corpus spongiosum
3 parts of the penis
- Root
- Body
- Glans
Root of the penis
- Attached portion
- Crura
- Bulb
- Bulbospongiosus and ischiocavernosus muscles
Crura of penis
- Attached to ischial rami
Bulb of penis
- Attached to perineal membrane
Bulbospongiosus and ischiocavernosus muscles of penis
- Surround bulb and crura
Body of penis
- Pendulous part
- Formed by 2 corpora cavernosa and corpus spongiosum coming together
Glans of penis
- Head (expansion of corpus spongiosum)
- External urethral orifice
Layers of the penis
- Skin
- Superficial fascia (Dartos fascia)
- Bucks fascia (deep fascia)
- Tunica albuginea
- Erectile tissue
Skin of penis
- Prepuce (foreskin) covers glans if uncircumcised
- Frenulum (attaches foreskin to ventral penis)
Tunica albuginea of penis
- 2 layers of fibrous tissue
- Thinner around the corpus spongiosum
- Glans penis is not surrounded by tunica albugine
Erectile tissue of penis contains
- Corpora cavernosa (separated by incomplete septum)
- Corpus spongiosum (spongy urethra)
Arterial supply of penis
- Internal pudendal arteries
- Dorsal arteries of the penis (paired)
- Deep arteries of the penis/cavernosal (paired)
Dorsal arteries of the penis (paired)
- Circumflex branches
- Supply skin, CT, corpus spongiosum, glans penis, urethra
Deep arteries of the penis/cavernosal (paired)
- Travel through corpora cavernosa
- Supply helicine arteries within the erectile tissue
Female internal anatomy
- Ovaries
- Uterine Tubes
- Uterus
- Vagina
Broad ligament
- Lateral extensions of peritoneum from uterus to pelvic wall
- Minimal role in uterine support
- Maintains organ alignment
- Passageway for vessels/nerves
3 subdivisions of the broad ligament
- Mesometrium
- Mesosaplinx
- Mesovarium
Mesosalpinx
- Surrounds the uterine tube
- Continuous with ovarian and suspensory ligament
- Contains branches of ovarian and uterine arteries
Mexovarium
- Projects from posterior aspect of broad ligament
- Attached to ovary
Suspensory ligament of the ovary
- Peritoneal fold that extends from pelvic wall to superior pole of ovary
- Contains ovarian vessels, nerves, lymph
Ovarian ligament
- Fibrous band within broad ligament
- Attaches ovary to cornu of uterus (just inferior to uterine tubes)
- Ovary is suspended in peritoneal cavity
Remnants of female gubernaculum
- Ovarian ligament
- Round ligament
Round ligament
- Attached to lateral cornu of uterus
- Travels through inguinal canal
- Contains small amounts of smooth muscle
Ovaries
- Female gonads within true pelvis, suspended in peritoneal cavity
- Supported by mesovarium and ovarian ligament
- Superior pole
- Inferior pole
Superior pole of ovary
- Suspensory ligament, fimbriae
Inferior pole of ovary
- Ligament of ovary
Uterine tubes (oviducts, fallopian tubes)
- Usual site of fertilization
- Conduct oocyte toward uterus
- Most common site of ectopic pregnancies
4 parts of the uterine tube
- Infundibulum
- Ampulla
- Isthmus
- Uterine (intramural)
Infundibulum
- Opens into peritoneal cavity through fimbriae
- Ovarian fimbria
Fimbriae
- Finger-like process of the infundibulum
Ampulla of the uterine tube
- Widest and longest part
- Fertilization most commonly occurs here
Uterus
- Thick-walled, muscular organ
- Anteverted, anteflexed position
- Covered by peritoneum (not cervix)
- Notice relationship of posterior vaginal fornix to rectouterine pouch
Nongravid uterus
- Located in lesser pelvis
Culdocentesis (largely replaced by ultrasound)
- Access the rectouterine pouch through posterior vaginal fornix
Body of uterus
- Fundus superior to uterine ostia
- In between layers of the broad ligament (movable)
- Wall made of 3 layers
- Uterine cavity
- Uterine horns
3 layers of uterus
- Endometrium
- Myometrium
- Perimetrium
Endometrium of uterus
- Site of implantation
- Cyclical regeneration
Myometrium of uterus
- Smooth muscle
Perimetrium of uterus
- Serosa
Uterine horns
- Where uterine tubes enter
Isthmus of uterus
- Constricted portion
Cervix
- Inferior 1/3 of uterus
- More fibroelastic tissue than body (less muscle)
- Supravaginal (endocervix)
- Vaginal (ectocervix)
- Cervical canal
Vaginal portion of cervix (ectocervix)
- Surrounded by vaginal fornices
Cervical canal contains
- Internal os (opens to uterine cavity)
- External os (opens to vagina)
Vagina
- Distensible musculomembranous tube
Vagina communicates with
- Cervical canal
- Vestibule of the vagina
Vagina function
- Part of the birth canal
- Conduit for menstrual flow
- Sexual intercourse
Vaginal walls
- Approximated (except around cervix)
Fornices
- Superior recesses that surround ectocervix (vaginal cervix)
Vaginal fornices located
- Anterior, posterior (approximates rectouterine pouch), lateral
Anterior wall of vagina size
- Shorter than posterior
Anterior wall of vagina location
- Posterior to the bladder and urethra (cervix/vaginal fascia also supports) bladder
Posterior wall of vagina is anterior to
- Rectum
- Anal canal
- Pouch of Douglas
Arterial supply ovaries and uterine tubes
- Ovarian artery
- Uterine artery
Ovarian artery
- Branches from abdominal aorta
- Travels through suspensory ligament
Uterine artery
- Ascending branch bifurcates into tubal and ovarian branches
- Ovarian and uterine arteries anastomose
Arterial supply of the uterus
- Ovarian arteries
- Uterine arteries
Arterial supply of the vagina
- Superior: uterine arteries
- Middle and inferior: vaginal and internal pudendal
Venous drainage of ovary
- Right ovarian vein > IVC
- Left ovarian vein > left renal
Pelvic viscera support
- Maintain proper alignment/prevents prolapse
- Pelvic diaphragm
- Endopelvic fascia/ligaments
Pelvic diaphragm
- Constant tone
- Dynamic
Endopelvic fascia/ligaments function
- Contain smooth muscle
- Help maintain alignment
Endopelvic ligaments
- Transverse cervical (cardinal ligament)
- Uterosacral ligament
- Pubocervical ligament
- Rectovaginal septum
Female external genitalia (vulva)
- Mons pubis
- Labia majora
- Labia minora
- Clitoris
Mons pubis
- Fatty eminence over pubic bone and symphysis
Labia majora
- Cutaneous fold containing fat and round ligament
- Lateral boundary of pudendal cleft
- Outer: Pubic hair and sebaceous glands (inner are hairless)
Labia minora
- Fat-free, hairless
- Has sebaceous glands and sensory nerve endings
- Contains a core of “erectile like” tissue
- Enclose vestibule of vagina
- Frenulum of clitoris
- Prepuce of clitoris
Vestibule of external female genitalia
- Space surrounded by labia minora
- Openings for external urethra and vagina
Mucous secreting glands of vestibule (vulva)
- Lesser vestibular glands (Skenes)
- Greater vestibular glands (Bartholins)
Lesser vestibular glands (Skenes)
- Sides of urethral orifice
Greater vestibular glands (Bartholins)
- 5’ and 7’ o’clock position relative to vaginal orifice
Clitoris
- Erectile, sensory organ
- Located where labia minor meet anteriorly
- Surrounded by tunica albuginea
Parts of the clitoris
- Crura (2)
- Body
- Glans
Crura (2) of clitoris
- Attached to inferior pubic rami
Body of clitoris
- Where the 2 corpora cavernosa meet
- Covered by prepuce
Glans of clitoris
- Spongy erectile tissue with high density of sensory endings
- Receives erectile tissue slips from vestibular bulb
Sensory innervation of clitoris
- Dorsal nerve of clitoris (pudendal nerve)
- Autonomics: cavernous nerves from uterovaginal plexus
Bulb of vestibule is located
- Alongside vaginal and urethral orifice
- Deep to labia
Bulb of vestibule is covered by
- Bulbospongiosus muscle
Bulb of vestibule contributes to
- Glans clitoris
Bulb of vestibule
- Erectile tissue
- Stabilizes vaginal wall
Internal iliac artery supplies
- Pelvic region
- Perineum
- Gluteal and medial thigh regions
Internal iliac artery location
- Begins L5/S1 disc level
- Variation in branching patterns
Internal iliac artery divides into
- Anterior division
- Posterior division
Nerves found in the pelvis
- Obturator nerve (L2,3,4)
- Lumbosacral trunk (L4,5)
Obturator nerve (L2,3,4)
- Descends into pelvis from lumbar plexus
- Exits pelvis through obturator canal (enters medial thigh)
Lumbosacral trunk (L4,5)
- Joins sacral plexus
Sacral plexus located
- S1-S4
- Anterior to piriformis
Nerves derived from sacral plexus can have
- L4 and L5 root because of lumbosacral trunk
Most branches of sacral plexus exit pelvis through
- GSF to lower extremity and perieneum
Pelvic autonomic nerves
- Inferior hypogastric plexus
Inferior hypogastric plexus receives sympathetics from
- Hypogastric nerves from superior hypogastric plexus
- Sacral splanchnic nerves from sacral sympathetic trunk
Inferior hypogastric plexus receives parasympathetic nerves from
- Pelvic splanchnic (S2-4)
Autonomic innervation of penis/clitoris (erection)
- Inferior hypogastric plexus > Prostatic/Uterovaginal plexus > Cavernous nerves
Autonomics involved with penis/clitoris (erection) contain
- Sympathetics and parasympathetics
- Parasympathetics: erection
- Innervates helicine arteries
Prostate surgery
- Can damage cavernous nerves
