Repro Flashcards
lets start off with an easy one, what are the external genital organs of the female collectively known as ?
The Vulva
YAY congrats 100% right so far, you’re on to a winner !
What are the functions of the vulva? (3)
- act as sensory tissue during sexual intercourse
- assist in micturation, by directing the flow of urine
- defend the internal female reproductive tract from infection.
What is bartholinitis?
Infection of the Bartholin’s glands/ greater vestibular nerves
How does an infection of the bartholin’s gland become a bartholin’s cyst?
when the duct is blocked, the gland fills with fluid, forming a cyst.
Blood supply to the external genitalia is supplied by?
by the paired pudendal arteries, but mainly by the internal branch.
What vessels supply the venous drainage to the vulva?
pudendal veins (smaller labial veins as tributaries)
Through what lymph node is the lymphatic drainage of the vulva through?
The superficial inguinal lymph nodes.
The external female genital receives sensory and sympathetic nervous supply, true or false?
false, it’s sensory and parasympathetic nervous supply.
What’s the sensory innervation of the anterior portion of the vulva?
ilioinguinal nerve and general branch of the genito femoral nerve.
What’s the sensory innervation of the posterior portion of the vulva?
pudendal nerve, and the posterior cutaneous nerve of the thigh
What nerves innervate the clitoris and vestibule?
parasympathetic-cavernous nerves derived from the uterovaginal plexus.
Approximately how long is a vagina?
9cm
What are the functions of the vagina? (3)
-during intercourse, it receives the penis and ejaculate, assisting its transport to the uterus.
-expands to provide a channel for delivery of a newborn.
serves as a canal for menstrual fluid and tissue to leave the body.
what are the three types of vaginal fistulae?
- vesicovaginal- vagina and bladder, leading to urine constantly entering the vagina.
- urethrovaginal- vagina and urethra, urine only enters on urination.
- rectovaginal- vagina and rectum, faecal matter enters the vagina.
What are the four histological layers of the vagina?
internal to external -epithelia -elastic lamina propria -fibromuscular layer adventitia
what type of epithelia is found in the vagina?
stratified squamous epithelia
what effect does oestrogen have on the vaginal epithelia?
oestrogen stimulates the epithelial cells to secrete glycogen.
How does the secretion go glycogen maintain the low pH of the vagina?
the glycogen is digested by Lactobacillus vaginalis which inhabits the vagina, producing lactic acid, which maintains the low vaginal pH at ~4.5
what muscular layers makeup the fibromuscular layer in the vagina?
- inner circular layer
- outer longitudinal layer
what type of muscle makes up the muscular layer of the vagina?
smooth muscle
explain why vaginal infections during pregnancy and with diabetes occur?
low levels of oestrogen disrupt the pH of the vagina, which can disrupt the natural flora, potentially leading to overgrowth infections such as candida and vaginosis.
through what arteries is blood supplied to the vagina?
by the uterine and vaginal arteries, which are both branches of the internal iliac artery.
Through which veins is blood from the vagina returned?
Through the vaginal plexus, which drains into the internal iliac veins via the uterine artery.
Through which lymph nodes is the vagina drained?
iliac and superficial inguinal lumph nodes
where can the uterovaginal plexus be found?
It lies at the base of the broad ligament, on either side of the supravaginal part of the cervix.
Which fibres does the uterovaginal plexus supply to the vagina?
Parasympathetic and sympathetic
What nerve innervates the inferior part of the vagina?
a branch of the pudendal nerve, called the deep perineal ring.
what is the ectocervix?
the part of the cervix that projects into the vagina
what epithelia lines the ectoocervix?
stratified squamous non-keratinised
what marks the transition between endocervix and ectocervix?
the external os
what is the endocervix/ endocervical canal
the more proximal ‘inner’ part of the canal
what epithelia lines the endocervix?
mucus-secreting simple columnar epithelia
what is the narrowing between the endocervix and uterine cavity called?
the internal os
what are the two main functions of the cervix?
- facilitates the passage of sperm into the uterine cavity, this is achieved by dilation of the internal and external os
- maintains sterility of the upper female reproductive tract
what provides the blood supply tot he uterus?
uterine artery
through what is the venous blood from the cervix drained?
a plexus in the broad ligament that drains into the uterine veins.
through which nodes is the uterus lymph drained? (4)
iliac, sacral, aortic and inguinal lymph nodes
which two infections are common causes for cervicitis?
chlamydia trachomatis and nisseria gonorrhoeae
what are the common symptoms of cervicitis?
- pelvic pain
- vaginal discharge
- postcoital bleeding
- dyspareunia
What are the two main classifications of cervical cancer?
- Squamous cell carcinoma
- adenocarcinoma
what are the three parts of the uterus?
fundus, body and cervix
what does it mean when the uterus is described as being anteverted and anteflexed?
anteverted- rotated forward, towards the anterior surface of the body
anteflexed- flexed towards the anterior surface of the body
what are the three layers of the uterus?
- peritoneum
- myometrium- a smooth muscle layer- these are the cells which undergo hypertrophy and hyperplasia during pregnancy
- endometrium- inner mucous membrane
what two divisions can the endometrium be divided into?
- deep stratum basalis- changes little and is not shed
- superficial stratum functionalis- proliferates in respose to oestrogens, and becomes secretory in response to progesterone. Shed during menstruation.
what is embryosis?
presence of ectopic endometrial tissue at sites outside the uterus, most commonly the ovaries and the ligaments of the uterus.
what are fibroids?
benign tumors of the endometrium. they are oestrogen dependant, enlarging during pregnancy and with the use of the contraceptive pill but regressing after menopause. most fibroids are asymptomatic .
where is the most common location of endometrial carcinoma?
transformation zone of the cervix between the columnar epithelium of the endocervix and the stratified squamous epithelium of the exocervix.
what are the 5 ligaments which keep the uterus in place?
- broad ligament
- round ligament
- ovarian ligament
- cardinal ligament
- uterosacral ligament
describe the broad ligament of the uterus.
a double layer of peritoneum attaching the sides of the uterus to the pelvis, it acts as a mesentery for th uterus and contributes to maintaining it’s position.
describe the round ligament of the uterus.
a remnant of the gubernaculum extending from the uterine horns to the labia major via the inguinal canal. it maintains the anteverted position of the uterus.
describe the ovarian ligament of the uterus.
connects the ovaries to the uterus.
describe the cardinal ligament of the uterus.
located at the base of the broad ligament, it extends from the cervix to the lateral pelvic walls. It contains the uterine artery and vein in addition to providing support to the uterus
describe the uterosacral ligament of the uterus.
connects the cervix to the sacrum.
where does the sympathetic innervation of the uterus come from?
uterovaginal plexus, which is mainly comprises the anterior and intermediate parts of the inferior hypogastric plexus.
where does the parasympathetic innervation of the uterus come from?
pelvic splanchnic nerves (S2-4)
what is the main function of the fallopian tubes?
assist in the transfer and transport of the ovum from the ovary to the uterus.
how does the inner mucosa of the fallopian tubes assist them in their role?
it’s lined with ciliated columnar epithelia and peg cells. they waft the ovum towards the uterus and supply it with nutrients.
how does the smooth muscle in the walls of the fallopian tubes assist with the movement of and ovum?
it contracts to assist with transportation of the ova and sperm. the muscle is sensitive to sex steroids, so peristalsis is greatest when oestrogen levels are high.
what are the four parts of fallopian tubes?
lateral to medial
- fimbriae
- infundibulum
- ampulla
- isthmus
which part of the fallopian tube does fertilisation normally occur?
the ampulla
through which arteries is blood supply to the uterine tubes?
uterine and ovarian arteries
through which nodes is the uterine tube lymph drained?
iliac, sacral and aortic nodes
where do the sensory afferent fibres to the fallopian tubes run from?
T11-L1
What is salpingitis?
inflammation on the uterine tubes, usually caused by bacterial infections. It can cause adhesions of the mucosa which may block the lumen of the uterine tube.
What is an ectopic pregnancy?
where a fertilised egg implants at a site which isn’t the uterus e.g. fallopian tubes
what are the two main methods of fallopian tube ligation?
- open abdominal via a suprapubic icision
- laproscopic via a fibre optic laproscope inserted via a small incision near the umbilicus.
through which structure do the neurovascular structures enter the ovary?
mesovarium
what are the two main functions of the ovary?
- produce oocytes
- produce sex steroid hormones (oestrogen and progesterone)
what are the three components of the ovary?
- surface
- cortex
- medulla
what epithelia is the surface of the ovary made of?
simple cuboidal epithelia (germinal epithelia)
what are the differences and similarities between cortex and medulla of the ovary?
- both are largely comprised of connective tissue stroma.
- the cortex contains follicles
- the medulla contains a neuromuscular network
what two (three) ligaments attach to the ovary?
-suspensory ligament of the ovary
-ligament of ovary
(-broad ligament)
what does the suspensory ligament of the ovary connect + contain?
it’s a fold of peritoneum extending from the mesovarium to the pelvic wall. it contains neuromuscular structures.
what does the ligament of ovary connect?
it extends from the ovary to the fundus of the uterus, it then continues to the connective tissue of the labium majora as the round ligament of the uterus.
which ligament is a continuation of the ovarian ligament ?
round ligament of the uterus
where does lymph from the ovaries drain to?
para-aortic nodes
what nerve supplies the ovaries?
sympathetic and parasympathetic nerve fibres from the ovarian and uterine plexuses respectively.
how can the ligaments of the female reproductive tract be divided?
- broad ligament- sheet of peritoneum associated with both he uterus and ovaries.
- uterine ligaments- ligaments primarily associated with the uterus
- ovarian ligaments- ligaments primarily associated with the ovaries
what 3 regions can the broad ligament be divided into?
- mesometrium
- mesovarium
- mesosalpinx
which part of the broad ligament is associated with the ovaries?
mesovarium
which part of the broad ligament encloses the fallopian tubes
mesosalpinx
what three other ligaments are located within the broad ligaments
- ovarian ligament
- round ligament of the uterus
- suspensory ligament of the ovary
what vessels are contained within the suspensory ligament?
- ovarian artery
- ovarian vein
- ovarian nerve plexus
- lymphatic vessels
which ligaments attach to the superior aspect of the uterus?
broad ligament and round ligaments
which ligaments attach to the middle aspect of the uterus?
cardinal, pubocervical and uretosacral ligaments
what supports the inferior aspect of the uterus?
pelvic floor- elevator anti, perineal membrane and perineal body.
why can the round ligament be a source of pain during pregnancy
increased force is placed on the ligament by the expanding uterus
why are the cardinal ligaments commonly removed during a hysterectomy?
they can be a common reservoir of cancerous cells.
what are the two main functions of the penis?
- sexual intercourse
- micturation
what three parts can the penis be divided into (theoretically of course, it would just be harsh)
- root
- body
- glans
what erectile tissues are contained in the root of the penis? (3)
two crura (corpus cavernosa) and bulb of the penis
which two (x2) muscles are found in the root of the penis?
ischiocavernous and bulbospongiosus
what three cylinders of erectile tissue form the body of the penis?
two corpus cavernosum and the corpus spongiosum.
the distal expansion of which erectile tissue forms the glans of the penis?
corpus spongiosum
what is the opening of the urethra in the glans penis called?
urethral orifice
what separates the two corpus cavernosum?
septum of the penis
through which erectile tissue does the urethra run?
corpus spongiosum
what stops the urethra being occluded during an erection?
the corpus spongiosum fills to a reduced pressure
what are the two main roles of the bulbospongiosus?
- contracts to empty the spongy urethra of any residual seamen and urine
- anterior fibres aid in maintaining erection by increasing the pressure in the bulb of the penis
where are the ischiocavernosus located in the male?
they surround the right and left crura of the penis.
what action does the ischiocavernosus perform?
it contracts to force blood from the cavernous spaces in the crura into the corpus cavernosa, so it helps maintain the erection.
what are the two layers of fascia which surround each mass of erectile tissue?
superficial-deep
- deep fascia of the penis
- tunica albuginea
what is the deep fascia of the penis a continuation of?
deep perianal fascia
which two ligaments support the penis?
- suspensory ligament
- fundiform ligament
what is the suspensory ligament and what does it do?
- condensation of deep fascia
- connects the erectile bodies of the penis to the pubic symphysis
what is the fundiform ligament and what does it do?
- condensation of abdominal subcutaneous tissue
- it runs down from the linea alba, surrounding the penis like a sling, allotting to the pubic symphysis.
how is the skin of the penis connected to the underlying tunica albuginea?
loose connective tissue
what is the potential space between the glans and prepuce (foreskin).
preputial sac
what three arteries does the penis receive arterial supply from?
- dorsal arteries of the penis
- deep arteries of the penis
- bulbourethral artery
what artery are the branches that supply the penis from?
internal pudendal artery, which arises from the internal iliac artery
which two veins drain the penis?
- cavernous spaces are drained by the deep dorsal vein of the penis which empties into the prostatic venous plexus
- superficial dorsal veins drain the superficial structures of the penis, such as the skin and cutaneous tissues.
which vertebral levels supply the penis?
S2-4
through which nerves is the penis supplied?
- sensory and sympathetic innervation of the skin and glans penis is supplied by the dorsal nerve of the penis (a branch of the pudendal nerve)
- parasympathetic innervation is through the cavernous nerves from the prostatic nerve plexus, and is responsible for the vascular changes which cause erection.
what is hypospadias?
a congenital condition where the opening to the urethra is on the ventral aspect of the penis- can be corrected with surgery
what are phimosis and paraphimosis?
- phimosis- the foreskin fits tightly over the glans and cannot be retracted. irritation can occur when smegma accumulates.
- paraphimosis- retraction of the prepuce is restricted to the neck of the glans. this interferes with venous and lymph drainage. this may cause the glans to enlarge to the extent that the prepuce cannot be drawn over it.
what is peyronie’s disease?
abnormal curvature of the shaft of the penis caused by a build up of scar tissue. it may cause pain on erection and in severe cases can be treated by surgery.
what is priapism?
an erection that persists for more than four hours despite a lack of sexual stimulation. it can often be painful and results from blood becoming trapped in the erectile bodies. If left untreated it may lead to scarring and erectile dysfunction.
where are the bulbourethral glands located and what is their function?
- a pair of exocrine glands located posteriolaterally to the membranous urethra.
- they contribute to the final volume of semen by producing mucus secretion
what epithelia lines the bulbourethral glands?
columnar epithelia
what embryological tissue is the bulbourethral gland derived from?
urogenital sinus
what structures are derived from the urogenital sinus?
bulbourethral sinus, bladder, prostate and urethra
which artery supplies blood to the bulbourethral gland?
arteries to the bulb of the penis
What ph are the secretions from the bulbourethral gland and why is this important?
alkaline
neutralises and residual acidity in the urethra.
from what is the autonomic innervation of the bulbourethral glands derived?
the prostatic plexus
Point and Shoot
which lymph nodes does the lymph from the bulbourethral gland drain to?
the internal and external iliac nodes
what does the prostate secrete and why is this necessary?
proteolytic enzymes into the semen, which break down clotting factors in the ejaculate. This allows it to remain in it’s fluid state which travelling through the female reproductive tract.
where is the prostate gland positioned?
inferiorly to the neck of the bladder and superiorly to the external urethral sphincter, with the elevator anti muscle lying inferolaterally to the gland. Posteriorly to the prostate lies the ampulla of the rectum.
How is the close proximity of the prostate gland to the ampulla of the rectum utilised?
in DRE
which lobes can the prostate be divided into? And by what? (4)
-inferoposterior
-inferolateral
-superomedial
-anteromedial
urethra and the ejaculatory ducts
how can the prostate be separated into zones? (4)
- central zone- surrounds the ejaculatory ducts (derived from the Wolffian duct)
- transitional zone- surrounds the urethra (derived from the urogenital sinus)
- peripheral zone- makes up the main bulk of the prostate, it’s located posteriorly (derived from the urogenital sinus)
- fibromuscular stroma- anteriorly in the gland, it merges with the tissue of the urogenital diaphragm.
which zone of the prostate can be felt during DRE?
the peripheral zone
what arteries supply the prostate?
prostatic arteries, which are branches of the internal iliac arteries. They also arise from the internal pudendal and middle rectal arteries.
what nerve innervates the prostate glands?
from the inferior hypogastric plexus. The smooth muscle of the prostate gland is innervated by sympathetic fibres which activate during ejaculation.
What is benign prostatic hyperplasia?
The increase in size of the prostate, without malignancy. It’s common with advancing age. it can compress both the bladder and urethra.
Which zone of the prostate increases in BPH?
transitional
how can prostate carcinomas metastasise to the spine?
malignant cells will commonly spread via baton venous plexus to the vertebral bodies and cause metastasis.
where does the spermatic cord originate?
the deep inguinal ring.
what are the three fascial coverings of the spermatic cords?
- external spermatic fascia
- cremaster muscle and fascia
- internal spermatic fascia
what is the external spermatic fascia of the spermatic cord derived from?
aponeurosis of the external oblique
what is the cremaster muscle and fascia of the spermatic cord derived from?
internal oblique and its fascial coverings
what is the internal spermatic fascia of the spermatic cord derived from?
transversalis fascia
what surrounds the three facial coverings of the spermatic cord?
superficial fascia which lies directly beneath the scrotal skin.
what orientation has the cremaster muscle?
longitudinal
what is the cremaster reflex and how is it stimulated?
- contraction of the cremaster muscle, elevating the testis on the side that has been stimulated
- stroking the superior medial part of the thigh
what afferent and efferent nerves form the cremaster reflex?
- afferent (sensory)- ilioinguinal or genitofemoral nerve
- efferent (motor)- genital branch of the genitofemoral nerve
what is contained within the spermatic cord? (8)
rule of three or mnemonic
3 arteries: testicular, ductus deferens, cremasteric.
3 nerves: genital branch of the genitofemoral, cremasteric, autonomics.
3 other things: vas deferens, pampiniform plexus, lymphatics.
· Note some argument about this: Moore doesn’t put in cremasteric nerve, Lumley puts in inguinal…
what happens to the palpiniform plexus as it travels through the inguinal canal?
condenses into the testicular veins
where do the right and left testicular veins drain into?
left- left renal vein
right- IVC
where does the vas deferens convey sperm from and to?
from the epididymis to the ejaculatory duct.
what muscular layers make up the wall of the vas deferens?
inner-outer
- longitudinal
- circular
- longitudinal
What are the possible causes of enlargement of the scrotum? (5)
- inguinal hernia
- hydrocele- collection of serous fluid within the tunica vaginalis, most commonly due to a failure of the processes vaginalis to close.
- haematocele- collection of blood in the tunica vaginalis.
- varicocele- gross dilation of the veins draining the testes.
- epididymitis- inflammation of the epididymis, usually by bacterial or viral infection.
why is the left testicle more commonly affected by a varicocele?
as the left testicular vein drains into a smaller vessel, the left renal vein, at a perpendicular angle.
what is testicular torsion?
the spermatic cord twists upon itself which can lead to occlusion of the testicular artery, resulting in necrosis of the testis- THIS IS A MEDICAL EMERGENCY.
The main clinical feature of testicular torsion is severe, sudden pain in one or both of the testes, where the onset is during physical activity.
how long are the seminal glands?
5cm
where are the seminal glands located?
between the fundus of the bladder and the rectum.
what two vessels combine to make the ejaculatory duct?
vas deferens and the duct of the seminal gland
what epithelia lines the seminal vesicles?
pseudo stratified columnar epithelia
how does the pseudo stratified columnar epithelia respond to testosterone?
they grow taller
What structures are embryologically derived from the mesonephric ducts? (4)
SEED
seminal glands, ejaculatory ducts, epididymis and ductus deferends
What’s contained in the seminal fluid the seminal gland secretes?
- alkaline fluid
- fructose
- prostaglandins
- clotting factors
what arteries supply the seminal glands?
branches of the inferior vesicle, internal pudendal and middle rectal arteries (all from the internal iliac)
which nodes do the seminal vesicles drain to?
external and internal iliac arteries
what embryological tissue is the scrotum derived from?
The genital folds
what is the scrotal raphe?
the remnant of the fusion between the genital folds
what three (paired) structures does the scrotum contain?
- testis
- epididymis
- spermatic cord
what is the dartos muscle and where is it located?
a sheet of smooth muscle which lies immediately underneath the skin of the scrotum. it regulates temperature and works to wrinkle the skin, reducing surface area and heat loss.
what artery supplies the scrotum?
anterior (external pudendal) and posterior (internal pudendal) scrotal arteries
which nerves supply the cutaneous innervation to the scrotum?
- genital branch of the genitofemoral
- anterior scrotal nerves
- posterior scrotal nerves
- perineal branches of posterior femoral cutaneous nerve
to what node does the scrotum drain?
superficial inguinal nodes
what’s the difference between the testes and the epididymis?
- testes are the site of sperm production
- epididymis have a role in the storage of sperm
- paired structures
where are the epididymis in relation to the testes
posterolateral aspect of each testes
embryologically, where are the testes originally located and why is this important regarding their blood supply etc.
posterior abdominal wall
- they descend through the abdomen and the inguinal canal to reach the scrotum
- they carry the neuromuscular and lymphatic supply with them
describe the path of a sperm from its creation in the seminiferous tubules to the epididymis.
seminiferous tubules-rete testes-efferent tubules-epididymis.
what are the two layers of fascia covering the testes?
superficial-deep
- tunica vaginalis
- tunica albuginea- a fibrous layer which encloses the testes and penetrates into the parenchyma, dividing it into lobules.
what three sections can the epididymis be divided into?
head, body and tail
