Repro- Anatomy And Histology Flashcards

0
Q

What are the female external organs?

A
Inferior 2/3 vagina
Labia majora
Labia minora
Vestibule
Clitoris
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1
Q

What are the female internal organs?

A
Ovary
Fallopian tube
Uterus
Cervix 
Superior 1/3 of vagina
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2
Q

What are the 2 main functions of the ovaries?

A

To produce oocytes (female gametes) in preparation for Fertilisiation
To produce sex steroid hormones (oestrogen and progesterone) in response to pituitary gonadotrophs - LH and FSH

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3
Q

What are the three components of the ovary?

A

Medulla
Cortex
Hilum

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4
Q

What cells are found on the outermost surface of the ovary?

A

Cuboidal epithelia- germinal epithelium (not germ cell origin)

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5
Q

Describe the cortex of the ovary

A

Largely comprised of CT stroma
Supports thousands of follicles
Each primordial follicle contains an oocyte surrounded by a singular layer of follicular cells

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6
Q

Describe the medulla of the ovary

A

Composed of supporting stroma and large neurovascular network which enters the hilum of the ovary from the mesovarium

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7
Q

What three ligaments are associated with the ovary?

A

Ligament of the ovary
Broad ligament
Suspension ligament

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8
Q

What is the suspensory ligament of the ovary?

A

Fold of peritoneum extending from mesovarium to the pelvic wall- contains neurovascular structures

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9
Q

What is the ligament of the ovary?

A

Peritoneal ligament which extends from ovary to the fundus of the uterus (then continues from uterus to CT of labia majora as the round ligament of the uterus via the inguinal canal)

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10
Q

What is the broad ligament?

A

Mesentery for the ovary, Fallopian tube and uterus

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11
Q

What is the arterial supply to the ovary?

A

AA–> ovarian arteries

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12
Q

What is the venous drainage of the ovary?

A

L ovarian vein –> L Renal vein –> IVC

R ovarian vein –> IVC

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13
Q

What is the lymphatic drainage of the ovary?

A

Para aortic lymph nodes

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14
Q

What is the nerve supply to the ovary?

A

Nerve supply runs via the suspensory ligament of the ovary with the Vasculature

Parasympathetic (uterine pelvic plexus) and sympathetic (ovarian pelvic plexus) nerve fibres

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15
Q

What are the Fallopian/ uterine tubes?

A

Muscular J shaped tubes which lie in the upper border of the broad ligament
Extend laterally from the uterus and open into abdominal cavity near the ovaries

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16
Q

What is the main function of the Fallopian tube?

A

Assists in transfer and transport of ovum from the ovary to the uterus

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17
Q

How does the ultra structure of the Fallopian tube assist with its function of transport?

A

Inner mucosa- lined with ciliated columnar epithelia and peg cells (non ciliated secretory cells) ; waft ovum towards the uterus and supply it with nutrients
Smooth muscle layer- contracts to assist transportation of ova and sperm - muscle is sensitive to sex steroids so peristalsis is greatest when oestrogen levels are high; also muscle thickens as it gets closer to the uterus

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18
Q

What are the 5 components of the Fallopian tube?

A

Fimbriae- ciliated finger like projections - capture ovum from ovary
Infundibulum- funnel shaped opening to which fimbriae are attached
Ampulla- widest section of Fallopian tube where fertilisation often occurs
Isthmus- narrow section connecting ampulla to uterus
Ostium- part nearest uterus

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19
Q

What is the arterial supply to the Fallopian tubes?

A

AA –> ovarian arteries

Internal ilIac artery –> uterine arteries

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20
Q

What is the venous drainage of the Fallopian tubes?

A

L ovarian vein –> L renal vein –> IVC
R ovarian vein –> IVC
Uterine veins –> internal iliac veins

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21
Q

What is the lymphatic drainage of the Fallopian tube?

A

iliac, sacral and aortic lymph nodes

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22
Q

What is the innervation of the Fallopian tubes?

A

Sympathetic (ovarian pelvic plexus) and parasympathetic (uterine pelvic plexus) nerve fibres
Sensory afferent fibres run from T11 to L1

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23
Q

What is the uterus?

A

Secondary sex organ - which matures in puberty under the influence of sex hormones produced from primary sex organs (ovaries)
Thick walled muscular organ
Capable of expansion to accommodate growing foetus
Connected distally to vagina and laterally to Fallopian tubes

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24
What is the main function of the uterus?
Maintenance and transportation of gametes
25
What are the 3 main components of the uterus?
Fundus - top of uterus, above entry point of fallopian tubes Body- usual site of implant of blastocyst Cervix - lower part of uterus linking it with vagina- structurally and functionally different to rest of uterus
26
Describe the position of the uterus
Varies with degree of distension of the bladder Uterus is anteverted wrt vagina - rotated forwards towards anterior surface of body Uterus is anteflexed wrt cervix - flexed towards anterior surface of body So uterus lies I mediately posterosuperior to the bladder and anterior to the rectum
27
What are the three layers of the body and fundus of the uterus?
Perimetrium- double layered membrane continuous with abdominal peritoneum Myometrium- thick smooth muscular layer; cells undergo hypertrophy and hyperplasia during pregnancy in preparation to expel fetus in birth Endometrium - inner mucous membrane lining uterus
28
What are the two layers of the endometrium of the uterus?
Deep stratum basalis - changes little throughout the menstrual cycle and shed at menstruation Superficial stratum functionalis - proliferate in response to oestrogens and become secretory in response to progesterone, shed in menstruation and regenerates from cells in stratum basalis layer
29
What are the 5 main ligaments of the uterus?
Tone of the pelvic floor provides primary support for the uterus Ligaments provide further support: Broad ligament - double layer of peritoneum attaching at side of uterus to pelvic wall; acts as a mesentery fortune uterus and maintains its position Round ligament - remnant of gubernaculum from the uterine horn to the labia majora via inguinal canal- maintains anteverted position of uterus Ovarian ligament - connects ovaries to uterus (then continues as round ligament) Cardinal ligament - base of broad ligament from cervix to lateral pelvic walls - contains uterine artery and vein and gives support to the uterus Uterosacral ligament - cervix to sacrum
30
What is the arterial supply to the uterus?
Internal iliac artery --> uterine artery
31
What is the venous drainage of the uterus?
Venous plexus in broad ligament --> uterine veins --> internal iliac vein
32
What is the lymphatic drainage of the uterus?
Iliac, sacral, aortic and inguinal lymph nodes
33
What is the innervation of the uterus?
Sympathetic (uterovaginal plexus- anterior and intermediate parts of hypogastric plexus) and parasympathetic (pelvic splanchnic nerves - S2-S4) Afferent fibres mostly ascend through inferior hypogastric plexus to enter spinal cord via T10-T12 and L1 nerve fibres
34
What is the cervix?
Most distal part of the uterus, connects vagina with main body of uterus
35
What are the two main functions of the cervix
Facilitates the passage of sperm into the uterine cavity - achieved by dilation of external and internal os Maintains sterility of upper female reproductive tract: - cervix and all structures superior to it are sterile - ultimately protects the uterine cavity and upper genital tract by preventing bacteria invasion - environment maintained by: --> 1) frequent shedding of endometrium --> 2) thick cervical mucus --> 3) narrow external os
36
What are the 2 main components of the cervix?
Endocervical canal - inner part of cervix; lined by mucus secreting simple columnar epithelia, between internal os and external os Ectocervix- portion of the cervix that projects into the vagina; lined by stratified squamous non kerr finished epithelia; external os is the opening into it and marks the transition of epithelia
37
What is the arterial supply to the cervix?
Internal iliac artery --> uterine artery
38
What is the venous drainage of the cervix?
Venous plexus in broad ligament --> uterine veins --> internal iliac veins
39
What is the lymphatic drainage of the cervix?
Iliac, sacral, aortic and inguinal lymph nodes
40
What is the innervation of the cervix?
Inferior nerve fibres of uterovaginal plexus
41
What is the vagina?
Distensible muscular tube approx 9cm long | Extends upwards and backwards from vestibule of external genitalia to cervix
42
What are the functions of the vagina?
During sexual intercourse the vagina receives the penis and ejaculate assisting in its transport to the uterus Expand to provide a channel delivery of a newborn from the uterus to the outside world during childbirth Serves as a canal for menstrual fluid and tissue to leave the body
43
Describe the position of the vagina
Anterior to vagina is the bladder and urethra Posterior to vagina is rectum and anus Lateral to vagina is the ureter and uterine artery
44
Describe the ultra structure of the vagina
Stratified squamous non keratinised epithelia - provides protection and is lubricated by cervical mucus (vagina does not contain glands) Oestrogen stimulates the epithelia to secrete glycogen which is digested by lactobacillus vaginalis to produce lactate and maintain a low vaginal pH and prevent infection Elastic lamina propria - dense CT, projects papillae into overlying epithelium, larger veins located here Fibromuscular layer- inner circular and outer longitudinal smooth muscle Adventitia- fibrous layer which provides additional strength to the vagina whilst also binding it to surrounding structures
45
What is the arterial supply to the vagina?
Internal iliac artery --> uterine and vaginal arteries
46
What is the venous drainage of the vagina?
Vaginal venous plexus --> uterine vein --> internal iliac vein
47
What is the lymphatic drainage of the vagina?
Iliac and superficial inguinal lymph nodes
48
What is the innervation of the vagina?
Sympathetic and parasympathetic nerve fibres (uterovaginal plexus)- base of broad ligament either side of supravaginal part of cervix Superior part of vagina supplied by inferior fibres from uterogenital plexus Inferior part of vagina supplied by deep perineal nerve branch of pudendal nerve
49
What are the three main functions of the vulva of the female external genitalia?
Acts as a sensory tissue In sexual intercourse Assists in micturition, by directing flow of urine Defend internal female reproductive tract from infection
50
What is the mons pubis?
Fat pad at anterior of vulva covered with pubic hair
51
What is labia majora?
2 hair bearing external folds | Fuse posteriorly and extend anteriorly into mons pubis
52
What is the labia minora?
2 hairless skin folds which lie within the labia majora Fuse anteriorly to form the prepuce (hood) of the clitoris and extend posteriorly either side of the vaginal opening Fuse again posterior to vestibule - fold of skin = fourchette
53
What is the vestibule?
Area between and surrounding the labia | External vaginal orifice and urethra enter into vestibule
54
What are the Bartholins glands?
Located either side of vaginal orifice | These glands secrete lubricating mucus from small ducts in sexual arousal
55
What is the clitoris?
Located under the prepuce (hood of labia minora) | Formed of erectile corpora cavernosa tissue- becomes engorged with blood on sexual stimulation
56
What is the arterial supply of the vulva?
Internal branches of paired pudendal arteries
57
What is the venomous drainage of the vulva?
Small labial veins --> pudendal veins (engorged in sexual arousal and increase the size of the clitoris)
58
What is the lymphatic drainage of the vulva?
Superficial inguinal nodes
59
What is the innervation of the vulva?
Sensory- - anterior vulva - ilioinguinal nerve, genital branch of genitive oral nerve - posterior vulva - pudendal nerve, posterior cutaneous nerve of thigh Parasympathetic - clitoris and vestibule- cavernous nerves; uterovaginal plexus
60
Where is the testis located?
Within the scrotum Epididymis located on posterolateral aspect of each testicle Commonly left testicle lies lower than the right They are suspended from abdomen by spermatic cord Originally testes are found on posterior abdominal wall- descend down abdomen through the inguinal canal to reach the scrotum- carry their neurovascular supply with them
61
What is the shape of the testes?
Ellipsoid shape
62
What are the main components of the testes and epididymis?
Seminiferous tubules- where spermatazoa are produced Rete testis- where developing sperm collect Efferent ductules- transport sperm to epididymis from rete testis Epididymis- head, body and tail Vas deferens
63
What are the two main coverings of the testis?
Tunica vaginalis - most externally, covers anterior and sides of each testicle, derived from abdominal peritoneum in development Tunica albuginea- most internally, fibrous capsule that encloses the testis, penetrates into the parenchyma of each testicle dividing it into lobules
64
Describe the epididymis
Single heavy coiled duct - 3 parts - head- most proximal part of epididymis, formed by efferent tubules of testes which transport sperm from testes to epididymis - body- heavily couled duct of epididymis - tail- most distal part of epididymis, marks origin of vas deferns - transports sperm to urethra for ejaculation
65
What is the arterial supply of the testes and epididymis?
AA --> Paired testicular arteries (descend down abdomen and pass into inguinal canal with spermatic cord and into scrotum
66
What is the venous drainage of the testes and epididymis ?
Pampiniform plexus (in scrotum) - network of veins wrapped around the testicular artery - become testicular vein in spermatic cord L testicular vein --> L renal vein --> IVC R testicular vein --> IVC
67
What is the lymphatic drainage of the testes and epididymis?
Paired lumbar and pre aortic nodes (at L1 level) - unlike scrotum itself which drains to nearby superficial inguinal nodes
68
What is the innervation of the testes and epididymis?
Testicular plexus - network of nerves derived from renal and aortic plexi They receive autonomic and sensory fibres
69
What is the scrotum?
Fibromuscular cutaneous sac between the penis and anus | Dual chambered forming and expansion of the perineum
70
What is the scrotum embryologically derived from?
Genital folds - fuse in the midline- in adults this fusion is marked by the scrotal raphe
71
What is the female equivalent of the scrotum?
Biologically homologous to labia majora
72
What is the contents of the scrotum?
Testis- site of sperm production Epididymis- site of sperm storage Spermatic cord- collection of muscle, fibres vessels nerves and ducts that run to and from the testes
73
What muscle fibres are found within the scrotum itself?
Dartos- sheet of smooth muscle - immediately underneath the skin Function- regulates the temperature of the scrotum by wrinkling the skin- decreases SA and heat loss
74
What is the arterial supply to the scrotum?
External pudendal artery --> anterior scrotal arteries | Internal pudendal artery --> posterior scrotal arteries
75
What is the venous drainage of the scrotum?
Scrotal veins (follow major arteries) --> external pudendal veins
76
What is the lymphatic drainage of the scrotum?
Nearby superficial inguinal lymph nodes
77
What is the innervation of the scrotum?
Cutaneous innervation: - femoral plexus --> genital branch of genitofemoral n - anteriolateral scrotum - ilioinguinal nerve --> anterior scrotal nerves - anterior scrotum - perineal nerve --> posterior scrotal nerves - posterior scrotum - sacral plexus --> perineal branches of posterior femoral cutaneous nerve - inferior scrotum
78
What is the spermatic cord?
Collection of muscles, fibres, vessels, nerves and ducts that run to and from testes surrounded by fascia - forming a cord like structure
79
What is the course of the spermatic cord?
Starts at posterior border of testes in scrotum Enters inguinal canal via superficial inguinal ring Passes through inguinal canal Leaves via the deep inguinal ring into the inferior abdomen
80
What are the three fascial coverings of the spermatic cord derived from?
Anterior abdominal wall External spermatic fascia- aponeurosis of EO Cremasteric spermatic fascia- IO and transversalis fascia Internal spermatic fascia- transversalis fascia
81
What are the three layers of fascial coverings of the spermatic cord?
External spermatic fascia Cremasteric spermatic fascia- contains cremaster muscle- discontinuous layer of striated muscle, longitudinally orientated Internal spermatic fascia
82
What is the Cremasteric reflex?
Stroking superior and middle part of thigh producing an immediate contraction of cremaster muscle elevating testes on side that has been stimulated
83
What two parts does the Cremasteric spinal reflex consist of?
Afferent (sensory) limb - ilioinguinal or genitofemoral nerve Efferent (motor) limb - genital branch of genitofemoral nerve
84
What does the spermatic cord consist of?
``` 3 Arteries -Testicular artery -Artery to vas deferens -Cremasteric artery (and vein) 3 nerves - Genital branch of genitofemoral nerve - Parasympathetic nerves - Sympathetic nerves 3/4 other things - Vas deferens - Pampiniform plexus- becomes testicular vein in spermatic cord - Lymph vessels (-Processus Vaginalis) ```
85
What is the Pampiniform plexus?
Network of veins responsible for venous drainage of testes Wraps around testicular artery Testes function best at a temperature below the body - plexus acts as a heat exchanger - cooling the arterial blood just before it reaches the testes As it travels through the inguinal canal the plexus condensed into a single testicular vein
86
What is the vas deferens?
Straight, thick, muscular tube which transports sperm from the epididymis to the ejaculatory duct
87
What are the three muscular layers of the vas deferens?
Inner layer of longitudinal muscle Intermediate layer of circular muscle Outer layer of longitudinal muscle
88
What nerve influence is the vas deferens under?
Rich autonomic innervation of these muscle fibres - permits the movement of sperm to the ejaculatory duct
89
What is the anatomical course of the vas deferens?
Continuous with tail of epididymis Travels through the inguinal canal Moves down the lateral pelvic wall close to the ischial spine Turns medially to pass between the bladder and urethra Joins duct from seminal vesicle to form the ejaculatory duct
90
What are the seminal vesicles?
Pair of small tubular glands which supply 70 % of semens final volume
91
What is the position of the seminal vesicles?
Located between the bladder fundus and the rectum (separated from the rectum by rectovesicle pouch) Duct of the seminal gland combines with the vas deferens to form the ejaculatory duct which drains into the prostatic urethra
92
What is the general structure of the seminal vesicles?
Internally the gland has a honey combed lobulated structure - Mucosa - pseudostratified columnar epithelia: highly influenced by testosterone- growing taller with higher levels; responsible for seminal secretions
93
What 4 structures are embryologically derived from the mesonephric ducts in males?
Seminal vesicles Ejaculatory duct Epididymis Ductus deferens
94
What is the function of the seminal vesicles?
Seminal gland secretions have a key role in the normal functioning of semen - alkaline fluid- neutralises the acidity of male urethra and vagina in order to facilitate the survival of sperm - fructose- energy source for sperm - keep swimming - prostaglandins- suppress female immune response to foreign semen - clotting factors- keep semen in the female reproductive tract post ejaculation
95
What is the arterial supply of the seminal vesicles?
Internal iliac artery --> inferior vesicle artery, internal pudendal artery, middle rectal artery
96
What is the lymphatic drainage of the seminal vesicles?
External and internal iliac lymph nodes
97
What is the innervation of the seminal vesicles?
Sympathetic - causes contraction of smooth muscle of the seminal vesicles- ejaculation
98
What are the bulbourethral / Cowper's glands?
Pea shaped exocrine glands- posterolateral to the membranous urethra Contribute to the final volume of semen - produce a lubricating mucus secretion
99
What is the position of the bulbourethral glands?
Enclosed within the fibres of the external urethral sphincter Posterolateral to the membranous urethra Superior to the bulb of the penis Duct of the gland penetrates the perineal membrane and opens into the proximal portion of the spongy urethra
100
What is the structure of the bulbourethral gland?
Compound Tubulo-alveolar glands lined by columnar epithelia
101
What is derived from the urogenital sinus in the male?
Bulbourethral glands, bladder, prostate and urethra
102
What are the functions of the bulbourethral glands?
Mucus secretion- lubrication in sexual arousal, alkaline- neutralise residual acidity in male urethra Theorised that secretion can carry sperm into the female reproductive tract prior to ejaculation- failure of common contraceptives
103
What is the arterial supply of the bulbourethral gland?
Arteries to the bulb of the penis
104
What is the lymphatic drainage of the bulbourethral glands?
Internal and external iliac lymph nodes
105
What is the innervation of the bulbourethral glands?
Sympathetic- prostatic plexus- ejaculation
106
What is the prostate?
Largest accessory gland in the male reproductive tract Secretes proteolytic enzymes into semen, which act to break down clotting factors in the ejaculate - allowing semen to remain in a fluid state moving throughout the female reproductive tract for potential fertilisation Walnut size- 2/3 glandular, 1/3 Fibromuscular Surrounded by fibrous capsule
107
What is the position of the prostate?
Positioned inferior to neck of the bladder and superiorly to the external urethral sphincter with levator ani muscle lying inferolaterally to the gland Ampulla of rectum lies posteriorly to the prostate (DRE) Proteolytic enzymes leave prostate via the prostatic ducts- open into the prostatic portion of urethra- secreting enzymes into semen immediately before ejaculation
108
What are the 4 anatomical lobes of the prostate gland? And what creates them?
Inferoposterior Inferolateral Superomedial Anteromedial By urethra and ejaculatory ducts as they pass through the organ
109
What are the 3 histological zones of the prostate gland?
Central zone- surrounds the ejaculatory duct; embryological lay derived from Wolffian ducts Transitional zone- centrally located and surrounds the urethra; embryo logically derived from urogenital sinus Peripheral zone- main body of gland and located posteriorly; embryo logically derived from urogenital sinus; zone felt against the rectum in the DRE
110
When are the zones of the prostate gland clinically important?
BPH and prostatic cancer
111
What is the arterial supply to the prostate?
Internal iliac arteries, internal pudendal arteries and middle rectal arteries --> Prostatic arteries
112
What is the venous drainage of the prostate gland?
Prostatic venous plexus --> internal iliac veins (also connects posteriorly to Batson venous plexus --> to internal vertebral venous plexus
113
What is the innervation of the prostate gland?
Sympathetic, parasympathetic and sensory innervation from the inferior hypo gastric plexus - smooth muscle of prostate gland innervated by sympathetic fibres which activate during ejaculation
114
Where is the Fibromuscular stroma of the prostate situated?
Fibromuscular stroma situated anteriorly on gland - merges with tissue of urogenital diaphragm
115
What is the orientation of the penis in the anatomical position?
Penis is erect - dorsal side is closest to the abdomen and ventral side is closest to the testes
116
What are the two main functions of the penis?
Sexual intercourse- during erotic stimulation, penis undergoes erection, becoming engorged with blood; following emission (mixing of components of semen in prostatic urethra), ejaculation can occur, whereby semen moves out of urethra through the external urethral orifice; finally penis undergoes remission returning to a flaccid state Micturition- contains urethra which carries urine from bladder to external urethral orifice where it is expulsed from body
117
What are the three main parts of the penis?
Root Body Glans
118
What are the main structures of the root of the penis?
Most proximal fixed part In superficial perineal pouch of the pelvic floor Not visible externally 3 erectile tissues- 2 crura and bulb of penis 2 muscles- ischiocavernosus, bulbospongiosus
119
What are the main structures of the body of the penis?
Free part of the penis Between root and glans Suspended from the pubic symphysis 3 cyclinders of erectile tissue- 2 corpora cavernosa and corpus spongiosum
120
What are the main structures of the glans of the penis?
Distal part of the penis Conical in shape Formed by distal expansion of corpus spongiosum Contains opening of the urethra - external urethral orifice
121
What erectile tissues are found in the penis?
Parts of the penis that fill with blood upon arousal Root- left and right crura and bulb of penis Body- 2 corpora cavernosa and corpus spongiosum
122
Which part of the penis does the male urethra run through and why?
Male urethra runs through the corpus spongiosum - to prevent it becoming occluded in erection - corpus spongiosum fills to a reduced pressure
123
What are the 4 muscles found in the penis?
2 x bulbospongiosus | 2 x ischiocavernosus
124
Describe bulbospongiosus
Associated with bulb of penis Contracts to empty spongy urethra of any residual semen and urine Anterior fibres aid in maintaining erection by increasing pressure in bulb of penis
125
Describe ischiocavernosus
Surrounds the left and right crura of penis | Contracts to force blood from cavernous spaces in the crura into the corpora cavernosa - helps to maintain an erection
126
What fascial coverings does the erectile tissue in the penis have?
Each mass of erectile tissue has 2 fascial coverings Deep fascia of penis- most superficial layer, continuation of deep perineal fascia and forms a strong membranous covering which binds erectile tissue together Tunica albuginea- under deep fascia, individual capsule around each cavernous body
127
What are the two main ligaments associated with the penis?
Root of Penis is supported by 2 ligaments: Suspensory ligament- condensation of deep fascia; connects the erectile bodies of the penis to pubic symphysis Fundiform ligament- condensation of abdominal subcutaneous tissue; runs down the linea alba, surrounding the penis like a sling and attaching to the pubic symphysis
128
Describe the colour of the skin of the penis
More heavily pigmented than rest of the body
129
What is a prepuce
Foreskin Double layer of skin and fascia at neck of glans - connected to skin of glans by frenulum Preputial sac - potential space between the glans and prepuce
130
What is the arterial supply to the penis?
Anterior division of internal iliac artery --> internal pudendal artery --> dorsal arteries of penis, deep arteries of penis and bulbourethral artery
131
What is the venous drainage of the penis?
Cavernous spaces --> deep dorsal veins of penis --> prostatic venous plexus Skin and cutaneous tissues --> superficial dorsal veins of penis
132
What is the innervation of the penis?
S2-S4 spinal cord segments and spinal ganglia Sensory and sympathetic innervation to the skin and glans penis is supplied by dorsal nerve of penis - branch of pudendal nerve Parasympathetic innervation is supplied by cavernous nerves from prostatic nerve plexus - responsible for vascular changes and causes erection