Repro- Anatomy And Histology Flashcards
What are the female external organs?
Inferior 2/3 vagina Labia majora Labia minora Vestibule Clitoris
What are the female internal organs?
Ovary Fallopian tube Uterus Cervix Superior 1/3 of vagina
What are the 2 main functions of the ovaries?
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
What are the three components of the ovary?
Medulla
Cortex
Hilum
What cells are found on the outermost surface of the ovary?
Cuboidal epithelia- germinal epithelium (not germ cell origin)
Describe the cortex of the ovary
Largely comprised of CT stroma
Supports thousands of follicles
Each primordial follicle contains an oocyte surrounded by a singular layer of follicular cells
Describe the medulla of the ovary
Composed of supporting stroma and large neurovascular network which enters the hilum of the ovary from the mesovarium
What three ligaments are associated with the ovary?
Ligament of the ovary
Broad ligament
Suspension ligament
What is the suspensory ligament of the ovary?
Fold of peritoneum extending from mesovarium to the pelvic wall- contains neurovascular structures
What is the ligament of the ovary?
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)
What is the broad ligament?
Mesentery for the ovary, Fallopian tube and uterus
What is the arterial supply to the ovary?
AA–> ovarian arteries
What is the venous drainage of the ovary?
L ovarian vein –> L Renal vein –> IVC
R ovarian vein –> IVC
What is the lymphatic drainage of the ovary?
Para aortic lymph nodes
What is the nerve supply to the ovary?
Nerve supply runs via the suspensory ligament of the ovary with the Vasculature
Parasympathetic (uterine pelvic plexus) and sympathetic (ovarian pelvic plexus) nerve fibres
What are the Fallopian/ uterine tubes?
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
What is the main function of the Fallopian tube?
Assists in transfer and transport of ovum from the ovary to the uterus
How does the ultra structure of the Fallopian tube assist with its function of transport?
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
What are the 5 components of the Fallopian tube?
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
What is the arterial supply to the Fallopian tubes?
AA –> ovarian arteries
Internal ilIac artery –> uterine arteries
What is the venous drainage of the Fallopian tubes?
L ovarian vein –> L renal vein –> IVC
R ovarian vein –> IVC
Uterine veins –> internal iliac veins
What is the lymphatic drainage of the Fallopian tube?
iliac, sacral and aortic lymph nodes
What is the innervation of the Fallopian tubes?
Sympathetic (ovarian pelvic plexus) and parasympathetic (uterine pelvic plexus) nerve fibres
Sensory afferent fibres run from T11 to L1
What is the uterus?
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
What is the main function of the uterus?
Maintenance and transportation of gametes
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
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
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
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
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
What is the arterial supply to the uterus?
Internal iliac artery –> uterine artery
What is the venous drainage of the uterus?
Venous plexus in broad ligament –> uterine veins –> internal iliac vein
What is the lymphatic drainage of the uterus?
Iliac, sacral, aortic and inguinal lymph nodes
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
What is the cervix?
Most distal part of the uterus, connects vagina with main body of uterus
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
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
What is the arterial supply to the cervix?
Internal iliac artery –> uterine artery
What is the venous drainage of the cervix?
Venous plexus in broad ligament –> uterine veins –> internal iliac veins
What is the lymphatic drainage of the cervix?
Iliac, sacral, aortic and inguinal lymph nodes
What is the innervation of the cervix?
Inferior nerve fibres of uterovaginal plexus
What is the vagina?
Distensible muscular tube approx 9cm long
Extends upwards and backwards from vestibule of external genitalia to cervix
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
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
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
What is the arterial supply to the vagina?
Internal iliac artery –> uterine and vaginal arteries
What is the venous drainage of the vagina?
Vaginal venous plexus –> uterine vein –> internal iliac vein
What is the lymphatic drainage of the vagina?
Iliac and superficial inguinal lymph nodes
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
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
What is the mons pubis?
Fat pad at anterior of vulva covered with pubic hair
What is labia majora?
2 hair bearing external folds
Fuse posteriorly and extend anteriorly into mons pubis
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
What is the vestibule?
Area between and surrounding the labia
External vaginal orifice and urethra enter into vestibule
What are the Bartholins glands?
Located either side of vaginal orifice
These glands secrete lubricating mucus from small ducts in sexual arousal
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
What is the arterial supply of the vulva?
Internal branches of paired pudendal arteries
What is the venomous drainage of the vulva?
Small labial veins –> pudendal veins (engorged in sexual arousal and increase the size of the clitoris)
What is the lymphatic drainage of the vulva?
Superficial inguinal nodes
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
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
What is the shape of the testes?
Ellipsoid shape
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
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
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
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
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
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
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
What is the scrotum?
Fibromuscular cutaneous sac between the penis and anus
Dual chambered forming and expansion of the perineum
What is the scrotum embryologically derived from?
Genital folds - fuse in the midline- in adults this fusion is marked by the scrotal raphe
What is the female equivalent of the scrotum?
Biologically homologous to labia majora
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
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
What is the arterial supply to the scrotum?
External pudendal artery –> anterior scrotal arteries
Internal pudendal artery –> posterior scrotal arteries
What is the venous drainage of the scrotum?
Scrotal veins (follow major arteries) –> external pudendal veins
What is the lymphatic drainage of the scrotum?
Nearby superficial inguinal lymph nodes
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
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
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
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
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
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
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
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)
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
What is the vas deferens?
Straight, thick, muscular tube which transports sperm from the epididymis to the ejaculatory duct
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
What nerve influence is the vas deferens under?
Rich autonomic innervation of these muscle fibres - permits the movement of sperm to the ejaculatory duct
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
What are the seminal vesicles?
Pair of small tubular glands which supply 70 % of semens final volume
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
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
What 4 structures are embryologically derived from the mesonephric ducts in males?
Seminal vesicles
Ejaculatory duct
Epididymis
Ductus deferens
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
What is the arterial supply of the seminal vesicles?
Internal iliac artery –> inferior vesicle artery, internal pudendal artery, middle rectal artery
What is the lymphatic drainage of the seminal vesicles?
External and internal iliac lymph nodes
What is the innervation of the seminal vesicles?
Sympathetic - causes contraction of smooth muscle of the seminal vesicles- ejaculation
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
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
What is the structure of the bulbourethral gland?
Compound Tubulo-alveolar glands lined by columnar epithelia
What is derived from the urogenital sinus in the male?
Bulbourethral glands, bladder, prostate and urethra
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
What is the arterial supply of the bulbourethral gland?
Arteries to the bulb of the penis
What is the lymphatic drainage of the bulbourethral glands?
Internal and external iliac lymph nodes
What is the innervation of the bulbourethral glands?
Sympathetic- prostatic plexus- ejaculation
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
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
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
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
When are the zones of the prostate gland clinically important?
BPH and prostatic cancer
What is the arterial supply to the prostate?
Internal iliac arteries, internal pudendal arteries and middle rectal arteries –> Prostatic arteries
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
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
Where is the Fibromuscular stroma of the prostate situated?
Fibromuscular stroma situated anteriorly on gland - merges with tissue of urogenital diaphragm
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
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
What are the three main parts of the penis?
Root
Body
Glans
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
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
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
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
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
What are the 4 muscles found in the penis?
2 x bulbospongiosus
2 x ischiocavernosus
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
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
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
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
Describe the colour of the skin of the penis
More heavily pigmented than rest of the body
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
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
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
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
