Reproduction Flashcards
upper female genital tract
upper 2/3rds of vagina, uterus, cervix, ovaries, fallopian tubes
lower female genital tract
lower third of vagina, external genitalia
blood supply of female
ovaries - ovarian arteries from abdominal aorta
uterus - uterine arteries from internal iliac
vagina - vaginal arteries from internal iliac
venous drainage
-vaginal venous plexus/uterine vein –> internal iliac vein –> ivc/ left renal vein
external genitalia = paired pudendal arteries from internal iliac
what germ layer is the genital tract derived from
mesoderm
what cells line vagina
stratified squamous
explain flexion and version of vagina
flexion - between cervix and uterus
version - between vagina and cervix
ligaments of female
broad
- mesosalpinx (area above ovarian ligament)
- mesoovariam (part that suspends the ovaries)
- mesometrium (area below ovarian ligament)
ovarian
suspensory
round
ovarian + round = male homologue of gubernaculum
nerve supply of female
inferior hypogastric plexus = T12
but derived from T10 down - so nerve block would be put here
what is
Hydrosalpinx
Pyo-salpinx
hydrosalpinx = Fallopian tubes filled with/blocked by serous/clear fluid near ovary (distal to uterus)
pyo-salpinx = filled with pus
Chandelier sign
touching of vagina is so painful they jump up and ‘reach for chandelier’
could indicate ectopic pregnancy/pelvic inflammatory diseases
what node does lymphs from ovarian drain to
+ nodes from external genitalia?
ovaries - para-aortic
external genitalia - superficial inguinal
sensory innervation of vulva (anterior and posterior)
+ clitoris & vestibule innervation
anterior
- ilioinguinal nerve
- genital branch of genitofemoral
posterior
- pudendal
- posterior cutaneousnerve of the thigh
clitoris/vestibule
-cavernous nerves, derived from the uterovaginal plexus. (parasympathetic)
clinical conditions:
- menorrhagia
- metrorrhagia
- dysmenorrhoea
- oligomenhorrhoea
-Endometriosis
- abnormally heavy bleeding
- abnormal bleeding from the uterus
- painful menstruation
- infrequent menstruation
-tissue similar to lining of uterus grow in other places (eg. ovaries/Fallopian tube)
no.1 reason for hysterectomy
+what can this condition cause
uterine fibroids (growth of tissue in non-cancerous way within myometrium)
cause
- polyuria if forwards
- constipation if forms backwards
- multiple bleeding throughout the month
adnexa
structures between uterus and pelvic side wall are referred as this
Salpingitis and what is the common cause
inflammation of fallopian tubes
chlamydia/gonoccocal (gonorrhoea)
3 types of cells found in the ovary
surface epithelium - covers outer lining of ovaries
germ cells - destined to form oocytes
stromal cells - release hormones and connect the different structures of the ovaries
how long is the vagina
3/4inches or 10cm
what does gubernaculum attach to
gonads–> labiascrotal swellings
Why can a cyst in the ovary lead to pain in the inner side of the thigh down to the knee?
obturator nerves are close to the ovaries
via referred pain
obturator nerve supplies the inner thigh (L2,3,4)
difference in venous drainage of the right and left ovaries?
ovarian veins drain the ovaries via suspensory ligaments
left ovarian vein drains into left RENAL vein
right–>abdominal IVC
relationship between the ovarian artery and ureter at the pelvic brim?
the ovarian artery crosses over the ureter
during an ovariectomy if you clip the ureter as well–> hydronephrosis (swelling of kidney due to build up of urine)
the uterine artery also passes above the ureter at level of lateral vagina fornix - must be careful during hysterctomy
level of ovarian/testicular artery
L2
5 parts of external male genitalia
scrotum penis ureter vas deferens testes
temperature regulation of scrotum/testes
dartos muscle contract - form rugae (wrinkles) decreasing SA
cremasteric muscle contracts pulling up the scrotum and testes
Hydrocele
Varicocele
swelling in the scrotum
around testicles
within the veins
what week do testes reach scrotum
what name is given to undescended testes
30-32 weeks
Cryptorchidism = undescended testes
Epididymo- orchitis
+ main causes
inflammation of testes AND epididymis (Epididymitis = just epididymis)
in old men = UTIs
younger men = STIs
+ can lead to hydroceles
what does artery to vas deferens arise from
superior vesicle artery = branch of internal iliac
2 parts of the root of penis + what corpus structures arise from them
crura - cavernousum
bulb - spongiosum
what is the connective tissue that surrounds the seminiferous tubules called
tunica albuginea
structures present in the spermatic cord
3 coverings
- internal spermatic fascia (inner) from transversalis fascia
- cremasteric fascia (middle) from internal oblique muscle
- external spermatic fascia from external oblique aponeurosis
3arteries
- cremasteric
- testicular
- artery to vas deferens
- genital branch of genitofermal nerve
- vas deferens
- lymphatics
- pampiniform plexus
- cremasteric vein
- remnant of tunica vaginalis
what accompanies the spermatic cord through the superficial inguinal ring but does not travel within the cord
ilioinguinal nerve
what causes the testes to descend
what could cause it not to descend
at what age should the testes be fully descended
descends through the inguinal canal because of the pressure produced by the intra-abdominal organs + androgens + gubernaculum
androgen insensitivity syndrome
should be by 1yrs old
what happens if processus vagnilias fails to close
becomes a potential weakness in anterior abdominal wall–> inguinal hernias
in males only the proximal end closes - the distal end expands to enclose most of the testes in the scrotum as the tunica vaginalis
which side is varicocele more commonly formed and why
left
left testicular vein drains into left renal vein whereas right –> IVC
Due to 2 reasons
- nutcracker effect (vein compressed as it passes between SMA and AB.aorta)
- lack of effective anti-reflux valves at the junction between left testicular vein and renal vein
cremasteric reflex
what may cause this to be absent
if you stroke the upper inner thigh
contraction via genitofemoral nerve –> cremasteric muscle
if absence - testicular torsion/ spine injury of L1/2
lymph drainage of scrotum vs testis
testis - para-aortic
scrotum - superficial inguinal
different because testes descend and take their innervation/blood supply and lymphatic drainage with them
lacunar ligament
connects the inguinal ligament to the pectineal line of pubis
conjoint tendon
combination/aponeruosis of transverses abdominis and internal oblique
inserts into the pubic crest right behind the superficial inguinal ring
contents of inguinal canal
spermatic cord in men
round ligament in women
genitofemoral nerve
ilioinguinal nerve but doesn’t enter via deep
direct vs indirect inguinal hernias
which is more common in men
indirect = peritoneal sac protrudes THROUGH deep inguinal ring
(most common)
direct = by passes the deep inguinal ring and it enters the medial end of inguinal canal
both protrude out of superficial
indirect is more common in men because some/all of the processes vaginalis remains patent
course of ductus deferens
- epididymis
- up spermatic cord
- superficial inguinal ring
- out of deep inguinal ring
- crosses over external iliac artery - bending laterally round the inferior epigastric artery
- over the ureters
- down inferomedially to behind bladder
- seminal vesicles to form the ejactulatory duct
it runs deep to the peritoneum
prostate division
4 zones
- anterior = non-glandular(isthmus)
- transitional (close to urethra)
- central (right infant of rectum)
- peripheral (on either side)
the other 3 are glandular = ducts/glands that secrete fluid
the clinical significance of the zones of the prostate
transitional + central (‘medial lobe’) undergoes transition under influence of hormones –> Benign prostate hypertrophy
when this lobe enlarges in BPH–> compress urethra–> urinary retention/outflow obstruction
peripheral zone - adenocarcinoma is most common
What is the blood supply of the prostate? Why is the venous drainage especially important in prostatic neoplasia? To which organs does prostate cancer often spread?
prostrate supplied by inferior vesicle artery - branch of internal iliac
venous drainage = prostatic plexus
prostatic neoplasia–> invade VERTEBRAE since the plexus communicates with the spinal venous plexus
can cause damage to the CNS
parts of urethra
- preprostatic - from base of bladder to start of prostate
(surrounded by internal urethral sphincter)
2.prostatic - within prostate
(on either side - opening of ejactulatory duct)
- membranous - surrounded by external urethral sphincter
- spongy/penile urethra (surrounded by erectile tissue = corpus spongiosum)
erection/ejaculation innervation
erection = parasympathetic S2,3,4 (vasodilation, BF to cavernosa)
emission = Sympathetic L1,2 (ductus deferens/seminal vesicles contract—> urethra)
Ejactulation = rhythmic contraction of bulbospongiosus muscle and opening of external urethral sphincter = PUDENDAL NERVE branches
what coverings restrict venous drainage during erection
tunica albuginea of penis (different to the one in scrotum)
surrounds the corpus cavernosum
+ buck fascia surrounding covering all 3
what sphincter closes to avoid retrograde ejaculation
+ What is the neurological significance of retrograde ejaculation
internal urethral
The internal urethral sphincter is neurologically controlled by L1-L2(parasympathetic) and is important in preventing retrograde ejaculation.
2 muscles associated with the penis
ischiocavernous muscle - they cover the crura part of the penis root (–>cavernosum)
bulbospongiosus muscle - cover the bulb part of root
female equivalent to scrotum + what does it contain
labia minora
scenes glands and bartholins glands
blood supply to the testes and the level
testicular arteries L2 of aorta
cremasteric artery from inferior epigastric (which is from ext.iliac)
artery of vas deferens from inferior vesicle artery (from int.iliac)
VENOUS DRAINAGE
pampiniform plexus–>testicular vein (left into renal vein, right straight into IVC)
mediastinum testis
tunica albuginea protrudes into the posterior border of the testis, forming a longitudinal ridge
how many lobules in testis/ how many tubules per lobule
200-300 lobules /testis
1-4 tubules/lobule
how many spermatozoa per day produced
108-300million
how many efferent ductules pass to the epididymis
+ how long is the epididymis
15-20
6-7m
4 muscles in root of penis + nerve supply
2x bulbiospongiosus - contraction to expel any semen/urine
2x ischiocavernosus - contraction to force blood in cavernosum (erection)
PERINEAL nerve (branch of pudendal)
covering around erectile tissue
Colles (from scarpa’s) superficial
Bucks (from deep perineal)
Tunica albuginea (around each separate tissue)
9 branches of anterior division of internal iliac artery
superior vesicle inferior vesicle umbilical uterine vaginal inferior gluteal internal pudendal middle rectal obturator
blood supply to penis
from internal pudendal
dorsal artery (cavernosum+ glans) deep artery (cavernosum) bulbourethral(spongiosum)
