Reproductive Anatomy Flashcards
which nerve supply the thoracic, pelvic, and urogenital diaphragms?
thoracic: C3-C5 (phrenic nerve)
pelvic: S3-S5 (somatic nerves)
urogenital: S2-S4 (pudendal nerve)
what are the three parts of the coxae/hip bones?
- ilium: iliac crest (L4/ abdominal aorta bifurcation landmark) + iliac fossa + anterior superior iliac spine
- ischium: spine serves as muscle/ligament attachment, pudendal nerve runs along spine
- pubis (+ pubic symphysis)
What is vertebral level does the abdominal aorta bifurcate into the common iliac arteries and what is the bony landmark of this?
L4 - iliac crest
pelvic diaphragm/floor =…
levator ani muscle + ischiococcygeus muscle + fascia
note levator ani muscles attach to the pelvic bones AND muscular white line/tendinous arch (thickening of obturator internus fascia)
What is contained in the deep versus superficial perineum?
perineum is inferior to the pelvic diaphragm
deep (superior), aka urogenital diaphragm: contains external urethral sphincter
superficial (inferior): contains erectile tissue/ skeletal muscle/ fascia of external genitalia
Which nerve and artery supplies both the deep and superficial perineal pouch?
pudendal nerve + internal pudendal artery
do not go through pelvic diaphragm, rather, pass through openings in the posterior pelvic wall (greater and lesser sciatic foreman)
from what do the gonadal arteries branch, and how do they reach the ovary and testis, respectively?
Gonadal arteries branch from the abdominal aorta at L2
Female – course through the suspensory ligament to reach ovary
Male – course through spermatic cord (in inguinal canal) to reach testes
branches of which arteries supply the pelvic viscera, including the oviducts, uterus, vagina, prostate, urinary bladder, and urethra?
branches of the internal iliac arteries
what kind of innervation does the aortic–gonadal plexus versus the inferior hypogastric plexus provide?
aortic-gonadal (autonomic, on gonadal artery): sympathetic splanchnic nerves with pain to T10-T11 DRG
inferior hypogastric (autonomic, in pelvis): sympathetic above pelvic pain line + parasympathetic below pelvic pain line
Contrast the sympathetic versus parasympathetic innervation by the inferior hypogastric plexus
sympathetic (above pelvic pain line): vasoconstriction, smooth muscle sphincter contraction, ejaculation, nerves with pain to T11-L2 DRG
parasympathetic (below pelvic pain line): smooth muscle contraction, sphincter inhibition, erection (cavernous nerves in prostatic plexus), nerves with pain to S2-S4 DRG
Where does visceral pain for the gonads refer to?
T10-T11 dermatomes, because the visceral afferent pain fibers from the ovaries/testes “piggyback” on the sympathetic splanchnic nerves originating from here to reach the DRG at this level
which internal female organs lie in the greater versus lesser pelvis?
greater pelvis - ovaries, uterine tubes, uterine fundus + body
lesser pelvis - uterine cervix and upper vagina
[external genitalia are in the perineum]
into which to the right versus left ovarian veins drain?
Right – IVC
Left – left renal vein
What is the relation of the ureter to the uterine artery and why is this anatomical relation important?
“water under the bridge” - ureter courses inferior to the uterine artery
Important to know during hysterectomy
From what are the suspensory ovarian ligament and proper ovarian ligament derived? what are their respective functions?
both are segments of the broad ligament, which is made of the inferolateral edges of the parietal peritoneum
Suspensory ovarian ligament (aka infundibulopelvic ligament) carries the ovarian arteries and vein, connects ovary to body wall
Proper ovarian ligament is a fibrous cord connecting the ovary to the uterine body
vagina fornices
Recesses between the cervix and the vagina walls (anterior, posterior, lateral)
Pouch of Douglas
A.k.a. rectouterine pouch – lowest point of peritoneal cavity where exudate or pelvic abscess pooling my occur
small space found between uterus and rectum
adnexa
uterine tubes + ovaries
what are the respective functions of the round ligament of the uterus and the cardinal/transverse cervical ligament?
round ligament - extends from the uterus to the anterior abdominal wall to pass through the inguinal canal and reach the labia majora
cardinal/transverse cervical - connects at the pericervical ring and carries the uterine vessels
cystocele vs rectocele vs uterine prolapse
cystocele: bulge/herniation of urinary bladder into anterior vaginal wall
rectocele: bulge/herniation of rectum into posterior vaginal wall
uterine prolapse: bulge/herniation of uterus through vaginal canal
leiomyomas
aka fibroids, benign smooth muscle tumors of the uterus
episiotomy
surgical incision made during childbirth at the posterior edge of the vagina to widen the birth canal (no longer recommended)
previously done to prevent random tearing of the perineal structures, such as the perineal body (central tendon of the perineum and critical for maintaining the integrity of the pelvic floor)
how is anesthesia of the perineum performed?
via pudendal nerve block, using the ischial spine as a landmark
what is the most common zone of the prostate for benign prostate hyperplasia vs prostatic cancer to arise?
transitional zone - typical site of BPH
peripheral zone - where majority of prostatic cancers arise
where are the 3 sites to which prostatic cancer typically metastasizes?
- bone
- lung
- liver
the ends of the ductus deferens dilate into an _____ that combines with the
________
ends of the ductus deferens dilate into an ampulla that combines with the
seminal vesicles
what are the 3 penile erectile bodies?
2 corpora cavernosa + 1 corpus spongiosum (contains penile/spongy urethra)
fill with blood to elicit erection
During erection, blood from the _______ leads to ______ arteries that fill the erectile tissues. Compression of the _______ vein against the thick Buck’s fascia of the penis stops venous return during erection.
During erection, blood from the internal pudendal artery leads to helicine arteries that fill the erectile tissues. Compression of the deep dorsal vein against the thick Buck’s fascia of the penis stops venous return during erection.
contrast the nervous input driving erection vs emission/ejaculation
erection - parasympathetic
ejaculation - sympathetic
the _____ is located in the ______ and serves as attachment for the external genitalia
the UG diaphragm is located in the deep perineum and serves as attachment for the external genitalia
The gonadal vessels branch from the _______. The ovarian vessels travel in the ________, while the testicular vessels travel in the _______ and inguinal canal.
The gonadal vessels branch from the abdominal aorta. The ovarian vessels travel in the suspensory ligament of the ovary, while the testicular vessels travel in the spermatic cord and inguinal canal.
Fibroids are also known as ______ and are benign smooth muscle tumors of the uterus.
Fibroids are also known as leiomyomas and are benign smooth muscle tumors of the uterus.
Sperm is formed in the _____, matured/stored in the _______, and travels through the ________ before reaching the ejaculatory ducts and prostatic urethra.
Sperm is formed in the testes, matured/stored in the epididymis, and travels through the ductus deferens before reaching the ejaculatory ducts and prostatic urethra.
the _______ is smooth muscle that contracts under ______ innervation to maintain urinary continence and prevent sperm entry into the urinary bladder during ejaculation
the internal urethral sphincter is smooth muscle that contracts under sympathetic innervation to maintain urinary continence and prevent sperm entry into the urinary bladder during ejaculation
the ________ supplies _____ motor innervation to the skeletal muscles of the perineum
the pudendal nerve supplies somatic motor innervation to the skeletal muscles of the perineum
Which of the following nerves carries visceral pain sensation from the cervix?
A. Sympathetic splanchnic nerves
B. Parasympathetic splanchnic nerves
C. Pudendal nerve
B. Parasympathetic splanchnic nerves
Organs touching the peritoneum (“above the pelvic pain line”) follow sympathetic fibers - fundus/body of uterus, oviducts, ovaries
Organs below the peritoneum (“below the pelvic pain line”) follow parasympathetic fibers - cervix
A pediatrician examined a healthy newborn male and noticed no abnormalities other than an opening located on the ventral surface of the penis. This malformation is the result of defective
closure of urethral folds.
Mesonephric ducts give rise to
a. urethra
b. ductus deferens
c. testes
d. kidney nephrons
e. prostate gland
b. ductus deferens
Which of the following organs contains epithelium that is endoderm-derived?
a. epididymis
b. ureters
c. uterine tubes
d. prostate
e. upper vagina
d. prostate
Prostate grows from the urethra, which is derived from the urogenital sinus.
An occlusion of the umbilical artery in the pelvis may result in reduced perfusion of the
a. anterior abdominal wall musculature
b. urinary bladder
c. prostate gland
d. cervix
b. urinary bladder
Prior to reaching the anterior abdominal wall where it becomes fibrotic postnatally, the umbilical artery gives off some superior vesicle branches to the bladder.
Which of the following nerves synapse on neuronal cell bodies in the inferior hypogastric plexus?
a. pelvic splanchnic nerves
b. pudendal nerve
c. greater thoracic splanchnic nerves
d. vagus nerve
a. pelvic splanchnic nerves
Preganglionic sympathetic and parasympathetic neurons synapse in the inferior hypogastric plexus. While the greater thoracic splanchnic and vagus nerves contain preganglionic axons neither reach the inferior hypogastric plexus. The pelvic splanchnic nerves contain preganglionic parasympathetic axons that synapse on neurons in the inferior hypogastric plexus.
Your patient suffers from erectile dysfunction following his prostatectomy. This postoperative outcome is most likely the result of a surgical lesion of the
cavernous nerves.
cavernous nerves carry postganglionic parasympathetic axons that stimulate relaxation of arteries to the erectile tissues. A lesion of these nerves frequently occurs during radical prostatectomy and lead to erectile dysfunction.
In performing a mediolateral episiotomy which of the following muscles in the superficial perineal pouch would you cut?
a. external anal sphincter
b. pubococcygeus
c. deep transverse perineal muscle
d. bulbospongiosus muscle
d. bulbospongiosus muscle
Of the choices the bulbospongiosus and the ischiocavernosus are the only muscles in the superficial perineal pouch. The bulbospongiosus muscle attaches to the perineal body which is cut during a mediolateral episiotomy.
Your patient suffers from retrograde ejaculations into the urinary bladder following his prostatectomy. This postoperative outcome is most likely the result of a
a. lesion of the cavernous nerves.
b. lesion of the pelvic splanchnic nerves.
c. relaxation of the detrusor muscle.
d. relaxation of the internal urethral sphincter.
d. relaxation of the internal urethral sphincter.
During ejaculation, sympathetic innervation stimulates contraction of the internal urethral sphincter muscle so that the ejaculate passes through the spongy urethra. Prostatectomy may disrupt the innervation to the internal urethral sphincter resulting the sphincter relaxing and the ejaculate passing retrograde into the urinary bladder.
An endometrial mass located in the rectouterine pouch
a. may be palpated through the posterior wall of the anal canal.
b. may be palpated through the posterior wall of the rectum.
c. may be palpated through the posterior fornix of the vagina.
d. is likely to result in retroflexion of the uterus.
c. may be palpated through the posterior fornix of the vagina.
Digital inspection of the rectouterine pouch is done via palpation of the posterior vaginal fornix.
Structures from which painful stimuli are carried via parasympathetic afferent nerve fibers include the
a. uterine fundus.
b. cervix
c. anal mucosa inferior to the pectinate line.
d. ovary.
e. uterine tube.
b. cervix
Painful stimuli carried via parasympathetic innervation is limited to structures located below the pelvic pain line defined as subperitoneal structures. The cervix is the only structure in this list that is subperitoneal.
Which of the following structures travel from the pelvis to the perineum by passing posteriorly and through both the greater and lesser sciatic foramina?
a. pudendal nerve
b. rectum
c. urethra
d. cavernous nerves
a. pudendal nerve
The pudendal nerve is the only choice here that passes through both openings to reach the perineum from the pelvis.
Your 30-year-old patient is in labor with her first child. Your patient’s cervix is dilated 7 cm and causing her a great deal of pain. The afferent nerve fibers transmitting pain have cell bodies located in dorsal root ganglion associated with the _____ spinal nerve.
The cervix is below the pelvic pain line and thus afferent impulses travel in the pelvic splanchnic nerves which arise from ventral rami of S2-S4.
During radical prostatectomy pelvic surgery, a surgeon notices severe bleeding from an internal iliac artery branch that supplies the prostate. Which of the following arteries is most likely injured?
a. internal pudendal artery
b. inferior rectal artery
c. umbilical artery
d. inferior vesicle artery
e. obturator artery
d. inferior vesicle artery
The prostate, seminal vesicle and proximal portions of the vas deferens receive their blood supply from branches of the inferior vesicle artery.
