Session 2 ILOs - Female Anatomy

Question 1

List the internal and external genitalia of the female

Answer 1

Internal genitalia:

• Ovaries
• Fallopian tubes
• Uterus
• Cervix,
• Vagina

External genitalia:

• Labia minora and Labia majora (the vulva)
• Clitoris

Question 2

Describe the main anatomical structures of the female reproductive tract (ovaries, fallopian tubes, uterus, vagina)

Answer 2

Ovaries:

• Held in place by the suspensory ligament of the ovary
• Doesn’t connect to the fallopian tubes directly, there is a small gap (opening into the peritoneal cavity)

Fallopian tubes:
- Ampulla (most common site of fertilisation)
- Fimbrae sweep released egg into the fallopian tube
Important = fallopian tubes open into the peritoneal cavity!!

Uterus:

• Uterus and ovaries held in place by multiple ligaments (broad ligament, round ligament, ovarian ligament, suspensory ligament of the ovary)
• Normal position is anteverted and anteflexed (maintained by round ligament)

Vagina:
- Lined with non-keranised stratified squamous epithelium

Question 3

Outline the roles of the pelvic floor

Answer 3

1. Support of abdominopelvic viscera (bladder, intestines, uterus etc.)
2. Resistance to increases in intra-pelvic/abdominal pressure (during activities such as coughing or lifting heavy objects)
3. Urinary and faecal continence
   - The muscle fibres have a sphincter action on the rectum and urethra, they relax to allow urination and defecation

Question 4

Outline common causes and risk factors for pelvic floor

dysfunction

Answer 4

Affects roughly 40% of women

Causes and risk factors together (causes thought to be multifactorial):

• Age
• Pregnancy (parity)
• Vaginal delivery
• Obesity and other causes of chronic raised intra-abdominal pressure
• Oestrogen deficiency
• Neurological or genetic causes

Question 5

Describe symptoms of pelvic organ prolapse

Answer 5

Symptoms:

• History of dragging sensation or lump
• Feeling of incomplete emptying of bladder

Question 6

Describe the classes of female genital mutilation

Answer 6

Class 1: Removal of clitoris

Class 2: Removal of clitoris and labia minor (maybe labia major)

Class 3: Narrowing of vaginal orifice and cutting labia minor and labia major

Question 7

Describe the histological features of the ovary, endometrium, cervix and vagina

Answer 7

Ovary:
- Surface covered by a single layer of cuboidal (and, in some parts, almost squamous cells)

Endometrium:

• Uterus is made up of an external layer of smooth muscle (myometrium) and an internal layer (endometrium)
• Endometrium is made of three layers: stratum compactum, stratum spongiosum and stratum basalis

Cervix:

• Cervix has more connective tissue and less smooth muscle (compared to body of uterus)
• Portion of the cervix that projects into the vagina, is covered with a stratified squamous epithelium

Vagina:
- Non-keranised stratified squamous epithelium

Question 8

Explain the role of the pelvic floor in pelvic organ support

Answer 8

Occurs via 3 mechanisms:

1. Suspension (sling like role)
   - Work against gravity
   - Cardinal ligaments (cervix and upper vagina)
   - Uterosacral ligaments (back of cervix and upper vagina at sides)
   - Round ligament (maintain anteverted position)
2. Attachment (between structure)
   - Arcus tendinous fascia pelvis (the white line)
   - Endopelvic fascia (from white line laterally, to vaginal wall medially)
   - Because urethra lies anterior and superior to the white line, gets compressed against it during increased intraabdominal pressure (urinary continence)
3. Fusion (of different muscle groups that fuse together)
   - Involves urogenital diaphragm and perineal body
   - Lower half of vagina is supported by fusions (perineal body, levator ani and urethra)