The female reproductive system Flashcards
Why do women get sharp pain at ovulation?
- Ovum ruptures capsule of ovary
- This is a traumatic process
What protects us from ovarian cancer?
- Anything that stops us from ovulating e.g. pregnancy, breastfeeding, contraception
- Release of ovum causes damage to ovary, making cancer more likely
What is an ovarian cyst?
- Fluid filled swelling of ovary
- Can be benign or malignant
- Vary massively in size
- Cystic ovary ca twist, resulting in torsion
- Don’t want cyst to burst - if it’s cancerous it can seed woman with cancer cells
What are the labia majora?
- Prominent folds of tissue extending from mons pubis to perineum
- Has same origins as male scrotum
What are the labia minora?
- Lesser folds extending from clitoral hood to posterior aspect of vagina
- Formed by urethral folds
What is the clitoris?
- Collection of nerve endings in anterior portion of external genitalia of women
- Develops from genital tubercle
- Site of sexual pleasure
What is the perineum?
- Portion of skin and muscle that stretches between vagina and anus
Describe the anatomical location of the vagina
- Extends from external genitalia to cervix in an superior-posterior direction
- Urethra and bladder sit anterior
- Rectum sits posterior
What are the functions of the vagina?
- Facilitates childbirth
- Intercourse
- Can expand drastically due to muscular walls and rugae
Describe the lining of the vagina
- Stratified squamous epithelium
- Glycogen-rich - provides nutrients for lactobacilli
- Lactobacilli metabolise glycogen to lactic acid to keep pH of vagina low
What is a fornix?
- Where cervix protrudes into vagina
- Leaves a circular gutter between walls of vagina and cervix
- Split into anterior, posterior, left and right fornix
What is the cervix?
- Narrow channel connecting vagina to uterus
- External os is opening to vagina
- Internal os is opening to uterus
What happens to the cervix during childbirth?
- Cervix stretches to 10 cm wide
- External os does not return to ‘pinpoint’ appearance following childbirth
- Appears more linear in shape
What is cervical ectropian?
- Columnar epithelium of the inside of the cervix is shown externally
- Can occur due to taking combined oral contraceptive pill or due to normal hormonal changes
What could be seen on the cervix that indicates cervical cancer?
- Pale tissue
- New blood vessel formation
- Some ulceration
Describe the anatomical location of the uterus
- Lies in the pelvis
- Superior to vagina
- Posterosuperior to bladder
- Anterior to rectum
- Ovaries sit superolateral to uterus
What is the name of the potential space between the uterus and the rectum?
- Rectouterine pouch or pouch of Douglas
- Important anatomical landmark because any free fluid in the peritoneum will sit here
What are the two components of the wall of the uterus?
- Myometrium
- Endometrium
What is the function of the myometrium?
- Muscular component of uterine wall
- Contracts during childbirth and shedding of the uterine lining during periods
What is the function of the endometrium?
- Proliferates, forming lining of womb for an embryo to embed in
What are the 3 axes of the female reproductive tract?
- Axis of vagina
- Axis of cervix
- Axis of uterine body
- 2 angles exist between the axes, maintained by the round ligament
Where does the angle of -version exist?
- Between axis of vagina and axis of cervix
- If angle is <180o, the cervix is antiverted
- If angle is >180o, the cervix is retroverted
Where does the angle of -flexion exist?
- Between axis of cervix and axis of uterus
- If angle <180o, uterus is antiflexed
- If angle >180o, uterus is retroflexed
What is the function of the fallopian tubes?
- Transport ovum from ovary to uterus
- Transport sperm from uterus to meet ovum ready for fertilisation
- Tubes contract by peristalsis to move ovum towards uterus
- Cilia help waft ovum and sperm
Why is it important to remember that the fallopian tubes are not attached to the ovary?
- Ovum could be released from ovary but not reach fallopian tube
- Can embed elsewhere in the abdomen
- Creates a gap in the peritoneum
What are the 4 parts of the fallopian tube?
- Fimbriae - finger like projections that act as a funnel to make sure the ovum ends up in the fallopian tube
- Infundibulum - first part of fallopian tube that ovum enters
- Ampulla - middle part of tube
- Isthmus - point of attachment to uterus
Where does ectopic pregnancy most commonly occur?
- Ampulla of fallopian tube
Why is ectopic pregnancy so dangerous?
- Embryo ruptures fallopian tube and cause severe internal bleeding
- Can lead to fertility issues, miscarriage and death of the mother (if bleeding isn’t treated)
What are the symptoms of ectopic pregnancy?
- Abdominal pain
- Vaginal bleeding
- Bleeding can lead to shock, tachycardia, hypotension
- Shoulder tip pain
Why does ectopic pregnancy cause shoulder tip pain?
- Blood irritates diaphragm
- Causes referred pain in dermatome of phrenic nerve roots
- C2, C3, C4
How do we rule out ectopic pregnancy?
- In any woman of child-bearing age
- Pregnancy test
- Ultrasound scan
What is the function of the ovaries?
- Storage and maturation site for oocyte
- Produce oestrogen and progesterone
What helps the ovaries descend?
- Gubernaculum
- Ovaries stop descending in pelvis because developing uterus gets in the way
What are the 3 main parts of the ovaries?
- Medulla (inner part)
- Cortex (outer part)
- Epithelium
What is the role of the medulla of the ovaries?
- Site of neurovascular structures
- Supplies nutrients through blood to cortex
What is the role of the cortex of the ovaries?
- Composed of connective tissue called stroma
- Contains thousands of follicles
What is the function of the epithelia of the ovaries?
- Simple cuboidal epithelium
- Called germinal epithelium because it protects the germ cells
Why is it significant that the ovaries are not covered by visceral peritoneum?
- Means that an ovum could miss the fallopian tubes and be released into the peritoneal cavity
- Peritoneum is a potential site for ectopic pregnancy
What is the broad ligament?
- Flat sheet of peritoneum that covers uterus, fallopian tubes and ovaries
- Runs from pelvic wall, across internal genitalia, and attaches to pelvic wall on opposite side
What are the 3 divisions of the broad ligament?
- Mesometrium - portion surrounding uterus and external iliac vessels
- Mesovarium - projects from broad ligament and attaches to hilum of ovary. It encloses neurovascular bundle supplying ovary but does not enclose ovary itself.
- Mesosalpinx - encloses fallopian tube only
Which structures are found within the broad ligament?
- Ovarian and uterine arteries
- Ovarian ligament
- Round ligament of uterus
- Suspensory ligament of ovary
What are the 2 main ligaments that attach to the ovary?
- Ovarian ligament
- Suspensory ligament of the ovary
What is the function of the ovarian ligament?
- Attaches ovary to uterus
- Fibrous band
- Lies within broad ligament
- Remnant of gubernaculum
What is the function of the suspensory ligament of the ovary?
- Extends outwards from ovary to lateral abdominal wall
- A fold of peritoneum
- Contains ovarian artery, vein, nerve plexus, lymphatics
What is the function of the round ligament?
- Remnant of gubernaculum
- Attaches to labia majora
- Passes through inguinal canal
- Attaches to uterus at point at which fallopian tubes also join
What are the main arteries supplying the female reproductive system?
- Ovarian artery - arise directly from abdominal aorta
- Uterine artery - branch of internal iliac artery
- These anastomose across the uterus creating Helicine branches
- Also branch to form tubal vessels which supply fallopian tubes
- Vaginal arteries - branches of internal iliac arteries
What are the main veins draining the reproductive system?
- Ovarian veins
- Left ovarian vein drains directly into left renal vein, right ovarian vein drains directly into vena cava
- Uterus drains into uterine veins via a plexus in the broad ligament
- Vagina drains via a plexus into vaginal vein
- Both then drain to internal iliac vein
