The female reproductive system Flashcards
Describe the presentation, development and position of the ovaries, along with the respective blood and lymphatic supply
- formed near and descend from the mesonephric ridge
- superior ligament: round ligament of uterus, inferior ligament: gubernaculum, attached to labia majora
- ovaries are almond shaped but may not be palpable following the menopause
- the mesovarium suspends the ovary in situ. It contains the ovarian ligament which tethers the ovary to the uterus and is a remnant of the gubernaculum
- ovarian arteries come directly from abdominal aorta
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Contrast the venous drainage of the ovaries to the lymphatic drainage, why is this clinically significant?
LEFT: left ovarian vein, left renal vein, IVC
RIGHT: ovarian vein, IVC
Lymphatic drainage is to the paraaortic nodes. Cancers of the ovaries will metastasise here.
Outline the anatomy and positioning of the uterus
- fundus, body, uterine tubes, cervix
- rectouterine pouch (douglas) and uterovesicle pouch
- covered by endometrium - cyclical growth and sheds
- proliferative, secretory and menstrual phase
- anteverted in relation to vagina
- antiflexed in relation to the cervix
- covered by the broad ligament (peritoneal folds)
- endocervix and ectocervix connect it to the vagina
Outline the vessel supply and lymphatic drainage of the uterus
- uterine artery-anterior division of the internal iliac artery
- the ureter passes inferiorly ‘water under the bridge’
- venous drainage through uterine venous plexus
- uterine veins - internal iliac veins - common iliac - IVC
- lymphatics: fundus to aortic nodes, body and cervix to iliac and sacral nodes
Outline the blood, nerve and lymphatic supply to the vagina
- superior part of the vagina: uterine arteries
- the rest: vaginal and pedundal arteries
- venous return: vaginal venous plexuses into the vaginal vein which runs into the uterine and internal iliac veins
- iliac and superficial inguinal lymph nodes
- inferior innervation: somatic from pudendal nerve
- superior innervation: uterovaginal plexus
- above pelvic pain line: referred up, below: localised
Relate the female reproductive anatomy to common clinical problems with the ovary
- The ovary may develop ovarian cysts, which are usually derived from follicles. Polycystic Ovaries (with more than 10 cysts) are usually associated with infertility
- Tumours of the ovary arise most commonly from epithelial components or from germ cells
Relate the female reproductive anatomy to common clinical problems with the uterus
- salpingitis: inflammation leading to adhesions in mucosa
* endometriosis: ectopic endometrial tissue ~ peritoneum
Relate the female reproductive anatomy to common clinical problems with the cervix
- endometrial carcinoma (presents abnormal uterine bleeding)
* PID
Relate the female reproductive anatomy to common clinical problems with the vagina
- batholinitis
- bartholin gland cyst
- vaginitis
- vaginismus (painful vaginal penetration)
What is the pelvic floor and what structures does it contain?
- funnel shaped musculature structure, separating the pelvic cavity from the inferior perineum
- it contains the bladder, rectum, pelvic genital organs and terminal parts of the urethra
What are the two physiological ‘holes’ within the pelvic floor?
- urogenital hiatus - urethra and vagina
- rectal hiatus
- these structures are separated by the perineum
What are the functions of the pelvic floor?
- support abdominal viscera through their tonic contraction
- resist the increase in intra pelvic or abdominal pressure
- urinary and faecal continence through sphincter action
What are the muscles of the pelvic floor?
- three parts: Levator Ani muscle, coccygeus muscle, fascia
- Levator ani includes the puborectalis, pubococcygeus, iliococcygeus
- coccygeus muscle: sits most posteriorly & is smallest
Outline the levator ani muscles
- puborectalis: U shaped sling attaching to pubic bones and passing around the anal canal. This forms the anorectal angle, contributing towards faecal continence
- pubococcygeus: largest component. Fibres run from the pubic bone, around the hiatuses forming another U shape like structure. They attach also at the coccyx and anococcygeal ligament
- iliococcygeus: thin muscle fibres running from the ischial spines and tendinous arch to the coccyx and anococcygeal ligament
Outline the coccygeus muscle
- originates from the ischial spines and travels to the lateral aspect of the coccyx and sacrum, along the sacrospinal ligament.
