1.Anatomy of female genital tract.....pptx

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1. Anatomy of the female genital tract Dr Fekade Ayenachew

2. Objectives Describe different parts of the external female genital tract Describe different parts of the internal female genital tract

3. Embryology Sex differentiation is a complex phenomenon, classified into Differentiation of gonads Differentiation of internal genital organs Differentiation of external genital organs Genital system development begins in embryonic period and ends at puberty. Gonads acquire male or female morphology on the 7 th week of development.

4. EXTERNAL GENITALIA – distal to the hymen Vulva Labia majora – folds of skin with fat, scrotum homolog, round ligament, posterior commissure Labia minora – folds of skin, cover introitus, meet at the frenulum & fourchette Mons veneris – a rounded pad of fatty tissue overlying the symphysis pubis Clitoris and associated erectile tissues – corpora and glans Associated muscles – bulbocavernosus, bulbospongiosus, perineal mm Perineum and the perineal body, fossa navicularis Vestibule – urethral meatus, glands (Skene, Bartholin), introitus, delicate SCE, vestibular bulb

5. C D I B F A E G H CLITORIS URETHRA GLANDS OF SKENE LABIUM MINOR VESTIBULE LABIUM MAJOR HYMEN BARTHOLIN’S GLAND POSTERIOR FOURCHETTE J PERINEUM

6. Superficial and deep spaces of anterior and perineal triangles

7. Neurovascular supply BLOOD SUPPLY: Arteries—(a) Branches of internal pudendal artery, (b) Branches of femoral artery—superficial and deep external pudendal. Veins —(a) Internal pudendal vein, (b) vesical or vaginal venous plexus and (c) Long saphenous vein. NERVE SUPPLY: (a) anterosuperior – cutaneous branches from the ilioinguinal and genital branch of genitofemoral nerve(L1 and L2). (b) posteroinferior – pudendal branches from the posterior cutaneous nerve of thigh (S1.2.3). (c) in between – labial and perineal branches of the pudendal nerve (S2.3.4). LYMPHATICS : (a) Superficial inguinal nodes, and intermediate groups of inguinal lymph nodes—gland of Cloquet and ( c) external and internal iliac lymph nodes. DEVELOPMENT : cranial aspect of ectodermal cloacal fossa; - clitoris from the genital tubercle; labia minora from the genital folds ; -labia majora from the labioscrotal swelling and - the vestibule from the urogenital sinus.

8. INTERNAL GENITALIA – proximal to the hymen Need instruments to visualize these structures Vagina Uterus Fallopian tubes Ovaries Associated muscles, vessels and connective tissue

9. Vagina Fibromusculomembranous sheath Communicating tube and organ of copulation, way of drainage and birth canal Directed upwards and backwards Wider AP lower 1/3 and transverse upper 2/3, Ø 2.5 cm at rest Walls – 4, highly distensible, 7 and 9 cm long, 4 tissue layers (mucosa, submucosa, muscularis, fibrous) Relations Anteriorly Upper 1/3 – base of the bladder Lower – urethra Relations Posteriorly Upper 1/3 – Douglas pouch Middle 1/3 – anterior rectal wall Lower 1/3 – perineal body

10. Uterus A hollow pyriform muscular organ situated in the pelvis between the bladder in front and the rectum behind Has the cervix, body (corpus) and isthmus, 8  5  4 cms , 50 – 80 gm, 1.25 cm thick Tubes ang ligaments attached above, opens to vagina below 3 tissue layers – body, cervix

11. Uterus (position and innervation) Anteversion – long axis of the cervix vs. that of the vagina, measures about 90 degrees Anteflexion – long axis of the body of the uterus vs. that of the cervix, measures about 120 degrees Nerves Principally sympathetic and partly parasympathetic Motor – T5 and T6

12. Uterus (relations) Anteriorly Above internal os – posterior wall of uterovesical fold Below internal os – base of the bladder Posteriorly Covered with peritoneum and forms the anterior wall of the pouch of Douglas containing loops of bowel Laterally Broad ligament and its contents (parametrium)

13. Fallopian tubes Paired fine tubes form the uterine fundus with two openings Muscular, with four different parts (intramural, isthmus, ampulla, and infundibulum) and measure about 10 cm Where fertilization takes place

14. Ovaries Paired sex organs / gonads, weigh 4–8 g, 2.5-5  1.5-3  0.7-1.5cm Ovarian fossa – bounded above by the external iliac vessels, below by the obturator nerve and vessels, posteriorly by the ureter and uterine artery and vein, and anteriorly by the pelvic attachment of the broad ligament. Ovarian and infundibulopelvic lig Have cortex and medulla Main functions include Germ cell maturation, storage and release Steroidogenesis Regulation of menstrual cycle

15. Endopelvic fascia and potential spaces

16. Components of the endopelvic fascia Parietal fascia Obturator fascia Levator ani fascia Coccygeus fascia (sacrospinous ligament) Piriform fascia Visceral fascia Covering the uterus, vagina, bladder, rectum Deep endopelvic connective tissue Contains six pericervical ligaments – pubocervical, cardinal, and uterosacral ligaments Septae – Pubocervical, rectovaginal septum Pericervical ring

17. Pelvic fascia and condensations

18. INTERNAL ILIAC ARTERY Division Branch Sub - Branches and/or Characteristics Anterior Umbilical a. Superior vesical a. (sometimes branches directly from anterior division) Obturator a. Through obturator canal/supply for thigh adductor muscles Uterine a. Intramural br. (arcuate a.), cervicovaginal br., tubal br., ovarian br. Inferior vesical a. (male) or vaginal a. (female)   Middle rectal a.   Internal pudendal a. Inferior rectal a., perineal a., posterior labial/scrotal a., artery of bulb of vestibule/penis, dorsal artery of clitoris/penis/through greater sciatic foramen Inferior gluteal a. Through greater sciatic foramen Posterior Iliolumbar a. Iliac and lumbar branches Lateral sacral a. Superior and inferior branches Superior gluteal a.  

19. COLLATERALS TO THE INTERNAL ILIAC A. Ovarian artery Round ligament artery of uterus Obturator artery External pudendal artery from femoral a. Deep circumflex iliac artery Superior rectal artery from inferior mesenteric artery Middle rectal artery Median sacral artery Iliolumbar artery

20. Pelvic diaphragm

21. Reading assignments Bony pelvis Anatomy of the lower urinary tract Anatomy of the lower gastrointestinal tract Anatomy of the breasts Pelvic and perineal Venous drainage Lymphatic drainage Nerve supply (somatic, autonomic) Normal and abnormal embryological development of the female genital tract