Anatomy female genital tract of external anatomy

Gynecologist note about female tract

2. Female external genitalia ( Vulva )
1.
Mons pubis , compose of fibrofattytissue which cover the
body of the pubic bone, in adult the skin that cover the
mons pubis bears pubic hair , the upper limit of which is
usually horizontal.
2.Labia majora, this is two fold of skin with underlinig
adipose tissue bounding either side of the vaginal opening
,they contain sebaceous glang& sweat gland &
specialized apocrine glands.thefibers of the round
ligament terminate her
3.Labia minoratwo thin folds of skin that lie between the
labia minora, they have sabeceousglanfbut no adipose
tissue

3. 3.The Vestibule, ,is the cleft between the labia minora&
the urethra.theduct of the bartolineglands & the vagina
open in the vestibule
4.
The Clitoris , this is small erectile structure
5.
The Greater vestibular gland
6.
The hymen is a thin fold of mucous memberane
across the enteranceto the vagina

5. The vagina
•Thevaginaisafibromuscularcanallinedwith
stratifiedsquamousepitheliumthatleads
fromtheuterustothevulvaItislongerinthe
posteriorwall(approximately9cm)thanin
theanteriorwall(approximately7cm).
•Thevaginalwallsarenormallyinapposition,
exceptatthevaultwheretheyareseparated
bythecervix.
•Thevaultofthevaginaisdividedintofour
fornices:posterior,anteriorandtwolateral.

6. The vagina
•Thevaginahasnoglandsandiskeptmoistby
secretionsfromtheuterineandcervicalglandsand
bytransudationfromitsepitheliallining.
•Theepitheliumisthickandrichinglycogenwhich
increasesinthepost-ovulatoryphaseofthecycle.
However,beforepubertyandafterthemenopause,
thevaginaisdevoidofglycogenduetothelack
ofoestrogen

7. Doderlein’sbacillusisanormalcommensalof
thevaginalfloraandbreaksdownglycogento
formlacticacidandproducingapHofaround
4.5.
Thishasaprotectiveroleforthevagina
indecreasingthegrowthofpathogenicbacteria.

8. Theupperposteriorwallformstheanterior
peritonealreflectionofthepouchofDouglas.The
middlethirdisseparatedfromtherectumbypelvic
fasciaandthelowerthirdabutstheperinealbody.
Anteriorly,thevaginaisindirectcontactwiththe
baseofthebladder,whiletheurethrarunsdownthe
lowerhalfinthemidlinetoopenintothevestibule.Its
musclesfusewiththeanteriorvaginawall.
Laterally,atthefornices,thevaginaisrelatedtothe
cardinalligaments.Belowthisarethelevatorani
musclesandtheischiorectalfossae.Thecardinal
ligamentsandtheuterosacralligamentswhichform
posteriorlyfromtheparametriumsupporttheupper
partofthevagina

9. The uterus
Theuterusisshapedlikeaninvertedpeartapering
inferiorlytothecervixandinitsnon-pregnantstateis
situatedentirelywithinthepelvis.Itishollowand
hasthick,muscularwalls.
Itsmaximumexternaldimensionsareapproximately
7.5cmlong,5cmwideand3cmthick.
Anadultuterusweighsapproximately70g.
Intheupperpart,theuterusistermedthebodyor
‘corpus’.TheareaofinsertionofeachFallopiantube
istermedthe‘cornu’andthatpartofthebodyabove
thecornuiscalledthe‘fundus’.

10. The uterus tapers to a small constricted area, the
isthmus, and below this is the cervix which projects
obliquely into the vagina.
The longitudinal axis of the uterus is approximately
at right angles to the vagina and normally tilts
forward. This is called ‘anteversion’.
In addition, the long axis of the cervix is rarely the
same as the long axis of the uterus. The uterus is also
usually flexed forward on itself at the isthmus –
antiflexion.
However, in around 20 per cent of women, the uterus
is tilted backwards –retroversion and retroflexion.
This has no pathological significance.

11. The cavity of the uterus is the shape of an inverted
triangle and when sectioned coronallythe Fallopian
tubes open at lateral angles
The constrictionat the isthmus where the corpus
joins the cervix is the anatomical os.
Seen microscopically, the site of the histological
internal osis where the mucous membrane of the
isthmus becomes that of the cervix.
The uterus consists of three layers: the outer
serous layer (peritoneum), the middle muscular
layer (myometrium) and the inner mucous layer
(endometrium).

12. Theperitoneumcoversthebodyoftheuterusandposteriorlythe
supravaginalpartofthecervix.Theperitoneumisintimatelyattachedto
asubserousfibrouslayer,exceptlaterallywhereitspreadsouttoform
theleavesofthebroadligament.
Themuscularmyometriumformsthemainbulkoftheuterusandis
madeupofinterlacingsmoothmusclefibresinterminglingwithareolar
tissue,bloodvessels,nervesandlymphatics.Externally,theseare
mostlylongitudinal,butthelargerintermediatelayerhasinterlacing
longitudinal,obliqueandtransversefibres.Internally,theyaremainly
longitudinalandcircular.
Theinnerendometriallayerhastubularglandsthatdipintothe
myometrium.Theendometriallayeriscoveredbyasinglelayerof
columnarepithelium.thisepitheliumismostlylostduetotheeffectsof
pregnancyandmenstruation.Theendometriumundergoescyclical
changesduringmenstruationandvariesinthicknessbetween1and5
mm.

14. The cervix
Thecervixisnarrowerthanthebodyoftheuterusandisapproximately
2.5cminlength.
Lateraltothecervixliescellularconnectivetissuecalledthe
parametrium.Theureterrunsabout1cmlaterallytothesupravaginal
cervixwithintheparametrium.
Theposterioraspectofthecervixiscoveredbytheperitoneumofthe
pouchofDouglas.
Theupperpartofthecervixmostlyconsistsofinvoluntarymuscle,
whereasthelowerpartismainlyfibrousconnectivetissue.
Themucousmembranehasnumerousdeepglandularfolliclesthat
secreteclearalkalinemucus,themaincomponentofphysiological
vaginaldischarge.
Theepitheliumoftheendocervixiscolumnarandisalsociliatedin
itsuppertwothirds.Thischangestostratifiedsquamousepithelium
aroundtheregionoftheexternalosandthejunctionofthesetwo
typesofepitheliumiscalledthe‘squamocolumnarjunction’

15. The Fallopian tubes

16. The Fallopian tubes
extendsoutwardsfromtheuterinecornutoendneartheovary.
Attheabdominalostium,thetubeopensintotheperitoneal
cavitywhichisthereforeincommunicationwiththeexteriorof
thebodyviatheuterusandthevagina.Thisisessentialtoallow
thespermandeggtomeet.
TheFallopiantuberunsintheuppermarginofthebroad
ligamentpartofwhich,knownasthemesosalpinx,enclosesit
sothetubeiscompletelycoveredwithperitoneum,exceptfora
narrowstripalongthisinferioraspect.Eachtubeisabout10cm
longandisdescribedinfourparts:
1Theinterstitialportion
2Theisthmus
3Theampulla
4Theinfundibulumorfimbrialportion

17. The muscular fibresof the wall of the tube are
arranged in an inner circular and an outer
longitudinal layer.

18. Thereisnosubmucosaandtherearenoglands.
TheepitheliumoftheFallopiantubescontains
twofunctioningcelltypes;theciliatedcellsand
thesecretorycellswhichcontributetothe
volumeoftubalfluid.Changesoccurunderthe
influenceofthemenstrualcycle,butthereisno
cellsheddingduringmenstruation.

19. The ovaries
Thesizeandappearanceoftheovariesdependsonbothageand
stageofthemenstrualcycle.
Inachild,theovariesaresmallstructuresapproximately1.5cm
long;however,theyincreasetoadultsizeinpubertydueto
proliferationofstromalcellsandcommencingmaturationofthe
ovarianfollicles.Intheyoungadult,theyarealmond-shapedand
measureapproximately3cmlong,1.5cmwideand1cmthick.
Afterthemenopause,noactivefolliclesarepresentandthe
ovarybecomessmallerwithawrinkledsurface.
Theovaryistheonlyintra-abdominalstructurenottobecovered
byperitoneum.
Eachovaryisattachedtothecornuoftheuterusbytheovarian
ligamentandatthehilumtothebroadligamentbythe
mesovariumwhichcontainsitssupplyofnervesandblood
vessels.
Laterally,eachovaryisattachedtothesuspensoryligamentof
theovary

20. AnteriortotheovarieslietheFallopiantubes,
thesuperiorportionofthebladderandthe
uterovesicalpouch.
Itisboundbehindbytheureterwhereitruns
downwardsandforwardsinfrontoftheinternal
iliacartery.

21. Structure
Theovaryhasacentralvascularmedullaconsistingofloose
connectivetissuecontainingmanyelastinfibresandnon-
striatedmusclecells.
Ithasanouterthickercortex,denserthanthemedulla
consistingofnetworksofreticularfibresandfusiformcells,
althoughthereisnoclear-cutdemarcationbetweenthetwo.
Thesurfaceoftheovariesiscoveredbyasinglelayerof
cuboidalcells,thegerminalepithelium.Beneaththisisanill-
definedlayerofcondensedconnectivetissuecalledthe
‘tunicaalbuginea’,whichincreasesindensitywithage.
Atbirth,numerousprimordialfolliclesarefoundmostlyin
thecortex,butsomearefoundinthemedulla.With
puberty,someformeachmonthintothegraafianfollicles
whichwillatalaterstageofdevelopmentformcorpuslutea
andultimatelyatreticfollicles,thecorporaalbicans.

23. The bladder
Thebladderwallismadeofinvoluntarymusclearrangedin
aninnerlongitudinallayer,amiddlecircularlayerandan
outerlongitudinallayer.Itislinedwithtransitional
epitheliumandhasanaveragecapacityof400mL.
Theuretersopenintothebaseofthebladderafterrunning
mediallyforabout1cmthroughthevesicalwall.
Theurethraleavesthebladderinfrontoftheureteric
orifices.Thetriangulararealyingbetweentheureteric
orificesandtheinternalmeatusoftheureterisknownas
the‘trigone’.
.

24. The urethra
Thefemaleurethraisabout3.5cmlongandislined
withtransitionalepithelium.Ithasaslightposterior
angulationatthejunctionofitslowerandmiddle
thirds.
Thesmoothmuscleofitswallisarrangedinouter
longitudinalandinnercircularlayers.
Astheurethrapassesthroughthetwolayersofthe
urogenitaldiaphragm(triangularligament),itis
embracedbythestriatedfibresofthedeep
transverseperinealmuscle(compressorurethrae)
andsomeofthestriatedfibresofthismuscleforma
loopontheurethra.

25. Posteriorly, it is firmly attached in its lower
two thirds to the anterior vaginal wall. This
means that the upper part of the urethra is
mobile, but the lower part is relatively fixed.

26. The ureter
Astheuretercrossesthepelvicbrim,itliesinfront
ofthebifurcationofthecommoniliacartery.
Itrunsdownwardsandforwardsonthelateralwall
ofthepelvistoreachthepelvicfloorandthen
passesinwardsandforwardsattachedtothe
peritoneumofthebackofthebroadligamentto
passbeneaththeuterineartery.Itnextpasses
forwardthroughafibroustunnel,theuretericcanal,
intheupperpartofthecardinalligament.Finally,it
runsclosetothelateralvaginalfornixtoenterthe
trigoneofthebladder.
.

27. Becauseofiscloserelationshiptothecervix,the
vaultofthevaginaandtheuterineartery,the
uretermaybedamagedduringhysterectomy.
Apartfrombeingcutortied,inradical
procedures,theuretermayundergonecrosis
becauseofinterferencewithitsbloodsupply.
Itmaybedisplacedupwardsbyfibromyomata
orcystswhicharegrowingbetweenthelayersof
thebroadligamentandmaysufferinjuryifits
positionisnotnoticedatoperation

28. Structure and function of
the pelvic floor
•The pelvic floor functions to support the pelvic
and abdominal viscera and help maintain
control of their contents. It has two major
components, which are interdependent: the
muscle and fascia.

29. Thepelvicdiaphragmisformedbythelevator
animuscleswhicharebroad,flatmuscles
thefibresofwhichpassdownwardsand
inwards.

30. Themuscleisdescribedintwoparts:
1-Thepubococcygeuswhicharisesfromthepubic
boneandtheanteriorpartofthetendinousarchof
thepelvicfascia(whiteline)
2-Theiliococcygeuswhicharisesfromtheposterior
partofthetendinousarchandtheischialspine.

31. Fascia
Fasciaenvelopeslevatorani,attachesittoboneatits
originandholdsthetwomusclestogetherinthe
midline.Theurethra,vaginaandrectumperforatethis
midlinefascia.Thus,thepelvicvisceraaresupportedby
boththelevatoranimuscleandthefascial
attachmentsthatarecondensedinsomeareasandare
oftenreferredtoasligaments–theuterosacral,cardinal
androundligamentsbeingexamples
anyfactorthatinfluencesthestrengthorintegrityof
pelvicfloorfasciawillinfluencethefunctionofthe
pelvicfloor.Thesefactorsmaybecongenital(suchas
hyperelasticityofthecollagenouscomponentoffascia)
orenvironmental,suchasstretchingortearingoffascia
duringchildbirthorheavylifting.

32. The blood supply
Theovarianarteryarisesfromtheaortajustbelow
therenalarteryandrunsdownwardsonthesurface
ofthepsoasmuscletothepelvicbrim,whereit
crossesinfrontoftheureterandthenpassesinto
theinfundibulopelvicfoldofthebroadligament
Thearterydividesintobranchesthatsupplythe
ovaryandtubeandthenrunontoreachthe
uteruswheretheyanastamosewiththeterminal
branchesoftheuterineartery.

34. The internal iliac (hypogastic) artery
Thisvesselisabout4cminlengthandbeginsatthebifurcationofthe
commoniliacarteryinfrontofthesacroiliacjoint.
Itsoondividesintoanteriorandposteriorbranches:
thebranchesthatsupplythepelvicorgansareallfromtheanterior
division.
Theuterinearteryprovidesthemainbloodsupplytotheuterus.
Thearteryfirstrunsdownwardsonthelateralwallofthepelvis,inthe
samedirectionastheureter.Itthenturnsinwardandforwardslyinginthe
baseofthebroadligament.Onreachingthewalloftheuterus,theartery
turnsupwardstoruntortuouslytotheupperpartoftheuterus,whereit
anastamoseswiththeovarianartery.Inthispartofitscourse,itsends
manybranchesintothesubstanceoftheuterus.Theuterineartery
suppliesabranchtotheureterasitcrossesitandshortlyafterwards
anotherbranchisgivenofftosupplythecervixanduppervagina.
Thevaginalarteryisanotherbranchoftheinternaliliacarterythatrunsat
alowerleveltosupplythevagina.
Thevesicalarteriesarevariableinnumbersandsupplythebladderand
terminalureter.Oneusuallyrunsintheroofoftheuretericcanal.

35. Themiddlerectalarteryoftenarisesincommon
withthelowestvesicalartery.
Thepudendalarteryisanotherbranchofthe
internaliliacartery.Itleavesthepelviccavitythrough
thesciaticforamenand,afterwindingroundthe
ischialspine,enterstheischiorectalfossawhereitgives
offtheinferiorrectalartery.Itterminatesinbranches
thatsupplytheperinealandvulvalarteries,including
theerectiletissueofthevestibularbulbsandclitoris.