Anatomyof female genital tract

anatomy of female genital tract

1. ANATOMY OF FEMALE GENITAL TRACT By AYMAN SHEHATA Assist. Lect. OB/GYN TANTA UNIVERSITY

2. External genitalia Internal genitalia Accessory reproductive organs

3. Female external genitalia

4. External genitalia ( vulva, pudendum )

5. External Genital Organs(vulva) Mons pubis Labia majora Labia minora Clitoris Vestibule of the vagina External urethral orifice Vestibule glands paraurethral glands (Skene’s glands) Bartholin's gland vagina opening hymen External genitalia of adult female (parous)

6. MONS PUBIS The triangular mound of fatty tissue that covers the pubic bone It protects the pubic symphysis During adolescence sex hormones trigger the growth of pubic hair on the mons pubis Hair varies in coarseness curliness, amount, color and thickness

7. LABIA MAJORA Referred to as the outer lips They have a darker pigmentation The Labia Majora : Protect the introitus and urethral openings Are covered with hair and sebaceous glands Tend to be smooth, moist, and hairless Become flaccid with age and after childbirth

8. LABIA MINORA Referred to as the “inner lips” Made up of erectile, connective tissue that darkens and swells during sexual arousal Located inside the labia majora They are more sensitive and responsive to touch than the labia majora The labia minora tightens during intercourse

9. CLITORIS Highly sensitive organ composed of nerves, blood vessels, and erectile tissue Located under the prepuce It is made up of a shaft and a glans Becomes engorged with blood during sexual stimulation Key to sexual pleasure for most women Urethral opening is located directly below clitoris Clitoris

10. VAGINAL OPENING INTROITUS Opening may be covered by a thin sheath called the hymen Using the presence of an intact hymen for determining virginity is erroneous Some women are born without hymens The hymen can be perforated by many different events UNIT 3: FEMALE REPRODUCTIVE SYSTEM 11

11. Blood supply Arteries Br. of internal pudendal artery Labial A., Transverse perineal A., A to vestibular bulb, deep & dorsal arteries to clitoris Br. of Femoral A Superficial & deep external pudendal A Veins Internal pudendal vein Vesical / vaginal venous plexuses Long saphenous vein

12. Nerve supply Ant-sup part Ilio inguinal & genital br. of genitofemoral N (L 1 ,L 2 ) Post- inf part Pudendal br. of post.cut . N of thigh (S 123 ) In between Labial & perineal br.of Pudendal N (S 234 ) Lymphatics Superf . Inguinal nodes Gland of Cloquet Ext. & Int. Iliac nodes

13. PERINEUM The muscle and tissue located between the vaginal opening and anal canal It supports and surrounds the lower parts of the urinary and digestive tracts The perinium contains an abundance of nerve endings that make it sensitive to touch An episiotomy is an incision of the perinium used during childbirth for widening the vaginal opening UNIT 3: FEMALE REPRODUCTIVE SYSTEM 18

14. Internal genital organs

15. Vagina Fibromuscular membranous sheath Excretory channel Organ of copulation Birth canal of parturition 45° horizontal 2.5cm diameter distensibility

16. VAGINA The vagina connects the cervix to the external genitals It is located between the bladder and rectum Functions : As a passageway for the menstrual flow For uterine secretions to pass down through the introitus As the birth canal during labor With the help of two Bartholin’s glands becomes lubricated during SI

17. Walls Ant : 7.5 cm Post : 9cm 2 lateral walls Fornices : Ant : shallow 2 lateral Post : deep

18. Normal vaginal mucosa

19. Pelvic floor superior view

20. Pelvic floor inferior view

21. Pelvic floor side view

22. levator ani muscle is largest and strongest muscle in the pelvis Ischiococcygeus Iliococcygeus Pubococcygeus (Master sphincter) (weight bearing) (weight bearing)

23. Urogenital diaphragm Braces the vagina and urethra (PUL) Provides the stage for sexual quartet Stabilizes the perineal body

24. The fetal head can damage the pelvic floor

25. Sexual quartet 1-Clitoris (Krause corpuscles) 2-Vestibular bulb (Erectile tissue) 3-Bartholin gland (Alkaline mucous) 4-Vagina (Copulatory canal)

26. Structure mucous coat Submucous layer of loose areolar vascular tissues Muscular layer Fibrous coat (from endopelvic fascia) :highly vascular Vaginal secretion Doderlein’s bacilli : lactic acid from glycogen Acidic pH (4-5)

27. Blood Supply Arteries Cervicovaginal br. Of uterine A Vaginal A Middle rectal A Internal pudendal Anastomose---form 2 azygos arteries Veins drain into: Internal iliac V Internal pudendal V Lymphatics drain into Upper 1/3 rd : internal iliac nodes Middle 1/3 rd : external iliac nodes Lower 1/3 rd (below hymen) : superficial inguinal gp . Nerve supply Parasympathetic : S234 Sympathetic: hypogastric plexus Lower end : pudendal N (sensory )

28. Uterus Hollow, pyriform muscular organ Position: anteversion & anteflexion uterus dextrorotated Measurements 7.5cm long 5cm wide 3cm thick Weight : 50-80gm

29. Parts of uterus

30. Structure Perimetrium : serous coat Myometrium : thick bundles of sm. M During pregnancy: Outer long. Middle interlacing Inner circular Endometrium Surface epithelium Lamina propria Stromal cells Endometrial glands Vessels & nerves Decidua in pregnancy Secretion: scanty & watery

31. Relation Anterior Above int.os : uterovesical pouch Below int.os : separated from UB by loose areolar tissue Posterior Pouch of Douglas with coils on intestine Lateral Broad ligament Mackenrodt’s ligament Uterine A & ureter

32. Ligaments of uterus Uterosacral ligament Transverse cervical/ Mackenrodt’s lig Pubovesicocervical lig Round ligament Broad ligament Mesovarium Mesosalpinx mesometrium Suspensory lig of ovary/ infundibulopelvic ligament

33. Water flows under a bridge ureter Uterine artery

34. Blood supply Arteries: Uterine A Ovarian & Vaginal As. Veins drain into Internal iliac veins Lymphatics Nerves Sympathetic Motor : T5 & T6 Sensory : T10 – L1 Parasympathetic Pelvic N ( S2,3,4) : both motor & sensory : ends in ganglia of Frankenhauser

35. 1 2 2 3 3 4 4 5 5 6 Figure: internal organs in female pelvis. 1. uterus, 2. ovaries, 3. fallopian tubes, 4. round ligaments, 5. utersacral ligaments, 6. rectouterine pouch (pouch of Douglas) , 7.broad ligaments . 7

36. Arterial system Ovarian artery : the chief source of the blood for ovaries. Uterine artery : corpus branch cervical-vaginal branch 3 . Vaginal artery : main source of the blood for the middle part of vagina 4 . Internal pudendal artery : supply for superficial perineum, labia majora, labia minora, lower part of the vagina, clitoris Blood supply for female genitalia

37. Fallopian tube (uterine tube, oviduct) 10-14 cm Lies within the superior border of broad ligament 2 openings Medially into cornua Laterally into abdominal cavity

38. Parts of fallopian tube

39. Structure : -3 layers

40. Blood Supply Arteries Uterine A Ovarian A Veins Through pampiniforn plexus into ovarian veins Lymphatics Para-aortic nodes Nerve supply Uterine & ovarian nerves

41. The Ovary Paired, situated on either side of uterus Close to lateral pelvic wall In ovarian fossa of Waldeyer Size: 4*3*2 cm Only intra-abdominal structure not covered by peritoneum Medial pole: attached to uterine cornua by ovarian ligament Laterally to the pelvic wall by infundibulopelvic ligament Fimbrial end of oviduct close to ovary & attached to it via fimbria ovarica

42. Structure : 2 parts

43. Blood Supply Arterial : Ovarian A Veins : Through pampiniform plexus ovarian V. Lt. Renal Vein IVC Lymphatics Para-aortic nodes Nerve supply Sympathetic supply from T10 along ovarian A.

44. Pelvic vessels

45. Pelvic vessels

46. Lymphatic drainage: External genital organ lymph group : 1. superficial inguinal lymph nodes. 2. deep inguinal lymph nodes Pelvic lymph group: 1. iliac lymph group. 2. presacral lymph group. 3. lumbar lymph group.

47. Lymphatic drainage

48. The nerve of external genitalia Pudendal nerve Obstetric local anesthesia Divided into 3 branches beside tuberosity Inferior hemorrhoid nerve Dorsal nerve Perineal nerve

49. The nerve of internal genitalia Sympathetic and parasympathetic nerves from lumbar and sacral spinal cord Sympathetic nerve are derived from Plexus Sacral plexus Ovarian plexus

50. Pelvic innervation Frankenhauser’s plexus Pudendal nerve Hypogastric nerve (s) Superior hypogastric plexus Inferior mesentric plexus Celiac plexus Inferior hypogastric plexus PSN LUNA

51. BREASTS Organs of sexual arousal Contain mammary glands Consist of connective tissue that serves as support Each breast contain 15-25 clusters called lobes Each lobule is connected by ducts that open into the nipples The nipples are made up of erectile tissue The pigmented around the nipples are called the areola Breast size is determined primarily by heredity Size also depends on the existing fat and glandular tissue Breasts may exhibit cyclical changes, including increased swelling and tenderness prior to menstruation Benign breast changes refer to fibrocystic disease Lumps or masses that are noncancerous

52. UNIT 3: FEMALE REPRODUCTIVE SYSTEM 67

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