FEMALE REPRODUCTIVE SYSTEM INT AND EXT GENITALIA.pdf

reproductive health

1. •It’s grouped into 2 (two) namely:-
–External genitalia
–Internal genitalia

2. DIAGRAM OF THE VULVA

4. 1.EXTERNAL GENITALIA/ VULVA
Vulva Is the collective term given/applied to the external
structures of the female genitalia.
Specific structures are:-
i. Mons veneris/pubis
–It’s a firm, cushion like formation (i.e. Pad of fat) over the
symphysis pubis
–The area is covered by hair as from puberty
–The mons role is sensuality and also protects the symphysis
pubis during copulation

5. ii.Labia majora/majus or greater lips
•They are two (2) prominent, longitudal folds of fat and areolar
tissue
•They arise from the lower margin of the mons veneris,
extends/runs downwards and backwards to merge into the
perineum posteriorly.
•Pubic hair covers their outer aspect/surface as from puberty
while the inner surface /aspect is smooth and moist.
•Precisely, the labia majora forms the anterior border of the
perineal body and protects the inner surfaces of the vulva.

6. iii.Labia minora/minus or lesser lips
•Are two (2) thin longitudinal folds of hairless skin entirely
covered with a thin membrane.
•Their outer surface joins with the inner edge of the l. Majora,
such that they lie between the L. Majora.
•Anteriorly and superiorly they separate to enclose the clitoris,
while posteriorly they fuse to form the fourchette.
NB: Fourchette is the posterior part of the vaginal orifice
(opening).

7. iv.Vestibule
•It is an oval-shaped area enclosed by the L. minora.
•Extends from the clitoris site superiorly to the fourchette
inferiorly.
•The external urethra meatus , vagina introitus and
bartholin glands outer opening are located on it.
NB: Bartholin glands secretions lubricate the vulva.
Skene’s glands ducts, opens on either side of the
urethra, just above the meatus, hence lubricate the
urethra opening.

8. v.Clitoris
•It’s a small undeveloped/rudimentary sexual organ.
•Comprises of erectile tissues, covered by a thin
epidermis and highly vascular, hence extremely
sensitive.
•The visible knob-like part is located above the urethra
meatus near the anterior junction of labia minora.
•It comprises of a prepuce superiorly and
frenulum/frenum inferiorly.

9. •Each results from the separation of the respective labia
minora into 2 pairs of folds, grouped as upper and lower
folds.
*The two (2) i.e. right and left, upper folds forms the
prepuce while the lower folds forms the frenulum.
•The main purpose of the structure / organ is:-
*Sexual excitement (arousal) and response (orgasm).
*Facilitates maximum stretching of the vulva during
childbirth hence tears rarely occur.

10. vi.Hymen.
•It is a thin membrane which partly occludes (closes)the vaginal
opening.
•Its presence in adulthood indicates virginity.
•Normally torn during first copulation experience, vigorous
exercises and use of tampon.
•The remaining tags following the tear are referred to as
Carunculae myrtiformes or hymenal caruncies.

11. vii.Perineum.
•It is a triangularly shaped area. On the anterior, superior
aspect is the fourchette while posteriorly - inferiorly is
the anus.
•Comprises of muscles which make the pelvic floor, fat
and connective tissues.
•Injury/trauma is almost inevitable during delivery.

12. BLOOD SUPPLY
•Main source is internal and external pudendal arteries,
drainage is through corresponding veins.
LYMPHATIC DRAINAGE
•Main route is through the inguinal glands which later
join the iliac glands.

13. NERVE SUPPLY
Derived from branches of pudendal nerve.
•The vaginal nerves supplies the erectile tissue of the
vestibular bulbs and clitoris. The nerves have
parasympathetic fibres hence have vasodilator effect.
•Other back up is from lumbar 1 (one) nerve root.

14. II INTERNAL GENITALIA


•Comprises of structures/organs located in the pelvic
cavity namely:
–The vagina
–The cervix
–The uterus
–Two uterine tubes
–Two ovaries

15. SAGITTAL VIEW OF INTERNAL FEMALE GENITALIA STRUCTURES

16. 1.VAGINA
•It’s a distensible fibromuscular tubular structure
connecting the external and internal genitalia.
•It is approximately 10cm in length & 2.5cm in diameter
(although there’s a wide anatomical variation)
•Its canal passes at an upwards and backwards direction
in the pelvic cavity hence comprises of an anterior and
posterior wall.
RELATIONS/NEIGHBOURING STRUCTURES
•Anteriorly: Are the urinary bladder and the urethra

17. •Posteriorly: are the pouch of Douglas (recto-uterine
pouch), rectum and perineal body each occupying 1/3 of
the posterior vaginal wall
•Superiorly- cervix and uterus
•Inferiorly – external genitalia
•Laterally – The upper 2/3 are the pelvic fascia and
lower portion of urethra, lower 1/3 is the pelvic floor

18. STRUCTURE
•Refers to description of the various parts
i. Vault
• The term given to the upper end of the vagina.
ii. Walls
• The anterior wall measures about 7.5 cm long hence closely
related to the adjacent structures anteriorly.
•The posterior wall measures 10cm long
•The difference in length is because the cervix is attached to the
vagina at a higher level posteriorly

19. iii. Fornices or arches
•These are circular recess/deeps formed as the cervix
projects/hangs into the vault. They are four (4) namely.
•Anterior fornix (singular) Located between the anterior vaginal
wall and the anterior aspect of the cervix.
•It is in contact with the base of the bladder
•Posterior fornix. Situated between posterior vaginal wall and
posterior part of the cervix. It is the largest
•The two (2) lateral fornices. Each lies on either side of the
cervix.

20. LAYERS
•Refers to tissues comprising the vaginal wall.
(i) Mucosa is the most innermost layer
•Consists of stratified squamous epithelium, which allows
exudates/oozes from the blood vessels to sip out and moisten
the vagina
(ii) Muscle layer:- Comprises of a weak inner coat of circular
fibres and a stronger outer coat of longitudinal fibres.

21. This arrangement facilitates stretching and dilatation as need
arises.
(iii) Pelvic fascial outermost layer
•Surrounds the vagina externally as well as the adjacent pelvic
organs. Allows independent expansion and contraction as
necessary.
•Generally, the walls are thrown (arranged) into tranverse folds
referred to as Rugae. These folds allow maximum stretching
and distension vagina yet no or minimal injuries occurs

22. NORMAL VAGINAL STATE
•In health, its warm, moist and pinkish in appearance
•Increased vascularity brings about the pinkish
colouration and warmth
•Cervical glands secretions and exudates from vaginal
wall brings about the moisture.
•Vaginal fluid (discharge) media is acidic (PH 4.5) in
reaction.
•The acidity results from the interaction of Dorderleins
bacilli on glycogen.

23. •The increased acidity aims at preventing growth of some
pathogenic organisms during the entire childbearing period.
NB:
•Dordeleins bacilli/lactobacilli are normal inhabitants of the
vagina.
•The action of oestrogen hormone produces glycogen in the
vagina cells.
•Before menarch, and after menopause the acidity levels are
quite low hence vaginitis occur easily.

24. BLOOD SUPPLY
•Originates from branches of the internal iliac artery which
includes descending branch of uterine artery as well as vaginal
artery.
LYMPHATIC DRAINAGE
•Through the inguinal, internal iliac and the sacral glands.
NERVE SUPPLY
•Derived from the Lee Frankenhauser Plexus, i.e. pelvic plexus
. Supplies the vaginal wall and the erectile tissues of the vulva.

25. FUNCTIONS
•Allows menstrual fluid to flow out during the entire
procreation period. OR
Serves as an excretory duct for the uterus.
•Receives the penis and the ejected sperms during copulation.
OR
It is the female organ for copulation.
•Provides an exit for the fetus during the process of birth.

26. 2. CERVIX
•Also referred to as the neck of the womb. Situated
between the uterine cavity and the upper end of the
vagina.
•The attachment site of the uterine cervix to the vaginal
vault divides the cervix into two (2) namely:-
(i) Supravaginal portion . The part above the vagina
(ii)Infravaginal portion. That part which protrudes/hangs
into the vault.

27. AREAS OF THE CERVIX
Are three (3) namely:
•Internal cervical os: The narrow opening between
isthmus and the cervical canal, in the cervix.
•Cervical canal: Lies between the two (2) oral (openings).
It is shaped like a spindle i.e. narrow at each end and
wider in the middle.
•External cervical os: Forms the opening at the lower
end of the cervix to the vagina.
**Before childbirth the opening is small and circular.
**Thereafter it becomes a transverse slit, that has an
anterior and a posterior lip.

29. LAYERS
Are basically two (2) namely:-
(i) The cervical endometrium / inner lining
•It is a mucous membrane lining, with tall columnar shaped epithelial
cells and mucus secreting glands.
•The coat is thinner than that of the uterine body and is folded into a
pattern known as the arbor vitae (tree of life) ,which is thought to
assist the passage of sperms.
(ii) Muscle/middle layer
•It is a continuation of the uterine muscle, though the coat is thinner.
• The fibres are arranged in longitudinal and circular patterns, as well as
embedded in collagen fibres to facilitate stretching and dilatation of
cervix during labour.

30. FUNCTIONS OF THE CERVIX
•Remains closed in non pregnancy state hence prevents
easy ascend of infectious organisms to the uterus.
•Remains closed prenatally for fetus to develop to term.
•Produces a plug of mucus prenatally at the cervical
canal hence prevent ascend of infectious organisms.

31. •Allows passage of bloody mucoid discharge as it dilates
which indicates true labour.
•Facilitate expulsion of the fetus during the birth
process as the cervix progressively dilate.
NB:* Caution regarding cancer of the cervix. Yearly, pap
smear screening is recommended from age of 18
years, for early diagnosis .
* Preventive measure is a vaccine against human
papilloma virus (Hpv) as from age of 9yrs.

32. 3. THE UTERUS

33. A CORONAL SECTION DIAGRAM OF THE UTERUS

34. A DIAGRAM OF THE CORONAL VIEW OF THE
UTERUS

35. 3. UTERUS

Space for coronal section diagram………
Also referred to as the womb.
Definition
•It’s a thick-walled hollow muscular organ, pear in shape but
flattened anteriorly as well as posteriorly and situated in the
pelvic cavity.
Measurements :- Diagram: measurements of non-pregnant
uterus
•Basically weighs about 30-40gm before the first pregnancy and
about 60gm thereafter.

36. NB: Average weight,
depends on the parity i.e.
number of deliveries.
•It measures 7.5cm long, 5cm
wide and 2.5cm in depth.
Each wall thickness being
1.25cm.
•Physiologically, cervix forms
the lower third (1/3) of the
uterus and measures 2.5cm
all through.

37. Position
•It is located between the urinary bladder and the rectum
respectively.
•On lateral view, it leans forward, collectively referred to as
anteversion and bends forward upon (on) itself, collectively
referred to as anteflexion.
**Therefore the normal position is that of anteversion –
anteflexion

39. SPECIFIC PARTS (AREAS)
Are basically four , namely:-
•Fundus :- Refers to the dome-shaped upper wall,
situated above the levels of uterine tubes insertion to
the cavity.
•Cornua (cornu singular) :- Are upper outer angles,
where uterine tubes join.

40. •Corpus (Body):- The part/area directly below the
cornua upto where the uterus starts to narrow.
In the outer aspect it measures 4cm long.
The inner aspect forms the uterine cavity which is
triangularly shaped with the base uppermost.
• Isthmus :- It is a narrow area located between the
uterine cavity and the cervix. It is about 0.7cm/7mm
long.

41. LAYERS/WALL
They are three (3) layers namely:-
PERIMETRIUM
•It is the outermost layer, made up of a double serous
membrane, an extension of the peritoneum.
•Anteriorly, covers the uterus up to the level of the internal
cervical os.
Then it is reflected back over the upper surface of the urinary
bladder forming a small pouch known as: uterovesical
pouch/vesico-uterine pouch.

42. contd
•Posteriorly covers the uterus completely to include the
supra-vaginal portion of the cervix.
* Then reflected onto the rectum forming recto-uterine
pouch of Douglas.
•Laterally covers the fundus only and continues to form
the broad ligaments.

43. 2.MYOMETRIUM
The middle(muscular) layer
•Thickest at the fundus and body while thinner at the isthmus and
cervix.
•At the fundus and body the fibres interlace i.e. run in all
directions to surround the blood and lymphatic vessels passing
to and from the endometrium.
•At the isthmus and cervix, circular fibres are more.
•Generally the outermost part of this layer comprises of
longitudinal fibres, which are continuous with those of uterine
tubes ligaments and the vagina.

44. 3.ENDOMETRIUM
The innermost layer.
•Formed of ciliated epithelium, whose base has a connective
tissue capable of rapid regeneration following every menstrual
phase.
•The epithelial cells are cuboidal shaped and have glands which
secrete alkaline mucus.

45. RELATIONS

•Anteriorly is the uterovesical pouch and the urinary bladder.
•Posteriorly, is the recto-uterine pouch of Douglas and the
rectum.
•Superiorly is the intestines.
•Inferiorly – The cervix and vagina.
•Laterally – the broad ligaments, uterine tubes, the ovaries,
uterine blood vessels, and lower portion of ureters.

46. FUNCTIONS

• Prepares for possibility of pregnancy every month.
• Shelters and facilitates the nourishment of the fetus.
 Nourishment is from the mother through the placenta.
• Expels the products of conception through the labour
process.

47. Blood supply

•Through uterine artery, a branch of the
internal iliac artery.
•Ovarian artery, a branch of abdominal aorta
provides supply back up.
•venous drainage follow the same course.
•This excellent network of supply from major
vessels, makes the uterus highly vascular.

48. Nerve supply
•Mainly from the autonomic nervous system.
•Sympathetic and parasympathetic through the pelvic
plexus.
LYMPHATIC DRAINAGE
•Uterine body drains to the internal iliac glands while
cervical areas drains into various pelvic lymph glands.
•Uterine infection under normal circumstances, does not
occur because of the good drainage network.

49. UTERINE SUPPORTS

Pelvic floor is the main supportive factor, though various ligaments
maintain the position.
Those attached to the cervical level are the most important. They are:-
THE TRANSVERSE CERVICAL LIGAMENTS
•Also referred to as Cardinal or Mackenrodt’s ligaments.
•Spreads out from the lateral aspect of the cervix to the side walls of
the pelvis.
•Results from thickening of the broad ligaments lower margin.

50. THE PUBOCERVICAL
•Originates from the anterior aspect of the cervix. Passes
forward, under the urinary bladder to be inserted to the
anterior aspect of the pubic bones. Pulls the cervix forward.
THE UTEROSACRAL
•Spreads from the posterior surface of the cervix, passes
backwards, to be inserted to the sacrum. Pulls the cervix
backwards.
Therefore, Pubocervical and Uterosacral ligaments maintains
the uterus in position.

51. THE BROAD LIGAMENTS
•Are formed from a double fold of the peritoneum draping over the
uterine tubes.
•Hangs like wings/curtains extending from the entire lateral margin of the
uterus to be inserted to the lateral aspect of the pelvic side walls.
THE ROUND LIGAMENTS
•They originate from the cornua, but anteriorly and inferiorly to the
insertion of each uterine tube.
•Passes between broad ligaments folds, through the inguinal canal to be
inserted into each of the labia majora.
 Maintains the uterine anteverted position though minimally.

52. THE OVARIAN LIGAMENTS
•Originates from the cornua, but posterioly to the uterine
tubes.
•Inserted to each of the ovaries after passing between broad
ligament folds.
NB: Round, ovarian ligaments and uterine tubes originate from
the cornua and resemble closely on inspection.
 For successful bilateral tubal ligation (BTL) specific
identification is mandatory.

53. A DIAGRAM OF THE SUPPORTS OF THE UTERUS

54. 4.UTERINE TUBES

Synonymes :- Fallopian tubes, Salpinges and Oviducts,
Definition
•Are 2 thin tubular structures running laterally from the
cornua to the ovaries and each measures about 10cm long.
AREAS (PARTS) OF THE UTERINE TUBES
•Based on location in relation to the cornua:

56. 1.Interstitial (intramural)
•It is the first part, lying within the uterine walls, i.e. between
the fundus and the body. Measures about 1.25cm long with a
lumen diameter of 1mm.
2.Isthmus
•It is the narrowest part of the uterine tubes immediately
adjoining the uterus. Measures 2.5cm long.
3.Ampulla
•It is about 5cm long and lumen diameter 2-3cm.
•This is where fertilization takes place.

57. 4. Infundibulum(Fimbriated/ fringed end)
•A funnel shaped fringed end which overhangs near the
ovaries.
•Comprises of many finger-like projections referred to as
fimbriae.
•The longest of all is known as ovarian fimbria.
 Its purpose is to direct the ovum to the specific tube since the
fimbria is attached to the ovary.

58. RELATIONS OF THE UTERINE TUBES

•Peritoneal cavity and intestines lies anteriorly,
posteriorly and superiorly.
•Inferiorly are the broad ligaments and ovaries
•Laterally are the side walls of the pelvis.
•Medially Uterus located between the two(2) tubes

59. LAYERS


Are three (3) namely:
i) Innermost lining
•It is a mucous membrane made of ciliated cuboidal epithelium
thrown into folds known as plicae.
The purpose of plicae is to slow down the ovum’s passive
movement hence some development processes occur.
•Presence of goblet cells on the same lining sustains the ovum
since they produce glycogen containing secretions.

60. ii) Middle layer
•Comprises of a thin muscular coat similar to that of the uterus
•Inner fibres arranged in circular and longitudinal form to produce
peristaltic movements.
•Therefore, in conjunction with ciliated lining and plicae, the
peristaltic action convey to ovum to the uterine cavity on time.
iii)The outermost layer
• It is a continuation of the peritoneum though the inferior surface
is uncovered.
•However, the infundibulum portion passes through the
peritoneum to open into the peritoneal cavity.

61. FUNCTIONS OF THE UTERINE
TUBES
•Facilitates passive movement of the ovum from ovary to
uterine cavity.
•Provides a site for conception ,i.e. fertilization to occur.
•Provides nourishment of the fertilized ovum as it travels
through
•Receives the spermatozoa (male gametes) from the uterine
cavity as they travel upwards and eventually direct them to the
ampulla.

62. Blood supply and lymphatic drainage
•Through uterine and ovarian arteries.
•Venous drainage follows the same course.
•Lymph drains to the lumber glands.
Nerve supply
•It’s from the ovarian plexus.

63. 5.OVARIES

DESCRIPTION
•They are two (2) glandular organs, located in the peritoneal cavity, but
attached to the broad ligaments.
Each weighs 4-8gms, and the right one is slightly larger.
DEVELOPMENT
•At birth, each ovary contain/holds between 200-400,000 (2-4 hundred
thousand) of primordial follicles.
•As the child grows and develop, some of these follicles undergo
developmental processes such that they are eventually referred to as
graafian follicles.
•Then as from puberty, each undergoes further development and finally
release the ovum monthly.

64. RELATIONS
•Anteriorly - Broad ligaments.
•Superiorly - Uterine tubes
•Posteriorly - Are intestines
•Laterally, Infundibulo-pelvic ligament and pelvic side walls.
•Medially, Uterus and ovarian ligament , 2.5 cm long.

NB: Since the ovaries and uterine tubes are closely related,
together with their mesentries, they are collectively known as
Adnexa or appendages of the uterus

65. STRUCTURE

Each ovary comprises of a medulla and cortex respectively.
MEDULLA
•It is the innermost zone/supporting framework in which the
ovarian blood and lymphatic vessels as well as nerves passes
through.
•The site (area) of their entry to the ovary is referred to as
Hilum
•Since at this site, the ovary is attached to the broad ligament,
then the area is collectively known as mesovarium.

66. CORTEX
•It is the outer zone and the functional part, because it
has ovarian follicles.
•They are surrounded by a connective tissue while the
outer layer of the zone comprises of a fibrous tissue
referred to as Tunica albuginea
•Over it is a modification of peritoneum known as
Germinal epithelium.

67. FUNCTIONS OF THE OVARIES
•Production of ova throughout the procreation period.
•Production of estrogen and progesterone hormones in
preparation of the endometrium for pregnancy.
BLOOD SUPPLY
•Ovarian arteries.
•Drainage is via ovarian veins in which the right ovarian
vein empties into the inferior vena cava while the left
one into the left renal vein.
END