Female Reproductive System Lecture Objectives Describe the peritoneal

Female Reproductive System

Lecture Objectives • Describe the peritoneal foldings on the pelvic viscera in the female. • Describe the structure of the female genital organs. • Describe the organs of the female urogenital triangle. • Describe the relationship, blood supply, innervation, and lymph drainage of all the above organs.

Female Reproductive System • Ovaries produce 2 nd oocytes & hormones • Uterine tubes transport fertilized ova • Uterus where fetal development occurs • Vagina & external genitalia constitute the vulva • Mammary glands produce milk

The Ovary • Pair of organs, size of shelled almonds (2 x 4 cm) found in upper pelvic region • Regional histology – tunica albuginea is capsule of dense connective tissue – cortex is region just deep to tunica, contains follicles – medulla is deeper region composed of connective tissue, blood vessels & lymphatics – germinal epithelium is simple epithelial covering over the ovary

Ovary • Located on the lateral wall of the pelvis at the ovarian fossa – Between the internal & external iliac vessels • Ovary is responsible on production of: oocytes & hormones (estrogen & progesterone)

Ovarian Ligaments • Mesovarium attaches ovaries to the posterior surface of broad ligament • Ovarian ligament (round ligament of ovaries) anchors ovary to uterus • Suspensory ligament – Between the mesovarium & lateral pelvic wall – Covers blood vessels to ovaries

Broad Ligament • Two layers extension of the peritoneum – Superiorly – continuous free edge – Inferiorly – split to cover the pelvic floor • Extend from the uterus to the lateral pelvic wall on both sides • Parts – Mesosalpinx – below the uterine tube – Mesovareium – posteriorly – Mesometrium – below mesovarium – Suspensory ligament of the ovary – lateral to mesovarium

Broad Ligament • Content Uterine tube Round lig. of the ovary Round lig. of the uterus Uterine & ovarian BVs, lymph vessels, & nerves – The epoophoron – – • In the mesosalpinx • Mesonephric remains – The paroophoron • In the mesometrium • Mesonephric remains

Ovary • Blood supply: – Ovarian aa. – aorta – at L 1 – Left ovarian v. – left renal v. – Right ovarian v. – IVC • Lymphatics: para aortic nodes – at L 1 • Nerve supply: aortic plexus Blood & lymphatic vv. & nerves reach ovary via suspensory lig. – mesovarium

Uterine (Fallopian) Tubes • Narrow, 4 inch tube extends from ovary to uterus – Infundibulum is open, funnel‐shaped portion near the ovary • fimbriae are moving finger‐like processes – Ampulla is widest, central region of tube – Isthmus is narrowest portion joins uterus – Intramural part pierces the uterine wall

Uterine Tube • Functions – Fimbriae sweep oocyte into tube – Transport for oocyte, sperms, zygote – Fertilization site (usually ampulla) – Nutrition for fertilized oocyte

Uterine Tube • Blood supply: – Uterine aa. – internal iliac – Ovarian aa. – aorta • Lymphatics: – Internal iliac & para aortic • Nerve supply: – Inferior hypogasrtic plexus

Uterus • Site of menstruation & development of fetus • Hollow pear shaped • 3 inches long by 2 in. wide and 1 in. thick • Parts – Fundus above uterine tube – Body below uterine tube • Uterine cavity – triangular, slit like cavity – Isthmus between body & cervix – Cervix supravaginal & vaginal parts • Cervical canal – Internal os & External os

Uterus: Relations • Anteriorly (inferior to superior): – anterior fornix, urinary bladder & uterovesical pouch • Posteriorly: – rectouterine pouch (pouch of Douglas) & sigmoid colon • Laterally (inferior to superior): – lateral fornix, ureters, uterine aa. , round ligaments of ovary & uterus, uterine tube & broad ligament

Position of Uterus • Anteversion – anterior angle between uterus and vagina – Opposite ‐ retroversion • Anteflexion – anterior angle between body & cervix of uterus – Opposite – retroflexion • Usually the uterus is anteversed anteflexed

Uterus • Blood supply: – Uterine aa. – internal iliac • Cross ureters at level of internal os – ascend at the lateral walls of uterus – Ovarian aa. – aorta • Lymphatics: – Fundus – para aortic nodes – Body & cervix – internal & external iliac nodes – Some follow round lig. to superficial inguinal nodes • Nerve supply: – Inferior hypogasrtic plexus

Uterus: Ligaments • Transverse cervical (cardinal) lig. • Pubocervical lig. • Sacrocervical lig. • Round lig. Of the uterus – From uterus – broad lig. – inguinal canal – to subcutaneous tissue of labia majora

Hysterectomy • Surgical removal of the uterus • Indications for surgery – endometriosis, ovarian cysts, excessive bleeding, cancer of cervix, uterus or ovaries • Complete hysterectomy removes cervix • Radical hysterectomy removes uterus, tubes, ovaries, part of vagina, pelvic lymph nodes and supporting ligaments

Vagina • Passageway for birth, menstrual flow & intercourse • Description – 4 inch long fibromuscular organ traversing the pelvis & perineum – It is oriented upward and backward ending at uterus – Cervix enters the vagina anteriorly – Orifice partially closed with membrane (hymen)

Vagina • The fornix is the sulcus surrounding the cervix • Anterior, posterior & lateral fornices • Relations • Anteriorly – bladder & urethra • Posteriorly – rectouterine pouch, ampulla of rectum & perineal body & anal canal • Laterally – ureter, levator anai m.

Vagina • Blood supply: – Vaginal a. – internal iliac – Vaginal branch of uterine a. – Vaginal plexus – internal iliac v. • Lymphatics: – Upper third– internal & external iliac nodes – Middle third – internal iliac – Lower third – superficial inguinal nodes • Nerve supply: – Inferior hypogasrtic plexus

Vagina: Support Structures • Upper part – Levator ani – Transverse cervical, pupocervical & sacrocervical ligaments • Middle part – Urogenital diaphragm • Lower part – Perineal body ‐ posteriorly

Vulva (External Genitalia) • Mons pubis ‐‐ fatty pad over the pubic symphysis • Labia majora – Analog to scrotum in male – Skin folds from the mons pubis anteriorly – Unit together posteriorly • Labia minora – – Hairless skin folds internal to the labia majora – Anteriorly – form the prepuce and the frenulum of clitoris – Posteriorly – fourchette (frenulum of labia minora) • Vestibule of the vagina – Space between the labia minora – Contains clitoris and the openings of: • Urethra – 1 in. posterior to clitoris • Vagina – posterior to urethral opening • Duct of the Greater vestibular glands (Bartholin’s glands) • Duct of the Paraurethral glands

Vulva • Blood supply – Branches of the internal & external pudendal aa. • Lymphatics – Skin – superficial inguinal nodes • Nerve supply – Anteriorly • Ilioinguinal nn. • Genital branch of the genitofemoral nn. – Posteriorly • Branches of the perineal nn. • Branches of the posterior cutaneous nn. of the thigh

• Greater vestibular glands – Small mucus secreting glands – Deep to the posterior part of the bulb of vestibule – It’s ducts open on the vestibule lateral to the vaginal opening • Paraurethral glands – Analog to the prostate gland in male – Open on the vestibule lateral to the urethral opening

Clitoris • Analog of penis in male • Structure – Root • Left & right crura – Covered by ischiocavernosus mm. • Bulb of the vestibule – Two halves around vagina – Covered by bulbospongiosus mm. – Body – small • Corpora cavernosa • Corpus spongiosum – Glans » At the apex of vestibule » Prepuce

Clitoris • Neurovascular and lymphatic supply as penis • Blood supply: branches of the internal pudendal a. – Deep aa. Of the clitoris – corpora cavernosa – Artery of the bulb of vestibule – corpus spongiosum – Dorsal artery of the clitoris • Lymphtics: – Skin – superficial inguinal nodes – Glans – internal iliac nodes • Nerve supply: – Dorsal nerve of the clitoris – pudendal n. – Parasympathetic – inferior hypogastric plexus