GENITAL ORGANS Semmelweis University Faculty of Pharmacy 1

Female genital organs - overview Uterine tube Uterus Ovary Vagina Clitoris Vestibule of vagina

Ovary Function: • production of ovum • secretion of female sex hormones: estrogen and

Follicle maturation Primary oocytes remain in the first meiotic division until puberty. End of

stroma tercier follicle germinal epithelium corpus luteum primer follicle zona pellucida secunder follicle primer

Uterine tube Isthmus Ampulla Mesosalpinx Infundibulum Function: transport of ovum from ovary to uterus

Uterus Fundus Uterine tube Body Isthmus Ovary Supravaginal part of cervix Vaginal part of

Hysterosalpingogram The radiograph shows a normal state with contrast medium exiting from the ostium

Uterus bicornis Paramesonephric duct (Müllerian duct) Undifferentiated gonad Mesonephric duct (Wolffian duct) http: //www.

anteflexion (˜ 60 o) cervix-body angle Position of the uterus anteversion (˜ 60 o)

Position of the uterus rectum ovary utherus vagina bladder vesicouterine pouch rectouterine pouch (Douglas)

Ligaments of the uterus Ligaments: broad ligament of uterus mesometrium mesosalpinx mesovarium round ligament

Ligaments of the uterus (see below) sacrum sacrocervical ligament rectum rectouterine pouch parametrium (cardinal

Ligaments of uterus (see lateral) Uterus Sacrocervical ligament Urinary bladder Rectum Pubocervical ligament Transverse

Bimanual examination of the uterus Colposcopic photographs (portio vaginalis cervicis) vaginal examination Spatula Speculum

Rectovaginal digital examination of the perineum The puncture of the rectouterine pouch of Douglas

Hystology and structure of the uterus ENDOMETRIUM MYOMETRIUM stratum submucosum stratum vasculare stratum supravasculare

The menstrual cycle – changes of the endometrium regeneration epithel stroma proliferative phase tubular

Position of the uterus during pregnancy Placenta Mucous plug in the cervical canal Situs

Blood supply of the internal genital organs Uterine tube Pampiniform plexus of veins Ovarian

External genital organs Mons pubis Prepuce of clitoris Labium majus Clitoris (glans) External urethral

External genital organs Crus of clitoris Body of clitoris Glans of clitoris Bulb of

Muscles of the pelvis, perineum mons pubis DIAPHRAGMA UROGENITALE symphysis pubic bone m. gluteus

The breast subclavicular lymphnodes parasternal lymphnodes axillar lymphnodes

MALE GENITAL ORGANS Gonads: (production of germ cells; secretion of sex hormones) testes Genital

MALE GENITAL ORGANS Seminal vesicle Prostate Penis Bulbourethral gland Ductus deferens Epididymis Testis Scrotum

TESTIS AND EPIDIDYMIS Head of epididymis Spermatic cord Testis: Body of epididymis 4 -5

TESTIS Structure: tunica albuginea connective tissue septa lobules (~200 -300): convoluted seminiferous tubules: 30

TESTIS Convoluted seminiferous tubules: Sertoli cells of spermatogenesis: spermatogonium primary spermatocyte secondary spermatocyte spermatid

Type A spermatogonium (2 N, 2 C) 16 --32 ------------64 --------128 ----- Type B

SPERMATOGENESIS Meiosis: production of haploid germ cells: 46 → 23 chromosome Prophase I genetic

SPERMATOGENESIS Spermiogenesis: spermatid → spermatid sperm

EPIDIDYMIS Head of epididymis Spermatic cord Testis Body of epididymis

EPIDIDYMIS Structure: head: ductuli efferentes testis: ~10 -20 20 cm long body and tail:

DUCTUS DEFERENS, SEMINAL VESICLE AND PROSTATE Ductus deferens Seminal vesicle Prostate Urethra

DUCTUS DEFERENS, SEMINAL VESICLE AND PROSTATE Ductus deferens Seminal vesicle Ejaculatory duct Prostate Urethra

DUCTUS DEFERENS Size and shape: 50 -60 cm long 3 -3. 5 mm in

SEMINAL VESICLE Size and shape: 5 -10 cm long highly folded tubular gland Structure:

PROSTATE Size and shape: 4 cm wide, 2 cm a-p, 3 cm vertical chestnut-shaped

ACCESSORY SEX GLANDS Prostate Seminal vesicle Cowper’s gland (bulbourethral gland) Semen: 2 -6 ml

PENIS Parts: glans penis – prepuce body root Erectile bodies: corpus cavernosum crus penis

PENIS Crus penis covered by: ischiocavernosus muscle Bulbus penis covered by: bulbospongiosus muscle

SCROTUM Coverings of the testis and spermatic cord: skin of scrotum tunica dartos –

MALE URETHRA Urinary bladder Internal urethral orifice Prostate Urogenital diaphragm Corpus spongiosum External urethral

MALE URETHRA Size and shape: 20 -25 cm long internal urethral orifice external urethral

5 th week, pronephros, mesonephros and metan

5 th week, mesonephric glomerulus, mesonephric duct, paramesonephric duct, metanephrogen tissue

Development of the genital organs (3 rd-6 th weeks)

6 th week 7 th week 8 th week 4 th month Development of

Mesonephric duct (Wolffian canal) and paramesonephric duct (Müllerian canal) in male

Mesonephric duct (Wolffian canal) and paramesonephric duct (Müllerian canal) in female

INTERNAL GENITAL ORGANS Undifferentiated gonad Müllerian duct Wolffian duct Gubernaculum

EXTERNAL GENITAL ORGANS Genital tubercle Genital fold Genital ridge

References: • Kahle W, Leonhardt H, Platzer W: Color Atlas/Text of Human Anatomy, 1993,

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GENITAL ORGANS Semmelweis University, Faculty of Pharmacy 1 st year 2 nd semester Katalin Kocsis Department of Anatomy, Histology and Embryology 2019. 03. 18.

Female genital organs

Female pelvis, sagittal section

Female genital organs - overview Uterine tube Uterus Ovary Vagina Clitoris Vestibule of vagina Labium major Labium minor

Ovary Function: • production of ovum • secretion of female sex hormones: estrogen and progesterone (menstrual cycle)

Follicle maturation Primary oocytes remain in the first meiotic division until puberty. End of the first meiotic division: ovulation End of the second meiotic division: fertilization Follicular epithelial cells: Granulosa cells Theca cells Follicle maturation is influenced by FSH (folliculestimulating hormone) from the hypophisis (pituitary gland). After ovulation (14 th days of the menstruatic cycle) under the influence of LH (luteinizing hormone) the follicular epithelium transform into a corpus luteum and begins to secrete progesteron.

stroma tercier follicle germinal epithelium corpus luteum primer follicle zona pellucida secunder follicle primer oocyta theca folliculi athretetic follicles

Uterine tube Isthmus Ampulla Mesosalpinx Infundibulum Function: transport of ovum from ovary to uterus • kinocilia • peristaltic muscular activity

Uterus Fundus Uterine tube Body Isthmus Ovary Supravaginal part of cervix Vaginal part of cervix

Hysterosalpingogram The radiograph shows a normal state with contrast medium exiting from the ostium of the tuba uterina into the abdominal cavity of the utherus tuba utherina injection tube

Uterus bicornis Paramesonephric duct (Müllerian duct) Undifferentiated gonad Mesonephric duct (Wolffian duct) http: //www. womenshealthandpleasure. com/gynae/uterus. html http: //www. gfmer. ch/genetic_diseases_v 2/gendis_detail_list. php? cat 3=988

anteflexion (˜ 60 o) cervix-body angle Position of the uterus anteversion (˜ 60 o) cervix-vagina angle Anteflexion of uterus Anteversion of uterus Retroflexion retroversion of uterus

Position of the uterus rectum ovary utherus vagina bladder vesicouterine pouch rectouterine pouch (Douglas)

Ligaments of the uterus Ligaments: broad ligament of uterus mesometrium mesosalpinx mesovarium round ligament of uterus (ligament of ovary) Broad ligament parametrium: lateral cervical ligament uterosacral ligament pubovesical ligament mesosalpinx mesovarium mesometrium Ovarian ligament Suspensory ligament (a. and v. ovarica)

Ligaments of the uterus (see below) sacrum sacrocervical ligament rectum rectouterine pouch parametrium (cardinal ligament) cervix pubovesical ligament + vesicouterine ligament = pubocervical ligament bladder symphysis

Ligaments of uterus (see lateral) Uterus Sacrocervical ligament Urinary bladder Rectum Pubocervical ligament Transverse cervical ligament

Bimanual examination of the uterus Colposcopic photographs (portio vaginalis cervicis) vaginal examination Spatula Speculum Uterine portion rectal examination Uterine cavity

Rectovaginal digital examination of the perineum The puncture of the rectouterine pouch of Douglas

Hystology and structure of the uterus ENDOMETRIUM MYOMETRIUM stratum submucosum stratum vasculare stratum supravasculare PERIMETRIUM

The menstrual cycle – changes of the endometrium regeneration epithel stroma proliferative phase tubular glands secretory phase menstruation

Position of the uterus during pregnancy Placenta Mucous plug in the cervical canal Situs of abdominal internal organs shortly before the end of pregnancy

Blood supply of the internal genital organs Uterine tube Pampiniform plexus of veins Ovarian artery and vein Uterus Ligament of ovary Isthmus Ampulla Ovarian and tubal branches Infundibulum Fimbriae Ovary Ureter Uterine plexus Internal iliac artery Uterine artery Vaginal artery and vein Vaginal plexus Internal pudendal artery Vagina

External genital organs Mons pubis Prepuce of clitoris Labium majus Clitoris (glans) External urethral orifice Labium minus Orifice of vagina

External genital organs Crus of clitoris Body of clitoris Glans of clitoris Bulb of vestibule Greater vestibular gland

Muscles of the pelvis, perineum mons pubis DIAPHRAGMA UROGENITALE symphysis pubic bone m. gluteus maximus coccygeal bone anus m. levator ani (DIAPHRAGMA PELVIS)

The breast subclavicular lymphnodes parasternal lymphnodes axillar lymphnodes

MALE GENITAL ORGANS

MALE GENITAL ORGANS Gonads: (production of germ cells; secretion of sex hormones) testes Genital tract: (transport of germ cells) epididymis ductus deferens Sex glands: seminal vesicle prostate bulbourethral gland External genital organs: penis scrotum

MALE GENITAL ORGANS Seminal vesicle Prostate Penis Bulbourethral gland Ductus deferens Epididymis Testis Scrotum

Male pelvis, sagittal section

TESTIS AND EPIDIDYMIS Head of epididymis Spermatic cord Testis: Body of epididymis 4 -5 cm long plumshaped

TESTIS Structure: tunica albuginea connective tissue septa lobules (~200 -300): convoluted seminiferous tubules: 30 -60 cm long interstitium mediastinum: rete testis Function: production of sperm secretion of male sex hormone: testosterone

TESTIS Convoluted seminiferous tubules: Sertoli cells of spermatogenesis: spermatogonium primary spermatocyte secondary spermatocyte spermatid sperm Interstitium: Leydig cell

Type A spermatogonium (2 N, 2 C) 16 --32 ------------64 --------128 ----- Type B spermatogonium (2 N, 4 C) Primary spermatocyte (2 N, 4 C) Secondary spermatocyte (1 N, 2 C) Spermatid (1 N, 1 C) Spermiogenesis Meiosis Spermatocytogenesis SPERMATOGENESIS Sperm (1 N, 1 C)

SPERMATOGENESIS Meiosis: production of haploid germ cells: 46 → 23 chromosome Prophase I genetic variability: crossing-over separation of homologous chromosomes Metaphase I Telophase I Anaphase I Prophase II Anaphase II Metaphase II Telophase II

SPERMATOGENESIS Spermiogenesis: spermatid → spermatid sperm

EPIDIDYMIS Head of epididymis Spermatic cord Testis Body of epididymis

EPIDIDYMIS Structure: head: ductuli efferentes testis: ~10 -20 20 cm long body and tail: ductus epididymis: 4 -6 m long Function: maturation of sperm storage of sperm

DUCTUS DEFERENS, SEMINAL VESICLE AND PROSTATE Ductus deferens Seminal vesicle Prostate Urethra

DUCTUS DEFERENS, SEMINAL VESICLE AND PROSTATE Ductus deferens Seminal vesicle Ejaculatory duct Prostate Urethra

DUCTUS DEFERENS Size and shape: 50 -60 cm long 3 -3. 5 mm in diameter – 0. 5 mm lumen Structure: mucosa extremely thick muscular wall Function: transport of sperm during ejaculation

SEMINAL VESICLE Size and shape: 5 -10 cm long highly folded tubular gland Structure: mucosa thick muscular wall

PROSTATE Size and shape: 4 cm wide, 2 cm a-p, 3 cm vertical chestnut-shaped Structure: stroma: smooth muscle fibroelastic connective tissue glands: mucosal submucosal main Prostatic hypertrophy

ACCESSORY SEX GLANDS Prostate Seminal vesicle Cowper’s gland (bulbourethral gland) Semen: 2 -6 ml – 99% is produced by accessory glands alkaline p. H >20 million (~100 million) sperm / ml >60% motile sperm

PENIS Parts: glans penis – prepuce body root Erectile bodies: corpus cavernosum crus penis corpus spongiosum glans penis bulbus penis

PENIS Crus penis covered by: ischiocavernosus muscle Bulbus penis covered by: bulbospongiosus muscle

PENIS

SCROTUM Coverings of the testis and spermatic cord: skin of scrotum tunica dartos – septum external spermatic fascia cremasteric fascia – cremaster muscle internal spermatic fascia tunica vaginalis Function: temperature of testes is maintained at 2 -3°C below body temperature

MALE URETHRA Urinary bladder Internal urethral orifice Prostate Urogenital diaphragm Corpus spongiosum External urethral orifice

MALE URETHRA Size and shape: 20 -25 cm long internal urethral orifice external urethral orifice – sphincter vesicae Parts: prostatic part: urethral crest, seminal colliculus membranous part – sphincter urethrae spongy part

DEVELOPMENT OF UROGENITAL ORGANS

5 th week, pronephros, mesonephros and metan

5 th week, mesonephric glomerulus, mesonephric duct, paramesonephric duct, metanephrogen tissue

Ascent of the kidneys

Development of the genital organs (3 rd-6 th weeks)

6 th week 7 th week 8 th week 4 th month Development of the genital organs 5 th

Mesonephric duct (Wolffian canal) and paramesonephric duct (Müllerian canal) in male

Mesonephric duct (Wolffian canal) and paramesonephric duct (Müllerian canal) in female

INTERNAL GENITAL ORGANS Undifferentiated gonad Müllerian duct Wolffian duct Gubernaculum

EXTERNAL GENITAL ORGANS Genital tubercle Genital fold Genital ridge

References: • Kahle W, Leonhardt H, Platzer W: Color Atlas/Text of Human Anatomy, 1993, Thieme, Stuttgart • Putz R, Pabst R (editors): Sobotta Atlas of Human Anatomy, 1993, Urban & Schwarzenberg, München • Romanes GJ (editor): Cunningham’s Textbook of Anatomy, 1991, Oxford University Press, Oxford • Ross MH, Kaye GI, Pawlina W: Histology. A Text and Atlas with Cell and Molecular Biology, 2002, Lippincott Williams & Wilkins, Philadephia • Röhlich P (szerkesztő): Szövettan, 1999, Semmelweis Kiadó, Budapest • Papp Z. : A szülészet nőgyógyászat tankönyve Standring S (editor-in-chief): Gray’s Anatomy, 2005, Elsevier Churchill Livingston, Edinburgh • Stevens A, Lowe JS: Human Histology, 2005, Elsevier Mosby, Philadelphia • Szentágothai J. , Réthelyi M. : Funkcionális anatómai, 1985, Part 2.