Female Genital System Fix.pptx

FEMALE GENITAL SYSTEM

Bela bagus setiawan Pembimbing : dr. Ika Pawitra Miranti, M.Kes, Sp.PA

INTRODUCTION The female reproductive system comprises the ovaries, oviducts, uterus, vagina, external genitalia, and mammary glands.  The external genitalia (vulva) includes the labia minora, labia majora, mons pubis, clitoris, and vestibule.  Female secondary sex characteristics appear at puberty, along with the monthly menstrual cycle 

ANATOMI FEMALE GENITAL SYSTEM

GENETALIA EXTERNAL FEMALE

Anatomy           

Vulvar Vestibule Urethral Orifice (Meatus Urinarius) Hymen Clitoris Labia Minora Labia Majora Mons Pubis (Mons Veneris) Lymphatic Drainage Arterial Supply Venous Supply Nerve Supply

CRINICAL PERSPECTIVE Vulvar symptoms are a common cause of clinical visits to gynecologists and family practitioners.  Complaints may include pruritus, burning, pain, external dyspareunia, and a visible or palpable mass 

VULVAR VESTIBULE The vulvar vestibule from the exterior surface of the hymen frenulum of the clitoris anteriorly, fourchette posteriorly, anterolaterally to the labia minora, and posterolaterally to Hart’s line  The vulvar vestibule is predominantly nonkeratinized stratified squamous epithelium, 

Superficial thin-walled vessels are prominent and are found within the delicate fibrous stroma

Note that the epithelium is stratified squamous and that the superficial cells have cytoplasmic clearing, reflecting the glycogen-rich epithelium

URETHRAL ORIFICE (MEATUS URINARIUS) 

The urethra has a transitional epithelial lining that merges with the stratified squamous epithelium at the urethral orifice.

HYMEN The hymen marks the distal most extent of the vagina and the most proximal boundary of the vulvar vestibule.  The hymen may be imperforate, round, annular, septate, cribriform, or porous  the hymen has a non-keratinized stratified squamous epithelium, 

LABIA MINOR 

The epithelium of the labia minora is of the stratified squamous type, it is not keratinized

The epithelium is pigmented, and melanocytes and pigmented basal epithelial cells are seen in the basal layer. The stratifed squamous epithelium has a thinly keratinized surface.

LABIA MAYOR 

the labia majora joins the non-keratinized squamous epithelium

woman peripheral to Hart’s line. This pigmented portion o the labia majora has a stratified squamous epithelium with a thin keratinized surface..

LYMPH 

the vulvar tissues drain to lymph nodes in the femoral and inguinal lymph node chains.

ARTERIAL 

The major arterial supply of the vulva originates with the superficial external pudendal arteries (branching from the femoral artery) and the internal pudendal arteries (branching from internal iliac arteries)

VENOUS 

Major venous drainage of the vulva is primarily from the bilateral internal iliac veins that drain into the external iliaca venous system

NERVES 

The anterior nerve is a branch of the ilioinguinal nerve, and the posterior labial branch is from the pudendal nerve

VAGINA 

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The vagina (from the Latin for sheath) extends from the vestibule of the vulva to the uterus, (dorsal) to the urinary bladder and anterior (ventral) to the rectum. The vaginal wall consists of three principal layers: Mucosa (epithelial stroma and submucosal) muscle, and adventitia. The basal cell layer consists of a single layer of columnar epithelial Ligaments Blood Supply Nerves Lymphatic Drainage

LIGAMENTS 

The vaginal supports are intimately related to the uterus,urethra, bladder, and rectum

BLOOD SUPPLY 

The internal iliac (hypogastric) artery is the principal source as branches of the uterine arteries and pudendal arteries.

NERVES 

The autonomic system of the pelvis originates in the superior hypogastric plexus

LYMPHATICS Branches terminate in a perivaginal plexus

VAGINAL WALL 

The vaginal musculature is continuous with that of the uterus.

ADVENTITIA WOLFFIAN DUCTS

Vestigial wolfian duct remnants, deep in wall.

MÜLLERIAN DUCT EPITHELIUM (ADENOSIS)

glandular epithelium is mucinous tuboendometrial

UTERUS

GROSS ANATOMIC FEATURES OF THE UTERUS The uterus is anterior to the rectum and posterior to the bladder  The adult uterus consists of the corpus, and a cervix (ectocervix and endocervix)  the corpus cephalad to a line connecting the origin of the two fallopian tubes is called the fundus. 

UTERINE CERVIX The uterine cervix or “neck” is the elongate bromuscular portion of the uterus  Consist of ectocervix and endocervix 

ECTOCERVIX

Mature squamous epithelium o the exocervix demonstrating a normal maturation sequence from basal cells to superfIcial cells

ENDOCERVIX

Normal endocervical mucosa with most nuclei in the characteristic basilar location columner

SQUAMOCOLUMNAR JUNCTION

GROSS ANATOMIC FEATURES OF THE FALLOPIAN TUBES 

The fallopian tubes are hollow epitheliumlined muscular structures 11 to 12 cm in length that run through the apex of the broad ligament to span the uterine cornu medially and the ovary laterally

Ciliated cells

Mucosa Lumen

Cilia

Muscularis Lamina propria Serosa

Peg cells

Endometrium

Myometrium

ENDOMETRIUM 

The normal endometrium consists of both epithelial (surface and glandular) and mesenchymal (stromal and vascular) elements

PROLIFERATIVE ENDOMETRIAL PHASE (OVARIAN FOLLICULAR PHASE)

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The endometrium responds to rising estrogen levels by synchronous proliferation of glands, stroma, and vessels

proliferative phase gland. The constituent cells are pseudostratified, and the characteristically elongate glandular nuclei have dense chromatin

The round cell with clear cytoplasm at the 3:00 o’clock position has the characteristic appearance o ciliated cells

ENDOMETRIAL SECRETORY PHASE (OVARIAN LUTEAL PHASE)  after ovulation occurs.  It is influenced by progesterone produced by the corpus luteum.  The morphologic changes can be divided into four periods: Interval, early secretory, mid-secretory, and late secretory

INTERVAL SECRETORY 

scattered nonuniform subnuclear vacuoles may appear. This morphologically indeterminate endometrium is termed “interval.”

EARLY SECRETORY 

the early secretory phase is the vacuolated gland

Early secretory endometrium with subnuclear vacuoles

MID SECRETORY glands set within a spindled edematous stroma  appearance is one of glandular crowding 

extreme glandular coiling and stromal edema are apparent

the coiled spiral arteries are seen within an edematous stroma

the characteristically round vesicular nuclei o the mid-secretory endometrium are apparent (

LATE SECRETORY 

As the late secretory phase progresses, the cells become apoptotic and apoptotic bodies accumulate within stromal macrophages.

the serrated appearance o the gland reflects their coiled state.

Predecidual reaction begins around the spiral arteries, and this reaction serves to distinguish mid-secretory endometria from late secretory endometria

MENSTRUAL PHASE 

The constituent glands and stroma of the functionalis fragment to crumble, often referred to as stromal breakdown.

MIOMETRIUM 

The bulk of the myometrium comprises smooth muscle cells, but an important contribution is made by extracellular components such as collagen and elastin

Myometrium

OVARY Germinal epithelium Cortex Tunica albuginea Medulla Primordial follicle

Primary follicle (multilaminar)

Granulosa cells Secondary follicle

Antrum Primary oocyte

Zona pellucida

Blood vessels Granulosa lutein cells

Theca lutein cells

Blood vessels Corpus albicans

HISTOLOGY The surface epithelium of the ovary consists of a single, focally pseudostratified layer  The cells vary from at to cuboidal to columnar 

STROMA 

The spindle-shaped stromal cells, which have scanty cytoplasm, are typically arranged in whorls or a storiform pattern the ovarian stroma cells from of fibroblastic type.

Ovarian stroma composed o whorls o plump spindle cells of fibroblastic type.

TERIMA KASIH