Female Reproductive Organs

Dr Sanjaya K Shrestha

External and internal genital organs

External – part of perineum

Internal genital organs: •A pair of ovaries •A pair of uterine/fallopian tubes •Uterus •Vagina

•Ovaries – homologous to testes – but much smaller

The Ovaries - Female gonads – female gamates (oocytes) are formed in them

Position -ovarian fossa- latera pelvic wall -Slight variation - nulliparous – long axis – vertical - multiparous - horizontal

External features

•Young girls- before onset of ovulation – smooth surfacegreyish pink in color

•After puberty- surfaces – uneven, color- grey •Two poles – upper tubal pole - lower uterine pole •Two borders- anterior- mesovarian border - posterior- free border •Two surfaces- lateral - medial

relations

eritoneal relatiions

Almost entirely covered by peritoneum Uncovered area- along mesovarium (anterior) border – 2 laye f peritoneum are reflected on to the posterior layer of broad gament of uterus

Mesovarium quamous epjithelium of mesovarium – continues with cubica pith of ovary – transmits vessels and nerves

Suspensory ligament of ovary

 



-infundibulopelvic lig Lateral part of broad ligament – extending from infundibulum of uterine tube and the upper pole of ovary to the external iliac vessels Contains ovarian vessels and nerves

Ovarian arteries arise from aorta Arterial supply just below the renal arterydescends over the posterior abdominal wall – enters suspensory lig- branches through mesovarium 

Venous drainage Form pampiniform plexus around the artery – condenses into a single ovarian v.- ascends on the posterior abd wall- drains into IVC on the rt side and into lt renal v on the lt side 

lymphatic



Lymphatics communicate with that of uterine tube and fundus of uterus – ascend along ovarian vessels – drain- lateral aortic and preaortic nodes

Nerve supply Ovarian plexus- derived From renal, aortic and hypogastric plexusesaccompanies ovarian artery – Sympathetic(T10,T11)afferent for pain;efferent as vasomotor Parasympathetic(S2,3,4) are vasodilator

Functions: 1. Production of oocytes – during reproductive life (puberty-menopause), ~30yrs Production of hormones 1. Oestrogen 2. progesterone

Uterine tubes (fallopian tubes) -tortuous ducts- convey oocyte from ovary to uterus. Fertilization usually takes place in the lateral part of tube. -position- free upper margin of broad ligament Dimensions 10 cm long Lateral end opens into peritoneal cavity- abdominal ostium (3mm in diameter) -

Parts: 1.

2.

3.

4.

Lateral end- like funnelinfundibulum- finger-like processes – fimbriae – fimbriated end Ampulla- medial to infundibulumthin-walled, dilated and tortuous(67cm), 4mm diam.; arches over upper pole of ovary Isthmus- narrow, rounded and cordlike – medial 1/3rd (2-3cm) Uterine or intramural part- 1cm, lies within the wall of uterus- opens at the superior angle of uterine cavity – uterine ostium 1mm diam.

Blood supply: Medial 2/3rd – uterine a. Lateral 1/3rd – ovarian a. Veins drain into pampiniform plexus of ovary

Lymphatics 



Join lymphatics from ovary – lateral and preaortic nodes Lymphatics from isthmus – accompany round ligament of uterus- drain into superficial inguinal nodes

Nerve supply SympatheticT10-L2 segments- from hypogastric plexus- both visceral afferent and efferent fibers- vasomotor + peristalsis ParasympatheticVagus – lateral ½ of tube Pelvic splanchnic n. from S2,3,4 – medial ½ - inhibits peristalsis; vasodilatation

Clinical Anatomy 1. 2.



 3. 4. 5.

Salpingitis Sterility – the most common cause in female- tubal blockage – congenital or caused by infection Patency investigationInsufflation test(Rubin’s test)- air pushed into uterus – fallopian tubes – peritoneal cavity- hissing or bubbling sound – on auscultation over iliac fossa Hysterosalpingography- radiologic technique Tubal pregnancy- tubal rupture Tubectomy- family planning Transport of ovum- tubal contraction; ciliary movement

The Uterus Hystera •A child-bearing organ in females, situated in pelvis, between bladder and rectum •Thick-walled and firm •Palpated bimanually during PV examination •At the time of child-birth (parturition) Contractions of muscle of the uterus Result in expulsion of foetus

Size and shape  

 



Pyriform 7.5cm long, 5cm broad, 2.5cm thick Weight- 30- 40 g Body- upper 2/3rd expanded part Cervix- lower 1/3rd cylindrical part

Normal position and angulation 





Normally, long axis of cervix forms 90 angle with the long axis of vagina Anteversion- forward bending of uterus relative to the vagina Uterus is also slightly flexed on itself –antiflexion ~ 125

Communication -Superiorly – uterine tubes -Inferiorly- vagina Body of uterus -Fundus -2 surfaces- anterior or vesical - posterior or intestinal - 2 lateral borders

Cervix of uterus   

Less mobile than body 2.5cm , slightly wider in middle Lower part projects into anterior wall of vagina – divides cervix into supravaginal and vaginal parts

Vaginal part of cervix  Vaginal fornices- space between vaginal wall and cervix  External os- small, circular in nulliparous – ant and post lips in multiparous  Cervical canal- fusiform in shape  Internal os

Supravaginal part of cervix 

Related - anteriorly- bladder -posteriorly- rectouterine pouch, containing coils of intestines and rectum -on each side – ureter, uterine art., embedded in parametrium (fibrofatty tissue betn 2 layers of broad ligament and below is called parametrium- it is abundant in the cervix and vagina)

Ligaments of uterus Peritoneal ligaments -peritoneal folds- do not provide support to uterus 1. Anterior lig- uterovesical fold 2. Posterior lig- rectovaginal fold 3. Rt & lt broad lig – attached to pelvic walls -mesovarium -mesosalpinx -mesometrium -suspensory lig of ovary (infundibulopelvic lig)

Broad ligament contains: 1. 2. 3. 4. 5. 6.

7. 8. 9.

10.

Uterine tube Round lig of uterus Lig of ovary Uterine vessels Ovarian vessels Uterovaginal and ovarian nerve plexus Epoophoron Paroophoron Lymph nodes and lumph vessels Dense c.t. or parametrium

Fibromuscular ligaments 1. 2. 3.

Round ligament of uterus Transverse cervical lig Uterosacral lig

Supports of uterus Primary supports - Muscular or active supports 1. Pelvic diaphragm 2. Perineal body 3. Urogenital diaphragm -

Fibromuscular or mechanical supports 1. 2. 3. 4. 5.

Uterine axis Pubocervical lig Transverse cervical lig Uterosacral lig Round lig of uterus

Secondary support 1. 2. 3.

Doubtful value Peritoneal folds Broad lig Uterovesical fold of peritoneum Rectovaginal fold of peritoneum

Clinical anatomy 1.

2.

3.

4. 5. 6. 7.

8.

Retroverted uterus- in straight line with vagina Prolapse of uterus- weakening of various supports of the uterus Intrauterine contraceptive devices- prevent implantation of fertilized ovum Caesarian section Hysterectomy Hysterosalpingography Ca cervis ~ commonest malignancy ~ 11%, next Ca breast~8% Therapeutic dilatation of cervix and curettage of endometrium - DUB

The vagina Fibromuscular canal Female copulatory organ Vagina- sheath Extends from vulva to uterus Situated behind bladder and urethra in front of rectum and anal canal Direction In erect posture- upwards and backwards – angle of 45 with uterus Size and shape Ant wall- 8cm Post wall- 10cm Diameter- vault-5cm, lower end~2.5cm Highly distensible- allows passage of head of foetus -

Lumen- circular- upper endbecause protrusion of cervix  Below cervix- ant and post wall in contact- transverse slit Virgin -lower end- partially closed- a thin membrane- hymen Non-virgin - Hymen is represented by rounded elevations around vaginal orifice- caruncular hymenale 