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TOPOGRAPHICAL & SURFACE ANATOMY OF THE PELVIS 4 – FEMALE PELVIC ORGANS & PERINEUM Basic Anatomical structures and Principles (syllabus) Understand the concepts and associated principles, functional and clinical applications of the female pelvic organs and perineum. OVARIES – 2-3.5cm long, 1-1.5cm wide. Visceral peritoneum covering the surface of the ovaries is called ovarian/germinal epithelium. Immediately below the epithelium is a layer of dense fibrous CT - Tunica Albuginea Cortex = dense outer part Medulla = loose inner part of the ovary UTERINE/FALLOPIAN TUBES/OVIDUCTS – open into peritoneal cavity to receive the oocyte from the ovary. It expands to form the infundibulum and has long thin processes called Frimbriae. Ampulla – nearest the infundibulum and is the widest and longest part Isthmus – nearest the uterus and is much narrower and thinker then ampulla Uterine/intramural part – passes through the uterine wall and ends in a very small uterine opening Uterine tube walls have 3 layers: 1. SEROSA – other layer formed by peritoneum 2. MUSCULAR LAYER – middle layer. Longitudinal and circular smooth muscle 3. MUCOSA – inner layer. Has mucous membrane of simple ciliated columnar epithelium. Mucosa provides nutrients for the oocyte/developing embryo and the ciliated epithelium helps move it through the tubes. UTERUS – about the size of a pear. Slightly flattened anteroposteriorly with the larger rounder part (fundus) superior to the narrower part (cervix). The body is between the fundus and the cervix. Major ligaments holding the uterus in place: Broad Lig – from the lat. margin of uterus to the wall of the pelvis on either side. Also ensheaths the ovaries and uterine tubes Round ligs – from uterus through the inguinal canals to labia majora Uterosacral ligs – attach lat wall of uterus to the sacrum Uterus walls have 3 layers: 1. Perimetrium (serous layer) – outer peritoneum covering the uterus 2. Myometrium (muscular layer) – middle layer. Majority of the uterine wall 3. Endometrium (mucous membrane) – inner layer. Composed of 2 layers: o Basal layer – thin and deepest part. Continuous with the myometrium o Functional layer – thicker and superficial. Lines the cavity and is sloughed off during menstruation VAGINA – approx. 10cm long. Extends from the uterus to the external genitalia Fornix – superior domed part of the vagina and is attached to the sides of the cervix Vaginal walls consist of and outer muscular layer of smooth muscle. Allows vagina to increase in size for penis and childbirth. Also has an inner mucous membrane composed of moist stratified squamous epithelium. It releases lubricating secretions during intercourse. Hymen – thin mucous membrane covering the vaginal opening. EXTERNAL GENITALIA Aka VULVA or PUDENDUM. Consists of the vestibule and surrounding structures Vestibule – space into which the vagina opens posteriorly and urethra opens anteriorly Labia Minora – thin longitudinal skin folds bordering the vestibule Clitoris – on the anterior vestibule margin. <2cm length and consists of a shaft and distal glans. Well supplied with sensory receptors and contains erectile structures corpora cavernosa. Prepuce – fold of skin over the clitoris where the labia minora meet. Labia Majora – lateral to labia minora. Consist mainly of subcutaneous fat. They unite anteriorly over the symphysis pubis at the mons pubis. MEDIAL surface covered with sebaceous and sweat glands. LATERAL surface covered with pubic hair. Pudendal cleft – space between the labia majora PERINEUM – divided into 2 triangles by superficial and deep transverse perineal muscles Anterior urogenital triangle – contains external genitalia Posterior anal triangle – contains anal opening Clinical perineum – region between vagina and anus. The skin and muscle here can easily tear during childbirth.