Download Anatomy of the female perineum, reproductive organs

Anatomy of the female perineum,
reproductive organs
Dr.Munirah Batarfi
MD, MSc, & PhD
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Female Reproductive System
consists of:
an ovary on each
side; and a uterus,
vagina, and clitoris
in the midline .
In addition, a pair of
accessory glands
(the greater
vestibular glands)
are associated with
the tract.
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Uterus
3 inches long by 2 in. wide and 1 in. thick.
Parts:•
Fundus: the rounded part of the body that lies superior to the
attachments of the uterine tubes.
•
Body : the part of the uterus between the fundus and the cervix.
The vesical surface of the body of the uterus faces the
vesicouterine pouch and the intestinal surface faces the
rectouterine pouch.
The broad ligament is attached to the lateral surface of the body
of the uterus.
•
•
Isthmus : the narrowed portion of the body that is superior to
the cervix.
•
Cervix : the thick walled portion of the uterus that protrudes
into the vaginal canal.
Uterus. Anterior view. The anterior
half of the uterus and vagina have
been cut away.
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Normal position of the uterus
Normal position: Anteverted, Anteflexed:
Anteversion refers to the angle at the
external os being approximately 90
degrees, measured from the angle
between the vagina and the cervical canal.
Anteflexion refers to the angle at the
internal os being approximately 170
degrees, measured from the angle
between the uterine and cervical canal.
Uterus and vagina.
A. Angles of anteflexion and anteversion.
B. The cervix protrudes into the vagina.
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RVF: Retroversion, Retroflexion:•
Retroversion is the widening of the angle
between the vaginal and cervical axis
greater than 90 degrees. If the angle of
the external os increases and approaches
180 degrees, the uterus is in danger of fall
into the vaginal canal (prolapse).
Retroflexion is the widening of the angle
between the cervical and uterine axis
greater than 180 degrees.
The two angles are independent of each
other, and the uterus can possibly be
found in any combination of anteversion,
retroversion, anteflexion, or retroflexion.
Variants of uterine positions
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Blood Supply to the Uterus
Uterine artery: Br. of internal iliac Ar.; crosses over the ureter at the base of the
broad ligament (risk of injury at hystrectomy).
Ovarian artery: Br. from abdominal aorta.
Uterine vein---drains into internal iliac vein.
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Peritoneum in the pelvis & Broad ligament
•
a shallow vesico-uterine pouch occurs
anteriorly, between the bladder and
uterus, and a deep rectouterine pouch
(pouch of Douglas) occurs posteriorly,
between the uterus and rectum.
•
large fold of peritoneum (the board
ligament), with a uterine tube enclosed
in its superior margin and an ovary
attached posteriorly, is located on each
side of the uterus and extends to the
lateral pelvic walls.
Rectouterine pouch (Douglas pouch):•Most dependent (PV exam.),
•Accumulation of pus or blood,
•Perforation by misguided, non sterile instr.
(illegal abortion)---- pelvic peritonotis, may
be fatal.
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Broad Ligament of the Uterus
The broad ligament of the uterus is formed by two
layers of peritoneum that extend from the
lateral side of the uterus to the lateral pelvic
wall.
The broad ligament has three parts:
• Mesosalpinx: supports the uterine tube.
• Mesovarium: attaches the ovary to the posterior
aspect of the broad ligament
• Mesometrium: the part of the broad ligament
that is below the attachment of the
mesovarium.
At the base of the broad ligament, the uterine
artery crosses the ureter.
Contents of the broad ligament:• Uterine tube
• Uterine artery, lymph vessels& nerves.
• Ovarian artery
• Round ligament
• Ovarian ligament
• Embryonic remenants (epoophoron&
paroophoron).
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Parts of the broad ligament (Cont’d)
Uterus& Adnexa
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Pelvic fascia in women
(Ligaments supporting the uterus)
Condensations of fascia form ligaments that extend from the cervix to these pelvic walls. :
• anterior (pubocervical ligament),
•lateral (transverse cervical or cardinal ligament or Mackenrodt ligament), and
•posterior (uterosacral ligament).
These ligaments, together with the perineal membrane, the levator ani muscles, and the perineal body, are
thought to stabilize the uterus in the pelvic cavity.
•The most important of these ligaments are the transverse cervical or cardinal ligaments, which extend
laterally from each side of the cervix and vaginal vault to the related pelvic wall.
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Ovary
•
Pair of organs, size of 4x2 cm, found in upper pelvic region.
•
Ligaments supporting:Mesovarium:
attaches ovaries to broad ligament
Ovarian ligament:
anchors ovary to uterus
Suspensory ligament:
covers blood vessels to ovaries
Blood supply:
Ovarian artery& corresponding vein.
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Ovaries and broad ligament
• The mesovarium, a posterior extension
of the broad ligament, which attaches
to the ovary.
• The peritoneum of the mesovarium
becomes firmly attached to the ovary as
the surface epithelium of the ovary.
• The ovaries are positioned with their
long axis in the vertical plane. The
ovarian vessels, nerves, and lymphatics
enter the superior pole of the ovary
from a lateral position and are covered
by another raised fold of peritoneum,
which with the structures it contains
forms the suspensory ligament of ovary
(infundibulopelvic ligament).
(Ovarian ligaments)
• The inferior pole of the ovary is
attached to a fibromuscular band of
tissue (the ligament of ovary), which
courses medially in the margin of the
mesovarium to the uterus and then
continues anterolaterally as the round
ligament of uterus.
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Uterine tubes
•
Narrow, 4 inch tube extends from ovary to uterus.
Parts:-Fimbria are moving, finger-like processes
-Infundibulum is open, funnel-shaped portion near the ovary.
-Ampulla is central region of tube
-Isthmus is narrowest portion, joins with uterus.
Function:
transport of oocytes by ciliary action and peristalsis. Ampulla is the site of
fertilization.
Blood supply:
•
•
Uterine artery& corresponding vein
Ovarian artery & corresponding vein
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Vagina
-
It lies between the urinary bladder and
rectum.
- It measures about 3 inches long.
– Its orifice is partially closed with membrane
(hymen).
– The anterior wall of the vagina is related to
the base of the bladder and to the urethra;
Posteriorly, the vagina is related principally
to the rectum.
Vaginal fornices:
– Anterior
– Posterior
– 2 lateral fornices.
Supports:
Pelvic floor muscles, ligaments of the cervix &
perineal body.
Blood supply:
Vaginal artery& vaginal br. of uterine artery.
Vaginal vein---drains into Intern. Iliac vein
Vagina. A. Left half of pelvis cut away. B. Vaginal fornices and
cervix as viewed through a speculum.
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Branches of the anterior trunk of
the internal iliac artery in Female
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The greater vestibular glands (Bartholin's glands)
•
•
•
•
•
The greater vestibular glands (Bartholin's
glands) are small, pea-shaped mucous glands
that lie posterior to the bulbs of the vestibule on
each side of the vaginal opening and are the
female homologues of the bulbourethral glands
in men .
However, the bulbourethral glands are located
within the deep perineal pouch, whereas the
greater vestibular glands are in the superficial
perineal pouch.
The duct of each greater vestibular gland opens
into the vestibule of the perineum along the
posterolateral margin of the vaginal opening.
Like the bulbourethral glands in men, the
greater vestibular glands produce secretion
during sexual arousal.
The ducts of the para-urethral glands (Skene's
glands) open into the vestibule, one on each
side of the lateral margin of the urethra.
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Pudendal nerve In women
The pudendal nerve has three major terminal branches:
• Inferior rectal
• Perineal nerves
• Dorsal nerve of clitoris
which are accompanied by branches of the internal pudendal artery
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Female external genitalia
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Cervical Carcinoma
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Uterine Endometrial
Carcinoma
Endometrial carcinoma is the most
common malignancy of the female
reproductive tract. It often occurs
between the ages of 55 and 65 years,
and risk factors include the following:
● Obesity (increased estrogen synthesis
from fat cells without concomitant
progesterone synthesis)
● Estrogen replacement therapy without
concomitant progestin
● Breast or colon cancer
● Early menarche or late menopause
(prolonged estrogen stimulation)
● Chronic anovulation
● Diabetes
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Chronic Pelvic Inflammatory Disease
•
Recurrent or chronic
infections of the uterine
tubes or other adnexa
result in cystic dilation
(hydrosalpinx) and can
account for
approximately 40% of
female infertility.
•
The inflammation can
cause scarring, causing
problems with fertility,
pelvic pain, or tubal
(ectopic) pregnancy.
•
The most affected age
group is 15 to 25 years
of age.
•
Unilateral or bilateral
adnexal masses are
usually sausage shaped
and may be palpable.
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Ovarian Cancer
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Radiograph of a hysterosalpingogram,
demonstrating a uterine cavity with a
rounded filling defect on one side and
probable bilateral proximal tubal
occlusion (blockage).
Note the slightly brighter region of white
dye circumscribing the filling defect,
which is a characteristic of persistent
defects like fibroids or endometrial
polyps (rather than round air bubbles in
the radiopaque dye).
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References:
• Gray's Anatomy for Students- Second edition
• Netter’s Clinical Anatomy, Second edition
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