Transcript 37-FEMALE REPRODUCTIVE SYSTEM

PROSTATIC EXAMINATION
The prostate can be 
examined by a rectal
examination (P.R).
The examiner’s 
gloved finger can feel
the posterior surface
of the prostate
through the anterior
wall of the rectum.
REPRODUCTIVE TRACT
It is contained 
mainly in the
pelvic cavity and
perineum.
It consists of : 
An ovary on each 
side.
A uterus, vagina 
and clitoris in the
midline.
REPRODUCTIVE TRACT
A pair of accessory
glands (greater
vestibular glands).
During pregnancy,
the uterus expands
into the abdomen.


OVARY
It is almond in shape. 
It lies against the 
lateral pelvic wall in a
depression (ovarian
fossa).
It is bounded 
Above : the external 
iliac vessels.
Behind : the internal 
iliac vessels and the
ureter.
LOCATION
It lies in the back
of the broad
ligament.
It is attached to
it by the
mesovarium.


POSITION OF THE OVARY
The ovary is kept
in position by:
Broad ligament. 
Mesovarium. 
Laxation of the 
broad ligaments
after pregnancy
cause prolapse
of the ovaries in
the rectouterine
pouch.

POSITION OF THE OVARY
This causes: 
Tenderness of
the ovaries and
Deyspareunia
(discomfort
during sexual
intercourse).
LIGAMENTS
(1) Suspensory 
ligament of the
ovary:
It is the part of 
the broad
ligament
between the
mesovarium and
the lateral pelvic
wall.
LIGAMENTS
(2) Round ligament
of the ovary :
It connects the 
ovary to the lateral
margin of the
uterus.
It represents the 
remains of the
upper part of the
gubernaculum

BLOOD SUPPLY
Arterial : 
Ovarian artery 
from abdominal
aorta (at L1).
Venous drainage:
Right vein to 
IVC.
Left vein to left 
renal vein.

HOW THEY ENTER THE OVARY?
The ovarian 
vessels,
lymphatics and
nerve supply
cross the
external iliac
vessels at the
pelvic brim.
HOW THEY ENTER THE OVARY?
They pass through
the suspensory
ligament of the
ovary.
They enter the 
hilum of the ovary
through the
mesovarium.

UTERINE TUBE
It is (10) cm. 
It lies in the 
upper part of the
broad ligament.
It connects the 
peritoneal cavity
at the region of
the pelvis with
that of the
uterus.
UTERINE TUBE
It is enclosed within
portion of the broad
ligament
(Mesosalpinx).

PARTS
It is divided into 
(4) parts:
1. Infundibulum: 
It is the lateral 
part.
It curves around 
the supero-lateral
margin of the
related ovary.
PARTS
Its margin has 
several finger like
projections
(Fimbriae).
The uterine tube 
opens into the
peritoneal cavity at
the narrowest end
of the
infundibulum.
PARTS
2. Ampulla : 
It is the widest
part where
fertilization can
take place.
3. Isthmus: 
Narrowest part
of the tube, just
lateral to the
uterus.


PARTS
4. Intramural : 
The part that pierces the
uterine wall.
The uterine tube serves:
(1) A channel through 
which the spermatozoa
can pass to reach the
ovum.
(2) It gives nourishment
to the fertilized ovum.
(3) It transports the 
fertilized ovum to the
uterine cavity.



TUBAL LIGATION
It is performed in 
women who already
have children to
obtain a birth control.
Ova degenerate in the
tube proximal to the
obstruction.
Restoration of the 
continuity of the tube
can be performed by
taking of the clip.

SALPINGITIS
The infecting 
organisms enter the
uterus and uterine
tube through sexual
intercourse (or after
labor).
Salpingitis and 
accumulation of pus
into the peritoneal
cavity (pelvic
peritonitis) later
general peritonitis.
BLOOD SUPPLY
Arterial : 
Uterine (internal
iliac).
Ovarian 
(abdominal
aorta).
Venous : 
correspond to
arteries.

UTERUS
It is a thick walled 
muscular organ.
It is pear shaped. 
It lies in the midline
between the bladder
and rectum.
In the nulliparous 
young adult :
(8cm) long. 
(5cm) wide. 
(2.5 cm) thick. 

PARTS
(1) Fundus : 
It is the round 
superior part
above the entery
of the uterine
tubes.
(2) Body : 
It is flattened 
anteroposteriorly.
PARTS
When viewed
laterally :
The cavity is a
narrow slit.


PARTS
When viewed 
anteriorly:
The cavity is shaped
like an inverted
triangle.
Each of the superior
corners of the cavity
is continuous with
the lumen of the
uterine tube.


PARTS
The inferior 
corner is
continuous with
the central canal
of the cervix.
PARTS
(3) Cervix : 
It is the part that
pierces the
anterior wall of
the vagina.
It is divided into
two parts :
Supravaginal. 
Vaginal. 


PARTS
Internal os : 
Site of 
communication
between the cervical
canal and the cavity
of the body.
External os : 
Site of 
communication
between the cervical
canal and vagina.
EXTERNAL OS
Before birth of the
first child :
Circular in shape. 
Parous women : 
Transverse with an
anterior and a
posterior lip.


RELATIONS (ANTERIOR)
The body: 
Uterovesical pouch. 
Superior surface of the
bladder.
Supravaginal cervix: 
Superior surface of the
bladder.
Vaginal cervix: 
Anterior fornix of the 
vagina.


RELATIONS (POSTERIOR)
Body : 
Rectouterine 
pouch (pouch of
Douglas) with
coils of ileum
and sigmoid
colon.
RELATIONS (LATERAL)
Body : 
Broad ligament. 
Uterine vessels. 
Supravaginal cervix:
Ureter. 
Vaginal cervix: 
Lateral fornix of 
vagina.

POSITION OF UTERUS
Anteversion : 
The uterus is bent 
forward.
The long axis of the
body is bent on the
long axis of the
vagina.

POSITION OF UTERUS
Anteflexion: 
At the level of internal
os, the long axis of
the body bents
forward with the long
axis of the cervix.
In the erect position :
With the bladder 
empty, the uterus lies
in a horizontal plane.


POSITION OF UTERUS
Retroverted : 
The fundus and body
of the uterus are
bent backwards on
the vagina.
They lie in the 
rectouterine pouch.
Retroflexed : 
The body bent 
backwards on the
cervix.

UTERINE ARTERY
It runs in the 
base of the broad
ligament.
It crosses 
superior to the
ureter.
It reaches the 
cervix at the
internal os.
UTERINE ARTERY
It ascends within 
the broad ligament
along the lateral
margin of the
uterus.
It terminates by 
anastomosing with
the ovarian artery.
UTERINE ARTERY
It supplies : 
Uterus. 
Uterine tubes.
Vagina. 

NERVE SUPPLY
From inferior 
hypogastric
plexus
(sympathetic &
parasympathetic
LYMPH DRAINAGE
1. Fundus : with the 
ovarian artery to paraaortic nodes.
2. Body & cervix : to 
internal & external
iliac nodes.
3. Vessels accompany
the round ligament to:
Superficial inguinal 
nodes.

SUPPORTS OF THE UTERUS
The uterus is supported 
mainly by:
(1) Tone of the levator 
ani muscles :
Together with the 
pelvic fascia on their
upper surface they are
effectively support the
uterus.
Their medial ends are 
attached to the cervix
through the pelvic
fascia.
PERINEAL BODY
It is a 
fibromuscular
structure.
It is situated in 
the perineum.
between the
vagina and anal
canal.
It receives the 
insertion of the
anterior fibers of
the levator ani.
PERINEAL BODY
It is elevated up 
to the pelvic
walls.
by the levator 
ani.
It supports the 
vagina and
indirectly the
uterus.
PERINEAL BODY
It is important in
maintaining the
integrity of the
pelvic floor.
Its damage 
during child birth
can cause
prolapse of the
pelvic viscera.

SUPPORTS OF THE UTERUS
(2) Ligaments: 
They are sub 
peritoneal fibromuscular
condensation of the
pelvic fascia on the
upper surface of the
levator ani muscles.
They are attached to 
the cervix and vagina
.They are important
in keeping the cervix
in its normal position.
LIGAMENTS
(1) Transverse 
cervical (cardinal)
ligaments:
They connect the 
lateral pelvic walls
to the cervix and
upper end of the
vagina.
They contain the 
ureter and uterine
artery.
PUBOCERVICAL LIGAMENTS
They are two firm 
bands of connective
tissue.
They connect the 
posterior surface of
the pubis to the
cervix.
They give support to
the neck of the
bladder
(pubovesical)
ligaments.

UTEROSACRAL LIGAMENTS
They are two 
firm bands
connecting the
lower end of the
sacrum to the
cervix and upper
end of the
vagina.
They form two 
ridges on either
side of the
rectouterine
pouch.
ROUND LIGAMENT OF UTERUS
It extends between
the superolateral
angle of the uterus
and the
subcutaneous tissue
of the labia majora.
It helps to maintain
the ante verted,
ante flexed position
of the uterus.


VAGINA
It is a distensible 
fibromuscular tube
(8cm).
It is the female 
genital canal.
It is the excretory 
duct for the
menstrual blood.
It is part of the birth
canal.

VAGINA
It extends from 
the perineum
(lower part)
through the
pelvic floor and
up into the pelvic
cavity (upper
part).
VAGINA
It has anterior 
and posterior
walls which are
normally in
position.
The cervix 
pierces the upper
end of the
anterior wall.
VAGINAL FORNICES
The area of the 
vaginal lumen
surrounding the
cervix is divided
into four regions
(fornices):
Anterior. 
Posterior. 
Lateral (right and
left).

HYMEN
It is a thin mucosal 
fold which covers
the external vaginal 
orifice in virgins.
It is perforated at its 
center .
After child birth, it 
consists of tags.
RELATIONS
Anterior: 
Bladder. 
Urethra. 
Posterior : 
Upper 1/3: 
rectouterine pouch.
Middle 1/3 : ampulla
of rectum.
Lower 1/3: perineal
body.


RELATIONS
Lateral: 
Upper part :ureter. 
Middle part: anterior
fibers of levator ani
(sphincter vaginae).
Lower part : 
urogenital
diaphragm.

BLOOD SUPPLY
Arterial: 
Vaginal artery 
from:
Internal iliac. 
Uterine. 
Venous : 
Vaginal plexus . 
It drains into the
internal iliac vein.

LYMPH DRAINAGE
Upper 1/3: to 
external &
internal iliac
lymph nodes.
Middle 1/3: to 
internal iliac
nodes.
Lower 1/3: to 
superficial
inguinal nodes.
SUPPORTS
Upper part: 
Levator ani muscles. 
Transverse cervical,
Pubocervical and
Sacrocervical
ligaments.
Middle part: urogenital
diaphragm.
Lower part : perineal 
body.

BROAD LIGAMENTS
They are double fold layers
of peritoneum extending
between the lateral
margins of the uterus and
the lateral pelvic walls.
Superiorly : the two layers
are continuous and form
the upper free edge.
Inferiorly (base) : they 
separate to cover the
pelvic floor. The uterine
artery crosses the ureter.


PARTS
Mesovarium. 
Suspensory 
ligament of the
ovary.
Mesosalpinx: 
Between the
uterine tube and
the mesovarium.
CONTENTS
1. Uterine tube (upper
free border).
2. Ligaments : ovarian
& round ligament of
uterus.
3. Vessels (blood

and lymphatic):
uterine & ovarian.
4. Nerves. 


CONTENTS
5. Epoophoron : 
It is a vestigial 
structure
representing the
remains of the
mesonephros.
It lies above the 
mesovarium.
CONTENTS
6. Paroophoron: 
It is a 
mesonephric
remnant.
It lies just lateral
to the uterus.
