Transcript File

Female Internal Genital Organs
Pelvis & Perineum Unit
Lecture 4
‫ حيدر جليل األعسم‬.‫د‬
Anterior Pelvic Viscera in Female
Ureters
They cross over pelvic inlet in front of bifurcation of the common iliac
artery. It runs downward and backward
in front of internal iliac artery and
behind the ovary until it reaches
the region of ischial spine.
It then turns forward and
medially beneath base of
broad ligament, where it is
crossed by uterine artery.
Ureter then runs forward,
lateral to the lateral fornix
of vagina, to enter the bladder.
Urinary Bladder
Urinary bladder is situated immediately behind pubic bones. Because of
the absence of prostate, bladder lies at a lower level than in male pelvis.
Neck rests directly on upper surface of
urogenital diaphragm.
Apex of bladder lies behind
symphysis pubis.
Base, or posterior surface, is
separated by vagina from rectum.
Superior surface is related to
uterovesical pouch of peritoneum
and to body of uterus.
Inferolateral surfaces are related
in front to retropubic pad of fat
and the pubic bones. More
posteriorly, they lie in contact
with obturator internus muscle
above and levator ani muscle below.
Female internal Genital Organs
Ovary
Each ovary is oval shaped, measuring (4X2 cm), and is attached to back
of broad ligament by mesovarium.
That part of the broad ligament
extending between attachment
of mesovarium and lateral wall
of pelvis is called suspensory
ligament of ovary.
Round ligament of ovary connects
lateral margin of uterus to ovary.
Ovary usually lies against lateral
wall of pelvis in a depression
(ovarian fossa) bounded by external
iliac vessels above and by internal iliac
vessels behind. Position of ovary is,
however, extremely variable, and it is
often found hanging down in
rectouterine pouch (pouch of Douglas).
During pregnancy, enlarging uterus pulls
ovary up into abdominal cavity.
Female internal Genital Organs
Blood Supply of ovary:
Arteries: ovarian artery from abdominal aorta at level of 1st lumbar
vertebra.
Veins: ovarian vein drains into
inferior vena cava on right side
& into left renal vein on left side.
Lymph Drainage: follow ovarian
artery & drain into para-aortic
nodes at level of 1st lumbar vertebra.
Nerve Supply: from aortic plexus
and accompanies ovarian artery.
Blood supply, lymph drainage,
and nerve supply of the ovary pass
over pelvic inlet and cross external
iliac vessels to reach the ovary by
passing through lateral end of broad
ligament, part known as suspensory
ligament of ovary. Vessels and nerves
finally enter hilum of ovary via mesovarium.
Uterine Tube (Fallopian Tubes)
They are about 10 cm long and lie in upper border of broad ligament.
Each connects peritoneal cavity to uterine cavity & divided into 4 parts
Infundibulum: funnel-shaped lateral end that projects beyond broad
ligament and overlies ovary. Its free edge has several fingerlike
processes (fimbriae) which are draped over the ovary.
Ampulla: widest part of the tube.
Isthmus: narrowest part of the tube and lies just lateral to the uterus.
Intramural part: is the segment that pierces the uterine wall.
Arteries: uterine artery & ovarian artery from abdominal aorta.
Veins: uterine vein & ovarian vein.
Lymph Drainage: internal iliac
and para-aortic nodes.
Nerve Supply: Sympathetic
and parasympathetic nerves
from inferior hypogastric
plexuses.
Function: site of fertilization,
Transport & nutrition of
Fertilised ovum.
Uterus
It is a hollow, pear-shaped organ with thick muscular walls. In young
nulliparous adult, it measures (8 cm long, 5 cm wide and 2.5 cm thick).
Fundus is part of uterus that lies above entrance of uterine tubes.
Body is part of uterus that lies below entrance of uterine tubes.
Cervix is the narrow part of uterus. It pierces anterior wall of vagina and
is divided into supravaginal and vaginal parts of cervix.
Cavity of uterine body: is triangular
in coronal section, but it is merely a
cleft in sagittal plane.
Cavity of cervix (cervical canal):
communicates with cavity of body
through internal os and with that of
vagina through external os. Before
the birth of first child, external os is
circular. In a parous woman, vaginal
part of cervix is larger, and external os
becomes a transverse slit so that it
possesses an anterior & posterior lips.
Function: site for reception, retention,
and nutrition of the fertilized ovum.
Relations of uterus
Anteriorly: body of uterus is related anteriorly to uterovesical pouch &
superior surface of bladder. Vaginal cervix is related to anterior fornix of
vagina. Supravaginal cervix is related to superior surface of bladder.
Posteriorly: body of uterus is related
posteriorly to rectouterine pouch
(pouch of Douglas) with coils of ileum
or sigmoid colon within it.
Laterally: body of uterus is related
laterally to broad ligament & uterine
artery and vein. Supravaginal cervix
is related to ureter as it passes
forward to enter bladder. Vaginal
cervix is related to lateral fornix of
vagina.
Uterine tubes enter superolateral
angles of uterus, and round ligaments
of ovary and of uterus are attached
to uterine wall just below this level.
Positions of Uterus
In most women, long axis of uterus is bent forward on long axis of
vagina (anteversion of uterus). Also, Long axis of body of uterus is bent
forward at level of internal os with long axis of cervix (anteflexion of
uterus). Thus, in erect position and with bladder empty, uterus lies in an
almost horizontal plane.
In some women, fundus and body of
uterus are bent backward on vagina so
that they lie in rectouterine pouch
(pouch of Douglas). Uterus is therefore
retroverted. If body of the uterus is,
in addition, bent backward on cervix,
it is also retroflexed.
Structure of Uterus
Uterus is covered with peritoneum except anteriorly, below level of
internal os, where peritoneum passes forward onto bladder. Laterally,
there is also a space between attachment of layers of broad ligament.
Muscular wall (myometrium) is thick and made up of smooth muscle
supported by connective tissue.
Mucous membrane (endometrium) is continuous above with mucous
membrane lining uterine tubes and
below with mucous membrane of
cervix. Endometrium is applied
directly to muscle with no submucosa.
Parametrium is visceral pelvic fascia
surrounding supravaginal part of cervix
and in which uterine artery crosses
ureter on each side of the cervix.
Uterus
Arterial Blood Supply: mainly uterine artery & partially ovarian artery.
Arteries: Uterine artery: is a branch of internal iliac artery. It reaches
uterus by running medially in base of broad ligament. It crosses above
ureter at right angles and reaches cervix at level of internal os. Then it
ascends along lateral margin of uterus within broad ligament and ends
by anastomosing with ovarian artery.
Ovarian Artery: assists in supplying uterus & gives off small descending
branch to cervix and vagina.
Veins: Uterine vein follows
artery into internal iliac vein.
Lymph Drainage:
Lymph vessels from fundus:
accompany ovarian artery and
drain into para-aortic nodes.
Vessels from body & cervix: into
internal & external iliac lymph nodes.
Few vessels follow round ligament
of uterus into superficial inguinal LNs
Nerve Supply: (Sympathetic and
Parasympathetic) inferior hypogastric plexuses.
Supports of Uterus
Uterus is supported mainly by tone of levatores ani muscles and
condensations of pelvic fascia which form three important ligaments.
A. Levatores Ani Muscles and the Perineal Body:
perineal body is important in maintaining integrity of pelvic floor; if
damaged during childbirth, prolapse of pelvic viscera may occur.
Perineal body lies in perineum between vagina and anal canal. It is slung
up to pelvis by levatores ani & supports vagina and, indirectly, uterus.
Supports of Uterus
B. Pelvic fascia: (Transverse Cervical, Pubocervical & Sacrocervical Lig.)
They are subperitoneal condensations of pelvic fascia on upper surface
of levatores ani muscle. They are attached
to cervix and vault of vagina and play an
important part in supporting uterus &
keeping cervix in its correct position.
Transverse Cervical Ligaments:
(Cardinal) pass to cervix and upper end
of vagina from lateral walls of pelvis.
Pubocervical Ligaments: consist of two
firm bands of connective tissue that pass
to cervix from posterior surface of pubis &
positioned on either side of bladder neck.
Sacrocervical Ligaments: two firm
fibromuscular bands of pelvic fascia that
pass to cervix and upper end of vagina
from lower end of sacrum. They form two
ridges, one on either side of rectouterine
pouch (pouch of Douglas).
Supports of Uterus
Broad ligaments of uterus are drap-like folds of peritoneum around the
uterine tubes. Its upper border is related to uterine tubes and lower
border is related to uterine artery.
Round ligament of uterus extends between superolateral angle of
uterus, through deep inguinal ring and inguinal canal, to subcutaneous
tissue of labium majus. It helps keep uterus anteverted (tilted forward)
and anteflexed (bent forward) but is considerably stretched during
pregnancy.
Broad & round ligaments
of uterus are lax structures,
and uterus can be pulled
up or pushed down for a
considerable distance before
they become taut. So, they play
a minor role in supporting uterus.
Vagina
It is a muscular tube that extends upward and backward from vulva to
uterus. It measures about 8 cm long and has anterior & posterior walls,
which are normally in apposition. At its upper end, anterior wall is
pierced by cervix, which projects downward and backward into vagina.
Upper half of vagina lies above pelvic floor and lower half lies within
perineum. Vaginal lumen, which surrounds cervix, is divided into four
fornices: anterior, posterior, right lateral, & left lateral. Vaginal orifice in
a virgin possesses a thin mucosal fold Hymen perforated at its center.
Relations of Vagina
Anteriorly: bladder above and to urethra below.
Posteriorly: upper 1/3 of vagina is related to rectouterine pouch (pouch
of Douglas), middle 1/3 to ampulla of rectum & Lower 1/3 is related to
perineal body (separates it from anal canal)
Laterally: In its upper part, it is related
to ureter; its middle part is related to
anterior fibers of levator ani, as they
run backward to reach perineal body
and hook around anorectal junction
(sphincter vaginae). Contraction of
fibers of levator ani compresses
walls of vagina together. In its
lower part, vagina is related to
urogenital diaphragm and bulb
of vestibule.
Functions:
• female genital canal
• excretory duct for menstrual blood
• forms part of birth canal
Vagina
Blood Supply:
Arteries: vaginal artery, a branch of internal iliac artery, and vaginal
branch of uterine artery supply vagina.
Veins: vaginal veins form a plexus around vagina that drains into internal
iliac vein.
Lymph Drainage: upper third of vagina drains to external and internal
iliac nodes, middle third drains to internal iliac nodes, and lower third
drains to superficial
inguinal nodes.
Nerve Supply:
inferior hypogastric plexuses.
Supports of the Vagina:
Upper part of vagina is supported
by levatores ani muscles and
transverse cervical, pubocervical,
and sacrocervical ligaments.
Middle part of vagina is supported
by urogenital diaphragm.
Lower part of vagina, especially
posterior wall, is supported by perineal body.
Pelvic Peritoneum in Females
Peritoneum passes down from anterior abdominal wall onto upper
surface of urinary bladder. It then runs directly onto anterior surface of
uterus, at level of internal os. Peritoneum now passes upward over
anterior surface of body and fundus of
uterus and then downward over
posterior surface. It continues
downward and covers upper
part of posterior surface of vagina,
where it forms anterior wall of
rectouterine pouch (pouch of Douglas).
Peritoneum then passes onto
front of rectum, as in the male.
In the female, the lowest part of
abdominopelvic peritoneal cavity
in erect position is rectouterine pouch
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