Transcript 1.The interstitial portion

Female reproductive anatomy
Dr Hiba Ahmed Suhail
M.B. Ch. B./F.I.B.O.G.
College of medicine
University of Mosul
External genitalia
The vulva
The female external genitalia ( the vulva )
includes :
1- the mons pubis.
2- the labia majora.
3- the labia minora.
3- the vestibule,and the vestibular orifice.
4- the clitoris.
5- the greater vestibular gland.
1-The mons pubis
Is composed of fibrofatty tissue, which covers
the body of the pubic bones. Inferiorly it divides
to become continuous with the labium majus .
2-The labia majora
Are two folds of skin with underlying adipose
tissue bounding either side of the vaginal
opening . They contain sebaceous and sweat
glands and a few specialized apocrine glands.
3-The labia minora
Are two thin folds of skin that lie between the
labia majora . Anteriorly they divide into two to
form the prepuce and frenulum of the clitoris.
Posteriorly they fuse to form a fold of skin
called the fourchette . They contain sebaceous
glands . They are not well developed before
puberty, and atrophy after the menopause.
4-The clitoris
Is 1cm length.
5-The vestibule
Is the cleft between the labia minora.
The urethra , the ducts of the Bartholin's glands and the
vagina open in the vestibule . The vestibular bulbs are
two oblong masses of tissue that lie on either side of the
vaginal entrance.They contain a rich plexus of veins.
6-Bartholin's glands
Each about the size of a small pea , lie at the base
of each bulb and open via a 2 cm duct into the vestibule
between the hymen and the labia minora . These are
mucus-secreting glands sometimes the ducts of this
gland obstruct leading to Bartholin cyst and if infection
develop Bartholin abscess is formed.
7- Vaginal orifice:
Is surrounded by the hymen which is a thin fold of
mucous membrane . There are openings in it to allow
menses to flow.
The perineal body:
Is a perineal mass of muscular tissue that lies between
the anal canal and the lower third of the vagina . Its apex is
at the lower end of the rectovaginal septum and its base is
covered with skin and extends from the fourchette to the
anus.
The urethral orifice:
Is immediately anterior to the vaginal orifice , beneath
the clitoris . It about 4 cm in length The skene ( Para
urethral ) gland duct presents an opening on its
posterior surface.
The internal reproductive organs
1234-
The vagina
The uterus
The fallopian tube
The ovaries
1-The vagina
 Is a fibromuscular canal that leads from the uterus to
the vulva . It is longer in the posterior wall ( around 9
cm ) than anteriorly(approximately 7cm). The vaginal
walls are normally in apposition , except at the vault,
where they are separated by the cervix.
 The vault of the vagina is divided into four fornices
1-anterior fornix
2-posterior fornix
3-right and left lateral fornix
 It lined with stratified squameous epithelium contain
no glands vaginal walls are characterized by a lot of
transverse folds ( rugeose ) allowing it to distend
during the process of labour .
 The vagina is kept moist by secretions from the
uterine and cervical glands and by some
transudation from its epithelial lining.
 The epithelium is thick and rich in glycogen , the
growth of Doderlein's bacillus a normal commensal
of the vagina that breaks down the glycogen to form
lactic acid , producing a pH of around 4.5 . This has
a protective role for the vagina against pathogens.
Age changes
At birth the vagina is under the influence of
maternal oestrogens , so the epithelium is well
developed . After a couple of weeks, the effects
of the oestrogens disappear and the pH rises to
7 and the epithelium atrophies.
At puberty the reverse occurs.
At the menopause the vagina tends to shrink
and the epithelium atrophies.
Anatomical relations
-Posterior the upper vaginal wall is covered by the
peritoneal reflection of the pouch of Douglas . The
middle posterior third is separated from the rectum by
pelvic fascia and the lower third by the perineal body.
-Anteriorly, the lip of the vagina is in direct contact with
the base of the bladder ; the urethra runs down the
lower half in the midline to open to the vestibule.
-Laterally , at the fornices , the vagina is related to the
Cardinal ligaments and the uterosacral ligaments ,
which support the upper part of the vagina .
2-uterus
 The uterus is a fibromuscular organ shaped like an
inverted pear , tapering inferiorly to the cervix, and in
the non-pregnant state is situated entirely within the
pelvis.
 It is hollow organ and has thick muscular walls.
 Its maximum external dimensions are approximately
7.5 cm long,5cm wide and 3 cm thick.
 An adult uterus weighs about 70 g.
 It consists of :
1-the corpus (body)
3-the cervix
The corpus
 It is the upper part of the uterus it consist of the
1- Cornu which is the site of insertion of the Fallopian tube.
2- The fundus which is the part of the body above the cornu .
3- The isthmus when uterus tapers to a small central constricted area,
end s by attaching to the cervix.
 The cavity of the uterus is the shape of an inverted triangle and,when
sectioned coronaly, the Fallopian tubes open at the lateral angles.
 The constriction at the isthmus where the corpus joins the cervix is
the anatomical internal os.
 Uterus is in anteflexion and anteversion position.
 The longitudinal axis of the uterus is, approximately,at right-angles to
the vagina and normally tilts forwards is called anteversion.
 The uterus is usually flexed forwards on itself at the isthmus is called
anteflexion.
The uterus consists of three layers:
1- The outer serous layer (peritoneum) it covers the body of
the uterus anteriorly and posteriorly, laterally it spreads out
to form the leaves of the broad ligament.
2-The middle muscular layer ( myometrium ) forms the main
bulk of the uterus and comprises interlacing smooth muscle
fibers externally these are mostly longitudinal, but the larger
intermediate layer has interlacing longitudinal , oblique and
transverse fibers.
3- The inner mucous layer ( endometrium ) . The inner
endometrial layer has tubular glands that dip into the
myometrium and covered by a single layer of columnar
epithelium . ciliated prior to puberty , this epithelium is
undergo cyclical changes and lost due to the effects of
pregnancy and menstruation.
The cervix:
 Is narrower than the body of the uterus approximately 2.5-3cm in
length.
 It consists of two parts:
-Supravaginal part: lies in continuation with isthmus, lined with columnar
epithelium. The ureter run about 1cm laterally.
-Vaginal part: protruding into the vagina, lined with stratified sequamous
epithelium.
 The upper part of the cervix mostly consist of involuntary muscles,
whereas the lower part is mainly fibrous connective tissue.
 The sequamocolummar junction is also known as the transformation
zone is an area of rapid cell division therefore is the common site of
cervical carcinoma (90%).
 The beginning and the end of the endocevical canal are called the
anatomical internal and external os respectively.
 The epithelium of the endocervix is cylindrical and also ciliated in its
upper 2/3 and change to stratified sequamous epithelium in the
region of the external os.
Age changes
After birth the disappearance of maternal oestrogens
causes the uterus to decrease in length by around
one third and cervix is then twice the length of the
uterus.
At puberty, the corpus grows much faster and the size
ratio reverses.
After menopause , the uterus atrophies , the mucosa
becomes very thin , the glands almost disappear and
the wall becomes less muscular.
The Fallopian tubes (oviducts)
Each tube is about 10 cm long and extends outwards
from the uterine cornu to end near the ovary.
 At the abdominal ostium , the tube opens into the
peritoneal cavity, which is therefore in communication
with the exterior of the body via the uterus and the
vagina.
 The it convey the ovum from the ovary towards the
uterus, and it is the site of fertilization which provides
oxygenation and nutrition for sperm , ovum and
zygote.
 It is distinguished in to 4 parts
1.The interstitial portion Interstitial portion: lies within
the wall of the uterus.
2.The isthmus : is the narrow portion adjoining the
uterus.
3.Ampulla: is the widest and longest portion.
4.The infundibulum: it terminates the tube , it is the
funnel shaped opening of the tube in to the peritoneal
cavity and is surrounded by finger like processes,
called fimbriae.
 Margin of
the broad ligament known as the
mesosalpinx , encloses it so that the tube is covered
with peritoneum except in its inferior end .
 The muscle fibres of the wall of the tube are arranged
in an inner circular and an outer longitudinal layer.
 The epithelium of the Fallopian tubes contains two
functioning cell types : the ciliated and the secretory
cells.
 Changes occur under the influence of the menstrual
cycle , but there is no cell shedding during
menstruation.
The ovaries
In the young adult they are almond shaped , solid , a
greyish pink and approximately 3 cm long ,1.5cm wide and
1cm thick.
 The ovary has a central vascular medulla and an outer
thicker cortex.
 The size and appearance of the ovaries depend on both
age and the stage of the menstrual cycle.
 The ovary is the only intra-abdominal structure not to be
covered by peritoneum.
 The ligaments of the ovaries:
1-the ovarian ligaments.
2-the suspensory ligaments.
 The mesovarian carry the blood supply to the ovary.
Age change.
 In the child , the ovaries are small structures , l.5 cm
long. They have a smooth surface and at birth contain
between 1 and 2 million primordial follicles.
 At puberty the ovaries increase to adult size in the
months preceding puberty. as a result of proliferation
of the stromal cells and the commencing maturation
of the ovarian follicles.
 After the menopause , no active follicles are present
and the ovary becomes a small , shrunken structure
with a wrinkled surface.
The blood supply:
 The vulva:pudendal artery (internal iliac artery).
 The pelvic viscera: continuous arterial anastomosis
connects the ovarian artery (from the aorta),uterine
and vaginal arteries ( branches of internal iliac
artery ) on the lateral border of the tubes , ovaries,
uterus and vagina.
The lymphatic drainage:
 Vulva , lower 1/3 of vagina → superficial inguinal and
femoral LN.
 Uterus , cervix , upper 2/3 of vagina → internal iliac ,
obturator and external iliac LN, common iliac and
Para aortic LN.
 Few vessels at the fundus → follow the ovarian
channels and
 some along the round ligament to the inguinal nodes.
 Ovaries and fallopian tubes→ para aortic LN nodes.
The nerve supply of pelvis:
 Nerve supply of vulva and perineum.
 Pudendal nerve ( S 2, 3, 4 ) divide into perineal n . Supply the
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vulva. The dorsal n. of the clitoris (sensory).
Sensory fibers from the mons and labia also pass in the
ilioinguinal and genitofemoral n. to the 1st lumber n.
Posteriofemoral cutaneous n. carries sensation from perineum
to the S1, 2, 3.
Nerve supply of the pelvic viscera.
Sympathetic nerve fibres of the pre aortic plexus are continuous
with those of the superior hypogastric plexus which divides , on
each side its fibres continuous with the uterovaginal plexus.
Parasympathetic fibres from S2 ,S3 ,S4 join the uterovaginal
plexus . Fibres from (or to) the bladder, uterus, vagina & rectum
join the plexus.