FEMALE REPRODUCTIVE ANATOMY

EXTERNAL GENITALIA

The VULVA includes:- Mons pubis- Labia majora- Labia minora- Hymen- Clitoris- Vestibule- Urethra- Skene’s glands- Bartholin’s glands- Perineum

MONS PUBIS- a triangular mound of fatty tissue that covers the pubic bone- it protects the pubic symphysis- becomes hairy during puberty (escutcheon)

- hair varies in coarseness curliness, amount, color and thickness- inverted triangle hair pattern in most women

LABIA MAJORA- a pair of large, longitudinal, cutaneous folds of adipose and fibrous tissue- protect the introitus and urethral openings- outer convex surface is pigmented and covered with hair follicles- inner surface has many sebaceous glands and does not have hair follicles- become flaccid with age and after childbirth- homologous to the scrotum

LABIA MINORA- made up of erectile, connective tissue that darkens and swells during sexual arousal- anteriorly, divide to form the prepuce and the frenulum of the clitoris- has many sebaceous glands but no hair follicles or sweat glands- homologous to the penile urethra

HYMEN- a thin, perforated membrane at the entrance of the vagina- remnant of which s termed carunculae myrtiformes

CLITORIS- highly sensitive organ composed of nerves, blood vessels, and erectile tissue- 1.5 to 2 cm in length; < 1 cm in diameter- made up of a shaft and a glans- becomes engorged with blood during sexual stimulation- key to sexual pleasure for most women- homologue to the penis in the male.

VESTIBULE- extends from the clitoris to the posterior fourchette- vaginal opening or introitus- lowest portion of the embryonic urogenital sinus

VESTIBULAR BULBS - 2 elongated masses of erectile tissue on either side of the vaginal orifice- homologous to the bulb of the penis in the male.

URETHRA- a membranous conduit for urine from the urinary bladder- 3.5 to 5 cm in length- mucosal edges grossly appear everted.

SKENE’S GLANDS- paraurethral glands-branched, tubular glands adjacent to the distal urethra- homologous to the prostate in the male

BARTHOLIN’S GLANDS- lobulated racemose gland located at 4 and 8 o’clock position- homologous to the Cowper’s glands in the male

PERINEUM- the muscle and tissue located between the vaginal opening and anal canal- supports and surrounds the lower parts of the urinary and digestive tracts- contains an abundance of nerve endings that make it sensitive to touch- site of episiotomyPELVIC DIAPHRAGM- a wide but thin muscular layer of tissue that forms the inferior border of the abdominopelvic cavity- extends from the symphysis pubis to the coccyx and from one lateral sidewall to the other

Muscles of the Pelvic Diaphragm1. Levator ani

a. Pubococcygeusb. Puborectalisc. Iliococcygeus

2. Coccygeus

UROGENITAL DIAPHRAGM- a strong muscular membrane that occupies the area between the symphysis pubis and ischial tuberosities- external and inferior to the pelvic diaphragm- major function: support of the urethra and maintenance of the urethrovesical junction

INTERNAL GENITALIAThe internal genitalia consists of the:- Vagina- Cervix- Uterus- Fallopian Tubes- Ovaries

VAGINA- thin-walled distensible, fibromuscular tube that connects the cervix to the external genitalia- it functions:

- as a passageway for the menstrual flow- as the birth canal during labor- for copulation

Levator ani muscles and lower portion of cardinal ligaments

Rugae – provide distensibility - more prominent on the lower 1/3

Anterior vaginal length = 6 to 9 cmPosterior vaginal length = 8 to 12 cm

CERVIX- consist predominantly of fibrous tissue

- (15% smooth muscle)- around its middle portion attaches the vagina - divisions:

- upper segment- supravaginal portion - covered anteriorly by the parametrium - covered posteriorly by the peritoneum

- lowest segment (portio vaginalis)

Endocervical canal = 2.5 to 3 cm in length = 7 to 8 mm in diameter

UTERUS- a pear shaped, thick-walled, hollow, muscular organ about the size of a clenched fist

Nulliparous:8 cm long5 cm wide2.5 cm thick40 to 50 g

Multiparous8 + 1.2 cm long5 + 1.2 cm wide2.5 + 1.2 cm thick40 to 50 + 20 to 30 g

1. Broad Ligament - double reflection of peritoneum

2. Round Ligaments- fibrous tissue and muscle fibers

3. Cardinal Ligaments(Mackenrodt’s ligaments)- form the base of the broad ligament- maintain anatomic postion of the cervix and upper part of vagina- provide the major support of the uterus and cervix

4. Uterosacral Ligaments

FALLOPIAN TUBES- referred to as the oviducts or uterine tubes- serve as a pathway for the ovum to the uterus- site of fertilization by the male sperm- its smooth muscle is arranged into inner circular and outer longitudinal layers

Distal opening = 3 mmProximal opening = 1.5 mmLength = 10 to 14 cmDiameter = < 1 cm

Anatomical sections:1. Interstitial (intramural)- 1 to 2 cm in length

2. Isthmic- 4 cm in length- 1 to 2 mm in diameter (most narrow)- most muscular; straight

3. Ampullary - 4 to 6 cm in length- 6 mm in diameter (widest)- most tortuous- site if fertilization

4. Infundibulum - surrounded by 20 to 25 fimbrae at its distal end

OVARIES- has the size and configuration of an almond - light gray in color- pitted and indented from previous ovulations- contains 1 to 2 million oocytes at birth- during a lifetime releases 300 to 500 fully matured eggs for fertilization, i ovum/month

Weighs 3 to 6 gramsSize = 1.4 x 2.5 x 4 cm

1. Mesovarium2. Ovarian ligament3. Infundibular pelvic ligament or suspensory ligament

BLOOD SUPPLY, INNERVATION, AND LYMPH DRAINAGE OF FEMALE GENITAL SYSTEM

0VARIAN ARTERY – from aorta descends in the suspensory ligament of the ovary to broad ligament, sending branches to ovary and uterine tube. Anastomoses with uterine artery.

OVARIAN VEIN – pampiniform plexus to ovarian vein, which travels with the ovarian artery to terminate on the right in the vena cava, on the left in the renal vein

BLOOD SUPPLY – uterine tube

ARTERY – same to that of the ovaryVEIN – similar to that of the ovary, with some flow to uterine plexus

BLOOD SUPPLY – uterus

UTERINE ARTERY – from anterior division of internal iliac, crosses ureter to reach side of uterus through broad ligament, where it ascends to level of uterine tube.Supplies cervix, upper vagina, body of uterus, uterine tube, and round ligament.

UTERINE VEIN – from uterine plexus on the sides and superior angles of uterus.Communicates with vaginal plexus but is drained chiefly by uterine veins, which end in internal iliac veins

BLOOD SUPPLY – vagina

VAGINAL ARTERY – from internal iliac. Sends branches to uterus and joins branches from uterine artery to form the azygos artery of the vagina

VAGINAL VEIN – from vaginal plexus, which has communications with vesical, rectal, and uterine plexuses, through vaginal vein to internal iliac vein.

LYMPHATIC DRAINAGE

OVARY – vessels following ovarian artery to enter lateral and preaortic nodes

UTERINE TUBES – follows ovarian and uterine drainage

UTERUS – body and fundus mostly follow ovarian drainage to lateral and preaortic nodes, some to external iliac and superficial inguinal nodes

CERVIX – to external, internal, and common iliac nodesVAGINA – upper, middle, and lower portions drain to external, internal, and common iliac nodes, vulvar drainage ends in superficial inguinal nodes.

INNERVATION

OVARY – receives fibers from hypogastric and ovarian plexuses

UTERINE TUBE – fibers from hypogastric and ovarian plexuses

UTERUS – uterovaginal portion of hypogastric plexus

VAGINA – uterovaginal portion of hypogastric plexus

- most of the pain fibers from the vagina travel with the sacral parasympathetic fibers, as do those from the cervix uteri, and enter the cord via nerves S2, S3, and S4

- the lower 2.5 cm of the vagina receives its innervations from the pudendal nerves.