Title MOD13-6-Gross Anatomy of the Female Reproductive System.pdf ✅

ANAT ● ANATOMY Gross Anatomy of the Female Reproductive System TRANS 6 MODULE 13 Joven Amor Mostajo, MD March 28, 2023 LECTURE OUTLINE I Female Urethra A. Structures of the Female Urethra B. Blood Supply and Innervation II Ovaries A. Structure of the Ovaries B. Ovarian Vessels C. Ovarian Attachment III Uterine Tubes A. Structures of the Uterine Tubes B. Blood Supply of the Uterine Tubes C. Ovarian Attachment IV Uterus A. Anatomical Position of the Uterus B. Parts of the Uterus C. Internal Anatomy of the Uterus D. Layers of the Uterus E. Ligaments of the Uterus F. Dynamic + Passive Support (Uterus) G. Passive Support (Cervix) H. Blood Supply of the Uterus V Vagina A. Functions of the Vagina B. The Vagina Wall C. Vagina Cross-Section D. Vaginal Fornix/Fornices E. Blood Supply of the Vagina F. Innervation of the Vagina VI External Anatomy of the Female Reproductive System A. Vulva/Pudendum B. Mons Pubis C. Labia Majora D. Labia Minora E. Clitoris F. Blood Supply of Vulva G. Innervation H. Female Urogenital Triangle LECTURE OBJECTIVES 1. Given a clinical condition involving the gross anatomy of the female reproductive system, the student must be able to create a correct anatomical explanation. 2. Use anatomical landmarks in performing a physical examination of the female reproductive system. 3. Rationalize common clinical procedures of the female reproductive system using anatomical structures and their relationship with one another. I. FEMALE URETHRA A. STRUCTURES OF THE FEMALE URETHRA ● Approx. 4cm ○ (Internal Urethral Orifice-External Urethral Orifice) ○ Shorter compared to male urethra ● Postero-inferior to the pubic symphysis ● Internal urethral orifice is NOT organized into an internal sphincter Figure 1. The Female Reproductive System Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) Table 1. Structures of the Female Urethra External Urethral Orifice (EUO) ● Opens at the vestibule, anterior to the vaginal orifice ● Surrounded by external urethral sphincter Paraurethral Glands (Skene’s Glands) ● Anterior to the vagina and opens near the EUO ● Homologue to the prostate Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) Figure 2. Structures of the Female Urethra Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) Group 6A & 7A | Gross Anatomy of the Female Reproductive System 1
B. BLOOD SUPPLY AND INNERVATION Table 2. Vascular Structures in the Female Urethra Blood Supply ● Internal pudendal arteries and veins ● Vaginal arteries and veins Innervation ● Vesical nerve plexus ● Pudendal nerve Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) II. OVARIES A. STRUCTURE OF THE OVARIES ● Known as the female gonads - produces oocytes & releases the female reproductive hormones ● Almond sized & shape (1-3 cm) ● Suspended in a short mesentery called mesovarium ○ The mesovarium is a subdivision of the broad ligament Table 3. Appearances of the Ovary Pre- Pubertal Before Puberty Tunica Albuginea ● Smooth layer of ovarian mesothelium (single layer of cuboidal cells) ● Grayish appearance After Puberty Ovarian surface ● Progressively scarred & distorted because of: ○ Repeated rupture of ovarian follicles ○ Discharge of oocytes during ovulation Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) Figure 3. Anatomy of Ovarian Follicle Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) B. OVARIAN VESSELS ● Pass through a peritoneal fold called the suspensory ligament of the ovary ● It is continuous with the mesovarium of the broad ligament RECALL: Ovarian artery is a direct branch of the abdominal aorta Figure 4. Blood Supply to Female Reproductive Tract Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) C. OVARIAN ATTACHMENT ● Ligament of ovary ○ Ovaries are medially attached ○ Attaches to the lateral angle of uterus inferior to the uterine tubes ● Ovary is suspended in the peritoneal cavity ● Expelled oocytes during ovulation passes → peritoneal cavity → trapped by the fimbriae of the infundibulum of the uterine tube → carried to the ampulla → fertilized Figure 5. Anatomy of Ovary Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) III. UTERINE TUBES A. STRUCTURES OF THE UTERINE TUBES ● Also known as the fallopian tubes ● Conducts the oocyte from the peritoneal cavity to the uterine cavity ● Approx. 10 cm in length ● Extends laterally from the uterus ● Supported by a mesentery called the mesosalpinx ○ It is also part of the broad ligament of the uterus ● Divided into 4 parts: ○ Infundibulum ○ Ampulla ○ Isthmus ○ Uterine Part MNEMONIC: “I Am IU” (lateral → medial) ○ Infundibulum ○ Ampulla ○ Isthmus ○ Uterine Part Group 6A & 7A | Gross Anatomy of the Female Reproductive System 2
NOTE: Doc Mostajo’s Tip: Try to visualize the uterus as Batman's body Table 4. Orientation of the Uterine Tubes Uterine Tubes NOTE: Represented by Batman’s arms ● Extended posterolateral to pelvic walls and will arc antero superiorly to the ovaries ● In reality, the tubes may be found asymmetrically lying within the pelvic cavity Broad Ligament NOTE: Represented by Batman’s cape Source: Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) 1. Infundibulum ● Funnel-shaped lateral end of the tube, opening into the peritoneal cavity and continuous with the reproductive tract ● Therefore, infections of the vagina, fallopian tube, and uterus may also migrate and affect the peritoneum resulting to peritonitis ● Fimbriae - finger-like processes that spread over the ovary ● A single ovarian fimbria is attached to the superior pole of the ovary IMPORTANT: The most common cause of infertility in women is the blockage of the uterine tubes secondary to salpingitis - Inflammation of the uterine tube often due to infection. 2. Ampulla ● Widest and longest part of the uterine tube ● Most common site of fertilization of the oocyte ● It is the most common site of tubal pregnancy 3. Isthmus ● Thick-walled part of the uterine tube which enters the uterine horn 4. Uterine Part (Intramural) ● Short segment that passes through the wall of the uterus ● Opens via the uterine ostium to connect into the uterine cavity B. BLOOD SUPPLY OF THE UTERINE TUBES a Tubal branches of Ovarian Artery (Abdominal Aorta) b Ascending branches of the Uterine Artery (Internal iliac) c Veins draining to Pampiniform Plexus → (L) & (R) Ovarian vein ● Drains into the inferior vena cava on the right side ● Drains into the left renal vein on the left side. ● The tubal veins will drain into the ovarian veins and uterine venous plexus ● Tubal branches of the ovarian artery are a direct branch of abdominal aorta ● Uterine artery will give off ascending branches to supply the fallopian tube ● The ovarian Artery + the uterine artery will both give off branches to supply the ovaries and the uterine tube IV. UTERUS ● Thick-walled, pear-shaped, hollow muscular organ ● Houses the developing embryo and fetus ● A non-gravid uterus lies in the lesser pelvis with its body just superior to the urinary bladder and its cervix between the rectum and the bladder ● The position of the uterus changes with the degree of fullness of the bladder ● The size may vary but a non-gravid uterus is approx. 7.5 cm long, 5 cm wide, and 2 cm thick ● Approx. 90 grams in weight ● The normal anatomical position of the uterus is resting on top of the bladder A. ANATOMICAL POSITION OF UTERUS Figure 6. Normal Anatomical Position of the Uterus Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) ● The anatomical position of the uterus as it sits on top of the bladder is anteverted and anteflexed. ● Angle of Anteversion (ANTEVERTED) ○ The axis of the cervix relative to the vagina ● Angle of Anteflexion (ANTEFLEXED) ○ Formed between the axis of the uterus and the cervix B. PARTS OF THE UTERUS Figure 7. Structures of the Uterus Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) Group 6A & 7A | Gross Anatomy of the Female Reproductive System 3
1. Body of the Uterus ● Forms the upper 2/3 which includes the fundus (rounded superior part) ● 2 Surfaces: ○ Vesical surface ■ Surface related to the urinary bladder ○ Intestinal surface ■ Surface related to the intestines of the GIT ● Isthmus ○ A narrowed or constricted segment that demarcates the body and the cervix ○ Approx. 1 cm in length ○ Found in the uterine cavity 2. Cervix of the Uterus ● Cylindrical, narrow inferior 1/3 of the uterus ● Approx. 2.5 cm in length in adults ● 2 Parts: ○ Supravaginal Part ■ Located between the isthmus and vagina ○ Vaginal Part ■ Protrudes on the superior part of vagina ■ Surrounds the external os ■ Surrounded by the vaginal fornix (1 anterior, 1 posterior, 2 lateral) ● Anterior to the cervix is the bladder ● Posterior to the rectum, separated by the recto-uterine pouch (Pouch of Douglas) C. INTERNAL ANATOMY OF THE UTERUS Figure 8. Internal Anatomy of Uterus Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) 1. Uterine Cavity ● Slit-like portion ● Approx. 6 cm from the external os up to the wall of the fundus 2. Uterine Horns ● Region of the uterine cavity where the uterine (fallopian) tube enters 3. Cervical Canal ● Inferior to the uterine cavity ● Inside the isthmus ● Bounded superiorly by the internal os and inferiorly by external os ● Communicating with the lumen of vagina Figure 9. Cervix Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) 4. Cervical Layers ● External os of cervix communicates with the lumen of vagina ● In performing, physical examination of female cervix, you will be able to appreciate the structures of the external os ● Center - external os of cervix ● Lateral to external os - a sudden change in appearance of cervical lining (squamocolumnar junction) ● Surrounding squamocolumnar junction - transformation zone of cervix ● Outermost part of cervix - surrounded by vaginal fornices ● Birth Canal = uterine cavity + lumen of vagina REMEMBER: Transformation zone is the most common site of cervical cancer or neoplasia. 5. Appearances of the Cervix Normal nonparous cervix Appearance of a female cervix that has not given birth yet Normal parous cervix Appearance of a female cervix that has already given birth Parous, everted cervix Appearance of a female cervix that has undergone multiple childbirth Figure 10. Different Appearances of the Cervix Dr. Mostajo’s Video Lecture on the Gross Anatomy of the Female Reproductive System (Part 1) NOTE: ● The variation in the cervix may only be observed if the mode of delivery is via normal spontaneous vaginal delivery. ● The appearance of the cervix may remain unchanged if the patient underwent cesarean section. Group 6A & 7A | Gross Anatomy of the Female Reproductive System 4