Female reproduction system

T/F: the parietal perineum does not reach the pelvic floor

True: it reflects onto the pelvic viscera, remaining separated from the pelvic viscera and the surrounding pelvic fascia

• only the superior and superolateral surfaces of the pelvic viscera are covered with peritoneum

The _________ and __________ are the only structures that are fully surrounded by peritoneum

Ovaries and uterine tubes (fallopian tubes)

There is a small opening in the parietal peritoneum at the junction of the ________ and __________

Ovaries, uterine tubes

• zygotes can implant outside of uterus = ectopic pregnancy

Identify

1. Ovary

2. Uterine tube

3. Parietal peritoneum

4. Uterus

5. Bladder

The parietal peritoneum forms two pouches between neighbouring pelvic viscera. What are they?

1. Vesico-uterine pouch: between bladder and uterus

2. Recto-uterine pouch: between rectum and uterus

Identify

1. Vesico-uterine pouch

2. Parietal peritoneum

3. Bladder

4. Vagina

5. Recto-uterine pouch

6. Parietal peritoneum

7. Rectum

8. Anal canal

9. Uterus

Identify

1. Vesico-uterine pouch

2. Recto-uterine pouch

What are the pelvic organs? Are they part of:

• Lower GI tract

• Lower urinary tract

• Internal pelvic organs

• External pelvic organs

1. Ureter - lower UT

2. Bladder - lower UT

3. Urethra - lower UT

4. Sigmoid colon - lower GI

5. Rectum - lower GI

6. Anal canal - lower GI

7. Ovary - internal pelvic

8. Uterine tube - internal pelvic

9. Uterus - internal pelvic

10. Vagina - internal pelvic

11. Vulva - external pelvic

12. Clitoris - external pelvic

The sigmoid colon becomes the _________ at the rectosigmoid junction (level of S3), which then becomes the ____________ at the anorectal flexure as it passes through the levator ani

Rectum, anal canal

What nerve and artery/vein are associated with the perineum?

• Pudendal nerve

• Internal pudendal artery and vein

Name and describe the different parts of the vulva

1. Mons pubis: the rounded, hair-bearing area of skin and adipose tissue over the pubic symphysis

2. Labia majora: two prominent, longitudinal folds of skin that extend back from the mons pubis to the perineum

3. Labia minora: two small cutaneous folds, devoid of fat, that lie between the labia majora

4. Glans of the clitoris: an erectile structure, partially enclosed by the anterior bifurcated ends of the labia minora

5. Vestibule: the cavity that lies between the labia minora; contains the following structures

6. Urethral orifices: open into the vestibule about 2.5cm below the clitorisa d above the vaginal opening

7. Vaginal orifice: external opening

8. Vestibular bulb: two elongated masses of erectile tissue, 3cm long, on each side of the vestibule (each covered posteriorly by bulbospongiosus)

What’s the function of the clitoris?

It is the organ of sexual arousal

• highly innervated (twice as much as penis)

Describe the external anatomy of the clitoris

• Suspensory ligament: attached to pubic symphysis and clitoral hood

• Clitoral hood: shaft skin from the clitoral body (also called prepuce)

• Glans of clitoris: 0.5 to 2.5cm

• Labia minora

• Vestibule → urethral orifice and vaginal orifice

The deeper anatomy of the clitoris includes structures such as the clitoral body, crura, and greater vestibular glands (Bartholins gland). Describe them.

1. Clitoral body:

   • Internal structure similar to shaft of penis

   • Includes corpora cavernosa (erectile tissue that engorges with arousal)

   • Dorsal nerve of the clitoris

2. Crura:

   • split of the body composed of corpora cavernosa

   • Attach the corpora cavernosa to the ischiopubic ramus

   • Extend from root of the clitoris

3. Bartholin’s glands:

   • two pea-sized compound alveolar glands, located on either side of the vaginal opening, deep to the labia majora in the vulva

   • Produce mucus to lubricate the vagina and vulva

   • Innervated by the pudendal nerve (sensory and parasympathetic stimulation)

Identify

1. Pubic symphysis

2. Clitoral hood

3. Glans of clitoris

4. Vestibule

5. Urethral orifice

6. Vaginal orifice

7. Labia minora

8. Crus

9. Suspensory ligament of clitoris

What is the vagina?

A fibromuscular tube lined by non-keratinized stratified epithelium

Describe the anatomy of the vagina (not the muscles)

• extends from the vestibule to the uterus

• Vaginal canal is usually collapsed so that the anterior wall is in contact with the posterior wall

• Vaginal vault: enlarged internal end of the canal

• The urethra is embedded in the anterior wall

• Recto-uterine pouch (pouch of Douglas) separates the posterior vagina from the rectum

Which muscles surround the vagina?

1. Levator ani: supports the upper part of the vagina laterally, together with the transverse cervical, pubocervical, and uterosacral ligaments

2. Pubovaginalis: provides a U-shaped muscular sling around the mid-vagina

3. Bulbospongiosus: surrounds the lower vagina

What is the uterus? What are its functions?

A thick-walled, muscular, pear-shaped organ in the midline between the bladder and rectum

• It’s position varies with distension of the bladder and rectum

• Functions: gestation, menstruation, labor and delivery

What does the uterus consist of?

• Body: flattened anteroposteriorly, made up of:

  • Fundus: rounded superior end

  • Isthmus: inferior-posterior part of the uterus, on its cervical end where the uterine muscle is narrower and thinner

• Cervix: the lower, cyndrical part

  • External os: opening between cervix and the vagina inferiorly

  • Normal cervix feels firm and smooth, and has a slight indentation in the middle

Where are the uterine tubes?

Connected to uterus; project laterally from the uterus and open into the peritoneal cavity immediately adjacent to the ovaries

The uterus has __ layers. What are they?

Three:

1. Perimetrium: the outer double-layered serous membrane of the uterus

   • Secretes a lubricating fluid that helps reduce friction

   • Also part of the peritoneum that covers some of the organs of the pelvis

2. Myometrium: the middle and thickest layer

   • made up mostly of smooth muscle

   • Cells undergo hypertrophy and hyperplasia during pregnancy

3. Endometrium: the inner layer that lines the uterus

   • Made up of glandular cells that make secretions

   • Site of implantation of a blastocyst

   • Sheds if pregnancy doesn’t happen

   • Subdivided into 2 parts (that I don’t need to know)

slide 14

What are the parts of the uterine tubes ?

1. Infundibulum: lateral, funnel-shaped portion

   • Fimbrae: pick up and carry the oocyte from the ovary after ovulation and transport it to the uterus over the course of 4-5 days

2. Ampulla: expanded portion medial to infundibulum

   • usual site for fertilization

3. Isthmus: narrow medial portion

   • visceral peritoneum, smooth muscle, ciliated epithelium

What’s the broad ligament?

A double-sheet of peritoneum (a mesentery) that supports and develops the ovaries, uterine tubes, and uterus

Identify

1. Ampulla

2. Isthmus

3. Uterine tube

4. Ovary

5. Ovarian artery and vein in suspensory ligament of ovary

6. Body of uterus

7. Cervix

8. Vagina

9. Fimbriae

10. Infundibulum

11. Ligament of ovary

12. Fundus of uterus

Identify

1. Endometrium

2. Myometrium

3. Isthmus

4. Supravaginal part of cervix

5. Vaginal part of cervix

6. Cervix — vagina (there are 2 6’s)

7. External os

8. Vaginal fornix

9. Ligament of ovary

Identify

1. Fundus

2. Uterine cavity

3. Cervix

4. Endometrium

5. Myometrium

6. Perimetrium

Identify

1. Isthmus

2. Uterine tubes

3. Ampulla

4. Broad ligament

5. Infundibulum

6. Fimbrae

7. Broad ligament again

8. Uterosacral ligament

9. Ureter

10. Ovary

11. Suspensory ligament of the ovary

Slide. 17

What artery supplies:

• Uterus

• Vagina

• Ovaries

• Uterine arteries (from internal iliac artery)

• Vaginal arteries (from internal iliac)

• Ovarian arteries (from aorta) and ovarian branches of the uterine arteries

The ovarian arteries are surrounded by the ______________

Suspensory ligament — a fold of peritoneum that extends from the upper pole of the ovary and uterine tube to the lateral pelvic wall

1. Umbilical a.

2. Superior vesical a.

3. Obturator a.

4. Uterine a.

5. Inferior vesical a.

6. Vaginal a.

7. Middle rectal a.

8. Ureter

9. Ovary

10. Uterine tube

11. Round ligament