💀GU Anatomy Lecture: Female Reproductive

female breast

-subcutaneous tissue
-Glandular and supporting fibrous connective tissue embedded in a fatty matrix
-Contains lobes, lobules, lactiferous ducts, blood vessels, lymphatics and nerves
-Modified sweat gland

female breast

-overlies pectoralis major/minor, parts of serratus anterior and external oblique mm
-transversely from lateral border of sternum to midaxillary line
-vertically base located from ribs 2-6

Suspensory ligaments of Cooper

fibrous connective tissue skin ligaments that attach breast tissue to dermis and provide support

Axillary tail/process (of Spence)

part of breast that extends over pectoralis major muscle to the axilla

Lobes

15-25 compound alveolar glands in breast

Lobules

clusters of alveoli in each lobe of breasts where milk is produced

Ducts

carry milk from glandular tissue in breasts

Lactiferous ducts

largest ducts, drain lobules

Lactiferous sinus

deep to areola, dilated region of lactiferous duct

Stroma of breast

Adipose tissue and connective tissue that surrounds the lobules and ducts

Breast vasculature

1.Subclavian a → internal thoracic a → medial mammary branches

2.Subclavian a → axillary a → lateral thoracic and thoracoacromial aa

3.Thoracic aorta → posterior intercostal aa → lateral mammary branches

Supply breast tissue

Breast Quadrants

Axillary lymph nodes

75% of lymph drainage in breast
-Primary route for metastasis of breast carcinoma

Parasternal lymph nodes

Medial quadrants of breast drain into _________ along internal thoracic blood vessels

Contralateral lymph nodes

Medial quadrants of breast drain into _________ by crossing midline

Abdominal lymph nodes

Lower quadrants of breast drain into _____

Uterus

-Pelvic hollow muscular organ; anterior to rectum, posterior to bladder

-Typically tilted over fundus of urinary bladder; covered superiorly by peritoneum

Body

main part of uterus

Fundus

rounded top of uterus

Cervix

narrow neck of uterus, projects into vagina

Isthmus

narrowed region of uterus between body and cervix

External os

cervix of uterus; opening into vagina; visible on speculum exam

Internal os

cervix of uterus; opening into uterus

Perimetrium

visceral peritoneum, external layer of uterus

Myometrium

smooth muscle, middle layer of uterus

Endometrium

-inner layer of uterus, shed with menses; highly vascular tissue where embryo implants

-contains stratum functionalis and stratum basalis layers

Stratum functionalis

-Layer of endometrium closer to lumen; simple columnar epithelium + underlying stroma

-Sloughed off with menstrual cycle

-Temporary tissue that regrows each cycle

Stratum basalis

-Permanent stromal tissue of endometrium + glandular tissue

-Source of regrowth for stratum functionalis

Cervix

Narrow inferior 1/3 of uterus that opens into vagina; contains internal and external os

Broad ligament

Part of peritoneum of uterus; includes Mesometrium, Mesovarium, Masosalpinx

Mesometrium

Broad ligament (peritoneum) of uterus that provides lateral support and covers uterus

Mesovarium

ovarian support, part of broad ligament (peritoneum) of uterus that covers ovaries

Mesosalpinx

Broad ligament (peritoneum) of uterus that covers uterine tubes (fallopian tubes)

Vesicouterine pouch

Portion of broad ligament (peritoneum) of uterus found between bladder and uterus

Rectouterine pouch

Portion of broad ligament (peritoneum) of uterus found between uterus and rectum

Round ligament

-Bilateral peritoneum attaches to superior lateral wall of uterus

-Runs through inguinal canal, attaches to labia majora

aka ligamentum teres

Uterine a/v

Which uterine blood vessels run in the transverse cervical ligament?

Transverse cervical ligaments

bilateral ligaments that attach cervix and superior portion of vagina to lateral wall

contain uterine artery and vein*

Uterosacral ligaments

bilateral ligaments that attach to posterior inferior portion of uterus and sacrum

provide posterior and inferior support

Adnexa

region adjacent to the uterus that includes ovary, uterine tube, broad ligament

Clinical significance: site of tumors, ovarian cysts, ectopic pregnancy

Uterine tube (Oviduct, Fallopian tube)

site of fertilization, receives oocyte after ovulation and transports oocyte from ovary to uterus

Infundibulum

funnel-shaped beginning part of uterine tubes

Fimbriae

Finger-like projections at end of uterine tubes

Ampulla

Main part of uterine tube where fertilization typically occurs

Isthmus

Narrowing of uterine tube

Uterine part

Section of uterine tube that travels through muscle of uterus

Ovary

female gonad, make hormones estrogen and progesterone (as well as androgens)

releases oocyte at ovulation

Suspensory ligament

ovarian support attached to lateral body wall

contains ovarian artery and vein*

Ovarian a/v

What blood vessels are contained within the suspensory ligament of ovary?

Proper ovarian ligament

ovarian support from ovary to uterus

Germinal epithelium

simple cuboidal epithelium on the surface of the ovary

Tunica albuginea

connective tissue capsule that surrounds the ovary

Follicle

cells that surround the oocyte in the ovary

Contains outer theca cells (make androgens) and inner granulosa cells (make estrogen)

Theca cells

outer follicle cells in the ovary that produce androgens

Granulosa cells

inner follicle cells in the ovary that produce estrogen

Oocyte

female haploid gamete

Graafian (mature) follicle

after follicle develops, typically contains antrum (fluid filled space) that will rupture

Antrum

fluid-filled space of a mature follicle

Ovulation

What is the term for when the follicle ruptures and oocyte is released?

Corpus luteum

remaining portion of follicle after ovulation (when follicle ruptures and oocyte released)

makes progesterone that maintains endometrium for first trimester of pregnancy until placenta takes over

*without fertilization, lifespan is 14 days, stops producing progesterone causing endometrial shedding

Corpus albicans

degenerated corpus luteum, forms in the absence of fertilization

Vagina

distensible musculomembranous tube and birth canal

canal for menstrual fluid, receives sperm

Anterior/Posterior/Lateral Fornix

What are the recesses around cervix?

Ovarian artery

Which pelvic artery travels from abdominal aorta in the suspensory ligament of the ovary?

Uterine artery

Which pelvic artery travels from internal iliac artery in the transverse cervical ligaments of the uterus?

Lateral sacral veins

Which pelvic veins make anastamosis with internal vertebral venous plexus draining internal vertebral canal
*metastasis of prostate/ovarian cancer to vertebral or cranial sites

plexuses

Pelvic veins form _____ that drain into:
-Internal iliac vein
-Superior rectal vein
-Lateral sacral vein: forms anastamosis with internal vertebral venous plexus*

*metastasis of prostate/ovarian cancer to vertebral or cranial sites

Pelvic cavity

What portion of pelvis is within pelvic girdle and sacrum?

Pelvic brim

What portion of pelvis is between pubic symphysis and sacral promontory?

Pelvic inlet

separates greater and lesser pelvis

Pelvic outlet

inferior margin of pubic symphysis, ischial tuberosity, sacrotuberous ligament, tip of coccyx

Greater pelvis (pelvis major, false pelvis)

above pelvic brim, within iliac fossa, part of abdominal cavity, contains sigmoid colon*

Lesser pelvis (pelvis minor, true pelvis)

below pelvic brim, between pelvic inlet/outlet

contains pelvic viscera and true pelvic cavity*

Male pelvis

thick, heavy, prominent markings

heart-shaped pelvic inlet, small pelvic outlet; narrow pubic arch

coccyx angled, large acetabulum anteriorly

Iliac ala less flared, round obturator foramen

Female pelvis

thin, light, shallower and wider, oval or rounded pelvic inlet

large pelvic outlet, wide pubic arch

coccyx angled, small acetabulum inferiorly

iliac ala more flared, oval obturator foramen

Sacroiliac joint

Part fibrous / part synovial joint of pelvis

Lumbosacral joint

Part secondary cartilaginous / part synovial joint of pelvis

Pubic symphysis

secondary cartilaginous joint of pelvis

Obturator internus m

anterolateral pelvic wall, passes through lesser sciatic foramen

Piriformis m

posterolateral pelvic wall, passes through greater sciatic foramen

Pelvic diaphragm (floor)

funnel shaped, separates pelvic cavity from perineum

supports pelvic viscera, resists increases in intra-abdominal pressure*

Levator ani mm (Puborectalis, Pubococcygeus, Iliococcygeus) + Coccygeus m

Levator ani mm

innervated by ventral rami of S4

1. Puborectalis m
2. Pubococcygeus m
3. Iliococcygeus m

Muscles of Pelvic Diaphragm (floor)

S4 ventral rami

What is innervation to the levator ani muscles of pelvic diaphragm?

Coccygeus m

innervated by ventral rami of S4-S5

Muscle of Pelvic Diaphragm (floor)

Puborectalis m

levator ani m (S4 ventral rami innervation) of pelvic diaphragm (floor)

attached laterally to pubic bone, makes a u-shaped sling around the rectum; helps to maintain fecal continence

Perineum

diamond shaped area below pelvic diaphragm (floor), bounded by pelvic outlet

contains external genitalia (urogenital triangle + anal triangle)

Urogenital triangle

Boundaries: pubic symphysis, ischiopubic ramus, ischial tuberosities

Contents: urethra, external genitalia

Perineum of female pelvis

Anal triangle

Boundaries: coccyx, ischial tuberosity, sacrotuberous ligament

Contents: anus, anal canal

Perineum of female pelvis

Perineal body

central tendon of perineum

posterior border of vagina, anterior border of external anal sphincter

attachment for urogenital diaphragm and external anal sphincter*

Episiotomy

surgical incision of perineum and vaginal wall, decreases trauma to pelvic diaphragm and perineum during delivery

easier to fix a cut muscle than torn muscle

Perineal muscles

inferior to pelvic diaphragm, support pelvic diaphragm, support perineal body (except for ischiocavernosus m*), resists increases in intra-abdominal pressure
■ Ischiocavernosus m* - not attached to perineal body
■ Bulbospongiosus m
■ Superficial transverse perineal m
■ Deep transverse perineal m
■ External anal sphincter**

innervated by perineal nerve (pudendal nerve branch ventral rami S2-S4)

**external anal sphincter innervated by inferior rectal nerve (S2-S4)

Perineal n

What is innervation to the:
Ischiocavernosus m
Bulbospongiosus m
Superficial transverse perineal m
Deep transverse perineal m?

Perineal muscles; pudendal nerve branch ventral rami S2-S4

Ischiocavernosus m

does not attach to perineal body*, perineal nerve innervation

runs along ischial pubic ramus to ischial tuberosity, inserts along crus of penis or crus of clitoris, helps to maintain an erection

Perineal muscle

Bulbospongiosus m

origin on perineal body, perineal nerve innervation

surrounds bulb of penis/vagina, supports and stabilizes pelvic diaphragm/perineal body and resists increases in intraabdominal pressure, assists with erection

Perineal muscle

Superficial transverse perineal m

runs from ischial tuberosity to perineal body, perineal nerve innervation

supports and stabilizes pelvic diaphragm/perineal body and resists increases in intraabdominal pressure

Perineal muscle

Deep transverse perineal m

deeper muscle, runs from ischial pubic ramus to perineal body, perineal nerve innervation

supports and stabilizes pelvic diaphragm/perineal body and resists increases in intraabdominal pressure

Perineal muscle

External anal sphincter

anteriorly attached to perineal body, innervated by inferior rectal nerve (S2-S4)

surrounds anal canal, helps to maintain fecal continence (closing off the anus)

Perineal muscle

Ischiocavernosus m

Which perineal muscle does NOT attach to the perineal body?

runs along ischial pubic ramus to ischial tuberosity

Vulva/Pudendum

female external genitalia, present on surface

sensory and erectile tissue, directs flow of urine, prevents entry of foreign material to urogenital tract

Mons pubis

overlies pubic symphysis on female