Transcript 13-Female organs.ppt

By
Prof. Saeed Makarem
Primary sex organ in the
female.
Almond-shaped, paired
organ,4 × 2 cm in size
Before puberty, Its
surface is smooth, but
after puberty, it becomes
progressively scarred
due to ovulation.
After menopause, ovary
becomes shrunken with
a pitted surface
The Ovary
Completely covered
by peritoneum
Attached to the
posterior layer of the
broad ligament by
mesovarium
Position of ovary is
extremely variable.
Usually lies against
the lateral wall of the
pelvis in a depression
called the ovarian
fossa
The Ovary
Bounded:
 Above:
 External iliac
vessels
 Below:
 Internal iliac
vessels and
ureter
The obturator
nerve crosses the
floor of the fossa.
The Ovarian
Fossa
Suspensory ligament:
connects ovary with the
pelvic wall.
In fact it is the lateral part
of the broad ligament
extending between the
mesovarium and the
pelvic wall
Round ligament:
Remains of the upper part
of the gubernaculum,
which extends from the
medial margin of the
ovary to the upper end of
the lateral wall of uterus
Ligaments of the
Ovary
Capsule of the Ovary
The ovary is
surrounded by thin
fibrous capsule
called tunica
albugenia
Tunica albugenia is
covered externally
by a single layer of
cuboidal cells called
the germinal
epithelium
The Ovary
Arterial supply:
Ovarian artery.(L3)
Venous Drainage:
ovarian vein, draining into IVC on right & left renal vein on left
Lymphatic:
follow the ovarian artery and drain into the para-aortic lymph
nodes.
Nerve supply: derived from aortic plexus, accompanies ovarian
artery
The blood vessels, lymphatics and nerves of the ovary
 Pass over the pelvic inlet
 Cross the external iliac vessels
 Pass through the suspensory ligament and the mesovarium.
 Reach the hilum of the ovary
Ovarian support
The ovary is kept
in its position by
the:
 Broad ligament
(Mesoverium)
Laxity of broad
ligament may
result in prolapse
of the ovary into
the rectouterine
(Douglas) pouch
Uterine Tube
Paired muscular tubes
Each is about 10cm long &
1cm in diameter
Lies in the upper free
margin of the broad
ligament.
The part of broad ligament
attached to the tube is
called mesosalpinx
Extends posterolaterally to
the lateral pelvic wall.
Medial end opens into the
uterus,
Lateral end opens into the
peritoneal cavity near the
ovary
Lateral end communicates
the peritoneal cavity to the
exterior of the body.
Divided into :
4 parts:
 1- Infundibulum:
 Expanded funnelshaped lateral end,
with free fimbriated
margin
 2- Ampulla:
 Widest part, site of
fertilization
 3- Isthmus:
 Narrowest part, just
lateral to uterus
 4- Intramural part:
 It pierces the uterine
wall
Uterine Tube
Uterine Tube
Arterial supply:
From uterine & ovarian arteries
Venous Drainage:
To uterine & ovarian veins
Lymphatic:
Follow the uterine & ovarian arteries and
drain into the internal iliac & para-aortic
lymph nodes
Nerve supply:
Derived from inferior hypogastric plexus
Hollow, pear-shaped, muscular
organ
In young nulliparous women it
measures 8× 5× 2.5 cm
Divided into:
 Fundus:
 Lying above the entrance of
the uterine tubes
 Body:
 Lying below the entrance of
the uterine tubes
 Cervix:
 Pierces the anterior wall of the
vagina and is divided into
supravaginal and vaginal
parts.
 The vaginal part is surrounded
all around by the cavity of
vagina, as anterior, posterior
and 2 lateral fornices
Uterus
The cavity of the uterus is
triangular in coronal section,
and is a slit in sagittal
section .
The cavity of the cervix is
spindle-shaped called the
cervical canal.
 It communicates with the
cavity of the body of
uterus through the
internal os and with the
cavity of vagina through
the external os.
 The external os is circular
in a nulliparous woman
and transverse (with
anterior and posterior
lips), in parous woman
Cavity of the Uterus
Peritoneal Covering
The uterus is covered
with peritoneum
except anteriorly,
below the level of the
internal os
Note the uterovesical
and rectouterine
(Douglas) pouches
Laterally it extends as
a double-layered fold,
called the broad
ligament, to the lateral
wall and the floor of
the pelvis
Double layered peritoneal
fold.
Extends from the sides of
the uterus to the lateral
wall and floor of the
pelvis.
Superiorly the two layers
are continuous and form
the free margin.
Inferiorly, at the base of
the ligament, the layers
are reflected to cover the
anterior & posterior wall
of the pelvis.
Here the uterine artery
crosses the ureter
Broad Ligament
The ovary is
attached to the
posterior layer of
the broad
ligament by
Mesoverium
Parts of the
broad ligament:
 Suspensory
ligament of the
ovary.
 Mesosalpinx
 Mesoverium
Broad Ligament
Contents:
 1-Uterine tube in its
upper free margin
 2-Round ligament of
ovary
 3- Round ligament of
uterus
 4- Uterine & ovarian
blood vessels,
 5- lymphatics & nerves
 6- Epoophoron &
paroophoron, vestigial
remnants of
mesonephros
Function of the broad
ligament:
Holds the uterus in its
normal position
Broad Ligament
Position of the Uterus
Normally, in erect position, with the
bladder empty, uterus lies in an
almost horizontal plane
The long axis of the uterus is
bent forward on the long axis of
the vagina forming an angle of
(Anteversion) 90 degrees
The long axis of body of uterus
is bent forward at the level of
internal os with the long axis of
the cervix, forming an angle of
(Anteflexion) 170 degrees
In some women, uterus is bent
backward, a retroverted
retroflexed.
Uterus
Anteriorly:
 Body of uterus related
to uterovesical pouch &
superior surface of
urinary bladder
 Supravaginal part of
cervix is related to
superior surface of
urinary bladder
 Vaginal part of cervix
related to the anterior
vaginal fornix
Posteriorly:
Rectouterine (Douglas)
pouch with coils of ileum
and sigmoid colon.
Laterally:
 Body of uterus is related to
the broad ligament, uterine
artery & vein.
 The uterine tubes enter the
superolateral angle of the
uterus, ovarian ligament
attached just below this
angle
 Supravaginal part of
cervix related to ureter
 Vaginal part of cervix is
related to lateral fornix
Uterus
Arterial Supply:
Mainly from uterine artery,
 lies in the base of the
broad ligament
 Crosses above the ureter.
 Reaches the cervix at the
level of internal os
 Ascends along the lateral
margin of uterus within the
broad ligament
 Ends by anastomosing
with the branches of the
ovarian artery which also
supplies the uterus
 Gives descending
branches that supply the
cervix & vagina
Uterus
Uterus
Venous Drainage:
uterine vein draining into internal iliac vein
Lymphatics:
 From fundus: accompany uterine artery
and drain into the para-aortic lymph nodes.
 From body & cervix: drain into internal &
external iliac lymph nodes.
 A few follow the round ligament and drain
into superficial inguinal lymph nodes
Nerve supply: from inferior hypogastric plexus
Mainly supported by:
 Tone of levator ani
 Perineal body
 Ligaments formed by
the condensations of the
pelvic fascia:
 Transverse cervical
 Pubocervical
 Sacrocervical
Broad ligament.
Round ligament (remnant
of lower part of the
gubernaculum) play a minor
role in support.
Round ligament helps in
maintaining the anteverted,
anteflexed position
Uterine support
Uterus in the child:
Small
Uterus after puberty:
Enlarges under the effect of
hormones secreted by ovary.
Uterus in pregnancy:
Greatly enlarged due to
estrogen & progesterone.
By 3rd month fundus rises
out of the pelvis.
By 9th month reaches the
xiphoid process.
Uterus after menopause:
Atrophies and becomes
smaller & less vascular
Uterus
Muscular tube, 8cm long,
forms part of birth canal
Has anterior and posterior
walls which are normally in
apposition
Upper half lies above the
pelvic floor, lower half lies
in perineum
Upper end of its anterior
wall is pierced by cervix.
Below it opens on the
exterior through vaginal
orifice
The lumen surrounding the
cervix is divided into
anterior, posterior and two
lateral fornices
Vagina
Anteriorly:
Base of the bladder above
and urethra below
Posteriorly:
 Upper 1/3: rectouterine
(Douglas) pouch
 Middle 1/3: rectal ampulla
 Lower 1/3: perineal body
Laterally:
 Upper 1/3: ureter
 Middle 1/3: anterior fibers
of levator ani
 Lower 1/3: urogenital
diaphragm & bulb of
vestibule
Vagina
Arterial supply:
vaginal artery, branch of
internal iliac & vaginal branch
of uterine artery
Venous drainage:
through vaginal veins to the
internal iliac vein
Lymphatic drainage:
 From upper 1/3: internal &
external iliac nodes
 From middle 1/3: internal
iliac nodes
 From lower 1/3: superficial
inguinal nodes
Nerve supply:
inferior hypogastric plexus
Vagina
Upper part:
By levator ani,
and the cervical
ligaments.
Middle part:
By the urogenital
diaphragm.
Lower part:
Especially the
posterior wall, by
the perineal body
Vaginal Supports
Clinical Notes
Pelvic floor injuries
Pelvic floor serves an important function during
child birth
Can get injured during a difficult or obstructed
labor that may result in:
Vaginal prolapse.
Uterine prolapse.
Bladder prolapse.
Rectal prolapse
CLINICAL NOTES
Ovarian prolapse into the
pouch of Douglas due to
laxity of broad ligament
Salpingitis (may lead to
closure of fallopian tube)
Ectopic pregnancy
Ligation and division of
uterine tubes as a birth
control.
Uterine prolapse
Vaginal prolapse
Abnormal Positions of the Uterus
Retroverted &
Retroflexed
 May be symptomless
 May give pain and
discomfort (dysparonia).
 Can be a cause of
infertility.