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Female Genital System

Dr. Lubna Nazli

1st April 2009

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Objectives

• External and internal organs• Ovaries: size, parts, relations and vessels and

nerves.• Uterine tube: size, parts, relations and vessels

and nerves.• Uterus: size, parts, relations and vessels and

nerves.• Ligaments of uterus• Vagina• Mammary gland• Clinical application.

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The Female Genital Organs

• The female genital organs consist of an internal and an external group.

• The internal organs are situated within the pelvis, and consist of the ovaries, the uterine tubes, the uterus, and the vagina.

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Female Reproductive System

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Female Reproductive System• Ovaries, the female gonads, are the

primary reproductive organs of the female• Like the testes of the male, ovaries serve a

dual purpose– Produce gametes– Produce female sex hormones (estrogen and

progesterone)

• The accessory ducts (uterine tubes, uterus, and vagina) transport or otherwise serve the needs of the reproductive cells and fetus

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• The external organs are placed below the urogenital diaphragm and below and in front of the pubic arch.

• They comprise the mons pubis, the labia majora & minora , the clitoris, the bulbar and the greater vestibular glands.

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The Ovaries• The paired

ovaries are situated on each side of the uterus and shaped like almonds.

• Each ovary is held in place within the peritoneal cavity by several ligaments

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The Ovaries

• The ovarian ligament anchors the ovary medially to the uterus

• The suspensory ligament anchors the ovaries laterally to the pelvic wall

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The Ovaries

• The mesovarium ligament suspends the ovaries between the fallopian tubes and the uterus

• Both the suspensory ligament and the mesovarium are part of the broad ligament

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The Ovaries

• The broad ligament is a peritoneal fold that “tents” over the uterus and supports the uterine tubes, uterus and vagina

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The Ovaries

• The ovaries are supplied by the ovarian arteries which are branches of the abdominal aorta

• The ovarian blood vessels reach the ovaries by traveling through the suspensory ligaments and mesovarium

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The Uterine Tube 

• The uterine tubes convey the ova from the ovaries to the cavity of the uterus.

• They are two in number, one on either side, situated in the upper margin of the broad ligament, and extending from the superior angle of the uterus to the side of the pelvis.

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Each tube is about 10 cm. long, and is described as consisting of three portions:

(1) the isthmus, or medial constricted third (2) the ampulla, or intermediate dilated

portion, which curves over the ovary(3) the infundibulum with its abdominal

ostium, surrounded by fimbria, one of which, the ovarian fimbria is attached to the ovary.

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Female Duct System

• The distal end of each uterine tube extends as it curves around the ovary, forming the ampulla, where fertilization occurs.

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Female Duct System

• The ampulla ends in the infundibulum, an open, structure bearing ciliated projections called fimbriae that drape over the ovary

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Female Duct System

• An ovulated oocyte is released into the peritoneal cavity, and many oocytes are lost there

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Female Uterus• The uterus is

located in the pelvis, anterior to the rectum and postero- superior to the bladder

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The Uterus

• The uterus is a hollow, thick walled organ that functions to receive, retain, and nourish the ovum

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The Uterus

• In a pre-menopausal woman who has never been pregnant, the uterus is about the size and shape of an inverted pear

• It is usually somewhat larger in woman who have borne children

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The Uterus• Normally, the

uterus is fixed anteriorly where it joins the vagina, causing the uterus as a whole to be inclined forward or anteverted

• However, the uterus is often turned backward, or retroverted in older woman

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 The long axis of the uterus usually lies approximately in the axis of the superior pelvic aperture, but as the organ is freely movable its position varies with the state of distension of the bladder and rectum.

It forms a forward angle with the vagina, since the axis of the vagina corresponds to the axes of the cavity and inferior aperture of the pelvis.

Anteversion is the forward angle between axis of cervix and that of vagina. It is 90 degrees.

Anteflexion is the forward angle between the body and cervix at the isthmus. It is 125 degrees.

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AntevertedAnteflexed

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The Uterus

• The main portion of the uterus is referred to as the body • The rounded region superior to the entrance of the uterine

tubes is the fundus, and the slightly narrowed region is the isthmus

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The Uterus

• The cervix of the uterus is its narrow neck, or outlet, which projects into the vagina inferiorly

• The cavity of the cervix, called the cervical canal, communicates with the vagina via the external os

• The internal os opens into uterine body

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The Uterus

• The mucosa of the cervical canal contains cervical glands that secrete a mucus that fills the cervical canal and covers the external os, to block the spread of bacteria from the vagina into the uterus

• Cervical mucus also blocks the entry of sperm, except at midcycle, when it becomes less viscous and allows sperm to pass through

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• Cancer of the cervix is common among women between ages of 30 and 50

• Risk factors include frequent cervical inflammations, sexually transmitted diseases including genital warts, and multiple pregnancies

• The cancer cells arise from the epithelium covering the cervical tip

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• In a Papanicolaou (Pap) smear, or cervical smear test, some of these epithelial cells are scraped away and then examined for abnormalities

• A Pap smear is the most effective way to detect this slow-growing cancer

• Woman are advised to have a Pap smear every year

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Supports of the Uterus

• The uterus is supported laterally by the broad ligament • Inferiorly, the lateral cervical (cardinal) ligaments extend

from the cervix and superior part of the vagina to the lateral walls of the pelvis

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Supports of the Uterus

• The paired uterosacral ligaments secure the uterus to the sacrum posteriorly

• The uterus is bound to the anterior wall by the fibrous round ligament, which runs through the inguinal canals to anchor in subcutaneous tissue

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Supports of the Uterus

• These various ligaments allow the uterus mobility, and its position changes as the rectum and bladder fill and empty

• The principle support of the uterus is provided by muscles of the pelvic floor, namely the muscles of the urogenital and pelvic diaphragms

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Uterus: Homeostatic Imbalance• These muscles are

sometimes torn during childbirth

• The unsupported uterus may sink inferiorly, until the tip of the cervix protrudes through the vaginal opening

• This condition is called a prolapse of the uterus

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The Uterus• The peritoneum

around covers the various pelvic structures and produces several blind ended peritoneal pouches

• The most important of these pouches are the vesicouterine pouch between the bladder and the uterus

• The rectouterine pouch lies between the rectum and the uterus

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The Uterine Wall

• The wall of the uterus is composed of three layers; the perimetrium, myometrium and endometrium

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The Uterine Wall

• The wall of the uterus– The perimetrium is the outermost serous layer

composed of visceral peritoneum– The myometrium is the bulky middle layer,

composed of interlacing bundles of smooth muscle. It is the myometrium that contracts during childbirth to expel the baby

– The endometrium is a simple columnar epithelium underlain by a thick lamina propria of highly cellular connective tissue

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Vascular supply of the uterus

• The uterine arteries arise from the internal iliac in the pelvis, ascend along the sides of the uterus and send branches into the uterine walls

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The Vagina• The vagina is a

thin-walled tube 8-10 cm / 3-4 in. long

• It lies between the bladder and the rectum and extends from the cervix to the exterior of the body

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The Vagina• The urethra is

embedded in its anterior wall

• Often called the birth canal, the vagina provides a passageway for delivery of an infant or for menstrual flow

• The vaginal mucosa has no glands; it is lubricated by the cervical mucus glands

urethra

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The Vagina

• The vaginal orifice forms an incomplete partition called the hymen

• The upper end of the vaginal canal loosely surrounds the cervix of the uterus, producing a vaginal recess called the vaginal fornix

• The posterior part of this recess, the posterior fornix, is much deeper than the lateral and anterior fornices

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The Vagina• Generally, the

lumen of the vagina is quite small and, except where it is held open by the cervix, its posterior and anterior wall are in contact with one another

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The Mammary Glands

• The mammary glands are present in both sexes, but they normally function in females only.

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The Mammary Glands

• Since the biological role of the mammary glands is to produce milk to nourish a newborn baby, they are actually important only when reproduction has already been accomplished

• Developmentally, mammary glands are modified sweat glands that are really part of the skin, or integumentary system

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The Mammary Glands• Each mammary gland

is contained within a rounded skin- covered breast anterior to the pectoral muscles of the thorax

• Slightly below the center of each breast is a ring of pigmented skin, the areola, which surrounds the central protruding nipple

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The Mammary Glands

• Large sebaceous glands in the areola make it bumpy and produce sebum that reduces chapping and cracking of the skin of the nipple

• Autonomic nervous system controls of smooth muscle fibers in the areola and nipple and cause the nipple to become erect when stimulated by contact or sexual stimuli and when exposed to the cold

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The Mammary Glands• Internally, each

mammary gland consists of 15 to 25 lobes that radiate around and open at the nipple

• The lobes are separated by fat and fibrous connective tissue

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• The interlobar connective tissue forms suspensory ligaments that attach the breast to the underlying muscle fascia and to the over- lying dermis

• The suspensory ligaments( lig of Cooper ) provide natural support for the breasts

• Within the lobes are smaller units called lobules which contain glandular alveoli that produce milk when lactating

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• These compound alveolar glands pass milk into the lactiferous ducts, which open to the outside at the nipple

• Just deep to the areola, each lactiferous duct has a dilated region called a lactiferous sinus

• Milk accumulates in these sinuses during nursing

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The Mammary Glands

• In nonpregnant women, the glandular structure of the breast is largely undeveloped and the duct system is rudimentary

• Breast size is largely due to the amount of fat deposits

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Breast Cancer• Invasive breast cancer, the most

common malignancy of women

• Breast cancer usually arises from the epithelial cells of the ducts, not from the alveoli

• A small cluster of cancer cells grows into a lump in the breast from which cells eventually metastasize

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Breast Cancer

• Known risk factors for developing breast cancer include– Early onset menses and late menopause– No pregnancies or first pregnancy late in life– Previous history of breast cancer– Family history of breast cancer (especially in

a sister or mother)

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Breast Cancer• Breast cancer is often signaled by a

change in skin texture, puckering, or leakage from the nipple

• Early detection by breast self-examination and mammography is the best way to increase one’s chances of surviving breast cancer

• Since most breast lumps are discovered by women themselves in routine monthly breast exams this should be a priority