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Anatomy of female genital tract

  3. The VULVA or pudendum, is the collective term for female genitalia . The vulva consists of the following organs: mons pubis, labia minora and majora, clitoris, vestibule, Skene glands, greater vestibular (Bartholin) glands, orifice of vagina, bulb of vestibule. The boundaries include the mons pubis anteriorly, the rectum posteriorly, and the genitocrural folds (thigh folds) laterally.
  4. MONS PUBIS  It is a rounded, hair-bearing elevation of skin, found anterior to pubic symphysis.  Pubic hair in the female has an abrupt horizontal margin.
  5. LABIA
  6. The labia majora are 2 large, longitudinal folds of adipose and fibrous tissue. They vary in size and distribution from female to female, and the size is dependent upon adipose content. They extend from the mons to 2.5cm from the anus. The labia majora have hair follicles. Anteriorly unite and form anterior labial commisure Posteriorly separated by posterior labial commisure.
  7. The labia minora, also known as nymphae, are 2 smaller cutaneous folds that lie between the labia majora . They consist of core of spongy tissue with blood vessels and sensory nerve endings. Anteriorly, the labia minora join to form the frenulum/clitoral hood/anterior prepuce above the clitoris. The L.minora enclose the vestibule and unite posteriorly in the abrupt fold called the fourchette.
  8. CLITORIS The clitoris is an erectile body.  Its width is approx.1 cm, with length of 2–3 cm.  The clitoris is made up of a root, a body composed by 2 crura, 2 corpora cavernosa, and a glans (squamous epithelium). It is innervated by the dorsal nerve of the clitoris, a terminal branch of the pudendal nerve.
  9.  The area between the inner aspects of the labia minora and bounded anteriorly by clitoris and posteriorly by the fourchette.  Structures that open in the vestibule are:  Urethra  The Bartholin’s glands ducts.  The vagina.  Skene’s glands.  Vestibular bulbs lie beneath mucus membrane of vestibule on either side of vagina and urethra. 3-4cm long, 1-2cm wide, 0.5-1cm thick. VESTIBULE
  11. Bartholin Glands: (Greater Vestibular Glands): bilateral compound racemose glands, 0.5 -1 cm diameter. situated deep in the labia majora, at the junction of the posterior and the middle thirds Its duct - 2 cm long and opens between the hymen and the labium minus responsible for secreting lubrication during sexual excitement . Have cells of endocrine function - secrete Serotonin, Calcitonin , HCG. Frequent site of abscess or cyst formation.
  12. Skene’s duct:  2 blindly ending para -urethral tubules open in the floor of the urethra, few millimetres from the external urethral meatus  Opening: 0.5mm diameter.
  13. HYMEN: a membrane, situated about 2 cm from the vestibule that demarcates the external from the internal genital organs, and partially closes the vaginal orifice.
  14. BLOOD SUPPLY  Arteries - Branches from Femoral artery and Internal pudendal and External pudendal artery.  Veins drain into corresponding external and internal pudendal veins. NERVE SUPPLY OF THE VULVA  Anterior - Ilioinguinal and Genitofemoral nerves.  Posterior- labial branch of Perineal nerve, branch of Pudendal nerve, perineal branches of femoral cutaneous nerve of thigh. LYMPHATIC DRAINAGE Medial group of superficial inguinal lymph nodes Deep inguinal and internal iliac lymph nodes.
  16. The VAGINA ,musculomembranous tube extends from the vulva externally to the uterine cervix internally. 7-9 cm long.  It is located within the pelvis, anterior to the rectum and posterior to the urinary bladder. Anterior and posterior walls in apposition except at superior end where anterior wall pierced by cervix.
  17. VAGINAL FORNICES: The cervix projects into the upper blind end of the vagina  forms a pouch (vaginal pouch) around the cervix  divided into four fornices : two lateral, anterior and posterior (deeper) fornices.
  18. HISTOLOGY OF THE VAGINA The cut section of the vagina is “H” shaped with approximation of the anterior to the posterior vaginal walls. It is formed of 3 layers; mucosa, formed of stratified squamous non- keratinised epithelium without glands, musculosa, which is fibromuscular with some fibres from the levator ani inserted into it, adventitia, which is connective tissue Lactobacilli + in vagina, Acidic pH ~ 4.5 , provides protection
  19. ANATOMICAL RELATIONS OF THE VAGINA ANTERIORLY: Upper 1/3 : urinary bladder Lower 2/3 : urethra. POSTERIORLY: Upper 1/3 : pouch of Douglas. Middle 1/3: ampulla of rectum. Lower 1/3 : the perineal body. LATERALLY: Upper part : ureters Middle part : levator ani muscle anterior fibres Lower end: urogenital diaphragm and vestibular bulb
  20. BLOOD SUPPLY Arterial supply: The vaginal artery (from internal iliac artery or uterine artery) Additional branches from: Middle rectal artery (both from internal iliac artery) Internal pudendal artery Venous drainage:  A plexus around the vagina (the vaginal plexus), drain - internal iliac vein
  21. The NERVE SUPPLY to the vagina is primarily from the autonomic nervous system(UV plexuses). Sensory fibers to the lower vagina arise from the pudendal nerve, and pain fibers are from sacral nerve roots.  LYMPHATIC DRAINAGE of the vagina - external iliac nodes (upper third of the vagina), - common and internal iliac nodes (middle third), - superficial inguinal nodes (lower third).
  22. The UTERUS, inverted pear-shaped female reproductive organ within the pelvis between the bladder and the rectum. It is thick-walled, hollow, muscular organ lining changes in response to hormone stimulation throughout a woman’s monthly cycle. 7-8 cm long, 5-7 cm wide, 2-3 cm thick.
  23. upper muscular part- the BODY (corpus uteri) lower fibrous part - the CERVIX Between these 2 is the ISTHMUS, a fibro muscular short area of constriction (internal ostium). Before puberty, body: cervix 1:1 in adulthood, 2:1 or 3:1
  24. THE CORPUS UTERI: Body that lies above the internal os Cornu = the area of insertion of the fallopian tubes Fundus lies above the insertion of the tubes. Three structures are attached to the cornu Round ligament anteriorly, Fallopian tube centrally, Ovarian ligament posteriorly
  25. THE CERVIX:  2.5 cm long. Divided into supravaginal portion vaginal portion The cervical canal is the cavity that communicates above with the uterine cavity at the internal os and below with the vagina at the external os. The external os is round in nulliparas and transverse slit shaped in multiparas. Supravaginal part expands after 24 weeks gestation - lower uterine segment.
  26. RELATIONS OF THE BODY OF THE UTERUS Anteriorly: The bladder and vesicouterine pouch. Posteriorly: The pouch of Douglas(rectouterine pouch). Laterally: The broad ligament on each side
  27. HISTOLOGY OF THE UTERUS Three layers: 1. Endometrium (mucosa) 2. Myometrium (musculosa) 3. Perimetrium or the peritoneal covering
  28. Endometrium:  columnar epithelium resting on thick lamina propria made of connective tissue called endometrial stroma. Contains tubular endometrial glands. Shows cyclic changes with the menstrual cycle under the influence of ovarian hormones
  29. Myometrium Three layers -outer longitudinal muscle layer -middle layer of interlacing criss-cross muscle fibres surrounding the blood vessels -inner circular muscle layer
  30. Perimetrium: (peritoneal covering) Anteriorly: firmly attached to the fundus and body till the isthmus, becomes loose , is reflected on the superior surface of the urinary bladder forming the vesicouterine pouch. Posteriorly: firmly attached to the fundus, body, cervix, and posterior vaginal fornix then is reflected on the pelvic colon forming the Douglas pouch. Laterally: the anterior and posterior peritoneal coverings blend as the anterior and posterior layers of the broad ligaments.
  31. HISTOLOGY OF THE CERVIX Endocervix: Lined by simple columnar epithelium with compound racemose glands or crypts prone chronic infection. It secretes alkaline cervical mucus. Muscle layer: Outer longitudinal and inner circular muscles. Ectocervix: stratified squamous epithelium covers outer portion of the cervix. The junction between squamous and columnar epithelium at the external os may form a transitional zone 1-3 mm - transformation zone.
  32. The uterine vessels arise from the anterior division of the internal iliac. BLOOD SUPPLY The ascending branches-upwards in a tortuous manner parallel to the lateral border of the uterus between the broad ligament anastomoses with branches of ovarian arteries near the uterine cornu. The descending cervical branch – Cervix.
  33. VENOUS DRAINAGE: Starts as a plexus between the 2 layers of the broad ligament (Pampiniform plexus) that communicate with the vesical plexus and drains into the uterine and ovarian veins.
  34. LYMPHATIC DRAINAGE: -Fundus: To the para-aortic lymph nodes -Cornu: To the superficial inguinal lymph nodes -Body: To the internal then external iliac lymph nodes -Isthmus and Cervix: Two groups of lymphatics: Primary groups: Paracervical (1st), parametrial, obturator, internal and external iliac nodes. Secondary groups: Common iliac, para-aortic, and lateral sacral lymph nodes.
  35. NERVE SUPPLY Sympathetic from T12 and L1 Uterine contraction and vasoconstriction Parasympathetic from S2,3,4 Inhibits uterine contractions and causes vasodilatation. Both reach the uterus through branches of inferior hypogastric and ovarian plexus.
  36. THE FALLOPIAN TUBE 2 tortuous tubes (10-12 cm in length) lie in the free upper part of the broad ligament ( mesosalphinx ). INFUNDIBULUM(3mm wide) AMPULLA(more than half of tube length, wider lumen) ISTHMUS(0.1-0.5mm,thickest) INTRAMURAL(1-2mm)
  37. HISTOLOGY OF THE FALLOPIAN TUBES Mucosa (endosalpnix): Composed of secretory and ciliated columnar cells. Invaginated into folds called major plicae with 2⁰ and 3⁰ folds. Muscle layer: Outer longitudinal and inner circular involuntary smooth muscles. Thick - isthmus and thin - ampulla. Serosa (peritoneal covering): The extrauterine part is covered by peritoneum in the upper margin of the broad ligament.
  38. ARTERIAL SUPPLY: Tubal branches of uterine and ovarian arteries. VENOUS DRAINAGE: Tubal branches into uterine and ovarian veins LYMPHATIC DRAINAGE: para-aortic LNs NERVE SUPPLY ovarian and uterine plexuses. Afferent fibres inT11,T12,L1 nerve roots.
  40. The ovary is bounded medially by the Fallopian tube, laterally by the lateral pelvic wall. superiorly and anteriorly it is surrounded by the small intestine inferiorly by the ovarian fossa where the ureter and the internal iliac vessels pass. ANATOMICAL RELATIONS
  41. Blood supply to the ovary is via the ovarian artery;  Both right and left ovarian arteries originate directly from the descending aorta at the level of the L2 vertebra. The ovarian artery and vein enter and exit the ovary at the hilum. LYMPHATIC DRAINAGE pre-aortic and para-aortic LNs.
  42. The left ovarian vein drains into the left renal vein, and  the right ovarian vein empties directly into the inferior vena cava. NERVE SUPPLY Ovarian plexus nerves communicates with uterine plexus. Sympathetic fibers -from T10-T11 . Parasympathetic fibers - vagus nerve.
  43. VIRAL INFECTIONS HERPES SIMPLEX VIRUS 1 and 2 HPV cervicitis, urethritis, vaginal discharge Genital warts, or Condylomata acuminate
  44. BACTERIAL INFECTIONS SYPHILIS( T.pallidum ) cervix,vagina,vulva GONORRHEA( N.gonorrhoea ) spares vulva, vagina,bladder Endocervicitis-block cervical glands- retention cysts/Nabothian follicles, protrude into vaginal part of cervix. Acute skenitis- tenderness, bead of pus at orifice Acute bartholinitis - pain, difficulty to walk, heaviness of genitalia Acute gonococcal vulvitis- edema, erythema, tenderness of labia Chlamydia trachomatis Asympt. cervicitis or urethritis, PID, ectopic pregnancy, infertility
  45. LymphogranulomaVenereum (Chlamydia trachomatis biovars L-1,2,3) PRIMARY STAGE - transient papule, pustule, non-sp urethritis, cervicitis, salpingitis, parametritis SECONDARY STAGE/INGUINAL SYNDROME TERTIARY STAGE/GENITO ANORECTAL SYNDROME Chancroid (H.ducreyi) genital lesion with vaginal discharge, dyspareunia affects labia, clitoris, fourchette, vestibule, cervix Donovanosis /G.inguinale/ G.venereum (Calymmatobacterium granulomatis) l.minora, fourchette 4 types- ulcerogranulomatous hypertrophic, necrotic, sclerotic
  46. Bacterial Vaginosis (Gardnerella vaginalis ,Lactobacillus, Mobiluncus, Bacteroides) vaginal discharge, normal-appearing labia, introitus, cervix, and cervical discharge Trichomoniasis (T.vaginalis) asymptomatic, may have vaginal discharge, itching, punctate bleeding in cervix (strawberry cervix) Candida albicans Vulvovaginal candidiasis