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The uterus
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External genitalia

  1. 1. EXTERNAL GENITALIA Britto.v Lecturer in nursing
  2. 2. INTRODUCTION • The generative (reproductive ) organs in the female are those concerned with copulation , fertilization, growth and development of the fetus , its subsequent exit into the outer world and nurture following birth. The generative organs constitute the external genitalia , the internal genital organs and the accessory reproductive organs.
  3. 3. EXTERNAL GENITALIA • The vulva or pudendum includes all the visible external genital organs in the perineum. Vulva consists of the following: • The mons pubis or mons veneris • Labia majora (greater lips) • Labia minora (lesser lips) • Hymen • Clitoris • Vestibule -Urethral openings and skene’s glands -the vaginal orifice or introitus -openings of Bartholin’s glands
  4. 4. MONS VENERIS (MONS PUBIS): • It is the pad of subcutaneous adipose connective tissue lying over the symphysis pubis. • It is covered with pubic hair from the time of puberty.
  5. 5. LABIA MAJORA: • These are two folds of fat and areolar tissue, covered with skin and pubic hair on the outer surface. • The inner surface of the labia majora are hairless. • The labia majora are covered with squamous epithelium and contain sebaceous glands, sweat glands, and hair follicles. • The adipose tissue is richly supplied with venous plexus, which may produce haematoma, if injured during childbirth. • The labia majora arise from the mons veneris and merge into the perineum behind. • The round ligaments terminate at its upper borders.
  6. 6. • Beneath the skin , there is dense connective tissue and adipose tissue. • The adipose tissue is richly supplied with venous plexus which may produce haematoma, if injured during childbirth. • The labia majora are homologus to the scrotum in the male. • The round ligament terminates at its upper border.
  7. 7. LABIA MINORS: • These are two thin folds of skin lying between the labia majora. • Anteriorly they divide to enclose the clitoris; posteriorly they fuse , forming the fourchette. • It is usually lacerated during childbirth. • Between the fourchette and the vaginal orifice is the fossa navicularis. • The labia minora do not contain hair folllicles. • The folds contain connective tissue, numerous sebaceous glands, erectile muscle fibers and numerous vessels and nerve endings.
  8. 8. CLITORIS: • It is a small cyclindrical erectile body, measuring about 1.5-2.5 cm situated in the most anterior part of the vulva. • It is a rudimentary organ corresponding to the male penis, but differs basically in being entirely separate from the urethra. • It is attached to the under surface of the symphysis pubis by the suspensory ligament. • It is extremely sensitive and highly vascular and plays a role in the orgasm of sexual intercourse.
  9. 9. VESTIBULAR: • It is a triangular space bounded anteriorly by the clitoris, posteriorly by the fourchette and on either side by labia minora. There are four openings into the veatibule. • Urethral opening & sken’s glands • Vaginal orifice or introitus • Openings of bartholins glands
  10. 10. • Uretheral opening: - The opening is situated in the midline just infront of the vaginal orifice about 2.5 cm posterior to the clitoris . - The skene’s glands open on either side of the uretheral orifice. • The vaginal orifice or introitus: - It occupies the posterior two-thirds of the vestibule and is of varying size and shape. - In virgins and nulliparae, the opening is closed by the labia minora, but in parous women , it may be exposed. - It is completely closed by a septum of mucous membrane, called hymen. - The membrane varies in shape, but is usually circular or crescentic in virgins. - The hymen is usually ruptured at the consummation of marriage. - During childbirth , the hymen is extremely lacerated and is known as the carunculae myrtiformes. - On both side it is lined by stratified squamous epithelium.
  11. 11. • Openings of bartholin’s glands: - Ther are two bartholin’s glands (greater vestibular glands), one on each side . - They open on either side of the vaginal orifice and lie in the posterior part of the labia majora. - They are open on either side of the vaginal orifice and lie in the posterior part of the labia majora. - They are pea-shaped and yellowish white in color. - During sexual excitement , it secretes abundant alkaline mucus, which helps in lubrication. - Each gland has a duct, which measures about two centimetres and opens into the vestibule outside the hymen. - The duct is lined by columnar epithelium.
  12. 12. BLOOD SUPPLY • This comes from the internal and external pudendal arteries. • The blood drains through the corresponding veins
  13. 13. LYMPHATIC DRAINAGE • Lymphatics drain into the inguinal lymph nodes and internal iliac lymph nodes
  14. 14. NERVE SUPPLY • This is from the branches of pudendal nerve. • Anterior part is supplied by the genito femoral nerve and postero-inferior part by the pudendal branches from the posterior cutaneous nerve of thigh. • The vulva is supplied by the labial and perineal branches of the pudendal nerve.
  15. 15. INTERNAL ORGANS • The vagina • The uterus • The uterine tubes • The ovaries • Accessory reproductive organs
  16. 16. INTERNAL GENITAL ORGANS • THE VAGINA: -vagina is a fibromusculo-membrane sheath connecting the uterine cavity with the exterior at the vulva. - It is a passage, which allows the escape of menstrual flow and uterine secretions. - It receives the penis and the ejected sperm during sexual intercourse and provide an exit for the fetus during delivery. - The canal is directed upward and backward forming an angle of 45 degrees with the horizontal in erect posture. - The long axis of the vagina almost lies parallel to the plane of the pelvic inlet and at right angles to that of the uterus. - The diameter of the canal is about 2.5 cm , being wider in the upper part and narrowest at the introitus. - It has enough power of distensibility as evidence during childbirth.
  17. 17. VAGINAL WALLS - Vagina has an anterior , a posterior and two lateral walls. - The anterior and posterior walls are apposed together but the lateral walls are comparatively stiffer specifically at its middle as such it looks H shaped on transverse section . - The length of the anterior wall is about 7cm and that of the posterior wall is about 9cm.
  18. 18. RELATIONS - Anterior : in front lie the bladder and urethra , which are closely connectd to the anterior vaginal wall. - Behind : the pouch of douglas, the rectum and the perineal body each occupy opprximately one-third of the posterior vaginal wall. - Lateral : beside the upper two-thirds are the pelvic fascia and ureters, while beside the lower third are the muscles of the pelvic floor. - Superior : above the vagina lies the uterus. - Inferior : below the vagina lies the external genitlia.
  19. 19. STRUCTURE - The posterior wall is 10cm long while the anterior wall is only 7 cm because the cervix projects at the right angles into its upper part. - The upper part of the vagina is known as the vault. - Where the cervix projects into it, the vault forms a circular recess, which is described as its 4 fornices. - The posterior fornix is the largest of these because the vagina is attached to the uterus at a higher – level behind than in front. - The vaginal walls are pink in appeareance and thrown into small folds known as rugae. - These allow the vaginal walls to stretch during intercourse and childbirth.
  20. 20. LAYERS - The lining of the vagina is made of squamous epithelium. - Beneath the epithelium lies a layer of vascular connective tissue. - The muscle layer has a weak inner coat of circular fibres and a stronger outer coat of longitudinal fibres. - Pelvic fascia surrounds the vagina , forming a layer of connective tissue.
  21. 21. CONTENTS - There are no glands in the vagina. - It is moistened by mucous from the cervix and a transudate , which seeps out from the blood vessels of the vaginal wall. - The vaginal fluid is strongly acid (p.H 4.5 cm) due to presence of lactic acid formed by the action of doderline’s bacilli on glycogen found in the squamous epithelium of the lining. - These bacilli are the normal inhabitants of the vagina. - The acid deters the growth of pathogenic bacteria.
  22. 22. BLOOD SUPPLY - This comes from the branches of the internal illaic artery and includes the vaginal artery and a descending branch of the uterine artery. - The blood drains through the corresponding veins.
  23. 23. LYMPHATIC DRAINAGE - This is via the inguinal , the internal iliac and the sacral glands.
  24. 24. NERVE SUPPLY - Sympathtetic and parasympathetic nerves from the pelvic plexus supply the vagina. - The pudendal nerve supplies the lower part.
  25. 25. THE UTERUS Position : - It is situated in the cavity of the true pelvis, behind the bladder and in front of the rectum. - It means forward which is termed as anteversion and it bends forwards on itself , which is termed as anteflexion. - In standing positions , a womens uterus is in horizontal position with the fundus resting on the bladder.
  26. 26. Relations - Anterrior : the uterovesical pouch and the bladder. - Posterior : the rectouterine pouch of douglas and the rectum. - Lateral : the broad ligaments, the uterine tubes and the ovaries - Superior : the intestines - Inferior : the vagina
  27. 27. SUPPORTS - The utreus is supported by the pelvic floor and maintained in position by several ligaments. - The transverse cervical ligaments extend from the sides of the cervix to the sidewalls of the pelvis . - They are known as the cardinal ligaments or the mackenrodt’s ligaments. - The uterosacral ligaments pass backward from the cervix to the sacrum. - The pubocervical ligaments pass forward from cervix under the bladder to the pubic bones. - The broad ligaments formed from the folds of peritonium, which are draped over the uterine tubes.
  28. 28. STRUCTURE - The nonpregnant uterus is a hollow , muscular , pear- shaped organ situated in the true pelvis. - It is 7.5cm long, 5cm wide, and 2.5 cm deep. - Each wall measures 1.25 cm . The uterus has the following parts: - The body or corpus: makes up the upper two-thirds of the uterus - The fundus: the domed upper wall between the insertions of the uterine tubes. - The cornua: the upper outer angles of the uterus where the fallopian tubes join. - The corpus or the body: lies between the openings of the tubes and the isthumus. - The cavtiy: a potential space between the anterior and posterior walls. It is triangular in shape, the base of the triangle being uppermost. - The isthumus : it is a narrow area between the cavity and the cervix, which is 7mm long. It enlarges during pregnancy to form the lower uterine segment.
  29. 29. - The cervix: protrudes into the vagina. The upper half which is above the vagina, is termed as the supravaginal portion while the lower half is the infravaginal portion. - The internal os: it is the narrow opening between he isthumus and the cervix. - The external os: a small round opening at the lower end of the cervix. After childbirth this is seen as a transverse slit. - The cervical canal: lies between the internal os and externl os . The canal is a continuation of the uterine cavity and is shaped like a spindle narrow at each end and wider in the middle.
  30. 30. LAYERS The uterus has 3 layers , of which the middle layer is the thickest. The from inside outwards are endometrium , myometrium and perimetrium. - Endometrium : this forms a lining of ciliated epithelium on a base of connective tissue or stroma. As there is no submucous layer , the endometrium is directly apposed to the muscle coat. In the uterine cavity , the endometrium is constantly changing in thickness through the menstrual cycle.
  31. 31. • Myometrium : it consists of thick bundle of smooth muscle fibres held by connective tissues and are arranged in various directions. It is thick in the upper part of the uterus and is more sparse in the isthumus and cervix. • Peritonium : it is a double serous membrane , an extension to the peritonium , which is draped over the uterus , covering all but a narrow strip on either side and the anterior wall of the supravaginal cervix from where it is deflected up over the bladder.
  32. 32. BLOOD SUPPLY -blood supply to the organs is thorugh the uterine artery and ovarian artery. - The uterine aretery is branch of the internal iliac artery and enters at the level of the cervix. - The ovarian artery is a branch of the abdominal aorta. It supplies the ovaries and uterine tubes. - The blood drains through corresponding veins.
  33. 33. NERVE SUPPLY • This is mainly from the autonomic nervous system, the sympathetic and parasympathetic system via pelvic plexus.
  34. 34. FUNCTIONS • The uterus serves to shelter the fetus during pregnancy . It prepares for this possibility each month. At the termination of pregnancy it expels the uterine contents.
  35. 35. THE UTERINE TUBES • Position : the uterine tubes or fallopian tubes extend laterally from the cornua of the uterus towards the sidewalls of the pelvis. They arch over the ovaries the fringed ends hovering near the ovaries in order to receive the ovum. They are attached to the broad ligament by two layers of peritonium, called the mesosalpinx. Each tube is about 10- 11.5 cm long.
  36. 36. RELATIONS • Anterior , posterior and superior : the peritoneal cavity and the intestines. • Lateral : the sidewalls of the pelvis • Inferior : the broad ligaments and the ovaries • Medial : the uterus lies between the two uterine tubes.
  37. 37. SUPPORTS • The uterine tubes are held in place by their attachment to the uterus. The broad ligaments and the infundibulopelvic ligaments support them.
  38. 38. STRUCTURE • Length of each tube is 10cm. The lumen of the tube provides a pathway to the peritoneal cavity. The uterine tube has 4 portions. • THE INTERSTITIAL PORTION: it is 1.25cm long and lies within the wall of the uterus. The lumen is 1cm wide. • THE ISTHUMUS: the narrow part that extends from the uterus and measures 2.5cm. • THE AMPULLA: the wider portion that is 5cm long. Fertilization usually occurs in ampulla. • THE INFUNDIBULUM: the funnel- shaped , fringed end of the tube , which is composed of many processes known as fimbriae. One fimbria is attached to the ovary. • THE INTRAMURAL PART: 1cm long and runs through the uterine wall.
  39. 39. BLOOD SUPPLY • This is via the uterine and ovarian srteries, returning by the corresponding veins.
  40. 40. LYMPHATIC DRAINAGE • This is to the lumbar glands.
  41. 41. FUNCTIONS • The uterine tube propels the ovum towards the uterus, receives the spermatozoa as they travel upward and provide a site for fertilization.
  42. 42. THE OVARIES • POSITION : -the ovaries or the or the female gonads are situated one on each side of the uterus and are attached to the back of the broad ligament within the peritoneal cavity.
  43. 43. RELATIONS • Anterior : the broad ligaments. • Posterior :the intestines. • Lateral : the infundibulopelvic ligaments and the sidewalls of the pelvis. • Superior : the uterine tubes • Medial : the uterus and the ovarian ligament.
  44. 44. SUPPORTS • The ovarian ligaments from above and the infundibulopelvic ligaments laterally support the ovaries. They are attached to the broad ligament.
  45. 45. STRUCTURE • The ovary is almond shaped and is about 3cm long, 1.5cm wide and 1cm thick. It is composed of a medulla and a cortex and is covered with germinal epitheilium. The ovarian blood vessels , lymphatics and nerves pass through medulla. The hilum (opening ) where the vessels enter the ovary , is called the mesovarium. • The cortex is the functioning part of the ovary. It contains the ovarian follicles in different stages of development surrounded by stroma . The outer layer is formed of fibrous tissue and is known as the tunica albugenia.
  46. 46. BLOOD SUPPLY • The blood supply is from the ovarian arteries and venous drainage through the ovarian veins. The right ovarian through the ovarian vein joins the inferior vena cava and the left returns its blood to the left renal vein.
  47. 47. LYMPHATIC DRAINAGE • This is to the lumbar glands.
  48. 48. NERVE SUPPLY • This comes from the ovarian plexus.
  49. 49. FUNCTIONS • The ovaries produce ova and the hormones estrogen and progestrone.
  50. 50. ACCESSORY REPRODUCTIVE ORGANS • BREASTS : - The breasts are bilateral glandular structures, which are concerned with lactation following childbirth. The shape of breasts varies in women and in different periods of life. They usually extends from the second to the 6th rib in the midclavicular line. They lie in the subcutaneous tissue over the fascia covering the pectoralis major and in some women beyond that over the serrate anterior and external oblique.
  51. 51. STRUCTURE • The areola is situated about the centre of the breast and is pigmented. It is about 2.5 cm in diameter and has numerous sebaceous glands over it. The nipple is a muscular projection covered by pigmented skin. It is vascular and surrounded by unstriped muscles that make it erectile. The nipple contains about 15-20 lactiferous ducts and their openings. The whole breast is embedded in the subcutaneous fat. The fat is absent beneath the nipple and areola.
  52. 52. BLOOD SUPPLY • Blood supply to the breasts is from the branches of the internal mammary artery, the auxiliary artery and the intercostals arteries. Superficial veins of the breasts drain into the internal mammary veins. Veins emptying into internal mammary, auxiliary and intercostals veins serve deep breast tissue.
  53. 53. NERVE SUPPLY • The 3rd and 4th branches of the cervical plexus provide the cutaneous nerve supply to the upper breast and thoracic intercoastals nerves to the lower breast.