Normal And Abnormal Development Of Female Genital Tract Dr Khalid Sait FRCSC A. Prof Gynecologist Oncologist

Embryology Baby sex established at the time of fertilization ( sperm meet ovum ) sperm 46 xy ovum 46 xx (23x + 23 y) (23 x + 23 x) Girl Boy

Genetic sex XX / XY Gonadal sex Testes / Ovaries Hormones Internal genitalia External genitalia

Embryology Gonads appear as genital ridges by proliferation of coalemic epithelium(mesoderm) Primordal germ cell appear in the endodermal cell in the wall of yolk sac , migrate along the mesentery of hindgut and invade the genital ridges At 7 weeks the gonads of embryo: indistinguishable male and female ( indifferent gonad) At 8 weeks if xx ----- Ovary xy------- Testis

Embryology Ovary Gonadal ovary : medullary cord degenerate and cortical cord develop Germ cells ----oogonia 11-12 w : onset of oogenesis 20 w : 7 million germ cells in each ovary Birth : 2 millions Puberty : 40,000 primary oocytes remaining in the ovaries. Only 400 ------------- secondary oocytes and extended at ovulation once every month during menst. Cycle. Descend of ovary is not an active migration, but result of rapid growth of body and failure of gubernaculum to elongatee ( that why its maintain blood supply from the aorta

Congenital Uterine Anomaly Precise incidence is unknown (range from 1-2 %)  Clinical presentation: 1 Usually asymptomatic 2 Menstrual disorder 3  Dysmenorrhea 4  Recurrent abortion ( decrease intrauterine volume and vascularity, increase uterine irritability and cervical incompetance ) 5 Premature labor 6 Abnormal presentation 7 Primary infertility 

Congenital Uterine Anomaly Diagnosis:  History Pelvic exam Hysterosalpingography U/S MRI Laproscopy Hysteroscopy IVP or U/S (Exclude Renal anomaly )

Congenital Uterine Anomaly Treatment:  1-   Double uterus (didelphic uterus): no need to treat. 2-   Bicornate ut. --------- Strassmann procedure ( if indicated ) 3-   Ut. Septum --------- (BCP for dysmenorrhea ), Tompkins metroplasty or Hysteroscopic resection of septum ) 4-   Unicornate ut. -------- Surgery indicated if there is blind horn which cause symptom----- surgical resection of blind horn.

Mullerian Agenesis Mayer Custer Hauser Rokitansky Syndrome 1: 4000  1: 4000  Abscent upper vagina, cervix and uterus and tubes Normal ovaries and vulva  Associated with spine and renal anomaly  Treatment: McIndoe procedure Self dilatation of vagina 

Vaginal Agenesis 1: 5000 Normal Vulva Ass. With spine, renal and middle ear anomaly  Treatment:  Karyotype, U/S - MRI ( only 5 % will have normal functioning uterus) Once patient sexually active 1-   Gradual vaginal dilatation against vaginal dimple (daily for 20-30 mint for few month with gradual dilators size. 2-   William procedure 3-   Wharton and Macindo procedure  

Transverse Vaginal Septum Mid vagina usually  May be partial or complete  Presentation:  Primary amenorrhea Dysparonia  Treatment:  Surgical resection  

Adult Equivalents of Embryonic Structures Female Embryonic Structure ovary Indifferent gonad ovarian follicles Cortex rete ovarii Medulla ovarian and round ligament of uterus Gubernaculum epoophoron, paroophoron Mesonephric tubules appendix vesiculosa, duct of epoophoron, duct of Gartner, ureter, pelvis, calices and collecting tubules Mesonephric Duct hydatid of Morgagni, uterine tube, uterus Paramesonephric Duct urinary bladder, urethra, vagina, urethral, paraurethral and greater vestibular glands Urogenital Sinus hymen Sinus tubercle clitoris Phallus labia minora Urogenital folds labia majora Labioscrotal swellings

Imperforated Hymen Presentation: Primary Amenorrhea Pelvic mass Treatment:  Cuciate incision at hymen  Follow up  Endometrosis  Vaginal adenosis