The Female Genital Organs An Overview Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008

Overview Ovary Tuba uterina (Fallopian tube, oviduct, salpinx) Uterus Female genital organs Overview Ovary Tuba uterina (Fallopian tube, oviduct, salpinx) Uterus Vagina Thieme p. 202 5.17 Uterus (latin), greek: hystera or metra, cf parametrium, perimetrium Vulva = External genitalia P. Brodal 2008

Relations Suspensory ligament of the ovary Tuba uterina The ovary Female genital organs Relations Suspensory ligament of the ovary Tuba uterina The ovary Lig. ovarii proprium Lig. teres uteri Ureter Uterus Bladder Rectum Thieme 3.12 p. 160 Position of the ovary – just below the linea terminalis, on the obturator internus muscle, fossa ovarica – in the angle between the bifurcating common iliac artery Vagina Urethra Urogenital diaphragm Thieme Atlas of Anatomy, 2006 P. Brodal 2008

Peritoneum Covers the Pelvic Organs Female genital organs Peritoneum Covers the Pelvic Organs Peritoneum Excavatio rectouterina (Fossa Douglasi) Fornix posterior (vaginae) Mention tjr close relationsship to the peritonela cavity – matter acumulating in the excav., spread of cancer P. Brodal 2008

Angles and Positions of the Uterus Female genital organs Angles and Positions of the Uterus Anteversion Anteflexion P. Brodal 2008

Positions and Ligaments of the Ovary and the Uterus Female genital organs Positions and Ligaments of the Ovary and the Uterus A. Iliaca communis Lig. Suspensorium ovarii Fundus uteri Ureter Thieme 3.9 p. 154 A. obturatoria Ovary Lig. ovarii proprium Lig. teres uteri Tuba uterina Thieme Atlas of Anatomy, 2006 P. Brodal 2008

The Ligamentum Latum is a Fold of the Peritoneum Female genital organs The Ligamentum Latum is a Fold of the Peritoneum Tuba uterina Uterus Ovary Tuba Ovary Lig. latum Ligamentum latum P. Brodal 2008

Some more Terms… Perimetrium Endometrium Myometrium Parametrium Female genital organs Some more Terms… Perimetrium Endometrium Myometrium Parametrium Levator ani muscle Ischioanal fossa P. Brodal 2008

Relations in the Parametrium Female genital organs Relations in the Parametrium Uterine artery Ureter Venous plexus and nerve plexus Sobotta P. Brodal 2008

The Uterus Fundus Cavum uteri Corpus uteri Isthmus Internal os Female genital organs The Uterus Fundus Cavum uteri Corpus uteri Isthmus Internal os Cervix uteri Mention mucous plug in the cervix; changing consistency with the menstrual cycle Isthmus develops to the lower uterine segment during pregnancy (starts 3rd mont) Canalis cervicis Fornix vaginae Portio vaginalis External os P. Brodal 2008

Portio Changes after Giving Birth Female genital organs Portio Changes after Giving Birth External os Nullipara Multipara P. Brodal 2008

Lower Uterine Segment Late pregnancy Late labor Obstructed labor Female genital organs Lower Uterine Segment Late pregnancy Late labor Obstructed labor Legend of Llewellyn, 7th ed, Fig 7.9: ”(a) The lower uterine segment in late pregnancy. (b) The lower uterine segment in late labour. It has dilated circumferentially and has thinned but is shorter. (c) In obstructed labour the dilated and thinned lower uterine segment stretches and is in danger of rupture This portion of the uterus lies btw the vesicouterine fold of the peritoneum and the cervix During pregnancy the upper part of the cervix is incorporated in the LUS which stretches … in labour the entire cervix is incorporated into the LUS (next slide) Llewellyn-Jones P. Brodal 2008

Uterus in Pregnancy and after Delivery Female genital organs Uterus in Pregnancy and after Delivery Months of pregnancy 6 9 10 Days after delivery 2 5 9 Uterus during pregnancy and after birth of the child To the left: uterus in the opening period – the cervix is open to one finger; the head is fully engaged in the pelvis Mention growth of the uterus – about 1 kg at term Uterus in the opening period Benninghoff/Goerttler P. Brodal 2008

The Ovary and the Fallopian Tube Female genital organs The Ovary and the Fallopian Tube Ampulla Isthmus Infundibulum Fimbriae Infundibulum (”funnel”) opens into peritoneal cavity (1-2 cm long) Fimbriae; one large f. is attached to the ovary Abdominal opening narrow (2 mm), esp. when muscular wall contracts P. Brodal 2008

Female genital organs Fixation of the Uterus But: Dynamic muscular support is absolutely necessary to prevent descent of the uterus! Condensations of the pelvic fasciae (”ligaments”) Sacrouterine ligament Cardinal ligament P. Brodal 2008

Female genital organs Fixation cont’d P. Brodal 2008

Perineal Region The urogenital region The perineum The anal region Female genital organs Perineal Region The urogenital region The perineum Different definitions – perineum (gynecology) – the area between the vulva and the anus The anal region P. Brodal 2008

Vulva Glans clitoris Labia minora Urethral opening Labia majora Female genital organs Vulva Glans clitoris Labia minora Urethral opening Labia majora Bulbospongiosus muscle Vestibulum Bulbus vestibuli Labia minora corresponds to the skin of the penis The crura of the clitoris (extends somewhat laterally) corresponds to corpora cavernosa in the male Bulbus vestibuli corresponds to the corpus spongiosum Hymen (not present) marks the border between the internal and external genitals Glandula vestibularis major (Bartholini) P. Brodal 2008 Thieme: Atlas of Anatomy

Examination of the Bartholini’s Gland Female genital organs Examination of the Bartholini’s Gland Abscess of the left Bartholini’s gland Hamilton Bailey’s: Demonstration of physical signs in clinical surgery 1967 P. Brodal 2008

Blood supply Extensive venous plexuses Ovarian artery Uterin artery Female genital organs Blood supply Extensive venous plexuses Ovarian artery Uterin artery A. ovarica from lumbar aorta V. ovarica to v. cava inf (right), possibly to v. renalis (left) External genitals: mainly from internal pudendal artery P. Brodal 2008

Lymphatic Drainage from the Female Genital Organs Vulva: to external inguinal lymph nodes (exception: anterior part of clitoris) Vulva: to the superficial inguinal glands. Exception: glans citoridis (to deep inguinal abd internal iliac lymph nodes). Fundus and oviducts to lumbar nodes Cornu (uterine horn) to superficial inguinal nodes! Corpus to external iliac nodes Cervix ventralwards, lateralwards and dorsalwards to external & internal iliac and sacral nodes Lowermost part of vagina to superficial inguinal nodes Ovary: Lymph to peri-aortic lumbar nodes Thieme, Atlas of Anatomy P. Brodal 2008