Systema genitale femininum Female genital system

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Systema genitale femininum Female genital system

• Anatomy

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Organa genitalia feminina internaFemale internal
genitalia

• ovarium ( ovary)
• tuba uterina / salpinx ( uterine tube)
• uterus ( womb)
• vagina
• developmental rudiments (epoophoron, paroophoron)

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• peritoneal duplicature
• sagital plate

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Ovarium Ovary

• Description
• Extremitas tubaria uterina
• Margo liber mesovaricus
• Facies medialis lateralis
• Hilum
• Section
• stroma, cortex, medulla, tunica albuginea
• Cortex
• folliculi, corpora, linea Farre-Waldeyer

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Ovarium Ovary

• Position
• fossa ovarica (between vasa iliaca int. and ext.)
• in multiparas fossa of Claudius (behind vasa
  iliaca int.)
• Fixation
• lig. ovarii proprium (lig. uteroovaricum) / lig.
  of ovary
• lig. suspensorium ovarii / suspensory lig. of
  ovary (infundibulopelvic ligament)
• lig. latum uteri / broad ligament of uterus
• mesovarium

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Ovariumblood supply

• aorta abdominalis ?
• a. ovarica
• a. iliaca int.
• r. ovaricus
• both arteries join and form an ovarian arcade

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Ovariumother supply

• veins
• plexus pampiniformis ? v. ovarica
• ? v. cava inf. dx. et v. renalis sin.
• lymph drainage
• n.l. lumbales
• nerves
• plexus ovaricus
• (viscerosensory, autonomic para- sympathetic
  fibres)

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Ovarium - histoloy

• cortex (cortical zone)
• simple cuboideal epithelium
• tunica albuginea
• loose connective tissue, fibroblasts, collagen
  and reticular fibres
• ovarian follicles
• medulla (vascular zone)
• collagenous tissue, vessels, nerves

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• Primordial follicles
• one layer of flattened follicular cells
• oocyte
• Primary follicles
• follicular cells proliferate
• cuboideal to columnar on basal lamina
• appearance of lipid granules - granulosa cells
• zona pellucida
• between follicular cells and oocyte -
  glycoproteins
• theca folliculi
• surrounding tissue and cells

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Secondary follicles

• small cavities between follicular cells
• fusing of cavities formation of antrum
  folliculi
• fulfilled with fluid - liquor folliculi
• oocyte is peripherally - cumulus oophorus
• surrounded by granulosa cells - corona radiata
• theca differentiates into
• theca interna - fibroblasts ? theca cells
• production of estrogens, vessels
• theca externa connective tissue, smooth muscle
  cells

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Tertiary follicles (Graafian)

• prominent on the surface of ovary - macula
  pellucida
• ? bad blood supply of covering tissue
• ? rupture and releasing of oocyte with corona
  radiata to uterine tube

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Corpus luteum

• develops from empty Graafian follicle
• corpus luteum graviditatis
• in function till 4th month of gravidity
• corpus luteum menstruationis
• functional for 10-12 days (till 24th-26th day of
  cycle)
• corpus luteum change to corpus albicans
  (connective tissue)
• c.a.graviditatis remains a recession on ovary
  surface
• c.a.menstruationis no traces ?

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Corpus luteum

• in the centre is a blood clot
• granulosa-lutein cells
• production of progesterone and estrogens
• contain lutein yellow color
• theca-lutein cells
• Production of progesterone and androstedione
• capsule from theca externa - septa
• ingrowth of vessels

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Ovary development

• from 12th week
• primary sex cords disappear
• development of cortical cords
• surrounding the primordial germ cells
• development of follicles with oogonia
• surface epithelium
• simple cuboideal ?? mesovarium
• tunica albuginea
• relative descent (elongation of body)
• gubernaculum ? lig. suspensorium ovarii, lig.
  teres uteri

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Tuba uterina / salpinxUterine tube (Falloppii)

• Parts
• ostium abdominale
• infundibulum
• ampulla
• isthmus
• pars uterina (p. intramuralis)
• ostium uterinum
• Fimbriae
• the longest ovarian fimbria reaching the ovary

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Tuba uterina / salpinxUterine tube (Falloppii)

• Fixation
• mesosalpinx
• Arteries
• r. tubarius a. uterinae
• r. tubarius a. ovaricae
• Veins
• vv. ovaricae, plexus venosus uterovaginalis
• Lymph drainage
• n.l. lumbales

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Tuba uterina / salpinx - structure

• tunica mucosa forms folds
• simple columnar epithelium with cilia
• secretory cells support of oocyte
• ? to the ostium uterinum, in the second half on
  cycle
• ciliated cells transport of oocyte
• lamina propria mucosae loose connective tissue
• tunica muscularis - ? to the uterus
• inner circular outer - longitudinal
• tunica serosa ( peritoneum)

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Tuba uterina / salpinxregional differences
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Tuba uterina isthmus - HE
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Tuba uterina ampula - HE
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Uterus (gr. metra, hystera) - womb

• Description
• fundus, corpus (body), cornua (horns), isthmus,
  cervix, facies vesicalis intestinalis
  (surfaces), margo (border)
• Section
• cavitas uteri (cavity), canalis cervicis, endo-,
  myo-, para- a perimetrium, glandulae uterinae
• Cervix
• portio supravaginalis (supravaginal part)
• portio vaginalis (vaginal part)
• ostium, plicae palmatae (palmate folds),
  glandulae cervicales

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Uterus fixation

• Suspensory apparatus
• lig. latum uteri (broad lig.)
• lig. cardinale Mackenrodti (lig. transversum
  cervicis)
• lig. teres uteri (round lig. of uterus)
• lig. pubocervicale et rectouterinum
• ventro-dorsal ligg. (! older nomenclature !)
• lig. pubovesicalia ? vesicouterina ? rectouterina
  sacrouterina
• Sustaining apparatust
• m. levator ani (m. pubococcygeus ? m.
  pubovaginalis)
• m. transversus perinei prof.

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Uterus - position

• anteflexion
• anteversion
• lateroposition
• dextrotorsion
• most common
• retroversion
• retroflexion
• - rupture risk in gravidity (sharp promontory)

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Uterus supply

• Arteries
• a. iliaca int.? a. uterina
• ventrally to ureter water under the bridge
• approaching rthe cervix laterally, bleeding in
  rupture
• Veins
• plexus venosus uterovaginalis ? vv. uterinae ? v.
  iliaca int.
• anastomoses to plexus venosus vesicalis et
  rectalisnerves
• Nerves
• plexus uterovaginalis ? plexus hypogastricus inf.
• viscerosensory, autonomic para- sympathetic
  fibres

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Uterus lymph drainage

• Lymph drainage 2 divisions
• Corpus uteri n.l. iliaci int. lumbales
  inguniales superficiales
• Cervix uteri n.l. iliaci int. sacrales
• n.l. lumbales - fundus et corpus
• n.l. iliaci interni (il. externi, il. communes,
  obturatorii) - corpus, isthmus et cervix
• nodus lymphoideus parauterinus Bayeri
• first lymph node bythe urter utrerine artery
  crossing
• n.l. inguinales superficiales - margines et
  cornua
• n.l. sacrales - isthmus, cervix

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Corpus uteri (Body of uterus) structure

• tunica mucosa - endometrium
• tunica submucosa not present !!!
• tunica muscularis - myometrium
• thick 15 mm
• spiral smooth muscles bundles network
• longest cells in the human body
• tunica adventitia - parametrium
• loose connective tissue
• vessels ligaments
• tunica serosa peritoneum - perimetrium

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Endometrium

• simple cuboideal epithelium
• glandulae uterales tubular glands
• lamina propria reticular fibers
• stromal cells - decidual
• stratum basale more cells and reticular fibres,
  vessels
• stratum functionale separated in menstruation

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Corpus uteri - HE
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Menstrual cycle

• menstrual phase (1st 4th day)
• proliferative phase (5th 14th day)
• secretory phase (15th 28th day)
• ischemic phase (28th day)

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Menstrual phase

• releasing of functional layer
• basal layer stays in place
• epithelisation of surface
• fisihed 5th day regeneration phase
• menstruation blood
• do not form clots enzymes of mucosa
• is mix of arterial and venous blood

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Proliferative phase

• influence of estrogens
• hyperplasia (? count) of functional layer
• glands elongate, get narrow with no lumen
• endothelial cells cytoplasma basophile (GER)
• at the end of proliferative phase ovulation

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Secretory phase

• influence of corpus luteum hormones
• functional layer - hypertrophy (? size)
• glands are wave-shaped (not in apical and basal
  parts)
• stratum spongiosum wave-shaped
• stratum compactum - direct
• secret contains mucin, glycogen and lipids
• epithelial cells contain glycogen and mucin
• arterioles elongate and get wave-shaped
• decidual change occurs during the nidation

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Ischemic phase

• contraction of arterioles ischemia of
  functional layer
• degenerative processes thanks to leukocytes
  arrival
• stop bleeding contraction of myometrium and
  vessels

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Cervix uteri (Neck of uterus)strucutre

• mucosa forms folds plicae palmatae
• simple columnar epithelium produces mucus
• glandulae cervicales uteri - mucous
• obliteration of ostium - ovula cervicalia Nabothi
• secret is alcalic with various viscosity
• vaginal surface of cervix
• stratified squamous epithelium
• junction at orifice of cervical canal
• ectopy columnar epithelium is changed into the
  stratified squamous - precancerous
• tunica muscularis - 3 layers (L, C, L)

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Cervix uteri - HE
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Female genital system rudiments

• Epoophoron v mesosalpinx
• - ductus longitudinalis (remnant of Wolffian
  duct)
• - ductuli transversi (remnatnts of mesonephric
  tubules)
• - appendices vesiculosae ( hydatis Morgagni)
• ductus longitudinalis Gartneri (remnant of
  Wolffian duct by the uteus margin in the broad
  lig.)
• Paroophoron (remnatnt of mesonephric tubules)
  in mesosalpinx closer to the uterus

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Vagina (gr. kolpos)

• Description
• Fornix anterior, posterior, laterales
• Paries (wall) anterior, posterior
• Hymen
• carunculae hymenales (remnants after defloration)
• Section
• rugae columnae rugarum (ant. post.), carina
  urethralis, area trigonalis Pawliki
• Fixation and position
• septum urethrovaginale et rectovaginale
• excavatio rectouterina
• m. pubovaginalis

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Vagina blood supply

• arteries a. iliaca interna
• ? a. vaginalis (sometimes missing)
• ? a. uterina ? r. vaginalis
• ? a. rectalis media ? r. vaginalis
• ? a. pudenda int. ? r. vaginalis
• veins ? v. iliaca int.
• plexus venosus uterovaginalis
• ? v. pudenda int.
• ? v. uterina

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Vagina lymph drainage and nerves

• lymph drainage
• n.l. iliaci int. ext.
• n.l. inguinales superficiales (caudally below
  hymen)
• nerves
• nn. vaginales z plexus uterovaginalis ? plexus
  hypogastricus inf.
• n. pudendus (caudally below hymen)

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Vagina inner structure

• tunica mucosa folds and columns - columna
  rugarum, rugae vaginales
• epithelium stratified squamous (? keratinizing
  ?)
• cells produce glycogen acid environment
• exfoliative cytology
• lamina propria loose connective tissue
• no glands
• tunica muscularis
• inner - circular, outer - longitudinal
• adventitia dense connective tissue, vessels,
  nerves

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Vagina - HE
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Vagina - PASHE
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Exfoliative vaginal cytology

• Proliferative phase cells with acidophilic (
  eosinophilic) cytoplasma
• Secretory phase - cells with basophilic cytoplasma

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Organa genitalia feminina externa (pudendum
femininum, vulva)

• mons pubis ( mons Veneris)
• labia majora et minora
• rima pudendi (pudendal cleft)
• commissura anterior posterior
• vestibulum vaginae (vestible)
• bulbus vestibuli (bulb of vestibule)
• glandulae vestibulares
• clitoris (corpus, crura,
• glans, corpora cavenosa
• ligaments, fascias)
• urethra feminina

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Female external genitalia - structure

• labia majora
• connective tissue, adipose cells
• outer surface skin with hair follicles,
  sebaceous, apocrine and sweat glands
• inner no follicles, only sebaceous glands
• labia minora
• no adipose cells, no hair follicles
• stratified squamous epithelium slightly
  keratinizing
• sebaceous gland - smegma praeputii

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Female external genitalia (vulva)

• vestibulum vaginae vestible
• glandulae vestibulares majores Bartholini
• paired, pea-sized, under and inm. transversus
  perinei prof.
• tuboalveolar and mucinous
• glandulae vestibulares minores
• tubulous and mucinous
• Erectiel bodies
• - clitoris (f.)
• paired corpus cavernosum
• covered with tunica albuginea
• stratified squamous epithelium
• - bulbus vestibuli bulb of vestible
• paired spongious body
• commissura bulborum

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Female external genitalia - supply

• arteries
• a. femoralis ? aa. pudendae ext. ? rr. labiales
  ant.
• a. iliaca int. ? a. pudenda int. ? rr. labiales
  post., a. profunda clitoridis, a. dorsalis
  clitoridis, a. bulbi vestibuli
• veins
• v. dorsalis superficialis clitoridis vv.
  labiales ant. ? vv. pudendae ext.
• v. dorsalis profunda clitoridis vv. labiales
  post. v. bulbi vestibuli ? v. pudenda int.

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Female external genitalia - lymph drainage and
innervation

• lymph drainage
• nl.l. inguinales superficiales (both
  homolaterally and contralaterally)
• nerves
• n. ilioinguinalis r. genitalis n.
  genitofemoralis
• n. pudendus ? nn. perineales, nn. labiales post.,
  n. dorsalis clitoridis

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Perineum

• corpus perineale / centrum perinei (perineal
  body)
• mm. perinei (n. pudendus, nn. sacrales, nn.
  splanchnici pelvici)
• corpus / lig. anococcygeum
• raphe perinei
• fascia perinei
• fossa ischioanalis (ischio-anal fossa)
• recessus pubicus
• corpus adiposum (fat body of ischio-anal fossa)
• canalis pudendalis Alcocki

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Urogenital floor

• diaphragma urogenitale
• no official term in Terminologia Anatomica 1998
• excellent term to understand the problem
• 4 muscles in a plane floor
• 3 more muscles around female urethra
• possible term perineal muscles musculi
  perinei
• the centre is so-called corpus perineale
  (perineal body) (former centrum tendineum perinei)

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• ?
• m. transversus perinei profundus
• m. transversus perinei superficialis
• m. bulbospongiosus
• m. ischiocavernosus
• m. sphincter urethrae externus

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• ?
• m. transversus perinei profundus
• m. bulbospongiosus
• m. ischiocavernosus
• smooth muslces fibres in the extent of male m.
  transversus perinei superficialis !!

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• ?
• m. sphincter urethrae
• m. compressor urethrae
• m. sphincter
• urethrovaginalis

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Urogenital floor - innervation

• nn. perineales n. pudendi
• rr. ventrales nn. sacralium
• nn. splanchnici pelvici

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Male ischio-anal fossa
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Female ischio-anal fossa