4. 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.
5. 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.
7. 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.
8. 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.
9. 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.
10.
11. 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
13. 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.
14. 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.
15. 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.
16. 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.
19. 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.
20. 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.
21. 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
22. 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
23. 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
24. 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).
25. 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.
26. 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
27. 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
28. 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.
29.
30. 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
31. HISTOLOGY OF THE UTERUS
Three layers:
1. Endometrium (mucosa)
2. Myometrium (musculosa)
3. Perimetrium or the peritoneal covering
32. 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
34. 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.
35. 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.
36. 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.
37. 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.
38. 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.
39. 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.
40. 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)
41. 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.
42. 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.
44. 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
45.
46. 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.
47. 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.
