Anatomy of Female Genital System

SGD B8
Day 2
Case 1 : A 42 year-old woman is referred for vaginal sonography to rule out luteal cyst. The
sonic proe is placed in the anterior vaginal forni! and aimed anteriorly
". #hat is the normal position of the uterus and its relation to other structure in pelvic cavity$
The non-gravid %non-pregnant& uterus usually lies in the lesser pelvis' with its ody lying on
the urinary ladder and its cervi! etween the urinary ladder and rectum. Adult uterus is
usually anteverted %tipped anterosuperiorly relative to the a!is of the vagina& and ante(e!ed
%(e!ed or ent anteriorly relative to the cervi!' creating the angle of (e!ion& so that its mass
lies over the ladder
)elation of uterus :
Anteriorly %anteroinferiorly in its normal anteverted position&: the vesicouterine pouch
and superior surface of the ladder* the supravaginal part of the cervi! is related to
the ladder and is separated from it y only +rous connective tissue.
,osteriorly: the rectouterine pouch and the anterior surface of rectum*
-aterally: the peritoneal road ligament and the fascial cardinal ligaments* the ureters
2. .ow much of the uterus can e felt per rectum$
/t normaly cannot palpale rectaly' 0ust can felt its wall to e!amine if there is any anormality
in there.
1. #hat is the normal support of the uterus$
The principal supports of the uterus holding it in this position are oth passive and active or
dynamic. 2ynamic support of the uterus is provided y the pelvic diaphragm. /ts tone during
sitting and standing and active contraction during periods of increased intra-adominal
pressure %snee3ing' coughing' etc.& is transmitted through the surrounding pelvic organs and
the endopelvic fascia in which they are emedded. ,assive support of the uterus is provided
y its position4the way in which the normally anteverted and ante(e!ed uterus rests on top
of the ladder. #hen intra-adominal pressure is increased' the uterus is pressed against the
ladder
4. #hy do you thin5 the uterus is in that position$
6. 2escrie the ovaries' uterine tues' uterus and road ligaments$
Ovaries : The ovaries are almond-shaped and -si3ed female gonads in which the
oocytes %female gametes or germ cells& develop. They are also endocrine glands that
produce reproductive hormones. 7ach ovary is suspended y a short peritoneal fold or
mesentery
Uterine tubes : The uterine tues %formerly called oviducts or fallopian tues&
conduct the oocyte. They are appro!imately "8 cm long and lie in a narrow mesentry
called the mesosalpin!. They are divided into 4 parts* infundiulum' ampula. /sthmus'
uterine part
Anatomy of Female Genital System
SGD B8
Day 2
Uterus : The uterus %wom& is a thic5-walled' pear-shaped' hollow muscular organ. /t
is located in the lesser pelvis. Adult uterus is usually anteverted and ante(e!ed so that
it les over the ladder.
Broad ligaments : The road ligament of the uterus is a doule layer of peritoneum
%mesentery& that e!tends from the sides of the uterus to the lateral walls and (oor of
the pelvis.This ligament assists in 5eeping the uterus in position. The two layers of the
road ligament are continuous with each other at a free edge that surrounds the
uterine tue
9. 2escrie the peritoneal relationship of the ovary and the uterine tues
7ach ovary is suspended y a short peritoneal fold or mesentery' the mesovarium. The
mesovarium is a sudivision of a larger mesentery of the uterus' the road ligament
The uterine lie in a narrow mesentery' the mesosalpin!' forming the free
anterosuperior edges of the road ligaments
/t e!tend laterally from the uterine horns and open into the peritoneal cavity near the
ovaries. /n ovaries' it is suspended in peritoneal cavity : not covered y peritoneum.
;. 2escrie the walls' fornices and immediate visceral relations of the vagina
The vagina is usually collapsed. The ori+ce is usually collapsed toward the midline so
that its lateral walls are in contact on each side of an anteroposterior slit. Superior to
the ori+ce' however' the anterior and posterior walls are in contact on each side of a
transverse potential cavity' .-shaped in cross section
The vaginal forni!' the recess around the cervi!' has anterior' posterior' and lateral
parts
Anteriorly to the fundus of the urinary ladder and urethra* laterally to the levator ani'
visceral pelvic fascia' and ureters* and posteriorly %from inferior to superior& to the anal
canal' rectum' and rectouterine pouch
<. To descrie the lood supply and lymph drainage of the female genital tract
Ovaries and uterine tubules : receive a doule %collateral& lood supply from the
adominal aorta via the ovarian arteries and from the internal iliac arteries via the
uterine arteries.
Uterus : receive lood from from the uterine arteries' and collateral supply from the
ovarian arteries .The uterine veins enter the road ligaments with the arteries and
form a uterine venous ple!us on each side of the cervi!. =eins from the uterine ple!us
drain into the internal iliac veins.
Vagina : lood for superior part of the vagina derive from the uterine arteries. The
arteries supplying the middle and inferior parts of the vagina derive from the vaginal
and internal pudendal arteries. The vaginal veins form vaginal venous ple!uses along
the sides of the vagina and within the vaginal mucosa .These veins are continuous
with the uterine venous ple!us as the uterovaginal venous ple!us and drain into the
internal iliac veins through the uterine vein
>. To descrie general anatomy' vasculari3ation' and lymphatic system of reast
Anatomy of Female Genital System
SGD B8
Day 2
The reasts %-. mammae& consist of glandular and supporting +rous tissue emedded
within a fatty matri!' together with lood vessels' lymphatics' and nerves. At the
greatest prominence of the reast is the nipple' surrounded y a circular pigmented
area of s5in' the areola %-. small area&.
Arterial supply : ?edial mammary ranches of perforating ranches and anterior
intercostal ranches of the internal thoracic artery' -ateral thoracic and
thoracoacromial arteries' ranches of the a!illary artery* ,osterior intercostal arteries'
ranches of the thoracic aorta in the 2nd' 1rd' and 4th intercostal spaces.
Venous drainage : The venous drainage of the reast is mainly to the a!illary vein'
ut there is some drainage to the internal thoracic vein
Lymph system : -ymph passes from the nipple' areola' and loules of the gland to the
suareolar lymphatic ple!us. Then ;6@%lateral& of this ple!us will drain into the a!illary
lymph nodes' while the remaining%medial& will drain into the parasternal lymph
node*the opposite reast and for the inferior Auadrants' to the adominal lymph node.
"8. 2escrie the anatomical feature of the female pelvis and its diBerence with the male
pelvis
Cony ,elvis ?ale Female
General structure Thic5 and heavy Thin and light
Greater pelvis %pelvis ma0or& 2eep Shallow
-esser pelvis %pelvis minor& Darrow and deep'
tapering
#ide and shallow'
cylindrical
,elvic inlet %superior pelvic
aperture&
.eart-shaped' narrow Eval and rounded* wide
,elvic outlet %inferior pelvic
aperture&
Fomparatively small Fomparatively large
,uic arch and supuic angle Darrow %G;8H& #ide %I<8H&
Eturator foramen )ound Eval
Acetaulum -arge Small
Greater sciatic notch Darrow %J;8H&* inverted
=
Almost >8H
"". 2escrie the pelvic diaphragm and perineum
The perineum refers to a shallow compartment of the ody %perineal compartment&
ounded y the pelvic outlet and separated from the pelvic cavity y the fascia
Anatomy of Female Genital System
SGD B8
Day 2
covering the inferior aspect of the pelvic diaphragm' formed y the levator ani and
coccygeus muscles
The pelvic (oor is formed y the owl- or funnel-shaped pelvic diaphragm' which
consists of the coccygeus and levator ani muscles and the fascias %-. fasciae& covering
the superior and inferior aspects of these muscles.The pelvic diaphragm lies within the
lesser pelvis' separating the pelvic cavity from the perineum' for which it forms the
roof
The (oor of the pelvis is formed y the pelvic diaphragm' encircled y and suspended
in part from the puic symphysis and puic ones anteriorly' the ilia laterally' and the
sacrum and coccy! posteriorly