FEMALE GENITAL ORGANS Organa genitalia feminina General medicine, aVLANII0222p, spring 2017 ANATOMY 2 spring 2017 for more see IS recommended literature materials to study Lectures Seminars Self-study 1. Female genital system Female pelvic floor Female genital systém, Female pelvic floor Description of x-ray pictures Female external genital organs The muscles of the external genitalia of women 2. Heart, aortic arch Heart, ascending aorta, aortic arch. A. carotis communis, a. carotis externa Innervation and the lymph system of the heart 3. Arteries, veins, lymph system (digest) Descending aorta, main arteries and veins Portal vein, portocaval anastomoses, Fetal circulation Branches of arteries. Tributaries of veins. Lymphatic system 4. Spinal cord and brain stem (structure) Gross anatomy of the CNS (spinal cord, brain stem). Appearance of the cranial nerves in the brainstem Cranial nerve nuclei on the floor of IV. ventricle General anatomy of nerve system 5. Cranial nerves (III.-VII., IX-XII) Cranial nerves (III.-VII., IX-XII), course. Skull base The main innervation regions of cranial nerves 6. Cerebellum and diencephalon (structure, connections, functions) Hypothalamic-pituitary connections Cranial nerve (V) Gross anatomy of the cerebellum and diencephalon Axonal transport 7. Telencephalon (structure) Basal ganglia (connections, functions) Telencephalon (anatomy; grey matter – cortex + basal ganglia; white matter – pathways) Basic cortical areas by Brodmann 8. Blood supply, meninges and ventricles of the CNS, cerebrospinal fluid Blood supply, meninges and ventricles of the CNS, cerebrospinal fluid Circumventricular organs 9. Auditory and vestibular system Cranial nerve VIII Auditory and vestibular system Temporal bone 10. Visual system + orbital region Visual system + orbital region Cervical plexus, intercostal nerves 11. Human body imaging techniques Organ projections Imaging techniques, reading of anatomical structures Skin and its derivatives 12. ANS (cervical sympathetic system, enteric system, central modulation of the ANS) Preparations for the dissection: head, neck and trunk regions ANS (division, characteristics, basic structural arrangements) 13. 14. Dissection (dissection of the head, neck and trunk) labia majora pudendi labia minora pudendi clitoris vestibulum vaginae bulbi vestibuli gll. vestib. maj. et min. External genitals: ovarium tuba uterina uterus vagina Internal female genitals:FEMALE GENITAL ORGANS Internal female genital organs Ovary (ovarium) Phalopian tube (tuba uterina) Uterus Vagina Ovarium 6-10g, 3-5cm Produces germ cells Endocrine function depends on functional state Descend of the ovaries At the beginning: abdominal cavityend of i.u. development: fossa iliaca - 1. year: fossa ovarica - after giving a birth: Claudius pit L1 Female gonads, paired, lie in shalow depressions, one on each side of the upper pelvic cavity Nullipara – fossa ovarica (in front of a. iliaca int.) Multipara – Claudius fossa (behind a. iliaca int.) LOCALIZATION OF OVARY Axis passes longitudinaly! Extremitas tubaria (upper) uterina (lower) Facies: med., lat. Margo liber (post) mesovaricus (ant, hilus) Ovarian cycle Lig. suspensorium ovarii (vasa ovarica) Lig. ovarii proprium Hilus ovarii Mesovarium Lig. latum uteri HANGING APPARATUS Tunica albuginea Cortex ovarii: Folliculi ovarici - primarii - secundarii - vesiculosi (Graaf) matured oocyt Medulla ovarii conn. tissue, blood and lymph vessels, nerves, smooth muscle Ovary - cortex with folicule, medulla Ovulation At birth 2 million follicles Puberty 300,000-400,000 Only 400 ever mature – one egg/month through reproductive years (from puberty (menarche) (12-13) until menopause (45-55) Follicular stage (Estrogen) Luteal stage (progesteron) c. l. graviditatis c. l. menstruat. > corpus albicans OVARIAN CYCLE Hypophysis a) FSH b) LH = gonadotropin hormones • Hormones levels cycle in the female on a monthly basis • Ovarian cycle drives the uterine cycle Ovarian cycle Tuba uterina (salpinx) 10-15 cm Ostium abdominale - infundibulum (fimbriae) ampulla - isthmus - pars uterina - ostium uterinum Isthmus – transversally (laterally) to the wall of pelvis minor Ampulla - dorsocranially to the upper pole of ovary Infundibulum - dorsocaudally Fimbriae - rotated to fac. medialis et superior ovarii PHALOPIAN TUBE COURSE OSTIUM ABDOMINALE TUBAE UTERINAE 1. Mucosal folds (cylind. epithelium cilliated) 2. Circular muscular layer 3. Longitudinal muscular layer 4. tunica serosa 5. mesosalpinx HISTOLOGY OF PHALOPIAN TUBE CLINIC NOTE Changes of the mucosa (inflamations!) could causes that the tube is not passable for the egg => extrauterine pregnancy (Ectopic tubal pregnancy)!!!! Uterus, hystera Corpus - fundus - cornua – dex. et. sin.: lig. ovarii propr. , lig. teres uteri - margines- dx., sin.: lig. latum, - facies intestinalis vesicalis Isthmus (1 cm) Cervix portio supravaginalis vaginalis (cervix) 8-10cm Cavum uteri (3 ml) Canalis isthmi Ostium internum canalis cervicis Canalis cervicis (plicae palmatae) Ostium externum canalis cervicis (= ostium uteri) Cervix portio supravaginalis portio vaginalis Fornix vaginae uterus arcuatus uterus subseptus uterus septus uterus bipartitus uterus duplex uterus duplex uterus duplex cum vagina septa uterus unicornis NULLIPARA MULTIPARA OSTIUM UTERI (OSTIUM EXTERNUM CANALIS CERVICIS) Labium anterius et posterius Epithel of the vagina x epithel of the uterus!!! HISTOLOGY OF UTERUS Endometrium Myometrium Perimetrium ENDOMETRIUM Simple cylindric epithelium zona basalis zona functionalis glandulae uterinae glandulae cervicales (mucouse closure) menstruation cycle menarche menopausa (climacterium) ostium uteri (multilayer stratified epithelium) ISCHEMIA 1. Menstruation phase 2. Proliferation phase 3. Secretory phase 4. Ischemia Menstruation cycle Ovarian and uterine cycles Ovarian cycle Events Uterine cycle events Follicular phase 1-13 FSH secretion begins Menstruation days 1-5 Endometrium breaks down Follicle maturation occurs Proliferative phase 6-13 Endometrium rebuilds Ovulation 14 Luteal phase 15-28 Estrogen secretion is prominent LH spike occurs LH secretion continues Corpus luteum forms Progesteron secretion is prominent Secretory phase 15-28) Endometrium thickens, and glands are secretory 1. stratum submucosum 2. stratum vasculosum 3. stratum supravasculosum 4. stratum subserosum MYOMETRIUM Lig. latum uteri Mesosalpinx Mesovarium Lig. teres uteri PERIMETRIUM (VISCERAL PERITONEUM) PERIMETRIUM Excavatio vesicouterina Excavatio rectouterina (cavum Douglasi) PARAMETRIUM Lig. pubouterinum lig. pubovesicale lig. vesicouterinum Lig. cardinale uteri Lig. sacrouterinum plica sacrouterina m. rectouterinus Lig. teres uteri Part of fixation apparatus Together with the pelvic floor Plica sacrouterina Lig. teres uteri Anteversion (700 – 1000) Anteflexion (1000) POSITION OF UTERUS POSITION OF UTERUS Arteria uterina – anastomosis with a. ovarica (ovarian arcade) Uterine artery crosses ureter (2 cm from uterine margine 1,5 cm from fornix vaginae) A. uterina x ureter Plexus venosus uterovaginalis Nll. lumbales, iliaci int., iliaci ext. nodus lymph.uterinus (Bayer), inguinales spf., sacrales Plexus uterovaginalis 3 4 5 6 7 8 9 10 GRAVIDITY uterus graviditatis – 1000 g Placenta Funiculus umbilicalis – 50 cm (v.umbilicalis, aa. umbilicales) HYSTEROSALPINGOGRAPHY VAGINA Position of vagina Ventrocaudal direction Ventrally: urinary bladder urethra - septum urethrovaginale Dorsally: excavatio rectouterina rectum - septum rectovaginale centrum perineale VAGINA (KOLPOS) Fornix vaginae pars anterior et posterior receptaculum seminis Paries anterior crista urethralis area trigonalis vaginae Paries posterior Rugae vaginales Columna rugarum ant. et post. Ostium vaginae (vestibulum vaginae) Defloration Carunculae hymenales Ostium vaginae - hymen Ostium urethrae ext. Ostium vaginae HISTOLOGY OF VAGINA Mucouse membrane Multilayer squamous epithelium No glands !!! submucouse tissue – venous net Muscular layer inner - circular outer - longitudinal Adventicia (paracolpium) Serosa – excavatio rectouterina A.uterina - a. vaginalis A. rectalis media A. pudenda int. Plexus venosus uterovaginalis Nll. iliaci int., ext, inguinales spf. Plexus uterovaginalis, n. pudendus Mons pubis (pubes, fatty tissue) Labia majora pudendi Labia minora pudendi Vestibulum vaginae Clitoris Bulbi vestibuli Gll. vestib. maj. et min. perineum Genitofemoralgroove Mons pubis Organa genitalia feminina externa sulcus interlabialis commiss. lab.post. frenulum lab. pud. Sulcus genitofemoralis Rima pudendi Commissura labiorum ant. Perineum (raphe perinei) Connective tissue, fat lig. teres uteri Labia majora pudendi Labia minora pudendi Sulcus interlabialis Vestibulum vaginae Smegma – sebaceous glands Elastic and collagenous connective tissue, venous plexus, nerve endings Frenulum labiorum pudendi Fossa navicularis between vagina and frenulum Praeputium clitoridis Frenulum clitoridis CLITORIS Crura clitoridis (crista phalica) Corpus clitoridis Glans clitoridis Praeputium clitoridis Frenulum clitoridis Corpora cavernosa clitoridis Lig. fundiforme clitoridis Lig. suspensorium clitoridis M. ischiocavernosus VESTIBULUM VAGINAE between labia minora pudendi Glans clitoridis (praeputium et frenulum clitoridis) Ostium urethrae externum (papilla urethralis, gll. vestib. minores - between ostium urethrae et. and vestibule of the vagina, rare in human females) Ostium vaginae (hymen) Fossa navicularis Frenulum labiorum pudendi (commisura labiorum pudendi) BULBI VESTIBULI Erectile bodies (corpus spongiosum) On (below) diaphragma urogenitale m. bulbospongiosus (from centrum tendineum perinei to the dorsum clitoridis) commisura bulborum (between glans clitoridis and ostium urethrae ext.) GLANDULAE VESTIBULARES MAJORES (BARTHOLINI) On the diaphragma urogenitale Dorsally from bulbi vestibuli m. bulbospongiosus Open to the vestibulum vaginae Thank you for your attention Illustrations were copied from: Čihák R: Anatomie 2 (Splanchnologia). Avicenum, zdravotnické nakladatelství, Praha, 1988. Sobotta, Putz,R., und Pabst,R. Atlas der Anatomie des Menschen 20. Auflage. München: Urban & Schwarzenberg, 1993 Neil A. Campbell, Jane B. Reece, Lisa Urry, Michael L. Cain et al.: Biology: A Global Approach (10th International Edition), 2014. Pearson Education Limited (Verlag) 978-1-292-00865-3 (ISBN)