13.11.2014 1 Female genital organs Ovary (ovarium) Phalopian tube (tuba uterina) Uterus Vagina Internal female genital organs OVARY Extremitas tubaria (superior) Extremitas uterina (inferior) Facies medialis Facies lateralis Margo mesovaricus (anterior) Margo liber (posterior) Lig. suspensorium ovarii (vasa ovarica) Lig. ovarii proprium Hilus ovarii Mesovarium Lig. latum uteri Germinative epithelium Tunica albuginea Cortex ovarii folliculi ovarici corpora lutea Medulla ovarii Histology of ovarium Folliculi ovarici primarii (300 000- 400 000) Folliculus ovaricus vesiculosus (Graaf´s) Ovulation Corpus luteum menstruationis graviditatis Corpus albicans 13.11.2014 2 Hypophysis a) FSH b) LH = gonadotropin hormones Ovarian cycle Hypophysis Ovary - hormones Ovulation cycle Uterus - menstr.cycle Ovary - cortex with folicule, medulla 1. antrum folliculi (liquor folliculi) 2. membrana granulosa 3. oocyt (cumulus oophorus) 4. theca folliculi interna 5. theca folliculi externa Folliculus ovaricus vesiculosus (Graaf´s) Ovum : zona pellucida, granulosa Ovulation 13.11.2014 3 Corpus luteum OVARIAN CYCLE Nullipara – fossa ovarica (in front of a. iliaca int.) Multipara – Claudius fossa (behind a. iliaca int.) LOCALIZATION OF OVARY TUBA UTERINA (SALPINX) Infundibulum tubae uterinae ostium abdominale tubae fimbriae (fimbria ovarica) Ampulla tubae uterinae Isthmus tubae uterinae Pars uterina tubae uterinae ostium uterinum tubae OSTIUM ABDOMINALE TUBAE UTERINAE 13.11.2014 4 HISTOLOGY OF PHALOPIAN TUBE 1. Mucosal folds (cylind. epithelium cilliated) 2. Circular muscular layer 3. Longitudinal muscular layer 4. tunica serosa 5. mesosalpinx Tuba uterina – mucosal fold = cylindric. epithelium – 1. secretory cells - 2 • from uterus runs laterally to the pelvic wall • dorsocranially to the upper pole of ovary • fimbriae rotated to fac. medialis ovarii PHALOPIAN TUBE COURSE UTERUS (HYSTERA, METRA) Fundus Corpus facies vesicalis facies intestinalis Cervix Isthmus uteri Margo dx. et sin. Cornu dx. et sin. lig. teres uteri lig. ovarii proprium fundus corpus cornu cervix ostium uteri portio vaginalis cervicis 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 NULLIPARA MULTIPARA OSTIUM UTERI (OSTIUM EXTERNUM CANALIS CERVICIS) Labium anterius et posterius 13.11.2014 5 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) ISCHEMIE 1. Menstruation phase 2. Proliferation phase 3. Secretory phase 4. Ischemia Menstruation cycle 1. stratum submucosum 2. stratum vasculosum 3. stratum supravasculosum 4. stratum subserosum MYOMETRIUM Myometrium, myocytes – smooth muscles Lig. latum uteri Mesosalpinx Mesovarium Lig. teres uteri PERIMETRIUM (VISCERAL PERITONEUM) 13.11.2014 6 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 Plica sacrouterina Lig. teres uteri Prolapsus Anteversion (700 – 1000) Anteflexion (1000) 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) 13.11.2014 7 3 4 5 6 7 8 9 10 GRAVIDITY uterus graviditatis – 1000 g Placenta Funiculus umbilicalis – 50 cm (v.umbilicalis, aa. umbilicales) 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 Serosa – excavatio rectouterina Position of vagina Ventrocaudal direction Ventrally: urinary bladder urethra - septum urethrovaginale Dorsally: excavatio rectouterina rectum - septum rectovaginale centrum perineale 13.11.2014 8 m. pubovaginalis symfýza promontorium vaginae Labia majora pudendi Labia minora pudendi Mons pubis Vestibulum vaginae Clitoris Glandulae vestibulares Bulbi vestibuli Organa genitalia feminina externa Labia majora pudendi Sulcus genitofemoralis Rima pudendi Commissura labiorum ant. Mons pubis Commisura labiorum post. Pubes Perineum (raphe perinei) MONS PUBIS Pubes Fatty tissue Labia minora pudendi Sulcus interlabialis Vestibulum vaginae Smegma Frenulum labiorum pudendi Fossa navicularis Praeputium clitoridis Frenulum clitoridis CLITORIS Crura clitoridis (crista phalica) Corpus clitoridis Glans clitoridis Praeputium clitoridis Frenulum clitoridis Corpora cavernosa clitoridis 13.11.2014 9 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) Ostium vaginae (hymen) Fossa navicularis Frenulum labiorum pudendi (commisura labiorum pudendi) BULBI VESTIBULI Erectile bodies (corpus spongiosum) na diaphragma urogenitale m. bulbospongiosus (from centrum tendineum perinei to the dorsum clitoridis) commisura bulborum (mezi glans clitoridis a ostium urethrae ext.) GLANDULAE VESTIBULARES MAJORES (BARTHOLINI) On the diaphragma urogenitale Dorsally from bulbi vestibuli m. bulbospongiosus Opene to the vestibulum vaginae Perineal membrane m. levator ani m. coccygeus (+ sacrococcyg. muscles) Urogenital diaphragm m. transversus perinei m. sphincter urethrae lig. transvers. perinei ( praeurethrale ) lig. arcuatum pubis m. bulbospongiosus m. ischiocavernosus m. sphincter ani ext. = ( perineal muscles) 13.11.2014 10 m.compressor urethrae m. sphincter urethrovaginalis m. bulbospong. m. ischiocavernosus m. transversus perinei profundus sphincter ani ext. m. transv. perinei superfic. ohlav. a) Perineal membrane b) Urogenital diaphragm + + fossa ischiorectalis + fossa ischiorectalis+Alcockův kanál 13.11.2014 11 Diaphragma + fossa ischiorectalis – canalis pudendalis - Alcocki m. obturatorius int.