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FEMALE REPRODUCTIVE SYSTEM Sameena.isat@student.manchester.ac.ukLEARNING OBJECTIVES • Describe the anatomical arrangement of the pelvic walls & floor • Describe the anatomical arrangement of the perineum and female external genitalia • Relate the changes in fundal height during pregnancy to anatomical landmarks PELVIC WALLS • Which bones contribute to the: oPosterolateral wall & roof ▪ sacrum and coccyx oLateral wall ▪ Ilium and ischium oAnteroinferior ▪ Pubic bodies, superior and inferior •Symphysis pubis is not a rami. bony componentWHAT ARE TH E FUNCT IONS OF T HE PELVIC MUS CLES 1. SUPPORT PELVIC ORGANS – Bladder, intestines, rectum and uterus 2. CONTINENCE – Controles the sphincters of the urethra and anus 3. RESISTANCE TO INTRA-ABDOMINAL PRESSURE – During activities like lifting, sneezing etc 4. MOVEMENT – Contributes to hip movement 5. PATHWAYS FOR NEUROVASCULAR STRUCTURES – transmits nerves and blood vesselsThe 4 muscles excluding piriformis go in alphabetical order Anococcygeal body is a mass of fibrous tissue which lies between the PELVIC FLOOR anus and the coccyx • Made up for 4 muscles. Three of which form the Levator ani. MUSCLE ORIGIN INSERTION Coccygeus ischial spine lateral border of the sacrum and coccyx Iliococcygeus ischial spine and the Coccyx, perineal body tendinous arch of and anococygeal i internal obturator fascia ligament a Pubococcygeus lateral aspect of the coccyx and the r t posterior surface of the anococcygeal body v body of the pubis e Puborectalis Posterior aspect of one Wraps around anorectal L pubic bone junction, inserts onto posterior aspect of the other pubic boneMUSCLE ACTION INNERVATION BLOOD SUPPLY Coccygeus supports abdominal organs Anterior rami of S4 and inferior gluteal, inferior vesical (pelvic viscera) and flexes S5 and pudendal arteries the coccyx Iliococcygeus elevates the pelvic floor and Nerve to levator Ani and inferior gluteal, inferior vesical anorectal canal Pudendal nerve and pudendal arteries Pubococcygeus involved in stability and Nerve to levator Ani and inferior gluteal, inferior vesical support of abdominal organs Pudendal nerve and pudendal arteries Puborectalis Maintaing faecal continence nerve to levator ani and inferior gluteal, inferior vesical pudendal nerve and pudendal arteries S2, 3 AND 4 KEEPS S*** OF THE FLOOR - (pudendal nerve) OTH ER MUSCLES OF TH E PELVIS MUSCLE ORIGIN INSERTION ACTION INNERVATION PIRIFORMIS anterior Fibres travel inferiorly Lateral Nerve to surface and laterally through rotation piriformis of the the greater sciatic and sacrum. foramen to insert abduction onto the greater of hip trochanter of the femur OBTURATOR pubis travels through the Lateral Nerve to INTERNUS and lesser sciatic rotation obturator ischium foramen, and and internus at the attaches to the abduction obturator greater trochanter of foramen. the femur. LIGAMENT S • Sacrotuberous – Lateral wall of sacrum and coccyx - Ischial tuberosity • Sacrospinous – Lateral margins of the sacrum and coccyx - Ischial spine • Sacroiliac – Sacrum to the posterior iliumANY QUESTIONS SO FAR?W HAT IS THE PERINEUM? • A compartment of the pelvis that lies inferior to the pelvic floor • Diamond shaped when observed from below WHAT IS THE FUNCTION? • It has a function of protecting and supporting your urogenital (uterus, vagina, rectum and bladder) and gastrointestinal systems • Therefore, it plays a role in micturition, defecation, sexual intercourse and childbirthLABEL THE BOUNDARIES • ANTERIOR – Pubic symphysis • ANTEROLATERAL – Ischiopubic rami • LATERAL – Ischial tuberosities • POSTEROLATERAL – Sacro tuberous ligament • POSTERIOR – Coccyx • ROOF – Pelvic diaphragm • FLOOR – Skin of the genital area ANAL AN D UROGEN ITAL TR IAN GLES - Imaginary line drawn between the ischial tuberosities - Anal triangle same in both males and females - Urogenital – bit different - The midpoint of the 'line' marks the perineal body – a fibromuscular mass.ANAL TRIANGLE • Anal canal & External anal sphincter • Ischioanal fossa is a wedge shaped space that lies either side of the anus. IT contains fat and loose connective tissue which supports the anal canal and permits distention during defecation. • Roof is formed by the fascia covering the pelvic diaphragm Not covered inferiorly • Pudendal nerve • Internal pudendal artery • Internal pudendal veinUROGEN ITAL T RIAN GLE - External genitalia - Transverse perineal muscles, Ischiocavernosus, bulobspongiosus - Orifices of the urethra and vagina in females - Covered inferiorly by a tough sheet of fascia – PERINEAL MEMBRANE - Superficial perineal pouch – Inferior to the mebrane - Deep perineal pouch – superior to the membraneCON TEN T S OF TH E PERIN EAL POUCHES SUPERFICIAL POUCH DEEP POUCH • Bulbs of vestibule • External urethral sphincter • Ischiocavernosus muscle • Deep transverse perineal muscle • Clitoris • Perineal body • Superficial transverse perineal muscles • Bulbospongiosus • Greater vestibular glands UROGEN ITAL MUSCLES MUSCLE ORIGIN INSERTION SUPERFICIAL TRANSVERSE ischial tuberosity perineal body PERINEAL DEEP TRANSVERSE PERINEAL Ischial ramus Perineal bdy ISCHIOCAERNOSUS ischial tuberosity ischial rami BULBOSPONGIOSUS Male: Perineal Male: Perineal membrane, dorsal aspect of corpus body, median spongiosum and corpora cavernosa, fascia of bulb of perineal raphe penis Female: Pubic arch, fascia of corpora cavernosa Female: Perineal and clitoris body EXTERNAL ANAL SPHINCETR EXTERNAL URETHRAL SPHINCTERP UD ENDAL NERVE • Main nerve to the perineum • Arises from ventral rami of S2,3&4 • Route: exits pelvic cavity through Greater sciatic foramen, passes through gluteal region and then enters erineum through the lesser sciatic foramen • Gives of 3 branches: o Inferior rectal - external anal sphincter, mucous membrane of the lower half of the anal canal, perianal skin o Dorsal nerve of clitoris – supplies clitoris o Perineal nerve - muscles of urogenital diagram, skin on posterior surface of the labia majoraFEMALE EXTERNAL GENITALIA • Clitoris – formed of erectile corpora cavernosa tissue that fills with blood during sexual stimulation • Mons pubis – subcutaneous fat.It is the part that bears most of the pubic hair. • Labia majora – external skin folds. Hair baring. • Labia Minora – internal hairless skin folds. Anteriorly fused to form the clitoris. Posteriorly merge to form a fold of skin called the fourchette. • Vestibule – enclosed by the labia minora. Contains vaginal and urethral openings. • Bartholion glands/greater vestibular glands – secrete lubricating mucus from small ducts during sexual arousal into the vestibule • Skenes glands/lesser vestibular gland – secrete a fluid during sexual arousal Pudendal cleft – the opening between the labia majora.GESTATIONAL AGE FUNDAL HEIGHT 12-14 WEEKS Pubic symphysis 16 WKS Between umbilicus and pubic symphysis 20-22 WKS Umbilicus 36 WEEKS Xiphoid process