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Female Reproductive System Hannah Neill hneill04@qub.ac.ukLearning Outcomes 1. Identify and describe the anatomy and relations of the female reproductive organs 2. Identify and describe the origin, course, relations and distribution of the ovarian and uterine arteries 3. Identify and describe the location of the recto-uterine pouch 4. Identify and describe the anatomy of the perineum 5. Identify and describe the anatomy of the pelvic floor in the female 6. Describe the lymphatic drainage of the pelvis in the female 7. Identify and describe the anatomy and lymphatic drainage of the female breastIdentify and describe the anatomy and relations of the female reproductive organs Ovaries Fallopian/Uterine Tubes Uterus VaginaOvaries Function - development of oocytes & secrete reproductive hormones (mainly oestrogen).Fallopian / Uterine Tubes Function – conduct oocyte which is expelled from the ovaries to the peritoneal cavity to the uterus. 4 parts: • Fimbriae • Infundibulum • Ampulla • IsthmusClinical Relevance: Fertilization & Ectopic PregnancyClinical Relevance: Female SterilizationUterus Function – muscular organ. Adapts to the growth of a fetus & provides power for expulsion during childbirth. 3 parts: • Fundus • Body • Cervix 3 layers: • Perimetrium • Myometrium • EndometriumUterus Anteverted (tipped antero- superiorly relative to the axis of the vagina) Anteflexed (flexed or bent anteriorly relative to the cervix)Clinical Relevance:Uterine ProlapseVaginal Canal • Functions • Sexual intercourse • Childbirth • MenstruationIdentify and describe the anatomy and relations of the female reproductive organs • Anterior – bladder & urethra • Posterior – rectouterine pouch, rectum & anal canal • Lateral – ureters & levator ani musclesAnterior PosteriorClinical Relevance:sterectomyClinical Relevance: Fistulas Definition: abnormal connection between two epithelial surfaces. • Types of fistulas • Vesicouterine fistula • Vesicovaginal fistula • Urethrovaginal fistula • Rectovaginal fistula • Causes: • Childbirth • Surgical complications • Inflammation (Crohn’s disease / UC) • InfectionLigamentsUterosacral Ligament pass superiorly and slightly posteriorly from the sides of the cervix to the middle of the sacrum; they are palpable during rectal examination.Clinical Relevance: Endometriosis PV exam findings: • fornix)nodular masses along a thickened uterosacral ligament (palpated in the posteriorIdentify and describe the origin, course, relations and distribution of the ovarian and uterine arteries Artery Origin Course & Relations Distribution Ovarian Abdominal Retroperitoneal. Runs anterior to psoas major, Abdominal & pelvic ureter aorta (L2/L3) above the ureter. Crosses pelvic brim and Ampulla of fallopian tube travels within the suspensory ovarian ligament Ovary towards the ovary. Uterine Internal iliac Passes inferiorly & medially across the floor of Uterus artery the pelvis above the ureter. Cervix Travels within the broad ligament towards the Vagina uterus. Ovaries Uterine tubeRemember: L ovarian vein drains into L renal vein, R ovarian Water under the bridge vein drains directly into the IVC!Identify and describe the location of the recto-uterine pouch (Pouch of Douglas) Anterior Uterus Posterior Superior & middle rectumClinical Relevance: Culdocentesis Check for abnormal fluid in the rectouterine pouch. Procedure: long thin needle inserted though the posterior vaginal wall of fluid.r fornix) to obtain a sample Causes of fluid in rectouterine pouch: • Ruptured ectopic pregnancy • Pelvic inflammatory disease • Tubo-ovarian abscess • Ascites • Pelvic abscess / haematoma • EndometriosisIdentify and describe the anatomy of the perineum Urogenital Triangle Anorectal Triangle Urogenital triangle: Superficial Perineal Pouch Content: •Clitoris & ischiocavernosus muscle •Bulbs of vestibule & bulbospongiosus muscle •Greater vestibular glands •Superficial transverse perineal membrane •Vessels & nerves Urogenital triangle: Deep Perineal Pouch Content: •Proximal urethra •External urethral sphincter •Anterior extensions of the ischioanal fat pads Identify and describe the anatomy of the pelvic floor in the female Levator Ani Function: support pelvic organs, especially with increases in intra-abdominal pressure (e.g. coughing, sneezing, laughing)Identify and describe the anatomy of the pelvic floor in the female Muscle Proximal Attachment Distal Attachment Innervation Action Coccygeus Ischial spine Inferior end of sacrum Branches of S4-S5 Pelvic diaphragm; & coccyx spinal nerves support pelvic viscera; flex coccyx Levator ani Body of pubis; tendinous arch Perineal body; coccyx; Nerve to levator ani Pelvic diaphragm; (puborectalis, of obturator fascia; ischial anococcygeal ligament; (branch of S4), support pelvic viscera; pubococcygeus, spine wall of prostate / inferior anal (rectal) resist increase in intra- vagina, rectum, anal nerve & coccygeal abdominal pressure iliococcygeus) canal plexusClinical Relevance: Stress Incontinence Loss of control over urination due to weakness of pelvic floor muscles.Clinical Relevance:Pelvic Organ ProlapseDescribe the lymphatic drainage of the pelvis in the female Organ Lymphatic Drainage Vulva Superficial inguinal lymph nodes Vagina Iliac lymph nodes & superficial inguinal lymph nodes Cervix Iliac, sacral, aortic & inguinal lymph nodes Uterus Iliac, sacral, aortic & inguinal lymph nodes Ovaries Para-aortic lymph nodes Clinical Relevance: Metastases of female reproductive cancers!Identify and describe the anatomy and lymphatic drainage of the female breast • Composed of mammary majors overlying pectoralisClinical Relevance: Breast Cancer Screening <35 years old >35 years old Ultrasound scan of breast Mammogram (x-ray) Older, fatty tissue Young, dense glandular tissueIdentify and describe the anatomy and lymphatic drainage of the female breast • Composed of mammary glands overlying pectoralis major • Lymphatic drainage: • >75% à anterior or pectoral nodes à axillary lymph nodes • <25% à parasternal lymph nodesClinical Relevance:Breast CancersPractise QuestionsQuestion 1 What part of the fallopian tube does fertilization usually occur? A) Fimbriae B) Infundibulum C) Ampulla D) IsthmusQuestion 1 What part of the fallopian tube does fertilization usually occur? A) Fimbriae B) Infundibulum C) Ampulla D) IsthmusQuestion 2 Name this structure: Question 3 This is an pelvic x-ray from a 35 year old lady. Name the circled structure. Tubal ligation clipsKnow your physiology!Thank You! Any questions? hneill04@qub.ac.uk