The Female External Genitalia

1. The Female External Genitalia • External genitaliaarethe reproductive organs external to the body. • Thefemaleexternalgenitaliaarecollectivelyreferred as thevulva. • Cosists of: • Themonspubis • Thelabiamajora • Thelabiaminora • Thebulb of thevestibule • Theclitoris • Thevestibula of thevagina • Thefemaleurethra • Ducts of theparaurethralandvestibularglands

2. The Female Internal Genitalia • Internal genitaliaarethe reproductive organs internal to the body. • Cosists of: • Theovary • Theuterinetube • Theuterus • Thevagina

3. The Female Internal Genitalia

4. The Female External Genitalia • Themonspubis • Conspicuous, subcutaneousfatpadoverthepubicbones. • It is coveredbypubichairand is largelyabsent in themale. Mons:From Latin mōns (“mountain”).

5. The Female External Genitalia • Thelabiamajora • Eachlabiummajus is a broad, longitudinalfold of skin filledwithsubcutaneousfatandfibroustissue. • Continuousanteriorlywiththesubcutaneoustissue of themonspubisandposteriorlywithischiorectalfat. • Thelateralsurface of thelabiafacingthethighs is hairy. • Theirsmoothmedialsurface is studdedwithsebaceousglands. • Pudendalcleft (rimapudendi) • is thespacebetweenthemedialsurfaces of thelabiamajora.

6. The Female External Genitalia • Thelabiamajora • Anteriorcommisure • Thejunction of twolabiamajora. • Posteriorcommisure • Thejunction of twolabiamajora. • is homologues of thetwohalves of thescrotal sac, andsomesubcutaneoussmoothmuscle in them, thehomologue of thedartos. • Theroundligament of theuterus is terminated in its CT and a patent proc. vaginalismayextendinto it.

7. The Female External Genitalia • Thelabiaminora • is a smallerfold of skin in thepudendalcleftandcontains no fat no hair. • Theirmedialsurfacesare in contactwitheachother. • Vestibule of vagina • Thespacebetweenthemedialsurfaces of thelabiaminora. • Housesfollowingsutructures: • Externalurethralorifice • Openings of paraurethral (Skene’s) ducts. • Vaginalorifice • Opening of greatervestibular (Bartholin’s) gland.

8. The Female External Genitalia • Thelabiaminora • Frenulum of thelabia(fourchette) • Thefoldthatunitesposteriorends of thelabiaminora • Prepuce of theclitoris • Formedbytheupperfolds of thelabiaminoraovertheclitoris. • Frenulum of theclitoris • Formedbythelowerfolds of thelabiaminoraundertheclitoris. • is homologues of the skin thatcoverspart of the penis.

9. The Female External Genitalia • Thebulb of thevestibule • Locatedalongthebaseandpartially in thesubstance of eachlabiumminus. • is oval-shapedmass of erectiletissue. • Eachbulb is a homologue of half of thebulb of the penis andposteriorpart of thecorpusspongiosum. • Does not surroundtheurethra. • Eachbulb is attachedtotheinferior facia of theurogenitaldiaphragmand is closedbythedeepperinealfascia. • As theytapertowardtheclitoris, thebulbusarejoinedtooneanotherbypars intermediaandthecommissura of thebulb.

10. The Female External Genitalia • Theclitoris • is thehomologue of the penis. • But it consists of onlytwoerectilebodies, corporacavernosaclitoridisand is not traversedbytheurethra. • Thecorporacavernosaclitoridiscommence as thecurura of theclitoris. • Thecurura of theclitoris is attachedtotheischiopubic rami andtheinferiorfascia of theurogenitaldiaphragm. • Theyunite in themidlineto form thebody of theclitoris. • Suspensoryligament of theclitoris • Glans of theclitoris

11. The Female External Genitalia • Theclitoris • Likethe penis, theclitorisandthebulb of thevestibulebecometumescentduringsexualexcitation. • Theclitoris is richlysuppliedwithsensorynerveending. • Plays a dominant role in theexcitatoryphase of thesexualresponse. Clitoris:"little hill." The Italian anatomist Mateo Renaldo Colombo (1516–1559), professor at Padua, claimed to have discovered it (De re anatomica, 1559, p. 243). He called it amorVeneris, veldulcedo "the love or sweetness of Venus.

12. The Female External Genitalia • Thevestibule of thevagina • Thespacebetweenthemedialsurfaces of thelabiaminoraandtheirfrenulum. • Housesfollowingsutructures: • Externalurethralostium • Openings of paraurethral (Skene’s) ducts. • Vaginalorifice (introitus) • Itmay be partiallyclosedbythehymen. • Thevestibular fossa • Opening of greatervestibular (Bartholin’s) gland. Vestibule:entrance, entrancehall, entry, lobby, antechamber, anteroom, doorway, entryway

13. The Female External Genitalia • Thehymen • is a thinfold of mucousmemmrane of variableextendandshape. • It is usualycrescenticandcoverstheposteriormargin of thevaginalorifice. • If it is imperforate, it must be incised at the time of pubertytoprovideexitforthemenstrualflow. • Afterthehymen has beenruptured, bycoitusorbyothermeans, it is recognizableonly as smalltags of mucousmembrane, thecarunculaehymenalis. • .

14. The Hymen

15. The Hymen

16. The Female External Genitalia • Greatervestibularglands • Pea-sizedlobulatedstructures. • Located at theposteriorpole of thebulbs of thevestibule. • arethehomologues of theblbourethralglands in male • They, likethenumerouslesservestibularglands, whichalsoopenintothevestibule, secretemucusandlubricatethe vulva.

17. The Female Internal Genitalia • Internal genitaliaarethe reproductive organs internal to the body. • Cosists of: • Theovary • Theuterinetube • Theuterus • Thevagina

18. The Female Internal Genitalia • Theovary • is thefemalegonad. • Itsfunction is theproduction of ova andsecretion of estrogenandprogesterone. • Throughthesehormone, theovaryinfluencesthecyclicmaturationanddischarge of the ova andthedevelopmentandmaintenance of thesecondarysexorgans.

19. The Female Internal Genitalia • Broad ligament • The uterus, its tubes, and ovaries are associated with the peritoneum. • Broad ligament , acting as a mesentery, suspends the uterine tubes and ovaries from the pelvic floor.

20. The Female Internal Genitalia • The ovary (ovarium) • Each ovary: • Firm and almond shaped • 3cm long • 1.5cm wide • 1cm thick • Surface of each ovary: • Devoid of peritoneum • Smooth until puberty • Somewhat irregular after puberty • Due to scars left by the degenerating corpora lutea (vide infra) • Mesovarium • Suspends the ovary. • is the posterior lamina of the broad ligament.

21. The Female Internal Genitalia • The ovary • is embraced anteriorly and laterally by the uterine tube. • It is quite mobile and its position may vary. • In the young is held against lateral pelvic wall by its suspensory ligament. • Surfaces • Lateral • medial • Margines • Mesovarian • Free border

22. The Female Internal Genitalia • The ovary • Extremities (poles) • Tubal extremity • Uterine extremity • Ligaments • Suspensory ligament of the ovary • (Proper) ligament of ovary

23. The Female Internal Genitalia • The uterine tube (tuba uterina, salpinx uterina, fallopian tubes) • About 10cm long • Almost completely surrounded by peritoneum • Attached by the mesosalpinx. • Its lateral part arches over the lateral pole of the ovary and turns posteriorly. • Its trumpet-shaped, expanded open end becomes closely applied to the ovary.

24. The Female Internal Genitalia • Parts of the uterine tube • Has four recognizable parts • The infundibulum • The ampulla • The isthmus • The uterine part

25. The Female Internal Genitalia • The infundibulum • is the funnel or trumpet-shaped lateral expansion of the tube (infundibulum meaning funnel; salpinx meaning trumpet) • The wide circumfernce of the infundibulum presents numerous fingerlike processes called fimbriae. • One of which, the ovarian fimbria, is attached to the ovary. • Abdominal ostium of the tube • Located at the bottom of the infundibulum

26. The Female Internal Genitalia • The ampulla • is wide, thin walled, and tortuous. • The isthmus • More narrow • Normally, fertilization takes place here. • The uterine part • Also called intramural part • Traverses the thick uterine wall • Opens into the uterine cavity through the uterine ostium (uterotubal junction) • Ectopic pregnancy • Tubal ectopic pregnancy • Abdominal ectopic pregnancy

27. The Female Internal Genitalia • The uterus • The uterus, or womb, is the organ of gestation. • It is somewhat pear-shaped, hollow organ. • Its thick muscular walls enclose a slitlike cavity. • Location • Behind the bladder • In front of the rectum • Entirely below the plane of the pelvic brim • Dimensions • 8cm long • 5cm between the attacment of the tubes • 2.5cm antero-posterior

28. The Female Internal Genitalia • Parts of the uterus • Corpus (body) • The upper, broad, priform part of the uterus • Fundus • Dome-shaped part of the body, projecting above the entrance of the uterine tubes. • Cervix (neck) • A narrow, more cylindirical inferior portion of the uterus. • Projects into the vagina through the anterior wall of its vault • The vaginal vault demarcates the supravaginal and vaginal parts of the cervix. • The vaginal lumen surrounding the cervix is called the fornices of the vagina.

29. The Female Internal Genitalia • Parts of the uterus • Isthmus • The lower part of the body adjoining the supravaginal cervix is the isthmus = lower uterine segment • Faces • Posterior (intestinal) surface • is convex, covered by peritoneum • İn contact with coils of intestine • Anterior (vesical) surface • is concave, covered by peritoneum only as far down as the cervix • İn contact with coils of intestine.

30. The Female Internal Genitalia • Uterine cavity • Triangular and small cavity. • Its connections • With uterine tubes • Through uterine ostia • With cervical canal • Through internal os • Cervical canal • Internal os • External os (ostium uteri) • Palmate folds • They interlock as they project into the canal from its anterior and posterior surfaces.

31. The Female Internal Genitalia A. arcuatum Mesosalpinx A. spiralis

32. Cervical Canal

33. The Female Internal Genitalia • Orientation of Uterine • The body of the uterus is normally bent anteriorly on the crevix. • This relationship is spoken of as anteflexion. • Ethe axis of the cervix is likewise bent forward on the axis of the vagina, so that external os faces the posterior wall of the vagina. • This relationship is called anteversion of the uterus. • Permenant reversal of these angles, called retroflexion and retroversion, has been suspected as a cause of infertility.

34. The Female Internal Genitalia

35. The Female Internal Genitalia

36. The Female Internal Genitalia • Layers of the uterus (metra meaning uterus) • Endometrium • Myometrium • Parametrium and paracervix • Mesometrium

37. The Female Internal Genitalia • Ligaments of the uterus • Peritoneal ligament (1) • Fibromuscular ligaments (2) • Ligaments derived from the subperitoneal pelvic connective tissue (numerous)

38. The Female Internal Genitalia • Ligaments of the uterus • Broad ligament • A peritoneal ligament • Parts: • Mesometrium • Mesosalpinx • Mesovarium • Proper ligament of the ovary • A fibromuscular ligament • From the uterine pole to inferior angle of the uterotubal junction. • Round ligament of the uterus • A fibromuscular ligament • From the uterotubal junction to labium majora

39. The Female Internal Genitalia • Ligaments of theuterus • Rectouterinefoldandmuscle • Ligamentformedbypelvicfascia • Uterosacralligament • Ligamentformedbypelvicfascia • Lateralcervicalligament(Mackenrodt’sligamentsorCardinalligaments of theuterus) • Ligamentsformedbypelvicfascia • The dense connectivetissuebelowthebroadligamentmakesupthis/theseligaments.

40. The Prolapse of Uterus

41. Uterus: Changes with Age

42. The Female Internal Genitalia • Vagina • is the female organ of copulation, the word vagina means sheath. • The entrance into the vagina (ostium vaginae) is in the vestibule. • 10cm long and greatly distensible. • It is flattened anteroposteriorly. • Its anterior and posterior walls lie in contact with each other.

43. The Female Internal Genitalia • Vaginal vault • is the upper end of the vagina • The lumen of the vagina forms recesses or fornices around the vaginal part of the cervix. • Posterior fornix is longer and deeper than anterior fornix.

44. The Arteries and Veins of Pelvic Organs • Uterus • Uterine a. (internal iliac a.) • Tubal branches • Ovarian branches • Paired vaginal artery

45. The Arteries and Veins of Pelvic Organs

46. The Arteries and Veins of Pelvic Organs

47. The Arteries and Veins of Pelvic Organs

48. TubalLigation