REVISIT OF MALE & FEMALE REPRODUCTIVE TRACTS

1. REVISIT OF MALE & FEMALE REPRODUCTIVE TRACTS Dr. Sarah Zahid

2. LEARNING OBJECTIVES • At the end of the lecture, students should be able to; • Discuss the brief anatomy of male & female reproductive systems • Discuss the location, blood supply, nerve supply & lymphatic drainageof male & female reproductive organ

3. FEMALE REPRODUCTIVE ORGANS

4. Female Reproductive Organs • Consists of; • A pair of sex glands (ovaries) • System of genital ducts (uterine tubes, uterus, vagina) • External genitalia

5. Exocrine as well as endocrine function. • Production and ovulation of “ova” [exocrine] • Production and secretion of hormones [endocrine] • Estrogen and progesterone. OVARIES • Almond-shaped, paired reproductive glands • Located close to the lateral pelvic walls on each side of the uterus

6. OVARIES • Each ovary is suspended by a short peritoneal fold or mesentery, the Mesovarium, subdivision of a larger mesentery of the uterus, the broad ligament. • Medially within the mesovarium, a short ovarian ligament tethers the ovary to the uterus.

7. Ovaries • Histological section of ovary consists of; • Outer cortex • Inner medulla

8. Uterine/ fallopian tubes • Paired muscular tubes, on either side of uterus, carries the ova from the ovaries to the uterus. • Normal site of fertilization. • (Approximately 10 cm long) lie in a narrow mesentery, the mesosalpinx

9. Uterine/ fallopian tubes • Uterine tube is divided into four parts: • Infundibulum • Ampulla- (site of fertilization) • Isthmus • fimbria

10. UTERUS • Commonly known as womb • Thick walled, pear shaped organ. • Site of implantation and placentation. • Lies b/w the urinary bladder and rectum with the perineal cavity.

12. UTERUS • Consists of fundus, body & cervix.

13. UTERUS • Upper expanded part- body • Rounded, superior part of the body or the dome- fundus

14. UTERUS • Tapered end- cervix that is nearly cylindrical in shape. The lumen of the cervix, the cervical canal, has a constricted opening at each end. • The internal os communicates with the cavity of the uterine • The external os communicates with the vagina

15. Layers of Uterus • The wall of the body of the uterus consist of three layers: • Perimetrium, the thin external layer • Myometrium, the thick smooth muscle layer • Endometrium, the thin internal layer

16. Layers of Uterus • Perimetrium is the outer most layer, a peritoneal layer that is firmly attached to the myometrium. • Myometrium is the thick middle layer made up of 3 layers of smooth muscle

17. Ligaments of Uterus • Broad ligament of the uterus is a double layer of peritoneum (mesentery) that extends from the sides of the uterus to the lateral walls and floor of the pelvis, assists in keeping the uterus in position. • Laterally, the peritoneum of the broad ligament is prolonged superiorly over the vessels as the suspensory ligament of the ovary. • Uterine tube lies in the anterosuperior free border of broad ligament, within a small mesentery called the mesosalpinx. • Ovary lies within a small mesentery called the mesovarium on the posterior aspect of the broad ligament. • Largest part of the broad ligament, inferior to the mesosalpinx and mesovarium, which serves as a mesentery for the uterus itself, is the mesometrium.

18. Ligaments of Uterus • Uterus is a dense structure located in the center of the pelvic cavity. • Main support of the uterus is provided by the pelvic diaphragm. • Passive support is provided by its position when it rests on top of the bladder— anteverted & anteflexed • Cardinal (transverse cervical) ligaments extend from the cervix and lateral parts of the fornix of the vagina to the lateral walls of the pelvis. • Uterosacral ligaments pass superiorly and slightly posteriorly from the sides of the cervix to the middle of the sacrum

20. Layers of Uterus • Endometrium- inner most layer • During the reproductive life, endometrium can be divided into 2 zones; 1) Stratum basale: • Adjacent to the myometrium. • Contains deep basal ends of uterine glands. • Serves as a source of regeneration of stratum functionale in the next menstrual cycle.

21. Layers of Uterus 2) Stratum functionale: • Thick superficial zone which sloughed off at the beginning of each menstrual cycle then is regrown during the next phase. • Includes most of the length of the glands as well as surface epithelium.

23. Vagina • Fibro-muscular tubular tract • Serves as a canal for menstrual fluid • Forms the inferior part of the birth canal • Receives the penis and ejaculate during sexual intercourse • Communicates superiorly with the cervical canal and inferiorly with the vestibule of the vagina

24. Blood supply of uterus, vagina & ovaries Blood supply and venous drainage of uterus, vagina, and ovaries. The broad ligament of the uterus is removed on each side of the uterus to show the anastomosing branches of the ovarian artery from the aorta and the uterine artery from the internal iliac artery supplying the ovary, uterine tube, and uterus. The veins follow a similar pattern also including a pampiniform plexus related to the ovary and continuous uterine and vaginal plexuses (collectively, the uterovaginal plexus).

25. Nerve supply of uterus, vagina & ovaries • The nerve supply derives from the ovarian & uterine (pelvic) plexus • Sympathetic innervation to the ovarian plexus and lumbar splanchnic nerves to cell bodies in the T11-L1 spinal sensory ganglia. • Parasympathetic fibers through the uterine (pelvic) and (vagina) inferior hypogastric plexuses and the pelvic splanchnic nerves to cell bodies in the S2-S4 spinal sensory ganglia. • Inferior 1/5th of the vagina is from the deep perineal nerve, a branch of the pudendal nerve.

27. Lymphatic drainage of female reproductive viscera • Ovaries- right and left lumbar (caval/ aortic) lymph nodes • Uterus: • Fundus and upper body- lumbar (caval/ aortic) lymph nodes • Lower body and some from the cervix- external iliac lymph nodes. • Cervix- internal iliac lymph nodes & sacral lymph nodes.

28. Lymphatic drainage of female reproductive viscera • Vagina: • Superior part: to the internal and external iliac lymph nodes. • Middle part: to the internal iliac lymph nodes. • Inferior part: to the sacral and common iliac nodes • External orifice: to the superficial inguinal lymph nodes

29. External female genitalia • Vulva: • Sensory and erectile tissue for sexual arousal and intercourse • Direct the flow of urine • Prevents entry of foreign material into the urogenital tract • Labia majora • Prominent folds of skin, made up of; • Loose subcutaneous tissue • Smooth muscle and the termination of the round ligament of the uterus • Function: indirectly provide protection for the urethral and vaginal orifices

30. External female genitalia • Labia minora: • Have a core of spongy connective tissue containing erectile tissue at their base and many small blood vessels

31. MALE REPRODUCTIVE ORGANS

32. MALE REPRODUCTIVE SYSTEM • Includes following structures: • Scrotum • Testes • Epididymis • Vas deferens • Seminal vesicles • Prostate gland • Penis

33. Consists of; • Skin • Fascia • Dartos muscle (smooth muscle) • Tunica vaginalis • Median raphe Scrotum • Supports, protects and regulates temperature of underlying male gonads.

34. Allows the testes to remain ~3°C cooler than core temperature Involuntary contraction of dartos& cremaster muscles (cremasteric reflex) in response to stimuli Scrotum

35. Contents of Spermatic cord • Ductus deferens • Artery to the ductus deferens • Testicular artery • Pampiniform plexus (venous plexus of testicular veins) • Cremasteric artery & vein • Sympathetic & visceral afferent nerve fibers • Lymphatics • Vestige of processus vaginalis

36. Testes (paired male gonads) • Develop adjacent to kidneys • Descend into scrotum through inguinal canal (function of gubernaculum testis) before birth

37. Internal Structure Of Testes • Fibrous capsule- tunica albuginea surrounds testes • Lobules contain approx. 800 seminiferous tubules which consists of; • Interstitial (Leydig) Cells → testosterone • Sustentacular (Sertoli) cells aids spermatogenesis

38. Seminiferous Tubules

39. EXCRETORY GENITAL DUCTS • Epididymis • Ductus deferens • They transport sperms from the scrotum to the penis during ejaculation.

40. Epididymis Epididymis Rete testis and Efferent ductules • Around 4-5m long, coiled tube • Head- superior, receives spermatozoa • Body-distal and inferior • Tail-leads to ductus deferens • Functions: • Monitors & adjusts tubular fluid (lining has stereocilia) • Stores sperm and facilitates maturation

41. DUCTUS DEFERENS • Long straight tube. • Thick, muscular wall. • Small lumen. • Continues toward the prostatic urethra where it transfers the sperms.

42. Accessory glands of the male reproductive system • Seminal vesicles • Prostate gland • Bulbourethral glands • Provide for 95% of the seminal fluid

43. Seminal Vesicles • Paired exocrine glands • Located posterior to urinary bladder • Tubular (~ 15 cm) • Produce 60% of seminal fluid, hormones, fructose, etc. • Activate sperm (leading to motility) Posterior view

44. Prostate Gland • Produces 20 -30% of seminal fluid. • Surrounds the urethra below the bladder. • Consists of Left & right lobes • Secretions open through ducts in prostatic urethra • Secretion contains: • Citrate • Plasmin (mild antibiotic)

45. Bulbourethral (Cowper’s) Glands • Pea size paired glands • Located at base of penis in the urogenital diaphragm • Produce about 10% of semen • Empty secretions into proximal part of penile urethra.

46. Semen • 2-5 ml ejaculate • Ejaculation of semen by pelvic floor and penile muscles (Sympathetic division induces peristalsis in tract) • Constituents: • Around 20 -100 million sperms/ ml • Seminal fluid –60% from seminal vesicles • Enzymes -proteases and seminal plasmin

47. Blood supply of male reproductive viscera • Testes: Testicular arteries & veins • Ductus deferens: superior vesical artery & testicular vein • Seminal glands: Inferior vesical &middle rectal arteries & veins • Prostate: prostatic arteries, inferior vesical arteries, internal pudendal, middle rectal arteries & prostatic venous plexus

48. Nerve supply of male reproductive viscera • T10 spinal segment provides the sympathetic nerve fibers that innervate the testes • Ductus deferens, seminal glands, ejaculatory ducts & prostate are innervated by sympathetic nerve fibers. • Presynaptic sympathetic fibers originate from cell bodies in the intermediolateral cell column of the T12-L2 (or L3) spinal cord segments, traverse the paravertebral ganglia of the sympathetic trunks to become components of lumbar (abdominopelvic) splanchnic nerves &hypogastric and pelvic plexuses • Presynaptic parasympathetic fibers from S2 &S3 spinal cord segments traverse pelvic splanchnic nerves, which also join the inferior hypogastric/pelvic plexuses.

49. Lymphatic drainage of male reproductive viscera • Testes, epididymis- lumbar nodes • Prostate- internal iliac nodes • Seminal vesicles & ductus deferens- external iliac & deep inguinal nodes • Prepuce of penis & scrotum- superficial inguinal nodes • Glans of penis- deep inguinal nodes

50. Refrences • Keith. L. Moore Clinically oriented Anatomy 7thedition • Gray’s Anatomy for students 2ndedition • Junqueira’s Basic Histology 14th edition