Systema genitale femininum Female genital system

1. Systema genitale femininum Female genital system Anatomy

2. Organa genitalia feminina internaFemale internal genitalia • ovarium (= ovary) • tuba uterina / salpinx (= uterine tube) • uterus (= womb) • vagina • developmental rudiments (epoophoron, paroophoron)

3. peritoneal duplicature • sagital plate

4. Ovarium Ovary • Description: • Extremitas tubaria + uterina • Margo liber + mesovaricus • Facies medialis + lateralis • Hilum • Section: • stroma, cortex, medulla, tunica albuginea • Cortex: • folliculi, corpora, linea Farre-Waldeyer

5. Ovarium Ovary • Position: • fossa ovarica (between vasa iliaca int. and ext.) • in multiparas fossa of Claudius (behind vasa iliaca int.) • Fixation: • lig. ovarii proprium (lig. uteroovaricum) / lig. of ovary • lig. suspensorium ovarii / suspensory lig. of ovary (infundibulopelvic ligament) • lig. latum uteri / broad ligament of uterus • mesovarium

7. Ovariumblood supply • aorta abdominalis → • a. ovarica • a. iliaca int. • r. ovaricus both arteries join and form an ovarian arcade

8. Ovariumother supply • veins: • plexus pampiniformis  v. ovarica •  v. cava inf. dx. et v. renalis sin. • lymph drainage: • n.l. lumbales • nerves: • plexus ovaricus • (viscerosensory, autonomic para- + sympathetic fibres)

9. Ovarium - histoloy • cortex (cortical zone) • simple cuboideal epithelium • tunica albuginea • loose connective tissue, fibroblasts, collagen and reticular fibres • ovarian follicles • medulla (vascularzone) • collagenous tissue, vessels, nerves

10. Primordial follicles • one layer of flattened follicular cells • oocyte Primary follicles • follicular cells proliferate • cuboideal to columnar on basal lamina • appearance of lipid granules - granulosa cells • zona pellucida • between follicular cells and oocyte - glycoproteins • theca folliculi • surrounding tissue and cells

11. Secondary follicles • small cavities between follicular cells • fusing of cavities – formation of antrum folliculi • fulfilled with fluid - liquor folliculi • oocyte is peripherally - cumulus oophorus • surrounded by granulosa cells - corona radiata • theca differentiates into: • theca interna - fibroblasts  theca cells • production of estrogens, vessels • theca externa – connective tissue, smooth muscle cells

12. Tertiary follicles (Graafian) • prominent on the surfaceof ovary-macula pellucida bad blood supply of covering tissue rupture and releasing of oocyte with corona radiata to uterine tube

13. Corpus luteum • develops from empty Graafian follicle • corpus luteum graviditatis • in function till 4th month of gravidity • corpus luteum menstruationis • functional for 10-12 days (till 24th-26th day of cycle) • corpus luteum change to corpus albicans(connective tissue) • c.a.graviditatis – remains a recession on ovary surface • c.a.menstruationis – no traces 

14. Corpus luteum • in the centre is a blood clot • granulosa-lutein cells • production of progesterone and estrogens • contain lutein – yellow color • theca-lutein cells • Production of progesterone and androstedione • capsule from theca externa - septa • ingrowth of vessels

15. Ovary development • from 12th week • primary sex cords disappear • development of cortical cords • surrounding the primordial germ cells • development of follicles with oogonia • surface epithelium • simple cuboideal  mesovarium • tunica albuginea • relative descent (elongation of body) • gubernaculum lig. suspensorium ovarii, lig. teres uteri

16. Tuba uterina / salpinxUterine tube (Falloppii) • Parts: • ostium abdominale • infundibulum • ampulla • isthmus • pars uterina (p. intramuralis) • ostium uterinum • Fimbriae • the longest ovarian fimbria reaching the ovary

17. Tuba uterina / salpinxUterine tube (Falloppii) • Fixation: • mesosalpinx • Arteries: • r. tubarius a. uterinae • r. tubarius a. ovaricae • Veins: • vv. ovaricae, plexus venosus uterovaginalis • Lymph drainage: • n.l. lumbales

18. Tuba uterina / salpinx - structure • tunica mucosa – forms folds • simple columnar epithelium with cilia • secretory cells – support of oocyte •  to the ostium uterinum, in the second half on cycle • ciliated cells – transport of oocyte • lamina propria mucosae – loose connective tissue • tunica muscularis -  to the uterus • inner – circular outer - longitudinal • tunica serosa(= peritoneum)

19. Tuba uterina / salpinxregional differences

20. Tuba uterina – isthmus - HE

21. Tuba uterina – ampula - HE

22. Uterus (gr. metra, hystera) - womb • Description: • fundus, corpus (body), cornua (horns), isthmus, cervix, facies vesicalis + intestinalis (surfaces), margo (border) • Section: • cavitas uteri (cavity), canalis cervicis, endo-, myo-, para- a perimetrium, glandulae uterinae • Cervix: • portio supravaginalis (supravaginal part) • portio vaginalis (vaginal part) • ostium, plicae palmatae (palmate folds), glandulae cervicales

24. Uterus – fixation • Suspensory apparatus: • lig. latum uteri (broad lig.) • lig. cardinale Mackenrodti (lig. transversum cervicis) • lig. teres uteri (round lig. of uterus) • lig. pubocervicale et rectouterinum • ventro-dorsal ligg. (! older nomenclature !) • lig. pubovesicalia → vesicouterina → rectouterina + sacrouterina • Sustaining apparatust: • m. levator ani (m. pubococcygeus → m. pubovaginalis) • m. transversus perinei prof.

25. Uterus - position • anteflexion • anteversion • lateroposition • dextrotorsion = most common retroversion retroflexion - rupture risk in gravidity (sharp promontory)

26. Uterus – supply • Arteries: • a. iliaca int.→ a. uterina • ventrally to ureter – „water under the bridge“ • approaching rthe cervix laterally, bleeding in rupture • Veins: • plexus venosus uterovaginalis → vv. uterinae → v. iliaca int. • anastomoses to plexus venosus vesicalis et rectalisnerves: • Nerves: • plexus uterovaginalis  plexus hypogastricus inf. • viscerosensory, autonomic para- + sympathetic fibres

27. Uterus – lymph drainage Lymph drainage: 2 divisions • Corpus uteri – n.l. iliaci int.+ lumbales+ inguniales superficiales • Cervix uteri – n.l. iliaci int.+ sacrales • n.l. lumbales - fundus et corpus • n.l. iliaci interni (il. externi, il. communes, obturatorii) - corpus, isthmus et cervix • nodus lymphoideus parauterinus Bayeri • first lymph node bythe urter – utrerine artery crossing • n.l. inguinales superficiales - margines et cornua • n.l. sacrales - isthmus, cervix

29. Corpus uteri (Body of uterus) structure • tunica mucosa - endometrium • tunica submucosa – not present !!! • tunica muscularis - myometrium • thick 15 mm • spiral smooth muscles bundles network • longest cells in the human body • tunica adventitia - parametrium • loose connective tissue • vessels + ligaments • tunica serosa = peritoneum - perimetrium

30. Endometrium • simple cuboideal epithelium • glandulae uterales – tubular glands • lamina propria – reticular fibers • stromal cells - decidual • stratum basale – more cells and reticular fibres, vessels • stratum functionale – separated in menstruation

31. Corpus uteri - HE

32. Menstrual cycle • menstrual phase (1st – 4th day) • proliferative phase (5th – 14th day) • secretory phase (15th – 28th day) • ischemic phase (28th day)

33. Menstrual phase • releasing of functional layer • basal layer stays in place • epithelisation of surface • fisihed 5th day = regeneration phase • menstruation blood • do not form clots – enzymes of mucosa • is mix of arterial and venous blood

34. Proliferative phase • influence of estrogens • hyperplasia ( count) of functional layer • glands elongate, get narrow with no lumen • endothelial cells cytoplasma – basophile (GER) • at the end of proliferative phase – ovulation

35. Secretory phase • influence of corpus luteum hormones • functional layer - hypertrophy ( size) • glands are wave-shaped (not in apical and basal parts) • stratum spongiosum – wave-shaped • stratum compactum - direct • secret contains mucin, glycogen and lipids • epithelial cells – contain glycogen and mucin • arterioles elongate and get wave-shaped • decidual change occurs during the nidation

36. Ischemic phase • contraction of arterioles – ischemia of functional layer • degenerative processes thanks to leukocytes arrival • stop bleeding – contraction of myometrium and vessels

38. Cervix uteri (Neck of uterus)strucutre • mucosa forms folds = plicae palmatae • simple columnar epithelium – produces mucus • glandulae cervicales uteri - mucous • obliteration of ostium - ovula cervicalia Nabothi • secret is alcalic with various viscosity • vaginal surface of cervix • stratified squamous epithelium • junction at orifice of cervical canal • ectopy= columnar epithelium is changed into the stratified squamous - precancerous • tunica muscularis - 3 layers (L, C, L)

39. Cervix uteri - HE

40. Female genital system rudiments • Epoophoron – v mesosalpinx - ductus longitudinalis (remnant of Wolffian duct) - ductuli transversi (remnatnts of mesonephric tubules) - appendices vesiculosae (=hydatis Morgagni) ductus longitudinalis Gartneri (remnant of Wolffian duct by the uteus margin in the broad lig.) • Paroophoron (remnatnt of mesonephric tubules) – in mesosalpinx closer to the uterus

41. Vagina (gr. kolpos) • Description: • Fornix anterior, posterior, laterales • Paries (wall) anterior, posterior • Hymen • carunculae hymenales (remnants after defloration) • Section: • rugae – columnae rugarum (ant. + post.), carina urethralis, area trigonalis Pawliki • Fixation and position: • septum urethrovaginale et rectovaginale • excavatio rectouterina • m. pubovaginalis

42. Vagina – blood supply • arteries: a. iliaca interna → a. vaginalis (sometimes missing) → a. uterina → r. vaginalis → a. rectalis media → r. vaginalis → a. pudenda int. → r. vaginalis • veins: → v. iliaca int. plexus venosus uterovaginalis →v. pudenda int. →v. uterina

43. Vagina – lymph drainage and nerves • lymph drainage: • n.l. iliaci int.+ ext. • n.l. inguinales superficiales (caudally below hymen) • nerves: • nn. vaginales z plexus uterovaginalis  plexus hypogastricus inf. • n. pudendus (caudally below hymen)

44. Vagina – inner structure • tunica mucosa – folds and columns - columna rugarum, rugae vaginales • epithelium – stratified squamous (? keratinizing ?) • cells produce glycogen – acid environment • exfoliative cytology • lamina propria – loose connective tissue • no glands • tunica muscularis • inner - circular, outer - longitudinal • adventitia – dense connective tissue, vessels, nerves

45. Vagina - HE

46. Vagina - PAS+HE

47. Exfoliative vaginal cytology • Proliferative phase – cells with acidophilic (= eosinophilic) cytoplasma • Secretory phase - cells with basophilic cytoplasma

48. Organa genitalia feminina externa (pudendum femininum, vulva) • mons pubis (= mons Veneris) • labia majora et minora • rima pudendi (pudendal cleft) • commissura anterior + posterior • vestibulum vaginae (vestible) • bulbus vestibuli (bulb of vestibule) • glandulae vestibulares • clitoris (corpus, crura, glans, corpora cavenosa ligaments, fascias) • urethra feminina

49. Female external genitalia - structure • labia majora • connective tissue, adipose cells • outer surface – skin with hair follicles, sebaceous, apocrine and sweat glands • inner – no follicles, only sebaceous glands • labia minora • no adipose cells, no hair follicles • stratified squamous epithelium – slightly keratinizing • sebaceous gland - smegma praeputii

50. Female external genitalia (vulva) • vestibulum vaginae = vestible • glandulae vestibulares majores Bartholini • paired, pea-sized, under and inm. transversus perinei prof. • tuboalveolar and mucinous • glandulae vestibulares minores • tubulous and mucinous • Erectiel bodies: - clitoris (f.) • paired corpus cavernosum • covered with tunica albuginea • stratified squamous epithelium - bulbus vestibuli= bulb of vestible • paired spongious body • commissura bulborum