1. Female Genital System
Dr. Lubna Nazli
1st April 2009

2. Objectives External and internal organs
Ovaries: size, parts, relations and vessels and nerves.
Uterine tube: size, parts, relations and vessels and nerves.
Uterus: size, parts, relations and vessels and nerves.
Ligaments of uterus
Vagina
Mammary gland
Clinical application.

3. The Female Genital Organs
The female genital organs consist of an internal and an external group.
The internal organs are situated within the pelvis, and consist of the ovaries, the uterine tubes, the uterus, and the vagina.

4. Female Reproductive System

5. Female Reproductive System
Ovaries, the female gonads, are the primary reproductive organs of the female
Like the testes of the male, ovaries serve a dual purpose
Produce gametes
Produce female sex hormones (estrogen and progesterone)
The accessory ducts (uterine tubes, uterus, and vagina) transport or otherwise serve the needs of the reproductive cells and fetus

6. The external organs are placed below the urogenital diaphragm and below and in front of the pubic arch.
They comprise the mons pubis, the labia majora & minora , the clitoris, the bulbar and the greater vestibular glands.

7. The Ovaries
The paired ovaries are situated on each side of the uterus and shaped like almonds.
Each ovary is held in place within the peritoneal cavity by several ligaments

8. The Ovaries
The ovarian ligament anchors the ovary medially to the uterus
The suspensory ligament anchors the ovaries laterally to the pelvic wall

9. The Ovaries
The mesovarium ligament suspends the ovaries between the fallopian tubes and the uterus
Both the suspensory ligament and the mesovarium are part of the broad ligament

10. The Ovaries
The broad ligament is a peritoneal fold that “tents” over the uterus and supports the uterine tubes, uterus and vagina

11. The Ovaries
The ovaries are supplied by the ovarian arteries which are branches of the abdominal aorta
The ovarian blood vessels reach the ovaries by traveling through the suspensory ligaments and mesovarium

12. The Uterine Tube 
The uterine tubes convey the ova from the ovaries to the cavity of the uterus.
They are two in number, one on either side, situated in the upper margin of the broad ligament, and extending from the superior angle of the uterus to the side of the pelvis.

13. Each tube is about 10 cm. long, and is described as consisting of three portions:
(1) the isthmus, or medial constricted third
(2) the ampulla, or intermediate dilated portion, which curves over the ovary
(3) the infundibulum with its abdominal ostium, surrounded by fimbria, one of which, the ovarian fimbria is attached to the ovary.

14. Female Duct System
The distal end of each uterine tube extends as it curves around the ovary, forming the ampulla, where fertilization occurs.

15. Female Duct System
The ampulla ends in the infundibulum, an open, structure bearing ciliated projections called fimbriae that drape over the ovary

16. Female Duct System
An ovulated oocyte is released into the peritoneal cavity, and many oocytes are lost there

17. Female Uterus
The uterus is located in the pelvis, anterior to the rectum and postero- superior to the bladder

18. The Uterus
The uterus is a hollow, thick walled organ that functions to receive, retain, and nourish the ovum

19. The Uterus
In a pre-menopausal woman who has never been pregnant, the uterus is about the size and shape of an inverted pear
It is usually somewhat larger in woman who have borne children

20. The Uterus
Normally, the uterus is fixed anteriorly where it joins the vagina, causing the uterus as a whole to be inclined forward or anteverted
However, the uterus is often turned backward, or retroverted in older woman

21.  The long axis of the uterus usually lies approximately in the axis of the superior pelvic aperture, but as the organ is freely movable its position varies with the state of distension of the bladder and rectum.
It forms a forward angle with the vagina, since the axis of the vagina corresponds to the axes of the cavity and inferior aperture of the pelvis.
Anteversion is the forward angle between axis of cervix and that of vagina. It is 90 degrees.
Anteflexion is the forward angle between the body and cervix at the isthmus. It is 125 degrees.

22. Anteverted
Anteflexed

23. The Uterus The main portion of the uterus is referred to as the body
The rounded region superior to the entrance of the uterine tubes is the fundus, and the slightly narrowed region is the isthmus

24. The Uterus
The cervix of the uterus is its narrow neck, or outlet, which projects into the vagina inferiorly
The cavity of the cervix, called the cervical canal, communicates with the vagina via the external os
The internal os opens into uterine body

25. The Uterus
The mucosa of the cervical canal contains cervical glands that secrete a mucus that fills the cervical canal and covers the external os, to block the spread of bacteria from the vagina into the uterus
Cervical mucus also blocks the entry of sperm, except at midcycle, when it becomes less viscous and allows sperm to pass through

26. Cancer of the cervix is common among women between ages of 30 and 50
Risk factors include frequent cervical inflammations, sexually transmitted diseases including genital warts, and multiple pregnancies
The cancer cells arise from the epithelium covering the cervical tip

27. In a Papanicolaou (Pap) smear, or cervical smear test, some of these epithelial cells are scraped away and then examined for abnormalities
A Pap smear is the most effective way to detect this slow-growing cancer
Woman are advised to have a Pap smear every year

28. Supports of the Uterus
The uterus is supported laterally by the broad ligament
Inferiorly, the lateral cervical (cardinal) ligaments extend from the cervix and superior part of the vagina to the lateral walls of the pelvis

29. Supports of the Uterus
The paired uterosacral ligaments secure the uterus to the sacrum posteriorly
The uterus is bound to the anterior wall by the fibrous round ligament, which runs through the inguinal canals to anchor in subcutaneous tissue

30. Supports of the Uterus
These various ligaments allow the uterus mobility, and its position changes as the rectum and bladder fill and empty
The principle support of the uterus is provided by muscles of the pelvic floor, namely the muscles of the urogenital and pelvic diaphragms

31. Uterus: Homeostatic Imbalance
These muscles are sometimes torn during childbirth
The unsupported uterus may sink inferiorly, until the tip of the cervix protrudes through the vaginal opening
This condition is called a prolapse of the uterus

32. The Uterus
The peritoneum around covers the various pelvic structures and produces several blind ended peritoneal pouches
The most important of these pouches are the vesicouterine pouch between the bladder and the uterus
The rectouterine pouch lies between the rectum and the uterus

33. The Uterine Wall
The wall of the uterus is composed of three layers; the perimetrium, myometrium and endometrium

34. The Uterine Wall The wall of the uterus
The perimetrium is the outermost serous layer composed of visceral peritoneum
The myometrium is the bulky middle layer, composed of interlacing bundles of smooth muscle. It is the myometrium that contracts during childbirth to expel the baby
The endometrium is a simple columnar epithelium underlain by a thick lamina propria of highly cellular connective tissue

35. Vascular supply of the uterus
The uterine arteries arise from the internal iliac in the pelvis, ascend along the sides of the uterus and send branches into the uterine walls

36. The Vagina The vagina is a thin-walled tube 8-10 cm / 3-4 in. long
It lies between the bladder and the rectum and extends from the cervix to the exterior of the body

37. The Vagina The urethra is embedded in its anterior wall
Often called the birth canal, the vagina provides a passageway for delivery of an infant or for menstrual flow
The vaginal mucosa has no glands; it is lubricated by the cervical mucus glands
urethra

38. The Vagina
The vaginal orifice forms an incomplete partition called the hymen
The upper end of the vaginal canal loosely surrounds the cervix of the uterus, producing a vaginal recess called the vaginal fornix
The posterior part of this recess, the posterior fornix, is much deeper than the lateral and anterior fornices

39. The Vagina
Generally, the lumen of the vagina is quite small and, except where it is held open by the cervix, its posterior and anterior wall are in contact with one another

40. The Mammary Glands
The mammary glands are present in both sexes, but they normally function in females only.

41. The Mammary Glands
Since the biological role of the mammary glands is to produce milk to nourish a newborn baby, they are actually important only when reproduction has already been accomplished
Developmentally, mammary glands are modified sweat glands that are really part of the skin, or integumentary system

42. The Mammary Glands
Each mammary gland is contained within a rounded skin- covered breast anterior to the pectoral muscles of the thorax
Slightly below the center of each breast is a ring of pigmented skin, the areola, which surrounds the central protruding nipple

43. The Mammary Glands
Large sebaceous glands in the areola make it bumpy and produce sebum that reduces chapping and cracking of the skin of the nipple
Autonomic nervous system controls of smooth muscle fibers in the areola and nipple and cause the nipple to become erect when stimulated by contact or sexual stimuli and when exposed to the cold

44. The Mammary Glands
Internally, each mammary gland consists of 15 to 25 lobes that radiate around and open at the nipple
The lobes are separated by fat and fibrous connective tissue

45. The interlobar connective tissue forms suspensory ligaments that attach the breast to the underlying muscle fascia and to the over- lying dermis
The suspensory ligaments( lig of Cooper ) provide natural support for the breasts
Within the lobes are smaller units called lobules which contain glandular alveoli that produce milk when lactating

46. These compound alveolar glands pass milk into the lactiferous ducts, which open to the outside at the nipple
Just deep to the areola, each lactiferous duct has a dilated region called a lactiferous sinus
Milk accumulates in these sinuses during nursing

47. The Mammary Glands
In nonpregnant women, the glandular structure of the breast is largely undeveloped and the duct system is rudimentary
Breast size is largely due to the amount of fat deposits

48. Breast Cancer
Invasive breast cancer, the most common malignancy of women
Breast cancer usually arises from the epithelial cells of the ducts, not from the alveoli
A small cluster of cancer cells grows into a lump in the breast from which cells eventually metastasize

49. Breast Cancer Known risk factors for developing breast cancer include
Early onset menses and late menopause
No pregnancies or first pregnancy late in life
Previous history of breast cancer
Family history of breast cancer (especially in a sister or mother)

50. Breast Cancer
Breast cancer is often signaled by a change in skin texture, puckering, or leakage from the nipple
Early detection by breast self-examination and mammography is the best way to increase one’s chances of surviving breast cancer
Since most breast lumps are discovered by women themselves in routine monthly breast exams this should be a priority