Systema genitale femininum Female genital system Anatomy

Organa genitalia feminina interna Female internal genitalia ovarium (= ovary) tuba uterina / salpinx (= uterine tube) uterus (= womb) vagina developmental rudiments (epoophoron, paroophoron)

peritoneal duplicature sagital plate

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

Ovarium Ovary Position: Fixation: 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

Ovarium blood supply aorta abdominalis → a. ovarica a. iliaca int. r. ovaricus both arteries join and form an ovarian arcade

Ovarium other supply veins: lymph drainage: nerves: 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)

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

Primordial follicles Primary 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

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

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

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 

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

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

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

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

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)

Tuba uterina / salpinx regional differences

Tuba uterina – isthmus - HE

Tuba uterina – ampula - HE

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

Uterus – fixation Suspensory apparatus: Sustaining apparatust: 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.

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

Uterus – supply Arteries: Veins: Nerves: 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

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

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

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

Corpus uteri - HE

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

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

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

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

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

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)

Cervix uteri - HE

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

Vagina (gr. kolpos) Description: Section: Fixation and position: 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

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

Vagina – lymph drainage and nerves 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)

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

Vagina - HE

Vagina - PAS+HE

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

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

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

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

Female external genitalia - supply arteries: a. femoralis → aa. pudendae ext. → rr. labiales ant. a. iliaca int. → a. pudenda int. → rr. labiales post., a. profunda clitoridis, a. dorsalis clitoridis, a. bulbi vestibuli veins: v. dorsalis superficialis clitoridis + vv. labiales ant.  vv. pudendae ext. v. dorsalis profunda clitoridis + vv. labiales post. + v. bulbi vestibuli  v. pudenda int.

Female external genitalia - lymph drainage and innervation nl.l. inguinales superficiales (both homolaterally and contralaterally) nerves: n. ilioinguinalis + r. genitalis n. genitofemoralis n. pudendus  nn. perineales, nn. labiales post., n. dorsalis clitoridis

Perineum corpus perineale / centrum perinei (perineal body) mm. perinei (n. pudendus, nn. sacrales, nn. splanchnici pelvici) corpus / lig. anococcygeum raphe perinei fascia perinei fossa ischioanalis (ischio-anal fossa) recessus pubicus corpus adiposum (fat body of ischio-anal fossa) canalis pudendalis Alcocki

Urogenital floor = diaphragma urogenitale no official term in Terminologia Anatomica 1998 excellent term to understand the problem 4 muscles in a plane = „floor“ + 3 more muscles around female urethra possible term „perineal muscles = musculi perinei“ the centre is so-called corpus perineale (perineal body) (former centrum tendineum perinei)

♂ m. transversus perinei profundus m. transversus perinei superficialis m. bulbospongiosus m. ischiocavernosus m. sphincter urethrae externus

♀ m. transversus perinei profundus m. bulbospongiosus m. ischiocavernosus smooth muslces fibres in the extent of male m. transversus perinei superficialis !!

♀ m. sphincter urethrae m. compressor urethrae m. sphincter urethrovaginalis

Urogenital floor - innervation nn. perineales n. pudendi rr. ventrales nn. sacralium nn. splanchnici pelvici

Male ischio-anal fossa

Female ischio-anal fossa