1. Normal And Abnormal Development Of Female Genital Tract
Dr Khalid Sait
FRCSC
A. Prof Gynecologist Oncologist

2. Embryology
Baby sex established at the time of fertilization ( sperm meet ovum )
sperm 46 xy ovum 46 xx (23x y) (23 x + 23 x)
Girl
Boy

3. Genetic sex
XX / XY
Gonadal sex
Testes / Ovaries
Hormones
Internal
genitalia
External
genitalia

4. Embryology
Gonads appear as genital ridges by proliferation of coalemic epithelium(mesoderm)
Primordal germ cell appear in the endodermal cell in the wall of yolk sac , migrate along the mesentery of hindgut and invade the genital ridges
At 7 weeks the gonads of embryo: indistinguishable male and female ( indifferent gonad)
At 8 weeks if xx Ovary xy Testis

5. Embryology Ovary
Gonadal ovary : medullary cord degenerate and cortical cord develop
Germ cells ----oogonia
11-12 w : onset of oogenesis
20 w : 7 million germ cells in each ovary
Birth : 2 millions
Puberty : 40,000 primary oocytes remaining in the ovaries Only secondary oocytes and extended at ovulation once every month during menst. Cycle.
Descend of ovary is not an active migration, but result of rapid growth of body and failure of gubernaculum to elongatee ( that why its maintain blood supply from the aorta

6. Congenital Uterine Anomaly
Precise incidence is unknown (range from 1-2 %) 
Clinical presentation: Usually asymptomatic Menstrual disorder   Dysmenorrhea   Recurrent abortion ( decrease intrauterine volume and vascularity, increase uterine irritability and cervical incompetance ) Premature labor Abnormal presentation Primary infertility 

7. Congenital Uterine Anomaly
Diagnosis:  History Pelvic exam Hysterosalpingography U/S MRI Laproscopy Hysteroscopy IVP or U/S (Exclude Renal anomaly )

8. Congenital Uterine Anomaly
Treatment:     Double uterus (didelphic uterus): no need to treat    Bicornate ut Strassmann procedure ( if indicated )    Ut. Septum (BCP for dysmenorrhea ), Tompkins metroplasty or Hysteroscopic resection of septum )    Unicornate ut Surgery indicated if there is blind horn which cause symptom----- surgical resection of blind horn.

9. Mullerian Agenesis Mayer Custer Hauser Rokitansky Syndrome 1: 4000
 1: 4000
 Abscent upper vagina, cervix and uterus and tubes
Normal ovaries and vulva
 Associated with spine and renal anomaly
 Treatment: McIndoe procedure Self dilatation of vagina 

10. Vaginal Agenesis 1: 5000 Normal Vulva
Ass. With spine, renal and middle ear anomaly 
Treatment:  Karyotype, U/S - MRI ( only 5 % will have normal functioning uterus) Once patient sexually active    Gradual vaginal dilatation against vaginal dimple (daily for mint for few month with gradual dilators size    William procedure    Wharton and Macindo procedure  

11. Transverse Vaginal Septum
Mid vagina usually 
May be partial or complete 
Presentation:  Primary amenorrhea Dysparonia 
Treatment:  Surgical resection  

12. Adult Equivalents of Embryonic Structures
Female
Embryonic Structure
ovary
Indifferent gonad
ovarian follicles
Cortex
rete ovarii
Medulla
ovarian and round ligament of uterus
Gubernaculum
epoophoron, paroophoron
Mesonephric tubules
appendix vesiculosa, duct of epoophoron, duct of Gartner, ureter, pelvis, calices and collecting tubules
Mesonephric Duct
hydatid of Morgagni, uterine tube, uterus
Paramesonephric Duct
urinary bladder, urethra, vagina, urethral, paraurethral and greater vestibular glands
Urogenital Sinus
hymen
Sinus tubercle
clitoris
Phallus
labia minora
Urogenital folds
labia majora
Labioscrotal swellings

13. Imperforated Hymen Presentation: Primary Amenorrhea Pelvic mass
Treatment:  Cuciate incision at hymen 
Follow up  Endometrosis  Vaginal adenosis