1. Systema genitale femininum Female genital system
Anatomy

2. Organa genitalia feminina interna Female 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: Section: Cortex:
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: 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

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

8. 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)

9. 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

10. 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

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 surface of 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 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 / salpinx Uterine 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 / 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

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 / salpinx regional 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: 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.

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

26. 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

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: 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

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
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

51. 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.

52. 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

53. 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

54. 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)

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

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

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

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

59. Male ischio-anal fossa

60. Female ischio-anal fossa