CAPS 391: Reproductive System (B)

Lumen of uterus

- Continuous with lumen of cervix Internal os: - Connection point: internal os External os: - Connects: - Tissue:

Sensory innervation of the breast

- Intercostal nerves TIV - TVI

Uterine tubes/Fallopian tube

Uterine tubes - 10 cm long located on superior border of the broad ligament - Connects the uterine cavity to the peritoneal cavity - Carries sperm towards the ovaries - Carries fertilized egg towards the uterine cavity Parts of the uterine tube (4): 1. Infundibulum 2. Ampulla 3. Isthmus 4. Uterine 1. Infundibulum - Funnel shaped lateral end of the tube that hangs over the over - Free margin carries finger-like projections = fimbriae -- Ovarian fimbria: longer and attaches to the ovary, one of the fimbriae - Collects the released ovum from the surface of the ovary 2. Ampulla - Most dilated part of the uterine tube - Lateral 2/3 of the tube - Fertilization of ovum by sperm 90% of time happens here - Egg then must pass through isthmus/narrowing 3. Isthmus - Narrowest part of the fallopian tube - Medial 1/3 of the tube 4. Uterine part (intramural) - Passes through the thickness of the uterine wall - Opens into the uterine cavity During ovulation - Fimbriae do a jelly fish like movement to try and grab egg cells -- Need enough estrogen

Blood and nerve supply of the male and fame reproductive systems

- Gonadal (ovarian or testicular) branches off the abdominal aorta: supplies testes or ovaries - Visceral branches of the internal iliac arteries: supply remaining internal and external reproductive organs in both M and F (uterus, vagina, prostate and penis) ANS is associated with gonadal arteries - Innervates the gonads (ovaries or testes) Sympathetic input to the plexuses: - provided by lesser, least and lumbar splanchnic nerves - Parasympathetic input to these plexuses is by the pelvic splanchnic nerves Inferior hypogastric plexuses innervates: - Internal and external reproductive organs in both genders - Sympathetic input: lesser, least, lumbar and sacral splanchnic nerves - Parasympathetic input: provided by the pelvic splanchnic nerves

Uterus

- Intraperitoneal organ - Inverted pear shaped hollow organ with thick muscular wall which accommodates and nourishes the fertilized ovum - Part of the passageway for sperms' journey to the ovaries - Source of menstrual flow - In nulliparous adult: 7.5cm long, 5 cm wide, 2.5 cm thick Has: - 2 surface (superior and inferior) - 2 lateral borders --> Surfaces are covered by peritoneum --> Superior surface related to: sigmoid colon and small intestine loops --> Inferior surface is related to: urinary bladder 3 parts of the uterus 1. Fundus: part located superior to the entrance of the uterine tubes 2. Body: middle part of the uterus between the funds and cervix (neck) - Isthmus: distal third of the body 3. Cervix (neck): extends between the isthmus and vagina Uterine cavity: triangular in coronal section - Connects with cervical canal via internal os (opening) Cervical canal - Opens into the vagina via the external os Uterus arches anteriorly over empty urinary bladder and forms angles: 1. Anteversion angle: - Angle between axis of cervix and axis of vagina - Opens anteriorly 2. Anteflexion angle - Angle between axis of uterine body and axis of cervix 2 peritoneal pouches formed (anterior and posterior to the uterus) A. Urerovescical pouch - Between uterus and bladder B. Rectouterine pouch - Between uterus and rectum - Deepest part of the peritoneal cavity in females - Also known as Douglas pouch -- Pouch can be drained via vagina or rectum

Vagina

- Stratified squamous epithelium - 10 cm - Fibromuscular tube starting at the vestibule, runs posterosuperiorly between the rectum and urinary bladder, to the cervix - Receptable for the penis during intercourse - Passage for sperm, menstrual flow and child birth - Hymen: thin mucus membrane, partially closes the entrance of the vagina - The vagina is normally collapsed; its anterior and posterior walls are in contact, except the proximal end where it surrounds the cervix to form a circular recess: formic Formix is divided into - Anterior - Posterior - Two lateral parts

Ovaries

- Two almond shaped structures - Location: lateral wall of the true pelvic cavity - Ovaries produce female gametes (ovum) and fame hormones (estrogen and progesterone) Each ovary has: - 2 surfaces (lateral and medial) - 2 borders (anterior and posterior) - 2 poles (superior and inferior) Anterior border: - Attaches to the mesovarium Posterior border: - Free! Ovarian hilum - Located on the anterior border where the ovarian blood vessels, nerves, and lymphatics enter or exit the ovary - Ovarian surfaces are smooth before puberty and become rough after due to ovulation (True pelvis and false pelvis are separated by superior pelvic aperture) Development of uterus - Starts with developing under the peritoneum - Uterus grows into it and raises two layers of peritoneum on either side (broad ligaments: double layer of peritoneum stretched between uterus and pelvic wall) Ligaments that hold the ovary in place: 1. Ligament of the ovary: attaches the inferior pole of the ovary --> lateral wall of the uterus near the entrance of the uterine tube 2. Suspensory ligament - Double layer fold of peritoneum - Attaches the superior pole ==> posterior abdominal wall - Carries ovarian vessels and nerves from posterior abdominal wall to and between the two layers of the broad ligament 3. Mesovarium - Double layer fold of peritoneum - Stretched between anterior border of ovary --> Posterior layer of broad ligament - Carries ovarian vessels, nerves and lymphatics from broad ligament into ovary via ovarian hilum - Ovaries are attached to posterior surface of broad ligament Things that hold ovaries in place - Ovarian ligament - Broad ligament: 2 layers, start from 1/4 of fallopian tube --> level of the cervix (ureters, round ligament, etc) Areas of broad ligament - Mesosalpinx: carries blood vessels for uterine tubes - Mesovarium: carries blood vessels for the ovaries - Mesometrium: carries blood vessels for the uterus --> These are key for holding uterus and vaginal canal in anatomical position - Slight changes in the angle or length of these ligaments may lead to the individual being sterile - Uterosacral: pulls the cervix posteriorly - Lateral cervical ligament: holds the vaginal canal by stabilizing to wall - Round ligament of uterus**: most important, know this one, exits the abdomen, leaves labia majora - Suspensory ligament of ovary: blood vessels and nerves pass through this before they get to the ovary

Always angles of the body of the uterus and axis of the cervix

Antiflexion angle - 120-125 degrees - Angle between uterine and vaginal axes Anteversion angle - 90 deg - Angle between axis of cervix and vaginal axis --> Changing angles prevents sperm from getting to the egg

Divide breast into four quadrants

Center is the nipple - Two lateral quadrants - Two medial quadrant 90% of malignant tumours develop in upper lateral quadrants - Check upper parts of breasts regularly - Inverted nipple is a bad sign that the tumour is pulling on the nipple - Skin of breast may be similar to orange peel

Female reproductive system

Components: (5) - Pair of ovaries - Pair of fallopian tubes - Uterus - Vagina - External genital organs + mammary glands may also be considered as parts of the female reproductive system

Uterus

Fundus: - Above entrance of uterine tube Body: - Below uterine tube Cervix: - Distal 1/3 of uterine body - Inserted into vagina canal so there is a round circular space around the cervix which enters the vagina = Formix - Site for cervical cancer

Ligaments of the uterus

Ligaments support weight and position of the uterus 1. Broad ligament - Double layer membrane made by peritoneum - Extends from lateral border of the uterus --> lateral pelvic wall and pelvic floor - Contains: uterine tube (superior border), and the ligament of ovary and round ligament of uterus inferior to the uterine tube - Part of broad ligament, between the uterine tube and mesocarium, form a mesentery for the uterine tube = mesosalpinx - Mesometrium: major part of the broad ligament, inferior to the mesosalpinx and mesovarium, serves as a mesentery for the uterus 2. Round ligament - Starts fro the superolateral angle of the uterus, passes through the inguinal canal, blends with the connective tissue of the labium majora 3. Transverse cervical (cardinal) ligament - Connects cervix and superior part of the vagina to the lateral pelvic wall 4. Pubocervical ligament - Anchors cervix to the posterior surface of the pubis 5. Uterosacral ligament - Extends from interior part of the anterior surface of the sacrum to the cervix and superior part of the vagina

Mammary gland

Modified sweat gland - within the superficial fascia of the pectoral region - Produces milk - Round base extends vertically between rib II and VI and transversely between the sternum and midaxillary line - Nipple: conical projection surrounded by the areola (circular pigmented skin) Areola: pigmented area in the centre (in pregnancy becomes darker. Will stay darker forever) - Secretes a wax to make it keep it soft and protect it - Protect it for the baby - Each breast consists of a number of lobes that are drained by individual ducts which open into the nipple - Suspensory ligaments: bands of connective tissue between the mammary gland lobes, arise from the skin and attach to the deep facia covering the pectorals major -- Supports the weight of the breast Hypodermis - Superficial fascia - Within this: glandular tissue Glandular tissue - Embedded in fat and hypodermis Pectoralis major - Deep to glandular tissue - Covered by fascia - There are walls between deep fascia to surface of the skin -- These create segments Ex of septum: suspensory ligament. Divides the glandular tissue into lobules - Each lobe has its own lactiferous duct - Ducts slightly dilate before the nipple: lactiferous sinus (some milk is always there during lactation)-- Often a site for growth of bacteria --> Infection - Lobes are separate which means they only have to remove some infected lobes. - Each lobe has its own opening at the tip of the nipple -- There are about 20 lobes in each breast = about 20 openings at the tip of the nipples Nipple piercing - Damages a lot of lobes of the breast - Will not be able to release milk from that lobe - If there is milk in that lobe, then pressure will build and it will really hurt Blood supply: - Branches of the internal thoracic artery - Anterior and posterior intercostal arteries - Axillary arter Innervation: - 4th to 6th intercostal nerves provide sensory innervation - Nerves carry sympathetic fibers to supply the smooth muscle fibers in the wall of the blood vessels, areola and nipple Prolactin and oxytocin - Controls the secretion and ejection of milk - Controlled by anterior pituitary and hypothalamus

External genitalia

Vulva or pudendum: - Includes: mons pubis, labia minora, vestibule, clitoris, and greater vestibular glands Mons pubis: skin prominence in front of the symphysis pubis that contains fat Labia majora: two skin folds that contain fat and are covered by coarse hairs after puberty - Equivalent to the scrotum in males Labia minora: Two hairless skin folds partially concealed by labia majora on the outside Vestibule - cleft between the two labia minor - Receives the opening of the urethra anteriorly and vagina posteriorly Clitoris - Homologous to the penis - Located at anterior end of the vestibule - Has a root and a body - Root: left and right crura and right and left bulbs of the vestibule -Crura and bulbs: continue anteriorly to form the corpora cavernosa, and glans of clitoris in the body of the clitoris - Extension of the labia minora encircles the body of the clitoris on either side to form the prepuce of the clit Greater vestibular glands - Pair of glands deep to the skin - Posterolateral to the vestibule - Homologous to the bulbourethral glands in males - Please their recreation by means of small ducts into vestibule posterolateral to the vaginal orifice to lubricate the vagina during sexual arousal --> Space between these two skin folds = vestibule - Urethral orifice - Vaginal orifice - Hymen - Opening of the duct of the greater vestibular gland which produces lubricant for the area Erectile tissue - Bulb of vestibule (2) (whereas males only have one bulb of penis) - Crura of the clitoris (2)--> form body of clitoris - Greater vestibular gland (like bulboutrethral gland in males)