RIU 332 - Female Anatomy

antrum of follicle

4

6 = ovarian ligament 7 = mesosalpinx 11 = suspensory ligament 13 = broad ligament 14 = round ligament 15 = cardinal ligament 16 = uterosacral ligament

6, 7, 11, 13, 14, 15, 16

anterior fornix

A

- Absence of menstruation - primary = never happened to begin with: can be due to pituitary gland path (ex: 15 year old female hasn't gotten period) - secondary = when menstrual cycle stopped: due to path (not preg), extreme exercise or stress, anexoria (because body doesn't have enough nutrients, it devotes all energy to living and stops non essential systems)

Amenorrhea: def, types

- Posterior to vesicouterine pouch and superior surface of bladder - Anterior to rectouterine pouch (of Douglas), ilium, colon - Medial to broad ligaments and uterine vessels - Uterine cavity is funnel-shaped in coronal plane; "slitlike" in sagittal plane

Body of the Uterus: posterior to what structures, anterior to what structures, medial to what, shape of uterine cavity in coronal and sagittal planes

Painful periods ; associated with endometriosis

Dysmenorrhea

- Infundibulum: Funnel-shaped lateral tube projects beyond broad ligament to overlie ovaries; "free edge" of the funnel has fimbriae - Ampulla: Widest part of tube where fertilization occurs - Isthmus: Hardest part; lies lateral to uterus - Interstitial portion: Pierces uterine wall at cornua - Length: 12 cm; blood is supplied by ovarian arteries and veins

Fallopian Tubes: infundibulum, ampulla, isthmus, interstitial portion; length + how is blood supplied

- All ova begin development during embryonic life. - Remain in suspended animation within preantral follicle as immature oocyte until onset of menarche

Follicular Development : what happens to all ova, how does it remain

- LH Surge often used as predictor for timing ovulation for conception - LH level usually reaches peak 10 to 12 hours before ovulation - LH surge, accompanied by smaller FSH surge, triggers ovulation on about day 14 - ovulation occurs and follicle ruptures - Rupture of follicle associated with small amounts of fluid in posterior cul-de-sac midcycle

Follicular Development and Ovulation 4: what is the LH surge used for, peak of LH, what triggers ovulation

- Secretion of follicle-stimulating hormone (FSH) by anterior pituitary gland causes ovarian follicles to develop during first half of menstrual cycle. - Phase of ovulatory cycle, known as follicular phase, begins with first day of menstrual bleeding and continues until ovulation on day 14.

Follicular Development and Ovulation: follicle-stimulating hormone: by what gland, what does it do to follicles, Phase of ovulatory cycle?

- The first phase of the ovarian cycle, during which a follicle (an oocyte and its surrounding cells) enlarges and matures. - This phase is under the control of FSH from the anterior pituitary, and typically lasts from day 1 to day 14 of the menstrual cycle. - The follicle secretes estrogen during this time period.

Follicular Development and Ovulation: follicular phase: what is happening to follicle, under control of what?, what does follicle secrete

- cells in lining of ruptured ovarian follicle begin to multiply and create the corpus luteum, or yellow body. - Process is known as luteinization and is stimulated by LH surge. - Corpus luteum immediately begins secreting progesterone. - 9-11 days after ovulation, corpus luteum degenerates due to absence of LH, causing progesterone levels to decline. - As progesterone levels decline, menstruation occurs and cycle begins again.

Follicular Development and Ovulation: luteal phase: what does follicle do, what is it called and what is it stimulated by, what does corpus luteum secrete, what happens if not preg to corpus luteum

- After ovulation, ovary enters luteal phase - Phase begins with ovulation and about 14 days in length - Menstruation almost always occurs 14 days after ovulation

Follicular Development and Ovulation: what happens after ovulation, name, length of phase

- As ovarian follicles grow, they fill with fluid and secrete increasing amounts of estrogen. - Typically 5-8 preantral follicles begin to develop; only one usually reaches maturity each month - Mature follicle known as graafian follicle; is typically 2 cm in size right before ovulation.

Follicular Development and Ovulation: what happens as follicles grow, how many reach maturity every month, what is the mature follicle known as

- As estrogen level in blood rises with follicle development, pituitary gland inhibited from further production of FSH and begins secreting luteinizing hormone (LH). - Luteinizing hormone level will typically increase rapidly 24 to 36 hours before ovulation in process known as LH surge.

Follicular Development and Ovulation: what occurs due to increasing levels of estrogen, what is LH surge

- Perimetrium: Serous outer layer of uterus; serosa - Myometrium: Muscular middle layer of uterus composed of thick, smooth muscle supported by connective tissue - Endometrium: Inner mucous membrane, glandular portion of uterine body

Layers of the Uterus (3): names and what they are

the first menstrual period; Menstruating approximately every 28 days

Menarche

excessive bleeding irregularly

Menometrorrhagia

Cessation of menses is known as:

Menopause

Abnormally heavy or long periods ; associated with uterine fibroids, intrauterine contraceptive devices (IUDs), or hormonal imbalances

Menorrhagia

irregular uterine bleeding (not on schedule, cannot be called menstruation because menstruation refers to regular monthly bleed)

Metrorrhagia

- Psoas major: Pelvic sidewall - Iliacus: Pelvic sidewall - Piriformis: Posterolateral wall - Obturator internus: Anterolateral pelvic sidewall - Levator ani: Pelvic floor (diaphragm) - Coccygeus: Posterior pelvic floor (diaphragm)

Muscles of the Pelvis (6 + where are they in pelvis)

- Piriformis muscles - Obturator internus muscles - Muscles of pelvic diaphragm: -- Levator ani: Pubococcygeus muscles, iliococcygeus muscles, puborectalis muscles -- Coccygeus muscles

Muscles of the True Pelvis and pelvic diaphragm

- Anterior to internal iliac artery and vein - Medial to external iliac artery and vein - Ellipsoid shape with long axis oriented vertically - Location highly variable as ligaments loosen, especially after pregnancy

Normal Positions of the Ovaries

- Almond shaped - Attached at posterior aspect of broad ligament by mesovarium - Lie in ovarian fossa - Fossa is bounded by external iliac vessels, ureter, obturator nerve - Dual blood supply; receives blood from ovarian artery and uterine artery - Blood drained by ovarian vein into IVC on right and into renal vein on left

Ovaries: shape, attached to what ligament by what, lie in what fossa, what is the fossa bounded by, blood supply, blood drainage

explosive release of ovum from ruptured graafian follicle

Ovulation def

- hypothalamus within brain - At puberty, hypothalamus begins pulsatile release of gonadotropin-releasing hormones (GnRHs) - GnRHs stimulate anterior pituitary gland to secrete varying levels of gonadotropins

Ovulation: process of ovulation is regulated by? what happens at puberty and what does this hormone stimulate?

- Ovulation: During menarchal years, ovum released once a month by one of two ovaries - Ovulation normally occurs mid-cycle on about day 14 of 28-day cycle - Speculated that ovum release alternates between the two ovaries; one month from right, next month from left - occurs from 11-45/55

Ovulation: what is ovulation, what day does it occur, how is ovum released from ovaries, what ages does ovulation occur

pouch of douglas

POD

- Vesicouterine pouch: Anterior cul-de-sac; anterior to fundus between uterus and bladder - Rectouterine pouch: Posterior cul-de-sac; posterior to uterine body and cervix, between uterus and rectum - Retropubic space: Space of Retzius; between bladder and symphysis pubis

Pelvic Recesses and Bowel (3)

- External iliac arteries: Medial psoas border - External iliac veins: Medial and posterior to arteries - Internal iliac arteries: Posterior to ureters and ovaries - Internal iliac veins: Posterior to arteries - Uterine arteries and veins: Between layers of broad ligaments, lateral to uterus

Pelvic Vasculature: iliacs and uterine location

most external structure of outlet of true pelvis and then there's skin and fat; inferior to pelvic floor

Perineal membrane

- Female's reproductive years begin around 11 to 13 years of age at onset of menses (menstruation) - End around age 50, when menses ceases - Cycle approximately 28 days in length, beginning with first day of menstrual bleeding

Physiology Menstrual Cycle: when does it start, end, avg length

Prepuberty

Premenarche

- Broad: Lateral aspect of uterus to pelvic sidewall - Mesovarium: Posterior fold of broad ligament; encloses ovary - Mesosalpinx: Upper fold of broad ligament; encloses fallopian tube - Round: Fundus to anterior pelvic sidewalls; holds uterus forward

Uterine Ligaments around ovaries (4) + location

- Cardinal: Extend across pelvic floor laterally; firmly supports cervix - Uterosacral: Extend from uterine isthmus downward, alongside rectum to sacrum; firmly supports cervix - Suspensory: Extends from lateral aspect of ovary to pelvic sidewall - Ovarian: Extends medially from ovary to uterine cornua

Uterine Ligaments around pelvis (4) + location

- Anteversion: Most common position; fundus and body bent forward toward cervix - Dextroversion or levoversion: uterus tilted to right or left - Retroversion: Entire uterus tilted posteriorly - Retroflexion: Fundus and body bent backward towards cervix

Uterine Positions (4): most common position,

- Collapsed muscular tube that extends from external genitalia to cervix of uterus - Lies posterior to urinary bladder and urethra, anterior to rectum and anus

Vagina: extends from where to where and posterior and anterior to what structures

polymenorrhea, oligomenorrhea, menorrhagia, dysmenorrhea, amenorrhea

abnormal menses

the fluid may fill the pouch of douglas (POD)

after ovulation, what can happen to the fluid that ruptured from the follicle

1 = ischial spine 2 = iliacus muscle 3 = psoas major muscle 4 = obturator internus muscle 5 = femoral nerve 6 = piriformis muscle

all

1 = piriformis muscle 2 = obturator externus muscle 3 = obturator internus muscle

all

1 = retroflexion 2 = anteflexion 3 = retroversion 4 = Anteversion

all

Occupied by bladder, ureters, ovaries, fallopian tubes, uterus, vagina

anterior landmarks to pelvis

Surrounds the oocyte and located between the oocyte and the follicular cells; fluid filled space

antrum of follicle

- Apex: Located posterior to pubic bones - Base: Anterior to vagina, superior surface related to uterus - Neck: Rests on upper surface of urogenital diaphragm; inferolateral surfaces relate to retropubic fat, obturator internus, levator ani muscles, pubic bone

bladder location: apex, base, neck

- consists of four bones: Two innominate (coxal) bones, Sacrum, Coccyx - Divided into two continuous compartments (true and false pelves) by oblique plane that passes through pelvic brim - Is situated inferior to caudal portion of parietal peritoneum

bony pelvis: consists of what bones, divided how, orientation to peritoneum

- Protrudes into upper portion of vaginal canal forming four archlike recesses called fornices - Posterior vaginal wall attaches higher on cervix, and fornices are blind pockets formed by inner surface of vaginal walls and outer surface of cervix. - Is a continuous ring-shaped space with posterior fornix running deeper than its anterior counterpart

cervix: how does it go into vaginal canal, how are fornices formed, shape of outer cervix

- Projects into vaginal canal - Endocervix: Cervical canal; communicates with uterine cavity by internal os; vagina by external os - Exocervix: Continuous with vagina

cervix: projects how, endocervix, exocervix

- yellow empty ovarian follicle that secretes progesterone after release of the egg cell; prepares the uterine lining for receiving an embryo - preg: corpus luteum remains until placenta development - not preg: degradation at day 25 and becomes corpus albucans (white)

corpus luteum: what is it? what happens to it if preg? not preg?

inner, mucous membrane lining of the uterus

endometrium

- Mons pubis - Labia majora - Labia minora - Clitoris - Urethral opening - Vestibule of vagina

external landmarks

where the uterus/cervix opens into the vaginal cavity

external orifice

above the line from the superior border of the sacrum to the superior margin of the pubic symphysis; communicated with abd cavity

false pelvis: location + communicated with what

clitoris, urethral opening, vestibule of the vagina, anus; labia majora is more lateral and outside than the labia minora

female landmarks from anterior to posterior? lateral to medial?

recesses between upper vaginal wall and cervix

fornices

A large, mature, ovarian follicle with a well-developed antrum and a secondary oocyte. Ovulation of the oocyte occurs from this type of follicle.

graafian follicle

pituitary gland controls the ovaries by secreting FSH on ovary that causes follicles to develop, which causes ovaries to produce estrogen, which causes thickening of the endometrium

how does the pituitary gland impact menstrual cycle

1 - 2 million (or in her pres: each ovary contains 200,000?)

how many oocytes are present at birth

- color will show in center of ovary in the medulla. there shouldn't be color in the outer cortex area because that contains the follicles that are fluid filled structures with no blood flow

in the ovary where should you see color show up?

inner opening of the cervix into the uterine cavity

internal orifice

consists of periodic changes occuring in OVARIES and UTERUS of the sexually non pregnant female that results in release of oocyte and prepares uterus for implantation of the fertilized egg

menstrual cycle def

Midcycle dull ache on either side of lower abdomen lasting a few hours; means middle pain

mittelschmerz

clitoris; erectile tissue analogous with the penis

most anterior portion of female reproductive system

iliacus and psoas major form the iliopsoas muscle in the pelvic sidewalls - never enter the true pelvis

muscles of false pelvis

3 cm

normal length of ovaries

collapsed

normal state of the vagina

When cycle prolonged >35 days ; associated with PCOS

oligomenorrheic

- development of oocyte - process starts before birth -> 2 million oocytes are developed prior to birth and that is all the eggs the female will ever have (can't make any more eggs like males can make sperm throughout life) - eggs start to degenerate by puberty and we are left with 300,000 eggs - with each menstrual cycle, groups of eggs grow in follicles and only one ends up being viable and the rest degenerate

oogenesis: when does it begin, how many eggs do females have and when are these produced, what happens with eggs once puberty occurs, what happens with eggs during each menstrual cycle

follicular phase, ovulation, luteal phase

ovarian cycle phases

- Ovaries supported medially by ovarian ligaments, originating bilaterally at cornua of uterus - Laterally by suspensory (infundibulopelvic) ligament, extending from infundibulum of fallopian tube and ovary to sidewall of pelvis - Ovary also attached to posterior aspect of broad ligament via mesovarium

ovarian ligaments (3): medially, laterally, posteriorly

- Produce reproductive cell—ovum - produce two known hormones: estrogen, secreted by follicles, and progesterone, secreted by corpus luteum - Hormones are responsible for producing and maintaining secondary gender characteristics, preparing uterus for implantation of fertilized ovum, development of mammary glands in female

ovaries function: produce what cell and hormones, where do hormones come from, what do the hormones do

- composed of connective tissue containing blood, nerves, lymphatic vessels, and some smooth muscle at region of hilum

ovaries: central medulla: composed of what

- Outer layer which surrounds central medulla - Cortex consists primarily of follicles in varying stages of development and is covered by layer of dense connective tissue, tunica albuginea.

ovaries: cortex: layer that surrounds what, what does the cortex consist of and what is it covered in

- surrounded by single, thin layer of cells known as germinal epithelium - white covering around ovaries, dense

ovaries: tunica albuginea

They usually lie posterior to the uterus at the level of the cornua

ovary and uterus relation

levator ani and coccygeus; Deepest layer of pelvic floor

pelvic diaphragm consists of what muscles

- pelvic floor: Lower margin of pelvic cavity is formed by levator ani and coccygeus muscles - Area below pelvic floor is perineum

pelvic floor: where is it, formed by what, area below is what

- Ovarian arteries: Branch laterally off aorta, run within suspensory ligaments and anastomose with uterine arteries - Ovarian veins: Right vein drains into IVC directly; left drains into left renal vein

pelvic vasculature: ovarian vessels location

- Arcuate arteries: Arclike arteries that encircle uterus in outer third of myometrium - Radial arteries: Branches of arcuate arteries that extend from myometrium to base of endometrium - Straight and spiral arteries: Branches of radial arteries that supply zona basalis of endometrium

pelvic vasculature: smaller vessels of the uterus

- Posterior wall formed by sacrum and coccyx - Posterolateral wall formed by piriformis and coccygeus muscles - Anterolateral walls formed by hip bones and obturator internus muscles, which rim ischium and pubis

pelvis: posterior wall, posterolateral wall, anterolateral walls formed by what

When cycle occurs at intervals of less than 21 days

polymenorrheic

Occupied by rectum, colon, ileum

posterior landmarks to pelvis

most dependent area of female body ; fluid accumulation can occurs here from infection or rupture or path of uterus

pouch of douglas clinical signficance

a follicle that has enlarged but does not yet have an antrum

preantral follicle

- growth of glands that secrete glycogen and lipids for nourishment of embryo

secretory phase: what is happening to the endometrial glands

these cells surround the egg after the follicle breaks and protect it so that fertilization can happen and the egg doesn't die right away

significance of supporting cells around the ovum during ovulation

blood shedding during menstruation

spiral arteries are responsible for what?

myometrium of the uterus

strongest smooth muscles in body

- Muscles extend from xyphoid process superiorly to symphysis pubis inferiorly - Paired rectus abdominis muscles anteriorly - External obliques - Internal obliques - Transversus abdominis muscles anterolaterally

the Abdominal Wall: how to muscles extend, what are the main muscles

- is encased by bones where we find repro organs - below line from the superior border of the sacrum to the superior margin of the pubic symphysis

true pelvis/pelvic cavity: what does it contain + where is the line

- functional layer: sheds during menses - basal layer: stays the same, doesn't shed, rise to functional layer cells (if basal layer gone from bad abortion, then female is infertile because their endometrium is unable to thicken for preg)

two layers of endometrium

- Cross pelvic inlet anterior to bifurcation of common iliac arteries - Run anterior to internal iliac arteries and posterior to the ovaries - Coarse anteriorly and medially under base of broad ligament where crossed by uterine artery - Run anterior and lateral to upper vagina to enter posteroinferior bladder

ureters: orientation to common iliac arteries, orientation to internal iliac arteries and ovaries, orientation to broad ligament, orientation to upper vagina

menstrual phase, proliferative phase, secretory phase

uterine cycle phases

- lasts approximately 1 to 5 days and begins with declining progesterone levels, causing spiral arterioles to constrict. - Causes decreased blood flow to endometrium, resulting in ischemia and shedding of zona functionalis -- period - First 5 days coincide with follicular phase of ovarian cycle

uterine cycle: menstrual phase: what happens and what days does this align with fo the ovarian cycle

- Days 1-14 - Corresponds to follicular phase of ovarian cycle - Menstruation occurs on days 1 to 4 - Thin endometrium that becomes thicker - Estrogen level increases as ovarian follicles develop - Increasing estrogen levels cause uterine lining to regenerate and thicken - Ovulation occurs on day 14 - increase in the number of cells

uterine cycle: proliferative phase: days ?, correspond how to ovarian cycle, what occurs at the beginning of this phase, thickness of endometrium, estrogen levels which causes what to happen, what happens at end, what happens to endometrial? cells

- Days 15-28 - Corresponds to luteal phase of ovarian cycle - Ruptured follicle becomes corpus luteum - Corpus luteum secretes progesterone - Endometrium thickens, spiral art. grow, glands grow - If no pregnancy, estrogen and progesterone decrease - Menses on day 28 - increase in the size of cells

uterine cycle: secretory phase: days ?, correspond how to ovarian cycle, what does follicle become, what does this secrete, thickness of endometrium, if no preg, what happens to estrogen and progesterone, what happens at end, what happens to endometrial? cells

- phase after ovulation - Extends from approximately day 15 to onset of menses (day 28) - Secretory phase of uterine cycle corresponds to luteal phase of ovarian cycle.

uterine cycle: secretory phase: what happens and what phase of ovarian cycle does it align with

- Menarchal: 6.0 - 8.0 cm long by 3.0-5.0 cm wide

uterine size: menarchal

- Postmenopausal: 3.5 - 5.5 cm long by 2.0-3.0 cm wide

uterine size: postmenopausal

- Premenarchal: 1.0 - 3.0 cm long by 0.5-1.0 cm wide

uterine size: premenarchal

- With multiparity: Increases size by 1.0-2.0 cm

uterine size: with multiparity

uterus is superior and posterior to bladder

uterus in relation to bladder

- Hollow, pear-shaped organ - Divided into fundus, body, cervix - Usually anteflexed and anteverted - Covered with peritoneum except anteriorly below os where peritoneum reflected onto bladder - Supported by levator ani muscles, cardinal ligaments, uterosacral ligaments - Round ligaments hold uterus in anteverted position

uterus: shape, divided into what parts, usual orientation, covered in what, supported by what muscle/ligaments, what holds the uterus in its position

- Arterial supply from vaginal and uterine arteries; - drains into internal iliac vein

vagina: blood supply and drain

- Normally directed upward and backward from vulva, forming 90-degree angle with uterine cervix - Upper half lies above pelvic floor - Lower half lies within perineum - Area of vaginal lumen surrounding cervix divided into four fornices; cups around cervix - Measures approximately 9 cm in length; is longest along posterior wall

vagina: normal orientation, where do upper and lower halves lie, area around cervix is divided how, length

external female genitalia; includes the labia, hymen, clitoris, and vaginal orifice

vulva

uterus can get stuck by bony pelvis and become incarcerated and then can't extend and stretch; needs to be reposition and unstuck for fetus to grow

what can happen with preg women and a retroverted uterus

the red line is opening to true/bony pelvis where we find repro organs

what does the red line indicate

faternal twins

what happens if ovaries both ovulate at the same time and release an egg

human chorionic gonadotropin (hCG) produced by zygote causes corpus luteum to persist; it will continue to secrete progesterone for 3 more months until placenta takes over.

what happens with corpus luteum during conception and implantation occurs and what hormone causes it

hymen; mucous membrane partially or completely covering the opening to the vagina

what is it

- With ovulation and luteinization of graafian follicle, progesterone secreted by ovary causes spiral arteries and endometrial glands to enlarge. - Prepares endometrium for implantation, should conception occur

what prepares the endometrium for implantation during secretory phase