1 Department of Anatomy Female genital organs MUDr. Marek Joukal, Ph.D. Ovary (ovarium) Phalopian tube (tuba uterina) Uterus Vagina Female internal genital organs Female external genital organs Mons pubis Labia majora et minora Clitoris Bulbus vestibuli Glandulae vestibulares OVARY Extremitas tubaria (superior) Extremitas uterina (inferior) Facies medialis Facies lateralis Margo mesovaricus (anterior) Margo liber (posterior) Lig. suspensorium ovarii (vasa ovarica) Lig. ovarii proprium Hilus ovarii Mesovarium Lig. latum uteri Germinative epithelium Tunica albuginea Cortex ovarii folliculi ovarici corpora lutea Medulla ovarii Histology of the ovarium Folliculi ovarici primarii (300 000- 400 000) Folliculus ovaricus vesiculosus (Graaf´s) Ovulation Corpus luteum menstruationis graviditatis Corpus albicans 2 Nullipara – fossa ovarica (in front of a. iliaca int.) Multipara – Claudius fossa (behind a. iliaca int.) LOCALIZATION OF THE OVARY TUBA UTERINA (SALPINX) Infundibulum tubae uterinae ostium abdominale tubae fimbriae (fimbria ovarica) Ampulla tubae uterinae Isthmus tubae uterinae Pars uterina tubae uterinae ostium uterinum tubae OSTIUM ABDOMINALE TUBAE UTERINAE HISTOLOGY OF PHALOPIAN TUBE 1. Mucosal folds (cylind. epithelium cilliated) 2. Circular muscular layer 3. Longitudinal muscular layer 4. tunica serosa 5. mesosalpinx Tuba uterina – mucosal fold = cylindric. epithelium – 1. secretory cells - 2 • from uterus runs laterally to the pelvic wall • dorsocranially to the upper pole of ovary • fimbriae rotated to fac. medialis ovarii PHALOPIAN TUBE COURSE 3 UTERUS (HYSTERA, METRA) Fundus Corpus facies vesicalis facies intestinalis Cervix Isthmus uteri Margo dx. et sin. Cornu dx. et sin. lig. teres uteri lig. ovarii proprium fundus corpus cornu cervix ostium uteri portio vaginalis cervicis Cavum uteri (3 ml) Canalis isthmi Ostium internum canalis cervicis Canalis cervicis (plicae palmatae) Ostium externum canalis cervicis (= ostium uteri) Cervix portio supravaginalis portio vaginalis Fornix vaginae NULLIPARA MULTIPARA OSTIUM UTERI (OSTIUM EXTERNUM CANALIS CERVICIS) Labium anterius et posterius uterus arcuatus uterus subseptus uterus septus uterus bipartitus uterus duplex uterus duplex uterus duplex cum vagina septa uterus unicornis HISTOLOGY OF THE UTERUS Endometrium Myometrium Perimetrium ENDOMETRIUM Simple cylindric epithelium zona basalis zona functionalis glandulae uterinae glandulae cervicales (mucouse closure) menstruation cycle menarche menopausa (climacterium) ostium uteri (multilayer stratified epithelium) 4 1. stratum submucosum 2. stratum vasculosum 3. stratum supravasculosum 4. stratum subserosum MYOMETRIUM Myometrium, myocytes – smooth muscles Lig. latum uteri Mesosalpinx Mesovarium Lig. teres uteri PERIMETRIUM (VISCERAL PERITONEUM) PERIMETRIUM Excavatio vesicouterina Excavatio rectouterina (cavum Douglasi) PARAMETRIUM Lig. pubouterinum lig. pubovesicale lig. vesicouterinum Lig. cardinale uteri Lig. sacrouterinum plica sacrouterina m. rectouterinus Lig. teres uteri Plica sacrouterina Lig. teres uteri 5 Anteversion (700 – 1000) Anteflexion (1000) POSITION OF UTERUS Arteria uterina – anastomosis with a. ovarica (ovarian arcade) Uterine artery crosses ureter (2 cm from uterine margine 1,5 cm from fornix vaginae) 3 4 5 6 7 8 9 10 GRAVIDITY uterus graviditatis – 1000 g Placenta Funiculus umbilicalis – 50 cm (v.umbilicalis, aa. umbilicales) VAGINA (KOLPOS) Fornix vaginae pars anterior et posterior receptaculum seminis Paries anterior crista urethralis area trigonalis vaginae Paries posterior Rugae vaginales Columna rugarum ant. et post. Ostium vaginae (vestibulum vaginae) Defloration Carunculae hymenales Ostium vaginae - hymen Ostium urethrae ext. Ostium vaginae 6 HISTOLOGY OF VAGINA Mucouse membrane Multilayer squamous epithelium No glands !!! submucouse tissue – venous net Muscular layer inner - circular outer - longitudinal Adventicia Serosa – excavatio rectouterina Position of vagina Ventrocaudal direction Ventrally: urinary bladder urethra - septum urethrovaginale Dorsally: excavatio rectouterina rectum - septum rectovaginale centrum perineale Labia majora pudendi Labia minora pudendi Mons pubis Vestibulum vaginae Clitoris Glandulae vestibulares Bulbi vestibuli Organa genitalia feminina externa Labia majora pudendi Sulcus genitofemoralis Rima pudendi Commissura labiorum ant. Mons pubis Commisura labiorum post. Pubes Perineum (raphe perinei) MONS PUBIS Pubes Fatty tissue Labia minora pudendi Sulcus interlabialis Vestibulum vaginae Smegma Frenulum labiorum pudendi Fossa vestibuli vaginae Praeputium clitoridis Frenulum clitoridis 7 CLITORIS Crura clitoridis (crista phalica) Corpus clitoridis Glans clitoridis Praeputium clitoridis Frenulum clitoridis Corpora cavernosa clitoridis Lig. fundiforme clitoridis Lig. suspensorium clitoridis M. ischiocavernosus VESTIBULUM VAGINAE between labia minora pudendi Glans clitoridis (praeputium et frenulum clitoridis) Ostium urethrae externum (papilla urethralis, gll. vestib. minores) Ostium vaginae (hymen) Fossa vestibuli vaginae Frenulum labiorum pudendi (commisura labiorum pudendi) BULBI VESTIBULI Erectile bodies (corpus spongiosum) on diaphragma urogenitale m. bulbospongiosus (from centrum tendineum perinei to the dorsum clitoridis) commisura bulborum (between glans clitoridis and ostium urethrae ext.) GLANDULAE VESTIBULARES MAJORES (BARTHOLINI) On the diaphragma urogenitale Dorsally from bulbi vestibuli m. bulbospongiosus Opens to the vestibulum vaginae Diaphragma pelvis Musculus levator ani (arcus tendineus m. levatoris ani) musculus pubococcygeus musculus iliococcygeus Musculus coccygeus Hiatus urogenitalis Lig. anococcygeum Fascia diaphragmatis pelvis superior et inferior 8 Diaphragma urogenitale Lig. transversum perinei M. transversus perinei profundus M. transversus perinei superficialis M. sphincter urethrae Fascia diaphragmatis urogenitalis superior et inferior FOSSA ISCHIORECTALIS Mediocranial: diaphragma pelvis Lateral: m. obturatorius int. fascia obturatoria (canalis pudendalis) Ventral: recessus pubicus Dorsal: m. glutaeus maximus Fascia pelvis parietale Fascia pelvis viscerale Arcus tendineus fasciae pelvis Cavum pelvis peritoneale Cavum pelvis subperitoneale FASCIA PELVIS M. ischiocavernosus M. bulbospongiosus M. sphincter ani externus Fascia perinei superficialis Spatium superficiale perinei MUSCLES OF THE EXTERNAL GENITAL ORGANS References: Putz, R. (2008): Atlas of Human Anatomy Sobotta. Elsevier Books. Keith L. Moore, Arthur F. Dalley (2005): Clinically Oriented Anatomy. Williams and Wilkins. Platzer, W., Kahle, W., Leonhardt H. (1992): Locomotor system. Georg Thieme Verlag, Stuttgart, New York, 4th edition. Čihák, R. (1987): Anatomie 1. Avicenum, Zdravotnické nakladatelství. Netter, F. H. (1997): Interactive Atlas of Clinical Anatomy. Novartis, USA.