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11/19/2018

Anatomy

By Dr. Azhar Mousa AL-Turiahi

Female external genitalia ( Vulva )

1) Mons pubis , compose of fibrofatty tissue which cover the body of the pubic
bone, in adult the skin that cover the mons pubis bears pubic hair , the upper
limit of which is usually horizontal.
2) Labia majora, this is two fold of skin with underlinig adipose tissue bounding
either side of the vaginal opening ,they contain sebaceous glang & sweat
gland & specialized apocrine glands.the fibers of the round ligament terminate
her
3) Labia minora two thin folds of skin that lie between the labia minora , they
have sabeceous glanf but no adipose tissue

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3) The Vestibule, ,is the cleft between the labia minora & the
urethra.the duct of the bartoline glands & the vagina open in the
vestibule

4) The Clitoris , this is small erectile structure

5) The Greater vestibular gland

6) The hymen is a thin fold of mucous memberane across the


enterance to the vagina

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1) Uterus
2) Vagina
3) Fallopian tubes
4) The Ovaries

The vagina is a fibromuscular canal lined with stratified squamous epiothelium that lead
from the uterus to the vulva, it is longer in the posterior wall ( around 9 cm ) than the
anterior wall ( 7 cm )
The vaginal wall are rugose kept moist by secretion from the uterine & cervical glands & by
some transudation from its epithelial lining, it has no glands , the epithelium is thick & rich in
glycogen. Which increase in the postovulatory phase of the cycle, however before puberty
& after menopause the vagina is deviod of glycogen because of oestrogen deficiency.

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Doderleins bacillus is a normal commensal of the vagina that breaks down the glycogen
to form lactic acid, producing a PH of around 4.5. this has a protective role for the vagina
in decreasing the growth of pathogenic organism
Vaginal boundaries
Psterir wall . Upper = form the anterior peritoneal reflection of the pouch of Douglas.
Moddle = separated from the rectum by pelvic fascia
Lower = to the perineal body

Anterior wall . The lip of the vagina is in direct contact with the base of
the bladder & the urethra

As the cervix project in the vagina , It divided the vagina into 4 fornix ( posterior , anterior & two lateral
fornix )

Age Changes

At birth the vagina is under the influence of maternal oestrogen .so the
epithelium is well developed, After a couple of weeks ,the effects of oestrogen
disappear & the Ph rises to 7 .7 the epithelium atrophies. At puberty the reverse
occurs & finally at the menopause the vagina tends to shrink & the epithelium
atrophies

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The uterus is shaped like an inverted pear. Taperd inferiorly to the cervix. In non
pregnnt state situated entirely within the pelvis . It is hollow & has thick
muscular walls .its maximum external dimensions are about
7.5 cm long
5 Cm width
3 Cm thick
An adult urerus weight about 70g
The area of insertion of each fallopian tubes is termed the Cornu
The part of the body above the cornu is the Fundus
The uterus tapers to a small central construcred area the Isthmus
Then below this is the Cervix which project obliquely into the vagina & can be
divided into Vaginal & Supravaginal portions

The cavity of the uterus is the shape of an inverted triangle . The


fallopian tubes open at the lateral angles . The construction at the
isthmus where the corpus jions the cervix is the anatomical internal
os

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The uterine wall consist of three layers


•The outer serous layer ( peritoneum )
• The middle muscular layer ( myometrium )
• The inner mucous layer ( endometrium )

•The peritonium covers the body of the uterus & posteriorly the
supravaginal portion of the cervix . The serous coat is intimately attached
to a subserous fiobrous layer except laterally where it spread out to form
the leaves of the broad ligament

The muscular myometrium forms the main bulk of the uterus


Externally the muscle are mostly longitudinal
The large intermediate layer has interlacing longitudinal, oblique &
transverse fibers.
Internally the muscle fiber are mainly longitudinal & circular

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The inner endometrial layer has tubular glands that dip into the
myometrium the endometrial layer is coverd by asingle layer of columnar
epithelium ,this epithelium is mostly lost due to effects of pregnancy &
menstruation , the endometrium undergo cyclical changes during
menstrual cycle & varies in thickness between 1-5 mm

The cervix is narrower than the body of the uterus & it is approximately 2.5 cm in
length, the ureter runs about 1 cm laterally to the supravaginal cervix. The vaginal
portion projects into the vagina to form the fornices. The cervix has numerous deep
glandular follicles that secret a clear alkaline mucous which is the main component of
physiological vaginal discharge. The epithelium of the endocervix is cylindrical &
ciliated in its upper two third & changes to stratified squamous epithelium around thr
region of the external os . This squamocolumnar junction is also known as the
transformation zone & is an area of rapid cell division in which 90% of cervical
carcinoma arise in this area

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The longitudinal axis of the uterus is approximately at right angles to the


vagina & normally tilts forewards , this is termed Anteversion
The uterus is usually also flexed forewards on itself at the isthmus Anteflexion

In around 20% of women this is not forewards but backwards ( retroversion


&retroflexion )

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Age changes
After birth the disappearance of maternal oestrogen causes the uterus to
decrease in its length by about one third & in weight by about one-half
Cervix / Uterus ratio = 2/1
At puberty the corpus grows much faster & the ratio is reverse
Cervix / uterus rati = ½
After the menopause the uterus atrophies, the mucosa become very thin
these changes affect the cervix more than the body of the uterus

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The fallopian tubes


Each fallopian tube extend outwards from thec uterine cornu to enf near the ovary at
the abdominal ostium , the tube open into the peritoneal cavity
The tubes ( Oviduct ) convy the ovum from the ovary toward the uterus & provided
oxygination & nutrition for sperm, ovum & zygot if fertilization occure.
Fallopian tubes run in the upper margin of the broad ligament
It is about 10 cm long 7 described in four parts
1-The interstitial portion
2- The isthmus
3- The ampulla
4- The infundibulum or fimbrial portion

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