useful for post med students.

1. Genito urinary system and its
development.
The female reproductive
system and clinical aspects.
-ROHINI Y.N

2. Why reproductive and urinary systems are
addressed together as urogenital system?

3. Development Of urinary and reproductive systems
The development of reproductive system has a close link throughout with the development of the
urinary system.

9. The gonad is in indifferent
stage.
The
In the first weeks of
urogenital development, all
embryos have two pairs of
ducts, both ending at the
cloaca. These are the:
Mesonephric (Wolffian)
ducts
Paramesonephric (Mullerian)
ducts

12. Female
In the female, there are no Leydig cells ( in testis)to produce testosterone. In the
absence of this hormone, the mesonephric ducts degenerate, leaving behind
only a vestigial remnant – Gartner’s duct.
The absence of anti-Mullerian hormone also allows for development of the
paramesonephric (MULLERIAN) ducts.
Initially, these ducts can be described as having three parts:
Cranial – becomes the Fallopian tubes
Horizontal – becomes the Fallopian tubes
Caudal – fuses to form the uterus, cervix and upper 1/3 of the vagina.
The lower 2/3 of the vagina is formed by sinovaginal bulbs (derived from the
pelvic part of the urogenital sinus).

13. Oestrogens in the female embryo are responsible for
external genital development. The genital tubercle
only elongates slightly to form the clitoris.
The urethral folds and genital swellings do not fuse,
but instead form the labia minora and labia majora
respectively.
The urogenital groove therefore remains open,
forming the vestibule into which the urethra and
vagina open.

14. Male
In the presence of testosterone (produced by the Leydig cells)
mesonephric ducts develop
Gives rise to the efferent ductules, epididymis, vas deferens and seminal vesicles.
The paramesonephric ducts degenerate in the presence of anti-Mullerian
hormone – produced by sertoli cells in the testes. Its developmental remnant is the
appendix testis; a small portion of tissue located on the upper pole of each
testicle, which has no physiological function.

15. Clinical Relevance:
Bicornuate Uterus
Bicornate uterus is a relatively common
structural defect. It occurs when there is
incomplete fusion of the
paramesonephric ducts.
This results in two distinct uterine horns,
both opening into a single vagina. As it is
asymptomatic, the condition is often only
picked up on ultrasound scan during
pregnancy.
This malformation is considered high-risk
in pregnancy, as there is an associated risk
of miscarriage and premature delivery.

16. Female genital system and clinical aspects.

17. The vulva (pudendum) refers to the
1. external female genitalia.

18. • Clinical Relevance: Infection of Bartholin’s
Glands
• The Bartholin’s glands (also known as the
greater vestibular glands) can become
infected and inflamed – known as
bartholinitis.
• This is initially treated with antibiotics, but
occasionally can be complicated by the
formation of a cyst or abscess. In case of an
infected cyst or abscess, the only effective
treatment is surgical drainage or excision of
the lesion.

19. Clinical Relevance: Vulval Warts
Genital warts are benign growths of epithelium caused by
certain HPV types, such as 6 & 11. They are highly infectious and
are easily transmitted between sexual partners through sexual or
even physical contact.
However they do NOT evolve into cancerous lesions.
Recently developed HPV vaccines are safe and efficient in
preventing high-risk HPV infections.

20. 2. The vagina
fibromuscular tube with anterior and posterior
walls – these are normally collapsed and thus in
contact with one another.
The shape of the vagina is not a round tunnel. In
the transverse plane it is more like an “H” lying on
the side. At the upper ending, the vagina
surrounds the cervix, creating two domes
(fornices or vaults): an anterior and a (deeper)
posterior one.
The posterior fornix is important as it acts like a
natural reservoir for semen after intravaginal
ejaculation. The semen retained in the fornix
liquefies in the next 20-30 mins, allowing for
easier permeation through the cervical canal.

21. Clinical Relevance: Vaginal (Obstetric)
Fistulae
A vaginal fistula is an open
communication between the vagina
and one of the adjacent pelvic organs.
It typically occurs as a result of
prolonged labour.
Fetus exerts pressure – obstructing
the blood supply and causing tissue
necrosis.
There are three main types of vaginal
fistulae:
• Vesicovaginal
• Urethrovaginal
• Rectovaginal

22. 3. CERVIX
• The cervix is composed of two regions; the
ectocervix and the endocervical canal.
• The ectocervix is the portion of the cervix
that projects into the vagina. It is lined by
stratified squamous non-keratinized
epithelium. The opening in the ectocervix,
the external os, marks the transition from the
ectocervix to the endocervical canal.
• The endocervical canal (or endocervix) is the
more proximal, and ‘inner’ part of the cervix.
It is lined by a mucus-secreting simple
columnar epithelium. The endocervical canal
ends, and the uterine cavity begins, at a
narrowing called the internal os.

23. The ectocervix, visible via a speculum inserted into
the vagina. The external os is marked with an
arrow.

24. Clinical Relevance: Disorders of the Cervix
Cervicitis
Caused by - Chlamydia trachomatis or Neisseria gonorrhoeae.
It is usually asymptomatic although pelvic pain, vaginal discharge, postcoital bleeding and
dyspareunia may be present. Complications of cervicitis include pelvic inflammatory disease,
whilst the potential blockage of mucus ducts and cyst formation increases the risk of
infertility by increasing the hostility of the environment for sperm.
Cervical Cancer
There are two main classifications of cervical cancer:
Squamous cell carcinoma – cancer of the epithelial lining of the ectocervix.
Adenocarcinoma – cancer of the glands found within the lining of the cervix.
Infection of the female genitalia with human papilloma virus (HPV), is widely known as the
cause of the majority of cervical cancers. Latest vaccinations against cervical cancer are, in
essence, a vaccination against HPV.

25. 4. UTERUS
In the normal adult uterus
Anteverted with respect to the vagina
Anteflexed with respect to the cervix:
Anteverted: Rotated forward, towards the
anterior surface of the body.
Anteflexed: Flexed, towards the anterior
surface of the body.
Thus, the uterus normally lies immediately
posterosuperior to the bladder, and anterior
to the rectum.

26. Blood supply and ligaments.

27. Important ligaments of Uterus

28. The ligaments of the female reproductive tract can be divided into three categories:
Broad ligament – a sheet of peritoneum, associated with both the uterus and ovaries.
Uterine ligaments – round ligament, cardinal, pubocervical, uterosacral ligaments
Ovarian ligaments – ovarian , suspensory ligament of ovary.
these ligaments are tough and non-extensible. They act to support the female viscera and
provide a conduit for neurovascular structures.
The broad ligament can be divided into three regions:
Mesometrium – Surrounds the uterus and is the largest subsection of the broad ligament.
It runs laterally to cover the external iliac vessels, forming a distinct fold over them. The
mesometrium also encloses the proximal part of the round ligament of the uterus.
Mesovarium – Part of the broad ligament associated with the ovaries. It projects from the
posterior surface of the broad ligament and attaches to the hilum of the ovary, enclosing
its neurovascular supply. It does not, however, cover the surface of the ovary itself.
Mesosalpinx – Originates superiorly to the mesovarium, enclosing the fallopian tubes.

30. The cardinal ligaments are also known as the lateral, transverse cervical, or
Mackenrodt’s ligaments. They are situated along the inferior border of the broad
ligament and house the uterine artery and uterine veins.
This ligament is pierced by ureter.
When a hysterectomy is being performed due to a malignancy, the cardinal ligaments
are often removed as they are common reservoir of cancerous cells.
The round ligament is a remnant of the embryonic gubernaculum( helps in descent of
gonads).
It originates at the uterine horns (the points at which the fallopian tubes enter the
uterus), and attaches to the labia majora, passing through the inguinal canal.
The round ligament can be a source of pain during pregnancy, due to the increased
force placed on the ligament by the expanding uterus.

31. Pubocervical Ligaments
The pubocervical ligaments are bilateral structures, which attach the cervix
to the posterior surface of the pubic symphysis. They function to support the
uterus within the pelvic cavity.
Uterosacral Ligaments
The uterosacral ligaments are also bilateral fibrous bands, which attach the
cervix to the sacrum. They are also known as the recto-uterine ligaments or
sacrocervical ligaments. This supports the uterus and holds it in place.

32. Ovarian Ligament
The ovarian ligament is attached to the ovary inferiorly. It connects
the ovary to the side of the uterus. Structurally, it is a fibrous band of
tissue that lies within the broad ligament. It joins the uterus just
below the origin of the fallopian tubes.
Suspensory Ligament of Ovary
The suspensory ligament of ovary extends outwards from the ovary
to the lateral abdominal wall. It consists of a fold of peritoneum,
thus some sources consider it to be part of the broad ligament. The
function of this ligament is to contain the ovarian vessels and nerves
(ovarian artery, ovarian vein, ovarian nerve plexus and lymphatic
vessels).

33. Clinical Correlation: Hysterectomy
A hysterectomy is the surgical removal of the
uterus, usually as a result of cervical or uterine
cancer.
The uterine artery crosses the ureters
approximately 1 cm laterally to the
internal os. Care must be taken not to
damage the ureters during clamping of
the uterine arteries during a
hysterectomy.
WATER UNDER THE BRIDGE

34. Disorders of the Endometrium
Endometriosis is the presence of ectopic endometrial tissue at
sites outside the uterus, most commonly the ovaries and the
ligaments of the uterus..
Fibroids are benign tumours of the myometrium which affect
20% of menopausal women. They are oestrogen dependent,
enlarging during pregnancy and with use of the contraceptive pill
but regressing after the menopause. Most fibroids are
asymptomatic, but if large enough the uterine mass can cause
symptoms including menorrhagia, pelvic pain and infertility.
Endometrial carcinoma is the most common malignancy of the
female genital tract, most often found during, or after, the
menopause, and characterised by abnormal uterine bleeding.

35. 5.The fallopian tube
Fimbriae – finger-like, ciliated projections which
capture the ovum from the surface of the ovary.
Infundibulum – funnel-shaped opening near the
ovary to which fimbriae are attached.
Ampulla – widest section of the uterine tubes.
Fertilization usually occurs here.
Isthmus – narrow section of the uterine tubes
connecting the ampulla to the uterine cavity.

36. Clinical Relevance
Salpingitis
Salpingitis is inflammation of the uterine tubes that is usually caused by
bacterial infection. It can cause adhesions of the mucosa which may partially
or completely block the lumen of the uterine tubes. This can potentially result
in infertility or an ectopic pregnancy.
Ectopic Pregnancy
If the lumen of the uterine tube is partially occluded, sperm may be able to
pass through and fertilise the ovum. However, the fertilised egg may not be
able to pass into the uterus, and can implant in the uterine tube. This is known
as an ectopic pregnancy.
An ectopic pregnancy is a medical emergency – if not diagnosed early, the
implanted blastocyst can cause rupture and haemorrhage of the affected tube.

37. 6.Ovary.

38. • In both the males and females, the gonads develop within the
mesonephric ridge and descend through the abdomen. However,
unlike the testes, the ovaries stop in the pelvis.
• The ovaries are paired, oval organs attached to the posterior surface
of the broad ligament of the uterus by the mesovarium (a fold of
peritoneum, continuous with the outer surface of the ovaries).
• Neurovascular structures enter the hilum of the ovary via the
mesovarium

39. • Clinical Relevance: Disorders of the Ovaries
• Ovarian cysts are fluid-filled masses that may develop in the ovary. They are most commonly
derived from ovarian follicles, reaching approximately 2-2.5 cm. Most ovarian cysts are benign
and develop during a woman’s child-bearing years, however, some larger cysts may cause
problems such as bleeding and pain and require surgical removal.
• Polycystic ovaries are characterized by hormone dysfunction and multiple (over 10) ovarian cysts.
It is associated with infertility.
• Ovarian tumours are another serious disorder. The most common cancers arise from epithelial
components or germ cells.
• 90% of ovarian cancers are derived from epithelium, these are termed ovarian adenocarcinomas.
• Most germ cell tumors are teratomas, which comprise cells from all 3 germ cell layers and are
usually benign.