Female reproductive anatomy and Perinuem.pdf

ADDIS ABABA UNIVERSITY
FACULTY OF MEDICINE DEPARTMENT OF ANATOMY
March, 2024
Addis Ababa, Ethiopia
By: Mankelklot Kasahun
Anatomy of female reproductive system and
Perineum
ANATOMY SEMINAR PRESENTATION
ON

Outline
• Introduction
• Female Reproductive tract
• Perineum
• Urogenital triangle
• Anal triangle
• Ischioanal fossa
• Pudendal canal
• Female external genitalia
• Clinical correlation
• Reference
4/5/2024 by: Mankelklot Kasahun 2

Objectives
 At the end of the lecture, students should:
List the organs of female reproductive system.
Describe the position and relations of the ovaries and uterus
Describe the supply (arteries, veins, lymph, nerves) of female
reproductive system.
Describe the anatomy and divisions of perineum
Explain the boundaries and contents of the urogenital and anal
triangle.

Introduction
Female Reproductive system
• Complex anatomical structure
• Responsible for:
-female gametes production,
-fertilization, pregnancy, childbirth.
• Comprises:
-Network of organs, glands, structures
for reproductive process.
• Maintains reproductive health.

Reproductive Tract in Women
• Mainly in pelvic cavity and perineum
• During pregnancy, uterus expands into
abdominal cavity
Major components:
I. Ovary
II. uterus
III. Uterine tubes
IV. Vagina
• pair of accessory glands
• Breast and vulva are accessory

Ovaries
• Almond-shaped & sized female gonads.
• 3cm long
• lie adjacent to lateral pelvic wall
-just inferior to pelvic inlet.
• attached to back of broad ligament
-by a peritoneal fold (mesovarium)

Cont’d
• Medial end: attached to uterus by
ligament of ovary
• Lateral end: related to the fimbriae
Function:
• Primary sex organs in female
• Production of female germ cells
• Secretion of female sex hormones

Cont’d
Arterial supply
• Ovarian artery
• (from the abdominal aorta)
Venous drainage
• Ovarian vein
• drain in IVC(for Rt. ovary)
• Lt. renal vein (for Lt. ovary)
Lymphatics
• To paraaortic LN (in abdomen)
Innervation
• Ovarian plexus(in abdomen)

Uterine Tube
• formerly called oviducts/fallopian tubes
• 10 cm long
• Extend laterally from uterine horns.
• Open into peritoneal cavity near ovaries.
• lie in a narrow mesentery mesosalpinx
Function:
• Site of fertilization.
• Transport of fertilized ovum into the
uterus.

Cont’d
 Divisible into 4 parts, from lateral to medial
I. Infundibulum:
• funnel-shaped end
• has finger-like processes (fimbriae)
• related to ovary
II. Ampulla:
• Widest and longest part of tube.
• Starts at medial end of infundibulum.
• Typically hosts oocyte fertilization.

Cont’d
III. Isthmus:
• Narrowest, thick-walled tube part.
• transport oocyte towards uterus
IV. Uterine Part
• Short intramural segment of tube.
• narrow, proximal part
• connects to the uterus
• Opens via uterine ostium.
• receive zygote from uterine Cavity
-transport it into the uterine tube for further passage towards the ampulla..

Cont’d
Arterial supply
• Ovarian, Uterine, tubal branch
Venous Drainage
• Ovarian, Uterine, tubal branch
Lymphatics
• Internal iliac lymph nodes
• Paraaortic
Innervation
• Ovarian plexus
• Inferior hypogastric/ pelvic plexus

Uterus
• Uterus or womb
• Thick-walled,
• Pear-shaped,
• Hollow muscular organ
• The embryo and fetus develop
Divided into:
1. Fundus
2. Body
3. Cervix

Cont’d
1. Fundus
• above the level of uterine tubes
• no cavity
2. Body
• From:
-The level of uterine tube
-to level of isthmus of uterus
• cavity is triangular

Cont’d
3. Cervix
• cylindrical, narrow inferior third of the uterus,
• below the level of the isthmus of the uterus
• divided into:
I. Supravaginal part: b/n the isthmus and vagina
II. Vaginal part: protrudes into superiormost Ant.
vaginal wall

Cont’d
 Uterine cavity
• slit-like
• 6 cm in length
• from external os to the wall of the fundus.
 Uterine horns (cornua)
• superolateral regions of the uterine cavity,
• Cont. inferiorly as the cervical canal.

Cont’d
• Cervical canal
• Narrow passageway from internal os to external os.
• Facilitates menstrual blood exit from uterus.
• Facilitates sperm passage during intercourse.
• Allows baby passage during childbirth.
.

Cont’d
• INTERNAL OS: opening b/n cavity of body of uterus &
cavity of cervix (cervical canal)
• EXTERNAL OS: opening b/n cervical canal & cavity of
vagina
• In a nulliparous woman: external os appears circular.
• In a multiparous woman: external os appears as a
transverse slit with an anterior & a posterior lip

Ligaments of the Uterus
• keep the uterus in its correct position
I. Ligaments at junction between fundus & body of uterus
(At the level of uterine tube) :
1. Round ligament of uterus (ligamentum teres uteri)
• Extends through inguinal canal to labium majus
• attaches antero-inferiorly to this junction.
2. Ligament of ovary
• attaches to the uterus postero-inferior to the uterotubal junction
• These two ligaments are vestiges of the ovarian gubernaculum.

Cont’d
II. Ligaments of cervix: Extend from cervix to :
1. Anterior pelvic wall (pubocervical)
2. Lateral pelvic wall (transverse cervical or cardinal) this is the main
support
3. Posterior pelvic wall (uterosacral or sacrocervical).

Cont’d
Broad Ligament
• A double layer of peritoneum extending from
the uterus to the pelvis floor.
• Helps keep the uterus in position.
• Has three main components
1. Mesometrium
2. Mesosalpinx
3. Mesovarium

Cont’d
I. Mesometrium:
• largest & most inferior part
• attaches the uterus to the lateral pelvic walls.
II. Mesosalpinx:
• It surrounds uterine tubes support & stabilize them.
III. Mesovarium:
• It attaches to ovaries,
• providing them with support & anchorage within pelvis.

POSITIONS OF UTERUS
• Usually anteverted and anteflexed,
• Changes with bladder fullness, rectum, and pregnancy stage.
RETROVERTED UTERUS
Fundus & body of uterus are
bent backward on the vagina
and lie in rectouterine pouch
RETROFLEXED UTERUS
Long axis of body of uterus is
bent backward on long axis of
cervix
ANTEVERTED UTERUS
Long axis of whole uterus is
bent forward on long axis of
vagina
ANTEFLEXED UTERUS
Long axis of body of
uterus is bent forward
on long axis of cervix

USUAL POSITION OF UTERUS
ANTEVERTED ANTEFLEXED UTERUS

Relations of Uterus:
 Fundus + Body + Supravaginal Part of Cervix:
• Anterior: Superior surface of urinary bladder
• Posterior: Sigmoid colon
• Lateral: Uterine artery
 Vaginal part of Cervix
• (surrounded by vaginal fornices)
• Anterior: Anterior fornix of vagina
• Posterior: Posterior fornix of vagina
• Lateral: Lateral fornices of vagina

Cont’d
• Arterial supply:
Uterine(from internal iliac artery in pelvis)
• Venous drainage:
Uterine plexus(to internal iliac vein)
• Lymphatics:
to internal iliac lymph nodes (in pelvis)
• Innervation:
Inferior hypogastric plexus (in pelvis)

Vagina
• Structure: Distensible musculomembranous tube
• Length: 7–9 cm long
• Extends:
• from superiormost of vaginal part of cervix of uterus
• to vaginal orifice
• Function:
1. Copulatory organ
2. Birth canal
3. Canal for menstrual fluid

Relations of Vagina
Anterior:
• Urinary bladder (in pelvis) & urethra (in perineum)
Lateral:
• ureters (in pelvis)
Posterior:
• Rectum (in pelvis) & anal canal (in perineum)

Cont’d
• Arterial supply:
Vaginal.A (from internal iliac artery in pelvis)
• Venous drainage:
Vaginal plexus (to internal iliac vein)
• Lymphatics:
to internal iliac lymph nodes (in pelvis)
• Innervation:
Inferior hypogastric plexus (in pelvis)

Anatomy of perineum
30
Male
female
4/5/2024 by: Mankelklot Kasahun

Perineum
• A diamond-shaped region
• lies below pelvic diaphragm,
-b/n inner aspects of thighs & Ant. to sacrum & coccyx

Cont’d
 Boundaries:
• Anterior : lower border of
symphysis pubis & arcuate pubic ligament
• Posteriorly : tip of coccyx.
• Antero-laterally :ischiopubic rami and ischial
tuberosities.
• Postero-laterally :Sacrotuberous ligament

Cont’d
Roof of Perineum
• Mainly formed by levator ani muscles.
• Separates pelvic cavity from perineum.
• Forms a funnel-shaped pelvic diaphragm.

Division
• Divided into two triangles
-by a transverse line.
1. Anal triangle-posterior
2. Urogenital triangle-anterior
• the two triangles are not in the same plane.

Cont’d
Anal Triangle
• Posterior to line.
• Constitute: anal canal and anus.
• Centrally surrounded by ischio-anal fat.
Urogenital Triangle
• anterior to the anal triangle.
• Contains: external genitalia,
-houses opening of urethra & vagina
• Closed by perineal mmb,
-thin, deep fascia.
-Covers ant. part of pelvic outlet.

Anal triangle
• Posterior part of perineum
Boundaries:
• Laterally: sacrotuberous ligaments medial margins.
• Anteriorly: horizontal line b/n ischial tuberosities.
• Posteriorly: coccyx.
• Roof: pelvic diaphragm

Cont’d
• It has
• Medially: Perineal body, anal orifice, anococcygeal ligament
• Bilaterally: ischiorectal fossa

Cont’d
Perineal Body
• Site of convergence &
-interlacing of several muscles.
• Lies Deep to skin,
-Post. to vagina/ penis vestibule,
-Ant. to anus & anal canal
 Includes:
Bulbospongiosus,
external anal sphincter,
superficial and deep transverse perineal muscles.

Main contents:
• Anal aperture
opening of the anus.
• External anal sphincter muscle
-voluntary muscle opening and closing the anus.
• Ischioanal fossae (x2)
-spaces located laterally to the anus.
• Additionally, pudendal N.
-supplies perineum with somatic fibres.

External Anal Sphincter
• Forms skeletal muscle surrounds anal canal.
• Comprises 3 parts:
I. Deep part:
thick ring-shaped muscle circling upper part of canal
II. Superficial part:
Anchored anteriorly to the perineal body and
posteriorly to the coccyx and anococcygeal ligament.
III. Subcutaneous part:
Horizontally flattened muscle circling the anal aperture just beneath the skin

Ischioanal fossae
• A perineal space on both side of anal canal.
• Wedge shaped with apex directed upwards
• Lateral wall vertical and medial wall sloping downward and medially.
• Fat filled: allows expansion of rectum and anal canal during
defecation.
• Communicate via deep postanal space over anococcygeal ligament.

Boundaries
• Laterally : obturator internus and its
fascia & ischial tuberosity
• Medially: levator ani covered by anal
fascia & external anal sphincter
• Anteriorly: superficial and deep
transverse perineal muscles.
• Posteriorly: sacrotuberous ligament
covered by gluteus Maximus
• Apex: fusion of obturator and anal
fascia
• Base: skin and superficial fascia

Recesses
• Anterior recess: anterior extension above the urogenital diaphragm.
• Posterior recess: posterior extension between sacrotuberous and
sacrospinous ligament

Anterior Recesses
• Shaped like three-sided pyramids tipped onto one side.
• Apex is closed, pointing towards pubis.
• Base is open, continuous with related fossa.
• Inferior wall: deep perineal pouch.
• Superomedial wall: levator ani muscle.
• Superolateral wall: obturator internus muscle.
• Normally filled with fat.

Posterior Recesses
• Shape: Triangular or wedge-shaped
• Extends b/n sacrotuberous ligament posteriorly and
-lateral wall of the anal canal anteriorly
• widens as it extends laterally from anal canal
-towards the ischial tuberosity
• Allows for the accommodation of structures
-internal pudendal vessels and
-pudendal nerve within the fossa

Lunate fascia
• Arched fascia in ischiorectal fossa
• Starts from the periosteum of ischial tuberosity makes medial wall
-of pudendal canal, lines obturator fascia goes towards apex and
-lines anal fascia blends with it at the level of white line of Hilton.
• Summit of this facia called tegmentum.

Parts of Ischiorectal fossa
I. Suprategmental:
• above lunate fascia contains loose fat.
II. Ischiorectal space proper:
• b/n lunate & perianal fascia.
-Contain fat with fibrous tissue.
III. Perianal space:
• b/n perianal fascia & skin.
-Contains
• loculated fat in tight fibroelastic compartments.

Contents
• Fat pads: Provide cushioning and support.
• Blood vessels: Internal pudendal artery and vein branches.
• Nerves: Including inferior rectal nerves and pudendal nerve.
• Lymphatic vessels: Drainage from the perineum and anal region.

Pudendal /Alcock’s canal
• Fascial tunnel in lateral wall of ischiorectal
fossa
• 2.5cm above ischial tuberosity
• Formed either
-by splitting of obturator fascia or
-by separation b/n lunate & obturator fascia or
-by splitting of perianal fascia.

Cont’d
• Covers medial aspect of obturator internus muscle.
• Lines lateral wall of ischio-anal fossa.
Extent:
• from lesser sciatic foramen-posterior limit of deep
perineal space
Content:
• internal pudendal vessels(A&V)
• pudendal nerve and its 2 branches-
-dorsal nerve of penis/clitoris
-perineal nerve.

Cont’d
Internal pudendal vessels and nerve
• Enter canal at inferior aspect of lesser sciatic notch
• Supply and drain most of the perineum.
• Enter canal, give rise to inferior rectal artery and
nerve.
• Supply external anal sphincter and peri-anal skin.
• Bifurcate further down canal, forming perineal nerve
and artery for superficial pouch and dorsal artery and
nerve for deep pouch.
• Proceed to glans penis or clitoris.

Urogenital Triangle
• Anterior part of perineum
Boundaries:
• Anteriorly: lower margin of
pubic symphysis & arcuate pubic ligament
• Posteriorly: imaginary line
joining two ischial tuberosities
• Laterally: lower margin of ischiopubic rami.
• Superficially : skin and superficial fascia
• Deep: thin endopelvic fascia

Cont’d
• Divided into 2 parts
-by a strong perineal membrane
I. Deep perineal space
lies above the membrane
II. Superficial perineal space
lies below the membrane

Cont’d
• Dissection in the urogenital triangle region reveals following layers from
superficial to deep:
1. Skin
2. Fatty layer of superficial facia
3. Membranous layer of superficial facia (Colles facia)
4. Contents of superficial perineal space
5. Perineal membrane (inf. Layer of urogenital diaphragm)
6. Contents of deep perineal space
7. Endopelvic facia (Superior facia of urogenital diaphragm)

Skin
• In male: midline raphe continuous with raphe of scrotum.
• In female: perineal raphe leading to midline cleft called vestibule
between two labia minora.
• Raphe indicates development from fusion of two symmetrical halves.

Fatty layer of superficial facia
Cont.'s with fatty layer of
superficial facia in lower abdomen
- facia of camper
provides
insulation,
padding, and
support to
-the structures of the urogenital region.

Colles fascia
• Membranous layer of superficial fascia.
• Forms lower limit of superficial perineal pouch.

Colles fascia
 Attachments:
• lateral:
-lower margin of ischiopubic rami
• posterior:
-attached to posterior margin of perineal
membrane
• Anterior:
-cont.’s with dartos muscle of scrotum,
superficial fascia of penis and Scarpa’s fascia
of lower abdomen.

Superficial perineal space:
• Interfascial space below perineal membrane
Boundaries
• superior: perineal membrane
• inferior: Colles fascia
• lateral: ischiopubic ramus
• posterior: closed by fusion of perineal
membrane and colles fascia
• anterior: open with deep to Dartos muscle and
superficial fascia of penis and ant. abdominal
wall between fascia Scarpa and external
oblique aponeurosis.

Cont’d
• Contents:
A. Muscles:
I. Ischiocavernosus: cover crus
penis or crus clitoris
II. Transversus perinei superficialis
III. Bulbospongiosus: cover bulb of
penis or bulb of vestibule.

Cont’d
I. Ischiocavernosus
• Origin: Ischial tuberosity and ramus
• Insertion: Crus of penis and clitoris
• Function:
Move b/d from crura into body of the erect penis and clitoris
II. Bulbospongiosus
• Origin: perineal body
• Insertion:
In women: bulb of vestibule, perineal mmb,
body of clitoris, & corpus cavernosum
In men: bulbospongiosus, perineal mmmb, corpus cavernosum

Cont’d
Function:
• Aids in ejaculation of semen by rhythmically contracting.
• Assists in expulsion of urine or vaginal secretions.
III. Superficial transverse perineal
• Origin: Ischial tuberosity and ramus
• Insertion: Perineal body
Function: Stabilize the perineal body
 By branches of internal pudendal artery
 All are innervated by Pudendal nerve(S2-S4)

Cont’d
B. Blood vessels
• Posterior scrotal/labial arteries
-branch of perineal or internal
pudendal artery
• Transverse perineal artery
-branch of perineal artery.

Cont’d
• C. Nerves
• Posterior scrotal/ labial
nerves: branches of
-superficial perineal nerve
• Perineal branch of posterior
femoral cutaneous nerve.

Cont’d
D. Other structures:
• Crus penis/ crus clitoridis
• Bulb of penis with urethra
-traversing it
• Bulb of vestibule with
-greater vestibular gland

Perineal membrane
• Inferior fascia of urogenital
diaphragm
• Triangular;
-apex directed in the front
• Stretched between pubic arch

Cont’d
• Attachments
• lateral: inner surface of ischiopubic
ramus
• anterior: thickened to form
transverse perineal ligament
• posterior: perineal body in midline
but laterally has free margin.

Structures piercing the perineal membrane
1. Posterior scrotal/labial nerves and
vessels
2. Deep artery of penis /clitoris
3. Dorsal artery of penis or clitoris
4. Urethra
5. In male: duct of bulbo-urethral
glands and artery to the bulb of
penis
6. In female: vagina

Deep perineal Space
• Closed interfacial space inside the urogenital
diaphragm
Boundaries
• superior: superior facia of urogenital
diaphragm
• inferior: perineal membrane (inferior facia)
• anterior: transverse perineal ligament
• posterior: fused superior and inferior facia of
urogenital diaphragm
• lateral: inner surface of ischiopubic rami

Cont’d
• Contents:
• A. Muscles
• Sphincter urethrae:
surround membranous
urethra
• Transversus perinei
profundus

Cont’d
• B. Blood vessels
• Internal pudendal artery and
-its terminal branches
• Deep artery of penis/ clitoris
• Dorsal artery of penis/ clitoris
• Artery to the bulb of penis/
bulb of vestibule

Cont’d
• C. Nerves
• Dorsal nerve of penis/clitoris

Cont’d
• D. Other structures
• Membranous urethra
• Bulbo-urethral glands in male
• Vagina in female

Female External Genitalia/ vulva
• Physical structures & features visible outside of
female body
-involved in reproduction & sexual function
Includes:
• Mons pubis
• labia majora
• labia minora
• clitoris,
• bulbs of vestibule, and
• greater/lesser vestibular glands.

The vulva
Serves:
• as sensory & erectile tissue for sexual
arousal & intercourse.
• to direct flow of urine.
• to prevent entry of foreign material
into urogenital tract.

Mons Pubis
• rounded, fatty eminence
• Anterior to pubic symphysis, tubercles, &
superior pubic rami.
• Forms by fatty subcutaneous tissue.
• Increases fat at puberty, decreases post-
menopause.
• Surface is continuous with anterior
abdominal wall.
• Post-puberty, covered with coarse pubic
hairs.

Labia Majora
• Prominent skin folds
• protect clitoris & urethral orifices.
• filled with loose subcutaneous tissue
• Passes inferoposteriorly from mons
pubis toward the anus.
• Externally pigmented with sebaceous
glands and pubic hairs.
• Internal smooth, pink, and hairless.
• form the anterior commissure.

Labia Minora
• Round, fat-free,
• hairless skin folds enclosed in the
pudendal cleft.
• Surround and close over the vaginal
vestibule
Contains:
• erectile tissue
• small blood vessels.

Cont’d
• Form two laminae:
• medial laminae unite as the clitoris frenulum and
• lateral laminae unite anterior to the glans clitoris,
-forming the prepuce.
• Connected posteriorly by a small transverse fold,
-frenulum of labia minora (fourchette).
• Internal surface is pink,
-contains sebaceous glands,
-sensory nerve endings.

Clitoris
• Erectile organ
• located where labia minora meet anteriorly.
Composition:
• Two crura: elongated structures extending
towards the pubic symphysis.
• Two corpora cavernosa: erectile tissue structures.
• Glans clitoris: a highly sensitive, rounded
structure at the tip.
• Unlike the penis, not involved in urination.
• function solely sexual arousal and pleasure.

Vestibule of Vagina
• Space surrounded by labia minora,
it houses :
• orifices of urethra & vagina
• Ducts of greater & lesser vestibular
glands.

Bulbs of Vestibule
• Pair masses of elongated erectile tissue,
• approximately 3 cm in length.
• Location:
-along sides of vaginal orifice,
-superior or deep to labia minora.
• Covered by bulbospongiosus muscles.
• Homologous with the bulb of the penis.

Vestibular Glands
Greater vestibular glands (Bartholin glands)
• 0.5 cm in diameter.
• Located in superficial perineal pouch.
• Partially overlapped by bulbs of vestibule.
• Secrete mucus into vestibule at sexual arousal.
Lesser vestibular
• Skene's glands or paraurethral glands
• Small glands on each side of vaginal vestibule.
• Open b/n urethral & vaginal orifices.
• Secrete mucus to moisten labia & vestibule.

Cont’d
• Arterial supply
• external and internal pudendal arteries
• Venous drainage
• Internal pudendal vein to internal iliac veins.
• Innervation
• Lumbar plexus & pudendal nerve
• Ant. Aspect-by lumbar plexus derivatives.
• Post. aspect-by post. cutaneous nerve of
thigh & br. Pudendal N.

Clinical correlated
• Ischiorectal abscess: loose fat so an abscess in
this region may grow to a large size before
producing pain.
• Perianal abscess: fat is in tight compartments
so the abscess is very painful due to tension
caused by building pus.
• Abscess bursting in the anal canal may
produce fistula in ano.

Cont’d
• Uterine prolapse
• Downward displacement of uterus due to damage of:
1. Ligaments of uterus
2. Levator ani muscles

Cont’d
Perineal tear:
• Commonly during parturition of nullipara women
• Perineal tear if not repaired cause prolapse
• Prevented by using Episiotomy.

Cont’d
• Pudendal block: for perineal anesthesia.
• Generally done in 2nd stage of labour
• To perform or Repair episiotomy.
• Transvaginal and Transperineal approach.

Reference
• Grays anatomy for students. 4th edition.
• Mooore clinically oriented anatomy 8th edition.
• Netter’s atlas of Human Anatomy

Female reproductive anatomy and Perinuem.pdf

Recommended

Recommended

More Related Content

Similar to Female reproductive anatomy and Perinuem.pdf

Similar to Female reproductive anatomy and Perinuem.pdf (20)

Recently uploaded

Recently uploaded (20)

Female reproductive anatomy and Perinuem.pdf