2. Male Reproductive System
– Testes
– Vas deferens
– Seminal vesicles
– Ejaculatory ducts
– External genitalia- Penis and scrotum
– Accessory sex glands- Prostate and bulbo-urethral gland
3. THE TESTES
The testes are male
reproductive glands
suspended into the scrotum by
the corresponding spermatic
cords.
5. Presenting Parts
– Two ends- upper and lower
– Two borders- anterior and posterior
– Two surfaces- medial and lateral
– Epididymis
– Upper end is overlapped by epididymis and connected to epididymis by efferent
ductules.
– Lower end is related to tail of epididymis.
– Anterior border is smooth and convex.
6. Presenting Parts
– Posterior border is broad and flat. Posterior border is related to body of
epididymis and vas deferens. Spermatic cord is attached to the upper part of
posterior border.
– Medial surface is smooth and convex
– Lateral surface is smooth and convex. It is related to body of epididymis
separated by sinus of epididymis.
– The epididymis is a coma shaped body that occupies the lateral surface and
posterior border of the testes. It is divided into three parts- head, body and tail.
Head is formed by the coiling of several efferent ductules. Body and tail is
formed by the coiling of single canal of epididymis which later on continues as
vas deferens.
7. Coverings of Testes
– Three capsules from outside inwards- Tunica vaginalis, Tunica albuginea, Tunica
vasculosa.
– Tunica vaginalis covers the testes and epididymis except the posterior border.
– Tunica albuginea is a thick fibrous membrane that covers the whole of testes
and projects into the gland from the posterior border as mediastinum testis. It
is an incomplete vertical partition. From mediastinum testes numerous septa
arise to divide testes into numerous lobules.
– Tunica vasculosa lines the individual lobule of testes.
8. Coverings of Testes
– Extrinsic coverings of testes-
– Skin
– Dartos muscle
– External spermatic fascia
– Cremasteric muscle and fascia
– Internal spermatic fascia
– Tunica vaginalis
9. Structure of Testes
– Macroscopic structure:
– Each lobule consists of one to three seminiferous tubules and interstitial cells of
Leydig.
– The seminiferous tubules consist of a convoluted part in front and a straight part
behind. The straight parts ascend in the mediastinum, join adjacent tubules and form
a reticular network known as Rete Testis.
– 12 to 2o efferent ductules arise from the Rete Testis and enter into the head of
epididymis. Each efferent ductule forms lobule of epididymis on coiling. All the
ductules unite to form canal of epididymis which traverses through the body and tail
of epididymis.
10. Structure of Testes
– Microscopic structure:
– Seminiferous tubules present two types of cells- spermatogenic cells and supporting
cells of Sertoli.
– Spermatogenic cells give rise to spermatozoa through a variety of cell lines- Stem
cells> spermatogonia> primary spermatocyte> secondary spermatocyte>
spermatids> spermatozoa.
– Sertoli cells help in formation of a hemato testicular barrier and the nourishment of
the spermatozoa. They work under the influence of FSH.
– Interstitial cells of Leydig are present in the lobules of testes. The secrete
testosterone under the influence of ICSH/ LH.
11. Structure of Testes
– Microscopic structuire:
– Rete testes are lined by flattened epithelium.
– Efferent ductules are lined by ciliated columnar epithelium.
– Canal of epididymis is lined by ciliated pseudo-stratified columnar epithelium.
12. Arterial Supply
– Testicular artery, branch of abdominal aorta
– Artery to vas deferens, branch of superior or inferior vesical artery
– Cremasteric artery, branch of inferior epigastric artery.
13. Venous Drainage
– 15-20 veins appear from the posterior border of testes and epididymis, and
unite to form a Pampiniform plexus.
– Pampiniform plexus is a content of spermatic cord. At superficial inguinal ring
the plexus unites to form four veins; then at deep inguinal ring these veins unite
to form two veins. Finally a single vein is formed and is known as testicular vein.
– Right testicular vein drains into IVC directly, left testicular vein drains into left
renal vein.
14. THE VAS
DEFERENS
It is a thick cord like tubular
structure. It acts as a transporter
of spermatozoa from the
epididymis to ejaculatory duct.
15. Course
– It begins as a continuation of canal of epididymis. It passes upward behind the
testis and medial to epididymis. It enters into the spermatic cord and traverses
the inguinal canal.
– After passing through the deep inguinal ring it winds round the lateral side of
inferior epigastric artery.
– It passes crosses the external iliac vessels, ureter in its course.
– Behind the bladder and in front of the rectum, it ends by joining with the duct
of seminal vesicle to form ejaculatory duct.
– Between the ureter and ejaculatory duct, the vas deferens forms a dilatation.
That is known as ampulla.
16. Structure
– Three coats- areolar, muscular and mucous.
– Muscular coat- outer longitudinal and inner circular layer of smooth muscles.
– Mucous membrane- non ciliated simple columnar secretory epithelium.
19. Structure
– A pair of seminal vesicles are present between the base of the bladder and
rectum. it has a base and apex. Base is directed upwards and laterally. Apex
joins with the vas deferens to form the ejaculatory duct.
– Each vesicle is formed by the coiling of a duct. The duct is lined internally by
simple columnar epithelium with occasional goblet cells. Seminal vesicle also
has a areolar and muscular coat similar to vas.
– The secretion of the vesicle is a viscid, yellowish fluid that makes the bulk of the
semen. The fluid is rich in fructose and prostaglandin.
– Seminal vesicle is supplied by inferior vesical artery and middle rectal arteries.
21. Structure
– Each ejaculatory duct is formed by the union of vas deferens and duct of
seminal vesicle.
– It opens at the colliculus seminalis, one on each side of prostatic utricle.
– The duct is 2 cm long.
– The duct is lined by simple columnar epithelium.
22. PROSTATE
It is a fibro-musculo glandular organ
which surrounds the proximal part of
male urethra. Its secretion forms a
considerable part of semen. The
secretion contains acid phosphatase,
zinc, prostaglandin & fibrinolysin.
23. Coverings
– Inner true and outer false capsule
– Inner true capsule is formed by the condensation of fibrous stroma and invests
the entire prostate.
– False capsule is derived from the visceral layer of pelvic fascia.
– In between two layers, the space is occupied by the prostatic venous plexus.
24. Structure
– Apex and base
– Surfaces- Anterior, posterior and two infero-lateral surfaces
– Apex is directed below and comes in relation with the uro-genital diaphragm.
– The base is directed above and is pierced by the urethra at the junction of
anterior one-third and posterior two-third of the gland.
– Posterior surface is broad and is related to the rectum separated by recto-
vesical fascia. The posterior surface is divided into upper small and lower large
areas by a transverse groove. The upper small area forms the median lobe. The
transverse groove is pierced on each side by the ejaculatory ducts. The lower
large area is divided by a vertical groove into two lateral lobes.
25. Structure
– The anterior surface is narrow and is situated behind symphysis pubis.
– Each infero-lateral surface is related to Levator Ani muscle.
– Anatomically prostate has three lobes- median and two lateral lobes.
– Median lobe is bounded in front by the urethra, behind by the ejaculatory
ducts, on each side by prostatic utricle.
– Lateral lobes are continuous with each other in front of the urethra.
– Prostate is traversed by urethra, two ejaculatory ducts and prostatic utricle.
Prostatic utricle is a mucosal sac that extends upward and backward from
colliculus semilunalis.
26. Histology
– The prostate consists of fibrous, muscular and glandular tissues.
– Fibrous tissue surrounds the gland and is thickened to form the true capsule.
– Muscular tissue consists of both smooth muscles and striated muscles. The
smooth muscles are arranged as outer sheet beneath the true capsule and an
inner sheet around the urethra. Smooth muscles are continuous with the
detrusor muscle.
– The glands of prostate are arranged in three layers- inner mucous glands,
intermediate submucous glands, outer main glands. Their ducts open above the
level of colliculus, at the level of colliculus and below the level of colliculus
respectively.
27. Blood Supply
– Arterial supply by inferior vesical, middle rectal and internal pudendal arteries.
– The veins form a prostatic plexus in the space between true and flase capsules.
The venous plexus receives deep dorsal vein of penis. Finally the blood is
drained into internal iliac veins.
– A few veins from the prostatic plexus communicate with the vertebral venous
plexus behind. They are known as para-vertebral veins of Batson.
29. Structure
– These are a pair of small glands on each side of the membranous urethra.
– Their ducts open into the spongy urethra.
– The secretion of bulbo-urethral glands forms a part of semen.
– These glands correspond with the greater vestibular glands.
31. Spermatic Cord
– The spermatic cord consists of a tubular sheath covering various structures,
extending from the deep inguinal ring to the upper part of posterior border of
testis.
– Each cord is 7.5 cm long.
– The sheath is derived from three layers- internal spermatic fascia, cremasteric
fascia and external spermatic fascia.
32. Contents
– Vas deferens
– Pampiniform plexus of veins
– Testicular artery, artery to vas deferens, cremasteric artery
– Lymphatics of testis and epididymis
– Genital branch of genito-femoral nerve, testicular plexus
– Loose connective tissue
34. Coverings
– From outside inwards:
– Skin: Elastic, pigmented, corrugated. Provided with hair, sweat and sebaceous glands.
– Dartos muscle: It forms a scrotal septum which divides scrotum into two
compartments.
– External spermatic fascia: Derived from external oblique aponeurosis.
– Cremasteric fascia: Derived from internal oblique aponeurosis.
– Internal spermatic fascia: Derived from fascia transversalis.
– Parietal layer of tunica vaginalis.
35. Blood Supply
– Arterial supply by superficial and deep external pudendal arteries and also from
a branch of internal pudendal artery.
– Veins drain into great saphenous vein and internal iliac vein.
36. THE PENIS
It forms the organ of copulation
and consists of two parts- a root
and a body.
37. Structure
– Root of the penis is situated in the superficial perineal pouch and is connected
to urogenital diaphragm. It contains 3 masses of erectile tissue- 2 crura and the
bulb of penis.
– Every crus is connected to pubic arch of corresponding side. Anteriorly they
converge and near symphysis pubis 2 crura come together and continue as
corpora cavernosa of the body of the penis.
– The bulb anteriorly is continuous as corpus spongiosum of the body. It is pierced
by the urethra.
– Every crus is covered by ischiocavernosus muscle, and the bulb is covered by
the bulbospongiosus muscle.
38. Structure
– Body is the penis is the free pendulous portion. It is subdivided into three parts:
body proper, neck and glans penis. Glans penis is the enlarged conical structure
at the distal end of the penis. It presents the external urethral aperture. Neck is
the grooved constriction just behind the base of the glans. Rest is the body
proper.
– In the flaccid state, it’s a cylindrical structure. In the erect state, it attains a
traingular prism like shape on cross section with rounded angles.
– The body has two surface- ventral and dorsal.
39. Structure
– The structure of penis describes 3 elongated masses of erectile tissue- 2 corpora
cavernosa and 1 corpus spongiosum.
– Both corpora cavernosa form the greater part of the body of penis. They are
enveloped by tunica albuginea. It has two layers. The superficial layer encloses
both the corpora whereas the deep layers enclose individual corpora. In the
midline the deep layers fuse to form the septum of penis.
– There is a groove in between two corpora cavernosa. The groove contains
corpus spongiosum ventrally. Dorsally the groove lodges deep dorsal vein of
penis, 2 dorsal arteries and dorsal nerves of the penis.
40. Structure
– Corpus spongiosum is enlarged at the distal end to form the glans penis. It is
traversed by spongy urethra through its entire length. It is also surrounded by a
layer of tunica albuginea.
– Skin is dark, thin, loose and devoid of hair. Skin is reflected upon itself at the
neck to form the prepuce. The internal layer of prepuce is continuous over the
glans penis. The skin covering the glans is continuous with the mucous
membrane of urethra at the external urethral orifice. This continuity is
demarcated by a fold of skin known as frenulum of prepuce which is very
sensitive.
– Two ligaments- suspensory and fundiform ligaments hang the penis.
41. Arterial Supply
– Deep arteries of the penis
– Dorsal arteries of the penis
– Arteries of the bulb
– They all are the branches of internal pudendal artery.
42. Venous Drainage
– Superficial dorsal vein of penis, drains into great sephanous veins.
– Deep dorsal vein of penis, drains into prostatic venous plexus.
45. THE
OVARIES
The ovaries are a pair of
female reproductive
glands present on either
side of the uterus, in the
ovarian fossa below the
pelvic brim, attached to
the broad ligament.
46.
47.
48. Shape and size
– Almond shaped
– Vertical: 3 cm
– Antero-posterior: 1.5 cm
– Transverse: 1 cm
49. Presenting parts
– Two ends- tubal and uterine
– Two borders- anterior and posterior
– Two surface- medial and lateral
– Tubal end is related to uterine tube, fimbria and suspensory ligament of ovary
– Uterine end is connected to the lateral angle of uterus by ligament of ovary
– Anterior border is also known as mesovarian border. It is attached to broad
ligament and acts as a hilum of the ovary conveying ovarian vessels and nerves.
50. Presenting parts
– Posterior border is free and is related to uterine tube.
– Medial surface is related to uterine tube.
– Lateral surface rests on ovarian fossa. The ovarian fossa is bounded above and
in front by obliterated umbilical artery, above by external iliac vein, behind by
ureter and internal iliac vessels and laterally by peritoneum.
51.
52. Structure
– The ovary is covered by a single layer of cubical cells known as germinal
epithelium.
– The substance of the gland can be divided into outer cortex and inner medulla.
– The medulla is composed of loose connective tissue, muscle fibres, blood
vessels, lymphatics and nerves.
– The cortex includes ovarian follicles at different stages of adulthood and
maturation.
– Instantly underneath the germinal epithelium, the connective tissue of the
cortex is condensed to create a fibrous coat, tunica albuginea.
53. At birth
– The cortex contains 1 million or more primordial follicles.
– Before puberty most of the primordial follicles undergo degeneration and
apoptosis.
– About 40000 follicles persist at puberty and exhibit periodic changes during
reproductive period.
– Each primordial follicle consists of a central primary oocyte and is surrounded
by a single layer of flat follicular cells.
54. In child bearing period
– After puberty, out of 40000 primordial about 5-10 follicles undergo a process of
maturation in each monthly menstrual cycle.
– One follicle from any of the two ovaries fully matures and thereafter ruptures
discharging a secondary oocyte in the peritoneal cavity.
– Rest of the follicles undergo atresia and are converted into interstitial cells.
– A mature follicle is known as Graafian follicle.
– During the development of Graafian follicle, it undergoes primary, secondary
and tertiary changes.
55. In child bearing period
– After ovulation the wall of the follicle collapse and it turns into corpus luteum.
Corpus luteum secretes progesterone and remains active for 12-14 days in
absence of fertilization.
– Then corpus luteum degenerates and turns into corpus albicans.
– Sudden withdrawal of progesterone will lead to shedding of the superficial layer
of endometrium leading to menstrual bleeding.
56.
57. Blood supply
– Ovarian artery, branch of abdominal aorta.
– Right ovarian vein drains into IVC. Left ovarian vein drains into left renal vein.
58.
59. THE
UTERINE
TUBES
The uterine tubes convey
the ova from the ovary to
the uterine cavity. Each
tube is 10 cm long and is
situated in the medial part
of upper free margin of
broad ligament of uterus.
60. Course
– The tube passes laterally from the angle of the uterus up to the uterine end of
the ovary.
– Then it passes upwards along the mesovarian border and arches backwards
around the tubal end of the ovary.
– Finally the tube turns downwards and comes in contact with the posterior
border of the ovary.
61. Presenting parts
– Two openings (ostium)
– Uterine opening: 1 mm
– Abdominal or pelvic opening: 3 mm.
– Four parts
– Intra mural part: 1 cm
– Isthmus: 3 cm
– Ampulla: 5 cm
– Infundibulum: 1 cm
62. Presenting parts
– The edge of the infundibulum presents a number of finger like projections,
known as fimbriae. One fimbria is longer and s attached to the upper end of the
ovary. This is known as ovarian fimbria. Each fimbria presents an outer surface
and an inner surface. Outer surface is lined by mesothelium. Inner surface is
lined by ciliated columnar epithelium and presents longitudinal grooves.
63. Structure
– From outside inwards the uterine tube presents three coats- serous, muscular
ad mucous.
– Serous coat is derived from peritoneum and covers the entire tube except the
intra-mural part.
– Muscular coat consists of outer longitudinal and inner circular layers of smoth
muscle.
– The mucous membrane is lined by simple columnar epithelium. There are
mainly three types of cells found in the epithelium- ciliated, secretory and
intercalary.
65. THE UTERUS
The uterus is pyriform
shaped. It is present
between urinary bladder
in front and rectum and
sigmoid colon behind. The
uterus communicates
with the uterine tubes
above and below with the
vagina.
66. Subdivisions
– Fundus, body and cervix
– Fundus is the part above the openings for uterine tubes
– Body extends from fundus to isthmus which corresponds with the internal os
– Cervix lies below isthmus
68. Axes
– Anteversion is forward angle between the axis of the cervix and that of vagina
measuring about 90 degree provided the bladder and rectum are empty.
– Anteflexion is a forward angle between the body and cervix at the isthmus
measuring about 125 degree provided the bladder and rectum are empty.
69. Fundus
– Fundus is situated above an imaginary horizontal line connecting the opening of
two uterine tubes.
– It is covered with peritoneum.
70. Body
– It extends from fundus to isthmus
– The body presents anterior and posterior surfaces, two lateral borders and a
uterine cavity.
– The anterior surface is covered with peritoneum up to isthmus. Then the
peritoneum is reflected towards bladder forming utero-vesical pouch.
– The posterior surface is covered with peritoneum. The peritoneum here is
reflected towards the rectum forming recto-uterine pouch of Douglas.
– Each lateral border is non-peritoneal and gives attachment to broad ligament.
71. Body
– The angle at the junction of body and fundus is known as lateral angle. Each
uterine tube pierces the lateral angle.
– The uterine cavity is triangular with its base formed by the fundus and apex
formed by the internal os.
– Through internal os, uterine cavity communicates with the cervical canal.
– From within outwards the uterus presents endometrium, myometrium and
perimetrium.
72. Body
– Endometrium consists of surface epithelium and lamina propria.
– Before puberty the surface is lined by ciliated columnar cells. During
reproductive period the surface is lined by simple columnar epithelium.
– Functionally the endometrium consists of outer basal layer and inner functional
layer.
– Inner functional layer undergoes different changes throughout the menstrual
cycle. Such changes may be classified into following phases- menstrual,
regenerative, proliferative, secretory and pre-menstrual.
73. Body
– Myometrium consists of outer longitudinal, middle circular and inner reticular
layer.
– The longitudinal muscles help in the anchorage of the uterus.
– The circular muscle layer contain a vascular bed which is the source of arterial
supply to the endometrium. Circular muscles are thickened at the isthmus to
form an anatomical sphincter.
– Endometrial vessels pass through the reticular layer. Such appearance help to
stop the bleeding on contraction in menstruation and during the separation of
placenta.
74. Body
– Perimetrium is the serous coat of the uterus and is derived from the
peritoneum. It covers the entire uterus except the lateral borders, anterior
surface of the supra-vaginal part of cervix and he vaginal part of the cervix.
75. Ligaments
– 8 true ligaments (fibro-muscular bands)
– Round ligament of uterus: It is attached to the lateral angle of uterus. Then it passes
through the broad ligament, deep inguinal ring, becomes a content of inguinal canal
and ultimately ends at the subcutaneous tissue of labia majora.
– Mackenrodt's ligament: it extends from cervico-vaginal junction to the fascia covering
levator ani muscle.
– Utero-sacral ligaments: it extends from 3rd sacral vertebra to cervix.
– Pubo-cervical ligaments: it extends from pubic bones to cervix.
76. Ligaments
– 6 false ligaments (peritoneal folds)
– Utero-vesical fold
– Recto vaginal fold
– Recto-uterine folds
– Broad ligaments: it extends from the lateral border of uterus to lateral pelvic wall.
77. Arterial supply
– Uterine artery, branch of anterior division of internal iliac artery
– Ovarian artery, branch of abdominal aorta
– The uterine artery supplies via many successive branches like arcuate artery,
radial artery, stratus vasculare, basal and spiral arteries.
81. Course
– Cervix extends downwards and backwards and is embedded into the vagina.
– Cervix can be described into two parts: Supra-vaginal part and vaginal part.
– Anterior surface of supra-vaginal part is non-peritoneal and is related to
bladder.
– Posterior surface of supra-vagina part is peritoneal and is related to rectum and
sigmoid colon.
– On either side of the supra-vaginal part, lies he ureter, the uterine artery,
Mackenrodt's ligament, broad ligament.
82. Course
– Vaginal part is conical in shape and it communicates with the vagina via external
os.
– The external os is bounded by anterior lip and posterior lip.
– This part of cervix is surrounded by vagina which forms four fornices here-
anterior fornix posterior fornix and two lateral fornices.
– From outside inwards cervix presents three coats- serous, muscular and
mucous.
– Serous coat is derived from peritoneum.
83. Course
– Muscular coat is formed by smooth muscles, collagen and elastic fibre.
– Supra-vaginal part is lined by simple columnar epithelium. The vaginal part of
cervix is lined by stratified squamous epithelium.
84. Ligaments
– Laterally, a pair of Mackenrodt's ligaments
– Anteriorly, a pair of pubo-cervical ligaments
– Posteriorly, a pair of utero-sacral ligaments
85. Blood supply
– Arterial supply by uterine arteries and ovarian arteries
– Venous drainage by uterine and ovarian veins
86. THE VAGINA
The vagina is the female
organ for copulation and
forms the lowest part of
birth canal. It extends
from vestibule to cervix.
87. Presenting parts
– Anterior wall is entirely non peritoneal. In the upper part t is related to bladder.
In the lower part urethra is embedded in the anterior wall.
– Posterior wall is covered with peritoneum in its upper part. From above
downwards the posterior wall is related to sigmoid colon, rectum and anal
canal.
– Lateral walls are related to Mackenrodt's ligaments, ureter, uterine artery, bulb
of the vestibule, greater vestibular gland etc.
88. Structure
– From outside inwards it presents the following coats- serous, fascial, muscular
and mucous.
– Serous coat is derived from peritoneum.
– Fascial coat is derived from endopelvic fascia.
– Muscular coat consists of outer longitudinal and inner circular layer.
– Mucous membrane is lined by non-keratinized stratified squamous epithelium.
89. Structure
– Hymen is an incomplete mucous fold which is situated close to the external
orifice of vagina. It is of various shapes- annular, crescentic or cribriform. During
coitus the margin of the hymen becomes fissured producing tags of mucous
membrane- the caruncle. The inspection of hymen bears a medico-legal
importance in the investigation of virginity.
90. Blood supply
– Uterine artery
– Vaginal artery
– Internal pudendal artery
– Middle rectal artery
– Veins correspond the arteries and drain into internal iliac vein
92. External genitalia
– Mons pubis is a rounded elevation in front of symphysis pubis. It contains fibro-
fatty tissue. This is the place for pubic hair.
– Labia majora are a pair of longitudinal cutaneous elevations containing fibro
fatty tissue. I front they meet each other at anterior commissure. Behind they
meet each other at posterior commissure. The outer fold contains hair follicles.
The inner fold contains sebaceous glands.
– Labia minora are a pair of longitudinal fat free cutaneous fold, situated inside
labia minora. In front labia minora splits into upper and lower layers. Upper
layers meet each other to form the prepuce. Lower layers meet each other to
form the frenulum. Behind they meet to form fourchette.
93. External genitalia
– The cleft between the labia minora is known as vestibule. It presents the
urethral orifice and the vaginal orifice. Lesser vestibular glands are present
around the two orifices here.
– The clitoris corresponds to penis of male. It is formed by a pair of erectile tissue,
corpora cavernosa. The tip of clitoris, the glans is highly sensitive.
– Bulbs of vestibule are a pair of elongated erectile tissue which is present on
either side of vaginal orifice.
– Greater vestibular glands or Barthrolin's glands are a pair of glands situated
behind the bulb. Their ducts open on each side of the vaginal orifice.
