Lecture 2: Anatomy of female reproductive system

Question 1

What is the structure of the ovary?

Answer 1

Hilum: neurovascular structures enter the ovary here
Germinal epithlium: lines the ovary, gametes formed from here
Connective tissue: supports developing follicles
Capsule: around ovary, derived from peritoneum

Question 2

Why do you get a sharp pain at ovulation?

Answer 2

Caused by mature follicle rupturing through the capsule (disrupting the sensory nerves)

Question 3

Why do nuns tend to have a higher incidence of ovarian cancer?

Answer 3

Damage each time a follicle ruptures- mitosis, higher chance of mutation to ovarian capsule
-more ovulations= more likely to get ovarian cancer, as you don’t get pregnant or take birth control

Question 4

How might a patient with an ovarian cyst present?

Answer 4

-pain (could twist/rupture)

Question 5

What is the structure of the uterus?

Answer 5

• Uterine tubes
• at top of uterine tubes are the fimbriae which surround the opening/ends of uterine tube
• top of uterus is the fundus
• body of the uterus is the majority
• cervix (continuous with uterus)
• top of cervix invaginates into the vagina

Question 6

Where does the uterus sit in the body?

Answer 6

Posterior to the bladder

Anterior to the rectum

Question 7

What is the hole in the cervix called?

Answer 7

External os

Question 8

What is the space between the cervix and the vagina called?

Answer 8

Fornices (fornix)

-anterior and posterior fornices

Question 9

What epithelium lines the cervix?

Answer 9

-outside of cervix is covered by stratified squamous epithelium (that you can see from looking up through the vagina)
-in cervical canal, it is lined by columnar epithelium
Transformation zone b/w these two epithelia: likely to get malignant changes here

Question 10

What causes a slightly red colouring around the external os?

Answer 10

Columnar epithelium coming onto outside of the cervix: Cervical ectropion (completely normal)
-appearance in women who are on their period/pregnant/oral contraceptive pill

Question 11

How does giving birth change the external os?

Answer 11

Stretches it into a more slit like shape

Question 12

How does the uterus expand as the fetus grows?

Answer 12

-fundus touches transverse colon (complain of gastro-oesophageal reflux in pregnant women)
-compresses rectum posteriorly (complain of constipation)
-compresses bladder
-ligaments being stretched (pain)
Uterus goes from a pelvic structure to an abdominal structure

Question 13

What is the structure of the uterine tubes?

Answer 13

• fimbriae surround the ovary top
• fimbrae connected to wide area called the infundibulum
• infundibulum opens into the ampulla (wide, fertilisation usually occurs here)
• tube narrows to form the isthmus
• at isthmus the tube enters the uterine cavity

Question 14

How are the uterine tubes lined?

Answer 14

Lined by ciliated cells
Walls are very convoluted
Peg cells found: release substances that are beneficial to the egg and the sperm

Question 15

What is an ectopic pregnancy?

Answer 15

When the fertilised egg implants itself into the uterine tube (some can be in the peritoneal cavity)

• erode into blood vessels as it grows
• causing catastrophic haemorrhage

Question 16

How do you detect if the uterine tubes are patent?

Answer 16

The egg (and air/sperm), enters the peritoneal cavity once it is released before reaching the fimbriae, so therefore if you inject contrast, you should see the contrast spilling out slightly into the peritoneal cavity.

THIS IS ALSO A WAY A WOMAN CAN DEVELOP PERITONITIS (as pathogens can also enter)

Question 17

How is the pelvic peritoneum related to the pelvic organs?

Answer 17

Cover the anterior surface of them

• this goes down b/w the uterus and the rectum to form the rectouterine pouch
• this goes down the gap b/w the bladder and uterus to form the vesicouterine pouch

Question 18

What are the peritoneal ligaments?

Answer 18

Broad ligament: peritoneal fold attaching uterus to pelvic side walls
Round ligament and ligament of ovary: remnants of the gubernaculum
(round ligaments anchor the uterus and attach pulling the fundus slightly forward to maintain an antiverted/antiflexed position)
Suspensory ligament: neurovascular pathway bulging into the peritoneum

Question 19

What are the different sections of the broad ligament?

Answer 19

The broad ligament folds over the uterus creating a double layer.

• vessels (internal iliac>uterine artery) and nerves enter through fold of broad ligament (like a mesentry)
• mesovarium: peritoneum surrounding the ovaries
• mesosalphinx: beneath the uterine tubes
• mesometrium: connects lateral pelvic wall to uterus
• uterine tubes open into the peritoneal cavity

Question 20

Where do the ovaries lie in relation to the uterus?

Answer 20

Slightly posterior/behind

Question 21

Where do the bladder/rectum lie in relation to the uterus?

Answer 21

Bladder: anterior
Rectum: posterior

Question 22

What is the major blood supply to the pelvic viscera?

Answer 22

Internal iliac artery
Branches:
-uterine artery
-vaginal artery
(there are many anastomoses between the uterine artery and vaginal artery= bleeding)

Question 23

Describe the position of the uterus:

Answer 23

-axis of the uterine body
-axis of the cervix
-axis of the vagina
Angle b/w axis of cervix and uterine body= angle of anterflexion (when less than 180 degrees, uterus is antiflexed, when greater than 180 degrees, uterus is retroflexed)
Angle between angle of cervix and vagina= angle of anterversion (when less than 180 degrees, cervix is antiverted, when greater than 180 degrees, cervix is retroverted)

Question 24

What is the most common position for the uterus?

Answer 24

Antiverted and antiflexed

Question 25

What epithelium lines the vagina?

Answer 25

Very thick stratified squamous epithelium
-contains large granules containing glycogen, metabolised by many bacteria, converting it into lactic acid (lactobacilli) to maintain an acidic pH

Question 26

What puts women at higher risk of thrush?

Answer 26

Douching (washing out the vagina)

-as it clears the beneficial bacteria