Session 2: Anatomy of the Female Reproductive System

Question 1

Venous drainage of the right ovary.

Answer 1

Very similar to right testis. Veins form a pampiniform venous plexus which then drain into right ovarian vein and then into IVC.

Question 2

Venous drainage of the left ovary.

Answer 2

Veins form a pampiniform venous plexus which then drain into left ovarian vein, this then drains into the left renal vein and then joint to drain to IVC.

Question 3

Venous drainage of the uterus.

Answer 3

Uterine venous plexus drain to uterine vein. This drains to the internal iliac vein and then the common iliac vein. This will then join into the IVC.

Question 4

Venous drainage of the cervix.

Answer 4

Venous drainage via a plexus found in the broad ligament that drains into the uterine veins.

Question 5

Venous drainage of the vagina.

Answer 5

Vaginal venous plexus drain to the uterine vein and then into the internal iliac vein.

Question 6

Lymphatic drainage of the right ovary.

Answer 6

Primarily the lateral aortic nodes but the iliac nodes are also involved.

Question 7

Lymphatic drainage of the left ovary.

Answer 7

Primarily the lateral aortic nodes but the iliac nodes are also involved. The lateral aortic nodes are also called the para-aortic nodes.

Question 8

Lymphatic drainage of the uterus.

Answer 8

Iliac Sacral Aortic Inguinal All are lymph nodes.

Question 9

Lymphatic drainage of the cervix.

Answer 9

Iliac Sacral Aortic Inguinal All are lymph nodes.

Question 10

Lymphatic drainage of the vagina.

Answer 10

Superior: External iliac nodes Middle: Internal iliac nodes Inferior: Superficial inguinal nodes

Question 11

4 parts of the fallopian tube.

Answer 11

Fimbrae, infundibulum, ampulla and isthmus.

Question 12

Blood supply of the ovaries.

Answer 12

Ovarian artery arising from the abdominal aorta.

Question 13

Blood supply of the uterus.

Answer 13

The uterine artery arising from the internal iliac artery.

Question 14

Blood supply of the vagina.

Answer 14

The vaginal artery which arises from the internal iliac artery and sometimes from the uterine artery.

It makes an anastomosis witht the uterine artery.

Question 15

Coating of the ovary.

Answer 15

It has a fibrous outer structure called the tunica albuginea.

However the ovary is fully enclosed in parietal peritoneum (the broad ligament).

Question 16

What does the ovary contain?

Answer 16

Follicles that are stimulated by FSH to produce a primary follice and then are released as an ovum.

Question 17

Explain ovarian cysts.

Answer 17

The ovary can develop ovarian cysts which are usually derived from follicles. They can be asymptomatic but also lead to complications.

Question 18

Complications of ovarian cysts.

Answer 18

Ovarian torsion where the ovary twists on its axis.

Rupture of ovary or accompanied blood vessels.

Question 19

What is polycystic ovary syndrome?

Answer 19

A condition where more than 10 cysts are found in a single ovary.

Question 20

Changes to the body (pathophysiology) of PCOS.

Answer 20

Unclear and seems to be multifactorial but there are some associations to it:

Excess androgens

Insulin resistance where there is loss of sensitivity to insulin causing hyperinsulinaemia in women with PCOS. Can cause weight gain.

Raised LH levels due to increased production from the anterior pituitary.

Raised oestrogen levels in some women which may lead to a hyperplastic endometrium.

Question 21

Symptoms of PCOS.

Answer 21

Oligomenorrhoea

Infertility

Acne

Hirsutism

Alopecia

Obesity or difficulty losing weight

Mood swings, depression, anxiety

Sleep apnoea

Question 22

Where are tumours of the genital reproduction system found?

Answer 22

Usually from epithelial components or from germ cells.

Ovarian cancer

Cervical

Uterine

Vulva

Fallopian

Germ cells like teratoma.

Question 23

Parts of the uterus.

Answer 23

Fundus (upper bit)

Body

Cervix (lower bit)

Question 24

Most common place of fertilisation.

Answer 24

The ampulla of the fallopian tube.

Question 25

What microstructures of the fallopian tube are important for the ovum.

Answer 25

The ciliated cells helps the ovum to propel forward to reach the uterus.

The peg cells are secretory cells which secrete substances in order to support the ovum but also the sperm

Question 26

Is the entire female reproductive system closed off from the peritoneal cavity?

Answer 26

No.

Question 27

Which part of the female reproductive system is not closed off to the paritoneal cavity?

Answer 27

The part where the ovary meets with the fimbrae. The ovary will release the ovum into the peritoneal cavity but the fimbrae will pick it up and it will once again be in the female reproductive system closed off from the paritoneal cavity (rarely it ends up in the paritoneal cavity).

Question 28

What is the clinical significance of this small opening to the peritoneal cavity where the fimbrae and the ovaries meet?

Answer 28

This small opening can cause trouble if and fluid or bacteria retrogradely find their way up the fallopian tube. This means that any sort of bacteria or other pathogen can reach the peritoneal cavity and cause e.g. peritonitis.

Question 29

Where will the bacteria most commonly accumulate?

Answer 29

In the vesico-uterine pouch or the recto-uterine pouch.

Question 30

What is the female reproductive system all coated by?

Answer 30

A peritoneum also called the broad ligament which is a peritoneal fold that is similar to the mesentery of the abdomen.

Question 31

Important ligaments of the female reproductive system.

Answer 31

Suspensory ligament

Ovarian ligament

Round ligament

Broad ligament

Question 32

Purpose and track of the suspensory ligament.

Answer 32

Ensheaths neurovascular structure most importantly the ovarian artery and ovarian vein. Allows passage of the ovarian artery and ovarian vein to the ovary.

It also anchors the ovary to the pelvic wall.

It can be found on the superior part of the ovary ascending into the peritoneal cavity to give off the ovarian artery to the abdominal aorta and the ovarian vein to IVC (or left renal vein in case if it’s on the left side).

Question 33

Purpose and track of the ovarian ligament.

Answer 33

Found attached to the inferior part of the ovary running obliquely to attach to the uterus. It anchors the uterus to the ovary.

The precursor of this ligament is the upper gubernaculum.

Question 34

Purpose and track of the round ligament.

Answer 34

This is continuous with the ovarian ligament. As the ovarian ligament goes to attach to the uterus it will then curve around and become the round ligament. This ligament will turn laterally and go inside the deep inguinal ligament and out of the superficial inguinal ligament.

It will then attach to the lambia major and anchor the uterus to the lambia major holding it in place.

Question 35

Three subdivisions of the broad ligament and where they can be found.

Answer 35

Mesovarium surrounding the ovaries

Mesometrium between the pelvic wall and the uterus.

Mesosalpinx surrounding the falloping tubes.

Question 36

Why do some women get a sharp pain at ovulation?

Answer 36

Because of a phenomenon called mittelschmerz or to put it simply just ovulation pain.

This is due to the rupture of the peritoneum when the ovum is released. This can be painful in some women when the nerves are broken.

Question 37

What is the uterus internally comprised of?

Answer 37

Smooth muscle which is called myometrium and an epithelial layer called endometrium. This is lined with simple columnar epithelium.

Question 38

What is endometriosis?

Answer 38

A condition in which ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond.

It may be associated wit hthe ovaries or the attachments of the uterus and is often associated with severe period pain, infertility or both.

Question 39

Which zone of the cervix is particularly susceptible to cervical cancer and why?

Answer 39

The transformation zone where the simple columnar epithelial of the cervical canal then becomes stratified squamous on the outside.

Such zone where there is a transition of the type of epithelium are zones which are susceptible to malignancy.

This is also the zone where HPV usually collects.

Question 40

What are the two holes of the cervix?

Answer 40

The internal os between the opening of the uterus to the cervix.

And the external os between the opening of the cervix to the vaginal canal. The zone close to the external os is the transitional zone.

Question 41

What is the main purpose of the simple columnar epithelium of the cervix?

Answer 41

To produce mucus which changes in consistency and pH depening on the menstrual cycle to help facilitate or prevent entry of sperm.

Question 42

What kind of substance does the bacteria (lactobacilli) in the vagina utilise?

Answer 42

Glycogen in order to form lactic acid to keep the vagina acidic.

Question 43

What are the anterior and posterior fornices of the cervix?

Answer 43

Invaginations found between the vagina and the beginning of the cervix.

Sperm can collect there.

Also palpating the anterior fornix can make you feel the uterus.