Anatomy of Reproductive system by Bitew

06/26/13 bitewm@gmail.com 1
Anatomy of Reproductive
System
Systemic Anatomy
By
Bitew M(Msc student)
Arbaminch University
College of Medicine and Health Science

Human Life Cycle
Figure 16.4

OBJECTIVES
When you have completed this section, you
should be able to
• name male RS organs
• describe the structure of the testes;
• trace the male reproductive tract and
describe the gross anatomy and histology
of each organ;
• describe the blood supply to the male
reproductive tract;
• Describe accessory glands.06/26/13 bitewm@gmail.com 4

• Reproduction is one of the fundamental
properties of all living things.

Part-I:Anatomy ofPart-I:Anatomy of
Male ReproductiveMale Reproductive
SystemSystem

Part-I:Male Reproductive System
In conjunction with the female
reproductive system, ensures the
survival and propagation of the species.
Consists of organs whose functions are
to produce, transfer, and ultimately
introduce sperm into the female
reproductive tract.
Secretes male sex hormones
(androgens).

Reproductive System
• Reproductive system functions in
gamete
–Production
–Storage
–Nourishment
–Transport
• Fertilization
–Fusion of male and female gametes to
form a zygote

Male Reproductive System
• Pathway of spermatozoa
– Epididymis
– Ductus deferens (Vas deferens)
– Ejaculatory duct
• Accessory organs
– Seminal vesicles
– Prostate gland
– Bulbourethral glands
– Scrotal sac encloses testes
– Penis

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Male PelvisMale Pelvis

What is Perineum?What is Perineum?
 Diamond-shaped area between the thighs that is
circumscribed anteriorly by the pubic symphysis,
laterally by the ischial tuberosities, and posteriorly by
the coccyx.
 2 distinct triangle bases
 formed by an imaginary horizontal line extending between
the ischial tuberosities of the ossa coxae.
A.Anterior triangle, or urogenital triangle
 contains the urethral and vaginal orifices in females
 contains the base of the penis and the scrotum in males.
A.Posterior triangle, or anal triangle
 location of the anus in both sexes.

Boundaries of the perineum
 Pubic symphysis- anteriorly
Inferior pubic rami and ischial rami-
anterolaterally
Ischial tuberosities- laterally
Sacrotuberous ligaments-
posterolaterally
Inferiormost sacrum and coccyx-
posteriorly

Anatomy of Male Reproductive System
• Testes-male gonads
• Series of ducts
– Epididymides
– Ductus deferenS
– Ejaculatory duct
– Urethra
• What are Accessory
glands?
– Seminal vesicles
– Prostate gland
– Bulbourethral
{cowpers} glands
• Supporting structures
– Scrotum
• 2 chambered sac that
contains testes
• Dartos and cremaster
muscles help regulate
temperature.
– Penis
• Perineum
– Diamond-shaped
areas between thighs

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Male Reproductive Structures

• Spermatic cord=Vasdeferens+Blood
vessels(testicular artery and vein)
+nerve(testicular verve).

Figure 28.1 The Male
Reproductive System
Figure 28.1

Male reproductive organs
• Are classified
as:
A.Essential Organs:
 Gonads, produce
gametes/sex cells
(sperm).
A.Accessory Organs:
genital ducts,
glands, and
supporting
structures

Testes
• Glands
– Exocrine
– Endocrine
• Compartments divided
by septa.
• Seminiferous
tubules-produce
sperm.
• Empty into rete testis
• Empties into efferent
ductules
• Interstitial or Leydig cells
• Descent
– Pass from
abdominal cavity
through inguinal
canal to scrotum
• Cryptorchidism
– Failure of of one or
both of testes to
descend into
scrotum
– Prevents normal
sperm development

Male Gonads >> Testes
Small, flattened, oval shaped
glands.
Size=4-5 cm long, wgt
about10-15 grams,2.5cm in
diameter.
 Left testis hangs about 1cm lower
in scrotal sac than the right this is
important …………..
 Suspended in scrotum.
 2 main functions:
- spermatogenesis
- secretion of
hormones{androgens}

 Consist of many
lobules (250-300 in
each testis)
 Each lobule contains:
Seminiferous
Tubules for
spermatogenesis
Interstitial cells of
Leydig that secrete
testosterone

₫ Sperm produced in
the testes leave via
the tubulus rectus
that conveys them
to a network of
tubules on one side
of each testis called
the rete testis.
₫ From here the
sperm are carried
via efferent ducts to
the epididymis.

 The testes are each
surrounded by two
protective coats (or
tunics):
Tunica VaginalisTunica Vaginalis (outer
Layer) extension of
peritoneum
Tunica AlbugineaTunica Albuginea
(Inner Layer) extends
between each of the
lobules

Scrotum
• This literally means "pouch" or "sac"
• It is a pouch of skin that is incompletely
divided into left and right halves.
• Each half houses one testis.
• The appearance of the scrotum changes with
temperature.
– Eg. Cold (or sexual arousal) it appears shorter and
quite wrinkled, because it is pulled closer to the
body for warmth.
– Eg. Heat, the skin is flaccid (loose) and the testes
hang lower in the scrotum to keep them cool.
• Raphe: external midline seam
– Continues on inferior surface of the penis, and toContinues on inferior surface of the penis, and to
anus.anus.

The movement of the scrotum and
testes helps to maintain intra scrotal
and hence testicular temperature
constant .
Movement of the scrotum is
achieved by two groups of muscles:
Dartos Muscle which is a smooth
muscle and causes shrinking of the
scrotum
Cremaster Muscle which is skeletal
muscle and it elevates the testes. It is
attached to the internal oblique muscle
of the trunk.

Scrotum
• Wall comprised of smooth muscle – the
Dartos
• Cremaster m. (skeletal m.) attached to
dermis
• Temperature control of testes
• Sperm development occurs at 35°
• Sperm will not develop at body
temperature.

Sperm

Structure of Sperm
• Sperm cells consist of:
1. Head – containing the nucleus (male
DNA)
2. Middle piece and neck – contains
large spiral mitochondrion
3. Tail – corkscrew motion to propel
sperm
 Acrosome – membrane bound bag of
enzymes covering head.

Structure of a Sperm
Figure 16.5b

Structure of Sperm

Epididymis
• Highly folded duct
approx 6m long, for the
passage of sperm from
the testis to the vas
deferens.
• It has 3 divisions:
– Head: connected to the
testes receiving immature
sperm
– Body
– Tail: continuous with the
vas deferens, contains
smooth muscle and
during ejaculation,
contractions of the
smooth muscle expel
mature sperm into the
vas deferens.
Epididymis is
shaped like a
comma

• Sperm may be stored in the epididymis
from 18 hrs - 20 days.
• During this time the sperm mature,
including becoming motile, so they can
fertilize an ovum.

Figure 28.9 The Epididymus
Figure 28.9

Vas deferens
• Short, fairly straight tube approx 45
cm long.
• Ascends from the scrotum into the
abdomen and passes over the
bladder.
– Tube cut in vasectomy
• doesn’t effect erection or performance
• Vas deferens stores the sperm.
– sperm are mature & motile
– the local accumulation of CO2 from
the normal metabolism of the sperm
causes the pH to become acidic.
• under these conditions sperm lose
their motility
– on ejaculation, the alkaline seminal
fluid will counteract the low pH and
the sperm will become motile again.

Seminal Vesicles
• 2 glands behind
prostate gland, size
& shape of finger,
• secretes viscous
fluid = 60-70% of
seminal fluid (nourish
& energize sperm)
• Also secrete
fructose, citric acid,
amino acids and
Prostaglandins.

Ejaculatory ducts
• Short tubes that
descend through the
prostate gland and
terminate in the
urethra.
• Formed by the union
of the vas deferens
and seminal vesicle
ducts

Prostate gland
– Chestnut-sized gland below
bladder.
– Surrounds the ejaculatory duct
and part of the urethra.
– Secretes a thin liquid that is
milky, alkaline and constitutes
30% of the seminal fluid volume
– Responsible for raising the pH
of the female vagina.
– Provides lubrication during
coitus Cowper’s Glands
– below prostate, 2 pea-sized
glands connect to urethra by
ducts;
– secrete thick, clear mucus
before ejaculation (at tip of
penis)
– alkaline to protect sperm from
acidic vagina.
– Fluid has sperm! (Sperm in
urethra > PREGNANT!!)

Hypertrophy of the Prostate
• The prostate is of considerable medical interest
because enlargement or benign hypertrophy of
the prostate (BHP), is common after middle age,
affecting virtually every male who lives long
enough
• An enlarged prostate projects into the urinary
bladder and impedes urination by distorting the
prostatic urethra
• The middle lobe usually enlarges the most and
obstructs the internal urethral orifice; the more
the person strains, the more the valve-like
prostatic mass occludes the urethra

Hypertrophy of the Prostate
• BHP is a common cause of urethral
obstruction,leading to nocturia (need to void
during the night), dysuria (difficulty and/or
pain during urination), and urgency (sudden
desire to void)
• BHP also increases the risk of bladder
infections (cystitis) as well as kidney
damage

Urethra
• Tube 18-20 cm long.
• Conveys urine and
sperm (at different
times).
– Three regions of urethra
– Contains glands which
secrete mucus to aid
lubrication during
intercourse.

Urethral Catheterization
• Is done to remove urine from a person who
is unable to micturate
• It is also performed to irrigate the bladder
and to obtain an uncontaminated sample of
urine
• When inserting catheters , the curves of the
male urethra must be considered

PenisPenis
The penis is the male copulatory organ and,
by conveying the urethra, provides the
common outlet for urine and semen.
The penis consists of a root, body, and
glans.
It is composed of three cylindrical bodies of
erectile cavernous tissue: the paired
corpora cavernosa dorsally and single
corpus spongiosum ventrally.

Penis
• Note that in the anatomical position, the
penis is erect; when the penis is flaccid,
its dorsum is directed anteriorly

Penis
• Copulatory organ of the external genitalia.
• Contains 3 compartments of erectile tissue which are covered by
a loose layer of skin.
• Two "corpora cavernosa"
• One "corpus spongiosum" which lies ventrally in the penis and houses the
spongy urethra. Expands at the end of the penis into the "glans penis".
• When aroused, inc. blood into penis, these compartments fill and expand
– Leads to erect penis – compression of vessels prevents blood flow out.

Penis
• Erectile tissue is sponge-like containing venous
sinuses surrounded by arteries and veins.
• Upon sexual stimulation, the arteries dilate and the
spaces (or caverns) fill with blood. As they fill, the
erectile tissue becomes rigid and the penis
becomes erect.
• Two main functions of the penis:
– Removal of urine via the urethra
– Receipt and ejection of sperm and seminal fluid during
copulation, again via the urethra.

Penis

A penis, with foreskin retracted

Penis-external portion is
about 8 to 10 cm8 to 10 cm (3–4 in.)
long and 3 cm in diameter
when flaccid (nonerect);
the typical dimensions of an
erect penis are 13 to 18 cm13 to 18 cm
(5–7 in.) long and 4 cm in
diameter.

Arterial Supply of the Penis
• The deep arteries of the penis are the
main vessels supplying the cavernous
spaces in the erectile tissue of the corpora
cavernosa and are, therefore, involved in
the erection of the penis
• They give off numerous branches that
open directly into the cavernous spaces
• When the penis is flaccid, these arteries
are coiled, restricting blood flow; they are
called hel-icinehel-icine arteries of the penis
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Circumcision
• The prepuce of the penis is usually sufficiently
elastic for it to be retracted over the glans
penis
• In some males, it fits tightly over the glans
and cannot be retracted easily
• As there are modified sebaceous glands in
the prepuce, the oily secretions from them
accumulate in the preputial sac, located
between the glans and prepuce, causing
irritation.

Circumcision
 Circumcision, surgical excision of theCircumcision, surgical excision of the
prepuceprepuce,is the most commonly performed
minor surgical operation on male infants
Although it is a religious practice in
Judaism and Islam, it is often done
routinely for non-religious reasons (a
preference usually explained in terms of
tradition or hygiene) in North America

Circumcision
• In uncircumcised males there is a structure that
covers the end of the glans penis called the
"prepuce or foreskin".
– Its proposed functions include protection, lubrication
of glans, part of sexual pleasure system.
uncircumcised circumcised

Ducts
• Epididymis
– Site of sperm cell
maturation
• Ductus deferens or
vas deferens
– Passes from
epididymis into
abdominal cavity
• Ejaculatory duct
– Joining of ductus
deferens and
seminal vesicle
• Urethra
– Extends from urinary
bladder to distal end
of penis
– Passageway for
urine and male
reproductive fluids
– 3 parts
• Prostatic urethra
• Membranous urethra
• Spongy or penile
urethra

The Ejaculate
• Ejaculate volume is about 3 ml and ranges
from 2 to 6 ml.
• pH is 7.5, slightly basic to neutralize the acidity
of the urethra and the vagina
• Of the 3 ml of an ejaculate
– About 0.2 ml, originates from the Cowper's gland
– About 0.5 ml from the prostate gland
– about 2 ml is secreted from the seminal vesicles

Tab.1 Reference values for semen analysis

Review: Journey of the Sperm

interstitial
cells-
testosterone

sperm
production
in the
seminferous
tubules

sperm
storage
in the
epididymis

transport
in the
vas
deferens

ampulla -
storage

fluid from
the
seminal
vessicles
ejaculatory
duct

fluid from
the
prostate
gland

cowper’s
gland

06/26/13 bitewm@gmail.com 100ejaculatio
Spinal reflex
triggers nerve
impulses to
ducts, glands,
muscles of
reproductive
system.

Part-II Anatomy
Of Female
Reproductive
System

Objectives
 When you have completed this section, you should
be able to
• describe the structure of the ovary;
• trace the female reproductive tract and describe the
gross anatomy and histology of each organ;
• identify the ligaments that support the female
reproductive organs;
• describe the blood supply to the female reproductive
tract;
• identify the external genitals of the female; and
• describe the structure of the nonlactating breast.

Female Reproductive System
• In conjunction with the male reproductive
system, ensures the survival and
propagation of the species.
• Female reproductive system also provides
protection and nutrition to the developing
offspring.
• Secretes female sex hormones (estrogens)

Female Reproductive Organs

Anatomy of Female
Reproductive System
• Female reproductive organs
– Ovaries
– Uterine tubes
– Uterus
– Vagina
– External genital organs
– Mammary glands

Female Internal GenitalFemale Internal Genital
OrgansOrgans
•The female internal
genital organs include
the vagina, uterus,
uterine tubes, and
ovaries

Female reproductive organs…
• Are classified as:
• Essential Organs:
- Gonads, produce
gametes/sex cells (ova)
• (Testes in men, Ovaries in
women.)
• Accessory Organs:
- uterine tubes, uterus,
vagina, vulva, and mammary
glands

Female Gonads >> Ovaries
. Its capsule, like that of the testis, is called the tunica
albuginea.
• are almond-shaped organ nestled in the
ovarian fossa, a depression in the dorsal
pelvic wall.
• Produce the female gametes (ova).
• Secrete female hormones estrogen and
progesterone.
• Each one located on one side of the uterus
(about 3 gms)
• measures about 3 cm long, 1.5 cm wide,
and 1 cm thick

• The interior of the ovary is indistinctly
divided into;
a)Cortex- an outer, where the germ cells
develop, and
b)medulla -a central; occupied by the major
arteries and veins .
The ovary lacks ducts comparable to the
seminiferous tubules.
each egg develops in its own fluidfilled,
bubble like follicle and is released by
ovulation.

• held in place by several connective tissue
ligaments .
 its medial pole is attached to the uterus by the
ovarian ligament and
its lateral pole is attached to the pelvic wall by
the suspensory ligament.
A sheet of peritoneum called the broad
ligament flanks the uterus on each side and
encloses the uterine tube in its superior margin.
The margin of the ovary is anchored to the
broad ligament by a peritoneal fold called the
mesovarium.

Female
Reproductive
System
Ovaries
• The female gonads or sex glands
• 2 almond sized glands, either side
of uterus
• They develop & expel 1 ovum/mth
• A woman is born with about
400,000 immature eggs called
follicles
• During a lifetime a woman
releases about 400 to 500 fully
matured eggs for fertilization
• The follicles in the ovaries
produce the female sex
hormones, progesterone and
estrogen
• These hormones prepare the
uterus for implantation of the
fertilized egg

Ovaries
• Each ovary is held in place by 3 ligaments:
– Broad ligament: suspends ovaries between the uterus & pelvic wall
– Ovarian ligament: attaches ovaries to the uterus
– Suspensory ligament: attaches ovaries to the pelvic wall

• These ligaments work with the Round and
Uterosacral ligaments to suspend female
reproductive system in the lower abdomen
• Significantly different from males where all
structures hang

Ovaries
• Each ovary is covered by 3 layers of epithelial cells –
each with different functions:
– Nurture developing follicles, secrete hormones, blood
vessels and muscles.

supplied with;
 an ovarian artery,
ovarian veins, and
ovarian nerves,
These all travel through the
suspensory ligament.
It receives an additional blood supply
from the ovarian branches of the uterine
arteries.

Uterine tubes
• At ovulation, a current draws the oocyte into
the fallopian tube.
– Finger-like projections called fimbriae
• Infundibulum:
– funnel-like structure
• Narrows into the ampulla
• Constricts further into isthmus as it enters
uterus

Uterine Tubes
• Also called “Fallopian” tubes or oviducts.
• Extensions of the uterus that “loosely” communicate with the
ovaries.
• Ovum carried through Fallopian tubes to uterus via cilia (tiny
hair-like projections).
• Fertilization occurs here.
• is a canal about 10 cm long from the ovary to the uterus.
• At the distal (ovarian) end, it flares into a trumpetshaped
infundibulum with feathery projections called
fimbriae(FIM-bree-ee);
• the middle part of the tube is the ampulla; and
• near the uterus it forms a narrower isthmus.
• The uterine tube is enclosed in the mesosalpinx, which is
the superior margin of the broad ligament.

• The wall of the uterine tube is well
endowed with smooth muscle.
• Its mucosa is extremely folded and
convoluted and has an epithelium of
ciliated cells and a smaller number of
secretory cells .
• The cilia beat toward the uterus and,
with the help of muscular contractions of
the tube, convey the egg in that
direction.

Ligation of the Uterine Tubes
• Ligation of the uterine tubes is a surgical
method of birth control
• Oocytes discharged from the ovaries that
enter the tubes of these patients degenerate
and are soon absorbed
• Most surgical sterilizations are done by tubal
ligation
• Abdominal tubal ligation is usually performed
through a short suprapubic incision made at
the pubic hairline

Uterine tubes
• Tubal ligation, commonly knows as "getting your
tubes tied," is a surgical sterilization technique for
women.
• This procedure closes the fallopian tubes, and
stops the egg from traveling to the uterus from
the ovary.
• It also prevents sperm from reaching the fallopian
tube to fertilize an egg.
• In a tubal ligation, fallopian tubes are cut, burned,
or blocked with rings, bands or clips.
• The surgery is effective immediately.
– Over 98% effective as birth control.
– They do not protect against reproductive tract
infections, including HIV/AIDS.

Ectopic Tubal Pregnancy
In some women, collections of pus may develop in
the uterine tube and the tube may be partly occluded
by adhesions
 In these cases, the blastocyst may not be able to
pass along the tube to the uterus, although sperms
have obviously done so
The blastocyst may implant in the mucosa of the
uterine tube, producing an ectopic tubal pregnancy
Although implantation may occur in any part of the
tube, the common site is in the ampulla

Ectopic pregnancy
Tubal pregnancy is the most common type of
ectopic gestation; it occurs in approximately 1 of
every 250 pregnancies in North America
If not diagnosed early, ectopic tubal pregnancies
may result in rupture of the uterine tube and severe
hemorrhage into the abdominopelvic cavity during
the first 8 weeks of gestation
Tubal rupture and the associated hemorrhage
constitute a threat to the mother's life and result in
death of the embryo

The Uterus
• The uterus is a thick muscular
chamber that opens into the roof of the
vagina and usually tilts forward over the
urinary bladder.
• function is to harbor the fetus, provide a
source of nutrition, and expel the fetus
at the end of its development.

Uterus
• Hollow, thick-walled organ – womb
• Receives, retains and nourishes the
fertilized egg
• Before first pregnancy it is the size and
shape of a pear
– after first child remains a bit larger

Uterus consists of:Uterus consists of:
a)a) IsthmusIsthmus - slightly narrower region between the body and cervix- slightly narrower region between the body and cervix
b)b) FundusFundus - rounded region superior to entrance of fallopian tubes- rounded region superior to entrance of fallopian tubes
c)c) BodyBody - major hollow part of the uterus- major hollow part of the uterus
d)d) CervixCervix - neck or narrow outlet of the uterus: projects into the vagina- neck or narrow outlet of the uterus: projects into the vagina

Wall of the Uterus
• The uterine wall is highly muscular and consists of
3 layers:
– Perimetrium - outermost layer (think of perimeter)
– Myometrium - thick smooth muscle layer, contracts in
childbirth
– Endometrium - mucosal lining, site of implantation for
embryo
• The endometrium receives a rich blood supply
from a complex network in the myometrium so
that it can respond to hormonal changes in the
blood
– Eg. Pregnancy, stages of menstrual cycle

d ligament helps keep the uterus and fallopian tubes in place.

Cervix
• The cervix connects the uterus to the vagina
• The cervical opening to the vagina is small
– This acts as a safety precaution against foreign
bodies entering the uterus
• During childbirth, the cervix dilates to
accommodate the passage of the fetus
• This dilation is a sign that labor has begun

The Uterus
• In a woman who has
never been pregnant
is pear-shaped, 3
inches long, 2 inches
wide and about an
inch thick.
• main parts: the
body ,cervix,isthmus,
fundus.

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Reproductive System

A. Fundus= a broad superior curvature.
B. body (corpus)=a midportion.
C. Isthmus=constricted portion
D. cervixa= cylindrical inferior end.
 The uterus measures about 7 cm from
cervix to fundus, 4 cm wide at its
broadest point, and 2.5 cm thick, but it is
somewhat larger in women who have
been pregnant.

lumen of the uterus is roughly
triangular, with its two upper corners
opening into the uterine tubes.
It communicates with the vagina by
way of a narrow passage through the
cervix called the cervical canal.
The superior opening of cervical
canal into the body of the uterus is
the internal os(oss) and its opening
into the vagina is the external os.

The canal contains cervical
glands that secrete mucus,
thought to prevent the spread of
microorganisms from the
vagina into the uterus.
Near the time of ovulation, the
mucus becomes thinner than
usual and allows easier
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Uterine Wall
• The uterine wall consists
of;
a)Perimetrium- an external serosa
b)Myometrium- a middle muscular layer
c)Endometrium- an inner mucosa

The myometrium
• constitutes most of the wall; it is about 1.25 cm
thick in the non pregnant uterus.
• composed of bundles of smooth muscle running in
all directions, but it is less muscular and more
fibrous near the cervix; the cervix itself is almost
entirely collagenous.
• The smooth muscle cells of the myometrium are
about 40um long immediately after menstruation,
but they are twice this long at the middle of the
menstrual cycle and 10 times as long in pregnancy.
• ThThe function of the myometrium is to produce the labore function of the myometrium is to produce the labor
contractions that help to expel the fetus.contractions that help to expel the fetus.

The endometrium
Ổ is the mucosa.
Ổ has a simple columnar epithelium, compound tubular
glands, and a stroma populated by leukocytes,
macrophages, and other cells .
Ổ site of attachment of the embryo
Ổ forms the maternal part of the placenta
Ổ Has layers;
a) stratum functionalis
 superficial half to two-thirds of it
 shed in each menstrual period.
a) stratum basalis - deeper layer
 stays behind and regenerates a new functionalis in the next
cycle.

Uterus, Vagina, Uterine Tubes, Ovaries and
Supporting Ligaments

Functions of the Uterus
Passage for sperm to ascend
to the uterine (fallopian)
tubes.
If no conception or
implantation, menstruation.
Site of implantation for
szygote.
Creates labor “contractions”.

Normal and abnormal
positions of the uterus.

• Blood Supply= A uterine artery arises
from each internal iliac artery.
Ligaments
• The uterus is supported by;
 the muscular floor of the pelvic outlet
and
folds of peritoneum that form supportive
ligaments around the organ.
as they do for the ovary and uterine tube.

A. The broad ligament has two parts: the
mesosalpinx and the mesometrium on
each side of the uterus.
B. The cervix and superior part of the vagina
are supported by cardinal (lateral
cervical) ligaments extending to the pelvic
wall.
C. A pair of uterosacral ligaments attach
the dorsal side of the uterus to the sacrum.

 a pair of round ligaments attach the ventral
surface of the uterus to the abdominal wall.
• The round ligaments continue through the
inguinal canals and terminate in the labia majora,
much like the gubernaculum of the male
terminating in the scrotum.
• As the peritoneum folds around the various pelvic organs,
it creates several dead-end recesses and pouches.
 Two major ones are the vesicouterine
pouch, which forms the space between
the uterus and urinary bladder, and
rectouterine pouch between the uterus and
rectum.

Uterine cavity
The uterine cavity (in particular, the cervical
canal) and the lumen of the vagina together
constitute the birth canal through which the
fetus passes at the end of gestation. i.e.
• birth canal = cervical canal + lumen ofbirth canal = cervical canal + lumen of
vaginavagina

The Vagina
The vagina is a muscular tube that extends
upward and backward from the vulva to the
uterus
It measures about 8-10 cm long and has anterior
and posterior walls, which are normally in
apposition
At its upper end, the anterior wall is pierced by
the cervix, which projects downward and
backward into the vagina
The upper half of the vagina lies above the pelvic
floor and the lower half lies within the perineum

Vagina
• Thin-walled, fibromuscular tube, 8-10 cm long.
• Lies between the bladder and rectum.
• Extends from cervix of uterus to exterior of body.
• Birth canal (and passage for menses).
• Female copulatory organ.
• Vaginal mucosa has NO glands.
– With the help of two Bartholin’s glands (outside
vagina) becomes lubricated during Sexual
intercourse.

Vagina
• Fornix at proximal end (meets cervix of uterus)
there is a fold - this is a potential site for
infection in the female reproductive tract.

The Vagina
The area of the vaginal lumen, which
surrounds the cervix, is divided into four
regions, or fornices: anterior, posterior, right
lateral, and left lateral
The vaginal orifice in a virgin possesses a
thin mucosal fold called the hymenhymen, which is
perforated at its center
After childbirth/sexual intercourse the hymen
usually consists only of tags.

The Vagina
• Hymen –is found in those
who didn’t have the first
sex in their life time
(virgins) ;at distal end
(external opening) there
may be an extension of
the mucosa partly or
completely covering the
vaginal orifice
– highly vascular and often
bleeds after first sexual
intercourse as it is ruptured

Vagina
• Tubular organ in front of rectum and behind
the bladder & urethra.
• During sexual intercourse, the lining
lubricates and stimulates the glans penis
triggering ejaculation.
• Serves as a receptacle for semen.
• Lower portion of birth canal.
• Transports blood and tissues during
menstruation.
birth canal, is a tube about 8 to 10 cm long that
allows for the discharge of menstrual fluid, receipt of
the penis and semen, and birth of a baby.

The vaginal wall
• It is thin but very distensible. The vagina can be
markedly distended, particularly in the region of the
posterior part of the fornix
• It consists of an outer adventitia, a middle
muscularis, and an inner mucosa. The vagina tilts
dorsally between the urethra and rectum; the
urethra is embedded in its anterior wall.
• The vagina has no glands, but it is lubricated by the
transudation (“vaginal sweating”) of serous fluid
through its walls and by mucus from the cervical
glands above it. The vagina extends slightly beyond the
cervix and forms blind-ended spaces called
fornices(singular, fornix).

• At its lower end, the vaginal mucosa folds
inward and forms a membrane, the
hymen, which stretches across the
orifice.
• The hymen has one or more openings to
allow menstrual fluid to pass through, but it
usually must be ruptured to allow for
intercourse.
• The lower end of the vagina also has
transverse friction ridges, or vaginal
rugae, which stimulate the penis and
help induce ejaculation.

• The vaginal epithelium is simpleThe vaginal epithelium is simple
cuboidalcuboidal in childhood, but the
estrogensestrogens of puberty stimulate it
to transform into a stratified
squamous epithelium. This is
an example of metaplasiametaplasia, the
transformation of one tissue
type to another

• The epithelial cells are rich in glycogen.
• Bacteria ferment this to lactic acidlactic acid, which
produces a low vaginal pH (about 3.5–4.0)
that inhibits the growth of pathogens.
• This acidity is neutralized by the semen so
it does not harm the sperm.
• The mucosa also has antigen-presentingantigen-presenting
cells called dendritic cells, which are a
route by which HIV from infected semen
invades the female body.

The Vagina
Serves as a canal for menstrual fluid
Forms the inferior part of the birth canal
Receives the penis and ejaculate during
sexual intercourse

The Vagina
4 muscles compress the vagina and act as
sphincters
a. pubovaginalis,
b. external urethral sphincter,
c. urethrovaginal sphincter, and
d. bulbospongiosus

Digital Examination through theDigital Examination through the
VaginaVagina
• Because of its relatively thin, distensible
walls and central location within the pelvis,
the cervix, ischial spines, and sacral
promontory can be palpated with the digits
in the vagina and/or rectum (manual pelvic
examination)
• Pulsations of the uterine arteries may also
be felt through the lateral parts of the
fornix, as may irregularities of the ovaries,
such as cysts

Vaginal Fistulae
 Because of the close relationship of the
vagina to adjacent pelvic organs, obstetrical
trauma during long and difficult labor may
result in weaknesses, ecrosis, or tears in
the vaginal wall and sometimes beyond
These may form or subsequently develop
into open communications (fistulas)
between the vaginal lumen and that of the
adjacent bladder, urethra, rectum, or
perineum

Vaginal Fistulae
• Urine enters the vagina from both
vesicovaginal and urethrovaginal fistulas;
but the flow is continuous from the former
and occurs only during micturition from the
latter
• Fecal matter may be discharged from the
vagina when there is a rectovaginal fistula

Female Perineum
• The female perineum includes the female
external genitalia, perineal muscles, and
anal canal

The Female External Genitalia
• Include the mons pubis and labia majora , labia
minora , clitoris, bulbs of the vestibule, and
greater and lesser vestibular glands.
• The synonymous terms vulva includes all these
parts.
• The vulva serves:
As sensory and erectile tissue for sexual arousal
and intercourse
To direct the flow of urine
To prevent entry of foreign material into the
urogenital tract
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183

The Vulva (Pudendum)
The external genitalia of the
female are collectively called the
vulva (pudendum).
this includes the mons pubis, labia
majora and minora, clitoris, vaginal orifice,
and accessory glands and erectile tissues.
It occupies most of the perineum.

Mons Pubis
 Is the rounded, fatty eminence anterior to the pubic
symphysis, pubic tubercles, and superior pubic rami. The
mons pubis consists mainly of a mound of adipose
tissue overlying the pubic symphysis.
 The eminence is formed by a mass of fatty subcutaneous
tissue
 The amount of fat increases at puberty and decreases after
menopause
 The surface of the mons is continuous with the anterior
abdominal wall
 After puberty, the mons pubis is covered with coarse pubic
hairs.
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186

Labia Majora
The labia majora are prominent folds of skin
that provide protection for the urethral and
vaginal orifices
Each labium majus largely filled with a finger-
like digital process of loose subcutaneous
tissue containing smooth muscle and the
termination of the round ligament of the
uterus passes infero-posteriorly from the
mons pubis toward the anus

• The labia majora (singular, labium
majus) are a pair of thick folds of skin
and adipose tissue inferior to the mons;
the slit between them is the pudendal cleft.
• Pubic hair grows on the mons pubis and
lateral surfaces of the labia majora at
puberty, but the medial surfaces of the
labia remain hairless.

Labia Majora
 The labia majora lie on the sides of a
central depression (a narrow slit when
the thighs are adducted), the pudendal
cleft, within which are the labia minora
and vestibule

Labia Majora
 The external aspects of the labia majora in
the adult are covered with pigmented skin
containing many sebaceous glands and are
covered with crisp pubic hair
 The internal aspects of the labia are
smooth, pink, and hairless
The labia are thicker anteriorly where they
join to form the anterioranterior commissurecommissure

Labia Majora
 Posteriorly, in nulliparous women
(never having borne children) they
merge to form a ridge, the posteriorthe posterior
commissurecommissure, which overlies the
perineal body and is the posterior limit
of the vulva
This commissure usuallyThis commissure usually
disappears after the first vaginaldisappears after the first vaginal
birthbirth

Labia Minora
 Are rounded folds of fat-free, hairless skin
Are enclosed in the pudendal cleft and immediately
surround the vestibule into which both the external
urethral and the vaginal orifices open
Have a core of spongy connective tissue
containing erectile tissue at their base and many
small blood vessels
 Anteriorly, the labia minora form two lamina
The medial laminae of each side unite as the
frenulum of the clitoris

Labia Minora
 The lateral laminae unite anterior to the glans of the
clitoris, forming the prepuce (foreskin) of the clitoris
 In young women, especially virgins, the labiaIn young women, especially virgins, the labia
minora are connected posteriorly by a smallminora are connected posteriorly by a small
transverse fold, the frenulum of the labia minoratransverse fold, the frenulum of the labia minora
(fourchette)(fourchette)
 Although the internal surface of each labium minus
consists of thin moist skin, it has the pink color
typical of mucous membrane and contains many
sebaceous glands and sensory nerve endings

Clitoris
 Is an erectile organ located where the
labia minora meet anteriorly
The clitoris consists of a root and a body,
which are composed of two crura; two
corpora cavernosa; and the glans of the
clitoris, which is covered by a prepuce
Together, the body and glans of the clitoris
are approximately 2 cm in length and < 1
cm in diameter

• The clitoris is highly sensitive and
enlarges on tactile stimulation
The glans of the clitoris is the most highly
innervated part of the clitoris and is
densely supplied with sensory endings

• Medial to the labia majora are the much
thinner, entirely hairless labia minora
(singular, labium minus).
• The area enclosed by them, called the
vestibule, contains the urinary and
vaginal orifices.
• At the anterior margin of the vestibule,
the labia minora meet and form a
hoodlike prepuce over the clitoris.
• The clitoris is structured much like a
miniature penis but has no urinary
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• Its function is entirely sensory, serving as
the primary center of erotic stimulation.
• Unlike the penis, it is almost entirely
internal, it has no corpus spongiosum,
and it does not enclose the urethra.
• Essentially, it is a pair of corpora
cavernosa enclosed in connective tissue.
• Its glans protrudes slightly from the
prepuce.
• The body (corpus) passes internally,
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• Like the penis, the clitoris is supplied by
the interna pudendal arteries, also called
the clitoral arteries in the female.
• Just deep to the labia majora, a pair of
subcutaneous erectile tissues called the
vestibular bulbs bracket the vagina like
parentheses.
• They become congested with blood
during sexual excitement and cause the
vagina to tight somewhat around the
penis, enhancing sexual stimulation.

• On each side of the vagina is a pea-sized
greater vestibular (Bartholin) gland with
a short duct opening into the vestibule or
lower vagina .
• These glands are homologous to the
bulbourethral glands of the male.
• They keep the vulva moist, and during
sexual excitement they provide most of the
lubrication for intercourse.
• The vestibule is also lubricated by a
number of lesser vestibular glands.

• A pair of mucous paraurethral
(Skene) glands, homologous to the
male prostate, open into the vestibule
near the external urethral orifice.
• External Genitalia, collectively called the
Vulva:
• Mons Pubis
– fatty, rounded area over the pubic area
– During adolescence sex hormones trigger the
growth of pubic hair on the mons pubis

vestibule
• The size and appearance of the vaginal
orifice vary with the condition of the
hymen, a thin anular fold of mucous
membrane immediately within the
vaginal orifice surrounding the lumen
• After its rupture, only remnants of the
hymen, hymenal caruncles (tags), are
visible
• These remnants demarcate the vagina
from the vestibule

• The hymen has no established physiological
function
• It is considered primarily a developmental
vestige, but its condition (and that of the
frenulum of the labia minora) often provides
critical evidence in cases of child abuse and
rape

• Labia Majora
• 2 fatty skin folds that are
homologous with the male
scrotum
• “Outer lips” – darker
pigmentation
• Protective covering
• Are covered with hair and
sebaceous glands
• Become flaccid with age
and after childbirth
• Swell during intercourse

• Labia Minora
• “Inner lips”
• smaller folds covered with
mucosa and richly supplied
with sebaceous glands
• Made up of erectile,
connective tissue that
darkens and swells during
sexual arousal
• Located inside the labia
majora
• They are more sensitive and
responsive to touch than the
labia majora
• The labia minora tightens
during intercourse

• Clitoris
• Contains erectile cavernous
tissue like the penis
• Richly supplied with nerves,
and so is one of the most
sensitive areas for women
• Engorges with blood upon
sexual arousal
• Housed in a hood of tissue
(prepuce) formed by the
junction of labia minora
• Highly sensitive organ
composed of nerves, blood
vessels, and erectile tissue
• Key to sexual pleasure for
most women

• Urethra
– Opening located directly
below clitoris
– Passage of urine
• Vaginal Opening
– Opening may be covered
by a thin sheath called the
hymen
– Using the presence of an
intact hymen for
determining virginity is
erroneous
– Some women are born
without a hymen
– The hymen can be
perforated by many
different events

• Vestibular Glands
– Greater vestibular
(Bartholin's)
• 2, posterior, mucous
secreting, can plug
and make cysts,
reservoir for VD
– Lesser vestibular
(Skene's)
• 2, anterior to
opening of the
vagina, mucous
producing

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Female External Genitalia
 Vulva or pudendum or
external female genitalia
Vestibule: Space
Labia minora: Form
borders on sides
Clitoris: Erectile
structure
-Corpora cavernosa
-Corpora spongiosa
Labia majora
-Unite to form mons
pubis

Female Perineum

VULVA = External Female Genitalia

VaginismusVaginismus
An emotional (psychosomatic)
gynecological disorder
Vaginismus is encountered clinically
when pelvic examination is attempted
In mild forms, it causes dyspareunia
(painful intercourse); in severe forms, it
prevents vaginal entry and is reportedly a
cause of unconsummated marriages

Episiotomy
• During vaginal surgery and labor, an
episiotomy (surgical incision of the perineum
and inferoposterior vaginal wall) is often
made to enlarge the vaginal orifice
• It was long held that episiotomy decreases
the prevalence of excessive perineal body
attenuation and decreases trauma to the
pelvic diaphragm,preventing jagged tears of
the perineal muscles

Episiotomy
• It is generally agreed that episiotomy is
indicated when descent of the fetus is
arrested or protracted, when instrumentation
is necessary (e.g., use of obstetrical
forceps), or to expedite delivery when there
are signs of fetal distress

The Female Breast

The Female Breast
• Mammary Glands: Internal Structure
• Each mammary gland is made up or 15-25 lobesup or 15-25 lobes
that radiate around the nipple
• Each lobule is connected by lactiferous ducts that
open into the nipples (gets milk to nipple)
• Lobes contain
– Alveolar Glands produce milk during lactation
• Lobes are separated by connective tissue and fat
• There are suspensory ligaments in the
connective tissue that attach the breasts to the
pectoral muscles of the chest

The Female Breast

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Mammary Glands
• Organs of milk
production located
within mammae or
breasts
– Consist of
glandular lobes
and adipose tissue
– Cooper’s
ligaments support
the breasts.

Female Breasts
• Lie over pectoral muscles.
• Development controlled by
estrogen and progesterone.
• Breast size determined by
amount of fat surrounding
glandular tissue so function is
notnot related to size.
• Main function is lactation for
nourishment of newborn infants.
• Lactation is important for:
- nutrients
- antibodies
- bonding

Anatomy of Reproductive system by Bitew

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