c

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THE GENITAL OR REPRODUCTIVE SYSTEM Ú
  

 

  
    


 

  
  

The embryology of urinary and genital systems is closely related. This is because the
same mesoderm called the urogenital ridge gives rise to parts of urinary and genital
systems.

The Urinary and genital systems develop from intermediate mesoderm along dorsal
body wall of embryo on each side of aorta

The kidneys develop in the pelvis and migrate superiorly; gonads develop in the
abdomen and migrate inferiorly

The part of urogenital ridge that gives rise to urinary system is the nephrogenic cord.
The part that gives rise to genital system is the gonadal ridge.

The Urinary system consists of kidneys, ureters, urinary bladder and the urethra.

The development of kidneys passes through three stages:

J Pronephros
J Mesonephros
J Metanephros

The first two developmental stages have a transitory character and the definitive
kidneys develop from the metanephros stage.

The pronephros develop during the 4 th week, beginning in the cranial part of the
nephrogenic cord which atrophies during the 5 th week. They are represented by few
cell clusters in the neck region of the embryo. A pronephric duct runs c audally and
opens into the cloaca.

The pronephric duct persists and is used by the next set of developing kidneys.
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The urogenital ri ge rojects into the lumen of the coelom. With the S-shaped
mesonephric tubules the mesonephric duct (Wolffian duct) forms a transitory
precursor of the adult excretory system. The medial end of the mesonephric tubule
is closed and forms a funnel (Bowman¶s capsule) that surrounds a tuft of
capillaries (the glomerulus). The capillaries come from lateral branches of the
dorsal aorta and drain into the inferior cardinal vein.
This functional unit is also termed the excretory unit of the mesonephros.

The mesonephros is the first excretory organs. The production of urine begins in the
mesonephros during the 6 th week.

etanephroi is the primordial of the permanent kidneys which begins to develop

early in the fifth week and starts to function about weeks later. The definitive
kidneys develop from: metanephric diverticulum (ureteric bud) and metanephric
mass or (metanephric blastema). Both metanephroi are mesodermal origin.

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"! w Development of the metanephros:

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The metanephric diverticulum is an outgrowth from the mesonephric duct near its
entrance into cloaca. It is the primordium of the ureter, renal pelvis, calyces and
collecting tubules. The diverticulum penetrates the metane phrogenic mass (mass of
cells that form the nephrons.).The stalk of the diverticulum becomes the ureter and
its cranial end forms the renal pelvis. The mesonephric buds branch to form
collecting tubules .The straight collecting tubules branches repeatedly and form
successive generations of collecting tubules, the major and minor calyces.

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The end of each arched collecting tubules induces clusters of mesenchymal cells in
the metanephric mass. The clusters soon become metanephric vesicles. These
vesicles elongate to become renal tubules. These tubules become part of the renal
corpuscle. Its proximal end is invaginated by the glomeruli and constitutes a proximal
convoluted tubule loop of Henle and distal convoluted tubule has nephron .

The fetal kidneys are subdivided into lobes. The lobulation usually disappears during
infancy as nephrons increase and grow. The nephron formation is complete at term.
Functional maturation of kidneys occurs after birth.
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Ãidneys attain their adult position by ninth week. As abdomen grows, kidneys
gradually come to lie in the abdomen and move further apart. As kidneys ascend
they rotate medially almost 90 degrees .Initially kidneys receive blood supply from
branches of common iliac arteries. Later the main supply is from abdominal aorta.

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"!w Migration of the kidneys ÷#
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Urinary bladder

Initially the urinary bladder is continuous with the allantois .The allantois is situated
ventrally in to the cloaca. The cloaca is the expanded terminal part of the hind gut.

The cloaca is divided into dorsal rectum and ventral urogenital sinus by urorectal
septum that develops in the angle between the allantois and the hindgut.

The urogenital sinus is divided into three parts: a cranial vesicle part that forms most
of the bladder and is continuous with the allantois; middle pelvic part that becomes
the entire urethra in females; and caudal phallic part that grows toward the genital
tubercle primordium of clitoris.

By 12th week of development, the allantois constricts and becomes a thick fibrous
cord the urachus.In adults urachus is represented by median umbilical ligament.

As bladder enlarges distal parts of mesonephric ducts incorporate into its dorsal wall
and contribute to the formation of th e connective tissue in the trigone of the bladder.
The epithelium of entire bladder is derived from endoderm of urogenital sinus. The
other layers of bladder wall develop from adjacent splanc hnic mesenchyme.
As the mesonephric ducts get absorbed into the d orsal wall, the ureters come to
open separately into the bladder. Later the distal orifices of the ducts move close
together and degenerate.

The epithelium of the entire female u rethra is derived from endoderm of urogenital
sinus.

The cortex of suprarenal glands develops from the mesenchyme lining of the
posterior abdominal wall whereas the medulla differentiates and derives from the
neural crest cells.

|EVEL PME T F GE ITAL SYSTEM

The development of genital apparatus accompanies t hat of urinary system.the

primordium gercells share in the formation of gonads.

The intermediate mesoblast is the origin of an elongated structure , the urogenital

ridge which lies on both sides of the midline between the lateral mesoderm and the
root of dorsal mesenterium of the embryo.it consists of two main components the
nephrogenic cord out of which the urinary apparatus arises and the genital ridge as
the origin of gonads.

The genital ridge extends from the upper thoracic region to the level of the c loaca.
The true gonad analage though develops from only the middle area.
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The initial period of genital development in the two sexes is similar and therefore is
referred to as indifferent state of sexual development .

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The Xchromosome and an autosomal gene plays an important role in ovarian

organogenesis

The ovaries are derived from three sources: mesodermal epithelium lining of the
posterior abdominal wall, the underlying mesenchyme embryonic connective tissue
and the primordial germ cell.

The gonadal cords extend into the medulla and for m a rudimentary rete ovarii this
structure degenerates and disappears. The developing ovaries have the cortical
cords extending from surface epithelium into underlying mesenchyme. As the cortical
cords increase in size ,the primordium germ cells are incorporated into them.

At about 1 weeks cortical cord begins to break into cell clusters called primordial
follicles. Each follicle consists of an oogonium derived from germ cell . Active
mitosis produces thousands of oogonia during fetal life. About 2 million enlarge to
become primary oocytes and the rest degenerate before birth. The surface
epithelium of the ovary is covered by a thin fibrous capsule called the tunica
albuginea. As the ovary separates from regressing mesoneph ros, it gets suspended
by mesentery called mesovarian.
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Female embryos have two pairs of genital ducts: mesonephric ducts wolffian ducts
and paramesonephric ducts mullerian ducts .The mesonephric ducts completely
disappear leaving only a few non functional remnants. The paramesonephric ducts
form most of the female genital tract.

The uterine tube develops from the unfused cranial parts of the paramesonephric
ducts. The caudal fused portion forms the uterovaginal primordium, which gives rise
to uterus and superior portion of vagina.
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To be observed is the development of the Ú
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Through atrophy of the mesonephros the (%%('(( connects the ovary à
 
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The endometrium stroma and myometrium are derived from splanchnic

mesenchyme.The fusion of paramesonephric ducts also bring together peritoneal
fold that form the right and left broad ligament and the peritoneal compartments
:recto uterine pouch and the vesicouterine pouch.

The vagina epithelium is derived from endoderm of uro genital sinus. The
fibromuscular wall of vagina develops from surrounding mes enchyme.
The contact of uterovaginal primordium with urogenital sinus induces paired
endodermal outgrowths called sinovaginal bulbs.these bulbs fuse to form vaginal
plate.

The central vaginal cells break down forming thelumen of vagina. Until late fetal life ,
the lumen of vagina is separated from cavity of urogenital sinu s by a membrane
called hymenthat persists at the inferior end

Through '
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the uteroL vaginal canal opens itself ca. 3rd month
towards the outside. The upper 3/4 of the Ú
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hymen. Its origin is not entirely clear.
|iscussed is a passive invagination of the
back wall of the SUG.

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The external genitalia of females ± phallus growth ceases and it becomes the clitoris

urogenital folds do not fuse except for small portion that forms the frenulum of the
labia minora
unfused urogenital folds become labia minora

labioscrotal folds fuse and form poster. labial commissure posteriorly, anter.labial
commisure and mons pubis anteriorly

middle portion of the folds remains unfused and forms labia majora

The ovaries also descend from posterior abdominal wall to the pelvis , just inferior to
the pelvic brim. The gurbenucumum is attached to the uterus near the attchmemmt
of the uterine tube. The cranial part of gurbenuculum becomes the ovarian ligmanet
and the caudal part foems the round lig of the uterus.the round lig passes throu gh
inguinal canal and terminate into labia majora.

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http://d3jonline.tripod.com/24
Reproduction/|evelopment_of_the_Urogenital_System.htm

The most common anomalies of the internal genitaliaresults from defect in fusionof
paired structures that form the uterus, cervix and vagina.

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The chromosal sex is determined at fertilization depending on the sex chromosome

complex XX or XY .The embryos can have abnormal sex chromosome complexes
such as XXX or XXY. The number of X chromosome appears to be unimportant in
sex determination. If a normal Y chromosome is present, the embryo develops as a
male. If Y chromosome is not present, female development occurs.

The loss of an X chromosome doesn¶t interfere with the migration of the primordial
germ cells to gonadal ridges. However an incomple te set of X fetal gonad of 45
develops
(  #  and have incomplete ovarian development. ?Females
with Turners syndrome typically experience dysfunctioning ovaries which results in
amenorrhea absence of menstrual cycle and sterility.

Various types of (

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 result from
developmetal arrest of the uterovaginal primordium during the 8 th week of
development:
These developmental anomalies may include:

J Incomplete fusion of the paramesonephric ducts

J Incomplete development of one or both paramesonephric ducts
J Failure of parts of one or both paramesonephricducts to develop
J Incomplete canalization of vaginal plate that forms the vagina.

A double uterus uterus didelphys results from failure of fusion of inferior parts of the
paramesonephric ducts.It may be associated with a double or single vagina.

In some cases the uterus is divided internally by a thin septum.if the duplication only
involves the superior part of the body of uterus, the condition ios called bicornuate
uterus.

If growth of one paramesonephric is retarded and the duct doesnot fuse with
theother one , a bicornuate uterus with a rudimentary horn develops .the rudimnaary
horn may not communicate with the cavity of the uterus.

A unicornuate uterus develops when one paramesonephric does not develop. This
results ina uterus with one uterine tube .

In many of these cases the individuals are fertile ,but may have an increased
incidence of premature delivery.
A disturbed fusion of the lower section of the paramesonephric duct RMüller S can lead to
a variety of abnormalities in the uteroT vaginal region. Such abnormalities in the genital
region are almost always associated with such of the urinary tract, since these two
systems are closely connected with each other.

Utero-vaginal abnormalities
As we saw earlier, the absence of AMH leads without fail to a further development of
the paramesonephric duct. Three phases can be distinguished:

J The spread of the paramesonephric duct down to the urogenital sinus.

J The fusion on both sides of the lower third of the paramesonephric duct out of
which the uterus and the upper 3/4 of the vagina arise
J The resorption of the dividing wall of the paramesonephric duct on both sides
after fusion Uend of the 3rd month V

An  
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"WXw Unilateral atresia, leading to
the paramesonephric duct in the direction a uterus unicornis unicollis
of the SUG is responsible for an atresia
and/or complete or incomplete aplasia of
the uterus, which is usually associated
with renal abnormalities. This syndrome is
called the Maye Rokitansky Ãuster
Hauser syndrome.

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(  or an incomplete development
YatresiaZ of one of two paramesonephric
ducts is responsible for the formation of a
uterus bicornis uni[ or bicollis with or
without doubling of the vagina. The uterus
bicornis unicollis is encountered the most
frequently.

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"^^w Uterus bicornis bicollis Ú
"_`w Uterus bicornis unicollis

The   %

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to a septated uterus:

J Uterus septus cfrom the body to

the uterine cervixd
J Uterus subseptus conly in the
body region d
J Uterus subseptus conly in the
cervical regiond
e
hen no vaginal plate develops, this
leads to a vaginal aplasia that, though,
only very rarely occurs in isolation. |ue to
their partly ' 

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abnormalities are mostly associated with
those of the vagina.
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" w Uterus septus unicornis bicollis

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Agenesis of vagina results from failure of sinovaginal bulbs to developand form the
vaginal plate.when the vagina is absent , the uterus is usually absent also because
the developing uterus induces formation of sinovaginal bulb which fuse to from the
vaginal plate.

Failure of cacnalization of vaginal plate resukts in blockage of vagina.

Failure of the inferior end of the vaginal plate to perforate results in an imperforate
hymen.

Absent perforation of the hymen

Missing hymen perforations are rare. |uring organogenesis a layer of endodermal
tissue divides the vagina from the urogenital sinus hfuture vaginal vestibulei. This tissue
layer degenerates during the 5th month and leaves only the hymen behind. If this
degeneration fails to occur, the hymen perforation does not occur and mucus from the
cervical glands, stimulated by the hmaternal i estrogen, collects above the hymen. This
can lead to a hydrometrocolpos. Sometimes this abnormality manifests itself only in
adolescence by a painful amenorrhoea with a hematometrocolpos.

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Endometriosis

In endometriosis 
# ectopic endometrial tissue outside the uterus, either on the
ovaries, the fallopian tube, the uterine ligaments, the rectoj vaginal septum, the pelvic
peritoneum or possibly in a scar following a laparotomy. Just like the uterine
endometrium, this tissue takes part in the menstrual cycle.
There are various theories concerning the 

&

(:

J · The %
& maintains that the coelomic epithelium, out of which
the paramesonephric duct through invagination has arisen, and formed the
fallopian tube, the uterus and parts of the vagina, retained its ability to
differentiate and become endometrium. c
 
J The (1& holds that scaly endometrial material gets into the 

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abdominal cavity retrogradely and primarily grows into the small pelvic area






and only secondarily into the peritoneum.
J The
%
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transplantation during a surgical intervention endometrial tissue gets outside
the uterus and starts to grow there.
J In the engendering of endometriosis 
'2
(
'#&#

' probably also play a role. This explains why not all women in whom
endometrial cells get into the abdominal cavity are susceptible to the same
extent for the formation of an endometriosis.

Possible localizations of an endometriosis Sagittal section at the

level of the abdomen
and pelvis

By:?http://www.gpnotebook.co.uk/simplepage.cfm?I|
959447005

http://www.icd10data.com/I |10 M/ odes

http://www.embryology.ch/genericpages/moduleorganoen.html
pongenital defects
pongenital defect s such as cervical stenosis, the lack of opening in the hymen or other
congenital abnormalities causing menstrual blood retention in the uterus or retrograde
menstruation that allows endometrial cells to implant in the abdominal region.

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http://eradiology.bidmc.harvard.edu/LearningLab/genito/Epps.pdf

Adenomyosis

abothian cysts

Gartners cyst

varian factors cystic ovarioan disease
Pp

Endometriosis

ormal pelvic anatomy

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The %$
2 is a bony ring, interposed between the movable vertebral column which it supports, ???
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and the lower limbs upon which it rests; Thepelvis is composed of four bones:?? ?hip bones?

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? ??sacrum? ?coccyx? 

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The pelvis is divided by an oblique plane passing through the prominence of the sacrum, the ???

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arcuate and pectineal lines, and the upper margin of the symphysis pubis, into the greatespelvis
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major and the lesser pelvisspelvis minor . The circumference of this plane is termed the %$
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The false pelvis lies superior to the pelvic brim.Its cavity is part of the abdominal cVITY.It contains
abdominal viscera e.g sigmoid colon.

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The true pelvis lies to superior pelvic apertureand pelvic brim.it is limited inferorly by pelvic outlet
wchich is closed by the pelvic diaphragm and thats closed mainly by leavtor ani mm.its inferior
boundarycorresponds to a line joining the tip of coccyx to the inferior border of pubic symphysis.?

This is the pelvic cavity and coantins pelvicIt contains, in the fresh subject, the pelvic colon, rectum,
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bladder, and some of the organs of generation. The rectum is placed at the back of the pelvis, in the
curve of the sacrum and coccyx; the bladder is in front, behind the pubic symphysis. In the female
the uterus and vagina occupy the interval between these viscera

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The pelvic cavity shortad curved forms basinlike partof abdominopelvic cavity.it is tilted
anteroinferiorly when it is in the anatomical position.

The posterior wall of pelvis minor is formed by concave pelvic surface of tghe sacrum and coccyx
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which is longer than its anterior wall.the anterior wall is formed by pubic symphsis, the body of pubis
and pubic rami.the lateral walls are formed byt he pelvic aspects of ilium amd ischium.?

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FIG. 239± 
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The superior pelvic aperture or pelvic inlet is variable in shape and contour by gender,race and ???
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also by nutritional differences.the periphery of the aperture if fromed bythe pelvic brim and is
indicated by the iliopectineal line.

The inferior pelvic aperture or the pelvic outletdoesnot have a smooyh contour because it is
bounded posteriorly by sacrum and coccyx, anteriorly by pubic symphsisand laterally by ischial
tuberosites.


  

The parts of bony pelvis are bound by dense ligs.The iliolumbar ligconnects tips of trtansverse
process of l5to iliac crest posteriorly. The inferior fibres of this lig are attached to lateral parts of the
sacrum. The sacrotuberous ligpasses from scarum to ischial tuberosities. It has a wide attachment
to the dorsal surfaces of the sacrumand coccyx and the posterior superior iliac spine.the
sacrospinouos lig
is a thin triangular lig extends from the lateral marginof the sacrum and coccyx to
ischial spine.the sacroiliac lig
these ligs hold the wedge shaped sacrum inbetween the iliac ones
froming sacroiliac joints. ?
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The lumbosacracl joint fromed by articulation of l5 and s1.

The sacrococcycegeal jointis a cartilaginous joint in which fibrocartilage and ligments join the
articulating bones, the apex of sacrum and base of coccyx.

The sacroiliac joints are synivial jointsbetween articular surfaces of sacrum and ilium

The pubic symphysis is a median secondary cartilaginous joint between the bodies of two pubic
bones. Each articular surface is covered by a thin layer of hyaline cartilage

**

The walls of pelvic cavity is composed of :superficial mm, hip bonesand their associated ligs , deep
mm, blood vessels ,nerves ,,lymphatics and peritoneum..

The anterior pelvic wall of tge pelvis is formed on each side by bodies of pubisc bones and its
superior and inferior ramiwchich terminate laterlallly in the body of isschium and obtruator internus
mmand its facsia. Tghe pubic symphysis also froms part of the anterior pelvic wall.
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Lateral pelvic walls is covered mostly by obtraor internus mm. Medial tyto this mm on each side are
obturaros nerves, vessels and other branches of internal iliac artery.. the obrturair inernus passes
from the pelvis through the lesser scatic foramen adn its fibres converge to form a tendon that is
attached to greater trochanter of the femur.

Posrerior pelvic wall is fromed by sacrum , adjacent parts of the ilium and the sacroiliac joints and
their ligs.the piriformis mm lines the posterior wall laterally .these pear shaped mm occupy a key
position in the glueteal region .each pirifromis mm leaves the pelvic minor thru greater s ciatic
foramen. Medial to these mm are scaral plexus and internal iliac vessels and its subsidiaries.

Floor of the pelvis is fromed by funnel shaped pelvic diaphragm.it is compsed of two levator ani
and two coccygeus mm.this diaphragm closed the pelvic outlet. Except for a gap in the pelvic floor
beween the anterior edges of the levator ani mm.this gap is filled with loose facsiaareound the
vagina and is closed by urogenital diaphragm . te pelvic doapghram also separates the pelvic cavity
from the perineum.the rectum and urethra an dthe vagina penetrate te pelvic diaphragm to reach
the exterior.
 

Levatro ani mm are the largest and most mporatnt mm in the pelvic floor the mm is divided into
three principal parts: puborecatlis, pubococygeus and iliococygeus.these mm supports the pelvic
visera and resists the inferior tnrust tht accompanies increase in traabdominal pressure. The parts
of these mm that inserts into the perineal body support the posterior wall of vagina

The coccygeus mm are triangular sheet s of mm that lie against posreior part of the iliococcygeal
mm with wchich it is continous.these along with levator ani from sthe pelvic diaphragm.

The pelvic fascia surrounds the pelvic viscera by loose connective tissue . the fascia is thickened
laterally to from the uterosacraland transverse cervical ligs . these ligs passing from the side of the
uterine cervix to the posterior wall of the pelvis are a major source of support for the uterus.

Arteries of the pelvis

The internal iliac artery
thses large vessels are paird temial branches of common iliac arety.it
supplies most of the blood to the pelvic viscera .the internal iliacs begins at at level between l5 and
s1 wghere it is crossed by the ureter.it passes posreromedially into the pelvis minor medial to the ?
extreernla iliac vien.it ends at the superior end of the great sciatic foamen by didving into anterior
and posterior divisions. The branches of anterior dividion aree mainly viscerla i.e to bladder, rectum
and reproductive organs.the bbranches of IIA whcihc commonly arise are:

Umbilical artery:these vessels run anteroinfriorly between the urinary bladder and the lateral wall of
the pelvis

The vaginal artery runs aneriorly and passes along the side of the vagina wehre it dividesinto
numerousbranches athat supp;y the anterior and posterior surface of the vagina., posterionfrior
parts of the urinary baldder and the pelvic prt of tthe urethra.

The uterine artey arises separtarly from IIA, but may arise from umbilical artery.it deccsends on the
latrla wall of the pelvis , anterior to the IIA and enters the root of the broadlig where it passed
superior to the lateral portion of the fronix of vagina to reach the lateral margin of the uterus.
The ovarian arety:arises from the abdominal aorta inferior to the rena aretrybut superior to inferior
mesenrtic artery.as it passes inferiorly it adhers to the parietal peritoneumand runs anterior to the
ureter on the posterior abdominal wall. As it enters the pelvis minor it crosses the proximal ends of
the external iliac vessels . it then runs medially in thesuspensory lig of the ovary snd uterinr tubes .
the ovarian arerty anastomoses with the uterine aertey.
u
VE US |rainage of pelvis

The pelvis is drained maily by internal iliac veins and their tributaries.

The IIV joins the EIV to form the common iliac vein. These unite with its partners to form the IVp.

The pelvic viscera

pontains rectum , urinary bladder and female genitalia.

The urinary organs

These consist of kidneys that produce urine which is conveyed to the urinary bladdr via uretes
before expelling to the exterior through uretehra.kidneys are located int he abdomen.

The Ureter is abdominal part and pelvic part. As ureter leaves the abdomen and enter the pelvis
minro tey pass over the pelvic brim, anterior to the origins of EIA.the ureter decsne don the lateral
wall of the pelvis minor , where it froms the posterior boundary of the ovarian fossa . it then passes
close to the lateral porion of the fornix of the vagina , especially on the left side and enters the
posterosuperior angle of the bladder.

Arterial supply and venous drainage:

The most constant arteries supplying the pelvic parts of the ureters in females are branches of
uterine areties

Lymphatic drainage of ureters are into aortic, common iliac, external iliacand ionternal lymph nodes.

The urinary bladder

Is a hollow mmuscular vesicle for storing urine.inadults it lies in the pelvis monor.the peritoneum is
reflected from the superior surface of the bladder near its posterior border and onto the anterior wall
of the uterus at the junction of its body and cervix . the vesicouterine pouch extends between the
baldder and the uterus.

The wall of baldder is composed of smooth mm called detrusa mm.its mm fibres run in many
directions and at theneck of the bladder these fibres form the invoulunatry internal sphincter.these
mm fibres ae continous with the mm in the wall of the urethra.the uretetic orifices and the internal
uretehral orifce are located at the angles of the trigone.

Arterial supply:branches of internal iliac areries.the superior vesicle arerty, brsnsnches of umbilical
arteries, supply anterosuperior parts of the bladder . the vagina arteries send branches to
poseroinferior parts of the baldder. The obtrurartr and inferior gluteal arteries also supply parts of
bladder.

Venouos drainage
veins of bladder correspond to te arteiries and are tributeries of internal iliac
veins.

Lymphatic drainage of bladder ±lymph vessels from superior partof bladder pass to the external
iliac lymph nodesand those from the inferior part pass to internal iliac lymph nodes

&- urethra is a short mm tube wchich is lined by mucous membrane. It passes

anteroinferiorly from urinary bladder,posterior and inferior to pubic symphysis. The external urethral
orifice is located inthe vestibule of vagina. It is located anterior to the vagina.it passes with the
vagina through pelvic and urogenital diaphragms and the perineal membrane.

The blood supply is from the internal pudendal and aginal arteries. The veins correspons to the
aretieries.

Most lymph vessels from urtehra pass to the scaral and internal iliac lymph nodes.

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Describe:

 
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4-of a nonpregnant womanis a holoow , thick walled , pear shaped muscular organ located
between the baldder an dthe rectum. It is 7
8 cm long and 5
7cm wide and 2
3 cm thick.the uerus
normally projects superoanteriolry over the urinary bladder.the uers consist of two major parts: the
bodyis the expanede superior twothirdsand cylindrical inferior third called cervix. A slight
constriction called isthmus marksthe junction between the body and the cervix.the fundus of uterus
is the rounded superior part of the body wchich is locatedsuperior to the line joining points of
entrance of uterine tube.. te region of body where the uterine tube enters are called the cornua.

The uetrrus can be bent anterioelry called anteverted or bent posteriorly called retroverted.

valls of uterus consists of 3 layers:

Perimetium ±the ourer serouos coat consist of peritoneum supported by a thin layer of connective
tissue.

Myometrium
middle muscular coat. Main branches of blood vessels an nerves are located in this
layer.

Endomertiuim
the inner mucous coat frmly adherent to myometroum.

The endometiurm is partly sloughed offeach month during menstruation

endometrium(  

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The middle coat of cervix mainly cocnsist of fibrous tissue.the cervix is more firm and rigid then the
bbody of uterus.

The body of uterus is enclosed between the layers of broad ligs and is freely movable.the cervix is
not mobile because it is held in position by several ligs.

The transverse cervical ligs extend from the cervix and lateral parts of the vagina; fornix to the
lateral walls of the pelvis.

The principal spport of uterus is the pelvic floor.the mm important in supporting the uterus are:2
levator ani mm,2 coccygues mm,and mm of urogenital diaphragm.
Peritoneum covers the uerus anteriorly and superiorly except for the vagina part of the cervix.

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 is a double layered sheet that etxends from the sides of the uterus to te lateral walls
and the floor of the pelvis.the broad lig holds the urteus in its normal position. The layers of broad
lig are continous with each other at the fee edge, which is directed anteriolry and superiory to
surround the uterine tube.the ovarian lig lies posterosuperiorly and the round lig of the ueterus lies
anteroinferiory within the broad lig.the broad lig gives attachement to the ovaries through
mesoovarium.

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% &(( 5 anteroirly the body of uterus is separated from the urinary
baldder by the vesicouterine pouch.this pouch is empty when uterus is inits normal position, but it
usually c onatians a loop of bowel when its retroverted.

Posteriorly the body of uterus and supravagina part of the cervix are separated from the sigmoid
colon by a layer of peritoneum and peritoneal cavity.the uterus is sperated from the rectum
w x
byrectouterine pouch pouch of douglas .. the inferior part of this pouch is closely related to the
posterior part of the fornix of vagina.

laterally the ureters is crossed supriorly by the uterine arteies at the side of the cervix.

Arterial supply of the uterus:the blood supply of uterus is manily derived from the uterine arteries ,
ewhich are braches of internal iliacs areteries.they enter the broad lig beside the lateral parts of the
fornix of the vagina.

Uterus is also supplied bythe ovarian arteries, which are branches of arota.the uterine arteries pass
along the sides of the uterus withn the broad lig and then turm laterally at the entrance to the
uterine tubes , where they ananstomose with the ovarian arteries.

Venaous drainage : uterine veins enter the broad ligmentswith the uterine arteries.. they form
venous plexus on each side of the c ervix and its tribuatatries drain into internal iliac veins.

Lymphatic d rainage;:the lymph vessels of the uterus follow thre main routes: lymph vessels vrom
the fundus pass with the ovarian vessels to the aortic lymph nodes.some pass to external iliac
lymph nodes and to the superficial inguinal lymph nodes.

Lymph vessels from body pass to the ei lymph nodes.

From the cervix pass to the internal iliacs and scacral lymph nodes.

cervical mucus(       



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Also called fallopiam tubes , 10
12 cm long and 1 cm in diamterer, extend lateraaly from the cornua
of tge uerus .the uerine tubes carru oocytes from the ovariesand sperms from the uerus to the
fertilization site in the ampulla of the uterine tube.. it also converys the dividing zygote to the uterine
cavuty.each tube opens at its proximal into the cornua or the hron of the uerus .and its distal end
into the peritoneal cavity near the ovary.consequently the uterine tubes allow communication
between the peritoneal cavty and the exterior of the body.

The uerine tube is divided into 4 parts:infundibilum
is funnel shaped lateral or distal end of the
uterine tube , whci is closely related to tthe ovary . iys opening into the peritonaeal cavity id called
the abdomainl ostium. About 2 mm in diamtere, the ostium lies at the bottom of the infundilulm.its
meargins have 20
30 fimpbrae. Thiese fingerlike processes spread over the surface of the ovary
and a large one , the ovarian fimbia,is attached to the ovary.during ovulation the fimbriae trap the
oocyte and sweep it thruuohg the abdominal ostium into the ampulla.

The ampulla of the uterine tube begins at the medial end of the infundibulum.the amulla is the
widest and the longest part of the uterine tube , making up over half of its length.

The isthmus of the uterine tube is the shaort narrow, thickwalled part of the uerien tube that enters
the cornau of the uterus.

The uteruen part or intramural portion is the short segment that passess thruioght the thick
myometrium of the uterusan dopens via the uterine ostium into the uterine cavity.

The uterine tube s lie in the free edge of the broad ligs of the uterus.the part of the broad lig
attached to the uterine tube is called the mesentry of the tube or mesosalpinx.the tubes extend
posterolaterallyto the laterall walls of the pelvis wher they ascend and arch over the ovaries.

Arterial supply: the arteies to the tubes are derived from the uetrien and ovarian artries.
Venous |rainage:the veins of the tube are arranged similarly to the arteriesand drain into the
uterine and ovarian veins.

Lymphatic drainage: the lymph vessels of the uterine tubes follow tgose of fundus of the uterusand

ovary and ascend with ovarian veins to the aortic lymph nodse in the lumbar region.

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6is the female organ of copulation , is a muscloumembranoues tube 7
9cm in length. It
forms the inferior portion of the female genital tract and birth canal.it extends from the ccervix to the
vestibule of vagina.tghe vagina descends anteroinferiorly.its anterior and posterior walls are
normally in apposition, except ts superior end where cervix of uterus enters its cavity.

It is located posterior to the urinary baldder and anterior to the rectum and passes between the
medial margins of the levator ani mm.it piecres the urogenital diaphragm with the shpincetr urethra
mm. The vagina recess around the cervix is called the fornix.. the posterior part of the fornix ids the
deepest and is related to the rectouterine pouch.its anterior wall is in contact with the cervix, the
fundus of the bladder, the terminal parts of the ureters and the urethra.

Atreial supply of the vagina: the vagina artery is branch of the uterine artery, which may RISE
FR M internal iliac artery.the internal pudendal artery and vaginal branches of the middle rectal
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artery also supplies vagina. branches of IIAzinternl iliac artery.

Venous drainage of :the vaginal veins from vaginal venous plexus along the sides of the vagina and
within its mucosa. They drain into the internal iliac vein and communicate with the vesice,uterine
and rectal venous plexus.

The lymphatic drainage:the s uperior part accompany the uterine artery and drain intointernal and
external lymph nodes. The middle part accompany the vaginal artery and drain into the internal
iliac lymph nodes. Those from vestibule drain mainly into the superficial inguinal lymph nodes.

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 are almond shaped , oval, pinkish white glands about 3cm long, 1.5cm wide and 1 cm
thick. Before pubebrty the surface of ovaries are smooth.thereafter it becomes progressively
scarred and distrorted owing to repeated ovulation, unless ovulation has been inhibited by brith
control pills.the ovaries are located on each side , close to the lateral wall of pelvis minor in a recess
called ovarian fossa.the fossa is bouneded anterior; by umbilical lig and posteriorly by ureter and
internal iliac artery.the anterior border of the ovary is atthatcehd to the posterior border of the broad
lig y peritoneal fold called the mesovarian.the ampulla of uterine tube curves over the lateral end of
the ovaries and the infundibulum engulfs the ovary so that it can trapthe oocyte at ovulation.
The superior or tubal end of ovary is connected to the lateral wall of the pelcvisby the suspensroy
lig of the ovary. This lig is a fold of the posterior layer of the broad lig.the suspensry lig conatins the
ovarian vessels and the nerves. {hich pass to the hilum of the ovary.each ovary is alos attached to
the uterus by a band if fibreous tissue, the ligment of the ovary.it connects the inferior or uterine end
of the ovary to the lateral angle of the uterus.the surface of ovary is not covered by peritoneum
therefore during ovulation the oocyte is expelled nto the peritoneal cavity. Its intraperitoneal life is
short because it is trappe byt he fimbrae of the uterine tube and carried to the ampulla.

Atreial supply of the ovary
the ovarian arteies arise from the abdominal arotaand decsnd along the
posterior abdominal wall. n reaching the pelvic brim, the retires cross over the external iliac
vessels and enter the suspensry lig.the ovarian atrey sends branches through the mesooavriums to
the ovary and continues medially in the broad ligto supply the uerine tube. It ananstomoses with the
uterine artery.

The ovarian veins leave hilum of the ovary and form a vine like network of vessels called
pampinifom plexus in the broad lig near the ovary and uterine tube.the rught ovarian vein ascend
sto the IVp wheras the left ovarian vein drains into the left renal vein.

The lymph vessels follow the ovarian blood vessels and joins those fromthe uterine tubes and
fundus of the uterus as they ascend to aortic lymph nodes in the lumber region.

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ormal ovarian cycle

FSH and LH produce cyclic changes in the ovaries. This developls the ovarian
follicle, ovulation and formation of corpus luteum. |uring each cycle fsh promotes
growth of several primary follicles however only one of them usually develop into
mature follicleand ruptures.

|evelopment of ovrian follicles is characterized by : growth an differentiation of

primary oocyte, proliferation of follicular cells, formation of zona pellucid,
development of connective tissue capsulesurrounding the follicle
theca folliculi.
The theca folliculi differentiate into 2 layers: internal vascular and glandular layer
called theca interna and capsule like layer called theca externa.theca cells are
believed to produce an angigenic factor that promotes growth of blood vessels in the
theca interna, these vessels provide nutritive supportfor follicular development.

vulation

The follicular cells divide actively producing stratified layer around the oocyte.
Subsequently fliud filed spaces appear around the follicular cells which co alesce to
form a single cavity, the antrum containing follicular fliud . after the antrum forms the
ovarian follicle is called the secondary follicle. The primary oocyte is surrounded by
mound of follicular cellsknown as cumulus oophorus which projects in to the enlared
antrum. The follicle continues to enlearge and soon forms a bulge on the surface of
the ovary . a small oval avascular spot, the stigma soon appears on this bulge..

Before ovulation the secondry oocyte and some cells of cumulus oophorus , detach
from the interior of the istennded follicle . ovulation follows within 24hrs of a surge of
lh production.this surge elicited by high estrogen level in the blood appears to cause
the stigma to rupture., expelling secondary oocyte with follicular fluid .

The expelled secondary oocyte is surrounded by the zona pellucida and one or more
layers of the follicular cells which are radilaly arranged to form the corona radiate
and the cumulus oophorus.

porpus luteum

Shortly after ovulation, the ovarian fol licle collapses.under the influence of LH, the
walls of the follicle develop into a glandular structure called corpus luteum which
secretes primariy progesterone but some oestrogen.. if the oocyte is fertilizrd the pL
enlarges to form a pL of pregnancy and increases its hormones
production.degeneratoin of pL is prevented by hcg.. if the oocyte is ot fertilized the
pL begins to degenerate aprox 10
12 days after ovulation. hich is then called pL
of menstruation.. The pL is subsequently transformed into w hite scar tissue in the
ovary, forming the corpus albicans degenerated pL .

Menstrual cycle

The menstrual or endometrial cycle is the period during which the oocyte matures , is
ovulated and enters the uterine tube, the hormones produces by ovarian follicl es ad
corpus luteum estrogen and progesterone produce cyclic changes in the
endometrium of te uterus.theses monthly changes in the uterine lining constitute the
endometrial , or mmenstrual cycle or period. The average menstrual cycle is 28
days , wit day 1 cycle corresponding to the day on which mesntruaation begins.
Mensus cycle may normally vary in length by several days in normal women.

Phases:
Menstrual cycle can be divied in to 3 main phases, however these are continuos
processes with each phase gradually passing in the next one.

Mensntrual phase
the 1std ay of the menstruation is the beginning of the menstrual
cycle. The functional alyer of uterine wall is sloughed off and discarded with
memstrual flow which usually lasts 4
5 days,. The menstrual flow discharged througg
the vagina consists of varying amounts of blood combne dwith small pieces of
endometrial tissue.. after menstrualtion eroded endometrium is thin.

Proliferative phase
lasts upto 9 days, coincides with the growth of the ovaria n
follicles and is controlled by estrogen secreted by thse follicles . this is a 2
3 fold
incresase in the thickness o fthe endometrium during this time. Early during this
phase , the surface epithelium of the endometrium regenerates..the glands increase
in number and length and spiral arteries elongate.

Luteal phase
or the secretory phase lasts approx 13 days coincides with the
formation , function aand growth of pL. Te progesterone produced by the pL
stimulates the glandular epithelium to secrete glycogen ±rich, mucoid material. The
glands become wide , tortouos and saccular and the endometrium thickens bcoz of
the influence of progesterone and estrogen from pL and increase in the fliud in the c
onnective tissue.:

If fertilization doesnot occur : pL degen erates,estrogen and progestwrone levels

decrase and endometrium enters an ischeamic phase during the alst day of luteal
phase. , mesnstrauation occurs.

Ischemia of spiral arteriesoccur by constriction resulting from decrease in the

secretion of progesterone. Hormone withdrawl also results in the stoppage of the
glandular secretion , a loss of interstitial fluid and a marked shrinking of the
endometruim . toward the end of the ischemic phase the spiral areteies become
constricted for longer periods . . t his results in venous statsis and patchy ischemic
necrosus in suoerficial tissues. Small pools of blood form and break thrugh the
endometrial suface resulting in bleeding in uterine ,lumen and subsequent drainage
into the vagina..

As small pieces of endometium detach and pass into the uterine cavity , the torn
ends of arteries bleed into uterine cavuty, resulting in aloss of 20
80 ks of blood .
eventually over 3
5 days , the entire compact layer and most of the spongy layer of
the endometrium are discarded . remnets of spongy layers and basal layers soon
undergo regeneration during the subsequent proofeartive phase of the
endomertium..

|uring prefnancy menstrual cycle ceasese and endometrium passes into pregnancy
phase.
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http://www.infertilityphysician.com/menstrual_ disorders/causes.html

varian cysts are small fluid
filled sacs that develop in a woman's ovaries. Most cysts are harmless,
but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to
|
remove the cyst s}. It is important to understand the function of the ovaries and how these cysts may
form.

~omen normally have two ovaries that store and release eggs. Each ovary is about the size of a
walnut, and one ovary is located on each side of the uterus. ne ovary produces one egg each
month, and this process starts a woman's monthly menstrual cycle. The egg is enclosed in a sac
|
called a follicle. An egg grows inside the ovary until estrogen a hormone}, signals the uterus to
prepare itself for the egg. In turn, the lining of the uterus begins to thicken and prepare for
implantation of a fertilized egg resulting in pregnancy. This cycle occurs each month and usually ends
when the egg is not fertilized. All contents of the uterus are then expelled if the egg is not fertilized.
This is called a menstrual period.
In an ultrasound image, ovarian cysts resemble bubbles. The cyst contains only fluid and is
surrounded by a very thin wall. This kind of cyst is also called a functional cyst, or simple cyst. If a
follicle fails to rupture and release the egg, the fluid remains and can form a cyst in the ovary. This

usually affects one of the ovaries. Small cysts smaller than one
half inch€ may be present in a normal
ovary while follicles are being formed.

varian cysts affect women of all ages. The vast majority of ovarian cysts are considered functional

or physiologic€. This means they occur normally and are not part of a disease process. Most ovarian
cysts are benign, meaning they are not cancerous, and many disappear on their own in a matter of
weeks without treatment. hile cysts may be found in ovarian cancer, ovarian cysts typically

represent a harmless benign€ condition or a normal process. varian cysts occur most often during a
woman's childbearing years.

The most common types of ovarian cysts are the following:

Ú
'(' : This type of simple cyst can form when ovulation does not occur or when a mature

follicle involutes collapses on itself€. A follicular cyst usually forms at the time of ovulation and can
grow to about 2.3 inches in diameter. The rupture of this type of cyst can create sharp severe pain

on the side of the ovary on which the cyst appears. This sharp pain sometimes called
mittelschmerz€ occurs in the middle of the menstrual cycle, during ovulation. About one
fourth of
women with this type of cyst experience pain. Usually, these cysts produce no symptoms and
disappear by themselves within a few months.

%( (( ' : This type of functional ovarian cyst occurs after an egg has been released
from a follicle. After this happens, the follicle becomes what is known as a corpus luteum. If a
pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however,
fill with fluid or blood and persist on the ovary. Usually, this cyst is found on only one side and
produces no symptoms.

7 &
'' : This type of functional cyst occurs when bleeding occurs within a cyst.
Symptoms such as abdominal pain on one side of the body may be present with this type of cyst.

 
#' : This is a type of benign tumor sometimes referred to as mature cystic teratoma. It
is an abnormal cyst that usually affects younger women and may grow to ‚ inches in diameter. A
dermoid cyst can contain other types of growths of body tissues such as fat and occasionally bone,
hair, and cartilage.

6 The ultrasound image of this cyst type can vary because of the spectrum of contents, but a pT
ƒ
scan and magnetic resonance imaging MRI„ can show the presence of fat and dense
calcifications.
ƒ
6 These cysts can become inflamed. They can also twist around a condition known as ovarian
torsion„, compromising their blood supply and causing severe abdominal pain.

4# 
  # 

#'  : Part of the condition known as endometriosis, this type
…
of cyst is formed when endometrial tissue the lining tissue of the uterus† is present on the ovaries.
It affects women during the reproductive years and may cause chronic pelvic pain associated with
menstruation.

6 Endometriosis is the presence of endometrial glands and tissue outside the uterus.
 ‡
6 omen with endometriosis may have problems with fertility.

6 Endometrioid cysts, often filled with dark, reddish
brown blood, may range in size from 0.75
8
inches.

a' 
'-%%
$: Polycystic
appearing ovary is diagnosed based on its enlarged size

usually twice that of normal
with small cysts present around the outside of the ovary. This
‰
condition can be found in healthy women and in women with hormonal ˆendocrine disorders. An
ultrasound is used to view the ovary in diagnosing this condition.

6 Polycystic
appearing ovary is different from the %' 

'$
 # ÑPp SŠ, which
includes other symptoms and physiological abnormalities in addition to the presence of ovarian
cysts. Polycystic ovarian syndrome involves metabolic and cardiovascular risks linked to insulin
resistance. These risks include increased glucose tolerance, type 2 diabetes, and high blood
pressure.

Polycystic ovarian syndrome is associated with infertility, abnormal bleeding, increased

incidences of miscarriage, and pregnancy
related complications.

Polycystic ovarian syndrome is extremely common and is thought to occur in 4%
7% of

women of reproductive age and is associated with an increased risk for endometrial cancer.

The tests other than an ultrasound alone are required to diagnose polycystic ovarian
syndrome.

 # 5 A cystadenoma is a type of benign tumor that develops from ovarian tissue. They
may be filled with a mucous
type fluid material. pystadenomas can become very large and may
measure 12 inches or more in diameter.

http://www.emedicinehealth.com/ovarian_cysts/article_em.htm

%&
 &'

#&'#  #( (#5