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Anatomy and Physiology of

Male and Female Genital Tract


Fossa navicularis
Female Genital Tract
Outline
Urethra
Paraurethral gland
Skenes gland
Vagina
Cervix
Uterus
The lymphatic drainage
Urethra
The female urethra
measures 34 cm in
length.

Proximally, the mucosa is


composed of transitional
epithelium gradually
becoming stratified
squamous as it courses
distally.
Paraurethral glands
The entire length of the
female urethra is
paralleled by paraurethral
glands of the mucosa.

These glands have their


openings on the posterior
and posterolateral wall of
the urethra .
Skenes glands
At the distal end of the
urethra there are usually
two larger glands,
commonly identified as
Skenes glands,

The ducts are visible on


the posterior wall.
Vagina
The vagina is a fibromuscular tube.
Vagina
The vaginal wall consists of three layers:

(1) The mucous membrane, composed of stratified


squamous nonkeratinized epithelium and an underlying
lamina propria of connective tissue.

(2) The muscular layer, composed of smooth


muscle fibers disposed both longitudinally and circularly.

(3) The adventitia, a dense connective tissue that


blends with the surrounding fascia.
There are no glands in the vaginal wall.

During sexual stimulation the marked increase


in fluid production in the vagina is believed to
be caused by transudation across the vaginal
wall.
Estrogen and vaginal wall
Estrogen stimulates the production of glycogen and
maintains the thickness of the entire epithelium.

Before puberty and after menopause, when estrogen


levels are relatively low, the epithelium is thin and
the pH is higher than in the reproductive years.
Lactic acid
The most superficial cells are desquamated into
the vaginal lumen where their intracellular
glycogen is converted into lactic acid, probably by
the bacteria normally resident in the vagina.

The resulting acidity is believed to be important


in protecting the female reproductive system
from infection by most pathogenic bacteria
Uterus
The uterus has two major components:
Cervix
The cervix consists primarily of dense collagenous
connective tissue.

Only about 15% of its


substance is smooth muscle.
Ectocervix is covered by stratified squamous,
nonkeratinizing epithelium.

The site of the squamocolumnar junction varies,


however it may occur higher up in the cervical canal.

The columnar epithelium may actually extend out


beyond the external os where it forms small patches
known as physiologic eversion, or ectopy, on the
vaginal surface of the cervix.

Ectopy is usually present in adolescents and


decreases during the third and fourth decades of life.
The mucosa contains large branched endocervical
glands.

In reality, they are not true glands but are merely


deep grooves or clefts (sometimes called crypts) that
serve to increase the surface area of the mucosa
tremendously.

The epithelium of both the mucosal surface and the


glands is of the simple columnar type in which
almost all the cells are mucus secreting.
It secretes up to 60 mg of mucus a day throughout
much of the cycle.

Near the time of ovulation (midcycle), when estrogen


secretion reaches a peak, the secretion rate
increases 10-fold and the abundant, clear mucus fills
the cervical canal.

It is less viscous than at other times during the cycle


and is easily penetrated by spermatozoa.
The body of the uterus
The wall of the body of the uterus is composed of three
layers:

(1)The endometrium:
simple columnar epithelium

(2)The myometrium
(smooth muscle layer)

(3)The serosa
The lymphatic drainage of
perineum and external genitalia
There is a dual pathway of the lymphatic drainage of the
perineum

(1) Deep lymphatics : draining the deep parts of both urogenital


and anal triangles.

(2) Superficial lymphatics : draining from the skin overlying the


vulvar and anal areas course to the medial thigh where they
communicate with superficial inguinal lymph nodes.

Adenopathy of superficial inguinal nodes is well known in


many vulvar and anal infections as well as in carcinoma of
these regions
The lymphatic drainage of
uterus and vagina
A plexus of uterine lymphatics parallels the course of
uterine veins, entering regional lymph nodes along
the internal iliac artery.

From these nodes lymph trunks ascend to para-


aortic nodes in the retroperitoneum.
Male Genital Tract
Outline
Penis
Urethra and glands
Male circumcision and STIs
Testis
The excretory duct
Prostate
Cowpers gland
The lymphatic drainage
Penis
There are two parts of the penis:

(1) The base which is attached to the pubis


(2) The pendular portion

Underlying the penile skin there are three cavernous


erectile bodies

- The paired corpora cavernosa that are primarily


concerned with erection.
- The corpus spongiosum that contains the urethra.
The corpora cavernosa are cylindrical bodies in the shaft
region but taper markedly at the base where they attach to
the pubic ramus and perineal membrane.

The corpus spongiosum has three parts;


(1) the bulb of the penis: beginning at the perineum
(2) the spongy portion
(3) the glans at the tip of the penis

During erection, blood fills the muscular structure of the


corpus spongiosum, causing it to expand.
Urethra and glans
The urethra is named according to the
part of the penis(bulbous, spongy, and
glandular portions).

The bulbous and spongy parts of the


urethra are lined by a pseudostratified
columnar epithelium, except at the tip
of the penis, termed the fossa
navicularis, which is lined by stratified
squamous epithelium.
The epithelium contains small acini of mucous cells
(glands of Littre) as well as mucosal and submucosal
glands, termed urethral or periurethral glands
On the superior surface of the corona of the glans
penis, as well as on the undersurface near the
frenulum, there are sebaceous glands, the glands of
Tyson.

These glands secrete a white cheesy type of material,


which with desquamating epithelial cells forms the
smegma.
Male circumcision and HIV and STIs
Presence of a foreskin has been related to an
increased risk of HIV infection, chancroid, and
perhaps other STIs.

Lack of keratinization of the mucosal surface of the


prepuce

Increasing rates of inflammation and trauma

Poor hygiene of the prepuce


Benefits of circumcision
Reduced risk of penile skin cancer
Decreased risk of cervical cancer partner
Protection from STIs
Reduced risk of urinary tract infection
Reduced risk of inflammatory genital skin disease
Testis
Two main functions:
produces sperm and secretes
male hormones.

Production of sperm takes


place in the seminiferous
tubules,

The production of
testosterone, the major male
hormone, takes place in the
tissue located between the
tubules.
Sperm are continuously produced in the testis from
puberty to senility.

In the testis this process takes about 64 days.

However, when they leave the testis, the sperm cells


are immature and are unable to fertilize an egg.

The capability of fertilizing an egg is developed


during transport of the immature sperm cells
through the excretory duct system.
The excretory ducts
The excretory ducts are composed of five
elements, beginning from the testis:
The efferent ducts
Epididymis
Vas deferens
Ejaculatory duct
Urethra
The Efferent ducts
There are approximately 12 efferent ducts,
which are convoluted tubules connecting the
rete testis to the epididymis.
Epididymis
The epididymis has three parts:
The head
The body
The tail
Epididymis
Within the epididymis, sperm undergo progressive
maturation during their movement from the head to the
tail.

As sperm emerge from the testis, they are infertile and


relatively nonmotile.

By the time they reach the tail of the epididymis, they are
both motile and fertile.

The average time of sperm transit through the epididymis is


12 days.
Vas deferens
From the inferior pole
of the testis, the vas
ascends in the
spermatic cord within
the scrotum, until it
reaches the superficial
inguinal ring.
Ejaculatory duct
Seminal vesicles
The seminal vesicles secrete an alkaline, slightly
yellowish viscid fluid which constitutes 6070% of
the ejaculate volume.

Fructose appear to be formed specifically by the


seminal vesicle.

Fructose is the principal energy source for sperm


motility.
Prostate gland
The prostate gland is composed of three zones
of tissue:
A periurethral zone
A central zone,
A peripheral zone
The prostate gland appears to be important in protecting the
male lower urogenital tract against infection.

Providing enzymes for liquefying the semen after


ejaculation.

Normally the pH of prostatic fluid is around 7.2. However, in


men with well-documented bacterial prostatitis, the
secretions alkalinize and may reach or exceed pH 8.25.

Zinc, magnesium, citric acid, and acid phosphatase in the


ejaculate appear to originate in the prostatic secretions.
The periurethra/transitional zone
The periurethral zone is surrounding the urethra.

Benign hyperplasia originates in this region and may


lead to obstruction of urinary outflow from the
bladder.
The central zone
The central zone of the prostate is located between
the urethra and ejaculatory duct.

This area appears to be least susceptible to


development of inflammatory, hyperplastic, or
neoplastic disease
The peripheral or outer zone
The portion of the prostate that is palpable on rectal
examination.

The peripheral zone is also the region of the prostate


that is most frequently involved in carcinoma and
inflammation.
Bulbourethral glands
(Cowpers glands)
These paired, peasized glands are
located in the urogenital diaphragm.

The bulbourethral glands secrete a thin,


mucoid material during the excitatory
stage of sexual response, but the
bulbourethral glands contribute only a
minimal amount to the ejaculate.

These glands are relatively immune to


hyperplastic and neoplastic disease,
although they can be involved in
infections.
The lymphatic drainage of the
perineum
All the skin and superficial structures of the perineum
have lymphatics which course via the medial aspect of
the thigh to the superficial inguinal nodes.

Anal and perianal ulcers caused by syphilis, chancroid,


herpes simplex virus, or lymphogranuloma venereum
cause inguinal lymphadenopathy.

Channels from these nodes penetrate the fascia of the


thigh at the saphenous opening to join the lymphatics
from the leg.
The lymphatic drainage of the testis

The testicular lymphatics course superiorly in the spermatic


cord, traverse the inguinal canal, and then ascend in the
retroperitoneum with the testicular vein.

In this manner, the lymphatics reach the para-aortic lymph


chain at the level of the renal vessels.

This point is important clinically because metastases from


testicular tumors do not cause inguinal adenopathy unless
the usual lymphatic channels have been disrupted by
infection or previous surgical procedures.
Rectum
In the rectum, there are two to four permanent
semicircular transverse folds of the mucosa, which
are termed rectal valves.

Microscopically, the mucosa of the rectum is


composed of columnar absorptive cells, although
goblet-type mucous cells are interspersed among the
absorptive cells.
Anus
The rectoanal junction is not a discrete point but a
longitudinal mucosal fold extending superiorly from mucosa
that is paler and flatter .

This gives the appearance of a horizontal band with teeth,


hence the term pectinate line.

The mucosal ridges forming the tooth-like character of the


line are termed anal folds or columns (of Morgagni).
At the pectinate line between the base of the anal
columns, the mucosa is redundant with outpockets
to form the anal crypts.

The epithelium of the anus, i.e., distal to the


pectinate line, is haracterized by stratified squamous
cells of the nonkeratinizing type.

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