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LEARNING OBJECTIVES

1. Significance of Reproductive Anatomy

2. Male reproductive anatomy
3. Female pelvis: components, types, functions. Pelvic
diaphragm
4. The vulva, perineal region and Vagina and its relations
5. The uterus and fallopian tubes: parts, supports,
physiology of the endometrium, reproductive functions,
sperm and ovum transport.
6. The ovary; structure and control and role in fertility
7. Pelvic Blood supply: Colatteral circulation and
Lymphatic drainage
8 Anterior abdomen and Breast:Clinical significance
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9 Pituitary: Control of fertility
 INTRODUCTION
Significance of reproductive anatomy.

* Understanding of the severity of any pathology.

* Surgical intervention

* Complications of operation and

Appropriate management

* Fertility potential

•Obstetrics-progress of pregnancy
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Male Reproductive System
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MALE GENITAL ORGANS

Prostate- shaped like chestnut

Scrotum- dartos muscle

testes
Testis: left lower than the right within the scrotum
capsule- tunica albuginea
Blood supply-testicular a
nerve supply- T10 sympathetic fibres via renal and
aortic plexus.
200-300 lobules(contain seminiferous- each 62 cm
long- Epididymis
Vas deferens 45 cm ( same as thoracic duct, spinal cord, femur,
from incisor to cardia of stomach)
Seminal vesicle 5 cm long on each side of peritoneal portion of
urinary bladder
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Penile organ- glans, body( corpus spongiosus and cavernosus.
Female Reproductive System- Female Pelvis

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 PELVIC BONE
Significance:
Weight bear
Types Parts Obstetric
* Gynaecoid * Inominate Outcome
* Android Ilium Pudendal
* Anthropoid Pubis block
* Platypelloid Ischium
* Sacrum
* Coccyx

Geneder differences Joints

Long A-P diameter Lumbo-sacral
Oval pelvic inlet Pubic symphysis
Sacral concavity Sacroiliac
Wide pubic arch Sacrococcygeal
Light ischial spines Coccygeal 9
Fetal Skull
FETAL SKULL

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 EXTERNAL GENITALIA

Perineum
Mons pubis Floor- skin
Urogenital triangle Room-pelvic diaphragm(Levator
labia majora ani and coccygeous muscles
labia minora
Clitoris -glans, body and
two crura
Vestibule Urogenital triangle Anal triangle
vagina---HYMEN superficial fascia anal canal
urethra Colles fascia lateral ischio
ostia of bartholin glands superficial perineal rectal fossa
pouch Sphincter ani
Deep perineal pouch muscle
Hymen Pudendal
Annular, Semilunar or neurovascular
crescentic, Septate bundle 12
COMPONENTS OF LEVATOR ANI MUSCLE
Muscle Origin Insertion Function

Pubovaginalis Pubic bone Perineal body

Constriction of
the vagina
Puborectalis Pubic bone Posterior rectum Sphincter of
anal canal
Pubococcygeus Tendon of Anococcygeal Constriction of
obturator fascia ligament anal canal
Iliococcygeus ” " "

Other muscles
Coccygeus Ischial spine Lower border
of sacrum and
coccyx
Obturator internus
Piriformis 13
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 SUPPORTS OF THE UTERUS

* Levatore Ani muscle

*Cardinal ligament(ligament of mackenrodts or
transverse ligament)
*Uterosacral ligament

LIGAMENTS

Sacrotuberous ligament- from dorsal surface of sacrum and

coccyx, and from the posterior and
inferior iliac spine and down to the
medial surface of ischiotuberosity
Sacrospinous ligament- From lateral margin of coccyx to
lowermost of sacrum and attaches to
ischial spine.
*Greater and lesser sciatic foramina 17
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 BLOOD SUPPLY OF THE PELVIS
Ovarian arteries Rich Collateral
superior rectal artery Circulation: Ovarian-
Middle sacral artery Uterine-vaginal
Common iliac artery
External iliac artery
Internal iliac arteries
Posterior trunk Anterior trunk
Iliolumbar artery Umbilical artery
Lateral sacral artery Obturator artery
Superior gluteal artery Uterine artery
Vaginal artery
Middle rectal artery
Internal pudendal artery
Inferior gluteal artery 19
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Lymphatic drainage of the pelvis

* External iliac lymph nodes

Bladder
Isthmus of the uterus
deep inguinal lymph nodes
superficial inguinal lymph nodes
* Internal iliac lymph nodes
* Sacral group of lymph nodes
* Lower paraortic nodes
Medial superficial lymph nodes
Inferior perineal structures
inferior anal canal
lower vaginal and distal urethra

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NERVES OF LESSER PELVIS

Lumbosacral trunk( L4, L5)

Sacral plexus( L4, L5, S1,S2, S3, S4
Sciatic nerve( L4,L5, S1, S2, S3) --Common peroneal and
tibial nerves
Pudendal (S2, S3, S4) passes through greater and lesser
sciatic foramina to the pudendal canal
Coccygeal plexus(S4, S5)

Lumbar plexus
Iliohypogastric nerve( L1, T12)
Ilioinguinal (L1)
Genitofemoral(L1, L2)
Femoral ( L2, L3, L4)

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THE AUTONOMIC NERVOUS SYSTEM

* Sympathetic pathway
paravertebral ganglia sympathetic trunk
prevertebral ganglia pelvic organs

* Parasympathetic system
preganglionic fibres from S2, S3, and S4
(Nervi erigentes). Postganglionic fibres supply
urinary bladder, descending colon, the rectum and
reproductive organs

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Anterior abdominal wall

• Layers:
skin
subcutaneous tissue (fat)
fascia and muscle
peritoneum
• Nerve supply
• Blood supply and lymphatic drainage

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Landmarks

• Umbilicus is obvious - unreliable in

anatomical terms
• Xiphoid process and symphysis pubis
• Costal margin
• Anterior superior iliac spine

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Skin

• Scars
• Striae - secondary to stretching
• Natural folds and creases - important
for surgical scars

• Lower intercostal (T6-11), subcostal

(T12), ilio-hypogastric and ilio-inguinal
(L1)
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Superficial fascia

• Varies in thickness with amount of

adipose tissue

• Below umbilicus is in two layers:

superficial fatty and deep membranous

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Rectus sheath

• Anterior layer of the rectus sheath is

the aponeurosis of the external and
anterior half of aponeurosis of internal
oblique muscles
• Posterior layer is formed of posterior
half of the internal oblique and the
whole aponeurosis of transversus
abdominis
• Linea alba 29
Inguinal canal

• Superficial inguinal ring

• Deep inguinal ring
• Anterior wall
• Posterior wall
• Floor

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Hernias 1

• Inguinal hernias more common in men

• Persistent processus vaginalis (layer of
peritoneum.
• Acquired or direct appears at superficial
ring and does not pass towards scrotum
(or labia)
• Femoral is inferior to medial part of
inguinal ligament
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Hernias 2

• Umbilical hernia is usually congenital

• In adults through linea alba near

umbilicus

• Incisional

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Muscles

• External oblique, internal oblique and

transversus abdominis
• Conjoint tendon
• Rectus abdominis - three tendinous
intersections, enclosed by rectus sheath

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Muscles 2

• Pyramidalis
lies between anterior layer of sheath
and rectus abdominis
attaches to pubis and linea alba
• Muscles supplied by lower six thoracic
spinal nerves (through intercostal and
subcostal) and first lumbar (ilio-
hypogastric and ilio-inguinal)
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Fascia transversalis

• Layer of fascia between muscles of

abdominal and pelvic walls and
peritoneum

• Thicker above ingiunal ligament

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Blood vessels and lymphatics

• Laterally - lower posterior intercostals

• Medial - superior and inferior epigastric
• Intercostal veins
• Superior and inferior epigastric veins
• Lymph nodes - four quadrants (inguinal
and axillary)

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The Abdominal incision: Integrity and aesthetic nature of scar

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Breast anatomy

• Exists in both sexes

• Rudimentary in adult male
• In female, varies with age and
functional state
• In lateral plane, base extends from 2nd
to 6th rib
• At level of 4th costal cartilage, extend
from sternum to mid axillary line
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Breast

• Superolateral extension upwards and

laterally - axillary tail
• Deep relation to pectoralis major,
• Separated by deep fascia and
submammary space

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Breast

• Nipple is surrounded by areola

• Traversed by 15-20 lactiferous ducts
• Contains numerous non-striated muscle
fibres
• Areola has sebaceous glands
(Montgomery)

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Structure of breast

• Consists of:
a) fat
b) glandular tissue
• Glandular tissue is arranged in 15-20
radial lobes
• Suspensory ligaments of Cooper
• Duct of each lobe opens onto nipple

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Changes in pregnancy

• Initial increase in duct tissue

• Followed by proliferation of secretory
tissue
• Initially, colostrum is produced
• After delivery, secretory tissue produces
milk

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Breast milk

• 88% water
• 7% lactose
• 4% fat
• 1% protein
• Ca, NA, K, Cl, phospate, antibodies
(IgA)

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Breast blood supply

• Arterial blood supply from thoracic

brances of axillary artery (lateral) and
mammary branches of internal thoracic
(medial)
• Veins form anastamotic circle at base of
nipple thence axillary and internal
thoracic veins

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Lymphatics
• Mainly to axillary lymph nodes
• Five groups:
lateral (axillary vein)
posterior (subscapular)
medial (pectoral)
• Drain into central group, thence apical
group
• Medial tissue drains to anterior end of
intercostal spaces
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Additional lymphatic connections

• Contra-lateral breast and axilla

• Nodes below clavicle
• Nodes above clavicle
• Parietal peritoneum
• Pleura

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Pituitary and Hypothalamus

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 Significance of anatomy and physiology of the Pituitary
1. The structure, location and relations
2. Components
* Neurohypophysis
* Adenohypophysis
i Follicle Stimulating hormone (FSH)
ii Lutuinising Hormone ( LH)
iii Prolactin (PRL)
iv Growth Hormone (GH)
v Thyroid Stimulating Hormone ( TSH)
vi Adreno-corticoid Stimulating Hormone (ACTH)
3. Endocrine control of pituitary function
4. Clinical significance of the pituitary
* Hyperprolactinaemia and infertility
* Hypopituitarism
* Pituitary necrosis- Shehan Syndrome
5. Pituitary control of ovarian function 52
Ovulation, Menstrauation and Conception
1. Physiology of menstrual cycle-: Involves a complex interaction between the
hypothalamus , pituitary, ovaries and the endometrium.
* Proliferative phase
*Secretory phase
2. Ovarian control of the menstrual cycle
* Follicular phase- oestrogen priming
* Ovulation
* Luteal phase- progestational
3 Normal menstrual cycle
Onset- Menarche 10-16 years of age
Cyclicity : 22-35 days
Duration of Menstruation : 3-7 days
Total amount of blood loss: 80 ml
4. Management of menstruation
5 Disorders of menstruation: amenorrhoea
Oligomenorrhoea
Polymenorrhoea
Menorrhagia
Metrorrhagia
6. Fertilisation and Implantation

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