Anatomy of female pelvic organs - PowerPoint Presentation

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Anatomy of female pelvic organs

Presented by : Dr. Sonu Lecturer

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Female pelvic organs Divided into---

External genitalia Internal genitalia

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External genitaliaIncludes- Mons pubis/veneris

Labia majora Labia minora Clitoris Vestibule PerineumSome gynecologists regard the perineum as part of vulva and many include under this term the perineal body (central tendon of perineum) as well as the overlying skin.To Anatomist s , perineum means all structures within the bony outlet of the pelvis.

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भगद्वादशाड्.गुलानि भगविस्तार:

(सु.सू.३५/१२)भगो योनि:, तस्य विस्तारो रन्ध्र:,तस्य परिणाहो द्वादशाड्.गुल:, इदं तु भगप्रमाणं हस्तिनीजातिस्रिया ,कामशास्त्रोक्तवात् (डल्हण टीका)अधस्ताद् रक्तवहं स्मरातपत्रस्याध: आर्तववहं| स्मरातपत्रं भगस्योपरितने भागे|………उक्तं च- विपुलपिप्पलपत्रसमाकृते: अवयवस्य शिरस्तलमाश्रितं।

सकलकामशिरामुखचुम्बितं निगदितं मदनातपवारणम्॥ (सु.शा.५/१० डल्हणटीका)

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Development of Ext. GenitaliaCloaca- the most caudal part of the hindgut.Cloacal membrane seperates

the cloaca from the proctodaeum or anal pit.Cloaca – subdivision into broad ventral part Narrow dorsal partThese two parts –separated from each other by the formation of urorectal septum.Later on ventral part forms- primitive urogenital sinus- form urogenital system.Dorsal part- primitive rectum.Urorectal septum grows towards the cloacal membrane and divides it also in ventral

urogenital

membrane and dorsal anal membrane.

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Cont.Urogenital system- derived from intermediate mesoderm and primitive urogenital sinus of cloaca.

P.U.S. divides-cranial vesicourethral canal and caudal definitive Urogenital sinus.Definitive urogenital sinus- divides into cranial pelvic part and caudal phallic part.Urogenital membrane becomes elongated in craniocaudal direction.Mesoderm on either side soon heaped up to form two longitudinal elevations called primitive urethral folds.Three more elevations are – genital tubercle , right and left genital swellings.

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Contd.Genital tubercle- forms clitoris.Genital swellings- labia majoraPrimitive urethral folds- labia minora

.urogenital membrane breaks down so that continuity establishes between urogenital sinus (which forms vestibule) and exterior.

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MONS PUBISMons veneris/Mons

venusMons means mountain/moundSubcutaneous adipose connective tissue that overlies the pubic symphysis and lower abdominal muscles.It protects the pubic symphysisDuring adolescence sex hormones trigger the growth of pubic hair on the mons pubis (adrenarche) in triangular pattern.Sexual sensation arises here. (Dawn)Hair varies in coarseness, curliness, amount, color and thickness

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LABIA MAJORAReferred to as the large/outer lips (7-9cm long, 2.4 cm wide, 1-1.5 cm thick) on each side of

pudendal cleft.formed of skin, subcutaneous adipose connective tissue.Adipose tissue richly supplied with venous plexus-hematomaJoin medially to form posterior commissure (covers the perineal body)Lateral boundary of vulvaRound ligaments insert at its anterior third Protect the introitus and urethral openings Covered with hair, sweat glands, sebaceous glands

Some of the sweat glands are large, coiled and

specialised

k/as

apocrine

glands…found in

axilla

, vulva and their secretion when modified by bacteria gives rise to specific

odour

which is of sexual significance.

Inner surface hairless

H

omologus

with scrotum in male (

labioscrotal

or genital swellings)

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Contd.The skin over the mons

and L.majora contains hair and has a subcutaneous layer similar to that of abdominal wall.The subcutaneous layer consists of a superficial fatty layer similar to Camper fascia and

a deeper membranous layer

called

Colles

fascia/Superficial

perineal

fascia

(

Scarpa

Fascia

of ant. Abdominal wall)

Clinical correlation-

Colles

fascia

attaches

firmly to the

ischiopubic

rami

laterally and the

perineal

membrane

posteriorly

. These attachments prevent the spread of fluid, blood or infection from the superficial

perineal

space to the thighs or posterior

perineal

triangle.

Anteriorly

Colles

fascia has

no attachments

to the

pubic

rami

and it is therefore continuous with the lower anterior

abd

wall, so spread of infection, fluid, blood between these compartments.

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Contd. The round ligament and the obliterated

processus vaginalis also termed the canal of Nuck, exit the inguinal canal and attach to the adipose tissue or skin of the labia majora.Thus the D/d

of a mass in the l.

majora

should include a

leiomyoma

arising from the round ligament or persistent

processus

vaginalis

.

A

congenital inguinal hernia

also may reach the labium

majus

.

Mons and

l.m

. are exposed to ordinary diseases of skin like psoriasis, sebaceous cysts, boils and

caruncles

and new growths.

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LABIA MINORAReferred to as the “inner lips”/small lips (5 cm long and 0.5-1cm thick)Made up of 2 thick folds of skin just within labia

majora.Ant. Divide to enclose clitoris& form prepuce, frenulumLower portion meets to form fourchette.Do not contain hair follicle, sweat glands, fat.Contain loose connective tissues (allow mobility of skin during intercourse and accounts for the ease of dissection with vulvectomy), sebaceous glands, erectile mm fibres, vessels, nr endingsFossa navicularis the depression b/w fourchette

and hymen.

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Clinical correlationLabia minora in some cases become pendulous (>5cm)

and can be drawn into the vagina during coitus. If associated with dyspareunia in this setting, the labia can be reduced surgically (V shaped wedge excision).Chronic dermatologic diseases such as lichen sclerosus (involved anogenital skin) may lead to significant atrophy or disappearance of the l. minora.The main hallmark of this disease is vulvar pruritus.

On physical examination, typical white atrophic papules may coalesce into porcelain white plaques and lead to labia

minora

regression, clitoral concealment, urethral obstruction and

introital

stenosis

. Over time a lesion may spread to the perineum and anus form a figure 8 or hourglass shape.

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स्मरातपत्र/भगशिश्निका/मदनातपत्रइसका वर्णन टीकाकार डल्हण ने किया हॆ।

यह भग के ऊपर के भाग मे स्थित होता हे।कामकला के समय यह अड.ग अत्यन्त हर्षण युक्त होता हे।

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CLITORISHighly sensitive organ composed of nerves, blood vessels, and erectile tissue.

Located under the prepuce.It is made up of a body (2 cm), glans (0.5 cm) ,2 crura.2 crura which attach it to pubic bones.Becomes engorged with blood during sexual stimulation.Key to sexual pleasure for most women.Analogus to penis in the male.Vessels of clitoris are connected with vestibular bulb

Attached to pubic

symphysis

by

suspensory

ligament.

Smegma

is secreted beneath the prepuce.

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VestibuleMeaning a forecourt or a hall next to entrance.Bounded laterally by Hart line (demarcates changes in epithelium) and medially by hymenal

ring.Beyond Hart line the startified sqamous epithelium has a thin keratin layer.Inside hart line, the epithelium is non keratinized.Clinical correlation- important for choosing incision sites for Bartholin gland duct drainage or marsupialization ( inside the Hart line good)Triangular space4 openings- (1) urethral opening (2) vaginal orifice and hymen (3) bartholin’s gland

Urethral opening

Situated in midline

In front of vaginal orifice

Paraurethral

ducts open here

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Vaginal orifice and hymenLies in post. end of vestibule

Incompletely closed by a septum of mucous membrane called hymenIt is one of the signs of loss of virginity.Hymen is relatively avascular so its tearing usually causes only a slightly loss of blood. during childbirth hymen is extremely lacerated& form carunculae myrtiformisBartholin’s gland/greater vestibular glandsPea sized 0.5 cmYellowish white colourSituated in superficial perineal pouch

during sexual excitement, it secretes abundant alkaline mucus which helps in lubrication

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Contd. Contraction of bulbocavernous helps to squeeze the secretion.Lined by columnar epithelium

Duct 2cm & opens into the vestibule at 5 and 7 o clock position.Bulb of the vestibuleTwo elongated (3 cm long)vascular erectile masses.Anterior ends are joined to one another and to clitoris.Posterior ends in contact with Bartholin glands.Their superficial surfaces partially covered with Bulbocavernosus muscles.Deep surfaces in contact with perineal membrane.Becomes engorged with blood during sexual arousal, narrowing the vaginal orifice & placing pressure on the penis during intercourse.

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Clinical correlationThe proximity of the Bartholin glands to the vestibular bulb accouts for the significant bleeding sometimes encountered with

Bartholin gland excision.

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PERINEUMThe muscle and tissue located between the vaginal opening and anal canal

Unlike the rest of vulva, it has very little sub-cutaneous fat so the skin is close to the underlying muscles.It supports and surrounds the lower parts of the urinary and digestive tractsThe perineum contains an abundance of nerve endings that make it sensitive to touch.An episiotomy is an incision of the perineum used during childbirth for widening the vaginal openingDiamond shaped area that includes urogenital triangle & anal triangle.Boundaries same as that of pelvic outlet.

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Urogenital trianglePierced by terminal part of vagina and urethra2 compartments-superficial and deep perineal

pouchS.P.P.- formed by deep layer of colles fascia and inferior layer of urogenital diaphragm(perineal membrane).Contents- superficial transverse perinei, bulbocavernosus, ischiocavernosus and Bartholin gland.D.P.P-formed by inferior and superior layer of urogenital diaphragm/triangular ligament.Contents are- Deep transverse perinei, sphincter urethrae

membranaceae

.

Both pouches contain vessels and nerves.

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Anal triangleNo obstetric importance.Terminal part of anal canal with sphincter ani externus

, anococcygeal body, ischiorectal fossa, blood vessels, nerves, lymphatics.

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Obstetrical perineumThe interval between post. Commissure and anus constitutes the perineum (4cm*4 cm)Also called

perineal body, central point of perineum.Contains fascia- camper, colles, urogenital diaphragm layers.Muscles- superficial and deep transverse perinei, bulbosongiosus, levator ani, sphincter ani externus.Importance-Helps to support the levator ani

Support the post. Vaginal wall.

Vulnerable to injury during childbirth

Episiotomy.

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Blood supply of VulvaArteriesVeins

Internal pudendal artery branches- Labial, transverse perineal, vestibular bulb, deep and dorsal branches of clitoris.Femoral artery- superficial and deep pudendal.Internal pudendal veinVesical or vaginal venous plexusLong saphenous vein

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Nerve supply of VulvaAnterosuperior part-Ilioinguinal and genitofemoral nerve (L1 and L2)

Posteroinferior part- Post. Cutaneous nerve of thigh (S234)In b/w- pudendal nerve- labial and perineal branches (S234)

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Lymphatics of vulvaDense lymphatic plexus in the dermis of vulvaIpsilateral free communication and also

contralateralHardly cross beyond labiocrural foldAlso anastomose with lower third of vagina lym.Superficial inguinal lymph nodes are the primary sentinel nodes of vulva.Deep inguinal lymph nodes are secondarily involved.It is unusual to find positive pelvic glands without metastatic disease in the inguinal nodes.Pattern- Lym. Of vulva- S.I.L.N.- D.I.L.N.-P.N.Responsible for spread of vulvar carcinoma. Incidence of lymph node involvement directly related to site, size of lesion and depth of stromal invasion.

Regional lymph nodes are assessed clinically and By MRI, USG, PET,

sentinal

node

lymphoscintigraphy

using technetium 99.

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Applied partSecondary sexual characters- Pubic hair growthVulval defence

Round ligament fibroidBartholin cyst/abscess-marsupilisationClitoromegalyCongenital anomalies-cryptomenorrhoeaEpisiotomyClitoris may be absent, may be bifid or may be double. It may be enlarged in hermaphroditism (adrenogenital syndrome/CAH)Labia minora may show partial fusion.Urethra may open on the anterior wall of vagina, this is the female equivalent of male hypospadias.

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INTERNAL GENITALIAThe internal genitalia consists of the:

VaginaCervixUterusFallopian TubesOvaries43

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योनि/मनोभवागारमुखपुरूषों में ९ बहि:मुख स्त्रोत होते हॆं।स्त्रियों में ३ अधिक होते हॆं।

एतानि एव स्त्रीणाम् अपराणि च त्रीणि-द्वे स्तनयो: अधस्ताद् रक्तवहम् च।(सु.शा.५/१०)सु- रक्तवहवा- रक्तपथभा.प्रा.- गर्भवर्त्मव्याख्या- भग के ऊपर के भाग मे स्थित स्मरातपत्र के नीचे यह आर्तववह स्त्रोतस स्थित हॆ।(डल्हण)

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योनि की आकृतिशड्ख.नाभ्याकृति: योनिस्त्रयावर्त्ता सा प्रकीर्तिता।

तस्यास्तृतीये तु आवर्त्ते गर्भशय्या प्रतिष्ठिता॥(सु.शा.५/४३)योनि की नाडियां एवं उनकी विशेषता-(भा.प्रा.पूर्व.३/१७-२०)(१) समीरणा- मदनातपत्र में रहती हॆ; यदि शुक्र यहां गिरता हॆ, तो निष्फल होता हॆ।(२) चन्द्रमुखी- कन्दर्पगेह में रहती हॆ; रति में सुखसाध्य, कन्या प्रसविनी होती हॆ।(३) गॊरी- उपस्थगर्भ में रहती हॆ; रति में कष्टसाध्य, पुत्रप्रसविनी होती हॆ।

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Avartha of YoniYoni is that organ whose structure is compared with

Shankha Nabhi i.e. Narrow below and broad above and also this structure is placed in such a manner i.e. it is seen like Concentric Circle that is called as Avartha.

These three

Avartha

of Yoni should be

1.

First

Avar

tha

should be Vagina: - It Starts from Vestibule to External Os.

2.

Second

Avartha

should be Cervix: - It starts from External Os to Internal Os.

3.

Third

Avartha

should be Uterus:- It starts from

Inernal

Os to

Fundus

of Uterus (

AlpaMuka

and Anta

Sushria

)

Avarta

also means

rugae

as told by

Acharya

Ghanekar

.

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VAGINAMeans sheath, fibromusculomembranous sheath.Hollow viscus, Communicating the uterine cavity with exterior at vulva.

Excretory channelOrgan of copulationForms the birth canalForming an angle of 45* with the horizontalLong axis of vagina parallel to the plane of inletCanal diameter-2.5 cm, distensibility power due to rugae.

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Contd.Walls- 4 (i) anterior : 7cm

(ii) posterior: 9cm (iii) 2 lateral wallsFornices- 4 (i) anterior: shallow one (ii) posterior: deeper one (iii) 2 lateralHistology of vagina- (i) Mucosa-stratified sq. epi. , rugae (ii) Submucosa-loose areolar vascular tissues (iii)Muscular layer-inner circular and outer long (iv) Serosa –tough and highly vascular

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Contd.3 distinct layers are defined: (1) para Basal cells/Basal cells

(2) Intermediate cells (3) Superficial cells contain glycogen under estrogen influenceGlycogen lactic acid {Doderlein’s bacilli} maintain vaginal pH [4- 5.5]

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Contd.Birthto 2 wks: maternal estrogen present, thick sq epithelium2 wks to

prepuberty: no estrogen , thin epitheliumPuberty: estrogen appears , thick epitheliumReproductive period: estrogen present, Post menopause: again estrogen amount decreased, atrophy

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Contd.Secretion: very small little excess in mid menstrual , just prior to menses, during pregnancy, during sexual excitement.

Derived from: cervical glands endometrial glands transudate of vaginal epithelium Bartholin’s glandsNote- dendritic cells in its mucosa are antigen presenting cells, so unfortunately they participate in transmission of viruses for e.g. HIV

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गर्भाशय / धरा / fMEHk

यथा रोहितमत्स्यस्य मुखम् भवति रूपत:। तत्संस्थानां तथारूपां गर्भशय्यां विदुबुधा:॥(सु.शा.५/४४)स्त्रीणाम् गर्भाशयोअष्टम इति। (सु.शा.५/८)पित्तपक्वाशयो:मध्ये गर्भशय्या यत्र गर्भ:तिष्ठति॥(सु.शा.५/४३)स्त्रीणाम् तु बस्तिपार्श्वगतो गर्भाशय: सन्निकृष्ट:॥(सु.चि.७/३३)तेषाम् अधस्ताद् विपुलम् स्त्रोत: कुण्डलसंस्थितम्।

जरायुणा परिवीतम्

स गर्भाशय उच्यत॥(का.शा.३/६,७)

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UTERUSHollow Pyriform

(pear shaped) Fibro-muscular (Garbhachidrasamshrita 3 peshi; three muscles of myometrium) organ (kshetra).Situated in pelvisIn b/w bladder & rectumMeasures about 7.5 cm long,5 cm wide,2.5 cm thick (during pregnancy 35 cm)Wt - 50-80 gmShape, wt, and dimensions vary a/c to parity and estrogen stimulation.Capacity-5-10 mlPosition-AVAF normal

In 15-20%, RVRF position

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Contd.Parts:- (1) body/corpus (muscular)- fundus

Fundus body proper cornua of uterus(2) isthmus- importance (3) cervix- fibrous

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Uterine cavityTotal length- 6-7 cmCavity/body- triangular-3.5cmNo cavity in fundusCavity/cervix- fusiform-2.5cm

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Changes of uterus with age and parityIn intrauterine life (28 wk)- body:cervix=5:1At birth- cervix much longer> body =2:1

Childhood (before menarche)- cervix: body= 1:1Puberty- body:cervix=2:1 (estrogens)Childbirth- body:cervix=3:1After menopause- body:cervix=1:1 (atrophy, less muscular more fibrous)

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Contd.Fundus:-

Lies above the openings of the uterine tubesNo cavity Body proper:-TriangularLies b/w uterine tubes & isthmusCornua:-Uterine tube,round lig.,lig. of ovary attached here

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contd.Cervix: Extends from histological int. os

to ext. os.Cylindrical shape,2.5 cm length and diameter 2 parts (1) supravaginal part-1.25 cm(2) vaginal part-1.25 cmIn nulliparous- conical cervix circular ext osIn multiparous- cylindrical cervix ext os having slits

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Uterus Strutures-Body-

3 layers– a) perimetrium b) myometrium c) endometrium

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Endometrium Mucous lining of the cavity, no submucosaThickness varies: 1-10 mm a/c to phase of menstrual cycle.

Basal zone and functional zone.Consists of lamina propria & surface epitheliumsurface epithelium- single layered ciliated Columnar epitheliumLP contains stromal cells,endometrial glands (tubular or spiral),vessels,nervesGlands lined by non ciliated but secretory columnar epitheliumChanged to

decidua

during pregnancy

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Perimetrium/PeritoneumPresent on- Whole fundus

Anterior wall upto isthmus (not cervix)Post. Wall as low as the attachment of vagina to the cervixIt is intimately connected with the underlying muscle that it cannot be stripped away.Absent on-Sides of uterus b/w the attachment of 2 leaves of broad ligament.Lower ant. Uterine wallWhole cervix except posteriorly

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MyometriumDuring pregnancy 3 layers-Outer longitudinal- continuity with outer muscles of tube and vagina.

Middle interlacing/oblique- main mass- smooth/involuntary muscle-crisscross fashionInner circularFibrous and elastic tissues are mixed with muscle in varying amounts.Repeated childbearing and advancing years –fibrous tissue increase and increased risk of spont. rupture of uterus during labor.

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CervixComposed mainly of fibrous connective tissuesSmooth mm fibres

10-15%Endocervix:- Arbor vitae uteri-the mucosa lining the canal thrown into folds which consist of ant. And post. Columns from which radiate circumferential folds to give apperance of tree trunk and branches. columnar epithelium basal/reserve cells underneath the columnar epi (these cells may undergo sq. metaplasia or may replace the superficial cells) glands complex racemose type-secretary columar epi

.

No

stroma

Ectocervix

/

Portio

vaginalis

:-

stratified

sq.epithelium

this epithelium extends

upto

ext.os

where there is abrupt change to columnar type.

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Contd. Transformation zone:-1-10mm widthNot static but changes with hormone level of estrogen,

infection,traumaMore chance of severe dysplasia,carcinoma in situ,invasive carcinomaSecretion:- endometrial secretion- scanty &wateryCervical secretion changes with cycle and pregnancy.Cervical glands- secrete alkaline mucus 7.8 pHMucus plug-functionally closes the cervical canal and bacteriolytic property.

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Contd.Mucus is rich in fructose,glycoprotein,mucopolysaccharides,NaClPosition:

anteversion&anteflexionUterus usually inclines to the right(dextrorotation)Cervix is directed to left(levorotation)In about 15-20%uterus remains in retroverted position Blood supply:- uterine artery (paired)- branch of int.iliac artery arcuate arteries

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Contd.Arcuate arteries arranged in a circular fashion in myometrium

radial arteries(deep penetrate in myometrium) Straight arterioles spiral arteries supply stratum basalis supply stratum functionalis in endometriumVeins:- uterine veins drain into int.iliac veins

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RelationsAnt.- Above the internal os- uterovesical pouch Below the internal

os- separated from base of bladder by loose areolar tissue.Post.- PODLaterally- Broad ligament- in which uterine artery ascends Mackenrodt’s ligament- extends from internal os, supravaginal cervix, lateral vaginal wall.About 1.5-2 cm away at the level of internal os, a little nearer to left side is the crossing of uterine artery and ureter (bridge over water).

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Lymphatics of CorpusExtrinsic drainage-1. from fundus and adjoining part of body------Para aortic lymph nodes

2. From cornua----superficial inguinal3. rest of body---external iliac group4. adjacent to cervix----cervical lymphaticsIntrinsic plexus-2 plexuses—1. Basal layer/endometrium 2. subserosal layerThe lymphatics from basal layer run through myometrium in close relation to blood vessels to reach subserosal plexus.

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Lymphatics of cervixPrimary group-1. sacral nodes2. external iliac3. internal iliac

4. obturator5. parametrialSecondary Group- the lymphatics from all primary groups drain into common iliac and superior lumbar group.

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आर्तववह स्त्रोतस्आर्तववहे द्वे,तयो:मूलम् गर्भाशय आर्तववाहिन्य:च धमन्य:।

तत्र विद्धायाम् वन्धयत्वम् मॆथुनासहिष्णुत्वमार्तवनाश: च॥(सु.शा.९/१२)स्त्री शरीर स्थित आभ्यन्तर स्त्रॊतसॊं का वर्णन केवल सु. जी ने किया हॆ।

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धमनी(१) ऊर्ध्वगा धमनी- द्वे

स्तन्यम् स्त्रिया वहत: स्तनसंश्रिते,ते एव शुक्रम् नरस्य स्तनाभ्यामभिवहत:।(सु.शा.९/५)(२) अधोगा धमनी- अधोगमा:तु ........आर्तवादीन्यधॊ वहन्ति। .......शुक्रवहे द्वे शुक्रप्रादुर्भावाय,द्वे विसर्गाय,ते एव रक्तमभिवहतो नारीणामार्तवसंग्यम्।(सु.शा.९/७)

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Fallopian tube10 cm long, Oviducts and ovary constitute adnexa.2 openings

Uterine Pelvic opening (1mm) (2mm)4 parts

Isthmus (2.5 cm)

Ampulla

(5cm)

Infundibulum (1.25cm)

Interstitial(1.25)

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Fallopian tubeLies in upper free border of broad ligament.It connects the peritoneal cavity to the uterine cavity.1. Infundibulum- bell shaped outer end surrounded by

fimbriae, Abdominal ostium- 2mm diameter.It is devoid of broad ligament and can move freely to cover the ovary and catch the ovum.2. Ampulla- longest, widest tortous part, 6mm diameter, fertilisation occurs here.3. Isthmus- straight part4. Interstitial/ Intramural- traverses the wall of uterus, devoid of peritoneum and longitudinal muscle fibres, uterine opening 1 mm diameter.

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Contd.Histology of fallopian tube-3 layers: (i) serosa- cover whole tube except

mesosalpinx attachment and intramural part. (ii) muscular-outer long. and inner circular, thickest at isthmus-acts as sphincter and thin in ampulla, peristalsis of f. tube is due to muscular layer. (iii) endosalpinx(mucosa)- lined by columnar epithelium partly ciliated secretory non ciliated Peg cellsNo

submucous

layer nor any glands.

Functions:- (1) transport of gametes

(2)facilitate

fertilisation

(3)survival of zygote through its secretion

.

Peristalsis and production of secretions from the

endosalpinx

are under the influence of ovarian hormones, undergo cyclical changes.

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Contd.Blood supply-Artery-uterine Vein

-ovarian veins ovarian Nerve supply- uterine & ovarian nerves.Note- Tube is very much sensitive to handling.

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OVARYEgg receptaclesFemale gonads or paired sex glands (3*2*1 cm), wt 5-10 gms average 7 gm

Intraperitoneal gland without peritoneal covering.Shape& size- unshelled almondsHomologus to testesConcerned with- (i) production of gametes (ii)hormones- estrogen, progestrone, relaxin, inhibin Note- ovary descend to the brim of superior portion of the pelvic cavity during 3rd month of development.

contains a

Hilum

,

the point of entrance & exit for blood

vessels,nerves

.

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Contd.Position- in nulliparous: vertical in multiparous

: horizontalExternal features- before onset of ovulation: smooth surface after puberty: puckered surface2 ends/poles- upper/tubal pole lower/uterine pole2 borders- Ant./mesovarian border Post./free border2 surfaces- medial & lateral

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Contd.Ligaments which hold them in position- (i)

mesovarium (ii)ovarian ligament (iii)infundibulopelvic/suspensory ligament Histology of ovary-(1)Germinal epithelium- covers the surface of ovary except at hilum.Note- it is a misnomer bcz it does not give rise to ova. The progenitors of ova arise from the yolk sac and migrate to the ovaries during embryonic development.(

2)Tunica

albuginea

(3)

Cortex

- contains primordial follicles, maturing

follicles,Graafian

follicles,corpus

luteum,corpus

albicans

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Contd. (4)Medulla- loose connective tissue, vessels, nerves, few unstriped muscles

Blood supply- ovarian artey ovarian veinNerve supply- sympathetic supply from T10 segment.

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Pelvic floor/ Pelvic DiaphragmConsists of all tissues lying in b/w pelvic cavity and surface of vulva and perineum.Includes the pelvic peritoneum, extraperitoneal fat and cellular tissue, l.

ani and its fascia, urogenital diaphragm, muscles of perineum, subcutaneous fascia and fat, the skin. (jeffcoate)The muscle with its covering fascia- k/as Pelvic diaphragm.Which muscle??Levator Ani- physiologically maintain a constant state of contraction. (Williams)Complex unit, Consists of three sets of muscles-1. Pubococcygeus2. Iliococcygeus

3.

Ischiococcygeus

/

coccygeus

Two surfaces- Upper-

concave….covered by parietal layer of pelvic fascia (direction downwards, backwards, medially)

Inferior-

Convex…….covered by anal fascia

.

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Bilateral Strong muscle, fatigue resistant, striated muscle (voluntary)Relaxed during evacuation of bowel and bladder (during bearing down effort)Slug like hammock around pelvic organs.Origin- from the back of pubic

rami-pubococcygeusfrom the condensed fascia covering obturator internus (white line)- iliococcygeusFrom the inner surface of ischial spine- IschiococcygeusInsertion-Pubococcygeus- post fibres into

anococcygeal

raphe

(extends from

anorectal

junction to tip of coccyx)

and

tip of coccyx

;

puborectalis

-

around

anorectal

junction and form sling;

puboanalis

- run b/w sphincter

ani

externus

and

internus

…

inserted

in wall of anal canal;

pubovaginalis

-

form U shaped sling, ant

fibres

inserted into

perineal

body

.

Iliococcygeus

-

from white line, inserted into coccyx.

Coccygeus

-

triangular in shape.

Arises from apex of

i.spine

and

sacrospinous

ligament.

Inserted into upper 2 pieces of coccyx and last piece of

sacrum

.

Its

fibres

are not inserted into the bladder and urethra.

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Piriformis muscle-origin from sacrum and inserted into Greater trochanter of femur.Gaps-

2Hiatus urogenitalis-transmitting urethra and vagina Bridged by muscles and fascia of urogenital triangle.Hiatus rectalis-transmitting rectum.Relations-Sup. Surface- Pelvic organs, pelvic cellular tissues, ureter, nervesInf. Surface-anatomical perineum.Nerve supply- 3rd and 4th

sacral nerve, inferior rectal nerve,

perineal

branch of

pudendal

nerve.

Blood supply-

inferior

gluteal

artey

of anterior division of internal iliac artery.

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FunctionsSupport the pelvic organs specially pubovaginalis…

..weakness or tear causes prolpaseCounteracts the downward thrust of increased intrabdominal pressure during coughing, sneezing, straining by its contraction.Guards the hiatus urogenitalisFacilitates anterior internal rotationIschiococcygeus stabilises the sacroiliac and sacrococcygeal joints.Steady the perineal body.

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Thanks