anatomy

Labia minoradivide to 2 surface outer : Thinly keratinized stratified squamous epithelium inner laterally to Hart line medially to Hart line : nonkeratinized stratified squamous epithelium

Labia minora superiorly >> divides into 2 lamellae lower lamellae fuse to form the frenulum of the clitoris upper lamellae merge to form the prepuce Inferiorly >> join to form the fourchette

Clitoris In male : it is the erectile homologue of the penis. size : rarely exceeds 2 cm in length. composed of a glans a corpus or body two crura

ClitorisGlans diameter: less than 0.5 cm. covered by stratified squamous epithelium richly innervatedClitoral body contains 2 corpora cavernosa

Crus each corpus cavernosum diverges laterally to form crus. lies along the inferior surface of its respective ischiopubic ramus and deep to the ischiocavernosus muscle.



Clitoris blood supply >> branches of the internal pudendal a. Deep artery of the clitoris supplies >> clitoral body Dorsal artery of the clitoris supplies >> glans & prepuce

Vestibule In adult women it is an almond-shaped area. enclosed by lateral : Hart line medial : external surface of the hymen anterior : clitoral frenulum posterior : fourchette

Vestibulevestibule usually is perforated by 6 openings: Urethra Vagina 2 Bartholin gland ducts 2 ducts of the largest paraurethral glands—the Skene glands. Between fourchette and vaginal opening = fossa navicularis (usually observed only in nulliparas)



Bartholin glands also termed greater vestibular glands are major glands >> 0.5 - 1 cm. in diameter, 1.5 - 2 cm. long lies inferior to the vascular vestibular bulb and deep to the inferior end of the bulbocavernosus muscle. opens distal to the hymeneal ring on the vestibule. (at 5 and 7 o’clock)

Bartholin glands Following trauma or infection duct may swell and obstruct to form a cyst if infected >> form to an abscessInMinor vestibular glands are shallow glands lined by simple mucin-secreting epithelium and open along Hart line.

Paraurethral glands Multiple small ducts open predominantly along the entire inferior aspect of the urethra. The two largest are called “Skene glands“ typically lie distally and near the urethral meatus If inflammation and duct obstruction >> lead to urethral diverticulum formation.

Urethral diverticulum

Urethral opening lower 2/3 of the urethra lie above the anterior vaginal wall. The urethral opening or meatus is in the midline of the vestibule, 1 - 1.5 cm below the pubic arch, and a short distance above the vaginal opening.

Vagina & HymenHymen is a membrane of varying thickness that surrounds the vaginal opening composed mainly of elastic and collagenous connective tissue both outer and inner surfaces are covered by nonkeratinized stratified squamous epithelium. In pregnant >> hymeneal epithelium is thick and rich in glycogen.

Vagina & HymenVagina a musculomembranous tube that extends to the uterus interposed lengthwise between the bladder and the rectum.

bladder & urethra >> separate by CNT - vesicovaginal septum.lower portion of the vagina & the rectum >> separate by CNT -rectovaginal septum.upper fourth of the vagina & rectum separate by rectouterine pouch(cul-de-sac or pouch of Douglas).

Vagina & Hymen No glands in vaginal >> Instead, the vagina is lubricated by a transudate that originates from the vaginal subepithelial capillary plexus and crosses the permeable epithelium. During pregnancy >> increased vascularity, vaginal secretions are notably increased.

vagina has an abundant vascular supply. proximal portion >> supplied by cervical branch of uterine artery and by vaginal artery. posterior vaginal wall >> supplied by middle rectal artery. distal walls >> supplied by internal pudendal artery.Lymphatics drainage of vagina upper third >> drain into external, internal, and common iliac LN middle third >> drain into internal iliac LN lower third >> drain into inguinal LN

Perineumdiamond-shaped area between thethighsboundaries : pubic symphysisanteriorly, ischiopubic rami and ischialtuberosities anterolaterally,sacrotuberous ligamentsposterolaterally, and coccyxposteriorly.divides the perineum into : anterior triangle, also called the urogenital triangle, posterior triangle, termed the anal triangle.

Perineal body is a fibromuscular mass found in the midline at the junction between these anterior and posterior triangles. measures 2 cm tall and wide and 1.5 cm thick. It serves as the junction for several structures and provides significant perineal support.

perineal supportSuperficially deeply perineal membrane bulbocavernosus m. portions of the pubococcygeus m. internal anal sphincter m. superficial transverse perineal m. external anal sphincter m.

Anterior triangle Superficial space Deep spaceDivided by perineal membrane

Superficial spaceBoundary deeply : perineal membrane superficially : Colles fascia laterally : pubic rami and fascia lata of the thigh inferiorly : superficial transverse perineal muscle and inferior border of the perineal membrane medially : urethra, clitoris, and vagina

Superficial spaceconsist of Bartholin glands vestibular bulbs Clitoral body and crura Branch of pudendal v. & n. Muscle ischiocarvernosus bulbocarvenosus superficial transverse perineal

Deep spaceBoundary Superficially : perineal membrane Deeply : Pelvic cavityconsist of portion of urethra, vagina portion of internal pudendal a. compressor urethrae urethrovaginal sphincter m.

Pelvic diaphragm deep to the anterior and posterior triangles is composed of levator ani and coccygeus m. levator ani is composed of pubococcygeus (pubovisceral) m. pubovaginalis, puboperinealis, and puboanalis muscles puborectalis m. iliococcygeus m.

Pelvic diaphragm

Posterior trianglecontains : ischioanal fossae anal canal anal sphincter complex internal anal sphincter external anal sphincter puborectalis muscle Branches of the pudendal nerve &internal pudendal vessels

Ischioanal fossa fat-filled spaces provides support to surrounding organs yet allows rectal distention during defecation and vaginal stretching during delivery. Clinically >> injury to vessels in the posterior triangle can lead to hematoma formation and large accumulation in these easily distensible spaces. Moreover, the two fossae communicate dorsally, behind anal canal. especially important because an episiotomy infection or hematoma may extend from one fossa into the other.

Anal canal length : 4 - 5 cm mucosa consists of columnar epithelium in the uppermost portion But at the dentate or pectinate line, simple stratified squamous epithelium begins and continues to the anal verge.

Anal canal 3 highly vascularized submucosal arteriovenous plexuses termed anal cushions in case ; Increasing uterine size, excessive straining, and hard stool create increased pressure leads to venous engorgement within cushions >> hemorrhoids

Anal sphincter complexInternal anal sphincter continuation from rectal circular smooth m. layer receives parasympathetic fibers, which pass through pelvic splanchnic n. supplied by superior, middle, and inferior rectal a. length : 3 - 4 cm it overlaps external sphincter for 1-2 cm function : resting pressure for fecal continence and relax prior defecation (70%)

External anal sphincter is a striated muscle ring function : resting contraction to continence (all time) , squeeze pressure when continence is threatened and relax prior to defecation (30%) has been 3 parts subcutaneous superficial deep : consist of puborectalis m. blood supply from inferior rectal a. Somatic motor fibers from inferior rectal br. of pudendal n.

Pudendal nerve formed from anterior rami of S2–4 spinal nerves.

Internal generative organs Uterus Cervix Ligament Blood supply Lymphatic Innervation Ovary Fallopian tube

Uterus pear shaped consists of two major ; (isthmus is the union site of these) upper triangular portion—the body or corpus lower cylindrical portion—the cervix length sized nulligravid : 6 to 8 cm multiparous : 9 to 10 cm

in normal in term pregnancy weight 70 gm. weight 1,100 gm capacity 10 ml. total volume 5 - 20 L.

Most of the uterus is composed of myometrium smooth muscle bundles united by CNT containing many elastic fibers. Interlacing myometrial fibers surround myometrial vessels and contract to compress vessels.

uterine cavity is lined with endometrium which is composed of an overlying epithelium, invaginating glands, and a supportive, vascular stroma.This layer is divided into functionalis layer : sloughed with menses basalis layer : serves to regenerate the functionalis layer following each menses.

Cervix is fusiform divided into 2 part upper cervical segment—portio supravaginalis lower cervical portion (protrudes into the vagina) — portio vaginalis

Cervix is fusiform divided into 2 part upper cervical segment—portio supravaginalis lower cervical portion (protrudes into the vagina) — portio vaginalis

lining ectocervix : nonkeratinized stratified squamous epithelium endocervix : single layer of mucin-secreting columnar epitheliumCharacteristic of cervix Before childbirth : small, regular, oval opening After labor : transverse slit (anterior & posterior cervical lips) AND If torn deeply , it appears irregular, nodular, or stellate.

Characteristic of cervix during pregnancy endocervical epithelium moves out and onto ectocervix = eversion show 3 signChadwick sign Goodell sign Hegar sign

Ligament There are several ligaments that extend from the uterine surface toward pelvic sidewalls >> include round ligaments broad ligaments cardinal ligaments uterosacral ligaments



Cardinal ligament = transverse cervical ligament = Mackenrodt ligament

Parametrium CNT adjacent and lateral to the uterus within the broad ligament.Paracervical CNT adjacent to the cervix.Paracolpium CNT adjacent lateral to the vaginal walls.

Blood supply Uterus is supplied from uterine and ovarian arteries. Uterine artery a main branch of the internal iliac a. (hypogastric a.) enters the base of the broad ligament and makes its way medially to the side of the uterus. 2 cm lateral to the cervix, the uterine artery crosses over the ureter.