I.

Anatomy and Physiology

EXTERNAL REPRODUCTIVE ORGANS(External Genitalia): Consists of the vulva(visible

portion) and the vagina (non-visible portion).

A. VULVA( synonym- pudenda)

The vulva is the name applied to the external organs of generation.

1. Mons Veneris –The pad of fat over the symphisis pubis and is covered with hair.
2. Labia Minora- Two skin Folds,lying at either side of the vagina,that unite with the
mons anteriorly and the perineum posteriorly. Their outer surface are covered with
hair, while their inner surface consist of smooth skin.They are very vascular.
3. Clitoris- a highly sensitive erectile tissue and is situated anteriorly where the labia
minora unite.
4. Vestibule- this is the triangular area bounded by the clitoris anteriorly and the labia
minora laterally, with the anterior vaginal wall lying posteriorly. The external urnary
meatus is situated init,about an inch below the clitoris. From it the urethra runs for
an inch and a half upwards and backwards to the bladder.
5. Skene’s ducts- these are two small openings just behind the urethral meatus and
lubricate the urethra.
6. Hymen- a thin membrane about eighth of an inch thick, with a free margin
anteriorly, that partially closes the vaginal orifice before c oitus.The tags that are left
after intercourse are called carunculae myrtiformes.
7. Bartholin’s glands- These are compound racemose glands whose ducts open just
externally and laterally to the hymen. Their mucoid secretion lubricates the vulva.
8. Perineum- this is a triangular- shaped wedge of skin, fat , muscle and connective
tissue, with its apex upwards. It seperates the lower one and a half inches of the
posterior vaginal wall from the anal canal. It is one and a half inches long and four
inches broad between the ischial tuberosities.
 THE VAGINA

The vagina is a canal running from above downwards and forwards connecting the cervix uteri
and the vulva. Its anterior wall is 3 inches long and the posterior, 4 inches.

It has four coats:

 Squamous epithelium- innermost

 Two coatsof unstriped muscle-middle
 Inner- circular
 Outer-longitudinal
 Connective tissue coat- outermost

The lining epithelium is thrown into many folds or rugae which together with the muscular layers
allow tremendous dilatation or distention to occur during labor and allow for the passage of the child.

Vaginal Secretion: There is no glands in the vagina and the secretion observed is derived from the
cervical glands.

Acid Medium: The acid reaction is due to the action of Doderlain bacilli which is normal inhabitants of
the vagina.

THE CERVIX

The cervix is about an inch in length and divided into supravaginal and vaginal portions.
The vaginal cervix forms the greater part of the organ and is formed of:
 Longitudinal and circular muscle
 Hard connective tissue
 Squamous epithelium
 Spindle-shaped cavity- is lined with the compound racemose mucose-secreting glands. It connects
through the internal os with the uterine cavity, and at the external os with the vagina.

Blood supply: This consists mainly of the descending branches of the uterine arteries, with twigs
from the vaginal and vesical vessels of the uterine artery of the bladder. Rarely annular
detachment of the part of the cervix occur.
 THE UTERUS

 Uterus is a hollow, thick-walled, muscular organ situated deeply in the pelvic cavity between the
bladder and rectum.

Size: It measures about 7.5 cm. in length, 5 cm. in breadth, at its upper part, and nearly 2.5 cm. in
thickness; it weighs from 30 to 40 gm.

Positon: The normal position of uterus is one of slight anteflexion.

Parts of the uterus:

1. Corpus or body- the upper triangular portion which constitutes the greater part. This is in turn
has the following parts.
a.) FUNDUS- the rounded or convex upper portion above the insertion of the fallopian tube.
b.) CORNUA- that portion where the fallopian tube come off, one on each side, at the junction
of the superior and lateral margins
c.) ISTHMUS- the lowermost portion of the uterine cavity which forms a narrow canal
between the corpus uteri above and the cervix below.( The isthmus is of greater obstetrical
significance because in pregnancy it expands to form the lower uterine segment.)

2. C ervix-the lower cylindrical portion

Layers of the uterine Wall:

1. Endometrium- This is a simple tubular glandular mucous membrane. During menstrual life it
differentiates into three layers:
 Compacta – surface
 Spongiosa- middle
 Basalis – next to the muscle coat
 The compacta and spongiosa are shed at menstruation, leaving the basalis with its own set of
end-arteries to regenerate the new endometrial lining. During pregnancy it changes to deciduas.

2. Myometrium- Three layers defined in pregnancy:

 Inner circular layer- this muscle is developed mainly round the tubal openings and the
isthmus. It forms the lower uterine segment of passive muscle fibers.
 Middle layer- composed of interlacing fibres that control postpartum bleeding like living
ligatures.
 Perimetrium- This is the peritoneal covering that is loosely reflected from the bladder on
to the junction of the upper and lower segments. Intimately connected to the muscle
anteriorly, it passes over the fundus and dips down the back of the uterus into thepouch
of Douglas. At each side it is reflected towards the pelvic walls as the broad ligaments.

THE BLOOD SUPPLY OF THE UTERUS

1. Uterine arteries- the uterine artery one on each side, is the main branch of the hypogastric
artery.It makes its way to the side of the uterus through the base of the broad ligament at the
level of the internal os, and divided into two branches:

a. A descending branch- whih supplies the lower portion of the cervix and the upper onje third
of the vagina ( cervico-vaginal branch)
b. An ascending branch- which runs alongside the body of the uterus giving off branches to the
cervix and corpus and terminating in the following branches:fundal, tubal and ovarian.

2. Ovarian Arteries- The ovarian artery, one on each side, is a branch of the aorta which reaches
the upper part of the uterus by crossing the pelvic cavity through the upper portions of the
broad ligament. It supplies the ovary and anastomases with the ovarian branch of the uterine
artery and sends a branch to the uterus.

The venous return from the uterus roughly parallels the anterial channels.

LIGMENTS SUPPORTING THE UTERUS