Female genital system pt.

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Vagina:
- Fibromuscular tube that extends from the cervix of the uterus to the vaginal orifice in the perineum.
- Its functions:
Forms the inferior part of the birth canal.
Serves as a canal for menstrual fluid.
Accommodates the penis during sexual intercourse.
Communicates superiorly with the cervical canal and inferiorly with the vestibule of the vagina.
- Located posterior to the bladder and urethra, and anterior to the rectum.
- Vaginal fornix: is a recess that surrounds the lower cervix, and
protrudes into the upper vagina are 4 parts:
anterior, posterior, and 2 lateral parts.
the posterior fornix is the deepest part and is closely related to the
rectouterine pouch, providing access to the peritoneal cavity.
Culdocentesis: is a procedure in which the peritoneal fluid is extracted
from the rectouterine pouch by needle aspiration. The needle is advanced
through the posterior fornix of the vagina.
Normally, no fluid or small amount of clear fluid is seen.
Pathologically, purulent fluid (pelvic inflammatory disease), or blood
(emergency surgery needed).

The vagina is related:

- Anteriorly to the fundus of the urinary bladder and urethra
- Laterally to the levator ani, visceral pelvic fascia, and ureters
- Posteriorly (from inferior to superior) to the anal canal, rectum, and rectouterine pouch.
Vaginal blood supply:
Internal iliac artery supplies the vagina through its uterine, vaginal, and internal pudendal branches.
- Arteries supplying the superior part of the vagina derive from the uterine arteries.
- Arteries supplying the middle and inferior parts of the vagina derive from the vaginal and internal
pudendal arteries.
The vaginal veins form the vaginal venous plexus along the sides of the vagina and within the vaginal mucosa.
These veins are continuous with the uterine venous plexus as the uterovaginal venous plexus and drain into
the internal iliac veins through the uterine vein.

Vulva:
- It is a combination of female external genitalia and contains:
 Erectile bodies
 Secretory glands
 Associated neurovasculature.
 Paired folds of skin that surrounds the urethral and vaginal orifices.
  As sensory and erectile tissue for sexual arousal and intercourse
Mons Pubis:
- Rounded, subcutaneous fatty tissue.
- Lies anterior to the pubic symphysis, pubic tubercles, and superior pubic rami.
- Continuous with the labia majora.
Labia Majora:
- Bilateral folds of fatty subcutaneous tissue
- Located between pudendal cleft.
- Indirectly protects the clitoris and urethral and vaginal orifices.
- Labia join anteriorly at the anterior commissure and posteriorly at the posterior commissure.
- Pigmented skin and coarse pubic hair cover the labia’s outer surface.
- Its inner surface is smooth and hairless.
Labia Minora:
- Bilateral folds of hairless skin within the pudendal cleft, border the vestibule of the vagina.
- Anteriorly, the labia minora form 2 laminae.
- The medial laminae of each side unite as the frenulum of the clitoris.
- The lateral laminae unite anterior to the glans of the clitoris, forming the prepuce of the clitoris
(foreskin) which covers the body of the clitoris.
Clitoris:
- It is an erectile organ located where labia minora meet anteriorly.
- It consists of a root and a small, cylindrical body, which are composed of 2 crura, 2 corpora
cavernosa, and the glans of the clitoris.
- It is highly sensitive and enlarges on tactile stimulation.
- The glans of the clitoris is the most highly innervated part of the clitoris and is densely supplied with
sensory endings.
- Vestibule of the vagina is a space surrounded by the two labia minora.
- Corpora cavernosa are paired erectile bodies creating the crura, which join to form the body/shaft of
clitoris and then glans of clitoris.
- Vestibular bulbs: paired masses of erectile tissue that lie deep to the labia minora and are covered
inferiorly and laterally by the bulbospongiosus muscles.
- Greater vestibular (Bartholin) glands: small glands that lie under the posterior end of the
vestibular bulbs, help to lubricate the vestibule during sexual arousal.
- Lesser vestibular glands: small glands lie on each side of
the vestibule and secrete mucus to moisten the labia and
vestibule.

Bartholin’s cyst: if the openings of the glands become

obstructed, causing fluid accumulation inside the glands giving rise
to a relatively painless swelling called a Bartholin’s cyst. If the
fluid within the cyst becomes infected, you may develop a
collection of pus surrounded by inflamed tissue (abscess). A
Bartholin's cyst or abscess is common.
Valvular blood supply:
- External pudendal artery supplies the skin over the mons pubis and labia majora and drain into the
external pudendal vein.
- Internal pudendal artery supplies most of the external genitalia
- Perineal artery: supplies perineal muscles and labia minora.
- Vestibular bulb artery
- Dorsal clitoral artery supplies the glans of the clitoris.
- Deep clitoral artery supplies the corpus cavernosum and is responsible for their engorgement during
arousal.

Female urethra:
- Extends 4cm from the internal urethral orifice at the bladder neck to the external urethral orifice
in the perineum.
- In the perineum, the urethra opens within the vestibule of the vagina directly anterior to the vaginal
orifice.

Perineum:
- A diamond-shaped area bounded by:
 Pelvic outlet (pubic symphysis, ischiopubic rami, sacrotuberous ligaments, and coccyx).
 Lower parts of the obturator internus muscles and their fasciae.
 Inferior surface of the pelvic diaphragm.
- Separated from the pelvic cavity by the fascia covering the inferior aspect of the pelvic diaphragm,
formed by the levator ani and coccygeus muscles.
- Imaginary line connecting the ischial tuberosities separates the perineum into an anterior urogenital
triangle and a posterior anal triangle.
- Perineal membrane is a fibrous sheet stretched between the ischiopubic rami extending towards the
pubic symphysis.
It separates the urogenital triangle into the deep perineal and superficial perineal spaces. It also
functions as attachment of the cavernous bodies.