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By: Michael Lu, Class of „07
. . called the tendinous arch. vagina.The pelvic diaphragm consists of the coccygeus.Note the piriformis muscle posteriorly and the obturator internus muscle laterally. The specialization of the obturator fascia. The last 3 muscles form the levator ani muscle.Note the relative locations of the urethra. puborectalis. and rectum. . .Note the sacrotuberal and sacrospinous ligaments forming the greater and lesser sciatic foramens with the pelvis bones. and iliococcygeus muscles. provides attachment for the levator ani muscles of the pelvic diaphragm. pubococcygeus..
and superior gluteal arteries. which are the end branches of the abdominal aorta. inferior vesical.The arterial supply of the pelvis is supplied by the common iliac arteries. which further branches off as the superior vesical artery and the medial umbilical ligament (obliterated umbilical artery. vaginal.The ovarian arteries branch off the abdominal aorta near the kidneys. respectively. The right ovarian vein drains directly into the inferior vena cava. . .NOTE: . and internal pudendal arteries. The common iliac arteries branch into the external iliac arteries (which continue as femoral arteries) and the internal iliac arteries. lateral sacral. while the left ovarian vein drains into the left renal vein and then into the inferior vena cava.The posterior division of the internal iliac artery gives off the iliolumbar. uterine. . middle rectal.The anterior division gives off the umbilical artery. inferior gluteal. . The anterior division also gives off the obturator. Note how the vessels cross over the ureters and enter and exit the inguinal canal with the spermatic cord via the deep and superficial inguinal rings.
The lumbosacral trunk combines L4 and L5.NOTE: . reenters through the lesser sciatic foramen.pudendal nerve: from S2 to S4.inferior gluteal nerve: from L5 to S2. Note the superior gluteal artery between L5 and S1. runs over the piriformis muscle through the greater sciatic foramen. . reenters through the lesser sciatic foramen into the pudendal canal. .The sacral plexus includes contributions from L4 to S4. exits under the piriformis muscle through the greater sciatic foramen. inferior to the piriformis muscle through the greater sciatic foramen. . . . runs inferior to the piriformis muscle through the greater sciatic foramen.superior gluteal nerve: from L4 to S1.sciatic nerve: two separate nerves that are usually fused together – tibial nerve from L4 to S3 and common fibular nerve from L4 to S2. . . .nerve to obturator internus muscle: from L5 to S2.posterior femoral cutaneous nerve: from S1 to S3. runs under the piriformis muscle through the greater sciatic foramen. exits under the piriformis muscle through the greater sciatic foramen.nerve to quadratus femoris muscle: from L4 to S1. inferior to the piriformis muscle through the greater sciatic foramen.
As the internal pudendal artery continues toward the external genitalia.. From there they enter the pudendal canal and exit into the perineum. The deep branch of the pudendal nerve continues as the dorsal nerve of the clitoris in the deep perineal space.The internal pudendal artery enters the perineum from the pudendal canal and gives off the inferior rectal artery. with its terminal branches ending as the dorsal artery and deep artery of the clitoris. The internal pudendal artery continues deep to the perineal membrane. it gives off the perineal artery superior to the perineal membrane and ends as the posterior labial artery.The pudendal nerve gives off the inferior rectal nerve. and continues as the perineal nerve superiorly and ends as the posterior labial nerve.Reminder: The internal pudendal vessels and pudendal nerve exit the greater sciatic foramen and reenter the pelvis through the lesser sciatic foramen. . . .
ovaries.As the peritoneal layers hang over the uterine or fallopian tubes. and from the uterus onto the posterior margin of the superior surface of the uterus called the vesicouterine pouch. mesovarium (associated with the ovaries). . which consists of the mesosalpinx (associated with the fallopian tubes). and rectum. .Note the relative relations of the pelvic viscera: urinary bladder. . and mesometrium (associated with the uterus).Note the peritoneal fold reflecting from the rectum to the posterior fornix of the vagina called the rectouterine pouch.. fallopian tubes. uterus. and deep inguinal ring. .Note the round ligament of the uterus connecting the lateral surface of the uterus to the inner aspect of the labium majus via the superificial inguinal ring. Note also the ovarian ligament between the ovary and uterus and the suspensory ligament that contains the ovarian vessels. It is the remnant of the gubernaculum that holds the fundus of the uterus forward. they “double up” to form the broad ligament. inguinal canal.
Clitoris Glans clitoris Prepuce Combination of 3 erectile bodies – glans clitoris and 2 corpora cavernosa Expanded distal end of corpus spongiosum Fold of smooth skin extending over the glans clitoris Hymen Labia majora Labia minora Vagina Vestibule Uterus Thin. contains vaginal fornices Region inferior to the hymen between labia minora. . and vagina as well.The list above has superficial features of the female external genitalia. and uterine parts. . contains the external urethral orifice and opening of vagina Hollow muscular organ for fetus growth. . isthmus.Histological slides are shown next. normally lies anteverted posterosuperior to the bladder . infundibulum. blending together anteriorly as the mons pubis Paired folds of hairless skin located medial to the labia majora Part of the female genital canal between the vestibule and cervix. ampulla. usually incomplete septum at the inferior vaginal orifice Joined across the midline by the anterior and posterior labial commissures.Note the fallopian tubes: fimbriae. Note the various parts of the uterus. cervix.
In the inset. small arrows point to ciliated cells. contain complex mucosal folds with distinct ciliated columnar epithelium.The funnel-shaped opening called the infundibulum contains many finger-like projections called fimbriae (bottom left).The uterine or fallopian tubes. non-ciliated secretory (peg) cells. . The ampulla (top left) shows the oviduct in low power. while arrowheads point to bulging. the mucosal folds become less complex. the fimbriae get close to the ovary and help to sweep the ovum that is released into the abdominal cavity. or oviduct..As the oviduct approaches the uterus. . During ovulation. The uterine or interstitial portion (bottom right) contains a relatively simple lumen and columnar epithelium. .
relatively straight endometrial glands. exhibit “basal vacuolization” (bottom right). and perimetrial (P) layers (top left). . many of which may be ciliated. as indicated by the arrows. myometrial (M). It can be divided into the basal and functional layers.The uterus is divided into endometrial (E). .Immediately following ovulation. The endometrium prepares for implantation of an ovum by cycling through proliferative and secretory phases. . The basal layer remains relatively unchanged through the cycles.The proliferative phase (bottom left) is characterized by long.. the glandular epithelial cells. which is the accumulation of glycogen in the basal cytoplasm.
. . Note the abundance of coiled or spiral arteries that supply the entire functional endometrium.During menstruation. the uterine glands open onto the surface (large arrow). The endometrial surface lacks epithelium. and there may be some blood clots (small arrows). which weakens the vascular walls resulting in hemorrhage (bottom right).The serrated endometrial glands are magnified in the bottom right panel.. The secretory cells are also shorter with rounder nuclei than those during the proliferative phase.The most characteristic change in the secretory phase of the endometrium is the “saw-tooth” or “serrated” appearance of the glands (top left). . the endometrial surface epithelium undergoes ischemia.
The red arrows point to the junction and change in epithelium.This is known as the strato-columnar junction. The epithelium contains simple. tall columnar mucussecreting epithelial cells. .The cervical canal contains complex folds that resemble glands. squamous epithelium of the vagina. . from the columnar epithelium of the cervical canal to the stratified.The cervix is shown in three different magnifications in the top panel.. . and earliest signs indicative of cervical cancer occur at this junction.The cervix also contains much smooth muscle and dense connective tissue. .
where bacterial action produces lactic acid to acidify the mucosa and protect it. . The inset shows the muscular layer in more detail.The vagina wall contains abundant connective tissue with large amounts of elastin. .The vaginal epithelium (bottom panel) is covered with non-keratinized stratified squamous epithelium that contain abundant glycogen in the cytoplasm. . . The glycogen is released into the vaginal lumen. There is also a thick muscular layer (bracket in top panel).The adventitia contains large nerves and arteries that blend with the connective tissue of the pelvis. with longitudinal and circular smooth muscle layers.The arrows indicate surface cells that can be collected for Pap smears to provide information on hormonal status and any abnormalities..
. . it releases the ovum to travel through the fallopian tubes to the uterus. The follicle continues to develop into the corpus luteum and corpus albicans.Primordial follicles develop into primary follicles.In the following slides. the female ovary already contains all of its oocytes at birth. .The term “-flexion” refers to the long axis of the uterine body compared to the long axis of the uterine cervix.Shown on the left are the various positions of the uterus within the pelvis.Note the normal position of the uterus. Unlike the male testis. .. . When the follicle ruptures. we will conclude by looking at the ovary and going through the various stages of the development of the ovum and follicle.Shown to the right is a schematic of the oval cycle.The term “-version” refers to the angle between the long axis of the uterus and the long axis of the vagina. . followed by mature Graafian follicles. .
abundant blood vessels and lymphatics. The medulla contains loose connective tissue. .The oocyte continues to grow at the same time follicular or granulosa epithelial cells continue to divide and form multiple layers (multilaminar)..The surface epithelium of the ovary (bottom left) is called the mesothelium. . and nerves.The hilus of the ovary is where all the nerves and vessels enter the organ. . Note the appearance of primordial follicles within the outer cortex. as shown in the bottom right). which sits on the tunica albuginea. The numbers in the top left panel indicate the stages of follicular development.
This is characteristic of a secondary follicle (bottom panel). . . . .The top panel shows a primary follicle. The oocyte is still surrounded by the zona pellucida.The oocyte is surrounded by a prominent glycoprotein coat called the zona pellucida (ZP). This layer of granulosa cells outside the zona pellucida is known as the corona radiata. . as shown in the next slide.With further development.Note how the granulosa cells are separated by the surrounding stromal or thecae by a distinct basement membrane (arrows)..The thecal cells also continue to differentiate into theca interna and externa cells with specialized functions. . The multilayered granulosa cells secrete a glycoprotein and proteoglycan rich fluid that accumulates in the spaces between the cells. and outside the zona pellucida are some granulosa cells that may accompany the oocyte when it is ovulated.The oocyte is supported by a mound of granulosa cells called the cumulus oophorus. there is a single fluid-filled space called an antrum.
the mature follicle converts into the corpus luteum (bottom left. separated by the basement membrane. The theca interna cells are larger and paler staining than regular stromal cells or the surrounding theca externa cells. or yellow body.The bottom right panel compares the granulosa lutein cells (GLC) with the theca lutein cells (TLC). It acts as an endocrine organ that secretes progesterone. . CL). Note the formation of inner granulosa lutein and outer theca lutein cells. . . The interna cells produce steroid precursors that are converted to estrogen by the granulosa cells.If the ovum is fertilized and implanted in the uterus..The stromal theca interna cells (top left) lie immediately outside the granulosa cells.
.The follicular basement membrane thickens and becomes what is called a glassy membrane.The corpus albicans is also formed during the later half of pregnancy after the placenta takes over the role of steroid (progesterone) secretion from the corpus luteum. The corpus luteum degenerates and forms the corpus albicans (top panel). it is expelled from the uterus with menstruation.If the ovum is not fertilized.. . This is the distinct identifying characteristic of an atretic follicle. which looks like a scar.Sometimes the oocyte degenerates prior to complete maturation. It begins to shrink within the zona pellucida and most of the granulosa cells degenerate. . or white body. There are dense accumulations of collagen. .
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