Clinical Female Reproductive Anatomy

Print PDF

Please help me out by filling out this quick feedback form after watching these videos – it shouldn’t take more than 1 minute!

Ovary and Fallopian Tubes

 

Uterus

 

Cervix

About this video

This tutorial was creating using the BioDigital Human web application. If you are having trouble viewing this, try the YouTube links: Part 1 Part 2 Part 3   

Click here to view tutorials on basic anatomy of the female reproductive tract.

 

Test yourself!

Click here to test yourself on these tutorials!

 

Ovaries and Fallopian Tubes

Ovaries

• Ovarian Cyst Accidents
• Polycystic Ovary Syndrome
• Ovarian Cancer

Ovarian Cyst Accidents

Three things can happen with ovarian cysts:

• Haemorrhage into the cyst
• Rupture of the cyst into the peritoneal space
• Ovarian torsion

Polycystic Ovary Syndrome

• Endocrine disorder
• Multiple enlarged follicles scattered underneath the surface of the ovary.

Features

• Polycystic ovaries on ultrasound
• Irregular menstruation
• Raised testosterone leading to hirsutism and acne

Ovarian Cancer

There are three main groups of cells within the ovary:

• Epithelial Ovarian Cells: outer layer of cells, also known as the germinal epithelium
• Germ cells: cells which make the eggs in the ovary
• Connective tissue: supportive tissue of the ovaries
  • Granulosa cells
  • Thecal cells

Ovarian cancer can arise from any of these three main groups of cells, however the most common type comes from the surface epithelium.

This constitutes 80-90% of all ovarian cancers and is more common in older, post-menopausal women.

Serous type is most common type of surface epithelial ovarian cancer.

Germ cell cancers are more common in younger women.

Sex-cord stromal tumours are quite rare.

Fallopian Tubes

This fallopian tubes open DIRECTLY into the peritoneal cavity – this is the only direct communication with the intraperitoneal space.

This direct communication is a possible route for the spread of an infection – a sexually transmitted infection such as gonorrhoea, or chlamydia could spread into the peritoneum.

Ectopic pregnancy

Blastocyst implants in the wrong place, i.e. not in the endometrium.

Locations of ectopic pregnancy:

• Fallopian tubes – this is the most common sites for ectopic pregnancy
  • Ampulla is the most common site in the fallopian tube for ectopic pregnancy
• Cornua of the uterus
• Cervix
• Ovaries
• Abdomen

Uterus

Prolapse

Structures supporting the uterus:

• Uterosacral ligament extending posteriorly from the cervix to the sacrum
• Transverse cervical/cardinal ligament extending laterally to the pelvic side wall side wall
• Pubocervical ligament extending anteriorly
• Levator ani muscle

If these structures are weakened, then the pelvic organs can prolapse.

It is useful to think of the prolapses in terms of three different compartments:

Anterior Compartment

• Urethrocele – urethra bulges into anterior wall of vagina.
• Cystocele – bladder bulges  superiorly into anterior wall of vagina.
• Urethrocele + cystocele = cystourethrocele.

Middle Compartment

• Uterine prolapse
  • Graded from 1 to 3:
    • Grade 1: Prolapse contained within the vagina.
    • Grade 2: Further descent: cervix reaches level of introitus but the fundus stays inside the pelvis
    • Grade 3: the entire uterus is prolapsed outside the vagina – procidentia.
  • Causes of uterine prolapse are:
    • Previous vaginal delivery
    • Iatrogenic causes/previous pelvic surgeries
    • Low oestrogen levels in post-menopausal women
    • Obesity.
• Enterocele – pouch of Douglas protrudes downwards.
•  Vaginal vault prolapse –  Occurs after  a hysterectomy. The superior end of the vagina prolapses and the vagina inverts on itself.

Posterior Compartment

• Rectocele

Benign Uterine Tumours

• Fibroids
• Intrauterine Polyps

Common causes for heavy menstrual bleeding (menorrhagia).

Fibroids

Uterine leiomyomata (leiomyoma = singular).

Benign tumours of smooth muscle and connective tissue differentiation, which affect the myometrium.

Three subtypes of fibroid:

• Subserosal: just below the serous layer of the uterus
• Intramural: directly within the wall of the myometrium.
• Submucosal: underneath the mucosa.

Polyps

Benign tumours which grow into the cavity of the uterus

Usually endometrial in origin

These cause menorrhagia and intermenstrual bleeding.

 Endometriosis

Characterised by ectopic endometrial tissue (areas of endometrial tissue that is out of place)

This tissue is responsive to oestrogen, just like the endometrium and therefore changes in size during the menstrual cycle as hormone levels change.

Chronic, cyclical pelvic pain is a common symptom of endometriosis.

Within the pelvic cavity, the common sites for endometriosis are

• Ovaries
  • Chocolate cysts (endometrioma): accumulations of blood which appear a dark brown colour.
• Pouch of Douglas (rectouterine pouch)
• Vesicouterine pouch
• Uterosacral ligaments
• Fallopian tubes

Also affects: rectum, vagina, bladder

Sites outside of the pelvic cavity can also be affected:

• Umbilicus
• Old wound scars
• Pleura
• Pericardium
• CNS

Long-term, endometriosis can lead to pelvic adhesions, and to immobile pelvic viscera.

Adenomysosis

Ectopic endometrial tissue within the myometrium

Endometrial cancer

Most common malignancy of the female reproductive tract

Mostly adenocarcinoma

Prolonged exposure to unopposed oestrogen (oestrogen without the protective effects of progesterone) is the biggest risk factor

Cervix

Ectocervix

• portion of the vagina which protrudes into the vagina
• squamous epithelium

Endocervix

• lines the endocervical canal
• columnar epithelium

Squamocolumnar junction occurs where the squamous epithelium meets the columnar epithelium

During puberty and pregnancy, the cervix gets pushed out and the columnar cells of the endocervix are exposed to the acidic environment of the vagina.

This causes metaplasia of the columnar cells to squamous cells and this area of change is called the transformation zone.

At the transformation zone, the cervix is more susceptible to neoplastic change.

Cervical ectropion

Benign condition of the cervix where the cervix protrudes out, exposing the columnar cells of the endocervix.

Results in a red area around the external os and is a common cause of post-coital bleeding (bleeding after intercourse).

Normal finding in:

• younger women
• pregnant women
• women using the combined oral contraceptive pill

Cervical intra-epithelial neoplasia (CIN)

Pre-malignant, pre-invasive stage of cervical cancer.

Atypical cells can be detected by a smear test

Smear test is a cytological test, which detects cellular changes, not histological changes.

The degree of cellular change (dyskaryosis) corresponds to the degree of CIN

Three grades of CIN:

• CIN 1: mild dysplasia  – affects lower 1/3 of epithelium.
• CIN 2: moderate dysplasia – affects lower 2/3 of epithelium.
• CIN 3: severe dysplasia – full thickness. Carcinoma in situ

Cervical cancer

Most often occurs near the external os, at the transformation zone.

Most common cause is human papillomavirus (HPV)

Squamous cell carcinoma (SCC) is the most common type

Adenocarcinoma is the second most common type.