Session 2 Anatomy of females, pelvic floor

• Three parts of uterus?

  • Fundus
  • Body
  • Cervix
• Three layers of uterus?

  • Perimetrium
  • Myometrium
  • Endometrium
• Two layers of endometrium?

  • Deep stratum basalis
  • Superficial stratum functionalis
• Anteverted: cervix pointing anteriorly

  Anteflexed: body pointing anteriorly
• Retroverted: cervix pointing posteriorly

  Retroflexed: body pointing posteriorly
• Usual position of uterus?

  Anteverted and anteflexed
• Broad ligament: double layer of peritoneum draped over the uterus, attaching the uterus to the lateral pelvic walls.
• 3 components of broad ligament?

  • Mesosalpinx
  • Mesometrium
  • Mesovarium
• Round ligament: remnant of the distal gubernaculum extending from the uterine cornua to the labia majora via the inguinal canal.
• Clinical relevance of uterus and management?

  • Leiomyomas/fibroids
  • Management: Hormones (IUS), contraceptives, surgical intervention (hysterectomy), Tranexamic acid
• Two parts of cervix and its epithelium?

  • Ectocervix (stratified squamous non-keratinised)
  • Endocervix (simple columnar)
• Pubocervical ligament: extends from the cervix to the posterior surface of the pubis
• Cardinal (aka transverse cervical) ligament: extends from the cervix to the lateral pelvic walls.
• Uterosacral ligament: extends from the cervix to the sacrum.
• Squamocolumnar junction (SCJ): junction between two epithelia of cervix
• Transformation zone: area of squamous metaplasia between the SCJ and the rest of the squamous epithelium.
• Clinical relevance of cervix and its management?

  Cervical ectropion - no particular management (maybe change contraception)
• Cervical ectropion - protruding squamocolumnar junction, usually because of high amount of hormones, obesity etc.
• Two layers of fallopian tube?

  • Inner mucosa: ciliated columnar epithelium
  • Smooth muscle: sensitive to sex steroids
• Clinical relevance of fallopian tube and its management?

  • Ectopic pregnancy: Implantation in the fallopian tube/ outside of uterine cavity.
  • Risk factors: any damage to the tubes such as STIs, previous surgery that left behind scar tissues, IVF, blockage in the uterine cavity (IUDs)
  • Management: surgery (medical emergency)
• Structure of the ovary?

  • Surface: simple cuboidal epithelium
  • Cortex: connective tissue stroma and ovarian follicles
  • Medulla: loose connective tissue and neurovascular structures
• Ligaments of the ovary?

  • Broad ligament - mesovarium
  • Suspensory ligaments (infundibulopelvic ligament): extends from the ovary to the pelvic wall and contains neurovascular structures.
  • Ovarian ligament (aka ligament of ovary): remnant of the proximal gubernaculum extending from the ovary to the uterus.
• Clinical relevance of ovaries and management?

  • Ovarian torsion (emergency)
  • Management: De-torsion/surgery
• 4 histological layers of vagina?

  • stratified squamous epithelium, elastic lamina propria, fibromuscular layer and adventitia.
• Clinical relevance of the vagina?

  • Anterior/posterior vaginal wall prolapse
  • Enterocoele, rectocele, Cystocele
  • Pelvic organ prolapse
• Clinical relevance of the external genitalia?

  • Female genital mutilation
• Any procedure resulting in injury to the female genital organs for non-medical purposes - female genital mutilation
• What carbohydrate do uterine glands secrete?

  Glycogen
• What is endometriosis?

  This is the presence of endometrial tissue in regions other than the lining of the uterus and can lead to pelvic inflammation, infertility and pain.
• Fibroids are the most common benign tumours of the female reproductive system. How do these arise?

  These arise from smooth muscle hyperplasia in the myometrium.
• What is an episiotomy?

  A surgical cut in the perineum during childbirth to avoid tearing and damage to the anal canal and anal sphincter.