GYN 1

• Vulva


  External genital organs including mons veneris, labia majora, labia minora, clitoris, vestibule and perineum

  
• Mons veneris (mons pubis)


  • Pad of subcutaneous adipose connective tissue lying in front of the pubis, covered by hair in adult females

  
• Labia majora

  • Elevation of skin and subcutaneous tissue forming the lateral boundaries of the vulva, continuous posteriorly to form the posterior commissure, covered in squamous epithelium with sebaceous glands, sweat glands and hair follicles, contain dense connective tissue and adipose tissue
• Labia minora


  • Two thick folds of skin without fat, enclosed by the labia majora, anteriorly divide to enclose the clitoris, posteriorly fuse to form the fourchette, contain connective tissue, sebaceous glands, erectile muscle fibres and numerous vessels and nerve endings
• Clitoris


  • Small cylindrical erectile body, 2.5cm long, consisting of glans, body and crura, richly supplied with nerves, attached to the symphysis pubis by the suspensory ligament
• Vestibule


  • Triangular space bounded by the clitoris, fourchette and labia minora, contains the urethral opening, vaginal orifice and openings of the Bartholin's glands

  
• Hymen


  • Septum of mucous membrane that incompletely closes the vaginal orifice in virgins, usually circular or crescentic, ruptured at consummation of marriage, extremely lacerated during childbirth
• Bartholin's glands


  • Pea-sized, yellowish-white, compound racemose glands located in the superficial perineal pouch, secrete alkaline mucus to aid lubrication, ducts open into the vestibule
• Vestibular bulbs


  • Bilateral elongated masses of erectile tissue situated beneath the vestibular mucous membrane, homologous to the bulb of the penis
• Perineum


  • Region between the vulva and the anus
• Blood supply of the vulva

  Arteries: branches of internal pudendal and femoral arteries. Veins: form plexuses draining into internal pudendal, vesical/vaginal and long saphenous veins
• Nerve supply of the vulva

  Anterosuperior part supplied by ilioinguinal and genitofemoral nerves, posteroinferior part by posterior cutaneous nerve of thigh, middle part by labial and perineal branches of pudendal nerve
• Vagina


  • Fibromusculomembranous sheath communicating the uterine cavity with the exterior, excretory channel for uterine secretions and menstrual blood, organ of copulation and birth canal, 7-9cm long, 'H' shaped on cross-section

  
• Vaginal fornices


  • Clefts formed at the top of the vagina due to the projection of the uterine cervix, one anterior, one posterior, two lateral
• Vaginal relations


  • Anterior: upper 1/3 with bladder base, lower 2/3 with urethra. Posterior: upper 1/3 with pouch of Douglas, middle 1/3 with anterior rectal wall, lower 1/3 with anal canal. Lateral: upper 1/3 with pelvic cellular tissue, middle 1/3 with levator ani, lower 1/3 with bulbocavernosus muscles, vestibular bulbs and Bartholin's glands
• Vaginal structure


  • Mucous coat of stratified squamous epithelium, submucous layer of loose areolar tissue, muscular layer of inner circular and outer longitudinal fibres, fibrous coat derived from endopelvic fascia

  
• Vaginal epithelium


  At birth and up to 10-14 days under maternal estrogen influence, then thin until puberty, from puberty to menopause stratified squamous with basal, intermediate and superficial cornified cells containing glycogen

  
• Vaginal secretion


  Small amount, acidic pH 4-5.5 due to lactic acid from glycogen breakdown by Doderlein's bacilli, contains tissue fluid, epithelial debris, leukocytes, electrolytes, proteins, lactic acid
• Doderlein's bacillus is a rod-shaped gram-positive anaerobic bacillus that grows in the vaginal secretion
• pH of vaginal secretions

  Acidic, varies during different phases of life and menstrual cycle
• Conversion of glycogen to lactic acid

  1. By Doderlein's bacilli

  2. Dependent on estrogen
• Vaginal pH


  More acidic during childbearing period, ranges 4-5.5 with average 4.5
• Vaginal secretion


  Consists of tissue fluid, epithelial debris, leukocytes, electrolytes, proteins, lactic acid
• Doderlein's bacillus


  Rod-shaped gram-positive bacillus, grows anaerobically on acid media
• Doderlein's bacillus function


  1. Converts glycogen in vaginal mucosa into lactic acid

  2. Maintains acidic vaginal pH
• Arteries supplying the vagina

  • Cervicovaginal branch of uterine artery
  • Vaginal artery
  • Middle rectal
  • Internal pudendal
• Veins draining the vagina

  Internal iliac and internal pudendal veins
• Nerve supply of the vagina

  Sympathetic and parasympathetic nerves from pelvic plexus, lower part supplied by pudendal nerve
• Normal position of the uterus

  Anteversion and anteflexion

  
• Uterus


  • Hollow pyriform muscular organ
  • Situated in the pelvis between bladder and rectum

  
• Uterine measurements


  Length 8 cm, width 5 cm at fundus, wall thickness 1.25 cm, weight 50-80 g
• Parts of the uterus


  • Body or corpus
  • Isthmus
  • Cervix
• Body or corpus


  • Divided into fundus and body proper
  • Cornua project outwards at superolateral angles
• Isthmus


  Constricted part 0.5 cm, between body and cervix

  
• Cervix


  • Lowermost part of uterus, 2.5 cm length and diameter
  • Divided into supravaginal and vaginal parts

  
• Uterine cavity


  • Triangular on coronal section, 3.5 cm length
  • Cervical canal fusiform, 2.5 cm length
• Uterine relations


  Anterior - with bladder, Posterior - with pouch of Douglas, Lateral - with broad ligament

  
• Layers of uterine wall

  • Perimetrium (serous coat)
  • Myometrium (smooth muscle)
  • Endometrium (mucous lining)
• Cervical epithelium


  • Endocervical canal and glands lined by columnar epithelium
  • Portio vaginalis covered by squamous epithelium
• Cervical secretion


  Alkaline mucus, rich in fructose, glycoprotein, mucopolysaccharides, sodium chloride