hello everyone and welcome back to Dr Asif lectures today we are going to start female reproductive organs which is chapter number 31 from britisha volume two okay reproductive organs may actually do topics one is called the um internal and the other one is called the external genital organs again so external general organs in a different video which is chapter number 28 but Aaj Ki video topic to discuss the anatomy of internal genital organs then there are Fallopian tubes yeah you're trying tubes then there is uterus and then the vagina so yeah the ovaries are homologous two testes of males but lie within the pelvis so um so in females the gonades are ovary and gonades are anything which produces basically germ cells they produce over okay so that is the job of the ovary video May one by one will start discussing with ovaries or AKA internal genitalia is first of all let us start discussing ovaries okay there are ovaries located there and ovaries vagina so basically yeah first will be the ovary then will be the uterine tube then will be the uterus and number four will be the vagina so let's start discussing the anatomy of ovaries ovaries are female gonads they are present outside the body in in a way not outside the body outside the abdominal cavity I should say so they're present in the scrotal region so they are hanging outside the abdominal cavity ovaries they lie in the ovarian fossa which is actually in the lateral pelvic wall or a pelvis motor basically simple drums May the ovaries are located in pelvis near to the lateral pelvic wall whiskey different bones that is the place where ovaries are present the twin number right and left side and the place where the ovaries are present is known as ovarian fossa orange it is bounded anteriorly by the obliterated umbilical artery uh and posteriorly by the ureter and internal iliac artery so that's a good diagram which is showing the ovary from the lateral side so agar is just like testis you see here that is the ovary is entirely there is this green thing which is the obliterated umbilical artery and posteriorly there is ureter your ureter has your urinary bladder mentor and the internal ilax may actually uh overly positioned this is called ovarian fossa so anteriorly it is bound by the obliterated and black Lottery and posteriority is bound by the ureter as well as the internal iliac okay the position of the ovary is variable in nulliperous women which means they have never been pregnant they have never delivered a baby its long excess is nearly vertical so that the ovary is usually described as having an upper pole and a lower pole is something like this it is vertical you see it is like this vertical Link in later on it becomes horizontal you see the change of plane of the okay in an Olympus and in a woman who has become pregnant at least once so you different here you see this is vertical and here you see this is horizontal the age of vertical there is an upper pole and there is a lower pole it becomes the literal pole and the lower pole becomes the medial pole okay however in multiple women the long axis become horizontal so that the upper pole points literally and the lower pole points it becomes the literal pole it becomes this one and this lower pole becomes the medial pole okay easy easy now some external features in young girls before the onset of ovulation which means before the age of monarchy menarchy is the age when the menstrual cycle for the first time begin or uh the ovaries have a smooth surface which are grayish pink in color after puberty now puberty is the age of monarchy and is a palid of our menstrual cycle start Hotel females May that is called the age of puberty or the age of monarchy the surface of ovary becomes uneven and the color changes from pink to gray so something like this it becomes uneven if you look at this diagram this is an ovary from a young female bilkul smooth rounded surface vertical orientation it is like this is so and it becomes horizontal so this is one change in the color changes as well from pinkish to grayish each ovary has two poles all extremities these are called the upper bowl or the lower pole which later on becomes a little pole in the medial pole obviously and there are two borders anterior border or uh posterior border I mean the anterior border is also known as miso very important diagram why it is called misovarian and the posterior border is also called the free border and also there are two surfaces little surface and medial surface relationships so ovary is an important structure peritoneal relations the ovary is almost entirely covered with peritoneum so important Point most of the ovary is covered with peritoneum except along the meso variant or the anterior border where the two layers of the covering of the peritoneum are reflected onto the posterior layer of the broad ligament of the uterus the ovary so if we look at this diagram which is the broad ligament broad ligament of uterus is something like this you see so here we have the uterus or yayfield lateral structures here this is all the fallopian tube and here would be the ovarian structure covering lateral structures so broad ligament is a very broad ligament easily it is called Broad and it covers a lot of structures so you brought up ligament all this blue thing is the broad ligament so everything here is under cover of the Broadway so the ovary is all over surrounded by the peritoneum apart from the anterior poles it's not happening like this so for example if I have to draw complete covering so it would have been something like this is continuous with this posterior border this is the posterior layer of the broad ligament yeah completely covered that is a bare area or is blood vessels the ovary is connected to the posterior layer of the broad ligament by a short fold of peritoneum which is called mesoverium mesovarium concept squamous epithelium of the mesovarium is continuous with the cubinal epithelium of the ovary so Point here is continuous with the covering of the ovary or epithelial covering hair so it is very close covering very close covering epithelium of the broad ligament then continues as the epithelium of the you know ovary so that's so close actually the mesoverium transmits the vessels and nerves to and from the ovary about them already okay it is like the gateway to the ovary May blood supply uh so that is the point which is called the mesoperium okay now the lateral part of the broad ligament of the uterus extending from the infundibulum of the uterine tube and the upper pole of the ovary to the external aliac vessels form a distinct fold which is known as the suspensory ligament of the ovary or it is also called the infangible pelvic ligament it contains ovarian vessels and nerves so the point is a broad ligament here it is kind of a very broad structure or Buzz areas but it becomes thickened and specialized so for example here we are talking about the lateral part of the broad ligament and it is specialized in a form of a band which is known as suspensory ligament of the ovary so if you look at the diagram here um let me tell you where is the suspensory ligament so this one in every diagram they have shown it so here for example is the ovary and we are talking about the thickening of the broad ligament in the in the lateral border and so this is the uterus therefore I know this is medial this is ovary therefore I know this is lateral and this would be the lateral most part of the broad ligament and here you see this is the specialized thickening which is called suspensory ligament of ovary so this is the suspensory ligament of ovary in each diagram you see suspensory ligament is present towards the literal part okay here this would be the suspensory ligament so it is actually between the uh you know parts of the fallopian tube infundibulum particularly and it is suspending the ovary in connection with the infantibular or yaha is particular ligaments the ovarian arteries are passing through it okay so that's an important one to remember suspense ligament which is present on the lateral side also called the infundibulo pelvic infundibulo is ligament yeah suspensory ligament is green structure okay then so all this is done these are all the peritoneal relations so peritoneal relations most of the ovary is surrounded by peritoneum apart from the anterior partium is the Gateway for ovarian vessels ligament now let us talk about some visceral relationships of ovary upper hair which is also called the tubal Pole it is broader than the lower Pole and is related to the uterine tube and external iliac vein the right ovary may be related to appendix that's an important one because appendix May uh inflammation coffee common hair is operations so one has to be very very clear about this okay upper pole of the ovary is in a closed context with the you know appendix on the right side uh you have to be careful the ovarian fimbria are suspensary and the suspensory ligament of the ovary are attached to the upper pole of the kidney so this is the upper pole of the kidney and again anyways so here if you see this is the suspensory ligament and this is the upper pole and the upper pole is in connection with the fimbriae of the uterine tube or is diagram maybe already um there is a concept behind it and it's easy one to understand so these are all the relations which you have to remember then let us talk about the lower pole which is also called the uterine pole because it is towards the uterus you see this is the uterus and this is the lower pole and it is towards the uterus therefore it is called the uterine pole uh it is narrower than the upper Pole and is related to the pelvic floor it is connected by the ligament of the ovary now here is another ligament which you should remember and that is called the ligament of ovary this is the ligament of ovary which kind of connects the lower pole with the uterus okay right the ligament lies between the two layers of the broad ligament of the uterus and contains the smooth muscle fibers as well T get now anterior or mesovarium border of the ovary ovary casual anterior border Hair It Is straight and is related to the uterine tubes and the obliterated umbilical artery it is attached to the back of the broad ligament of the uterus by meso barium so I'll be a different and it forms the highest of the ovary just a kidneys in this view what we are seeing cage your interior border hair not kidneys sorry uh so anterior border of ovary party connected disconnected with the meso variume the anterior border is obliterated and for this you have to remember this diagram in this diagram which we are viewing from the lateral side this is the ovary and in front of the ovary which is the anterior side is the obliterated umbilical artery details posterior border is the free border or it is related to uterine tube and urator posterior borderator this is the ovary and this is right then the lateral surface is related to the ovarian fossa in a little pelvic wall and the medial surface is large covered by the uterine tube the peritoneal races between the mesosulpings and the surface is known as the origin bursa is so please hold on to that for now only the lower pole and the lateral surface are not related to the uterine tube remaining two borders upper pole and the middle surface are all related so that's an important point and a catchy Point as well which is the lower pole and the lateral surface which are not in relation with the uterine tube everything else is okay so anyways easy stuff ovary upper Pole lower poles surfaces borrowers and now let's talk about the arterial Supply the ovarian artery arises from the abdominal aorta just below the renal artery it descends over the posterior abdominal wall and enters the suspensory ligament of ovary yeah it sends branches to the ovary through mesovarium and continues medially through the broad ligament of the uterus to anastomose with the uterine artery so the ovarian artery is obviously not an end artery it in Astros where with the uterine Branch as well and it is pretty clear here so if you see here this is ovary and this is the ovarian vessel and it's coming in and supplying the ovary but also anastomozing with branches of the uterine artery so that's the uterine artery and it is anastomizing with ovarian arteries okay so there is a good anastomosis around and therefore the uterine artery is also giving branches to the ovary so if you look here again this is the uterine artery and it also gives blood supply to the ovary okay simple now the venous drainage wind emerges at the high less and from a pampany form plexus around the artery the plexus condenses into a single ovarian vein near the pelvic Inlet the vein ascends on the posterior abdominal wall and drains into the inferior vena cava so that's the story so there are so many small veins which make plexus which is known as pampiniform plexus and they ultimately drain into inferior vena cava on the right side and left Arena on the left side so it's the same like the testicular vein now goodness and that belongs actually to the embryology CVS embryology playlist now the lymphatic drainage lymphatics from the ovary communicate with the lymphatics from the uterine tube and fundus of the uterus they ascend along the ovarian vessels to drain in the lateral aortic and pre-aotic group of lymph nodes Supply the ovarian plaques is derived from renal aortic and hypogastric plexuses accompany the ovarian artery in it contains both sympathetic as well as parasympathetic fibers the sympathetic T10 and 11 are afferent for pain as well as efferent for vessel motor so the sympathetic fibers are pain sensatory fibers as well as the Vaso motor fibers or your parasympathetic Supply here they are vasodilator so that's simple easy stuff read and remember what are the functions of ovary overiga basic arm obviously have production of oocytes making ovum throughout the life which is what we call the reproductive life of the female evolife menstrual cycles and that's about 30 years from puberty to menopause puberty is this is what we call monarchy and menopause is when Menses stop okay right then they produces every eight cycle the menstrual cycle they produce om so every month female produces ovum and these ovum are actually released around day 14 of the menstrual cycle okay so that's the story which we deal in the menstrual cycle physiology 14th deeper in a 28 day menstrual cycle now and oocyte is viable once released from the ovary it is there for about 12 24 hours so if this is the ovary and at day 14 the obam pops out it is there for one to two days okay it is alive the other function of ovary is the production of hormones cancer hormones estrogen is an important hormone produced by the ovary it is secreted by the follicular and paralyutil cells it also produces progesterone secreted by the luteal cells okay so two main important female hormones very very important for female secondary sexual characteristics and a lot of other metabolic functions now histology histology embryology from IBS in my different playlist okay so we are living histology all right clinically determination of ovulation in case of sterility the ovulation can be determined by repeated ultrasonography so um for a long period of time and they are unable to conceive the baby so via ultrasonography ovulation okay prolapse of ovaries is not a very uncommon phenomena because sometimes ovs you know slip into the pouch of Douglas that's that's not very uncommon I'm telling you and that can be actually palpated by upper vaginal examination okay ovarian cysts are also a common pathology which is reported the developmental arrests of the ovarian follicles at various stages of their development and there are so many cysts in the ovary so if this is the ovary there's so many cysts Seeker already insists multiple small fecal utenses involve both the ovaries in case of the Steen Livingston syndrome it's a severe thing the syndrome is characterized by mild hercuism as well because the production of androgens starred and the progesterone and estrogen balance is Disturbed the wise characteristics change secondary a minoria so the you know ladies not menstruating and their cystic enlargement of both the ovaries these are all the features of Stein leventhil syndrome carcinoma of the ovary is also reported account for 15 of all cancers very common and very lethal and 20 of all the gynecological cancers now ovaries are the Communist size of abdomen for in the abdomen for endometriosis the endometrial cyst in the ovary then make the chocolate so endometriosis is basically when the endometrial tissue is present somewhere else and it is also undergoing the menstrual cycle ovary is one of the common places okay endometrial tissue menstrual cycle phases it bleeds again and again it it leads to formation of chocolate cysts okay so that's all about the ovarian Anatomy about the uterine tubes part number two of the video where we have to discuss the anatomy of uterine tubes uterine tubes are also known as Fallopian tubes or cell pains so yes synonymous words is a synonymous word for uterine tube so is the fallopian tube synonymous word for the uterine tube okay they are tortuous ducts which convey oocyte from the ovary to the uterus that's their job introduce into the vagina pass up in the uterus and from there into the uterine tubes and the fertilization actually happen in the uterine tubes or lateral part of the uterine tube so sorry story diagram they can so for example this diagram so the this is the place where the sperms are deposited vagina they move up in the uterus and then they move towards the uterine tube or you're trying to move and yes this is the place where fertilization happens so the job of the um you know Fallopian tubes yeah uterine tube is to transport the sperm towards the Obama and obam towards this pump and this happens when obviously sperms are deposited here so if there are no sperms deposited which means there is no fertilization chance then what happens and with the menstrual cycle bleeding it will get out of the body through vagina so that's the job of the uterine tube to convey the overm from the ovary through the whole tube system and then getting out from from the vagina during the menstrual cycle this happens when there is no fertilization but if fertilization happens then the job of the uterine tube is to provide the site of fertilization and it will then be you know implanted in the uterine wall so it's an important tube okay these are situated in the free upper margin of the broad ligament of the uterus again broad ligament is really broad or harsh is here this is the broad ligament this is the upper border of the broad ligament so upper borders this is present right dimensions each uterine tube is about 10 centimeter long um it's pretty pretty long tube at the later end the uterine tube opens into the peritoneal cavity uh through an opening which is known as abdominal osteum this osteum is about three millimeters in diameter and that's you know an important thing for you to remember okay peritoneal cavities so this is one of the sites of communication okay at one end there is you know this is all uterine tube or is there a future uterine tube here this uterine is openly communicating with the peritoneal cavity or your pericardinal cavity or you're trying to start off is also openly communicating to the exterior through the uterus through the vagina it is communicating with the exterior so actually uterine tube is one of the channels jaha exterior or anterior your peritoneal cavity communication established this is known as osteum abdominal osteum okay the lateral end of the uterine tube is shaped like a funnel and is therefore known as infundibulum which is uh also meaning to the word funnel it Bears a number of finger like processes which are called fibriae and is therefore known as fibrated end so you sub terminology should make sense to you later so this is the fallopian tube yes [Applause] it is like a flask flask is and this is all a torches tube so yeah projection is usually in a very close contact with the ovary ovary tubal pole has an upper pole hair and this is known as ovarians okay so that's the most literal part yeah this part this is the most literal part which is called the fimbriated end yeah which you have to remember is the part of the uterine tube which is just medial to the infernibulum and next to the infundibulum and that part is known as ampulla it is thin walled dilated and tortious and forms approximately little two thirds of the six to seven centimeters of the tube so it's a very very long part as well that and it is making up about six to seven centimeters of the tube it arches over the pole of the ovary the ampulla is four millimeter in diameter this is the site of fertilization so that's an important point that was the lateral party and that long six to seven centimeter part is known as ampulla and this is where fertilization actually happens that is shot is called intramural the HR parts and ampulla the long portion jaha fertilization a short portion which connects the ampulla with the intramural part which is the last thing which enters into the uterus you can have the Charo Parts you have to explain um literally which is which is a small part two to three centimeters only and then the uterine on the intramural part or the interstitial party it enters into the wall of the uterus and it opens at the superior angle and the opening is known as uterine osteum this osteum is about one millimeter egg which was the abdominal osteum yane is called abdominal osteum this is known as the uterine osteum so the uterine tube at one end has abdominal osteum on the other hand has uterine osteum okay straight forward air yes or no the part of the broad ligament between the attachment of the mesoverium and the uterine tube is known as mesosalpanics it contains the termination of uterine and ovarian vessels as well as the iforon Missouri so epipheron is also present in this area mesos because it supplies the ovary here so that's the story of the mesos helpings blood supply uterine artery supplies the proximately the medial two third and the ovarian artery supplies the literal one-third of the foreign artery as well as the ovarian artery and the veins run in parallel with the arteries and drain in the form plexus and ultimately into the um system and the renal system okay right then the lymphatic drainage most of the tubal lymphatic joint the lymphatics from the ovary and drain them into the lateral aortic and pre-aortic it's same as the ovary actually the lymphatic from the eastmas accompany the round ligament of the uterus and drain also into the superficial so you're trying to push drainage Into The Superficial group of inguinal lymph nodes we have okay now nerve Supply the uterine tubes are supplied both by the sympathetic as well as parasympathetic from sympathetic Supply BT parasympathetic Supply you're trying tubesky hair that is from the segments T10 to L2 and they derived from the hypogastric black says they contain both visceral afferent as well as efferent fibers the later which means efferent they are Vaso motor and perhaps stimulate the tubal peristalsis which is very important phenomena fertilization which means there is a sperm available and ovum available at the same time or employment fertilization is in this direction from lateral to medial that is facilitated by contractions of the uterine tube is contraction movements is for little half of the tube and from pelvic splanching nerve for the medial half of the tube they inhibit peristalsis and produce dilation so usually body mean systems that sort of thing okay now the histology of the uterine tube again my histology dropped around because the word used for inflammation of the uterine tube so the inflammation of uterine tube is called self-injitis okay sterility is the inability to having a child which is uh defined as a sterility a person cannot produce child okay sterile couple now the most common cause of sterility in female obviously there can be causes in males and there can be causes in females in females one of the common cause is tubal blockage because of so many different reasons it can be congenital it can be because of chronic infection p latency of the tube can be actually investigated you know one of the common reasons for not conceiving a baby or not being able to conceive a baby is that the tube is blocked us and then you can scan it radiographically is that means it is or the Rubin test is that normally air pushed into the uterus passes through the tube and leaks into the peritoneal cavity and you hear it a hissing a bubbling sound in the eyelid fossa if this is all happening this is normal okay blockage in here then there is hysterosal pingography uh you get this image you insert a dye from the vagina and you see if the Fallopian tubes are patent or not okay tubal pregnancy is an ectopic pregnancy your name um into the walls of the uterine tube implantic so that is what is known as tubal pregnancy okay it may actually rupture the tube to your words your tube vasculature or walls they are not designed to you know contain and entertain the developing embryo uterus is here okay then there's a technique called you back to me to back to me is actually used for uh permanent sterilization so for example somebody wants a permanent method of contraception system so this is what is done to back to me the chubby card the ovary says fertilization even without using any formal contraceptive methods such as condoms or stuff like this uh the sperms are coming here but fertilization is not happening because there is uh tube removal okay transport of overm is by the peristaltic movement in the uterine tube or there are also cilia so ciliary movements towards the uterus okay so that's all about the uterine tube next bit which is the anatomy of uterus the third part of this video anatomy of uterus so lemon language it is also known as the womb uh the place where the baby is developed throughout the pregnancy is the very layman term for womb okay or it is also called the hystera word is then clinically associated with a lot of terminologies for example hysterectomy disease hysterectomy okay so uterus hegia it is actually the child bearing organ in the female particular definition then what was the job of the uterine tube you're trying to cut it's a passage for either the overm or the fertilized uh over which is the zygote then we are talking about uterus uterus uterus is the child bearing organ in the female is the baby also comes out of the vagina by the contraction of the uterus can come here taking care of the baby developing the baby as well as delivering the baby and then lastly we will discuss about vagina so vagina it is the main quietest organ yeah actually penis inside it is child bearing it's maybe generate developed okay so the hollow it is thick world and firm and can be palpated by the per vaginal examination okay if the organ which it is the organ which protects and provides nutrition to the fertilized ovum enabling it to grow into a fully formed fetus this is the main Hub okay what is the size and shape of the uterus uterus is basically pyriform in shape about 7.5 centimeters long five centimeters broad 2.5 centimeters thick Dimensions exact numbers it's about 30 to 40 grams in weight so it's considerable in size actually and it is divided into upper expanded part which is called the body and the lower cylindrical part which is known as cervix the body or cervix don't know actually uterus is there are different parts of uterus the junction of these two parts is marked by a circular constriction which is known as Isthmus part of the uterus above the fallopian tube is known as fundus the body forms the upper 2 of the organ and the cervix forms the lower so yeah basically different terminologies there is a body which is the upper part there is a cervix which is the lower part and then they have also thrown a terminology called the fundus so here we are actually seeing a lot of different organs so this bit is the uterus is uterus all this is the body is your lower part here all this is the cervix okay Fallopian tubes so that's the point where actually the uterine tubes are entering into the uterus is entry point all this is known as the fundus what is funders it is the point of uterus above the entry of the uterine tube so that is fundus this upper part is the body and this lower part is this cervix angle of the body projects outward at the junction of the body and the fundus and are called the corona so these are the lateral parts of literal side pay uh these Corona are out you know projecting outward structures which are called Corona the uterine tube ligament of the ovary and round ligament are attached on the lateral side up again let us go back to the same diagram here so these are the coronal portions okay these are Corona or lateral side uterus is now the normal position in the angulation this is important stuff because actually is my confusion normally the long axis of the uterus forms an angle of about 90 degree with the long axis of the version so either point is yoga so look here but this is a good diagram so it got all be diagrammed here so this diagram as well so this is the vaginal entry this is vagina vagina long axis so that is the long axis of vagina or yeah this is what is shown here you see this is the long axis of vagina this is the long axis of uterus and there is an angle of 90 degrees almost between the two long axises okay so that's the first point is okay this is the vaginal entry so vagina and then the uterus is kind of anterior side it is tilted it is in an angle with the long axis of the vagina no it's not like this it's not vertical Arrangement it's a 90 degree turn Okay the important Point here the angle is open forward pregnancy symptoms the forward tilting of the uterus relative to vagina is known as antiversion the backward tilted of uterus relative to vagina is known as retro version retro version yeah the uterus is forward tilted version the uterus is also slightly flexed and that flexion is known as anti-flexion or the anti-flexion angle about 125 degrees so the uterus is antiverse statement is the uterus is antiverse as well as and anti-flexed so it is anti-flexed as well okay anterior part is also anti-flexed so is important terminology here roughly the long axis of uterus correspond to the excess of the pelvic Inlet it is normally deviated to the right or is it also called text to rotation so you served terms it is usually slightly on the right side it is antiversed it is anti-flexed anti-version angle has 90 degree anti-flexion angle here 125 or yes Communications superiorly the uterus communicates on each side with the uterine tube and inferiorly with the vagina simplest thing is foreign tube and the cervix is communicating uh on the lower side with the vagina and on the upper side with the body is known as external opening so there is an internal us which is opening internally and there is an external loss which is opening externally okay the easy busy stuff it will all be very very easy for you okay right okay now let's talk about the parts of the uterus there is a fundus which is above the entry of the Fallopian tubes then there is a body which has two surfaces anterior sideway or posterior side or two bottles and lateral and there is a cervix fundus is formed by the free upper end of the uterus for this lies above the opening of the uterine tubes it is convex like a dome yes and this is then the body of the uterus it is covered with the peritoneum and is there It Forward when the bladder is empty the fertilize or yes so is diagram where is the fundus and it is directed forward okay right now the fertilized oocide is usually implanted in the posterior wall of the fundus or the upper part of the body of the uterus so fund display your body of uterus pay actually zygotech development um surface because it is facing towards the bladder so this is the anterior surface for example and here is the bladder so this is also called the vasocal surface easy to understand it is a very close relationship with loops of the terminal allium also to sigmoid colon it is also covered with peritoneum and forms the anterior wall of the recto-uterine pouch so this is the posterior walls peritoneal Reflections each literal border is round and convex is heck either this is the lateral border of uterus border this is the lateral border this is another lateral border so your right side a little border hey left side a little water there are two little borders in per side ligaments so the lateral border is rounded and convex it provides attachment to the broad ligament and um you know which attaches it with the little pelvic wall the uterine tube also opens in the lateral border this end of the Border gives attachment to the round ligament of the uterus as well so cavisary ligaments attached basically lateral border repair in sagittal section the cavity and the surround here yes well this is not too much important The Junction internal loss internal OS is the communication between cervix and vagina that's the internal loss and ex sorry the external loss internal OS is the communication between D cervix and the body of the uterus and external loss is the communication between the cervix and the vagina okay so external loss and internal object Concepts we have discussed already now let's talk about cervix itself the lower part uteruska cervix is the lower cylindrical part of the uterus it is less mobile than the body the body is actually pretty much mobile movement possible it's very much fixed portion okay it is 2.5 centimeters long cervical cancer okay the lower part of the cervix projects into the vagina um or actually is different parts there is a part which is above the vagina it's called supravaginal part and there's a part which is actually entering into the vagina this is called vaginal part so the Supra vaginal particle relation May entirely there is bladder posteriorly there is rectum and rectal uterine pouch on each side is the ureter and and the fibro fatty tissue between the two layers of the broad ligament is called parametrium um it's tightly interlocked with vagina and produces vaginal furnaces this is gonna come later in this chapter interior posterior lateral foreign cervical Canal is the canal which is going through the cervix the walls show mucosal fold which resemble the branches of a tree and therefore it is also sometimes called Arbor YT you try the foils in the anterior and posterior walls interlock with each other and close the canal all right okay so cervix is a simple story guys internal OS external OS and that's shared about cervix easy stuff okay let's move on um ligaments of uterus I said ligaments ligaments will be there obviously for support purpose things like that yeah are not much contributing to the support of the uterus leading to fibromuscular ligament hair they are important for supporting the uterus so supportive these are not critical okay but since they are there peritoneum key coverings they are there in the form of anterior ligament uh they're they're there in the form of posterior ligament the broad ligaments already discussed here suspensary ligament of ovary um [Music] [Music] which is between the two layers of broad ligament so a lot of structures are there uh actually within the broad ligament ligaments ligament broad ligament yes a peritoneal reflections they do not provide any support to the uterus that's bottom line they are not providing support they are just peritoneal Reflections on the uterus muscular ligaments they are important for support they are separately therefore defined Under The Heading of support of the uterus so the support of the uterus there are so many structures which provide support to the uterus pelvic floor Services they are later defined separately Under The Heading of support of the uterus actually arterial Supply it is chiefly supplied by two uterine arteries which are markedly enlarged during pregnancy and obviously pregnancy um they are very much enlarged during pregnancy partly by the ovarian vessels as well so Chief Supply is by the uterine partly also by the ovarian uterine is a branch of the entry division of the internal iliac and it goes through you put a root DIY which I don't recommend but this is important you try notary branch of the internal iliac measure Supply okay okay it also gives branches to vagina also gives branches to ovary urator and structures present in the broad ligament that's fine like in neutronetric a major calm hair to supply the uterus particularly during pregnancy okay now Venus drainage the vein forms the plexus along the little border and ultimately they drain into the internal iliac vein so that's the final Destiny lymphatics lymphatics of the uterus begin at the three intercommunicating networks endometrial myomaterial and sub-peritoneal a different layers uterus these plexuses drain into lymphatics on the side of the uterus of these the upper lymphatics from the fundus in the upper part of the body drain mainly into the aortic nodes and only partly to The Superficial inguinal nodes the middle lymphatics from the lower part of the body drain into the external eyelid nodes and the lower lymphatics from the cervix drain into the internal egg diagram upper part is going to the aortic node you see they are going to the aortic node the middle part is going to the external iliac nodes and the lower part which is the cervix are going to either internal ileax sacral superficial and one also different areas okay nerve Supply the uterus is richly supplied by both sympathetic as well as parasympathetic nerves they are chiefly supplied by sympathetic as well as parasympathetic okay through the inferior hypogastric and ovarian plexuses sympathetic fibers a root value segments of the spinal cord produce uterine contraction now that's critical here uterine contraction because of the process of delivery baby Pura developers sympathetic system is important for contractions okay parasympathetic system uh produce uterine inhibition so if this activated no delivery okay pain Sensation from the body of the uterus pass along the sympathetic fibers as well and from the cerfix through the parasympathetic confusing after the age and reproductive changes uterus actually goes through a lot of changes fetal life mates very small cervix large puberty by uters it becomes much vascular and then it bleeds out chicken or pregnancy with a very large tremendously undergoes hypertrophy of the smooth muscle as well as hyperplasia it increases in size to prepare for pregnancy okay and old age may it kind of becomes atrophic it regresses internal loss external loss in old age okay support of the uterus now when we talk of the support of the uterus actually yes which one that particular diagram so is there are only three ligaments which are kind of supporting it and the pelvic floor muscles so that you know physics and mechanics makes it uh less vulnerable uh to prolapse and herniation those support mechanisms the uterus is a mobile organ which undergoes extensive size in change in size and shape during the reproductive period of life so particularly in the pregnancy it's it's very much mobile organ fix organisms actually mobile so these are actually not providing big support primary support is either via the muscles of the pelvic diaphragm or The Perennial body or the distal urethral sphincter mechanism your muscles these are all muscles of the pelvis which are supplying great strength and support to the uterus then there are some fibromuscular ligaments such as ectoscope cervical ligament transfers cervical ligament and utero cervical ligament and round ligaments so this is the diagram showing you different pelvic floor muscles pelvic diaphragm okay muscles so they provide big support okay so pelvic diaphragm all the muscles they are listed here during delivery muscle fiber problems that's an important thing then the perennial body is a strong support So perennial body is very very important structure and it is a big time support to the whole different organs which are present in the pelvis perineum or um perennial body support extensive either during perforation or any other trauma then the pelvic floor key Integrity is Disturbed and once the pelvic floor Integrity is Disturbed uterus can prolapse so perennial body is a fibromuscular node-like structure to which 10 muscles are attaching you know you have no problem already pelvic muscles or diaphragm playlist as an anchor for the pelvic diaphragm so if perennial body is Disturbed the whole pelvic diaphragm in the muscles all of them attaching they are Disturbed and prolapse can happen okay then there is urethral sphincter mechanism the urogenital diaphragm does not exist as a sphincter Euro 3 is within the wall of the urethra they also give support to the uterus then the uterine excess itself forward Direction lateral Direction and backward Direction they're all very important ligament of the uterus the round ligament of the uterus the round ligament at two fibromuscular flat bands 10 to 12 centimeters long which lie between the two layers of the broad ligament anterior infinitely broad ligaments each ligament begins at the lateral angle of the uterus run forwards and literally passes through the yes okay transverses the inguinal canal and merges with the alular tissue of the labium measures so labium they also provide support to the uterus they're they're good in support structures muscles of pelvic diaphragm perennial body and all these ligaments foreign and maintains the angle of anti-version so use your angle of anti-version but a beautiful diagrams ligament these are all providing support so um to me in corporate posterior pulpotomy is done to drain pus from the pouch of Douglas so called now intrauterine contraceptive devices are used to prevent implantation and fertilization is a permanent devices or there is no pregnancy so that's a type of contraception so obviously side effects okay uterus is common side the formation of fibroids very very common muscular cells they make structures called fibroids very common perennial body is one of the chief supports of the pelvic organs damage to the perennial party because of any reason such as during pregnancy or during any other trauma prolapse of uterus is important not only uterus but also other organs okay so that's all which is used as a synonymous to vagina or is it related to coach medical terminologies such as colposcopy is from colpos so is the you know the walls looking like and what is the gross morphology so colposcopy called me is for vagina okay now vagina is what's the definition is a fibromuscular canal forming the female copulatory organ so that's basically the female copulatory organ so if you look at this diagram for example uh your uterus here cervix and then uterus above uterusala say uterus is the organ the development of the embryo takes place but vagina is the organ which receives the male penis it is the organ which is the female quital organ it is the organ which receives the sperm so the penis is inserted into the vagina and this is the area where sperms are released and these sperms then travel up way into the uterus and then go to the uterine tube so the female copulatory organ the male penis does not enter into uterus for example it enters into vagina so vagina is the female copulatory organ okay and literal terms mean vagina means a sheath so it's a sheet before the actual reproductive organs it receives the sperm vagina extends from the vulva of the uterus so at one end is the uterus and is situated behind the bladder and urethra and in front of the rectum and anal Canal so again they are easily visible in this diagram only okay in front of vagina so this is all the vagina in front of the vagina is the unit bladder and the urethra and at the backside in a posterior end of vagina pain there is rectum and anal Canal so anteriorly what is there bladder and urethra bladder and urethra this is the anterior relation to the vagina and posteriorly catch is a rectum and anal Canal so here's the rectum here's the anal Canal okay now what is the direction and the situation of vagina in erect posture which means if the female is standing the vagina is directed upwards and backwards long axis of the uterus and cervix forms an angle of about 90 degrees with a long axis of vagina what does that mean a simple thing to understand what we are talking about if the female is standing like for example in this diagram so what's happening it's upward and backward so in the upward Direction and slightly tilted towards the backwards uterus okay so that's the angle that they are talking about the vertical axis of uterus which is this and the vertical long axis of vagina which is this and they are making an angle of 90 degrees okay so long axis of uterus and long axis of vagina makes an angle with each other size and shape the anterior wall is about eight centimeter and the posterior wall is about 10 centimeters which means that the posterior wall is a little longer than the interior wall so here this is the interior wall and this is the posterior wall okay the diameter of the vagina gradually increases From Below upwards any blow up words which means initial bits of vagina diameter come here that's a small diameter and as you see here in the upward there is a bigger diameter the upper end or the world is roughly five centimeter twice the size of the lower end the lower end is 2.5 centimeter if a it's not a fixed size upper end which is the Vault of the vaginal part okay however it is quite distensible and allows the passage of the head of the features during delivery of the important point they were starting this is a fibromuscular canal so this is a fibromuscular canal uh so it is made up of fibers and muscles and it is extensively distendables the tube of vagina is highly elastic it can get you know elongated in the diameters the Lumen is circular at the upper end and slit banjati that's irrele Limited in the version the lower end of the vagina is partially closed by a thin membrane which is known as a hymen so hymen is usually it's a muscular fold um which is present or it's a mucosal fold not the muscular fold it's a mucosal fold which is present towards the lower end only in The Virgins and not necessarily versions maybe because of you know a lot of such as masturbation or such as other stuff jumping being in Olympics and athletes vaginal rupture is a very common phenomena but anyways it is usually present in virgins the hymen this mucosal membrane but in married women because of obviously the quietial procedures insertion of penis this hymen is ruptured and is represented by remnants which are called coroncular hyminals so hymen is not the hundred percent uh you know sign of being a somebody version that's an important point to remember okay it is more commonly seen in version hymen but not necessarily always seen in versions as well okay the furnaces of vagina the interior of the upper end of the vagina or the vaginal wall is in the form of a circular Groove that surrounds the protruding cervix it is kind of fixed to the lower end of the cervix is an anterior phonics there is a posterior phonics and there are two little phonices that's all a kind of fixation projections relationships anterior relation simple upper half is related to the base of the urinary bladder and lower half is related to urethra again refer to this diagram and if we divide the vagina into the upper part of the lower part so say for example this is the upper part is anterior relation main unit bladder here and if we say this is the lower part the skin anterior relation mean there is urethra okay in the posterior wall upper one fourth is separated from the rectum by the rectal uterine pouch middle two third separated from the rectum by the loose connective tissue and the lower one-fourth is separated from the anal Canal by The Perennial body terminologies it is separated from the rectum by this pouch which is called the rectal uterine pouch a peritoneal folding which is which is between the vagina and the rectum so recto uterine uterus bienna is fatty tissue hair or the lower end of vagina or analysis there is bulb of the vegetable and what is the arterial supply of vagina no vagina is a very vascular organ it's a highly vascular organic important point and is supplied by the following arteries direct Supply which is the vaginal Branch it is also supplied by the uterine artery branches the lower part is supplied by the middle rectal as well as the internal potential so it's pretty heavy blood supply even if you look at the diagram here so you see this is vagina that is vagina supplied by a lot of arteries and in fact they make a plexus branches internal pudendal or middle rectal branches branches make an anastomosis to form anterior and posterior midline vessels which are called vaginal izygous arteries interior or posterior is branches which are an astromosome with each other interior vaginal is artery okay the rich vaginal venous plexus drains into the internal iliac vein veins and they accompany the vaginal arteries lymphatic drainage from the upper third of the vagina goes into the external iliac lymph nodes from the middle one third goes to the internal iliac and from the lower one third goes to the superficial inguinal so again little side middle third or lower third it goes to the inguinal lymph node upper or middle parts and they go to the external and internal aliac lymph nodes respectively nerve Supply uh that is pain sensitive okay the lower one third of the vagina is pain sensitive and is supplied by the pudendal nerve so during quietest your name during the process of sexual inter so that is the fibers are traveling into the Prudential nerve okay through the inferior rectal and posterior labial branches of the perennial nerve the upper two third of the vagina is pain insensitive and is supplied by the sympathetic drive as well as the parasympathetic Drive different segments are written here nerves are derived from the inferior hypogastric and neutral vaginal plexuses sympathetic fibers are vasoconstrictor and parasympathetic fibers are vasodilator the fibers which accompanying the vaginal arteries form the vaginal nerve so that's all simple important that is very pain sensitive okay at a ureter in female pelvis pelvis it is in very close relationship to some of the you know internal female genital organs or for example the ureter lies anterior to the internal iliac and immediately behind the ovary so if you are dealing with ovary you have to take care of the ureter is it is also in close relationship to the vaginal furnaces for example cervix uterine artery or you try and artery so one has to be very careful if you are dealing with ureter or if you are dealing with artery obviously there are some ways to differentiate the the two obviously the ureter is because it contains more muscular and peristaltic functions so it exhibits actually peristaltic movement which can be appreciated on the operation table okay or it is pale glistening and is palparated as a firm cord so there are some identification features and the experienced surgeon can obviously identify which one is urator and which one is a uterine artery or um is a common routingly performed examination in you know routine gynecological practice inspection and palpation inspection is to inspect the vagina vagina is first inspected just by opening the labia minora in Libya majority you physically look at how the vagina is actually grossly visible that sort of thing so this is all under the heading of inspection here one can also insert a speculum and actually examine the vagina up till the vaginal Vault service to check the culture and sensitivity then palpation of pelvic organs can also be done by per vaginal examination just a per rectal examination you insert a you know finger into the rectum similarly you insert a finger into the vagina to feel different organs through vagina because urethra and urinal bladder and pubic symphysis posteriorly there is rectum anal canal and pouch of Douglas literally there are ovary um lateral pelvic wall structures ureters and superiorly there is cervix so all these structures can actually be felt and more so with the bimanual examination into the vagina you can have a feel of how the bladder is urethra is rectum is recto uterine pouches you can also palpate if there is something wrong within uh the uterine structures okay so this is called the bi-manual examination vaginal lacerations are actually traumatic lacerations in the vagina traumatic upper laceration ulcers you have wounds that is indicative of forcible quieters such as in the condition of rapes okay and also during childbirth child birthday this is possible accidents maybe this is possible or extensive masturbation for example this is possible so all these possibilities would lead to vaginal lacerations okay which are visible on inspection hymen can be examined for medical legal purposes but I told you the presence of hymen a or absence of hymen is not 100 indicative of virginity so virginity 100 relation because hymen is lost during you know masturbation for example during you know if somebody is doing a strenuous exercise or somebody's athlete things like that um so that's possible okay vaginitis is inflammation of vagina that can be because of infections such as gonococcal infection or sexually transmitted diseases and other range of you know stuff and white discharge from vagina because of infection is a common condition known as leukeria females is once or more than once in their reproductive age leukuria white liquid discharge okay now prolapse of prolapse of anterior wall vagina prolapseota because of Any troubles in the pelvic diaphragm or the musculature or the normal framework possibility structures that sort of stuff neoplasms primary new growth of vagina like the infections are uncommon so that is one thing which is uncommon is so it's not a very favorite site for neoplasms episiotomy is a procedure where an incision is given to the posterior literal side of the vagina and to the pelvic floor structures okay because see this is a very small opening to the vagina and the pelvic floor easily out of vagina us again okay so that is all about this chapter basically hum development reproductive organs from embryology system based embryology with this the internal genitals are all done we discussed about ovary we discussed about uterine tubes we discussed about uterus and we discussed about vagina so that's all about the female internal reproductive organs take care of yourself