Queen female genitals. The structure of the female pelvic organs: diagram. Functions of the female reproductive organ clitoris

Reproduction is the main purpose of all life on our planet. To achieve this goal, nature has endowed people with special organs, which we call reproductive. In women, they are hidden in the pelvis, which provides a favorable environment for fetal development. Let's talk on the topic - “Structure of the female pelvic organs: diagram.”

The structure of female organs located in the pelvis: diagram

In this area of ​​the female body the reproductive and genitourinary organs are located:

• ovaries, the main purpose of which is to produce eggs;
• fallopian tubes, which carry eggs to the uterus for fertilization by male sperm;
• vagina - entrance to the uterus;
• urinary system, consisting of the bladder and urethra.

The vagina (vagina) is a muscular tube that extends from the entrance hidden behind the labia to the cervical uterus. That part of the vagina that surrounds the cervix forms a vault, conditionally consisting of four sectors: posterior, anterior, as well as left lateral and right.

The vagina itself consists of walls, which are also called posterior and anterior. The entrance to it is covered by the external labia, forming the so-called vestibule. The vaginal opening is also known as the birth canal. It serves to remove discharge during menstruation.

Between the rectum and the bladder (in the middle of the pelvis) is the uterus. It looks like a small, hollow, pear-shaped muscle bag. Its function is to provide nutrition to the fertilized egg, the development of the embryo and its gestation. The fundus of the uterus is located above the entry points of the fallopian tubes, and below is its body.

The narrow part protruding into the vagina is called the cervix. It has a fusiform cervical passage, which begins with the pharynx on the inside of the uterus. The part of the canal that goes into the vagina forms the external pharynx. The uterus is attached to the peritoneal cavity by several ligaments, such as the round, cardinal, broad left and right.

A woman's ovaries are connected to the uterus through the fallopian tubes. They are held in the abdominal cavity on the left and right by broad ligaments. Pipes are a paired organ. They are located on both sides of the uterine fundus. Each tube begins with an opening resembling a funnel, along the edges of which there are fimbriae - finger-like projections above the ovary.

The widest part of the pipe extends from the funnel - the so-called ampoule. Tapering along the tube, it passes into the isthmus, which ends in the uterine cavity. After ovulation, a mature egg moves from the ovary along the fallopian tubes.

The ovaries are a pair of female reproductive glands. Their shape resembles a small egg. In the peritoneum, in the pelvic area, they are held by their own ligaments and partly due to the wide ones, and have a symmetrical arrangement relative to the uterine body.

The narrower tubal end of the ovaries is turned towards the fallopian tube, and the wide lower edge is turned towards the uterine fundus and is attached to it by means of its own ligaments. The fimbriae of the fallopian tube surround the ovary from above.

The ovary contains follicles inside which eggs mature. As the follicle develops, it moves to the surface and eventually breaks through, releasing the mature egg into the abdominal cavity. This process is called ovulation. It is then captured by the fimbriae and sent on a journey through the fallopian tubes.

In women, the urinary duct connects the internal opening of the bladder to the external urethral adjacent to the external genitalia. It runs parallel to the vagina. Near the external urethral opening, two paraurethral ducts flow into the canal.

Thus, the urethra can be divided into three main parts:

• internal opening of the urinary duct;
• intramural part;
• outer hole.

Possible anomalies in the development of organs in the pelvis in women

Uterine developmental anomalies are common: they occur in 7-10% of women. The most common types of uterine anomalies are caused by incomplete fusion of the Müllerian ducts and are:

• with complete nonfusion of the ducts - double vagina or uterus;
• with partial nonunion, the so-called bicornuate uterus develops;
• the presence of intrauterine septa;
• arcuate uterus;
• asymmetrical unicornuate uterus due to delayed development of one of the Müllerian ducts.

Variants of vaginal anomalies:

• vaginal infertility - most often occurs due to the absence of the uterus;
• vaginal atresia - the lower wall of the vagina consists of fibrous tissue;
• Müllerian aplasia - absence of the vagina and uterus;
• transverse vaginal septum;
• intravaginal urethral outlet;
• anorectal or vaginorectal fistula.

There are also abnormalities in the development of the ovaries:

• Turner syndrome - the so-called infantilism of the genital organs, caused by chromosomal abnormalities, which leads to infertility;
• development of an additional ovary;
• absence of fallopian tubes;
• displacement of one of the ovaries;
• hermaphroditism - a condition when a person has both male testicles and female ovaries with the normal structure of the external genital organs;
• false hermaphroditism - the development of the gonads occurs according to one type, and the external organs - according to the opposite gender.

The external genitalia (genitalia externa, s. vulva), collectively called “vulva” or “pudendum”, are located below the pubic symphysis (Fig. 2.1). These include the pubis, labia majora and minora, clitoris and vestibule of the vagina. In the vestibule of the vagina, the external opening of the urethra (urethra) and the ducts of the large glands of the vestibule (Bartholin's glands) open.

The pubis (mons pubis), the border region of the abdominal wall, is a rounded median eminence lying in front of the pubic symphysis and pubic bones. After puberty, it becomes covered with hair, and its subcutaneous base, as a result of intensive development, takes on the appearance of a fat pad.

The labia majora (labia pudendi majora) are wide longitudinal folds of skin containing a large amount of fatty tissue and fibrous endings of the round uterine ligaments. In front, the subcutaneous fatty tissue of the labia majora passes into the fatty pad on the pubis, and in the back it is connected to the ischiorectal fatty tissue. After reaching puberty, the skin on the outer surface of the labia majora becomes pigmented and covered with hair. The skin of the labia majora contains sweat and sebaceous glands. Their inner surface is smooth, not covered with hair and rich in sebaceous glands. The connection of the labia majora in front is called the anterior commissure, in the back - the commissure of the labia majora, or posterior commissure. The narrow space in front of the posterior commissure of the labia is called the navicular fossa.

1 - pubis; 2 - anterior commissure; 3 - labia majora; 4 - labia minora; 5 - posterior wall of the vagina; 6 - fossa of the vestibule of the vagina; 7 - posterior commissure (commissure of the labia); 8 - anus; 9 - crotch; 10 - entrance to the vagina; 11-free edge of the hymen; 12 - external opening of the urethra; 13 - frenulum of the clitoris; 14 - clitoris.

Labia minora (labia pudendi minora). Thick, smaller folds of skin called the labia minora lie medial to the labia majora. Unlike the labia majora, they are not covered with hair and do not contain subcutaneous fatty tissue. Between them is the vestibule of the vagina, which becomes visible only when the labia minora are separated. At the front, where the labia minora meet the clitoris, they divide into two small folds that merge around the clitoris. The superior folds join above the clitoris to form the clitoral foreskin; the lower folds meet on the underside of the clitoris and form the clitoral frenulum.

The clitoris (clitoris) is located between the anterior ends of the labia minora under the foreskin. It is a homologue of the corpora cavernosa of the male penis and is capable of erection. The body of the clitoris consists of two cavernous bodies enclosed in a fibrous membrane. Each corpus cavernosum begins with a pedicle attached to the medial edge of the corresponding ischiopubic branch. The clitoris is attached to the pubic symphysis by the suspensory ligament. At the free end of the body of the clitoris there is a small projection of erectile tissue called the glans.

Bulbs of the vestibule (bulbi vestibuli) - venous plexuses located in the depths of the labia minora and covering the vestibule of the vagina in a horseshoe shape. Near the vestibule of the vagina, along the deep side of each labia minora, is an oval-shaped mass of erectile tissue called the vestibular bulb. It is represented by a dense plexus of veins and corresponds to the corpus spongiosum of the penis in men. Each bulb is attached to the inferior fascia of the urogenital diaphragm and is covered by the bulbospongiosus (bulbocavernous) muscle.

The vestibule of the vagina (vestibulum vaginae) is located between the labia minora, where the vagina opens in the form of a vertical slit. The open vagina (the so-called opening) is framed by nodes of fibrous tissue of varying sizes (hymenal tubercles). In front of the vaginal opening, approximately 2 cm below the head of the clitoris in the midline, the external opening of the urethra is located in the form of a small vertical slit. The edges of the external opening of the urethra are usually raised and form folds. On each side of the external opening of the urethra there are miniature openings of the ducts of the urethral glands (ductus paraurethrales). The small space in the vestibule of the vagina, located behind the vaginal opening, is called the fossa of the vestibule of the vagina. Here, on both sides, the ducts of the large glands of the vestibule, or Bartholin's glands (glandulae vestibulares majorus), open. The glands are small lobular bodies the size of a pea and are located at the posterior edge of the vestibular bulb. These glands, along with numerous small vestibular glands, also open into the vestibule of the vagina.

Internal genital organs (genitalia interna). The internal genital organs include the vagina, uterus and its appendages - fallopian tubes and ovaries (Fig. 2.2).

The vagina (vagina s. colpos) extends from the genital slit to the uterus, passing upward with a posterior inclination through the urogenital and pelvic diaphragms (Fig. 2.3). The length of the vagina is about 10 cm. It is located mainly in the pelvic cavity, where it ends, merging with the cervix. The anterior and posterior walls of the vagina are usually connected to each other at the bottom, having the shape of the letter H in cross section. The upper section is called the vaginal vault because the lumen forms pockets, or vaults, around the vaginal part of the cervix. Because the vagina is at a 90° angle to the uterus, the posterior wall is much longer than the anterior one, and the posterior fornix is ​​deeper than the anterior and lateral fornix. The lateral wall of the vagina is attached to the cardiac ligament of the uterus and to the pelvic diaphragm. The wall consists mainly of smooth muscle and dense connective tissue with many elastic fibers. The outer layer contains connective tissue with arteries, nerves and nerve plexuses. The mucous membrane has transverse and longitudinal folds. The anterior and posterior longitudinal folds are called fold columns. The stratified squamous epithelium of the surface undergoes cyclic changes that correspond to the menstrual cycle.

1 - vagina; 2 - vaginal part of the cervix; 3 - cervical canal; 4 - isthmus; 5 - uterine cavity; 6 - the bottom of the uterus; 7 - wall of the uterus; 8 - fallopian tube; 9 - ovary; 10 - interstitial part of the pipe; 11 - isthmic part of the pipe; 12 - ampullary part of the pipe; 13 - pipe fimbriae; 14 - sacrouterine ligament; 15 - own ligament of the ovary; 16 - infundibulopelvic ligament; 17 - wide ligament; 18 - round ligament; 19 - section of the ovary with follicles and corpus luteum; 20 - steam varium.

The anterior wall of the vagina is adjacent to the urethra and the base of the bladder, with the terminal part of the urethra protruding into its lower part. The thin layer of connective tissue that separates the anterior wall of the vagina from the bladder is called the vesicovaginal septum. At the front, the vagina is indirectly connected to the back of the pubic bone by fascial thickenings at the base of the bladder known as the pubovesical ligament. Posteriorly, the lower part of the vaginal wall is separated from the anal canal by the perineal body. The middle part is adjacent to the rectum, and the upper part is adjacent to the rectouterine cavity (Douglas pouch) of the peritoneal cavity, from which it is separated only by a thin layer of peritoneum.

The uterus (uterus) outside of pregnancy is located at or near the midline of the pelvis between the bladder in front and the rectum in back (see Fig. 2.3). The uterus has the shape of an inverted pear with dense muscular walls and a triangle-shaped lumen, narrow in the sagittal plane and wide in the frontal plane. The uterus is divided into body, fundus, cervix and isthmus. The vaginal insertion line divides the cervix into vaginal (vaginal) and supravaginal (supravaginal) segments. Outside of pregnancy, the curved fundus is directed anteriorly, with the body forming an obtuse angle with respect to the vagina (tilted forward) and bent anteriorly. The anterior surface of the uterine body is flat and adjacent to the apex of the bladder. The posterior surface is curved and faces above and behind the rectum.

The cervix is ​​directed downward and posteriorly and is in contact with the posterior wall of the vagina. The ureters approach the cervix directly laterally and are relatively close.

Rice. 2.3.

(sagittal section).

1 - uterus; 2 - rectal-uterine cavity; 3 - cervix; 4 - rectum; 5 - vagina; 6 - urethra; 7 - bladder; 8 - symphysis; 9 - round ligaments of the uterus; 10 - ovaries; I - fallopian tubes; 12 - funnel ligament; 13 - sacral cape; 14 - sacrum.

The body of the uterus, including its fundus, is covered with peritoneum. In front, at the level of the isthmus, the peritoneum bends and passes to the upper surface of the bladder, forming a shallow vesicouterine cavity. At the back, the peritoneum continues forward and upward, covering the isthmus, the supravaginal part of the cervix and the posterior vaginal fornix, and then passes to the anterior surface of the rectum, forming a deep rectouterine cavity. The length of the body of the uterus is on average 5 cm. The total length of the isthmus and cervix is ​​about 2.5 cm, their diameter is 2 cm. The ratio of the length of the body and cervix depends on age and number of births and is on average 2:1.

The wall of the uterus consists of a thin outer layer of peritoneum - the serous membrane (perimetry), a thick intermediate layer of smooth muscle and connective tissue - the muscular layer (myometrium) and the inner mucous membrane (endometrium). The body of the uterus contains many muscle fibers, the number of which decreases downwards as it approaches the cervix. The cervix consists of an equal amount of muscle and connective tissue. As a result of their development from the fused parts of the paramesonephric (Müllerian) ducts, the arrangement of muscle fibers in the uterine wall is complex. The outer layer of the myometrium contains mainly vertical fibers that run laterally in the upper body and connect to the outer longitudinal muscular layer of the fallopian tubes. The middle layer includes most of the uterine wall and consists of a network of spiral-shaped muscle fibers that are connected to the inner circular muscle layer of each tube. The bundles of smooth muscle fibers in the suspensory ligaments intertwine and merge with this layer. The inner layer consists of circular fibers that can act as a sphincter at the isthmus and at the openings of the fallopian tubes.

The uterine cavity outside of pregnancy is a narrow slit, with the anterior and posterior walls closely adjacent to each other. The cavity has the shape of an inverted triangle, the base of which is located at the top, where it is connected on both sides to the openings of the fallopian tubes; the apex is located below, where the uterine cavity passes into the cervical canal. The cervical canal in the isthmus region is compressed and has a length of 6-10 mm. The place where the cervical canal meets the uterine cavity is called the internal os. The cervical canal widens slightly in its middle part and opens into the vagina with an external opening.

Uterine appendages. The uterine appendages include the fallopian tubes and ovaries, and some authors include the ligamentous apparatus of the uterus.

Fallopian tubes (tubae uterinae). On both sides of the uterine body laterally there are long, narrow fallopian tubes (fallopian tubes). The tubes occupy the superior portion of the broad ligament and arc laterally over the ovary before running downward over the posterior portion of the medial surface of the ovary. The lumen, or canal, of the tube runs from the upper corner of the uterine cavity to the ovary, gradually increasing in diameter laterally along its course. Outside of pregnancy, the stretched tube has a length of 10 cm. There are four sections: the intramural section is located inside the wall of the uterus and is connected to the uterine cavity. Its lumen has the smallest diameter (1 mm or less). The narrow area running laterally from the outer border of the uterus is called the isthmus (istmus); then the tube expands and becomes tortuous, forming an ampulla, and ends near the ovary in the form of a funnel. Along the periphery of the funnel there are fimbriae that surround the abdominal opening of the fallopian tube; one or two fimbriae are in contact with the ovary. The wall of the fallopian tube is formed by three layers: the outer layer, consisting mainly of the peritoneum (serous membrane), the intermediate smooth muscle layer (myosalpinx) and the mucous membrane (endosalpinx). The mucous membrane is represented by ciliated epithelium and has longitudinal folds.

Ovaries (ovarii). The female gonads are represented by oval or almond-shaped ovaries. The ovaries are located medial to the curved part of the fallopian tube and are slightly flattened. On average, their dimensions are: width 2 cm, length 4 cm and thickness 1 cm. The ovaries are usually grayish-pink in color with a wrinkled, uneven surface. The longitudinal axis of the ovaries is almost vertical, with the upper extreme point at the fallopian tube and the lower extreme point closer to the uterus. The posterior part of the ovaries is free, and the anterior part is fixed to the broad ligament of the uterus with the help of a two-layer fold of the peritoneum - the mesentery of the ovary (mesovarium). Vessels and nerves pass through it and reach the hilum of the ovaries. Attached to the upper pole of the ovaries are folds of the peritoneum - ligaments that suspend the ovaries (infundibulopelvic), which contain the ovarian vessels and nerves. The lower part of the ovaries is attached to the uterus by fibromuscular ligaments (proprietary ovarian ligaments). These ligaments connect to the lateral edges of the uterus at an angle just below where the fallopian tube meets the body of the uterus.

The ovaries are covered with germinal epithelium, under which there is a layer of connective tissue - the tunica albuginea. The ovary has an outer cortex and an inner medulla. Vessels and nerves pass through the connective tissue of the medulla. In the cortex, among the connective tissue, there are a large number of follicles at different stages of development.

Ligamentous apparatus of the internal female genital organs. The position in the pelvis of the uterus and ovaries, as well as the vagina and adjacent organs, depends mainly on the condition of the muscles and fascia of the pelvic floor, as well as on the condition of the ligamentous apparatus of the uterus (see Fig. 2.2). In a normal position, the uterus with fallopian tubes and ovaries are held by the suspensory apparatus (ligaments), the fixing apparatus (ligaments that fix the suspended uterus), the supporting or supporting apparatus (pelvic floor).

The suspensory apparatus of the internal genital organs includes the following ligaments.

1. Round ligaments of the uterus (ligg. teres uteri). They consist of smooth muscles and connective tissue, look like cords 10-12 cm long. These ligaments extend from the corners of the uterus, go under the anterior leaf of the broad ligament of the uterus to the internal openings of the inguinal canals. Having passed the inguinal canal, the round ligaments of the uterus fan out into the tissue of the pubis and labia majora. The round ligaments of the uterus pull the fundus of the uterus anteriorly (anterior tilt).

2. Broad ligaments of the uterus (ligg. latae uteri). This is a duplication of the peritoneum, extending from the ribs of the uterus to the side walls of the pelvis. In the upper sections of the wide

The fallopian tubes pass through the ligaments of the uterus, the ovaries are located on the posterior layers, and fiber, vessels and nerves are located between the layers.

3. Own ligaments of the ovaries (ligg. ovarii proprii, s. ligg. suspensorii ovarii) start from the fundus of the uterus behind and below the origin of the fallopian tubes and go to the ovaries.

4. The ligaments that suspend the ovaries, or infundibulopelvic ligaments (ligg. suspensorium ovarii, s.infundibulopelvicum), are a continuation of the wide uterine ligaments, running from the fallopian tube to the pelvic wall.

The anchoring apparatus of the uterus consists of connective tissue cords mixed with smooth muscle fibers that come from the lower part of the uterus:

B) posteriorly - to the rectum and sacrum (lig. sacrouterinum).

The uterosacral ligaments extend from the posterior surface of the uterus in the area of ​​transition of the body to the cervix, cover the rectum on both sides and are attached to the anterior surface of the sacrum. These ligaments pull the cervix posteriorly.

The supporting, or supporting, apparatus consists of the muscles and fascia of the pelvic floor. The pelvic floor is of great importance in maintaining the internal genital organs in a normal position. When intra-abdominal pressure increases, the cervix rests on the pelvic floor as if on a stand; The pelvic floor muscles prevent the genitals and viscera from descending. The pelvic floor is formed by the skin and mucous membrane of the perineum, as well as the muscular-fascial diaphragm.

The perineum is the diamond-shaped area between the thighs and buttocks where the urethra, vagina and anus are located. In front, the perineum is limited by the pubic symphysis, in the back by the end of the coccyx, and the lateral ischial tuberosities. The skin limits the perineum from the outside and below, and the pelvic diaphragm (pelvic fascia), formed by the lower and superior fascia, limits the perineum deep above (Fig. 2.4).

The pelvic floor, using an imaginary line connecting the two ischial tuberosities, is divided anatomically into two triangular regions: in front - the genitourinary region, in the back - the anal region. In the center of the perineum, between the anus and the entrance to the vagina, there is a fibromuscular formation called the tendinous center of the perineum. This tendon center is the site of attachment for several muscle groups and fascial layers.

Urogenital area. In the genitourinary region, between the lower branches of the ischial and pubic bones, there is a muscular-fascial formation called the “urogenital diaphragm” (diaphragma urogenitale). The vagina and urethra pass through this diaphragm. The diaphragm serves as the basis for fixing the external genitalia. From below, the urogenital diaphragm is limited by the surface of whitish collagen fibers that form the lower fascia of the genitourinary diaphragm, which divides the genitourinary region into two dense anatomical layers of important clinical significance - the superficial and deep sections, or perineal pockets.

Superficial part of the perineum. The superficial section is located above the lower fascia of the genitourinary diaphragm and contains on each side a large gland of the vestibule of the vagina, a clitoral stalk with an overlying ischiocavernosus muscle, a bulb of the vestibule with an overlying bulbospongiosus (bulbocavernosus) muscle and a small superficial transverse perineal muscle. The ischiocavernosus muscle covers the stalk of the clitoris and plays a significant role in maintaining its erection, as it presses the stalk against the ischiopubic branch, delaying the outflow of blood from the erectile tissue. The bulbospongiosus muscle starts from the tendinous

A - superficial section of the urogenital diaphragm: 1 - external opening of the urethra, 2 - labia minora, 3 - hymen, 4 - internal genital artery, 5 - levator ani muscles, 6 - inferior hemorrhoidal artery, 7 - gluteus maximus muscle , 8 - external anal sphincter, 9 - lower fascia of the pelvic diaphragm, 10 - tendon center of the perineum, 11 - external transverse muscle of the perineum, 12 - lower fascia of the urogenital diaphragm, 13 - bulbospongiosus muscle, 14 - ischiocavernosus muscle, 15 - superficial fascia of the perineum; b* - deep section of the genitourinary diaphragm: 1 - clitoris: A - body, B - head, C - leg; 2 - urogenital diaphragm, 3 - pelvic diaphragm, 4 - external anal sphincter muscle, 5 - inferior hemorrhoidal artery, 6 - internal obturator muscle, 7 - internal pudendal artery, 8 - perineal artery, 9 - greater gland of the vestibule, 10 - vestibular bulbous artery, 11 - vaginal wall, 12 - bulb of the vestibule, 13 - urethra.

The center of the perineum and the external sphincter of the anus, then passes posteriorly around the lower part of the vagina, covering the bulb of the vestibule, and enters the perineal body. The muscle can act as a sphincter to tighten the lower part of the vagina. The poorly developed superficial transverse perineal muscle, which looks like a thin plate, starts from the inner surface of the ischium near the ischial tuberosity and runs transversely, entering the perineal body. All muscles of the superficial section are covered by the deep fascia of the perineum.

Deep perineum. The deep part of the perineum is located between the lower fascia of the genitourinary diaphragm and the indistinct upper fascia of the genitourinary diaphragm. The urogenital diaphragm consists of two layers of muscles. The muscle fibers in the urogenital diaphragm are generally transverse, arising from the ischiopubic rami on each side and joining at the midline. This part of the urogenital diaphragm is called the deep transverse muscle of the perineum (m. transversus perinei profundus). Part of the fibers of the urethral sphincter rises in an arc above the urethra, while the other part is located circularly around it, forming the external urethral sphincter. The muscle fibers of the urethral sphincter also pass around the vagina, concentrating where the external opening of the urethra is located. The muscle plays an important role in restraining the process of urination when the bladder is full and is a voluntary compressor of the urethra. The deep transverse perineal muscle enters the perineal body behind the vagina. When contracted bilaterally, this muscle thus supports the perineum and the visceral structures passing through it.

Along the anterior edge of the urogenital diaphragm, its two fascia merge to form the transverse perineal ligament. In front of this fascial thickening is the arcuate pubic ligament, which runs along the lower edge of the pubic symphysis.

Anal (anal) area. The anal region includes the anus, the external anal sphincter, and the ischiorectal fossa. The anus is located on the surface of the perineum. The skin of the anus is pigmented and contains sebaceous and sweat glands. The anal sphincter consists of superficial and deep parts of striated muscle fibers. The subcutaneous part is the most superficial and surrounds the lower wall of the rectum, the deep part consists of circular fibers that merge with the levator ani muscle. The superficial part of the sphincter consists of muscle fibers running mainly along the anal canal and intersecting at right angles in front and behind the anus, which then enter the perineum in front, and behind - into a faint fibrous mass called the anal-coccygeal body, or anal-coccygeal body. coccygeal ligament. The anus is externally a longitudinal slit-like opening, which may be explained by the anteroposterior direction of many muscle fibers of the external anal sphincter.

The ischiorectal fossa is a wedge-shaped space filled with fat, which is externally limited by the skin. The skin forms the base of the wedge. The vertical lateral wall of the fossa is formed by the obturator internus muscle. The sloping supramedial wall contains the levator ani muscle. Ischiorectal fat allows the rectum and anal canal to expand during bowel movements. The fossa and the fatty tissue it contains are located anteriorly and deep upward to the urogenital diaphragm, but below the levator ani muscle. This area is called the front pocket. At the back, the fatty tissue in the fossa extends deep to the gluteus maximus muscle in the area of ​​the sacrotuberous ligament. Laterally, the fossa is bounded by the ischium and the obturator fascia, which covers the lower part of the obturator internus muscle.

Blood supply, lymphatic drainage and innervation of the genital organs. The blood supply (Fig. 2.5, 2.6) of the external genitalia is mainly carried out by the internal pudendal (pudendal) artery and only partially by branches of the femoral artery.

The internal pudendal artery (a.pudenda interna) is the main artery of the perineum. It is one of the branches of the internal iliac artery (a.iliac interna). Leaving the pelvic cavity, it passes through the lower part of the greater sciatic foramen, then goes around the ischial spine and runs along the side wall of the ischiorectal fossa, transversely crossing the lesser sciatic foramen. Its first branch is the inferior rectal artery (a.rectalis inferior). Passing through the ischiorectal fossa, it supplies blood to the skin and muscles around the anus. The perineal branch supplies the structures of the superficial part of the perineum and continues in the form of posterior branches going to the labia majora and minora. The internal pudendal artery, entering the deep perineal section, branches into several fragments and supplies the bulb of the vestibule of the vagina, the large gland of the vestibule and the urethra. When it ends, it divides into the deep and dorsal arteries of the clitoris, approaching it near the pubic symphysis.

The external (superficial) pudendal artery (r.pudenda externa, s.superficialis) arises from the medial side of the femoral artery (a.femoralis) and supplies the anterior part of the labia majora. The external (deep) pudendal artery (r.pudenda externa, s.profunda) also arises from the femoral artery, but more deeply and distally. Having passed the wide fascia on the medial side of the thigh, it enters the lateral part of the labia majora. Its branches pass into the anterior and posterior labial arteries.

The veins passing through the perineum are mainly branches of the internal iliac vein. For the most part they accompany the arteries. An exception is the deep dorsal clitoral vein, which drains blood from the erectile tissue of the clitoris through a fissure below the pubic symphysis into the venous plexus around the bladder neck. The external genital veins drain blood from the labia majora, passing laterally to enter the great saphenous vein of the leg.

The blood supply to the internal genital organs is carried out mainly from the aorta (the system of the common and internal iliac arteries).

The main blood supply to the uterus is provided by the uterine artery (a.uterina), which arises from the internal iliac (hypogastric) artery (a.iliaca interna). In about half of the cases, the uterine artery arises independently from the internal iliac artery, but it can also arise from the umbilical, internal pudendal and superficial cystic arteries.

The uterine artery goes down to the lateral pelvic wall, then passes forward and medially, located above the ureter, to which it can give an independent branch. At the base of the broad uterine ligament, it turns medially towards the cervix. In the parametrium, the artery is connected to the accompanying veins, nerves, ureter and cardinal ligament. The uterine artery approaches the cervix and supplies it with several tortuous penetrating branches. The uterine artery then divides into one large, very tortuous ascending branch and one or more small descending branches supplying the upper part of the vagina and adjacent part of the bladder. The main ascending branch runs upward along the lateral edge of the uterus, sending arcuate branches to its body.

1 - fallopian tube; 2 - ovary; 3 - ovarian vein; 4 - ovarian artery; 5 - anastomoses of uterine and ovarian vessels; 6 - ureter; 7 - uterine artery; 8 - uterine vein; 9 - wall of the bladder; 10 - cervix; 11 - body of the uterus; 12 - round ligament of the uterus.

These arcuate arteries surround the uterus under the serous layer. At certain intervals, radial branches depart from them, which penetrate into the intertwining muscle fibers of the myometrium. After childbirth, the muscle fibers contract and, acting as ligatures, compress the radial branches. The arcuate arteries quickly decrease in size along the midline, therefore, with midline incisions of the uterus, less bleeding is observed than with lateral ones. The ascending branch of the uterine artery approaches the fallopian tube, turning laterally at its upper part, and divides into tubal and ovarian branches. The tubal branch runs laterally in the mesentery of the fallopian tube (mesosalpinx). The ovarian branch goes to the mesentery of the ovary (mesovarium), where it anastomoses with the ovarian artery, which arises directly from the aorta.

The ovaries are supplied with blood from the ovarian artery (a.ovarica), which arises from the abdominal aorta on the left, sometimes from the renal artery (a.renalis). Descending together with the ureter, the ovarian artery passes through the ligament that suspends the ovary to the upper part of the broad uterine ligament, giving off a branch to the ovary and tube; the terminal section of the ovarian artery anastomoses with the terminal section of the uterine artery.

1 - left renal vein; 2 - left kidney; 3 - left ovarian vein and artery; 4 - left ureter; 5 - abdominal aorta; 6 - common iliac artery and vein; 7 - fallopian tube; 8 - internal iliac artery; 9 - external iliac artery and vein; 10 - left ovary; 11 - uterine artery and vein; 12 - inferior cystic artery (vaginal branch); 13 - lower epigastric artery and vein; 14 - superior vesical artery; 15 - left ureter; 16 - bladder; 17 - right ureter; 18 - vagina; 19 - round ligament of the uterus; 20 - body of the uterus; 21 - rectum; 22 - middle sacral vein and artery; 23 - edge of the parietal peritoneum (in section); 24 - right ovarian artery and vein; 25 - inferior vena cava; 26 - right ureter; 27 - right kidney.

In addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries also participate in the blood supply to the vagina. The arteries of the genital organs are accompanied by corresponding veins.

The venous system of the genital organs is very highly developed; the total length of the venous vessels... significantly exceeds the length of the arteries due to the presence of venous plexuses that widely anastomose with each other. The venous plexuses are located in the clitoral region, at the edges of the vestibule bulbs, around the bladder, between the uterus and ovaries.

The lymphatic system of the genital organs consists of a dense network of tortuous lymphatic vessels, plexuses and many lymph nodes. Lymphatic pathways and nodes are located mainly along the course of blood vessels.

Lymphatic vessels that drain lymph from the external genitalia and the lower third of the vagina go to the inguinal lymph nodes. Lymphatic ducts extending from the middle upper third of the vagina and cervix go to the lymph nodes located along the hypogastric and iliac blood vessels.

The intramural plexuses carry lymph from the endometrium and myometrium to the subserosal plexus, from which the lymph flows through efferent vessels. Lymph from the lower part of the uterus enters mainly the sacral, external iliac and common iliac lymph nodes; some lymph also flows to the lower lumbar nodes along the abdominal aorta and to the superficial inguinal nodes. Most of the lymph from the upper part of the uterus drains laterally into the broad ligament of the uterus, where it joins lymph collecting from the fallopian tube and ovary. Further, through the ligament that suspends the ovary, along the course of the ovarian vessels, the lymph enters the lymph nodes along the lower abdominal aorta. From the ovaries, lymph is drained through the vessels located along the ovarian artery, and goes to the lymph nodes lying on the aorta and inferior vena cava. Between these lymphatic plexuses there are connections - lymphatic anastomoses.

The sympathetic and parasympathetic parts of the autonomic nervous system, as well as the spinal nerves, participate in the innervation of the female genital organs.

The fibers of the sympathetic part of the autonomic nervous system, innervating the genital organs, originate from the aortic and celiac (“solar”) plexuses, go down and at the level of the V lumbar vertebra form the superior hypogastric plexus (plexus hypogastricus superior). Fibers depart from it, forming the right and left lower hypogastric plexuses (plexus hypogastricus sinister et dexter inferior). Nerve fibers from these plexuses go to the powerful uterovaginal, or pelvic, plexus (plexus uterovaginalis, s.pelvicus).

The uterovaginal plexuses are located in the parametrial tissue lateral and posterior to the uterus at the level of the internal os and cervical canal. The branches of the pelvic nerve (n.pelvicus), which belongs to the parasympathetic part of the autonomic nervous system, approach this plexus. Sympathetic and parasympathetic fibers extending from the uterovaginal plexus innervate the vagina, uterus, internal parts of the fallopian tubes, and bladder.

The ovaries are innervated by sympathetic and parasympathetic nerves from the ovarian plexus (plexus ovaricus).

The external genitalia and pelvic floor are mainly innervated by the pudendal nerve (n.pudendus).

Pelvic fiber. Blood vessels, nerves and lymphatic tracts of the pelvic organs pass through the tissue, which is located between the peritoneum and the fasciae of the pelvic floor. Fiber surrounds all pelvic organs; in some areas it is loose, in others in the form of fibrous strands. The following fiber spaces are distinguished: peri-uterine, pre- and peri-vesical, peri-intestinal, vaginal. Pelvic tissue serves as a support for the internal genital organs, and all its sections are interconnected.

2.1.3. Pelvis from an obstetric point of view

A large pelvis is not essential for the birth of a child. The bone base of the birth canal, which is an obstacle to the fetus being born, is the small pelvis. However, by the size of the large pelvis one can indirectly judge the shape and size of the small pelvis. The inner surface of the large and small pelvis is lined with muscles.

The pelvic cavity is the space enclosed between the walls of the pelvis, limited above and below by the planes of inlet and outlet of the pelvis. It has the appearance of a cylinder, truncated from front to back, with the front part facing the womb almost 3 times lower than the back part facing the sacrum. Due to this shape of the pelvic cavity, its various parts have different shapes and sizes. These sections are imaginary planes passing through identification points of the inner surface of the pelvis. In the small pelvis, the following planes are distinguished: the entrance plane, the wide part plane, the narrow part plane and the exit plane (Table 2.1; Fig. 2.7).

Rice. 2.7.

(sagittal section).

1 - anatomical conjugate; 2 - true conjugate; 3 - direct size of the plane of the wide part of the pelvic cavity; 4 - direct size of the plane of the narrow part of the pelvic cavity; 5 - direct size of the exit of the small pelvis in the normal position of the coccyx; 6 - the direct size of the exit of the small pelvis with the coccyx bent backwards; 7 - wire axis of the pelvis. Rice. 2.8. Dimensions of the plane of entry into the small pelvis.

1 - direct size (true conjugate); 2 - transverse size; 3 - oblique dimensions.

The plane of entry into the pelvis passes through the superior inner edge of the pubic arch, the innominate lines and the apex of the promontory. In the entrance plane, the following dimensions are distinguished (Fig. 2.8).

Direct size is the shortest distance between the middle of the upper inner edge of the pubic arch and the most prominent point of the cape. This distance is called true conjugate (conjugata vera); it is equal to 11 cm. It is also customary to distinguish the anatomical conjugate - the distance from the middle of the upper edge of the pubic arch to the same point of the promontory; it is 0.2-0.3 cm longer than the true conjugate (see Fig. 2.7).

Transverse dimension - the distance between the most distant points of the nameless lines of opposite sides. It is equal to 13.5 cm. This size intersects the true conjugate at a right angle eccentrically, closer to the cape.

Oblique dimensions - right and left. The right oblique dimension goes from the right sacroiliac joint to the left iliopubic tubercle, and the left oblique dimension goes from the left sacroiliac joint to the right iliopubic tubercle. Each of these sizes is 12 cm.

As can be seen from the given dimensions, the entrance plane has a transverse oval shape.

The plane of the wide part of the pelvic cavity passes in front through the middle of the inner surface of the pubic arch, on the sides - through the middle of the smooth plates located under the fossae of the acetabulum (lamina acetabuli), and behind - through the articulation between the II and III sacral vertebrae.

In the plane of the wide part, the following dimensions are distinguished.

Straight size - from the middle of the inner surface of the pubic arch to the articulation between the II and III sacral vertebrae; it is 12.5 cm.

The transverse dimension connecting the most distant points of the acetabular plates of both sides is 12.5 cm.

The plane of the wide part is close in shape to a circle.

The plane of the narrow part of the pelvic cavity passes in front through the lower edge of the pubic symphysis, from the sides through the ischial spines, and from behind through the sacrococcygeal joint.

In the plane of the narrow part, the following dimensions are distinguished.

Straight size - from the lower edge of the pubic joint to the sacrococcygeal joint. It is 11 cm.

The transverse dimension is between the inner surface of the ischial spines. It is equal to 10.5 cm.

The plane of exit of the small pelvis, unlike other planes of the small pelvis, consists of two planes converging at an angle along the line connecting the ischial tuberosities. It passes in front through the lower edge of the pubic arch, on the sides - through the inner surfaces of the ischial tuberosities and behind - through the top of the coccyx.

In the exit plane, the following dimensions are distinguished.

Straight size - from the middle of the lower edge of the pubic symphysis to the tip of the coccyx. It is equal to 9.5 cm (Fig. 2.9). The direct size of the outlet, due to some mobility of the coccyx, can lengthen during labor as the fetal head passes by 1-2 cm and reach 11.5 cm (see Fig. 2.7).

The transverse dimension is between the most distant points of the internal surfaces of the ischial tuberosities. It is 11 cm (Fig. 2.10).

Table 2.1.

Rice. 2.9.

(measurement). Rice. 2.10.

This classical system of planes, in the development of which the founders of Russian obstetrics took part, especially A.Ya. Krassovsky, allows you to correctly navigate the movement of the presenting part of the fetus along the birth canal and the turns it makes during this.

All direct dimensions of the planes of the small pelvis converge in the area of ​​the pubic symphysis, but diverge in the area of ​​the sacrum. The line connecting the midpoints of all direct dimensions of the pelvic planes is an arc, concave in front and curved in back. This line is called the pelvic axis. The passage of the fetus through the birth canal occurs along this line (see Fig. 2.7).

The angle of inclination of the pelvis - the intersection of the plane of its entrance with the plane of the horizon (Fig. 2.11) - when a woman is standing, can vary depending on the body type and ranges from 45 to 55°. It can be reduced if you ask a woman lying on her back to strongly pull her hips towards her stomach, which leads to the elevation of the pubis, or, conversely, it can be increased if a roll-shaped hard pillow is placed under the lower back, which will lead to a downward deviation of the pubis. A decrease in the pelvic inclination angle is also achieved if the woman takes a semi-sitting or squatting position.

Large and important changes occur in the human body during puberty and they manifest themselves in changes in appearance, well-being and mood, as well as in the intensity of development and formation of the organs of the reproductive system.

Studying the anatomical structure and functions of your body will help you better understand and appreciate this important period in the life of every person.

The male genital organs include the following anatomical elements: internal - testicles (male sex glands), their ducts, accessory sex glands and external - scrotum and penis (penis).

Testicles (testes, or testos) are two round-shaped glands in which sperm are produced and male sex hormones (androgen and testosterone) are synthesized.

The testicles are located in the scrotum, which performs a protective function. The male reproductive organ (penis) is located at the bottom of the pubic lobe. It is formed by spongy tissue, which is supplied with blood from two large arteries and has the ability, when excited, to fill with blood and increase the size of the penis, changing the angle of inclination (erection). The penis has a body and head covered by a fold of skin and mucous membrane called the “foreskin.”

The urethra, or urethra, is a thin tube that connects to the bladder and the vas deferens of the testicle. Urine and semen are expelled through it.

The vas deferens are two thin tubes through which sperm pass from the testicle to the seminal vesicles, where they accumulate and mature.

The prostate, or prostate gland, is a muscular organ that produces a white fluid that, when mixed with sperm, forms sperm. When the prostate muscles contract, sperm is pushed out through the urethra. This is called ejaculation.

The female genital organs include the following anatomical elements: internal - ovaries, uterine or fallopian tubes, uterus, vagina - and external - small and large labia, clitoris, hymen (maiden's hymen).

The ovaries are two glands that resemble the shape and size of a large bean. They are located on either side of the uterus in a woman's lower abdomen. In the ovaries, female sex cells develop - eggs - and female sex hormones - estrogens are synthesized. The egg matures in a small ovarian vesicle for 24-30 days, after which the vesicle ruptures and the egg is released into the fallopian tubes. This is called ovulation.

The fallopian tubes connect the uterine cavity to the ovaries. Fertilization of the egg by the sperm occurs in the fallopian tubes.

The uterus is a cavity muscular organ resembling a pear, lined from the inside with a mucous membrane.

The uterus has three openings: two lateral ones, connecting it to the fallopian tubes, and a lower one, connecting it through the cervix to the vagina. When a fertilized egg enters the uterus, it sinks into the mucous membrane, attaching itself to the wall of the uterus. This is where the embryo develops, and later the fetus. The unfertilized egg leaves the woman's body along with parts of the uterine lining and a small amount of blood. This is called menstruation.

The lower thin part of the uterus is called the cervix. In pregnant women, the cervix and vagina form the birth canal, through which the fetus emerges from the uterine cavity at birth.

The labia minora (vulva) are folds of skin that cover the external opening of the vagina and urethra. Here is the clitoris, which contains many nerve receptors, which is important for erection (sexual arousal). On the sides of the labia minora are the labia majora.

In girls who have not had sexual intercourse (coitus), the external entrance to the vagina is closed by a thin connective tissue membrane called the hymen, or hymen.

Maturation of germ cells

The process of formation of male and female germ cells is called gametogenesis, which occurs in the gonads and consists of four periods: reproduction, growth, maturation and formation.

During reproduction, the primary germ cells - gametogonium (sperm or eggs) divide several times through mitosis.

During the growth period, they increase in size in preparation for the next period. During the period of maturation, during the process of meiosis, the number of chromosomes decreases, female and male germ cells with a haploid set of chromosomes are formed. The latter, without dividing, enter a period of formation and are transformed into mature male reproductive cells - sperm and female - eggs.

The topic of the shape and structure of the female genital organs sooner or later begins to interest every girl. Attempts to familiarize yourself with the structure of the organs of the reproductive system with the help of medical atlases and diagrams rarely end in success - there are too many complex and incomprehensible terms. It’s shy to go to your mother with questions; it’s scary to go to the gynecologist. So the girl suffers in uncertainty and doubt. We are happy to help you and will tell you about everything that interests you in “human” language

Reproductive system: organs united by a common purpose

The female reproductive system includes organs that are in one way or another involved in the process of conception, gestation and birth of a child. Each organ has its own unique function, so the absence (or improper development) of any organ of the reproductive system often leads to a woman’s inability to bear children. The female genital organs are divided into internal and external, depending on whether they are located inside the pelvis (the lowest part of the abdominal cavity) or outside.

External genitalia: what does a gynecologist see during examination?

The external genitalia (vulva) include organs located outside the pelvic cavity that are accessible for direct inspection. It is with the examination of the external genitalia that a gynecological examination begins. The external genitalia include the pubis, labia majora, labia minora, clitoris, vaginal opening, hymen (it is the boundary between the internal and external genitalia). Let's figure out what each of the listed organs is.

So, pubis- This is the lowest part of the front wall of the abdomen. The pubis is located above the pubic bone, contains a lot of fatty tissue, and is covered with skin and hair. With normal levels of sex hormones, the upper border of a woman's pubic hair is horizontal.

Labia majora They are two large folds of skin running from front to back - from the pubis to the anus (anus). The labia majora are covered with hair. Under the skin of the lips there is adipose tissue, sweat and sebaceous glands. Inside each labia majora (in the posterior third) there is a Bartholin's gland The function of the Bartholin glands is to secrete a secretion (fluid) that moisturizes the external genitalia during sexual arousal. If, as a result of an infection, the Bartholin gland becomes inflamed, a seal forms inside the labia, and the secretion of the gland acquires an unusual color and an unpleasant odor.

Located inside the labia majora labia minora. The labia minora look like two small thin folds of skin running parallel to the labia majora. The labia minora do not have hair, but they are penetrated by a large number of vessels and nerve endings, which provides increased sensitivity.

Between the anterior parts of the labia minora is located clitoris. The clitoris is the female analogue of the male penis, the development of which stopped in the prenatal period under the influence of female sex hormones. The clitoris has a body and a glans, which contain many nerves and nerve endings. The clitoris, like the labia, has increased sexual sensitivity. Normally, the clitoris is quite small in size and only slightly enlarges at the time of sexual arousal. In some girls (women), as a result of increased levels of male sex hormones, the size of the clitoris increases significantly - this is a sign of a hormonal disorder that needs treatment.

Between the clitoris and the entrance to the vagina is located external opening of the urethra- a small hole through which urine is released during urination.

Between the labia minora, behind the clitoris and the opening of the urethra, is the entrance to the vagina. At a shallow depth (at a distance of 1-2 cm from the entrance) in the vagina of virgins there is hymen. The hymen is a connective tissue septum that partially covers the entrance to the vagina. Normally, the hymen has one or more holes of varying sizes that allow menstrual blood to flow freely. Doctors know of cases of complete absence of the hymen in virgins - this developmental feature occurs in approximately 5% of girls. During the first sexual intercourse, the hymen is torn (this process is called defloration), and during childbirth it is completely destroyed. The hymen can have different shapes, thickness and elasticity, so when it ruptures, girls experience different sensations - from severe pain to almost complete absence of discomfort. The hymen is penetrated by a small number of blood vessels, so its rupture is often accompanied by bleeding, which is not profuse and lasts no longer than 1-2 days. The hymen (like other organs of the reproductive system) tends to lose its elasticity and firmness as a woman gets older. Therefore, sometimes, with late defloration (after 30 years), rupture of the hymen requires significant effort on the part of the man and is accompanied by severe pain and quite heavy bleeding. In such a situation, a man is not recommended to be persistent, and a girl (to avoid problems) needs to see a gynecologist who will perform a surgical dissection of the hymen.

Internal genital organs: guarantors of procreation

The organs of the reproductive system located behind the hymen (deep in the pelvis) are called internal genital organs. The internal genital organs include the vagina, uterus, fallopian tubes and ovaries. Sometimes the fallopian tubes and ovaries are combined under the general name of the uterine appendages.

Vagina It is an extensible hollow organ, 8-10 cm long. It starts from the entrance to the vagina, goes up and back. Normally, the walls of the vagina are in contact with each other. Thanks to the muscular elements of the vaginal wall and the folds of the mucous membrane, the vagina can significantly change its length and volume, which allows it to adapt to the large size of the partner’s penis and avoid injury during childbirth. The color of the vaginal mucosa of a non-pregnant woman is pale pink; during pregnancy it is dark lilac (bluish). At the top, the vagina encloses the cervix (the vaginal part of the cervix). Vaginal part of the cervix hangs freely in the vagina and is palpated with fingers inserted into the vagina in the form of a dense elastic oval formation with a hole in the middle (external uterine os). To examine the vagina and the vaginal part of the cervix, the gynecologist uses a special instrument - a gynecological speculum. The mirror doors allow you to spread the walls of the vagina to the sides and make it accessible for inspection. Depending on the woman’s constitution, mirrors of various sizes are used. There are special mirrors that allow you to examine the vagina and cervix of a virgin without damaging the hymen. When examined using speculum, the doctor assesses the condition of the vaginal mucosa and the visible part of the cervix - color, integrity, signs of damage and inflammation (redness, pathological discharge, ulceration, etc.). Directly above the vagina in the pelvic cavity, inaccessible to direct inspection, is the uterus.

Uterus is a hollow organ located in the pelvic cavity between the bladder in front and the rectum in back. The “non-pregnant” uterus is located quite deep in the pelvis and cannot be felt through the anterior wall of the abdomen. A feature of the structure of the uterus is the presence of powerful muscle layers in its walls. This structure of the muscular layer of the uterus ensures the expulsion of the fetus during childbirth. The uterus has the shape of a flattened pear; the structure of the uterus includes the fundus, body and cervix. The length of the non-pregnant uterus (including the cervix) is normally 6-8 cm (in adult women). The body of the uterus has a triangular shape, narrows downwards and passes into a rounded part - the cervix. In nulliparous women, the cervix is, as a rule, conical in shape, and in women who have given birth, it is cylindrical. The cervical (cervical) canal runs inside the cervix, connecting the uterine cavity to the vagina. In the upper part of the uterus (from its corners) the uterine (fallopian) tubes extend to the right and left.

The uterine lining, or endometrium, forms the inner layer of the uterine wall. The thickness of the mucous membrane depends on the phase of the menstrual cycle, ranging from 1-2 mm to 1 cm. That part of the endometrium that lines the uterine cavity (functional layer) under the influence of hormones undergoes monthly changes aimed at creating optimal conditions for pregnancy. If pregnancy does not occur, the functional layer of the endometrium is torn away and, together with blood, is washed out of the uterine cavity - this is called menstruation (menstruation).

There, in the small pelvis on either side of the body of the uterus, there are two ovary. The ovary is the sex gland in which the maturation of eggs and the formation of female (and a small amount of male) sex hormones (estrogens and progesterone) occur. The ovaries are oval in shape (look like a small egg - hence the name), the average dimensions of the ovary are: length 3 cm, width 2 cm, thickness 2 cm.

The ovary is divided into superficial (cortical) and inner (medulla) layers. The medulla of the ovary is made up of cells that produce hormones. In the cortical layer there are ovarian follicles (vesicles), one of which matures monthly, bursts and releases a mature egg, ready for fertilization, into the lumen of the fallopian tube. In place of the burst follicle, a corpus luteum is formed - a temporary gland that secretes the hormone progesterone. Once conception has occurred, this gland ensures that the pregnancy is maintained during the first 12-16 weeks of pregnancy (until the placenta develops). If pregnancy does not occur, 12-14 days after ovulation the corpus luteum undergoes reverse development, progesterone production stops - menstruation occurs.

The fallopian tubes- start from the corners of the uterus and go to the sides - to the right and left. The length of the fallopian tube is 10-12 cm, the size of the lumen of the tube does not exceed 2-4 mm. Each fallopian tube has an expanded end (ampulla), which is located in close proximity to the ovary and serves to capture the egg that is released from the ovary during ovulation. The fallopian tube serves to transport the egg into the uterine cavity. The process of fertilization occurs in the lumen of the fallopian tube.

How to see the invisible?

The uterus, ovary and fallopian tubes are not subject to direct examination (as they are located inside the body - in the pelvic cavity). To examine these organs, gynecologists use a method known as palpation (palpation). Since palpation through the anterior wall of the abdomen of a non-pregnant uterus with appendages is not possible (they are located very deep), a two-handed examination method is used. To conduct a two-handed examination, the gynecologist inserts the fingers of one hand (inner) into the vagina, and places the fingers of the other hand (outer) on the lower abdomen, above the pubis. With fingers located in the vagina, the doctor “pushes” the uterus and appendages upward, towards the outer arm. This technique allows you to determine the location of organs, their size, mobility and a number of other signs necessary to assess the woman’s health status. To examine virgins (in order to preserve the hymen), a rectal examination is performed (the inner fingers are inserted not into the vagina, but into the rectum). For healthy girls and women, the examination procedure is absolutely painless (provided you relax as much as possible and follow the doctor’s instructions).

Finally

This is the complex structure of the female reproductive system. Only a gynecologist can accurately determine what is the norm and what is a deviation from it. He will figure out what is the cause of the violation and help to cope with it. Therefore, armed with knowledge about your body, you need to boldly go to the doctor and discuss all issues with him as equals, without fear or embarrassment. Be healthy!

Figure 1. Female reproductive system and its surrounding organs (side view)

Figure 2. External female genitalia

Figure 3. Internal genitalia of a woman (front view)

For normal sexual intercourse, sufficient development of the external genitalia is necessary, which allows free insertion of the penis into the vagina. A woman who has reached puberty must have genitals that are properly developed and formed in accordance with her age.

The female genital organs are divided into external and internal.

The external genitalia include the pubis, labia majora, labia minora, vaginal opening (vestibule) and clitoris.

Pubis (mons veneris). The pubis is the area of ​​the lower part of the abdominal wall, located in the form of a triangle between the two groin folds. The lower corner of this triangle gradually turns into the labia majora.

Ovary

The ovary (ovarium) is the female sex gland (female gonad), is a paired organ and has two mutually related functions: generative and hormonal.

The shape and size of the ovary are very variable and depend on age, physiological conditions and individual characteristics. Of course, in shape and size it is compared to a small plum. It is attached by a short duplication of the peritoneum (mesovary) to the posterior sheet of the broad ligament. Vessels and nerves enter the ovary from the mesovarium. The ovary is connected to the uterus by the ligament lig. ovarii proprium.

The ovary is fixed to the lateral surface of the pelvis by the ligament. infundibulo-pel-vicum. During childbearing age, the surface of the ovary is smooth, but in older women it becomes wrinkled.

The ovary consists of vaguely demarcated outer - cortical and inner - medulla layers. The first horseshoe-shaped covers the second, and there is no cortex only on the side of the ovarian gate (hilus ovarii), through which the last of the mesosalpinx is provided with vessels. The medulla of the ovaries contains only a large number of blood vessels. The cortical layer consists of a connective tissue base - stroma and parenchyma - epithelial elements. The ovarian stroma is formed from small oval or spindle-shaped cells located among collagen fibers. From them, during the process of differentiation, theca cells are formed. The stroma also contains blood vessels and nerve endings.

The ovarian parenchyma in women of childbearing age consists of primordial follicles, small and large maturing follicles and a mature follicle ready for ovulation, atretic follicles and corpus luteum of various stages of development.

The ovarian hilum and mesovarium contain cells resembling the Leydig cells of the testis. These cells are detected in 80% of the ovaries and, according to a number of researchers, are the source of androgen release.

The cortex in a child's ovary is very thick. In old women, on the contrary, the medulla occupies most of the section, and the cortical layer is very thin or absent at all. The number of follicles in the ovary varies widely. Thus, the number of primordial follicles in the ovary of a newborn girl averages from 100,000 to 400,000 Pa; the beginning of puberty, their number decreases to 30,000-50,000. At the age of 45 years, the number of primordial follicles decreases on average to 1000. During the life of a woman, she matures 300-600 follicles. All others experience physiological atresia at various stages of development.

It is generally accepted that the first full maturation of follicles occurs at the time of the first menstruation. However, regular maturation of follicles followed by ovulation is established at the age of 16-17 years. During menopause, the ovary significantly decreases in size, and there is a tendency toward small cystic degeneration. 3-4 years after menopause, functional rest of the ovary occurs.

As we have already noted, the gonads (ovaries) perform a dual role in a woman’s body. On the one hand, they carry out a generative function, producing germ cells, and on the other, they form sex hormones. The latter actively influence the growth, metabolism, formation of external features, temperament and performance of a woman.

Pipes

The tube (tubae Fallopii) is the excretory duct for the ovary. They extend from the uterus at its upper corner and are a bent tube about 12 cm long, which ends with a free opening into the abdominal cavity near the ovary. This hole is surrounded by a rim.

One of the fimbriae reaches the ovary, attaches to its upper pole and is called fimbria ovalica. The entire tube is covered by peritoneum, which is the upper edge of the broad ligament. The upper part of the broad ligament, located between the tube, the ovary and the latter's own ligament, is called the mesosalpinx. The mucous membrane of the tube is thin, folded, covered with a single-layer high cylindrical ciliated epithelium. The wall of the tube, in addition to the serous cover, consists of muscle elements, layers of connective tissue and blood vessels. The tube has the ability to contract peristaltically.

Uterus

The uterus (uterus) is a pear-shaped muscular organ located in the pelvic cavity between the bladder and rectum.

• The uterus of an adult woman who has not given birth weighs 30-40 g, and a woman who has given birth weighs 60-80 g.
• There are such parts of the uterus body (corpus uteri), cervix (cervix uteri) and isthmus (isthmus uteri).

The body of the uterus in a mature woman is the largest part of these three. Its anterior surface is less convex than its posterior one. The cervix in a normally developed woman is a cylindrical body that fits into the lumen of the vagina.

An integral part of the cervix is ​​the cervical canal (canaIis cervicalis), which connects the uterine cavity with the vaginal cavity. From the side of the uterine cavity, it begins with the internal pharynx, and from the side of the vagina it ends with the external pharynx. The external pharynx of a woman who has not given birth has the shape of a round indentation, and in the one that gave birth, it has a transverse slit.

The uterine cavity in the frontal section has a triangular shape, the upper corners of which pass into the lumens of the tubes, the lower corner is directed to the region of the internal os. Since the anterior wall of the uterus is directly adjacent to the posterior one, then, in fact, in non-pregnant women there is no uterine cavity, but there is a narrow gap.

The wall consists of a mucous membrane covering the uterine cavity and the cervical canal, a muscular wall and peritoneum covering a large part of the uterus.

The mucous membrane of the uterus has a smooth surface. In the cervical canal, the mucous membrane lies in folds, especially pronounced on the uteruses of little girls. These folds form tree-like figures called arbor vitae. In women who have not given birth, they are very mildly expressed and appear only in the cervical canal.

It contains glands that produce mucus, which clogs the external opening of the cervix. This mucous (kristeller's) plug protects the uterine cavity from infection. During sexual intercourse, the mucus plug can be pushed out by contraction of the muscles of the uterus. This improves the possibility of sperm penetration into the uterus, but is by no means a prerequisite for fertilization, since sperm freely penetrate through it.

The histological structure of the uterine mucosa depends on the phase of the menstrual cycle. The main mass of the uterus consists of smooth muscle with layers of connective tissue and elastic fibers. The body of the uterus contains more muscle than elastic tissue, while the cervix and isthmus, on the contrary, consist almost entirely of connective tissue and elastic fibers.

The peritoneum (perimetrium) covers the uterus in front and along its posterior surface. Along the anterior surface it descends to the level of the internal pharynx, and from there it passes to the bladder. On the posterior surface of the peritoneum it reaches the fornix of the uterus. On the sides it forms two leaves, which make up a wide connection. The latter reaches the walls of the pelvis, where it passes into the peritoneum parietale. The uterus is held in its position by connections through which, in addition, blood vessels approach it and nourish it. The upper edge of the wide ligament contains pipes. The broad ligament also contains a number of facial thickenings that form the following connections: lig. ovarii proprium, Hg. suspensorium ovarii, lig. rotundum, lig. cardinale, lig. sacro-uterinum.

In addition to the ligamentous apparatus of the uterus, the pelvic floor is of great importance for the normal position of the pelvic organs. The pelvic floor (diaphragma pelvis) is a complex complex of muscles and fascia arranged in three layers. This system closes the abdominal cavity from below, leaving only a lumen for the passage of the urethra, vagina and rectum.

Vagina

The vagina (vagina) in its structure is a tube flattened from front to back, starting from the vestibule of the vagina and ending at the top with arches (anterior, posterior and lateral), with which it is attached to the cervix. On the one hand, the vagina is an organ of copulation, on the other hand, it is an excretory canal for maintaining the uterus during menstruation and childbirth. The walls of the vagina consist of a mucous membrane covered with stratified squamous epithelium, subepithelial connective tissue, which contains many elastic fibers and an outer muscular layer.

Due to this structure, the vagina can stretch significantly. Its length varies, reaching an average of 7-10 cm. The vaginal mucosa has a folded character. The folds are especially developed along the midline on both the anterior and posterior walls of the vagina. Transverse folds form a ribbed surface, providing friction during sexual intercourse.

The entire set of transverse folds is called folded columns (columna rugarum). Columna gigarum are well developed in young years. Over time, after repeated births, they are significantly smoothed out, the mucous membrane becomes thinner, and in older women it becomes thin and smooth. The vaginal mucosa has glands. The content of the vagina consists of a small amount of transudate, which is mixed with desquamated squamous epithelium, mucus from the cervical canal and a liquid secret from the uterine cavity. In a healthy woman, the vaginal secretion has a slightly acidic reaction (pH is 3.86-4.45). Due to the fact that the vagina communicates with the surface of the body, it contains bacterial flora of various forms.

Due to the fact that the anterior wall of the vagina is directly adjacent to the posterior one, the lumen of the vagina is a capillary slit, which is H-shaped in cross section and borders the urethra and bladder in front. Behind the vagina lies the rectum.

Clitoris

The clitoris (clitoris) is a female reproductive organ, capable of erection and similar to the male penis. It is located in front of the urethra and consists of legs, body and head. All parts of the clitoris are formed from cavernous tissue. One-third of the corpora cavernosa are fused together and form the free part of the clitoris, and its posterior parts diverge and are attached to the descending branches of the lateral bones.

The free part of the clitoris is covered with movable skin and forms a frenulum.

Due to the large number of nerve elements, the clitoris plays the role of a sensory organ during sexual intercourse. At rest the clitoris is ke. visible because it is covered by a fold of skin. Only with irritation, when the cavernous bodies of the clitoris are filled with blood, does it protrude under the skin fold.

The internal genital organs include the vagina, uterus, tubes and ovaries.

Vaginal vestibule

The vestibule of the vagina (vestibulum) is part of the vulva, limited by the labia minora. It is closed in front by the clitoris, behind by the frenulum, and on top by the hymen. In the anterior part of the vestibule, the urethra (orificium urethrae externum) opens. From the vaginal cavity vestibulum is the solitary hymen (hymen, valvula vaginae).

The hymen is a duplication of the vaginal mucosa; its size, shape and thickness can be very diverse.

As numerous observations show, a common form of the hymen is ring-shaped with the following varieties: semilunar (semilunaris), ring-shaped (annularis), tubular (tubiformis), funnel-shaped (infundibuloformis), labiform (Iabialis) - they are one hole with an equal, smooth edge.

The second sign that forms the basis of the classification is unevenness of the free edge: the vestibule of the vagina can be fringed, jagged, spiral, patchwork.

The third type is characterized by the presence of not one, but several holes or their complete absence. This includes the very rare, so-called non-vocal, or blind, hymen and the more commonly observed bi-, trivicontal or ethmoid hymen, when there are more than three openings.

During the first sexual intercourse, defloration occurs - the hymen is torn. As a result, it has long received this name. The hymen is usually torn in a radial direction, most often on the sides. However, there is also a one-sided gap. It is not always easy to diagnose the integrity of the hymen, since in some cases it does not tear during sexual intercourse. At the same time, it often has cracks in the state of virginity, which are difficult to distinguish from cracks during defloration sub coitu. After childbirth, the hymen is completely destroyed, and its remains in the form of scar papillae are called carunculae hymenales (myrtiformes).

Labia minora

The labia minora (labia minora) are thin, leaf-shaped folds. They are contained in the middle of the genital slit, starting from the skin of the clitoris and stretching along the base! labia majora back, not reaching the end of the slit and ending mainly at the level of the middle and lower thirds of the labia majora. The labia minora are separated by a groove from the labia majora. In women who have not given birth, they are connected at the back in the form of a thin fold.

With normally developed genitals, the small lips are covered by the large ones. In women who have been sexually active for a long time, or during normal masturbation, the labia minora can become significantly hypertrophied and become noticeable along the entire length of the genital slit. Changes in the small lips and their coarsening, asymmetry, when one of them is much larger than the other, often indicate that these changes arose as a result of masturbation. Congenital enlargement of the labia minora is quite rare.

Under the base of the labia minora there are dense venous formations on both sides, reminiscent of the cavernous bodies of the male genital organs.

Labia majora

The labia majora (labia majora, labia pudenda externa) are folds of skin between which the genital slit is located. The large lips have the greatest height and width at the top. At the entrance to the vagina they become lower and narrower, and at the perineum they disappear, connecting with each other by a transverse fold called the frenulum of the lips.

Immediately below the frenulum you can see the so-called navicular fossa (fossa navicularis). At the onset of puberty, the labia majora enlarge, the amount of fat and sebaceous glands in them increases, they become elastic, and cover the genital opening more tightly. The inner surface of the lips is smooth, soft pink, moist from the secretion of mucous glands, the secretion of which is associated with the function of the ovaries. The underlying tissue of the labia majora contains many blood and lymphatic vessels.

When the labia majora are stretched, the external female genital organs resemble a funnel-shaped depression, at the bottom of which there are: at the top - the opening of the sechovilus canal, and below it - the entrance to the vagina.

Female pubis

The pubis has well-defined subcutaneous tissue. The entire pubic area is covered with hair, most often the same color as on the head, but coarser. Of course, for women, the upper border of the hair forms a horizontal line.

Often women have the male type of hairiness, when hair growth extends from the midline of the abdomen, to the navel. This type of hairiness in women is a sign of insufficient development - infantilism. With old age, pubic fat gradually disappears.