FEMALE REPRODUCTIVE ANATOMY AND REPRODUCTIVE FUNCTION doc

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FEMALE REPRODUCTIVE ANATOMY

The female reproductive system is composed of the external and

internal genitalia. The external genitalia (Fig. 2-1) are collectively

termed the pudendum or vulva and are directly visible.

The internal genitalia include the vagina, cervix, uterus, uter￾ine (fallopian) tubes, and ovaries (Figs. 2-2 and 2-3). Special in￾struments are required for inspection of the internal genitalia. Sim￾ple specula or other instruments allow direct visualization of the

vagina and cervix, but the intraabdominal group can be inspected

only by invasive methods (laparotomy, laparoscopy, or culdoscopy)

or by sophisticated imaging techniques (ultrasonography, CT scan,

or magnetic resonance imaging).

EXTERNAL GENITALIA

MONS PUBIS (MONS VENERIS)

The mons veneris, a rounded pad of fatty tissue overlying the

symphysis pubis, develops from the genital tubercle. It is not an

organ but a region or a landmark. Coarse, dark hair normally ap￾pears over the mons early in puberty. During reproductive life,

the pubic hair is abundant, but after the menopause, it becomes

sparse. The normal female escutcheon is typically a triangle with

the base up, in contrast to the triangle with the base down pat￾tern in males.

The skin of the mons contains sudoriferous and sebaceous

glands. The amount of subcutaneous fat is determined by heredity,

age, nutritional factors, and possibly, steroid hormone factors.

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FEMALE REPRODUCTIVE

ANATOMY AND REPRODUCTIVE

FUNCTION

CHAPTER

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FIGURE 2-1. External female genitalia.

BENSON & PERNOLL’S

22 HANDBOOK OF OBSTETRICS AND GYNECOLOGY

Innervation

The sensory nerves of the mons are the ilioinguinal and gen￾itofemoral nerves.

Blood and Lymph Supply

The mons is supplied by the external pudendal artery and vein. The

lymphatics merge with those from other parts of the vulva and from

the lower abdomen. The crossed lymphatic circulation of the labia

within the mons is clinically important because it permits metasta￾tic spread of cancer from one side of the vulva to the inguinal glands

of the opposite as well as to the affected side.

FIGURE 2-2. Internal female genitalia (superior view).

Clinical Importance

Dermatitis is common in the pubic area, and it is important to ob￾serve closely if infestation with Phthirus pubis (lice, crabs) is sus￾pected. Edema can occur secondary to infections, vulvar varicosi￾ties, trauma, or carcinomatous infiltration of the lymphatics. Cancer

elsewhere in the vulva also can involve the mons.

LABIA MAJORA

In the adult female, these two raised, rounded, longitudinal folds of

skin are the most prominent features of the external genitalia. They

are homologous to the male scrotum. They originate from the gen￾ital swellings extending posteriorly and dorsally from the genital

tubercle. From the perineal body, they extend anteriorly around the

labia minora to merge with the mons. The labia normally are closed

in nulliparous women but later open progressively with succeeding

vaginal deliveries and become thin and atrophic with sparse hair in

later life.

CHAPTER 2

FEMALE REPRODUCTIVE ANATOMY 23