Porth's Essentials of Pathophysiology, 4e

1018

Genitourinary and Reproductive Function

U N I T 1 1

Suspensory ligament of ovary

Sacrum

Ureter

Ovary

Fallopian tube Ovarian ligament Round ligament Medial umbilical ligament

Rectum Uterus

Rectouterine pouch (Pouch of Douglas)

Urinary bladder Pubic symphysis Urethra Clitoris

Cervix

Levator ani (muscle) Vagina Anus

Prepuce of clitoris

Urethral orifice Labium minus Labium majus Vaginal orifice

FIGURE 40-1. Female reproductive system as seen in sagittal section. (Adapted from Anatomical Chart Company. Atlas of Human Anatomy. Springhouse, PA: Springhouse; 2001:253.)

The area between the labia minora is called the vesti- bule . Located in the vestibule are the urethral and vag- inal openings. The urethra is located posterior to the clitoris and usually is closer to the vaginal opening than to the clitoris. The vaginal orifice, commonly known as the introitus , is the opening between the external and

internal genitalia. The ducts of the lesser vestibular (Skene) and greater vestibular (Bartholin) glands also open into the vestibule. Secretions from the Bartholin glands are responsible for sexually stimulated vaginal lubrication (see Fig. 40-2). Internal Genitalia The female internal genital organs include the vagina, uterus and cervix, and the paired fallopian tubes and The vagina is a fibromuscular tube that connects the exter- nal and internal genitalia. It is located behind the urinary bladder and urethra and anterior to the rectum (Fig. 40-3). The uterine cervix projects into the vagina at its upper end, forming recesses called fornices . The vagina functions as a route for discharge of menses and other secretions, as well as an organ of sexual fulfillment and reproduction. Uterus and Cervix The uterus is a thick-walled muscular organ. This pear- shaped, hollow structure is located between the bladder and the rectum. The uterus can be divided into three parts: the upper portion above the insertion of the fal- lopian tubes, called the fundus ; the central tapering ovaries. Vagina

Mons pubis

Labium minus Urinary meatus

Prepuce Clitoris

Orifice of the lesser vestibular (Skene) glands

Vestibule

Orifice of vagina

Orifice of the greater vestibular (Bartholin) glands

Labium majus Hymen

Anus

FIGURE 40-2. External genitalia of the female.