The development and anatomy of the female sexual organs and pelvis
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
The uterus tapers to a small constricted area, the isthmus, and below this is the cervix, which projects obliquely into the vagina. The longitudinal axis of the uterus is approximately at right angles to the vagina and normally tilts forward. This is called ‘anteversion’. In addition, the long axis of the cervix is rarely the same as the long axis of the uterus. The uterus is also usually flexed forward on itself at the isthmus – antiflexion. However, in around 20% of women, the uterus is tilted backwards – retroversion and retroflexion. This has no pathological significance in most women, although retroversion that is fixed and immobile may be associated with endometriosis. This has relevance in gynaecological surgery and is referred to again in Chapter 2, Gynaecological history, examination and investigations. The cavity of the uterus is the shape of an inverted triangle and when sectioned coronally the Fallopian tubes open at lateral angles The constriction at the isthmus where the corpus joins the cervix is the anatomical os. Seen microscopically, the site of the histological internal os is where the mucous membrane of the isthmus becomes that of the cervix. The uterus consists of three layers: the outer serous layer (peritoneum), the middle muscular layer (myometrium) and the inner mucous layer (endometrium). The peritoneum covers the body of the uterus and posteriorly it covers the supravaginal part of the cervix. The peritoneum is intimately attached to a subserous fibrous layer, except laterally where it spreads out to form the leaves of the broad ligament. The muscular myometrium forms the main bulk of the uterus and is made up of interlacing smooth muscle fibres intermingling with areolar tissue, blood vessels, nerves and lymphatics. Externally, the muscle fibres are mostly longitudinal, but the thicker intermediate layer has interlacing longitudinal, oblique and transverse fibres. Internally, they are mainly longitudinal and circular. The inner endometrial layer has tubular glands that dip into the myometrium. The endometrial layer is covered by a single layer of columnar epithelium. Ciliated prior to puberty, this epithelium is mostly lost due to the effects of pregnancy and menstruation. The endometrium undergoes cyclical changes during menstruation, as described in Chapter 3, Hormonal control of the menstrual cycle and hormonal disorders, and varies in thickness.
Uterine Swellings
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
The main function of the uterus (womb) is to contain a developing pregnancy (Fig. 1). Its anatomy is, therefore, adapted to fulfil this function by comprising a cavity encased by involuntary muscle fibres. These are arranged in a herring-bone pattern allowing expansion and contraction. When contracting, the fibres act as living ligatures, constricting the blood vessels to the cavity. The uterus is covered by peritoneum and lined by a glandular epithelium, which allows implantation of a fertilised egg. Swellings of the uterus can be divided into:those that are pregnancy related;those that are non-pregnancy related or anatomically related.These can essentially be considered benign or malignant, the latter usually being primary tumours, although secondary uterine malignancies do occasionally occur.
A Holistic Social Work Approach to Providing Sexuality Education and Counseling for Persons with Severe Disabilities
Romel W. Mackelprang, Deborah Valentine in Sexuality and Disabilities: A Guide for Human Service Practitioners, 2013
The labia minora (inner lips) are thin folds of tissue which protect the urethral and vaginal openings. Normally closed over the vagina, during sexual arousal they engorge with blood and spread apart to allow vaginal penetration. The clitoris is a small sexual organ at the anterior part of the vulva. Homologous to the male penis, it has the same number of nerve endings as the penis and is extremely sensitive to touch. It is unique in that it's only purpose is for sexual pleasure. When women become intensely sexually aroused, the clitoris often retracts protectively under the clitoral hood, which normally sits above the clitoris. The urethral meatus which lies between the clitoris and vagina is the opening from the bladder and through the urethra for the excretion of urine. The vagina lies between the rectum and urethra and is a muscular tubular organ approximately four inches long but which lengthens and widens during sexual arousal and intercourse. It acts as a passageway to the uterus and is the passageway for childbirth and through which menses flow. The Bartholin's glands lie near the opening of the vagina and secrete lubricating fluid during sexual arousal. The uterus (womb) is a hollow muscular organ about the size and shape of a pear to which a fertilized egg attaches and in which fetus grows. The lining builds up vascular tissue which is expelled during menstruation when a woman is not pregnant. The cervix is the narrow, lower end of the uterus which extends into the top of the vagina and through which sperm and menstrual flow pass, and which dilates, allowing a child to pass during childbirth. The ovaries are two almond shaped organs on each side of the uterus that secrete female hormones and from which, from puberty to menopause, mature eggs are expelled into neighboring fallopian tubes. The fallopian tubes carry eggs that, when fertilized, implant into the uterus. Male sexual anatomical structures include the penis which contains the urethra through which urine and semen pass. It contains spongy tissues that engorge when blood flow to the penis increases, causing erections. The head or glans of the penis is very sensitive to touch. At birth the glans is covered by tissue called the foreskin (which is sometimes removed by a process called circumcision). The scrotum is a small external pouch containing the testes and that reflexively raises and lowers in response to stimuli such as sexual arousal and temperature changes. The testes are contained within the scrotum and produce sperm and male hormones.
A comparison of ultrasound-guided high intensity focused ultrasound for the treatment of uterine fibroids in patients with an anteverted uterus and a retroverted uterus
Published in International Journal of Hyperthermia, 2016
Wenyi Zhang, Min He, Guohua Huang, Jia He
Objective: The aim of this study was to compare the treatment outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids in patients with an anteverted uterus versus a retroverted uterus. Materials and methods: Based on the principles of statistics we enrolled 221patients with an anteverted uterus and 221 with a retroverted uterus. All patients had a solitary uterine fibroid and every fibroid was identified as hypointense on the T2 weighted images (T2WI) on magnetic resonance. The baseline characteristics of the patients, treatment results and adverse events were compared between the two groups. Results: There were no significant differences in baseline characteristics between the two groups. The average non-perfused volume ratio of fibroids was 85.2 ± 18.7% in the group of patients with a retroverted uterus, while it was 87.7 ± 11.8% in patients with an anteverted uterus (P
First report on fertility after allogeneic uterus transplantation
Published in Acta Obstetricia et Gynecologica Scandinavica, 2010
César Díaz-García, Shamima N. Akhi, Ann Wallin, Antonio Pellicer, Mats Brännström
Uterus transplantation may become the first available treatment for uterine factor infertility, which is due to the absence or malfunction of the uterus. Here we describe for the first time pregnancy after allogeneic uterus transplantation, as a proof of concept of uterine function in a transplanted uterus in a standardized animal model (rat) under immunosuppression.
A review of 93 cases of ruptured uterus over a period of 2 years in a tertiary care hospital in South India
Published in Journal of Obstetrics and Gynaecology, 2012
P. Veena, S. Habeebullah, L. Chaturvedula
This was a retrospective descriptive study carried out on cases in JIPMER between July 2008 and June 2010 among 32,080 deliveries. The study sample included 93 women who had a ruptured uterus. Outcome variables included maternal characteristics, risk factors, management and complications of ruptured uterus. The incidence of ruptured uterus was 0.28%. Most of these women were multiparous (95%), between 20 and 30 years (82%). The majority had a scarred uterus (77%) and 83% were at term gestation. Among women with a scarred uterus, 57 women (79%) had an unknown uterine scar type and 46 women (64%) had < 18 months’ duration from the last caesarean section. A total of 37 women (39.7%) presented with ruptured uterus and a dead fetus. Out of 71 women with previous caesarean section, 46 women (49.4%) were allowed trial of scar and developed a ruptured uterus in hospital. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Out of the 93 cases, 87% were managed with uterine repair and 12 women underwent hysterectomy. A total of 31 babies were born with good Apgar scores; 48 babies were stillborn. We conclude that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and < 18 months’ duration from the last caesarean section. There were no maternal deaths. Maternal morbidity was seen in 17% of cases. Perinatal mortality was 60.6%. As a result of the study, we have implemented changes to improve patients’ care.
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