The structure and difference of the female genital organs. The external and internal genital organs of a woman

Although the male and female genital organs (organa genitalia) perform an identical function and have a common embryonic rudiment, they differ significantly in their structure. Gender is determined by the internal genital organs.

Male reproductive organs

Male genital organs are divided into two groups: 1) internal - testicles with appendages, vas deferens and ejaculatory ducts, seminal vesicles, prostate gland; 2) external - penis and scrotum.

Testicle

The testicle (testis) is a paired organ (Fig. 324) of an oval shape, located in the scrotum. The mass of the testicle is from 15 to 30 g. The left testicle is slightly larger than the right one and lowered below. The testicle is covered with a protein membrane (tunica albuginea) and a visceral sheet of the serous membrane (tunica serosa). The latter is involved in the formation of the serous cavity, which is part of the peritoneal cavity. In the testicle, the upper and lower ends (extremitates superior et inferior), lateral and medial surfaces (facies lateralis et medialis), posterior and anterior edges (margines posterior et inferior) are distinguished. The testicle with its upper end is turned upward and laterally. On the posterior margin are the epididymis (epididymis) and the spermatic cord (funiculus spermaticus). There are also gates through which blood and lymphatic vessels, nerves and seminiferous tubules pass. Connective tissue septa diverge from the perforated and somewhat thickened albuginea of ​​the hilum of the testicle towards the anterior edge, lateral and medial surfaces, dividing the testicular parenchyma into 200-220 lobules (lobuli testis). In the lobule lie 3-4 blindly beginning convoluted seminiferous tubules (tubuli seminiferi contort!); each has a length of 60-90 cm. The seminiferous tubule is a tube, the walls of which contain spermatogenic epithelium, where the formation of male germ cells - spermatozoa occurs (see Initial stages of embryogenesis). The convoluted tubules are oriented in the direction of the gate of the testis and pass into the direct seminiferous tubules (tubuli seminiferi recti), which form a dense network (rete testis). The network of tubules merges into 10-12 efferent tubules (ductuli efferentes testis). The efferent tubules on the posterior edge leave the testicle and participate in the formation of the epididymal head (Fig. 325). Above it, on the testicle, there is its appendage (appendix testis), which represents the remainder of the reduced urinary duct.

epididymis

The epididymis (epididymis) is located on the posterior edge of the testis in the form of a club-shaped body. In it, without clear boundaries, the head, body and tail are distinguished. The tail passes into the vas deferens. Like the testicle, the epididymis is covered with a serous membrane that penetrates between the testicle, head and body of the epididymis, lining a small sinus. The efferent tubules in the epididymis are twisted and collected into separate lobules. On the back surface, starting on the head of the appendage, passes the ductulus epididymidis, into which all the tubules of the lobules of the appendage flow.

On the head of the appendage there is a pendant (appendix epididymidis), which is part of the reduced genital duct.

Age features. The mass of the testicle with the appendage in a newborn is 0.3 g. The testicle grows very slowly until puberty, then it develops rapidly and by the age of 20 its mass reaches 20 g. The lumens of the seminiferous tubules appear by the age of 15-16.

vas deferens

The vas deferens (ductus deferens) is 45-50 cm long and 3 mm in diameter. Consists of mucous, muscular and connective tissue membranes. The vas deferens starts from the tail of the epididymis and ends with the vas deferens in the prostatic urethra. Based on the topographic features, the testicular part (pars testiculars) is distinguished in it, corresponding to the length of the testicle. This part is convoluted and adjacent to the posterior edge of the testis. The cord part (pars funicularis) is enclosed in the spermatic cord, which runs from the upper pole of the testicle to the external opening of the inguinal canal. The inguinal part (pars inguinalis) corresponds to the inguinal canal. The pelvic part (pars pelvina) starts from the internal opening of the inguinal canal and ends at the prostate gland. The pelvic part of the duct is devoid of the choroid plexus and passes under the parietal sheet of the peritoneum of the small pelvis. The end part of the vas deferens near the bottom of the bladder is expanded in the form of an ampulla.

Function. Ripe, but immobile spermatozoa, together with an acidic fluid, are removed from the epididymis through the vas deferens as a result of the peristalsis of the duct wall and accumulate in the ampulla of the vas deferens. Here, the liquid in it is partially resorbed.

spermatic cord

The spermatic cord (funiculus spermaticus) is a formation consisting of the vas deferens, testicular arteries, plexus of veins, lymphatic vessels and nerves. The spermatic cord is covered with membranes and has the form of a cord located between the testicle and the internal opening of the inguinal canal. Vessels and nerves in the pelvic cavity leave the spermatic cord and go to the lumbar region, and the remaining vas deferens deviates to the middle and down, descending into the small pelvis. The membranes are most complex in the spermatic cord. This is due to the fact that the testicle, leaving the peritoneal cavity, is immersed in a sac, representing the development of the transformed skin, fascia and muscles of the anterior abdominal wall.

Layers of the anterior abdominal wall, membranes of the spermatic cord and scrotum (Fig. 324)

Anterior abdominal wall 1. Skin 2. Subcutaneous tissue 3. Superficial fascia of the abdomen 4. Fascia covering m. obliquus abdominis internus et transversus abdominis 5. M. transversus abdominis 6. F. transversalis 7. Parietal peritoneum spermatic cord and scrotum 1. Skin of the scrotum 2. Fleshy membrane of the scrotum (tunica dartos) 3. External seminal fascia (f. spermatica externa) 4. F. cremasterica 5. M. cremaster 6. Internal seminal fascia (f. spermatica interna) 7. Vaginal membrane ( tunica vaginalis testis on the testicle has: lamina perietalis, lamina visceralis)

seminal vesicles

The seminal vesicle (vesicula seminalis) is a paired cellular organ up to 5 cm long, located lateral to the ampulla of the vas deferens. Above and in front it is in contact with the bottom of the bladder, behind - with the anterior wall of the rectum. Through it, seminal vesicles can be palpated. The seminal vesicle communicates with the terminal part of the vas deferens.

Function. Seminal vesicles do not live up to their name, as there are no spermatozoa in their secretion. By value, they are excretory glands that produce an alkaline reaction fluid that is ejected into the prostatic urethra at the time of ejaculation. The liquid mixes with the secretion of the prostate gland and a suspension of immobile spermatozoa coming from the ampulla of the vas deferens. Only in an alkaline environment do spermatozoa acquire mobility.

Age features. In a newborn, seminal vesicles look like twisted tubes, are very small and grow vigorously during puberty. They reach their maximum development by the age of 40. Then come involutive changes, primarily in the mucous membrane. In this regard, it becomes thinner, which leads to a decrease in secretory function.

ejaculatory duct

From the junction of the ducts of the seminal vesicles and the vas deferens, the ejaculatory duct (ductus ejaculatorius) 2 cm long begins, which passes through the prostate gland. The ejaculatory duct opens on the seminal tubercle of the prostatic urethra.

Prostate

The prostate gland (prostata) is an unpaired glandular-muscular organ that has the shape of a chestnut. It is located under the bottom of the bladder on the urogenital diaphragm of the pelvis behind the symphysis. It has a length of 2-4 cm, a width of 3-5 cm, a thickness of 1.5-2.5 cm and a weight of 15-25 g. It is possible to palpate the gland only through the rectum. The urethra and ejaculatory canals pass through the gland. In the gland, a base (basis) is distinguished, facing the bottom of the bladder (Fig. 329). and the apex (apex) - to the urogenital diaphragm. On the back surface of the gland, a groove is felt, which divides it into the right and left lobes (lobi dexter et sinister). The part of the gland located between the urethra and the ejaculatory duct stands out as the middle lobe (lobus medius). The anterior lobe (lobus anterior) is located in front of the urethra. Outside, it is covered with a dense connective tissue capsule. Vascular plexuses lie on the surface of the capsule and in its thickness. The connective tissue fibers of its stroma are woven into the capsule of the gland. From the anterior and lateral surfaces of the prostate capsule, the middle and lateral (paired) ligaments (lig. puboprostaticum medium, ligg. puboprostatica lateralia) begin, which are attached to the pubic fusion and to the anterior part of the tendon arch of the pelvic fascia. Among the ligaments there are muscle fibers, which are distinguished by a number of authors into independent muscles (m. puboprostaticus).

The parenchyma of the gland is divided into lobes and consists of numerous external and periurethral glands. Each gland opens with its own duct into the prostate urethra. The glands are surrounded by smooth muscle and connective tissue fibers. At the base of the gland, surrounding the urethra, there are smooth muscles, anatomically and functionally combined with the internal sphincter of the canal. In old age, hypertrophy of the periurethral glands develops, which causes narrowing of the prostatic urethra.

Function. The prostate gland produces not only an alkaline secretion for the formation of sperm, but also hormones that enter the sperm and blood. The hormone stimulates the spermatogenic function of the testicles.

Age features. Before puberty, the prostate gland, although it has the beginnings of a glandular part, is a muscular-elastic organ. During puberty, iron increases 10 times. It reaches its highest functional activity at the age of 30-45, then there is a gradual fading of the function. In old age, due to the appearance of collagen connective tissue fibers and atrophy of the glandular parenchyma, the organ thickens and hypertrophies.

prostate uterus

The prostatic uterus (utriculus prostaticus) has the shape of a pocket, which is located in the seminal tubercle of the prostatic part of the urethra. It is not related to the prostate gland in origin and is a remnant of the urinary ducts.

External male genital organs

male penis

The penis (penis) is a combination of two cavernous bodies (corpora cavernosa penis) and one spongy body (corpus spongiosum penis), covered on the outside with membranes, fascia and skin.

When viewed from the penis, the head (glans), body (corpus) and root (radix penis) are isolated. On the head there is a vertical slot of the external opening of the urethra with a diameter of 8-10 mm. The surface of the penis, facing upward, is called the back (dorsum), the lower one is the urethra (facies urethralis) (Fig. 326).

The skin of the penis is thin, delicate, mobile and devoid of hair. In the anterior part, the skin forms a fold of the foreskin (preputium), which in children tightly covers the entire head. According to the religious rites of some peoples, this fold is removed (the rite of circumcision). On the underside of the head there is a frenulum (frenulum preputii), from which the suture begins along the midline of the penis. Around the head and on the inner sheet of the foreskin there are many sebaceous glands, the secret of which is secreted into the groove between the head and the fold of the foreskin. There are no mucous and sebaceous glands on the head, and the epithelial lining is thin and delicate.

Cavernous bodies (corpora cavernosa penis), paired, (Fig. 327) are built from fibrous connective tissue, which has a cellular structure of transformed blood capillaries, so it resembles a sponge. With the contraction of the muscle sphincters of venules and m. ischiocavernosus, which compresses v. dorsalis penis, the outflow of blood from the chambers of the cavernous tissue is difficult. Under the pressure of blood, the chambers of the cavernous bodies straighten out and an erection of the penis occurs. The anterior and posterior ends of the cavernous bodies are pointed. At the front end, they are fused with the head (glans penis), and at the back in the form of legs (crura penis) grow to the lower branches of the pubic bones. Both cavernous bodies are enclosed in a protein shell (tunica albuginea corporum cavernosorum penis), which protects the chamber of the cavernous part from rupture during erection.

The spongy body (corpus spongiosum penis) is also covered with a protein membrane (tunica albuginea corporum spongiosorum penis). The anterior and posterior ends of the spongy body are expanded and form the head of the penis in front, and the bulb (bulbus penis) in the back. The spongy body is located on the lower surface of the penis in the groove between the cavernous bodies. The spongy body is formed by fibrous tissue, which also contains cavernous tissue, which is filled with blood during erection, like the cavernous bodies. In the thickness of the spongy body passes the urethra for the excretion of urine and sperm.

Cavernous and spongy bodies, with the exception of the head, are surrounded by deep fascia (f. penis profunda), which is covered with superficial fascia. Between the fascia are blood vessels and nerves (Fig. 328).

Age features. The penis grows vigorously only during puberty. In the elderly, there is a greater keratinization of the epithelium of the head, foreskin and skin atrophy.

Erection and sperm ejaculation

For fertilization, one sperm is needed, which connects with the egg in the fallopian tube or the woman's peritoneal cavity. This is achieved when the spermatozoa enter the female genital tract. When filling the vascular system of the penis, an erection is possible. When the glans penis is rubbed against the vagina, the labia minora and labia majora, with the participation of the spinal centers, a reflex contraction of the muscle elements of the ampulla of the vas deferens, seminal vesicles, prostate and cooper glands occurs. Their secret, mixed with spermatozoa, is thrown into the urethra. In the alkaline environment of the secretion of the prostate gland, spermatozoa acquire mobility. With the contraction of the muscles of the urethra and perineum, the sperm is poured into the vagina.

male urethra

The male urethra (urethra masculina) is about 18 cm long; most of it mainly passes through the spongy body of the penis (Fig. 329). The canal begins in the bladder with an internal opening and ends with an external opening on the glans penis. The urethra is divided into prostatic (pars prostatica), membranous (pars membranacea) and spongy (pars spongiosa) parts.

The prostate corresponds to the length of the prostate and is lined with transitional epithelium. In this part, a narrowed place is distinguished according to the position of the internal sphincter of the urethra and below an expanded part 12 mm long. On the back wall of the expanded part is the seminal tubercle (folliculus seminalis), from which the scallop (crista urethralis), formed by the mucous membrane, extends up and down. Around the mouths of the ejaculatory ducts, which open on the seminal tubercle, there is a sphincter. In the tissue of the ejaculatory ducts there is a venous plexus, which acts as an elastic sphincter.

The membranous part represents the shortest and narrowest section of the urethra; it is well fixed in the urogenital diaphragm of the pelvis and has a length of 18-20 mm. Striated muscle fibers around the canal form an external sphincter (sphincter urethralis externus), subordinate to the human mind. The sphincter, except for the act of urination, is constantly reduced.

The spongy part has a length of 12-14 cm and corresponds to the spongy body of the penis. It begins with a bulbous expansion (bulbus urethrae), where the ducts of two bulbous urethral glands open, secreting protein mucus to moisten the mucous membrane and thin the sperm. Bulbourethral glands the size of a pea are located in the thickness of m. transversus perinei profundus. The urethra of this part starts from the bulbous expansion, has a uniform diameter of 7-9 mm, and only in the head passes into a spindle-shaped expansion called the navicular fossa (fossa navicularis), which ends with a narrowed external opening (orificium urethrae externum). In the mucous membrane of all sections of the canal, there are numerous glands of two types: intraepithelial and alveolar-tubular. The intraepithelial glands are similar in structure to goblet mucous cells, and the alveolar-tubular glands are flask-shaped, lined with a cylindrical epithelium. These glands secrete a secret to moisten the mucous membrane. The basement membrane of the mucosa is fused with the spongy layer only in the spongy part of the urethra, and in other parts - with the smooth muscle layer.

When considering the profile of the urethra, two curvatures, three expansions and three narrowings are distinguished. The anterior curvature is located in the root area and is easily corrected by lifting the penis. The second curvature is fixed in the perineum and goes around the pubic fusion. Canal extensions: in the pars prostatica - 11 mm, in the bulbus urethrae - 17 mm, in the fossa navicularis - 10 mm. Narrowing of the channel: in the area of ​​​​the internal and external sphincters, the channel is completely closed, in the area of ​​\u200b\u200bthe external opening, the diameter decreases to 6-7 mm. Due to the extensibility of the canal tissue, if necessary, it is possible to pass a catheter with a diameter of up to 10 mm.

urethrograms

With ascending urethrography, the cavernous part of the male urethra has a shadow in the form of an even strip; an expansion is noted in the bulbous part, the membranous part is narrowed, the prostate is expanded. The membranous and prostatic parts make up the posterior urethra, located at right angles to its two anterior parts.

Scrotum

The scrotum (scrotum) is formed by skin, fascia and muscle; it contains the spermatic cords and testicles. The scrotum is located in the perineum between the root of the penis and the anus. The layers of the scrotum are discussed in the "Spermoid cord" section.

The skin of the scrotum is richly pigmented, thin, on its surface in young people there are transverse folds, which, when the muscle membrane contracts, constantly change their depth and shape. In the elderly, the scrotum sags, the skin becomes thinner, loses folding. The skin has sparse hair, many sebaceous and sweat glands. In the midline, there is a middle suture (raphe scroti), devoid of pigment, hair and glands, and in the depths of the scrotum there is a septum (septum scroti). The skin is adjacent to the fleshy membrane (tunica dartos) and therefore is devoid of subcutaneous tissue.

Female reproductive organs

The female genital organs (organa genitalia feminina) are conditionally divided into internal - ovaries, uterus with tubes, vagina and external - genital gap, hymen, large and small labia and clitoris.

Internal female reproductive organs

Ovary

The ovary (ovarium) is a paired female gonad, having an oval shape, length 25 mm, width 17 mm, thickness 11 mm, weight 5-8 g. The ovary is located vertically in the cavity of the small pelvis. Distinguish between its tubal end (extremitas tubaria) and uterine end (extremitas uterina), medial and lateral surfaces (facies medialis et lateralis), free posterior (margo liber) and mesenteric (margo mesovaricus) edges.

The ovary is located on the lateral surface of the small pelvis (Fig. 280) in a hole bounded from above a. et v. iliacae externae, below - aa. uterina et umbilicalis, in front - by the parietal peritoneum when it passes into the posterior leaf of the broad ligament of the uterus, behind - a. et v. iliacae externae. The ovary lies in this fossa in such a way that the tubal end is directed upwards, the uterine end is downward, the free edge is directed backward, the mesenteric is forward, the lateral surface is adjacent to the parietal peritoneum of the pelvis, and the medial one is turned towards the uterus.

In addition to the mesentery (mesosalpinx), the ovary is fixed to the side wall of the pelvis with two ligaments. Suspension ligament (lig. suspensorium ovarii) starts from the tubular end of the ovary and ends in the parietal peritoneum at the level of the renal veins. Arteries and veins, nerves and lymphatic vessels pass through this ligament to the ovary. Own ligament of the ovary (lig. ovarii proprium) goes from the uterine end to the lateral corner of the uterine fundus.

The parenchyma of the ovary contains follicles (folliculi ovarici vesiculosi), (Fig. 330), which contain developing eggs. Primary follicles are located in the outer layer of the cortical substance of the ovary, which gradually move into the depth of the cortical substance, turning into a vesicular follicle. Simultaneously with the development of the follicle, an egg (oocyte) develops.

Blood and lymphatic vessels, thin connective tissue fibers and small bands of invaginated enzymatic epithelium, surrounded by follicular epithelium, pass between the follicles. These follicles lie in a continuous layer under the epithelium and albuginea. Every 28 days, usually one follicle develops, having a diameter of 2 mm. With its proteolytic enzymes, it melts the protein membrane of the ovary and, bursting, releases the egg. The ovum released from the follicle enters the peritoneal cavity, where it is captured by the fimbriae of the fallopian tube. In place of the bursting follicle, a corpus luteum (corpus luteum) is formed that produces lutein, and then progesterone, which inhibits the development of new follicles. In the case of conception, the corpus luteum develops rapidly and, under the action of the lutein hormone, inhibits the maturation of new follicles. If pregnancy does not occur, under the influence of estradiol, the corpus luteum atrophies and overgrows with a connective tissue scar. After atrophy of the corpus luteum, new follicles begin to mature. The mechanism that regulates the maturation of follicles is under the control of not only hormones, but also the nervous system.

Function. The ovary is not only an organ for the maturation of the egg, but also an endocrine gland. The development of secondary sexual characteristics and the psychological characteristics of the female body depend on the hormones that enter the bloodstream. These hormones are estradiol, produced by follicular cells, and progesterone, produced by corpus luteum cells. Estradiol promotes the maturation of follicles and the development of the menstrual cycle, progesterone ensures the development of the embryo. Progesterone also enhances the secretion of the glands and the development of the uterine mucosa, reduces the excitability of its muscle elements, and stimulates the development of the mammary glands.

Age features. The ovaries in newborns are very small 0.4 g and in the first year of life increase 3 times. Under the ovarian albuginea in newborns, the follicles are arranged in several rows. In the first year of life, the number of follicles decreases significantly. In the second year of life, the albuginea thickens and its bridges, plunging into the cortical substance, separate the follicles into groups. By the period of puberty, the ovary has a mass of 2 g. At 11-15 years old, intensive maturation of the follicles, their ovulation and menstruation begin. The final formation of the ovary is observed by the age of 20.

After 35-40 years, the ovaries slightly decrease. After 50 years, the menopause begins, the mass of the ovaries decreases by 2 times due to fibrosis and atrophy of the follicles. The ovaries turn into dense connective tissue formations.

Ovarian appendages

Ovarian appendages (epoophoron and paroophoron) are a paired rudimentary formation representing the remnants of mesonephros. It is located between the sheets of the broad ligament of the uterus in the mesosalpinx region.

Uterus

The uterus (uterus) is an unpaired, pear-shaped hollow organ. It distinguishes the bottom (fundus uteri), body (corpus), isthmus (isthmus) and neck (cervix) (Fig. 330). The bottom of the uterus is the highest part, protruding above the mouths of the fallopian tubes. The body is flattened and gradually narrows to the isthmus. The isthmus is the most narrowed part of the uterus, 1 cm long. The cervix has a cylindrical shape, starts from the isthmus and ends in the vagina with the anterior and posterior lips (labia anterius et posterius). The posterior lip is thinner and protrudes more into the lumen of the vagina. The uterine cavity has an irregular triangular fissure. In the region of the bottom of the uterus, there is the base of the cavity, into which the mouths of the fallopian tubes (ostium uteri) open, the top of the cavity passes into the cervical canal (canalis cervicis uteri). In the cervical canal, internal and external openings are distinguished. In nulliparous women, the external opening of the cervix has an annular shape, in those who have given birth, it has the shape of a gap, which is due to its ruptures during childbirth (Fig. 331).

The length of the uterus is 5-7 cm, the width in the bottom area is 4 cm, the wall thickness reaches 2-2.5 cm, the weight is 50 g. -4 ml of liquid, in those giving birth - 5-7 ml. The diameter of the cavity of the uterine body is 2-2.5 cm, in those who gave birth - 3-3.5 cm, the neck has a length of 2.5 cm, in those who gave birth - 3 cm, the diameter is 2 mm, in those who gave birth - 4 mm. Three layers are distinguished in the uterus: mucous, muscular and serous.

The mucous membrane (tunica mucosa seu, endometrium) is lined with ciliated epithelium, penetrated by a large number of simple tubular glands (gll. uterinae). In the neck there are mucous glands (gll. cervicales). The thickness of the mucous membrane ranges from 1.5 to 8 mm, depending on the period of the menstrual cycle. The mucous membrane of the body of the uterus continues into the mucous membrane of the fallopian tubes and cervix, where it forms palm-like folds (plicae palmatae). These folds are clearly expressed in children and nulliparous women.

The muscular coat (tunica muscularis seu, myometrium) is the thickest layer formed by smooth muscles interspersed with elastic and collagen fibers. It is impossible to isolate individual muscle layers in the uterus. Studies show that in the process of development, when the two urinary canals merged, the circular muscle fibers intertwined with each other (Fig. 332). In addition to these fibers, there are circular fibers braiding corkscrew-shaped arteries, oriented radially from the surface of the uterus to its cavity. In the region of the neck, the loops of muscle spirals have a sharp bend and form a circular muscle layer.

The serous membrane (tunica serosa seu, perimetrium) is represented by the visceral peritoneum, which is firmly adherent to the muscular membrane. The peritoneum of the anterior and posterior walls along the edges of the uterus is connected into wide uterine ligaments, below, at the level of the isthmus, the peritoneum of the anterior wall of the uterus passes to the posterior wall of the bladder. A deepening (excavatio vesicouterina) is formed at the transition point. The peritoneum of the posterior wall of the uterus completely covers the cervix and is even fused for 1.5-2 cm with the posterior wall of the vagina, then passes to the anterior surface of the rectum. Naturally, this depression (excavatio rectouterina) is deeper than the vesicouterine cavity. Due to the anatomical connection of the peritoneum and the posterior wall of the vagina, diagnostic punctures of the recto-uterine cavity are possible. The peritoneum of the uterus is covered with mesothelium, has a basement membrane and four connective tissue layers oriented in different directions.

Bundles. The broad ligament of the uterus (lig. Latum uteri) is located along the edges of the uterus and, being in the frontal plane, reaches the side wall of the small pelvis. This ligament does not stabilize the position of the uterus, but performs the function of the mesentery. In conjunction, the following parts are distinguished. 1. The mesentery of the fallopian tube (mesosalpinx) is located between the fallopian tube, the ovary and its own ligament of the ovary; between the leaves of mesosalpinx are epoophoron and paroophoron, which are two rudimentary formations. 2. The fold of the posterior peritoneum of the broad ligament forms the mesentery of the ovary (mesovarium). 3. The part of the ligament, located below the own ligament of the ovary, makes up the mesentery of the uterus, where loose connective tissue (parametrium) lies between its sheets and on the sides of the uterus. Through the entire mesentery of the broad ligament of the uterus, vessels and nerves pass to the organs.

The round ligament of the uterus (lig. teres uteri) is steam room, has a length of 12-14 cm, a thickness of 3-5 mm, starts at the level of the orifices of the fallopian tubes from the anterior wall of the body of the uterus and passes between the leaves of the wide uterine ligament down and laterally. Then it penetrates into the inguinal canal and ends on the pubis in the thickness of the labia majora.

The main ligament of the uterus (lig. cardinale uteri) is a steam room, located in the frontal plane at the base of the lig. latum uteri. It starts from the cervix and attaches to the lateral surface of the pelvis, fixes the cervix.

The recto-uterine and vesico-uterine ligaments (Hgg. rectouterina et vesicouterina), respectively, connect the uterus to the rectum and bladder. The ligaments contain smooth muscle fibers.

Topography and position of the uterus. The uterus is located in the pelvic cavity between the bladder in front and the rectum in the back. Palpation of the uterus is possible through the vagina and rectum. The bottom and body of the uterus are mobile in the small pelvis, so the filled bladder or rectum affects the position of the uterus. With empty pelvic organs, the bottom of the uterus is directed forward (anteversio uteri). Normally, the uterus is not only tilted forward, but also bent in the isthmus (anteflexio). The opposite position of the uterus (retroflexio), as a rule, is considered pathological.

Function. The fetus is born in the uterine cavity. During childbirth, the fetus and placenta are expelled from the uterine cavity by contraction of the muscles of the uterus. In the absence of pregnancy, rejection of the hypertrophied mucous membrane occurs during the menstrual cycle.

Age features. The uterus of a newborn girl has a cylindrical shape, a length of 25-35 mm and a mass of 2 g. The cervix is ​​2 times longer than her body. There is a mucous plug in the cervical canal. Due to the small size of the small pelvis, the uterus is located high in the abdominal cavity, reaching the fifth lumbar vertebra. The anterior surface of the uterus is in contact with the posterior wall of the bladder, the posterior wall is in contact with the rectum. The right and left edges are in contact with the ureters. After birth during the first 3-4 weeks. the uterus grows faster and a well-defined anterior curve is formed, which is then preserved in an adult woman. By the age of 7, the bottom of the uterus appears. The size and weight of the uterus are more constant up to 9-10 years. Only after 10 years does the rapid growth of the uterus begin. Its weight depends on age and pregnancies. At 20 years old, the uterus weighs 23 g, at 30 years old - 46 g, at 50 years old - 50 g.

The fallopian tubes

The fallopian tube (tuba uterina) is a paired oviduct through which the egg moves from the peritoneal cavity after ovulation to the uterine cavity. The fallopian tube is divided into the following parts: pars uterina - passes through the wall of the uterus, isthmus - the narrowed part of the tube, ampulla - expansion of the tube, infundibulum - the end part of the tube, representing the shape of a funnel, bordered by fringes (fimbriae tubae) and located on the side wall of the pelvis near the ovary . The last three parts of the tube are covered with peritoneum and have a mesentery (mesosalpinx). Pipe length 12-20 cm; its wall contains mucous, muscular and serous membranes.

The mucous membrane of the tube is covered with stratified ciliated prismatic epithelium, which contributes to the promotion of the egg. In fact, the lumen of the fallopian tube is absent, since it is filled with longitudinal folds with additional villi (Fig. 333). With minor inflammatory processes, part of the folds can fuse with each other, being an insurmountable obstacle to the advancement of a fertilized egg. In this case, an ectopic pregnancy may develop, since the narrowing of the fallopian tube is not an obstacle to the sperm. Obstruction of the fallopian tubes is one of the causes of infertility.

The muscular coat is represented by the outer longitudinal and inner circular layers of smooth muscles, which directly continue into the muscular coat of the uterus. Peristaltic and pendulum contractions of the muscle layer contribute to the movement of the egg into the uterine cavity.

The serous membrane represents the visceral peritoneum, which closes below and passes into the mesosalpinx. Under the serous membrane there is a loose connective tissue.

Topography. The fallopian tube is located in the small pelvis in the frontal plane. It follows almost horizontally from the angle of the uterus, and in the region of the ampulla forms a curve backwards with a bulge upwards. The funnel of the tube descends parallel to the margo liber of the ovary.

Age features. In newborns, the fallopian tubes are tortuous and relatively longer, so they form several bends. By the time of puberty, the tube straightens out, keeping one bend. In older women, the bends of the tube are absent, its wall becomes thinner, the fringes atrophy.

X-rays of the uterus and tubes (hysterosalpingograms)

The shadow of the uterine cavity has a triangular shape (Fig. 334). If the fallopian tubes are passable, then the intra-wall narrowed part of the tube begins from the base of the triangle, then it, expanding in the isthmus, passes into the ampoule. The contrast agent enters the peritoneal cavity. On the pictures of the uterus, it is possible to establish the deformation of the uterine cavity, the patency of the tubes, the presence of a bicornuate uterus, etc.

Menstrual cycle

Unlike the male activity of the female reproductive system, it proceeds cyclically with a frequency of 28-30 days. The cycle ends with the onset of menstruation. The menstrual period is divided into three phases: menstrual, postmenstrual and premenstrual. In each phase, the structure of the mucous membrane has its own characteristics depending on the function of the ovaries (Fig. 335).

1. The menstrual phase lasts 3-5 days. During this period, the mucous membrane, as a result of spasm and rupture of blood vessels, is torn away from the basal layer. Only parts of the uterine glands and small islands of the epithelium remain in it. In the menstrual phase, 30-50 ml of blood flows out.

2. In the postmenstrual (intermediate) phase, the process of restoration of the mucous membrane occurs under the influence of estrogen in the developing follicle. This phase lasts 12-14 days. Despite the fact that the uterine glands completely regenerate, their lumens remain narrow and, most importantly, devoid of secretion. After the 14th day, ovulation of the egg occurs and the formation of a corpus luteum that secretes progesterone, which is a powerful stimulant for the development of the glands of the mucous membrane and uterine epithelium.

3. The premenstrual (functional) phase lasts 10 days. During this time, under the action of progesterone, the glands of the uterine mucosa secrete a secret, glycogen and lipid granules, vitamins and microelements accumulate in epithelial cells. If fertilization occurs, then the embryo is introduced onto the prepared mucous membrane with the subsequent development of the placenta. In the absence of fertilization of the egg, menstruation occurs - rejection of the mucous membrane and hypertrophied mucous glands.

Vagina

The vagina (vagina) is an easily stretchable muco-muscular tube 3 mm thick and up to 10 cm long. The vagina starts from the cervix and opens into the genital slit with a hole. Its anterior and posterior walls (parietes anterior et posterior) are in contact with each other. At the place of attachment of the vagina to the cervix, there are anterior and posterior arches (fornices anterior et posterior). The posterior fornix is ​​deeper and contains vaginal fluid. This is where sperm is poured during copulation. The opening of the vagina (ostium vaginae) is covered by the hymen (hymen).

The hymen is a derivative of the Mullerian tubercle, which appears at the end of the vagina at the confluence of the urinary ducts. The mesenchyme of the Müllerian tubercle grows and covers the urogenital sinus with a thin plate. Only for the 6th month of embryonic development, holes appear in the plate. The hymen is a semilunar or perforated plate with a hole of about 1.5 cm. During intercourse or childbirth, the hymen is torn and its remnants atrophy, forming shreds (carunculae hymenales).

The vaginal wall is made up of three layers. The mucous membrane is covered with stratified squamous epithelium, tightly fused with a hypertrophied basement membrane, which is connected to the muscular membrane. This protects the mucous membrane from damage during intercourse and childbirth. In nulliparous women, the vaginal mucosa has distinct transverse wrinkles (rugae vaginales), as well as longitudinal folds in the form of columns of wrinkles (columnae rugarum), among which there are anterior and posterior columns (columnae rugarum anterior et posterior). After childbirth, the mucous membrane of the vagina, as a rule, becomes smooth. Mucous glands were not found in it, and the acidic secret of the vagina is a waste product of microorganisms that destroy glycogen granules, exfoliating epithelial cells. As a result of this mechanism, a biological protective barrier is formed for many microorganisms that are inactive in the acidic environment of the vagina. Alkaline sperm and the secretion of the glands of the vestibule partially neutralize the acidic environment of the vagina, ensuring sperm motility.

The muscular coat has a reticulate structure due to the mutual interlacing of spiral smooth muscle bundles. Striated muscle fibers around the opening of the vagina form a muscle pulp (sphincter urethrovaginalis) 5-7 mm wide, which also covers the urethra.

The connective sheath (tunica adventitia) consists of loose connective tissue in which the vascular and nerve plexuses lie.

Topography. Most of the vagina lies on the urogenital diaphragm. The anterior wall of the vagina is fused with the urethra, the posterior - with the anterior wall of the rectum. On the sides and in front from the outside, at the level of the arches, the vagina is in contact with the ureters. The final part of the vagina is connected with the muscles and fascia of the perineum, which take part in strengthening the vagina.

Age features. The vagina of a newborn girl has a length of 23-35 mm and an obliterated lumen. The anterior wall is in contact with the urethra, the posterior - with the rectum. Only during the period of increase in the size of the pelvis, when the bladder descends, does the position of the anterior fornix of the vagina change. At 10 months the internal opening of the urethra is at the level of the anterior fornix of the vagina. At 15 months the level of the arch corresponds to the triangle of the bladder. After 10 years, increased growth of the vagina and the formation of mucosal folds begin. At 12-14 years old, the anterior fornix is ​​located above the entry of the ureters.

Function. The vagina serves for copulation, being a reservoir for sperm. The fetus is expelled through the vagina. Irritation of the nerve receptors of the vagina during intercourse causes sexual arousal (orgasm).

External female genital organs (Fig. 336)

Large labia

Large labia (labia majora pudendi) are located in the perineum and are paired skin rollers 8 cm long, 2-3 cm thick. Both lips limit the genital gap (rima pudendi). The right and left lips are joined in front and behind by adhesions (commissurae labiorum anterior et posterior). The labia majora, with the exception of the medial surface, are covered with sparse hair and are richly pigmented. The medial surface faces the genital fissure and is lined with a thin layer of stratified squamous epithelium.

Small labia

The labia minora (labia minora pudendi) is located in the genital gap medial to the labia majora. They represent thin paired skin folds, as a rule, not visible in a closed genital fissure. Rarely, the labia minora are higher than the large ones. In front, the labia minora go around the clitoris and form the foreskin (preputium clitoridis), which fuses under the head of the clitoris into a frenulum (frenulum clitoridis), and also forms a transverse frenulum (frenulum labiorum pudendi) from behind. The labia minora is covered with a thin layer of stratified squamous epithelium. They are based on loose connective tissue with vascular and nerve plexuses.

Vaginal vestibule

The vestibule of the vagina (vestibulum vaginae) is limited by the medial surfaces of the labia minora, in front - by the frenulum of the clitoris, behind - by the frenulum of the labia minora, from the outside it opens into the genital gap.

In the vestibule, the ducts of the paired large glands of the vestibule (gll. vestibulares majores) open. These pea-sized glands are located at the base of the labia majora in the thickness of the deep transverse perineal muscle and, therefore, are similar to the male bulbo-urethral glands. A duct 1.5 cm long opens on the medial surface at the base of the labia minora 1-2 cm anterior to its transverse frenulum. The secret of the large glands of the vestibule of white color, alkaline reaction, is released during the contraction of the muscles of the perineum and moisturizes the genital slit and the vestibule of the vagina.

In addition to the paired large glands of the vestibule, there are small glands (gll. vestibulares minores), which open between the opening of the urethra and the vagina.

Clitoris

The clitoris (clitoris) is formed by two cavernous bodies (corpora cavernosa clitoridis). It has a head, body and legs. The body is 2-4 cm long and is covered with dense fascia (f. clitoridis). The head lies in the upper part of the genital slit, has a frenulum (frenulum clitoridis) from below, and the foreskin (preputium clitoridis) from above. The legs are attached to the lower branches of the pubic bones. Thus, the clitoris in structure resembles the penis, only devoid of a spongy body, and is smaller.

Function. With sexual arousal, the clitoris lengthens and becomes elastic. The clitoris is richly innervated and contains numerous sensitive endings; there are especially many genital bodies in it, which perceive irritations that occur during sexual intercourse.

Bulb vestibule

Bulb vestibule (bulbus vestibuli) in origin corresponds to the spongy body of the penis. The difference is that the spongy tissue in a woman is divided into two parts by the urethra and is located around not only this channel, but also the vestibule of the vagina.

Function. When excited, the spongy tissue swells and narrows the entrance to the vestibule of the vagina. After orgasm, the blood from the vestibular bulb chambers drains and the swelling subsides. The bulb of the vestibule is especially developed in some monkeys.

Age features of the external female genital organs. In a newborn girl, the clitoris and labia minora protrude from the genital slit. By the age of 7-10, the genital gap opens only when the hips are divorced. During childbirth, the vestibule of the vagina, the frenulum and adhesions of the labia are sometimes torn; the vagina is stretched, many folds of its mucous membrane are smoothed out. In conditions where the vaginal vestibule is stretched, the genital slit is open. In this case, protrusion of the anterior or posterior wall of the vagina is possible. After 45-50 years, atrophy of the labia, large and small mucous glands of the vestibule occurs, thinning and keratization of the mucous membrane of the genital slit and vagina are noted.

Crotch

The perineum (perineum) represents all soft formations (skin, muscles, fascia) located at the exit of the small pelvis, limited in front by the pubic bones, behind by the coccyx, and laterally ischial tubercles. Due to the large size of the small pelvis in women and the perineum is slightly larger than in men. In women, the perineum is clearly visible with the hips apart. In men, the perineum is not only narrower, but also deeper. The perineum can be divided by the intersciatic line passing between the ischial tubercles into the anterior (genitourinary) and posterior (anal) regions. The urogenital region is strengthened by the urogenital diaphragm (diaphragma urogenitale), through which the urethra passes, and in women, the vagina. The anal region contains the pelvic diaphragm (diaphragma pelvis), through which only the rectum passes.

The perineum is covered with pigmented thin skin, contains sebaceous, sweat glands and sparse hair. Subcutaneous fat and fascia are unevenly developed. The urogenital and pelvic diaphragms withstand the weight of the internal organs and intra-abdominal pressure, preventing the internal organs from falling into the perineum. In addition, the muscles of the perineum form arbitrary sphincters of the urethra and rectum.

Urogenital diaphragm (Fig. 337, 338)

The urogenital diaphragm (diaphragma urogenitale) consists of striated muscles.

1. The bulbous-spongy muscle (m. bulbospongiosus) is steam room, in men it is located on the corpus spongiosum bulb. It starts on the lateral surface of the cavernous bodies and, meeting with the muscle of the same name of the opposite side along the midline of the spongy body, forms a suture.

Function. Muscle contraction promotes the ejection of sperm and urination.

In women m. bulbospongiosus covers the opening of the vagina (see Fig. 339). In those who have given birth, this muscle, as a rule, is torn and atrophied, as a result of which the entrance to the vagina is more open than in those who have not given birth.

2. Ischiocavernosus muscle (m. ischiocavernosus) steam room, starts from the ischial tubercles and the anterior branch of the ischium and ends on the fascia of the cavernous body.

Function. The muscle contributes to the erection of the penis or clitoris. When the muscle contracts, the fascia of the root of the penis or clitoris tenses and compresses v. dorsalis penis or v. clitoridis, preventing the outflow of blood from the penis or clitoris.

3. Superficial transverse muscle of the perineum (m. transversus perinei superficialis) paired, weak, located behind m. bulbospongiosus, starting from the ischial tuberosity; ends in the center of the perineum.

4. Deep transverse muscle (m. transversus perinei profundus) steam room, starts from the lower branch of the pubic bone and ends in the median tendon suture. In its thickness lie gl. bulbourethralis (in men) and gl. vestibularis major (in women).

Function. Strengthens the urogenital diaphragm.

5. The external sphincter of the urethra (m. sphincter urethrae externus) surrounds its membranous part. The muscle is represented by annular bundles - derivatives of m. transversus perinei profundus. In women, the sphincter is less developed.

pelvic diaphragm

The pelvic diaphragm (diaphragma pelvis) also includes muscles.

1. External sphincter of the anus (m. sphincter ani externus), circularly covers the anus, located under the skin (Fig. 339).

Function. It is under the control of human consciousness. Closes anus.

2. The muscle that lifts the anus (m. levator ani), steam room, triangular shape. It starts on the lateral surface of the small pelvis from the lower branch of the pubic bone (pars pubica m. pubococcygei), from the tendon arch of the obturator fascia (pars iliaca m. iliococcygei), covering the internal obturator muscle; descending to the anus, the bundles converge.

Function. It is determined depending on the beginning of the muscle bundles. The bundles of the pubic part of the muscle, contracting, press the anterior wall of the intestine to the posterior. When the ampulla of the rectum is full, the pubic part of the anus lift promotes defecation, and when the ampulla of the rectum is empty, it closes. In women, the pubic part m. levator ani compresses the vagina. The second part m. levator ani, iliac, raises the anus. In general, both parts of the muscle, having the shape of a funnel, open into the abdominal cavity and consisting of a thin muscle plate, withstand a relatively large pressure of the viscera. The strength of the muscle is due to the fact that, under intra-abdominal pressure, it is pressed against the walls of the pelvis, where in the center of this muscle funnel, the rectum is a "locking wedge".

3. The coccygeal muscle (m. coccygeus) in the form of a paired plate covers the bottom of the pelvis, starting from the IV-V sacral vertebrae and the coccyx, is attached to the sciatic spine and lig. sacrospinosum.

Fascia of the pelvis, perineum and interfascial tissue

Fascia of the pelvic diaphragm. The fascia of the pelvic diaphragm is anatomically related to the pelvic fascia (f. pelvis), which is a continuation of the iliac fascia located in the large pelvis. The pelvic fascia covers the back of the sacrum and piriformis muscles, laterally - internal obturator muscles and, reaching the tendon arc (arcus tendineus) of the pelvis, from which m. levator ani, is divided into parietal sheet (f. pelvis parietalis) and the upper fascia of the pelvic diaphragm (f. diaphrag-matis pelvis superior). The parietal sheet below the tendon arch covers the walls of the pelvis and ends on the ischial tuberosities, pubic bones, ischiosacral, sacrospinous ligaments. Ahead, it forms the ligaments of the prostate (see Prostate gland). The upper diaphragmatic sheet of the pelvic fascia lies on m. levator ani and m. coccygeus from above and is woven into the external sphincter of the rectum (m. sphincter ani externus). From the outer surface, i.e. from the side of the crotch, m. levator ani is lined with the lower fascia of the pelvic diaphragm (f. diaphragmatis pelvis). This fascia continues from the gluteus maximus muscle, then covers the ischial bones, partially - m. obturatorius internus and, moving to the lower surface of m. levator ani, ends in the external sphincter of the rectum (Fig. 340).

The subcutaneous tissue in the region of the pelvic diaphragm is covered with the superficial fascia of the perineum (f. perinei superficial), which is part of the subcutaneous fascia of the body. Thus, between the rectum, the lateral wall of the pelvis and, from below, the superficial fascia of the perineum, an ischiorectal fossa (fossa ischiorectalis) is formed, filled with fatty tissue. This fossa has the shape of a triangular pyramid, with the apex facing upwards. In men, it is much deeper than in women. In children, it has the shape of a narrow slit and is relatively deep.

Interfascial tissue of the pelvis. Between the peritoneum lining the small pelvis, and f. diaphragmatis pelvis space does not exist, but there is a layer of loose fatty tissue with many venous and nerve plexuses, which is located in front of the bladder, behind the rectum and around the vagina.

Fascia of the urogenital diaphragm. The urogenital diaphragm has superior and inferior fascial sheets. The upper fascial sheet is woven into m. transversus perinei profundus and m. sphincter urethrae externus. In the lateral parts, these sheets are fused with the capsule of the prostate gland. The lower fascial sheet covers the deep transverse perineal muscle and the external sphincter of the urethra, then the cavernous and spongy bodies with m. ischiocavernosus et bulbospongiosus, and is woven into the external sphincter of the rectum from behind. In women, both fasciae are woven into the wall of the vagina. Near the front edge of m. transversus perinei profundus, the upper and lower fascial sheets are connected to the transverse ligament of the pelvis (lig. transversus pelvis), which is adjacent to the lig. arcuatum pubis. Between these ligaments pass a. et v. dorsalis penis, nerves of the penis, clitoris, vagina and bulbus vestibularis. On the back edge m. transversus perinei profundus, the upper and lower fascial sheets also close, forming a common thin connective tissue plate covered by m. transversus perinei superficialis.

The superficial fascia of the perineum (f. perinei superficialis) directly passes from the pelvic diaphragm to the urogenital diaphragm and covers mm. bulbospongiosus, ischiocavernosus et transversus perinei superficialis, i.e. superficial muscles of the perineum. This fascia continues into the superficial fascia of the penis, inner thighs, and pubis.

Development of male and female internal genital organs

Male and female internal genital organs, although they differ significantly in structure, nevertheless have common rudiments. In the initial stage of development, there are common cells that are sources of formation of the sex glands associated with the urinary and genital ducts (mesonephros duct) (Fig. 341). During the period of differentiation of the gonads, development reaches only one pair of ducts. During the formation of a male individual, convoluted and straight testicular tubules, the vas deferens, seminal vesicles develop from the genital duct, and the urinary duct is reduced and only the male uterus remains in the colliculus seminalis as a rudimentary formation. When a female is formed, development reaches the urinary duct, which is the source of the formation of the fallopian tube, uterus and vagina, and the genital duct, in turn, is reduced, also giving a rudiment in the form of epoophoron and paroophoron.

Testicular development. The formation of the testis is associated with the ducts of the genitourinary system. At the level of the middle kidney (mesonephros), under the mesothelium of the body, the rudiments of the testis are formed in the form of strands of the testis, which are a derivative of the endodermal cells of the yolk sac. The gonadal cells of the testis cords develop around the ducts of the mesonephros (genital duct). For the fourth month intrauterine development, the seminal cord disappears and the testicle is formed. In this testicle, each tubule of the mesonephros divides into 3-4 daughter tubules, which turn into convoluted tubules that form testicular lobules. The convoluted tubules join into a thin straight tubule. Strands of connective tissue penetrate between the convoluted tubules, forming the interstitial tissue of the testis. The enlarging testis retracts the parietal peritoneum; as a result, a fold is formed above the testicle (phrenic ligament) and a lower fold (inguinal ligament of the genital duct). The lower fold turns into a conductor of the testis (gubernaculum testis) and takes part in the descent of the testicle. In the inguinal region, at the site of attachment of the gubernaculum testis, a protrusion of the peritoneum (processus vaginalis) is formed, which grows together with the structures of the anterior abdominal wall (Fig. 342). In the future, this protrusion will participate in the formation of the scrotum. After the formation of a protrusion of the peritoneum, the anterior wall of the recess closes into the internal inguinal ring. Testicle for VII-VIII months. prenatal development passes through the inguinal canal and at the time of birth is in the scrotum lying behind the peritoneal outgrowth, to which the testicle grows from its outer surface. When moving the testicle from the abdominal cavity to the scrotum or the ovary to the small pelvis, it is not entirely correct to talk about its true lowering. In this case, it is not a sinking that occurs, but a mismatch in growth. The ligaments above and below the gonads lag behind the growth rate of the trunk and pelvis and remain in place. As a result, the pelvis and trunk increase, and the ligaments and glands "go down" towards the developing trunk.

Anomalies of development. A common developmental anomaly is a congenital inguinal hernia, when the inguinal canal is so wide that through it the internal organs exit into the scrotum. Along with this, there is a testicular retention in the abdominal cavity near the internal opening of the inguinal canal (cryptorchidism).

Ovarian development. In the area of ​​the seed cord in the female, germ cells are scattered in the mesenchymal stroma. The connective tissue base and sheath develop poorly. In the mesenchyme of the ovary, the cortical and brain zones are differentiated. In the cortical zone, follicles are formed, which in a newborn girl under the influence of mother's hormones increase, and then atrophy after birth. Vessels grow into the medulla. In the embryonic period, the ovary is located above the entrance to the small pelvis. With an increase in the ovary for the IV month. development, the inguinal ligament of mesonephros bends and turns into a suspensory ligament of the ovary. From its lower end, the proper ligament of the ovary and the round ligament of the uterus are formed. The ovary will be located between the two ligaments in the pelvis (Fig. 343).

Anomalies of development. Sometimes there is an additional ovary. A more frequent anomaly is a change in the topography of the ovary: it can be located at the internal opening of the inguinal canal, in the inguinal canal, or in the thickness of the labia majora. In these cases, anomalies in the development of the external genital organs can also be observed.

Development of the uterus, fallopian tubes and vagina. The epididymis, vas deferens and seminal vesicles develop from the genital duct in the wall of which a muscular layer is formed.

The fallopian tubes, uterus and vagina are formed by the transformation of the urinary ducts. This duct for the III month. development between the ovary and the uterus turns into a fallopian tube with an extension at the upper end. The fallopian tube is also drawn into the pelvis by the descending ovary (Fig. 344).

The urinary ducts in the lower part are surrounded by mesenchymal cells and form an unpaired tube, which for the second month. separated by a roller. The upper part is overgrown with mesenchymal cells, thickens and forms the uterus, and the vagina develops from the lower part.

Development of the external genitalia

Male and female external genitalia develop from a common sexual eminence (Fig. 345, 346).

Male external genitalia arise from the sexual eminence, from which the penis is formed. Laterally and posteriorly, there are two urogenital folds that meet along the midline of the penis over the urinary trough. In this case, a spongy part of the penis is formed. A seam is formed at the place of fusion of the folds. Simultaneously with the formation of the spongy part, the epithelium of the skin covers the head (part of the spongy body) of the penis, transforming into the foreskin. The genital folds of the inguinal region increase when the processus vaginales of the peritoneum penetrate into them, and also fuse along the midline into the scrotum.

In women, the genital tubercle is transformed into the clitoris, and the genital folds into the labia minora. The urethral groove on the genital tubercle does not close and the spongy part develops independently around the vagina, not being connected with the cavernous bodies of the clitoris. The labia majora develop from the genital folds. In these folds there is only adipose tissue, while in their homologue - the scrotum - there are testicles.

secretory gonads

The seminal vesicles develop from the terminal part of the genital duct.

The prostate gland is formed from the epithelium of the urethra, from which individual glands are formed, about 50 in number, wrapped in mesenchyme.

Bulbo-urethral glands are formed from the epithelial outgrowths of the spongy part of the urethra.

The secret of all these glands is involved in the formation of sperm and stimulation of sperm motility.

Alveolar-tubular glands of the urethra that secrete mucin develop from the epithelium of the urethra.

The large vestibular glands of a woman are a derivative of the epithelium of the urogenital sinus.

Anomalies of the external genitalia

The sex of a person is determined not by the external genital organs, but by the gonads. Due to the fact that the external genital organs develop from the genital tubercle, paired genital and urogenital folds and independently of the internal genital organs, developmental anomalies are often encountered. True hermaphroditism (bisexuality) occurs when the testicle and ovary develop. This anomaly is very rare and, as a rule, both glands are defective in their structure and function. False hermaphroditism is more common (Fig. 347). With false female hermaphroditism, the ovaries are located in the labia majora, which in this case resemble the scrotum. The hypertrophied clitoris covers a narrow genital gap. There is also male false hermaphroditism, when the testicles will be located in the thickness of the labia majora (i.e., the split scrotum), and the external genital organs are represented by the genital slit and the atrezated vagina.

An even more common anomaly in men is hypospadias, when the urinary folds that form the urethra do not close along the length of the urinary trough all along or in a limited area. In newborns, hypospadias is often mistaken for the genital gap and, due to incorrect sex determination, the boy is brought up as a girl.

Phylogeny of the reproductive system

In lower animals (sponges, hydra), germ cells have no connection with any particular germ layer or organ. These cells differentiate early and can be found in any layer of the body. In more highly organized animals (worms, arthropods, lancelets), not only heterosexual sex cells already exist, but also ways of their excretion appear. Vertebrates have all the elements of the reproductive system, but differ in structure. So, for example, in amphibians, reptiles, birds, the urinary passages do not merge and two independent oviducts develop. This can also explain the presence of two queens in rodents, elephants, pigs and other animals. Thus, a comparison of embryogenesis and phylogenesis shows the ways of formation and formation of the reproductive system. The external genital organs have a different origin in different animals. The genital organs are more complex in males. In selahia, the male copulatory organ is the posterior transformed fin. In bony fish, amphibians, as a rule, there are no organs of copulation, with the exception of viviparous fish, in which the penis is also a fin inserted into the cloaca of the female. Male reptiles have two types of copulatory organs. In snakes and lizards, the subcutaneous sacs protrude through the cloaca to the outside. Through these protrusions, the seed flows into the cloaca of the female. Turtles, crocodiles have a penis, which is a thickening of the wall of the cloaca, which is supported by an erect cavernous tissue. Birds have a similar structure of the external genital organs. The penis is more perfectly represented in mammals. In some of them, the copulatory organ is located inside the cloaca and is able to exit and be drawn into the cloaca by special muscles. In viviparous mammals, the cloaca disappears, and the urogenital sinus and canal of the penis merge into a common urethra, through which urine and semen flow. The elasticity of the penis is supported by erect cavernous and spongy tissue, and in many animals, additional bone tissue develops in the cavernous bodies of the penis and clitoris.

External genitalia.
The external female genital organs include the pubis - the lowest part of the anterior abdominal wall, the skin of which is covered with hair; labia majora, formed by 2 folds of skin and containing connective tissue; the labia minora, located medially from the large ones and containing the sebaceous glands. The slit-like space between the small lips forms the vestibule of the vagina. In its front part is the clitoris, formed by the cavernous bodies, similar in structure to the cavernous bodies of the male penis. Behind the clitoris is the external opening of the urethra, posterior and downward from which is the entrance to the vagina. On the sides of the entrance to the vagina, the ducts of the large glands of the vestibule of the vagina (Bartholin's glands) open, secreting a secret that moisturizes the labia minora and the vestibule of the vagina. In the vestibule of the vagina there are small sebaceous glands. The hymen is the boundary between the external and internal genital organs.

Pubis- elevation above the pubic symphysis, resulting from a thickening of the layer. The pubis in appearance is a triangular-shaped surface located in the lowest part of the abdominal wall. With the onset of puberty, pubic hair begins, while the pubic hairline is hard and curly. The color of the pubic hair, as a rule, corresponds to the color of the eyebrows and hair on the head, but they turn gray much later than the latter. The growth of pubic hair in women, paradoxically, is caused by male hormones, which, with the onset of puberty, begin to secrete the adrenal glands. After menopause, hormonal levels change. As a result, they thin out, their waviness disappears. It is worth noting that pubic hair is genetically determined and differs somewhat depending on nationality.

So, in women of the Mediterranean countries, there is abundant hair growth, which also extends to the inner surface of the thighs and up to the navel, which is explained by an increased level of androgens in the blood. In turn, in Eastern and Northern women, pubic hair is sparse and lighter. According to most experts, the nature of pubic hair is associated with the genetic characteristics of women of different nationalities, although there are exceptions here. Many modern women are unhappy with the presence of pubic hair and seek to get rid of them in different ways. At the same time, they forget that the pubic hairline performs such an important function as protection against mechanical injuries, and also does not allow vaginal discharge to evaporate, while maintaining natural female protection and smell. In this regard, the gynecologists of our medical center advise women to remove hair only in the so-called bikini zone, where they really look unaesthetic, and only shorten in the pubic and labia area.

Large labia
Paired thick folds of skin running from the pubis posteriorly towards the perineum. Together with the labia minora, they limit the genital gap. They have a connective tissue basis and contain a lot of fatty tissue. On the inner surface of the lips, the skin is thinned, contains many sebaceous and sweat glands. Connecting near the pubis and in front of the perineum, the labia majora form anterior and posterior adhesions. The skin is slightly pigmented and covered with hair from puberty, and also contains sebaceous and sweat glands, due to which it can be affected by specific ones. The most common of these are sebaceous cysts, which are associated with clogged pores, and boils when an infection enters the hair follicle. In this regard, it is necessary to say about the importance of hygiene of the labia majora: be sure to wash yourself daily, avoid contact with dirty other people's towels (not to mention underwear), and also change underwear in a timely manner. The main function performed by the labia majora is to protect the vagina from germs and retention in it of a special moisturizing secret. In girls, the large labia are tightly closed from birth, which makes the protection even more reliable. With the onset of sexual activity, the labia majora open.

Small labia
Inside of the labia majora are the labia minora, which are thinner skin folds. Their outer surfaces are covered with stratified squamous epithelium, on the inner surfaces the skin gradually passes into the mucous membrane. In the small lips there are no sweat glands, they are devoid of hair. Have sebaceous glands; richly supplied with vessels and nerve endings, which determine sexual sensitivity during intercourse. The front edge of each small lip splits into two legs. The anterior legs merge above the clitoris and form its foreskin, and the posterior legs join under the clitoris, forming its frenulum. The size of the labia minora in different women is completely different, as well as the color (from pale pink to brown), while they can have even or peculiar fringed edges. All this is a physiological norm and in no case speaks of any diseases. The tissue of the labia minora is very elastic and can stretch. Thus, during childbirth, she gives the opportunity for the child to be born. In addition, due to the many nerve endings, the small lips are extremely sensitive, so they swell and turn red when sexually aroused.

Clitoris
Ahead of the small labia is such a female genital organ as the clitoris. In its structure, it is somewhat reminiscent of the male penis, but several times smaller than the latter. The standard size of the clitoris in length does not exceed 3 cm. The clitoris has a leg, body, head and foreskin. It consists of two cavernous bodies (right and left), each of which is covered with a dense shell - the fascia of the clitoris. The cavernous bodies fill with blood during sexual arousal, causing an erection of the clitoris. The clitoris contains a large number of blood vessels and nerve endings, making it a source of arousal and sexual satisfaction.

Vaginal vestibule
The space between the internal ones, bounded from above by the clitoris, from the sides by the labia minora, and from behind and below by the posterior commissure of the labia majora. The hymen is separated from the vagina. On the eve of the vagina, the excretory ducts of large and small glands open. The large gland of the vestibule (Bartholin's) is a paired organ the size of a large pea. It is located in the thickness of the posterior parts of the labia majora. It has an alveolar-tubular structure; the glands are lined with secretory epithelium, and their excretory ducts are stratified columnar. The large glands of the vestibule, during sexual arousal, secrete a secret that moisturizes the entrance to the vagina and creates a weak alkaline environment favorable for spermatozoa. The Bartholin glands were named after Caspar Bartholin, the anatomist who discovered them. The bulb of the vestibule is an unpaired cavernous formation located at the base of the labia majora. It consists of two lobes connected by a thin arcuate intermediate part.

Internal sex organs
The internal genital organs are probably the most important part of the female reproductive system: they are entirely designed for conceiving and bearing a child. The internal genital organs include the ovaries, fallopian tubes, uterus and vagina; The ovaries and fallopian tubes are often referred to as the uterine appendages.

Video about the structure of the genital organs in women

female urethra has a length of 3-4 cm. It is located in front of the vagina and somewhat protrudes the corresponding part of its wall in the form of a roller. The external opening of the female urethra opens on the eve of the vagina posterior to the clitoris. The mucous membrane is lined with pseudo-stratified epithelium, and near the external opening - with stratified squamous epithelium. In the mucous membrane there are Littre's glands and Morgagni's lacunae. Paraurethral ducts are tubular branching formations 1-2 cm long. They are located on both sides of the urethra. In depth, they are lined with columnar epithelium, and the outer sections are cuboidal and then stratified squamous. The ducts open in the form of pinholes on the lower semicircle of the roller, bordering the external opening of the urethra. Allocate a secret that moisturizes the external opening of the urethra. Ovary- a paired sex gland, where eggs are formed and mature, sex hormones are produced. The ovaries are located on both sides of the uterus, with which each of them is connected by a fallopian tube. Through its own ligament, the ovary is attached to the corner of the uterus, and by the suspensory ligament to the side wall of the pelvis. Has an ovoid shape; length 3-5 cm, width 2 cm, thickness 1 cm, weight 5-8 g. The right ovary is somewhat larger than the left. The part of the ovary protruding into the abdominal cavity is covered with cuboidal epithelium. Beneath it is a dense connective tissue that forms the tunica albuginea. In the cortical layer located under it there are primary, secondary (vesicular) and mature follicles, follicles in the stage of atresia, corpus luteum at different stages of development. Under the cortical layer lies the medulla of the ovary, consisting of loose connective tissue, which contains blood vessels, nerves and muscle fibers.

The main functions of the ovaries are the secretion of steroid hormones, including estrogens, progesterone and small amounts of androgens, which cause the appearance and formation of secondary sexual characteristics; the onset of menstruation, as well as the development of fertile eggs that ensure reproductive function. The formation of eggs occurs cyclically. During the menstrual cycle, which usually lasts 28 days, one of the follicles matures. The mature follicle ruptures, and the egg enters the abdominal cavity, from where it is carried into the fallopian tube. In place of the follicle, a corpus luteum appears, functioning during the second half of the cycle.

Egg- a sex cell (gamete), from which a new organism develops after fertilization. It has a rounded shape with an average diameter of 130-160 microns, motionless. Contains a small amount of yolk, evenly distributed in the cytoplasm. The egg is surrounded by membranes: the primary is the cell membrane, the secondary is the non-cellular transparent shiny membrane (zona pellucida) and follicular cells that feed the egg during its development in the ovary. Under the primary shell is the cortical layer, consisting of cortical granules. When the egg is activated, the contents of the granules are released into the space between the primary and secondary membranes, causing agglutination of spermatozoons and thereby blocking the penetration of several spermatozoons into the egg. The egg contains a haploid (single) set of chromosomes.

The fallopian tubes(oviducts, fallopian tubes) is a paired tubular organ. In fact, the fallopian tubes are two filiform canals of a standard length of 10 - 12 cm and a diameter not exceeding a few millimeters (from 2 to 4 mm). The fallopian tubes are located on both sides of the bottom of the uterus: one side of the fallopian tube is connected to the uterus, and the other is adjacent to the ovary. Through the fallopian tubes, the uterus is "connected" with the abdominal cavity - the fallopian tubes open with a narrow end into the uterine cavity, and with an expanded one - directly into the peritoneal cavity. Thus, in women, the abdominal cavity is not airtight, and any infection that could get into the uterus causes inflammatory diseases not only of the reproductive system, but also of internal organs (liver, kidneys), and peritonitis (inflammation of the peritoneum). Obstetricians and gynecologists strongly recommend visiting a gynecologist once every six months. Such a simple procedure as an examination prevents complications of inflammatory diseases - the development of precancerous conditions - erosion, ectopia, leukoplakia, endometriosis, polyps. The fallopian tube consists of: a funnel, an ampulla, an isthmus and a uterine part. in turn, they consist of a mucous membrane covered with ciliated epithelium, from the muscular membrane and from the serous membrane. The funnel is the expanded end of the fallopian tube, which opens into the peritoneum. The funnel ends with long and narrow outgrowths - fringes that "cover" the ovary. The fringes play a very important role - they oscillate, creating a current that "sucks" the egg that has left the ovary into the funnel - like into a vacuum cleaner. If something in this infundibulum-fimbria-ovum system fails, fertilization can occur right in the abdomen, resulting in an ectopic pregnancy. The funnel is followed by the so-called ampulla of the fallopian tube, then - the narrowest part of the fallopian tube - the isthmus. Already the isthmus of the oviduct passes into its uterine part, which opens into the uterine cavity with the uterine opening of the tube. Thus, the main task of the fallopian tubes is to connect the upper part of the uterus with the ovary.

Fallopian tubes have dense elastic walls. In a woman's body, they perform one, but a very important function: as a result of ovulation, the egg is fertilized by a sperm in them. Through them, the fertilized egg passes into the uterus, where it strengthens and develops further. The fallopian tubes serve specifically to fertilize, conduct and strengthen the egg from the ovary to the uterine cavity. The mechanism of this process is as follows: the egg that has matured in the ovaries moves along the fallopian tube with the help of special cilia located on the inner lining of the tubes. On the other hand, spermatozoa that have previously passed through the uterus are moving towards her. In the event that fertilization occurs, the division of the egg immediately begins. In turn, the fallopian tube at this time nourishes, protects and promotes the egg to the uterine cavity, with which the fallopian tube is connected with its narrow end. Promotion is gradual, about 3 cm per day.

If any obstacle is encountered (adhesions, adhesions, polyps) or a narrowing of the canal is observed, the fertilized egg remains in the tube, resulting in an ectopic pregnancy. In such a situation, it becomes very important to identify this pathology in time and provide the woman with the necessary assistance. The only way out in a situation of ectopic pregnancy is its surgical interruption, since there is a high risk of rupture of the tube and bleeding into the abdominal cavity. Such a development of events poses a great danger to the life of a woman. Also in gynecological practice, there are cases when the end of the tube facing the uterus is closed, which makes it impossible for the sperm and the egg to meet. At the same time, at least one normally functioning tube is sufficient for the onset of pregnancy. If they are both impassable, then we can talk about physiological infertility. At the same time, modern medical technologies make it possible to conceive a child even with such violations. According to specialists - obstetricians and gynecologists, the practice of introducing an egg fertilized outside the body of a woman directly into the uterine cavity, bypassing the fallopian tubes, has already been established.

Uterus is a smooth muscle hollow organ located in the pelvic area. The shape of the uterus resembles a pear and is intended mainly for carrying a fertilized egg during pregnancy. The weight of the uterus of a nulliparous woman is about 50 g. During pregnancy, thanks to the elastic walls, the uterus can grow up to 32 cm in height and 20 cm in width, supporting a fetus weighing up to 5 kg. In menopause, the size of the uterus decreases, atrophy of its epithelium, sclerotic changes in blood vessels occur.

The uterus is located in the pelvic cavity between the bladder and the rectum. Normally, it is tilted anteriorly, on both sides it is supported by special ligaments that do not allow it to fall and, at the same time, provide the necessary minimum of movement. Thanks to these ligaments, the uterus is able to respond to changes in neighboring organs (for example, an overflow of the bladder) and take an optimal position for itself: the uterus can move backward when the bladder is full, forward - when the rectum is full, rise up - during pregnancy. The fastening of the ligaments is very complex, and it is precisely its nature that is the reason why a pregnant woman is not recommended to raise her hands high: this position of the hands leads to tension in the ligaments of the uterus, to the tension of the uterus itself and its displacement. This, in turn, can cause unnecessary displacement of the fetus in late pregnancy. Among the developmental disorders of the uterus, congenital malformations are distinguished, such as the complete absence of the uterus, agenesis, aplasia, doubling, a bicornuate uterus, a unicornuate uterus, as well as position anomalies - uterine prolapse, displacement, prolapse. Diseases associated with the uterus are most often manifested in various menstrual irregularities. Such problems of women as infertility, miscarriage, as well as inflammatory diseases of the genital organs, tumors are associated with diseases of the uterus.

In the structure of the uterus, the following departments are distinguished

Cervix
Isthmus of the uterus
The body of the uterus
The bottom of the uterus - its upper part

A kind of muscular "ring" with which the uterus ends and which connects to the vagina. The cervix makes up about a third of its entire length and has a special small opening - the cervical canal of the cervix, the yawn, through which menstrual blood enters the vagina and then out. Through the same opening, spermatozoa enter the uterus for the purpose of subsequent fertilization in the fallopian tubes of the egg. The cervical canal is closed with a mucous plug, which is pushed out during orgasm. Spermatozoa penetrate through this plug, and the alkaline environment of the cervix contributes to their stability and mobility. The shape of the cervix differs in women who have given birth and who have not given birth. In the first case, it is round or in the form of a truncated cone, in the second - wider, flat, cylindrical. The shape of the cervix also changes after abortions, and it is no longer possible to deceive the gynecologist after the examination. In the same area, uterine ruptures can also occur, since this is the thinnest part of it.

The body of the uterus- actually the main part of it. Like the vagina, the body of the uterus consists of three layers (shells). First, it is the mucous membrane (endometrium). This layer is also called the mucosal layer. This layer lines the uterine cavity and is abundantly supplied with blood vessels. The endometrium is covered with a single layer of prismatic ciliated epithelium. The endometrium "submits" to changes in the hormonal background of a woman: during the menstrual cycle, processes occur in it that prepare for pregnancy. However, if fertilization does not occur, the surface layer of the endometrium is rejected. For this purpose, menstrual bleeding occurs. After the end of menstruation, the cycle begins again, and the deeper layer of the endometrium takes part in the restoration of the uterine mucosa after the rejection of the surface layer. In fact, the “old” mucosa is replaced with a “new” mucosa. Summing up, we can say that, depending on the phase of the monthly cycle, the endometrial tissue either grows, preparing for the implantation of the embryo, or is rejected if the pregnancy does not occur. If pregnancy does occur, the uterine mucosa begins to act as a bed for a fertilized egg. This is a very cozy nest for the fetus.

Hormonal processes during pregnancy change, preventing endometrial rejection. Accordingly, there should be no bleeding from the vagina normally during pregnancy. The mucous membrane lining the cervix is ​​rich in glands that produce thick mucus. This mucus, like a cork, fills the cervical canal. This mucous "plug" contains special substances that can kill microorganisms, preventing infection from entering the uterus and fallopian tubes. But during the period of ovulation and menstrual bleeding, the mucus "liquefies" so as not to interfere with the spermatozoa to enter the uterus, and the blood, respectively, to flow out of there. At both these moments, the woman becomes less protected for the penetration of infections, the carrier of which can be spermatozoa. If we take into account that the fallopian tubes open directly into the peritoneum, the risk of infection spreading to the genitals and internal organs increases many times over. It is for this reason that all doctors urge women to be very attentive to their health and prevent complications by undergoing preventive examinations by a professional gynecologist every six months and carefully choosing a sexual partner.

Middle layer of the uterus(muscular, myometrium) consists of smooth muscle fibers. Myometrium consists of three muscle layers: longitudinal outer, annular middle and inner, which are closely intertwined (arranged in several layers and in different directions). The muscles of the uterus are the strongest in a woman's body, because by nature they are designed to push the fetus during childbirth. This is one of the most important functions of the uterus. It is precisely at the time of birth that they reach their full development. Also, the thick muscles of the uterus protect the fetus during pregnancy from external shocks. The muscles of the uterus are always in good shape. They contract slightly and relax. Contractions increase during intercourse and during menstruation. Accordingly, in the first case, these movements help the movement of sperm, in the second - the rejection of the endometrium.

outer layer(serous layer, perimetry) is a specific connective tissue. This is a part of the peritoneum, which is fused with the uterus in different parts. In front, next to the bladder, the peritoneum forms a fold, which is important when performing a caesarean section. To access the uterus, this fold is surgically dissected, and then a suture is made under it, which is successfully closed by it.

Vagina- a tubular organ bounded at the bottom by the hymen or its remnants, and at the top - by the cervix. It has a length of 8-10 cm, a width of 2-3 cm. It is surrounded on all sides by perivaginal tissue. At the top, the vagina expands, forming arches (anterior, posterior and lateral). There are also anterior and posterior walls of the vagina, which consist of mucous, muscular and adventitious membranes. The mucous membrane is lined with stratified squamous epithelium and is devoid of glands. Due to the vaginal folds, more pronounced on the anterior and posterior walls, its surface is rough. Normally, the mucous membrane is shiny, pink. Under the mucous membrane there is a muscular layer, formed mainly by longitudinally extending bundles of smooth muscles, between which the annular muscles are located. The adventitial membrane is formed by loose fibrous connective tissue; it separates the vagina from neighboring organs. The contents of the vagina are whitish in color, cheesy consistency, with a specific odor, formed due to extravasation of fluid from the blood and lymphatic vessels and desquamation of epithelial cells.

The vagina is an elastic kind of canal, an easily extensible muscular tube that connects the vulva and uterus. The size of the vagina is slightly different for every woman. The average length, or depth, of the vagina is between 7 and 12 cm. When a woman is standing, the vagina curves upward slightly, neither vertical nor horizontal. The walls of the vagina are 3-4 mm thick and consist of three layers:

• internal. This is the lining of the vagina. It is lined by stratified squamous epithelium, which forms numerous transverse folds into the vagina. These folds, if necessary, allow the vagina to change its size.
• Medium. This is the smooth muscle layer of the vagina. The muscle bundles are oriented mainly longitudinally, but there are also bundles of a circular direction. In its upper part, the muscles of the vagina pass into the muscles of the uterus. In the lower part of the vagina, they become stronger, gradually weaving into the muscles of the perineum.
• outdoor. The so-called adventitial layer. This layer consists of loose connective tissue with elements of muscle and elastic fibers.

The walls of the vagina are divided into anterior and posterior, which are connected to each other. The upper end of the vaginal wall covers part of the cervix, highlighting its vaginal part and forming around this area the so-called vaginal vault.

The lower end of the vaginal wall opens into the vestibule. In virgins, this opening is closed by the hymen.

Usually pale pink in color, during pregnancy, the walls of the vagina become brighter and darker. In addition, the vaginal walls have body temperature and are soft to the touch.

With great elasticity, the vagina expands during intercourse. Also during childbirth, it is able to increase to 10 - 12 cm in diameter to enable the fetus to come out. This feature is provided by the middle, smooth muscle layer. In turn, the outer layer, consisting of connective tissue, connects the vagina with neighboring organs that are not related to the female genital organs - with the bladder and rectum, which, respectively, are located in front and behind the vagina.

The walls of the vagina, as well as the cervical canal(the so-called cervical canal), and the uterine cavity are lined with glands that secrete mucus. This mucus is whitish in color with a characteristic odor, has a slightly acidic reaction (pH 4.0-4.2) and has bactericidal properties due to the presence of lactic acid. To determine the nature of the contents and microflora of the vagina, a vaginal smear is used. Mucus not only moisturizes a normal, healthy vagina, but also cleanses it of the so-called “biological debris” - from the bodies of dead cells, from bacteria, due to its acidic reaction it prevents the development of many pathogenic microbes etc. Normally, mucus from the vagina is not excreted outside - internal processes are such that during the normal functioning of this organ, the amount of mucus produced is equal to the amount absorbed. If mucus is secreted, then in very small quantities. In the event that you have abundant discharge that is in no way connected with the days of ovulation, you need to contact a gynecologist and undergo a detailed examination, even if nothing bothers you. Vaginal discharge is a symptom of inflammatory processes that can be caused by both not very, and very dangerous infections, in particular, chlamydia. Thus, chlamydia infections often have a latent course, but cause irreversible changes in the female reproductive system, leading to miscarriages, miscarriages, and infertility.

Normally, the vagina should be moist all the time, which not only helps to maintain a healthy microflora, but also to ensure a full-fledged sexual intercourse. The process of vaginal secretion is regulated by the action of estrogen hormones. Characteristically, during menopause, the amount of hormones decreases sharply, as a result of which there is dryness of the vagina, as well as pain during intercourse. In such a situation, a woman should consult a specialist. After the examination, the gynecologist will prescribe medications that help with this problem. Individually selected treatment has a positive effect on general well-being in the premenopausal and menopausal period.

In the depths of the vagina is Cervix, which looks like a dense rounded roller. The cervix has an opening - the so-called cervical canal of the cervix. The entrance to it is closed with a dense mucous plug, and therefore objects inserted into the vagina (for example, tampons) cannot pass into the uterus in any way. However, in any case, objects left in the vagina can become a source of infection. In particular, it is necessary to change the tampon in a timely manner and monitor whether it causes any pain.

In addition, contrary to popular belief, there are few nerve endings in the vagina, so it is not as sensitive and is not the main woman. The most sensitive of the genital organs of a woman is the vulva.

Recently, in the special medical and sexological literature, much attention has been paid to the so-called G-spot, located in the vagina and capable of delivering a lot of pleasant sensations to a woman during intercourse. This point was first described by Dr. Grefenberg, and since then there has been debate whether it really exists. At the same time, it has been proven that on the front wall of the vagina, at a depth of about 2-3 cm, there is an area that is slightly dense to the touch, about 1 cm in diameter, the stimulation of which really gives strong sensations and makes the orgasm more complete. At the same time, the G-spot can be compared with the prostate in a man, since, in addition to the usual vaginal secretion, it secretes a specific fluid.

Female sex hormones: estrogen and progesterone
There are two main hormones that have the greatest impact on the condition and functioning of the female reproductive system - estrogen and progesterone.
Estrogen is considered the female hormone. It is often referred to in the plural because there are several types. They are constantly produced by the ovaries from the onset of puberty to the menopause, but their number depends on what phase of the menstrual cycle the woman is in. One of the signs that these hormones have already begun to be produced in the girl’s body is an increase in the mammary glands and swelling of the nipples. In addition, the girl, as a rule, suddenly begins to grow rapidly, and then growth stops, which is also affected by estrogens.

In the body of an adult woman, estrogens perform a number of important functions. Firstly, they are responsible for the course of the menstrual cycle, since their level in the blood regulates the activity of the hypothalamus and, consequently, all other processes. But besides this, estrogens also affect the functioning of other parts of the body. In particular, they protect blood vessels from the accumulation of cholesterol plaques on their walls, which cause a disease such as; regulate water-salt metabolism, increase the density of the skin and contribute to its hydration, regulate the activity of the sebaceous glands. Also, these hormones maintain bone strength and stimulate the formation of new bone tissue, retaining in it the necessary substances - calcium and phosphorus. In this regard, during menopause, when the ovaries produce a very small amount of estrogens, fractures or development are not uncommon in women.

considered a male hormone since it dominates in men (recall that any person contains a certain amount of both hormones). Unlike estrogens, it is produced only after the egg has left its follicle and the corpus luteum has formed. In the event that this does not happen, progesterone is not produced. According to gynecologists and endocrinologists, the situation of the absence of progesterone in a woman's body can be considered normal in the first two years after the onset of menstruation and in the period preceding menopause. However, at other times, a lack of progesterone is a serious enough violation, as it can lead to the inability to become pregnant. In a woman's body, progesterone acts only together with estrogens and, as it were, in opposition to them, according to the dialectical law of philosophy about the struggle and unity of opposites. So, progesterone reduces the swelling of the tissues of the mammary glands and uterus, contributes to the thickening of the fluid that the cervix secretes, and the formation of the so-called mucous plug that closes the cervical canal. In general, progesterone, preparing the uterus for pregnancy, acts in such a way that it is constantly at rest, reduces the number of contractions. In addition, the hormone progesterone has a specific effect on other body systems. In particular, it is able to reduce the feeling of hunger and thirst, affects the emotional state, “slows down” the vigorous activity of a woman. Thanks to him, body temperature can rise by several tenths of a degree. It should be noted that, as a rule, frequent mood changes, irritability, sleep problems, etc. in the premenstrual and menstrual period itself are the result of an imbalance of the hormones estrogen and progesterone. Thus, having noticed such symptoms in herself, it is best for a woman to contact a specialist, a gynecologist, in order to normalize her condition and prevent possible health problems.

Infections of the female genital organs.
In recent years, the prevalence of sexually transmitted infections in women has reached alarming proportions, especially among young people. Many girls begin their sexual life early and are not distinguished by discriminating partners, explaining this by the fact that the sexual revolution took place long ago and a woman has the right to choose. Unfortunately, the fact that the right to choose promiscuous relationships also implies the “right” to get sick is of little interest to young girls. You have to deal with the consequences later, being treated for infertility caused by infections. There are other causes of female infections: a woman becomes infected from her husband or simply by household means. It is known that the female body is less resistant to STI pathogens than the male body. Studies have shown that the reason for this fact is female hormones. Therefore, women face another danger - when using hormone therapy or using hormonal contraceptives, they increase their susceptibility to sexually transmitted infections, including HIV and herpes viruses. Previously, only three sexually transmitted diseases were known to science: syphilis, gonorrhea and mild chancre. Recently, some types of hepatitis and HIV have joined them.

However, with the improvement of diagnostic methods, many unknown female infections affecting the reproductive system were discovered: trichomoniasis, chlamydia, gardnerellosis, ureaplasmosis, mycoplasmosis, herpes and some others. Their consequences are not as terrible as the consequences of syphilis or HIV infection, but they are dangerous because, firstly, they undermine the woman's immune system, opening the way to all sorts of diseases, and secondly, without treatment, many of these diseases lead to female infertility or have a damaging effect on the fetus during pregnancy or during childbirth. The main symptoms of women are copious discharge from the genital tract with an unpleasant odor, burning, itching. If the patient does not seek medical help in a timely manner, then bacterial vaginitis may develop, that is, inflammation of the vagina that affects the internal genital organs of a woman and again becomes the cause. Another complication of genital infections in a woman that develops in all cases of infection is dysbacteriosis or dysbiosis, that is, a violation of the vaginal microflora. This is due to the fact that any STI pathogen, getting into the female genital tract, violates the natural normal microflora, replacing it with a pathogenic one. As a result, inflammatory processes develop in the vagina, which can also affect other organs of the woman's reproductive system - the ovaries and uterus. Therefore, in the treatment of any sexual infection in a woman, the causative agent of the disease is first destroyed, and then the vaginal microflora is restored and the immune system is strengthened.

Diagnosis and treatment of genital infections in women is carried out successfully only if the patient consults a doctor in a timely manner. In addition, it is necessary to treat not only the woman, but also her sexual partner, otherwise re-infection will occur very quickly, which will lead to even more serious consequences than the primary one. Therefore, at the first signs of infection of the genital organs (pain, itching, burning, discharge and unpleasant odor from the genital tract) or with signs of infection in a sexual partner, a woman should immediately consult a doctor for diagnosis and treatment.

As for prevention, its main method is discriminating in the choice of sexual partners, using barrier contraception, observing the rules of intimate hygiene and maintaining a healthy lifestyle that will help maintain immunity that prevents infection with STIs. Diseases: HIV, gardnerellosis, genital herpes, hepatitis, candidiasis, mycoplasmosis, thrush, papillomavirus, toxoplasmosis, trichomoniasis, ureaplasmosis, chlamydia, cytomegalovirus.

Let's take a closer look at some of them.

Candidiasis (thrush)
Candidiasis, or thrush, is an inflammatory disease caused by yeast-like fungi of the genus Candida. Normally, Candida fungi in a small amount are part of the normal microflora of the mouth, vagina and colon in absolutely healthy people. How can these normal bacteria cause disease? Inflammatory processes are caused not just by the presence of fungi of the genus Candida, but by their reproduction in large numbers. Why are they growing rapidly? W often the reason is a decrease in immunity. The beneficial bacteria of our mucous membranes die, or the body's defenses are depleted, and cannot prevent the uncontrolled growth of fungi. In the vast majority of cases, a decrease in immunity is the result of some kind of infection (including latent infections). That is why very often candidiasis is a litmus test, an indicator of more serious problems in the genitals, and a competent doctor will always recommend to his patient a more detailed diagnosis of the causes of candidiasis than just the detection of Candida fungi in a smear.

Video about candidiasis and its treatment

Candidiasis quite rarely "takes root" on the genitals of men. Often, thrush is a female disease. The appearance of symptoms of candidiasis in men should alert them: either immunity is seriously reduced, or the presence of candida signals the likely presence of another infection, in particular, STIs. Candidiasis (the second name is thrush) in general terms can be defined as vaginal discharge, accompanied by itching or burning. According to official statistics, candidiasis (thrush) accounts for at least 30% of all vaginal infections, but many women prefer self-treatment with antifungal drugs to see a doctor, so the true frequency of the disease is unknown. Experts note that most often thrush occurs in women in the range from 20 to 45 years. Often, thrush is accompanied by infectious diseases of the genital organs and the urinary system. In addition, according to statistics, there are more patients with candidiasis in the group of women prone to diabetes mellitus. Many women themselves diagnose themselves with thrush when discharge appears. However, discharge, itching and burning are not always a sign of candidiasis. Exactly the same symptoms of colpitis (inflammation of the vagina) are possible with gonorrhea, gardnerellosis (), genital herpes, mycoplasmosis, ureaplasmosis, trichomoniasis, chlamydia and other infections. Thus, the discharge you see is not always caused by Candida fungi. Gynecologists understand thrush (candidiasis) as a STRICTLY defined disease caused by a fungus of the genus Candida. And pharmaceutical companies too. That is why all drugs in pharmacies only help against Candida fungi. This is the reason why these drugs often do not help in self-treatment of "thrush". And this is the reason why, when written complaints are disturbing, you need to go to a gynecologist for an examination and find out the pathogen, and not self-medicate.

Very often, with unusual discharge, a smear shows candida. But this does not give grounds to assert (neither the patient, nor, especially, the gynecologist) that the inflammatory process is only the result of uncontrolled growth of candida in the vagina. As you already know, Candida fungi are part of the vaginal microflora, and only some kind of shock can cause their rapid growth. The undivided dominance of fungi leads to a change in the environment in the vagina, which causes the notorious symptoms of thrush and inflammation. An imbalance in the vagina does not happen by itself!!! Often, this failure of the microflora may indicate the presence of another (other) infection in the genital tract of a woman, which "helps" the candida to grow actively. That's why "candidiasis" is a very good reason for a gynecologist to order a serious additional examination for you - in particular, tests for infections.

Trichomoniasis is one of the most common sexually transmitted diseases (STDs) in the world. Trichomoniasis is an inflammatory disease of the genitourinary system. Penetrating into the body, Trichomonas causes such manifestations of the inflammatory process as (inflammation of the vagina), (inflammation of the urethra) and (inflammation of the bladder). Most often, Trichomonas exist in the body not alone, but in combination with other pathogenic microflora: gonococci, yeast fungi, viruses, chlamydia, mycoplasmas, etc. In this case, trichomoniasis occurs as a mixed protozoal-bacterial infection. It is believed that 10% are infected with trichomoniasis population of the world. According to WHO, trichomoniasis is registered annually in approximately 170 million people. The highest incidence rates of trichomoniasis, according to the observations of venereologists from different countries, occur in women of childbearing (reproductive) age: according to some reports, almost 20% of women are infected with trichomoniasis, and in some areas this percentage reaches 80.

However, such indicators may also be related to the fact that in women, as a rule, trichomoniasis occurs with severe symptoms, while in men, the symptoms of trichomoniasis are either completely absent or not so pronounced that the patient simply does not pay attention to it. .Of course, there are also a sufficient number of women with asymptomatic trichomoniasis, and men with a pronounced clinical picture of the disease. In a latent form, trichomoniasis can be present in the human body for many years, while the Trichomonas carrier does not notice any discomfort, but can infect his sexual partner. The same applies to an infection that has not been fully treated: at any time it can return again. It must also be borne in mind that the human body does not produce protective antibodies against Trichomonas, so that, even if trichomoniasis is completely cured, it is very easy to become infected with it again from an infected sexual partner.

Based on the characteristics of the course of the disease, there are several forms of trichomoniasis: fresh trichomoniasis chronic trichomoniasis trichomonas carriers Fresh trichomoniasis is called, which exists in the human body for no more than 2 months. Fresh trichomoniasis, in turn, includes an acute, subacute and torpid (that is, "sluggish") stage. In the acute form of trichomoniasis, women complain of the classic symptoms of the disease: profuse vaginal discharge, itching and burning in the vulva. In men, acute trichomoniasis most often affects the urethra, causing burning and pain during urination. In the absence of adequate treatment, after three to four weeks, the symptoms of trichomoniasis disappear, but this, of course, does not mean the recovery of the patient with trichomoniasis, but, on the contrary, the transition of the disease to a chronic form. Chronic trichomoniasis is called more than 2 months old. This form of trichomoniasis is characterized by a long course, with recurrent exacerbations. Various factors can provoke exacerbations, for example, general and gynecological diseases, hypothermia, or violations of the rules of sexual hygiene. In addition, in women, the symptoms of trichomoniasis may increase during menstruation. Finally, trichomonas carriage is such a course of infection in which trichomonads are found in the contents of the vagina, but the patient does not have any manifestations of trichomoniasis. With trichomonas carriers, trichomonas are transmitted from the carrier to healthy people during sexual intercourse, causing them to have typical symptoms of trichomoniasis. There is still no consensus among specialists about the danger or not of the danger of trichomoniasis. Some venereologists call trichomoniasis the most harmless sexually transmitted disease, while others talk about the direct connection of trichomoniasis with oncological and other dangerous diseases.

The general opinion can be considered that it is dangerous to underestimate the consequences of trichomoniasis: it has been proven that trichomoniasis can provoke the development of chronic forms of prostatitis and. In addition, complications of trichomoniasis can cause infertility, pathology of pregnancy and childbirth, infant mortality, inferiority of offspring. Mycoplasmosis is an acute or chronic infectious disease. Mycoplasmosis is caused by mycoplasmas - microorganisms that occupy an intermediate position between bacteria, fungi and viruses. There are 14 types of mycoplasmas in the human body. Only three are pathogenic - Mycoplasma hominis and Mycoplasma genitalium, which are the causative agents of urinary tract infections, and - the causative agent of respiratory tract infections. Mycoplasmas are opportunistic pathogens. They can cause a number of diseases, but at the same time they are often detected in healthy people. Depending on the pathogen, mycoplasmosis can be genitourinary or respiratory.

Respiratory mycoplasmosis occurs, as a rule, in the form of acute respiratory infections or, in severe cases, pneumonia. Respiratory mycoplasmosis is transmitted by airborne droplets. Symptoms include fever, inflammation of the tonsils, runny nose, in the case of the transition of mycoplasma infection to there are all signs of pneumonia: chills, fever, symptoms of general intoxication of the body. Genitourinary mycoplasmosis is an infection of the genitourinary tract that is transmitted sexually or, less commonly, by household means. Mycoplasmas are detected in 60-90% of cases of inflammatory pathology of the genitourinary system. In addition, when analyzing healthy people for mycoplasmosis, mycoplasmas are found in 5-15% of cases. This suggests that quite often mycoplasmosis is asymptomatic, and does not manifest itself in any way until the human immune system is sufficiently resistant. However, under such circumstances as pregnancy, childbirth, abortion, hypothermia, stress, mycoplasmas are activated, and the disease becomes acute. The predominant form of urogenital mycoplasmosis is considered to be a chronic infection with an asymptomatic and slow course. Mycoplasmosis can provoke diseases such as prostatitis, urethritis, arthritis, sepsis, various pathologies of pregnancy and the fetus, postpartum endometritis. Mycoplasmosis is widespread throughout the world. According to statistics, mycoplasmas are more common in women than in men: 20-50% of women in the world are carriers of mycoplasmosis. Most often, mycoplasmosis affects women who have had gynecological diseases, sexually transmitted infections, or lead a promiscuous lifestyle. In recent years, cases have become more frequent, which is partly due to the fact that during pregnancy a woman’s immunity is somewhat weakened and an infection enters the body through this “gap”. The second reason for the “increase” in the proportion of mycoplasmoses is modern diagnostic methods that make it possible to identify “hidden” infections that are not subject to simple diagnostic methods, such as a smear.

Mycoplasmosis for pregnant women- a very undesirable disease that can lead to miscarriage or missed pregnancy, as well as the development of endometritis - one of the most serious postpartum complications. Fortunately, mycoplasmosis, as a rule, is not transmitted to the unborn child - the fetus is reliably protected by the placenta. However, it is not uncommon for a child to become infected with mycoplasmosis during childbirth, when a newborn passes through an infected birth canal. It should be remembered that early diagnosis, timely treatment of mycoplasmosis, and its prevention will help to avoid all the negative consequences of this disease in the future.

Chlamydia - a new plague of the XXI century

Chlamydia is gradually becoming the new plague of the 21st century, winning this title from other STDs. According to the World Health Organization, the rate of spread of this infection is like an avalanche. Numerous authoritative studies unequivocally indicate that chlamydia is currently the most common disease among diseases transmitted mainly through sexual contact. Modern high-precision laboratory diagnostic methods detect chlamydia in every SECOND woman with inflammatory diseases of the urogenital area, in 2/3 of women suffering from infertility, in 9 out of 10 women suffering from miscarriage. In men, every second urethritis is caused by chlamydia. Chlamydia could win back the title of affectionate killer from hepatitis, but very rarely die from chlamydia. Have you already breathed a sigh of relief? In vain. Chlamydia causes the widest range of various diseases. Once in the body, it is often not content with one organ, gradually spreading throughout the body.

To date, chlamydia is associated not only with diseases of the genitourinary organs, but also with eyes, joints, respiratory lesions, and a number of other manifestations. Chlamydia simply, affectionately and gently, imperceptibly makes a person old, sick, barren, blind, lame ... And early deprives men of sexual strength and children. Forever. Chlamydial infection threatens the health of not only adults, but also children, newborns and unborn babies. In children, chlamydia causes a whole bunch of chronic diseases, making them weak. Chlamydia they cause even inflammatory diseases of the genital area. Newborns, due to chlamydia, suffer from conjunctivitis, pneumonia, diseases of the nose and pharynx ... A baby can get all these diseases even in the womb from an infected mother, or may not be born at all - chlamydia often provokes a miscarriage at different stages of pregnancy. The frequency of infection with chlamydia according to various sources fluctuates. But the results are disappointing.

Extensive studies show that only young people infected with chlamydia, at least 30 percent. Chlamydia affects 30 to 60% of women and at least 51% of men. And the number of infected is constantly growing. If a mother has chlamydia, the risk of infecting her child with chlamydia during childbirth is at least 50%. But the most amazing thing is that you, being infected, suffering from these diseases, you may NOT KNOW AT ALL about the disease. This is a hallmark of all chlamydia. Often there are no symptoms of chlamydia. Chlamydia occurs very "softly", "gently", while causing destruction to your body, comparable to the consequences of a tornado. So, basically, patients with chlamydia feel only that something is “wrong” in the body. Physicians call these sensations "subjective". Discharge can be “not like that”: men often have the “first drop” syndrome in the morning, women have incomprehensible or simply abundant discharge. Then everything can go away, or you, having got used to it, begin to consider this state of affairs as the norm. Meanwhile, in both men and women, the infection moves "deep" into the genitals, affecting the prostate, testicles in men and the cervix, fallopian tubes in women. The most amazing thing is that it doesn't hurt anywhere! Or it hurts, but very modestly - it pulls, some kind of discomfort appears. AND NOTHING MORE! And chlamydias are doing underground work, causing such an extensive list of diseases, one listing of which would take at least a page of text! Reference:

Our elders from the Ministry of Health have not yet introduced the diagnosis of chlamydia into the compulsory health insurance system. In your clinic, you will never be tested for chlamydia, and for free. In state outpatient and inpatient institutions, such diseases of an infectious nature are simply referred to as diseases of an unknown cause. Therefore, until now, for taking care of your health, the health of your loved ones and children, you have to pay not to the state, but to you and me - the most conscious citizens. The only way to know if you are sick is to conduct a quality diagnosis.

The vagina is a muscular tube covered from the inside with a mucous membrane, which is open in front and covers the cervix in the back. The anterior wall is located under the bladder, the posterior - above the rectum. The length of the vagina is 8-10 cm, in the middle part it reaches a width of 3 cm. At the same time, the vagina is very elastic and can stretch. So, during childbirth, the width of this organ can increase to 10-12 cm, ensuring the release of the fetus. Recent studies have shown that the vagina is able to "adapt" to the size of the penis of a permanent partner. Therefore, it does not matter how long or wide the man's penis is, in any case, the vagina will tightly “grapple” it, providing friction, which is a pleasure for both partners.

Inside, the vagina is lined with a mucous membrane that secretes an oily, whitish lubricant that is produced by the cervix during ovulation and the Bartholin glands during intercourse. The acidic environment inside this organ is a good defense against pathogenic microbes, although in some cases it can contribute to the occurrence of fungal diseases.

On the way from the vagina to the uterus there is a dense muscular roller with a diameter of 3-4 cm with a tiny hole in the middle. This is the cervix. Menstrual blood flows through a small hole in it. The same hole allows spermatozoa to enter, which move towards the fallopian tubes. In a nulliparous woman, the cervix has a round shape; after childbirth, the cervix becomes wider, denser and transversely elongated. Like other "stages" of the birth canal, the cervix is ​​​​very elastic, and during the birth of the baby, it opens a few centimeters.

The uterus (or rather, the body of the uterus) is a pear-shaped muscular organ about 8 cm long and about 5 cm wide. Usually, the body of the uterus is tilted slightly forward and is located in the small pelvis behind the bladder. Inside the organ there is a triangular cavity lined with endometrium - a mucous membrane with a network of blood vessels and glands, which thickens during ovulation. Thus, the uterus prepares to receive a fertilized egg. If conception does not occur, the mucous membrane is rejected and menstruation occurs.

The fallopian tubes (fallopian tubes) are paired filamentous organs that extend from the upper part of the uterus and lead to the ovaries, as if hugging them with their fringed endings. The length of the fallopian tubes is approximately 10-12 cm, and the inner diameter is very small, no thicker than a hair. The muscular tissue of the walls is dense and elastic, from the inside they are covered with a mucous membrane lined with cilia of the ciliated epithelium.

In the body of a woman, the fallopian tubes perform a very important function, it is in them that the egg is fertilized - it merges with the sperm. The fallopian tubes are also the channel through which the egg enters the uterus. The cilia of the epithelium and the fluid flow help the fertilized egg, slowly (3 cm per day), move towards the uterus. Once in the uterus, the egg attaches to the wall of its inner surface and grows and develops in the uterus for about 40 weeks.

Any obstruction or narrowing of the fallopian tubes can lead to the development of an ectopic pregnancy, which has to be terminated, since the growing fetus can rupture the fallopian tube, which is a mortal danger for a woman.

The fallopian tubes, together with the ovaries, form the appendages of the uterus.

The ovaries are also paired organs that are located in the pelvis on either side of the uterus. Each of them is connected to the uterus by two ligaments, one of which is attached directly to the uterus, the other connects the ovary to the fallopian tube. The ovaries themselves are about 3 cm long and weigh about 5-8 g. Already from the name it is clear that the main function of these organs is to produce eggs. In addition, the ovaries produce sex hormones - estrogen and progesterone. These substances are extremely biologically active and are responsible for the formation of secondary sexual characteristics, physique, voice timbre, body hair, regulate the functioning of the genital organs and ensure the mechanisms of menstruation and the normal course of pregnancy.

Unlike male testicles, which are capable of producing sperm from puberty until death, the life span of the ovaries is limited - the production of eggs stops with the onset of menopause. Data on the number of germ cells (oocytes) in the ovaries vary. Most scientists agree that a newborn girl has about half a million of them, by the time of puberty there are about 30 thousand of them, but only 500-600 germ cells will turn into mature eggs and come out of the ovaries. And only a few will be fertilized and give rise to a new life.

However, if in men in the body cavity there is only the prostate gland, then the female reproductive apparatus located in the abdominal cavity, of course, is much more complicated. We will understand the structure of the system, the health of which we will discuss later.

The external system of the female genital organs is formed by the following elements:

• pubic- a layer of skin with well-developed sebaceous glands that covers the pubic bone in the lower abdomen, in the pelvic area. The onset of puberty is characterized by the appearance of pubic hair. In the original, it exists there in order to protect the delicate skin of the genital organs from contact with the external environment. As for the pubis itself, its well-developed layer of subcutaneous tissue has the ability, if necessary, to store some of the sex hormones and subcutaneous fat. That is, the tissues of the pubis can, under certain circumstances, act as a repository - for a minimum of sex hormones necessary for the body;
• large labia- two large folds of skin that cover the labia minora;
• clitoris and labia minora- which are, in fact, a single body. In hermaphroditism, for example, the clitoris and labia minora may develop into a pelvic organ and testicles. Structurally they are. and represent a rudimentary penis;
• vestibule- Surrounding the entrance to the vagina tissues. The exit of the urethra is also located there.

As for the internal genital organs of a woman, these include:

• vagina- formed by the muscles of the hip joint and covered from the inside with a multilayer mucous membrane of the tube. The question of what is the actual length of the vagina can be heard often. In fact, the average length of its length varies depending on race. So, in the Caucasoid race, the average indicator ranges from 7-12 cm. In representatives of the Mongoloid race, from 5 to 10 cm. Anomalies are possible here, but they are much less common than anomalies in the development of bottom organs in general;
• cervix and uterus- organs responsible for the successful fertilization of the egg and the bearing of the fetus. The cervix ends with the vagina, so it is available for examination by a gynecologist using an endoscope. But the body of the uterus is completely located in the abdominal cavity. Usually with some tilt forward, to rely on the muscles of the lower press. However, the variant with its deviation back, in the direction of the spine, is also quite acceptable. It is less common, but it does not belong to the number of anomalies and does not affect the course of pregnancy in any way. The only "but" in such cases concerns the increased requirements for the development of the muscles of the small pelvis, and not the longitudinal muscles of the abdomen, as in the standard position;
• fallopian tubes and ovaries- responsible for the very possibility of fertilization. The ovaries produce an egg, and after maturation, it descends into the uterus through the tubes. The inability of the ovaries to produce viable eggs leads to infertility. A violation of the patency of the fallopian tubes forms cysts, often subject to removal only by surgery. An egg literally stuck in the fallopian tube is a dangerous formation. The fact is that it contains many substances and cells designed specifically for active growth. Normally - for the growth of the embryo. And in case of deviation from the norm, the same factors can trigger the process of malignancy of its cells.

Protective barriers of female genitals

Thus, the external genitalia of a woman communicates with the internal ones through the vagina and cervix. Everyone knows that until some time the internal space of the vagina is protected from contact with the external environment by the hymen - a connective tissue, elastic membrane located immediately behind the entrance to the vagina. The hymen is permeable due to the holes present in it - one or more. It only further narrows the entrance to the vagina, but does not provide absolute protection. During the first sexual intercourse, the hymen is torn, expanding the entrance. However, there are also scientifically recorded cases when the hymen is preserved, despite an active sex life. Then it breaks only during childbirth.

One way or another, there is a fact of the presence in the body of a woman of a channel of direct connection of two different systems - not only with each other, but also with the environment. It should be noted that the mucous secretion secreted by the vaginal membrane has a pronounced bactericidal and astringent property. That is, it is able to neutralize and remove a certain number of microorganisms from the vagina. Plus, the main environment in the vagina is alkaline. It is unfavorable for the reproduction of most harmful bacteria, but it is suitable for the reproduction of beneficial ones. In addition, it is safe for sperm. The beneficial properties of an alkaline environment are known to all of us. Due to them, for example, the digestive enzymes of the small intestine remain viable, while the pathogens that come with food die. At least for the most part, although this mechanism does not work effectively enough with food poisoning ...

In addition, it is difficult for pathogens to enter the body of the uterus through its cervix. First, it is normally closed. Secondly, even open for some reason, the cervix is ​​protected by a mucous plug, which is part of the alkaline environment. The cervix opens, for example, during orgasm, but this can also happen with any other strong contractions of its walls. The uterus is a muscular organ. And her work is subject to the action of any myostimulants - both produced in the body and those received from the outside, with an injection. In the case of orgasm, the opening of the cervix naturally aims to make it easier for the spermatozoa contained in the semen to reach the ovum. Another case of physiologically conditioned contractions is menstruation or childbirth.

Of course, at any moment of the opening of the cervix, it becomes possible for pathogens or microorganisms to penetrate into it. But more often than not, another scenario works. Namely, when the pathogen affects the cervix itself, leading to its erosion. Erosion is considered one of the precancerous conditions. In other words, non-healing ulceration of the cervix or surface of the vagina can serve as a catalyst for malignant degeneration of the affected tissues.

So, the protective barriers of the vagina do not look insurmountable for various types of pathogens. The essence of their vulnerability lies mainly in the need to create not a completely “blank wall”, but a wall that is permeable to some bodies and closed to others. This is the "weakness" of any physiological barriers of the body. Even the most powerful, multistage blood-brain barrier that protected the brain can be overcome. Direct proof of this is the abundance of cases of viral encephalitis and syphilitic brain damage.

And then, a significant role in the quality of the work of such protective systems is played by the general condition of the body. In particular, the correct formation and vital activity of the cells of the mucous membranes. Including gland cells that produce the secret itself. It is clear that for its sufficient release, cells must not only remain viable, but also receive the entire set of substances they need for work.

Plus, an additional failing factor creates the use of certain antibiotics of the latest generation. These potent, fully synthetic substances are incomparably more effective than the penicillins of past years, while still not expected to have a narrowly targeted effect from them. That is why their intake, as before, is always accompanied by intestinal dysbacteriosis. And quite often - and thrush, dry mucous membranes, changes in the composition and amount of secretions.

All these indirect factors have little noticeable influence while acting separately. That is, hardly noticeable from the point of view of subjective sensations, since for the body, so to speak, they are always very noticeable. However, their coincidence and overlap can cause a fundamental failure. Perhaps one-time, which will disappear by itself, upon the disappearance of one of the influences. But this is not always the case. There is a direct dependence on the time of the negative impact. The longer it lasts, the more serious the violation will be, the more noticeable the recovery period will be, and the less likely it is to fully recover on the “by itself” principle.

The difference in the levels of protection of external and internal organs

Is there a difference in the level of protection of the external and internal genital organs? Strictly speaking, yes. The external genitalia are more often and more closely in contact with the external environment, which creates more opportunities for them to be affected by pathogens. On the other hand, the level of hygiene standards in modern society makes it possible to attribute most of these cases to the fault of the patient herself. Careful hygienic care of the external genital organs is necessary. The fact is that the skin covering the external genital organs is saturated with sweat and sebaceous glands much stronger than the skin of the body. Speaking conventionally, she secretes almost as much secretion as the armpits. Therefore, it is impossible to do without hygiene procedures for a long time, without risking getting local inflammation in this area. Even with a perfectly functioning immune system.

It should also be added that in the chronic stage, such inflammations tend to spread upward through the reproductive system, to the fallopian tubes. Which leads to adhesive process and violation of their patency. Why pipes, medicine is already known. The mucous membranes of the fallopian tubes are most similar in structure to the skin of the external genital organs. That is why bacteria that successfully multiply on the external organs most actively affect this particular segment of the internal organs.

The times when maintaining personal hygiene was a known problem due to the lack of sewerage and running water have not yet passed. The development of ideas about various drainage systems affected mainly city houses. In rural areas, the success of hygiene procedures often continues to depend on the strength of the hands and the serviceability of the well gate. However, the more effective emollients, disinfectants and anti-inflammatories of today greatly improve the hygienic environment even in such conditions.

The discovery and launch of mass production of antibiotics played an important role here. The action of the antiseptic lasts not one hour, but at least six. Therefore, to maintain body hygiene, one visit to the shower cabin per day is enough. And twice a day provide absolute protection of the skin from external attacks. However, there are a number of problems here.

The fact is that the constant presence of antibiotics on the skin causes changes in its surface layer. This will not necessarily be destruction - the epidermis, for example, does not lose strength at all under their influence. But the mucous membranes, on the contrary, are very prone to the appearance of microcracks caused by prolonged contact with antibiotic molecules. For this reason, the use of such funds should also be measured. The optimal solution for most cases are specially designed intimate hygiene products. And the guarantee of the absence of the effect of secondary infection is achieved by the frequency of procedures at least once a day.

Unlike the external genital organs, the internal genital organs are relatively protected from accidental infection. But, as we can see, there are also a lot of factors for their defeat. Secondary damage due to irregular hygiene occurs only over time. In the absence of other prerequisites, it may not lead to the development of internal inflammation. On the other hand, cases where the focus of the disease initially formed in the internal organs are by no means uncommon. This can be caused by a single direct penetration of the virus through the vagina. Usually during sexual intercourse, since the very physiology of sexual intercourse is quite traumatic for the mucous membranes of the genital organs. This creates more than favorable conditions for infection.

But there are several scenarios for secondary infection. It is no secret that diseases such as syphilis and HIV, for example, are also transmitted through household contact. Of course, HIV does not affect the sexual, but the immune system, but as the immune system weakens, it will inevitably affect absolutely all body systems.

One way or another, there is a scenario of a secondary violation due to the deterioration of the state of the whole organism. We should understand in this regard that diseases of the internal genital organs only rarely occur due to infection from the outside. But more often they arise indirectly - due to the development or treatment of diseases of other organs. Usually, there is a decrease in their resistance to attacks from the vagina due to the suppression of immune functions.

This, paradoxically, is easiest to achieve with prolonged use of antibiotics. Then the drug taken directly affects the type of tissues and pathogens that caused the main symptoms. And indirectly, it inhibits the activity of the protective functions of the membranes of other organs.

This kind of "dysbacteriosis" - only not in the intestines, but in the internal genital organs, often causes inflammation of the ovaries, the inner lining of the uterus and fallopian tubes. Of course, in functional terms, the most dangerous is the violation of the patency of the tubes and the timing of maturation of the eggs. The uterus is a hollow organ formed by muscles. Therefore, the inflammatory process in its tissues has little effect on the function of removing an unfertilized egg. Therefore, it is not always visible. Additionally, the matter is complicated by the often occurring in such cases, reduced immune response. The latter, respectively, means less pronounced symptoms of inflammation - the absence of a feeling of heaviness, swelling and aching pain in the affected area.

external genitalia (genitalia externa, s.vulva), which have the collective name "vulva", or "pudendum", are located below the pubic symphysis. These include pubis, labia majora, labia minora, clitoris and vaginal vestibule . On the eve of the vagina, the external opening of the urethra (urethra) and the ducts of the large glands of the vestibule (Bartholin's glands) open.

Pubic - the border area 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 fatty pad.

Large labia - wide longitudinal skin folds 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 behind it is connected to the ischiorectal fatty tissue. After reaching puberty, the skin of the outer surface of the labia majora is 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 saturated with sebaceous glands. The connection of the labia majora in front is called the anterior commissure, in the back - the commissure of the labia, or the posterior commissure. The narrow space in front of the posterior commissure of the labia is called the navicular fossa.

Small labia - thick folds of skin of smaller sizes, called the labia minora, are located medially from 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 diluting the labia minora. Anteriorly, where the labia minora meets the clitoris, they divide into two small folds that merge around the clitoris. The upper folds join over the clitoris and form the foreskin of the clitoris; the lower folds join on the underside of the clitoris and form the frenulum of the clitoris.

Clitoris - located between the anterior ends of the labia minora under the foreskin. It is a homologue of the cavernous bodies 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 cavernous body begins with a stalk attached to the medial edge of the corresponding ischio-pubic branch. The clitoris is attached to the pubic symphysis by a suspensory ligament. At the free end of the body of the clitoris is a small elevation of erectile tissue called the glans.

bulbs of vestibule . Adjacent to the vestibule along the deep side of each labia minora is an oval-shaped mass of erectile tissue called the bulb of the vestibule. It is represented by a dense plexus of veins and corresponds to the spongy body 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.

Vaginal vestibule located between the labia minora, where the vagina opens in the form of a vertical slit. The open vagina (the so-called hole) is framed by nodes of fibrous tissue of varying sizes (hymenal tubercles). Anterior to the vaginal opening, approximately 2 cm below the head of the clitoris in the midline, is the external opening of the urethra 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 glands of the urethra (ductus paraurethrales). A small space in the vestibule, located behind the vaginal opening, is called the fossa of the vestibule. Here, on both sides, the ducts of the Bartholin glands (glandulaevestibularesmajores) open. The glands are small lobular bodies about the size of a pea and are located at the posterior edge of the bulb of the vestibule. These glands, along with numerous minor vestibular glands, also open into the vestibule of the vagina.

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

Vagina (vaginas.colpos) extends from the genital slit to the uterus, passing upward with a posterior inclination through the urogenital and pelvic diaphragms. The length of the vagina is about 10 cm. It is located mainly in the cavity of the small pelvis, where it ends, merging with the cervix. The anterior and posterior walls of the vagina usually join each other at the bottom, shaped like an H in cross section. The upper section is called the fornix of the vagina, since 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, and the posterior fornix is ​​deeper than the anterior and lateral fornixes. 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.

The anterior wall of the vagina is adjacent to the urethra and the base of the bladder, and the final part of the urethra protrudes into its lower part. The thin layer of connective tissue that separates the anterior wall of the vagina from the bladder is called the vesico-vaginal septum. Anteriorly, the vagina is indirectly connected to the posterior part of the pubic bone by fascial thickenings at the base of the bladder, known as the pubocystic ligaments. 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 recto-uterine recess (Douglas space) of the peritoneal cavity, from which it is separated only by a thin layer of peritoneum.

Uterus (uterus) outside of pregnancy is located along the midline of the pelvis or near it between the bladder in front and the rectum in the back. The uterus has the shape of an inverted pear with dense muscular walls and a lumen in the form of a triangle, narrow in the sagittal plane and wide in the frontal plane. In the uterus, the body, fundus, neck and isthmus are distinguished. The line of attachment of the vagina divides the cervix into vaginal (vaginal) and supravaginal (supravaginal) segments. Outside of pregnancy, the convex bottom is directed anteriorly, and the body forms an obtuse angle with respect to the vagina (tilted forward) and bent anteriorly. The front surface of the body of the uterus is flat and adjacent to the top of the bladder. The back surface is curved and turned from above and behind to the rectum.

The cervix is ​​directed downward and backward and is in contact with the posterior wall of the vagina. The ureters come directly laterally to the cervix relatively close.

The body of the uterus, including its bottom, is covered with peritoneum. In front, at the level of the isthmus, the peritoneum folds over and passes to the upper surface of the bladder, forming a shallow vesicouterine cavity. Behind, the peritoneum continues forward and upward, covering the isthmus, the supravaginal part of the cervix and the posterior fornix of the vagina, and then passes to the anterior surface of the rectum, forming a deep recto-uterine 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 the age and number of births and averages 2:1.

The wall of the uterus consists of a thin outer layer of the peritoneum - the serous membrane (perimetry), a thick intermediate layer of smooth muscles and connective tissue - the muscular membrane (myometrium) and the internal mucous membrane (endometrium). The body of the uterus contains many muscle fibers, the number of which decreases downward as it approaches the cervix. The neck consists of an equal number of muscles and connective tissue. As a result of its development from the merged parts of the paramesonephric (Müllerian) ducts, the arrangement of muscle fibers in the uterine wall is complex. The outer layer of the myometrium contains mostly vertical fibers that run laterally in the upper body and connect with the outer longitudinal muscular layer of the fallopian tubes. The middle layer includes most of the uterine wall and consists of a network of helical muscle fibers that are connected to the inner circular muscle layer of each tube. Bundles of smooth muscle fibers in the supporting 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 gap, 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 on 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 is compressed and has a length of 6-10 mm. The place where the cervical canal enters the uterine cavity is called the internal os. The cervical canal expands slightly in its middle part and opens into the vagina with an external opening.

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

The fallopian tubes (tubaeuterinae). Laterally on both sides of the body of the uterus are long, narrow fallopian tubes (fallopian tubes). The tubes occupy the top of the broad ligament and curve laterally over the ovary, then down over the posterior 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 tube in a stretched form has a length of 10 cm. There are four of its sections: intramural area located inside the wall of the uterus and connected to the uterine cavity. Its lumen has the smallest diameter (Imm or less). The narrow section extending laterally from the outer border of the uterus is called isthmus(istmus); further the pipe expands and becomes tortuous, forming ampoule and ends near the ovary in the form funnels. On the periphery on 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 oval or almond-shaped. The ovaries are located medially to the folded 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 with the lower extreme point closer to the uterus. The back of the ovaries is free, and the front 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 gates of the ovaries. The folds of the peritoneum are attached to the upper pole of the ovaries - ligaments that suspend the ovaries (funnel pelvis), which contain the ovarian vessels and nerves. The lower part of the ovaries is attached to the uterus by fibromuscular ligaments (the ovaries' own ligaments). These ligaments connect to the lateral margins 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 albuginea. In the ovary, the outer cortical and inner medulla layers are distinguished. Vessels and nerves pass through the connective tissue of the medulla. In the cortical layer, among the connective tissue, there are a large number of follicles at different stages of development.

The ligamentous apparatus of the internal female genital organs. The position in the small pelvis of the uterus and ovaries, as well as the vagina and adjacent organs, depends mainly on the state of the muscles and fascia of the pelvic floor, as well as on the state of the ligamentous apparatus of the uterus. In a normal position, the uterus with fallopian tubes and ovaries hold suspension apparatus (ligaments), fixing apparatus (ligaments fixing the suspended uterus), supporting or supporting apparatus (pelvic floor). The suspensory apparatus of the internal genital organs includes the following ligaments:

Round ligaments of the uterus (ligg.teresuteri). They consist of smooth muscles and connective tissue, they 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 branch out fan-shaped in the tissue of the pubis and labia majora. The round ligaments of the uterus pull the fundus of the uterus anteriorly (anterior tilt).

Broad ligaments of the uterus . This is a duplication of the peritoneum, going from the ribs of the uterus to the side walls of the pelvis. In the upper sections of the wide ligaments of the uterus, the fallopian tubes pass, the ovaries are located on the back sheets, and fiber, vessels and nerves are located between the sheets.

Own ligaments of the ovaries start from the bottom of the uterus behind and below the place of discharge of the fallopian tubes and go to the ovaries.

Ligaments that suspend the ovaries , or funnel-pelvic ligaments, are a continuation of the wide uterine ligaments, go from the fallopian tube to the pelvic wall.

The fixing apparatus of the uterus is a connective tissue strand with an admixture of smooth muscle fibers that come from the lower part of the uterus;

b) backwards - to the rectum and sacrum (lig. sacrouterinum). They depart from the posterior surface of the uterus in the area of ​​​​the transition of the body to the neck, cover the rectum on both sides and are attached to the anterior surface of the sacrum. These ligaments pull the cervix backwards.

Supporting or supporting apparatus make up the muscles and fascia of the pelvic floor. The pelvic floor is of great importance in keeping the internal genital organs in a normal position. With an increase in intra-abdominal pressure, the cervix rests on the pelvic floor, as on a stand; the muscles of the pelvic floor prevent the lowering of the genitals and viscera. 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, behind - by the end of the coccyx, laterally ischial tubercles. The skin limits the perineum from the outside and below, and the pelvic diaphragm (pelvic fascia), formed by the lower and upper fascia, limits the perineum from deep above.

The pelvic floor, using an imaginary line connecting the two ischial tuberosities, is divided anatomically into two triangular regions: in front - the urogenital region, behind - 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 tendon center of the perineum. This tendon center is the site of attachment of several muscle groups and fascial layers.

Urogenitalregion. In the genitourinary region, between the lower branches of the ischial and pubic bones, there is a muscular-fascial formation called the "urogenital diaphragm" (diaphragmaurogenitale). The vagina and urethra pass through this diaphragm. The diaphragm serves as the basis for fixing the external genital organs. From below, the urogenital diaphragm is bounded by the surface of whitish collagen fibers that form the lower fascia of the urogenital diaphragm, which divides the urogenital region into two dense anatomical layers of clinical importance - the superficial and deep sections, or perineal pockets.

Superficial part of the perineum. The superficial section is located above the lower fascia of the urogenital diaphragm and contains on each side a large gland of the vestibule of the vagina, a clitoris leg with the ischiocavernosus muscle lying on top, a bulb of the vestibule with the bulbous-spongy (bulb-cavernous) muscle lying on top and a small superficial transverse muscle of the perineum. The ischiocavernosus muscle covers the clitoral stalk and plays a significant role in maintaining its erection, as it presses the stalk against the ischio-pubic branch, delaying the outflow of blood from the erectile tissue. The bulbospongiosus muscle originates from the tendinous center of the perineum and the external sphincter of the anus, then passes behind 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 compress the lower part of the vagina. The weakly developed superficial transverse muscle of the perineum, which looks like a thin plate, starts from the inner surface of the ischium near the ischial puff and goes transversely, entering the perineal body. All muscles of the superficial section are covered with deep fascia of the perineum.

Deep section of the perineum. The deep section of the perineum is located between the lower fascia of the urogenital diaphragm and the indistinct upper fascia of the urogenital diaphragm. The urogenital diaphragm consists of two layers of muscles. The muscle fibers in the urogenital diaphragm are mostly transverse, arising from the ischio-pubic branches of each side and joining in the midline. This part of the urogenital diaphragm is called the deep transverse perineal muscle. Part of the fibers of the sphincter of the urethra rises in an arc above the urethra, while the other part is located around it circularly, forming the external sphincter of the urethra. 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 an arbitrary constrictor 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 fasciae merge to form the transverse ligament of the perineum. 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 (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 sphincter of the anus 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 that run mainly along the anal canal and intersect at right angles in front of and behind the anus, which then fall in front of the perineum, and behind - in a mild fibrous mass called the anal-coccygeal body, or anal-coccygeal. coccygeal ligament. The anus externally is a longitudinal slit-like opening, which may be due to the anteroposterior direction of many muscle fibers of the external sphincter of the anus.

The ischiorectal fossa is a wedge-shaped space filled with fat, which is externally bounded by the skin. The skin forms the base of the wedge. The vertical side wall of the fossa is formed by the obturator internus muscle. The inclined supramedial wall contains the levator ani muscle. Ischiorectal adipose tissue allows the rectum and anal canal to expand during a bowel movement. The fossa and the fatty tissue contained in it are located anteriorly and deeply upward to the urogenital diaphragm, but below the levator ani muscle. This area is called the front pocket. Behind the fatty tissue in the fossa runs 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, lymph drainage and innervation of the genital organs. blood supply external genitalia is mainly carried out by the internal genital (pubescent) artery and only partially by branches of the femoral artery.

Internal pudendal artery is the main artery of the perineum. It is one of the branches of the internal iliac artery. Leaving the cavity of the small pelvis, it passes in the lower part of the large sciatic foramen, then goes around the ischial spine and goes along the side wall of the ischiorectal fossa, transversely crossing the small ischial foramen. Its first branch is the inferior rectal artery. 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 perineum and continues as posterior branches to the labia majora and labia minora. The internal pudendal artery, entering the deep perineal region, 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.

External (superficial) genital artery departs from the medial side of the femoral artery and supplies blood to the anterior part of the labia majora. External (deep) pudendal artery also departs 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 vein of the clitoris, which drains blood from the erectile tissue of the clitoris through a gap below the pubic symphysis to the venous plexus around the bladder neck. The external pudendal veins drain blood from the labia majora, passing laterally and entering the great saphenous vein of the leg.

Blood supply to the internal genital organs It 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 uterine artery , which departs from the internal iliac (hypogastric) artery. In about half of the cases, the uterine artery independently departs from the internal iliac artery, but it can also originate 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 connects 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 the adjacent part of the bladder. . The main ascending branch goes up along the lateral edge of the uterus, sending arcuate branches to her body. These arcuate arteries surround the uterus under the serosa. 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 like ligatures, compress the radial branches. The arcuate arteries rapidly decrease in size towards the midline, so there is less bleeding with median incisions of the uterus than with lateral ones. The ascending branch of the uterine artery approaches the fallopian tube, turning laterally in 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 originates directly from the aorta.

The ovaries are supplied with blood from the ovarian artery (a.ovarica), which extends from the abdominal aorta on the left, sometimes from the renal artery (a.renalis). Going down along with the ureter, the ovarian artery passes along the ligament that suspends the ovary to the upper section of the wide uterine ligament, gives off a branch for the ovary and tube; the terminal section of the ovarian artery anastomoses with the terminal section of the uterine artery.

In the blood supply of the vagina, in addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries are also involved. The arteries of the genital organs are accompanied by corresponding veins. The venous system of the genital organs is highly developed; the total length of the venous vessels significantly exceeds the length of the arteries due to the presence of venous plexuses, widely anastomosing with each other. The venous plexuses are located in the clitoris, at the edges of the bulbs of the vestibule, around the bladder, between the uterus and ovaries.

lymphatic system 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. The lymphatic pathways 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 subserous plexus, from which the lymph flows through the efferent vessels. Lymph from the lower part of the uterus enters mainly the sacral, external iliac and common iliac lymph nodes; some also enters the lower lumbar nodes along the abdominal aorta and 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 With lymph collected 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. There are connections between these lymphatic plexuses - lymphatic anastomoses.

In innervation The genital organs of a woman involve the sympathetic and parasympathetic parts of the autonomic nervous system, as well as the spinal nerves.

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 form the upper hypogastric plexus at the level of the V-lumbar vertebra. Fibers depart from it, forming the right and left lower hypogastric plexuses. Nerve fibers from these plexuses go to a powerful uterovaginal, or pelvic, plexus.

The uterovaginal plexuses are located in the parametric tissue on the side and behind the uterus at the level of the internal os and cervical canal. Branches of the pelvic nerve (n.pelvicus), which belongs to the parasympathetic part of the autonomic nervous system, are suitable for this plexus. Sympathetic and parasympathetic fibers extending from the uterovaginal plexus innervate the vagina, uterus, internal parts of the fallopian tubes, and the bladder.

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

The external genital organs and the pelvic floor are mainly innervated by the pudendal nerve.

Pelvic tissue. 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 the organs of the small pelvis; in some areas it is loose, in others in the form of fibrous strands. The following fiber spaces are distinguished: periuterine, pre- and paravesical, periintestinal, vaginal. The pelvic tissue serves as a support for the internal genital organs, and all its departments are interconnected.