Women’s Health

The endometrium of uterus is the innermost of three layers of uterus and consists of epithelial cells.

Cervical Endometrium:

The cervix is spindle shaped and measure about 2.5 cm and bounded by external os below and internal os above. The mucosal lining of cervical endometrium is different from that of the body of the uterus and the sub mucosa is absent in cervix. The cervix is lined by high columnar ciliated epithelium. The nuclei of the epithelium are spindle shaped and near the basement membrane. The direction of cilia is downwards and toward external os. The cervical endometrial glands are racemose type and secrete mucus which is rich in fructose. The secretion is alkaline and its high pH and fructose content make it attractive to ascending spermatozoa (male sperms). The secretions rich in sucrose and high pH collects in the cervical canal as a plug and probably stops the ascending infection. In gonorrhea the gonococcus are present in the crypts of the glands.

The external os is circular in nulliparous (woman who has not born a child) woman, but after vaginal delivery there is transverse slit of the external os, which is characteristic of parous (woman who has given birth) women.

The body of the uterus differs from that of cervix both structurally and functionally. Unlike epithelium of the body of the uterus the cervical epithelium does not show changes during menstrual cycle and also during pregnancy the cervical epithelium rarely changes, unlike the epithelium of the body of the uterus which undergo dramatic change in shape and size. The cancer of the body of the uterus is adenocarcinoma od the endometrium but that of the cervix is squamous cell carcinoma (cancer) type which is highly malignant.

There is an intermediate zone between endometrium of body and the mucous membrane of the cervix, known as the isthumus which is about 6 mm in length. The endometrium of the isthumus is anatomically and functionally similar to the body of the uterus. This isthmic portion forms the lower uterine segment in late pregnancy.

The relationship between the length of cervix and the body of the uterus varies according to age. The ratio of cervix to the body is 2:1 before puberty. At puberty the ratio reverses and become 1:2. During reproductive age the ratio is between, 1:3 to 1:4. After menopause the whole of the organ (uterus) atrophy.

The myometrium of the uterus is the middle muscle layer of the uterus and it is the thickest of the three layers of the uterus. The cervical part of myometrium is made up of plain muscle tissue with large amount of fibrous tissue that gives the hard consistency of the cervix. But the muscle fibers and fibrous tissues are mixed in with out any orderly fashion.

The myometrium is about 10-12 mm thickness in the body of the uterus. In the body of the uterus three layers of myometrium can be easily distinguished in pregnant uterus. The outermost layer is just below the peritoneum or perimetrium and it is longitudinal, the fibers passing from the cervix anteriorly over fundus and reaches backside of cervix. The layer can not be distinguished in non pregnant because it is thin. The main function of this layer is expulsion of fetus.

The middle layer is the thickest among three layers of myometrium and it consists of bundles of muscle fibers separated by connective tissue. The amount of connective tissue varies with age. The muscle content is much abundant during child bearing age (more during pregnancy) and much less before puberty and after menopause. The blood vessels which supply the uterus are distributed in the connective tissue of the middle layer. The blood vessel calibers depend on the contraction of the muscle of this layer. The function of this layer is expulsion of the fetus and hemostasis (control of bleeding). This layer is also called living ligature of the uterus and is responsible control of bleeding in the third stage of labour. Inefficient contraction of this layer is and retraction of this layer is responsible for postpartum hemorrhage (PPH)

The innermost layer of the myometrium consists of circular muscle fibers. The layer is not well marked, but is best represented in the opening of fallopian tubes and the internal os. The main function of the inner layer is to act like sphincter.

The perimetrium of uterus is the peritoneal lining and is the outermost layer of the uterus. The peritoneal lining of the uterus is incomplete. Front side of the whole body of the uterus is covered with peritoneum and the back of body of uterus is also covered with peritoneum. Anteriorly or in front side the peritoneum is reflected over the urinary bladder at the level of internal os and the whole of the cervix of uterus has no peritoneal lining in the front side.

Posteriorly or backside the perimetrium, the supravaginal portion of cervix is covered with peritoneal lining and from supra vaginal portion of uterus the peritoneal lining is reflected to the posterior fornix. On either side the peritoneal lining is incomplete due to insertion (joining) of fallopian tubes, the round ligaments and the ovarian ligaments into the uterus. Below the level of round and ovarian ligaments is the broad ligament which is formed by joining two sheets of peritoneum.

The uterus is a pyriform (pear shaped) organ. Uterus measures about 9 cm in length, 6.5 cm in width and about 3.5 cm in thickness. The weight of the uterus is approximately 70 grams. The uterus is divided into two parts the body of uterus and the cervix, and this division is both anatomical and functional. The cervix is divided into vaginal and supra vaginal portions. This junction of body of the uterus and the cervix is the level of internal os and here the mucous membrane of the body of uterus becomes continuous with that of cervical canal. The cervical epithelial lining is the site of cancer (one of the commonest cancer in females only next to breast cancer) in the females.

The fundus of the uterus is the portion of the uterus which lies above the insertion (where the fallopian tube joins the uterus) of Fallopian tubes. There are two fallopian tube one right and the other left which joins the uterus. The fallopian tubes open into the cavity of the uterus. Through this fallopian tube opening the cavity of the uterus is directly in communication with that of peritoneal cavity.

The wall of the uterus contains three layers and they are perimetrium, myometrium and endometrium. The perimetrium is the outermost peritoneal lining or covering, myometrium is the muscle layer and the middle part and the innermost mucous membrane is the endometrium.

Bartholin’s glands lie in outer and posterior (behind) aspect, on either side of vaginal opening. There are two Bartholin’s glands one right and the other on left. Bartholin’s gland is deep to bulbospongious muscle and superficial to triangular ligament. It is embedded into the erectile tissue of the vestibule. It is a form of compound racemose gland and consists of low columner epithelium. The duct epithelium is of cubical type near the gland and become transitional in the middle and in the opening it becomes squamous type.

The main function of Bartholin’s gland is to secrete lubricating mucus during sexual intercourse.

Bartholin’s gland can be palpated when enlarged due to inflammation, but it is generally not palpable during healthy state. Palpation can be done by using fingers and thumb. Bartholin’s gland is richly supplied by blood vessels and can cause bleeding if it is removed surgically. The opening of the gland is on the inner side of labium minus (singular of labia majora) and out side of hymen. The length of the duct of Bartholin’s gland is about 25 millimeter and size of the gland is about 10 millimeter in diameter. In normal state if we press on the gland thin mucus can be expressed.

Bartholin’s glands and its ducts are infected in gonorrhea, at that time the opening of the duct become red and it can be easily seen at that time. The glands also become palpable if infected by gonorrhea.

This blog, as the name suggest is about women health guide, so to understand the women health guide properly one has to know the basic anatomy of female genitalia and female reproductive system. Here anatomy of the female genitalia and reproductive system are discussed one by one in a simple manner that everybody can understand without any problem. Without knowing the anatomy it is difficult to understand the problems of women’s health, so the anatomy is discussed first.

The Vulva

The vulva is an ill defined area which includes the entire female external genitalia and also perineum (the region between the thighs bounded in females by anus in the back and vulva in the front) for convenience. The vulva is bounded by mons veneris (the rounded fleshy prominence over pubis in females) in the front, in the both sides by labia majora and in posteriorly (backside) by perineum.

The vulva includes two labia majora on both side, two labia minora on the inner aspect of labia majora, bartholin’s gland, the clitoris, the vestibule which lie between in front and inner aspect of labia minora, the external urinary orifice lie just behind the clitoris. The vaginal opening lies just behind urinary orifice and surrounded by the hymen.

Labia majora has specialized sweat glands called apocrine glands which produce characteristic aroma and hidradenoma (rare tumor) arises from this apocrine gland. Labia majora contain sweat glands, hair follicle and sebaceous glands. Because of all these labia majora is a common site for boils, folliculitis and sebaceous cyst (closed epithelial lining cavity containing liquid or semisolid material). Male counterpart of labia majora is scrotum.

The labia minora lie on the inner aspect of labia majora. In front they join at the clitoris and behind they join to form fourchette, which is a thin fold of skin which is torn during childbirth. There is a small hollow between the hymen and the fourchette called fossa navicularis. The labia minora are thin fold of skin with elastic tissue and are erectile during sexual activity. Labia minora does not contain hair follicle or sebaceous glands.

The clitoris contains a glans covered by prepuce and a body. The clitoris corresponds to penis in male and it is attached to symphysis pubis with a suspensory ligament. The clitoris is extremely sensitive as it is very well supplied by nerves. It becomes erect during sexual act and plays an important role in inducing female orgasm.

The hymen surrounds the vaginal opening. In virgins the hymen is a thin membrane covered on both surfaces by squamous epithelium. The hymen has a small eccentric opening which is not big enough to admit even a finger tip. Sexual intercourse results in the rupture of hymen and laceration. Sometime coital rupture can cause brisk bleeding to require medical attention. During childbirth the hymen is further lacerated and gets stretched which is called carunculae myrtiformes.

Use of sanitary tampone usually results in breakdown of hymen and rupture of hymen is not a sign of loss of virginity any more.