Clinical anatomy of the uterus (uterus). Uterus: structure, changes during pregnancy and childbirth Female body structure of the uterus

The uterus is the main organ of the female reproductive system, which is a dense muscular structure, hollow inside. It provides menstrual functions and is responsible for the development of the fetus after conception. The unpaired reproductive organ is located in the pelvic area between the rectum and bladder. What is the structure of the uterus, and what developmental anomalies exist?

When conducting an ultrasound, you can see that the uterus consists of 3 parts: the bottom (upper convex side), the body (the middle expanded cavity) and the cervix (narrowed lower part). Below is the isthmus, cervical canal and vaginal part. The cavity communicates with the vaginal lumen, and on the sides with the fallopian tubes.

Anatomical structure: the walls of the female uterus consist of several layers (see photo No. 1):

1. Perimetry (serous membrane). The outer layer, which faces the cavity and is closely associated with the integument of the intestines and bladder. Comprises connective tissue.
2. Myometrium. The thickest layer, located in the middle. Consists of three muscle structures (longitudinal, internal and circular).
3. Endometrium. Includes functional and basal layers that face the uterine cavity. The endometrium consists of epithelial cell structures that form secretions.

The cervix is ​​made up of a large amount of connective tissue containing collagen. There are fewer muscle fibers here than in other parts of the reproductive organ. The structure of the cervix - the lower segment, is peculiar. The dimensions of this part of the female reproductive system are from 3 to 4 cm. Topographically, it is divided into supravaginal and vaginal parts. On the outer part there is a pharynx (the entrance to the cervical canal). It has a round shape in those women who have not given birth, and a slit-like shape after childbirth.

The position of the cervix is ​​normal - the center of the small pelvis. Each stage of the menstrual cycle changes these indicators through the hormonal level of the body. The position of the cervix can determine the phases of the menstrual cycle. In order to avoid infection, it is recommended to entrust this to a gynecologist.

There are many blood vessels on the walls, as shown in the diagram (photo No. 2). Circulatory processes are provided by paired uterine arteries and internal branches of the iliac artery. Branching, they feed the vascular structures, which have a smaller calibration, which makes it possible to supply oxygen and nutrients to the entire organ and its appendages.

The blood passing through the capillaries is concentrated in large vascular structures (internal iliac, ovarian and uterine veins). In addition to the circulatory structures, lymphatic ones are also located here.

The vital activity of the tissues and the functions of the female uterus are provided by hormones that are produced by the endocrine system. Of no small importance in the work of the internal reproductive organ is nervous system. The walls are equipped with branches of the pelvic internal nerve endings associated with the hypogastric plexus.

Muscles and ligaments

From the inside, the uterus consists of connective tissue ligaments that are necessary for fixation in the small pelvis:

1. Wide (paired). They are attached to the walls of the peritoneum and have an anatomical connection with the structures that fix the ovaries.
2. Round. Consists not only of connecting, but also of muscle cells. It passes through the wall of the uterus to the deep opening of the inguinal canal, ending with fiber in the region of the labia majora.
3. Cardinal. Designed to connect the lower part with the urogenital diaphragm. This bundle is necessary to exclude offsets to the right and left.

With the help of ligaments, the body of the reproductive organ is connected to the tubes and ovaries. Such anatomical structure uterus in a woman is observed in the absence of pathological disorders.

In addition to the ligaments, the position of the body and appendages is provided by muscle structures - the pelvic floor, consisting of the external, transverse, bulbous-spongy and ischiocavernosus muscles. In the middle layers is the urogenital diaphragm, which compresses the deep transverse structure and the urethra. They are designed to prevent deformation. internal organs, which can lead to dysfunctions and disorders of circulatory processes.

Location area and dimensional characteristics

Healthy uterus in nulliparous women childbearing age weighs no more than 50 gr. After childbirth, the weight of the internal organ increases by 2 times. The reproductive organ is 7-8 cm long and 5 cm wide. An increase in the size and mass of the internal organ is due to a change in the muscle layer during pregnancy - hypertrophy. The uterine cavity from the inside is only 5 to 6 cm. This is due to the fact that it has fairly thick walls.

The uterus of a healthy woman is located in the pelvic area in such a way that the longitudinal part of the reproductive organ runs parallel to the bones of the pelvis. It has physiological mobility and easily moves in the area of ​​nearby structures. In this case, we are talking about temporary bends. When the bladder is empty, the bottom "looks" forward towards the peritoneum. If it stretches, filling, then there is a temporary bend backwards - towards the intestines.

What changes occur during ovulation and pregnancy?

Before ovulation, the cervix is ​​hard and dry. Under the influence of hormones, it loosens, preparing for conception. The internal os is covered with viscous mucus, which increases the chances of sperm penetration, which facilitates the entire pregnancy process. At this time, the neck drops down

In the absence of conception during the period of ovulation, the menstrual function is triggered, and bloody issues. In this case, the internal pharynx expands, which is necessary for the expulsion of part of the endometrium and blood clots. This position of the cervix after ovulation can cause infection if personal hygiene is not observed and swimming in pools or ponds. The average duration of the menstrual cycle is 26-28 days.

After menstruation ends, a healthy uterus takes its usual position - the pharynx narrows, the cervix rises and the endometrium begins to recover. By ovulation, the functional layer completely regenerates, which contributes to the conception of a child. Pregnancy occurs when the sperm reaches the mature egg, which is released from the ruptured follicle into the area of ​​the fallopian tube.

After the onset of pregnancy, a change in the body and neck occurs. The growth of the organ is observed throughout the entire period of gestation. At the same time, it begins to change hormonal background body, which prevents the rejection of endometrial cells and the onset of menstruation.

What happens to the uterus during pregnancy? The following changes are observed:

• The spindle cells begin to divide, increase in diameter and elongate. The maximum thickness of the myometrium (from 3 to 4 cm) is noted by the middle of pregnancy.
• Closer to the birth process, the myometrium is stretched, so it becomes thinner.
• The cervix becomes bluish after conception. Its lumen is clogged with a mucous plug that serves as protection.
• Rapid growth leads to tension in the ligaments. This is accompanied by characteristic pains, which intensify in the 3rd trimester with sudden movements.

The position of the uterus varies from week to week. From 13-14 weeks of gestation during gynecological examinations, the height of the uterine fundus is determined. By this time, there is an increase in the upper part of the organ, which gradually goes beyond the small pelvis. By week 24, the bottom rises to the level of the navel. At 9 months, the height is maximum. It can be felt between the costal arches. Further, omission is observed in order to advance the fetus to the birth canal.

By the way the uterus looks during pregnancy, the doctor can determine the timing. Appearance internal reproductive organ before conception also matters. During a gynecological examination, a specialist can determine the presence of pathological processes.

Pathology of the structure and location of the uterus

The structure of the uterus may differ from the above. This is possible with the development of the following anomalies:

• Agnesia (rudimentary organ short and narrow).
• Hyperplasia (parts underdeveloped).
• Aplasia (parts are partially missing and/or "blind" pockets are present).
• Doubling of parts or complete absence of an organ.
• Uniform or bipedal.
• Saddle or the presence of a partition in the internal cavity.

Pathologies of the uterus associated with its structure are often the cause of infertility. When pregnancy occurs in this case, its course can be purely individual. Developmental anomalies are accompanied by violations endocrine system and functions of the urinary organs.

A healthy uterus may be misplaced. This may be due to the pathological development of internal organs that are in abdominal cavity. Such disorders, as a rule, are congenital in nature. Among the main anomalies in the location of the uterus, one should single out omission and prolapse, raising, displacement, twisting, retroflexion (backward bend), hyperanteflexia (kind to the anterior wall of the peritoneum).

The uterus has a special structure, which normally changes only during pregnancy. The position of the cervix varies with the menstrual cycle. With the development of any deviations from the norm, you need to visit a gynecologist. For example, the sooner the treatment of uterine mima or other formations is started, the greater the chances of a positive outcome of therapy. Every woman should know the symptoms of common diseases of the reproductive system in order to seek help from a specialist in time.

The uterus is the reproductive unpaired internal organ of the female. It is made up of plexuses of smooth muscle fibers. The uterus is located in the middle part of the small pelvis. It is very mobile, therefore, relative to other organs, it can be in different positions. Together with the ovaries, it makes up the female body.

General structure of the uterus

This internal muscular organ of the reproductive system is pear-shaped, which is flattened in front and behind. In the upper part of the uterus on the sides there are branches - the fallopian tubes, which pass into the ovaries. Behind is the rectum, and in front is the bladder.

The anatomy of the uterus is as follows. The muscular organ consists of several parts:

1. The bottom is the upper part, which has a convex shape and is located above the line of discharge of the fallopian tubes.
2. The body into which the bottom smoothly passes. It has a conical shape. Tapers down and forms an isthmus. This is the cavity leading to the cervix.
3. Cervix - consists of the isthmus, and the vaginal part.

The size and weight of the uterus is individual. The average values ​​of her weight in girls and nulliparous women reach 40-50 g.

The anatomy of the cervix, which is a barrier between the internal cavity and the external environment, is designed so that it protrudes into the anterior part of the vaginal fornix. At the same time, its posterior fornix remains deep, and the anterior - vice versa.

Where is the uterus?

The organ is located in the small pelvis between the rectum and the bladder. The uterus is a very mobile organ, which, in addition, has individual characteristics and shape pathologies. Its location is significantly affected by the condition and size of neighboring organs. The normal anatomy of the uterus in the characteristics of the place occupied in the small pelvis is such that its longitudinal axis should be oriented along the axis of the pelvis. Its bottom is tilted forward. When filling the bladder, it moves back a little, when emptying, it returns to its original position.

The peritoneum covers most of the uterus, except for the lower part of the cervix, forming a deep pocket. It extends from the bottom, goes to the front and reaches the neck. The back part reaches the wall of the vagina and then passes to the anterior wall of the rectum. This place is called Douglas space (recess).

Anatomy of the uterus: photo and wall structure

The organ is three-layered. It consists of: perimetrium, myometrium and endometrium. The surface of the uterine wall is covered by the serous membrane of the peritoneum - the initial layer. At the next - middle level - tissues thicken and have more complex structure. Plexuses of smooth muscle fibers and elastic connective structures form bundles that divide the myometrium into three inner layers: inner and outer oblique, circular. The latter is also called the average circular. This name he received in connection with the structure. The most obvious is that it is the middle layer of the myometrium. The term "circular" is justified by a rich system of lymphatic and blood vessels, the number of which increases significantly as it approaches the cervix.

Bypassing the submucosa, the wall of the uterus after the myometrium passes into the endometrium - the mucous membrane. This is the inner layer, reaching a thickness of 3 mm. It has a longitudinal fold in the anterior and posterior region of the cervical canal, from which small palm-shaped branches extend at an acute angle to the right and left. The rest of the endometrium is smooth. The presence of folds protects the uterine cavity from the penetration of unfavorable contents of the vagina for the internal organ. The endometrium of the uterus is prismatic, on its surface are the uterine tubular glands with vitreous mucus. The alkaline reaction they give keeps the sperm viable. During the period of ovulation, secretion increases and substances enter the cervical canal.

Ligaments of the uterus: anatomy, purpose

In the normal state of the female body, the uterus, ovaries and other adjacent organs are supported by a ligamentous apparatus, which is formed by smooth muscle structures. Functioning of internal reproductive organs largely depends on the condition of the muscles and fascia of the pelvic floor. The ligamentous apparatus consists of a suspension, fixation and support apparatus. The combination of the performed properties of each of them ensures the normal physiological position of the uterus among other organs and the necessary mobility.

The composition of the ligamentous apparatus of the internal reproductive organs

Apparatus	Functions performed	The ligaments that form the apparatus
Suspensory	Connects the uterus to the pelvic wall	Paired wide uterine
		Supporting ligaments of the ovary
		Own ligaments of the ovary
		Round ligaments of the uterus
Fixing	Fixes the position of the body, stretches during pregnancy, providing the necessary mobility	Main ligament of uterus
		Vesicouterine ligaments
		sacro-uterine ligaments
supportive	Forms the pelvic floor, which is a support for the internal organs of the genitourinary system	Muscles and fascia of the perineum (outer, middle, inner layer)

The anatomy of the uterus and appendages, as well as other organs of the female reproductive system, consists of a developed muscle tissue and fascia, which play a significant role in the normal functioning of the entire reproductive system.

Characteristics of the suspension device

The suspension apparatus is made up of paired ligaments of the uterus, thanks to which it is “attached” at a certain distance to the walls of the small pelvis. The wide uterine ligament is a fold of the peritoneum of the transverse type. It covers the body of the uterus and the fallopian tubes on both sides. For the latter, the ligament structure is an integral part of the serous cover and the mesentery. At the side walls of the pelvis, it passes into the parietal peritoneum. The supporting ligament departs from each ovary, has a wide shape. Characterized by durability. Inside it passes the uterine artery.

The proper ligaments of each of the ovaries originate at the uterine fundus from the back side below the branch of the fallopian tubes and reach the ovaries. The uterine arteries and veins pass inside them, so the structures are quite dense and strong.

One of the longest suspensory elements is the round ligament of the uterus. Its anatomy is as follows: the ligament has the form of a cord up to 12 cm long. It originates in one of the corners of the uterus and passes under the anterior sheet of the broad ligament to the internal opening of the groin. After that, the ligaments branch into numerous structures in the tissue of the pubis and labia majora, forming a spindle. It is thanks to the round ligaments of the uterus that it has a physiological inclination anteriorly.

The structure and location of the fixing ligaments

The anatomy of the uterus should have assumed its natural purpose - the bearing and birth of offspring. This process is inevitably accompanied by active contraction, growth and movement. reproductive organ. In this connection, it is necessary not only to fix the correct position of the uterus in the abdominal cavity, but also to provide it with the necessary mobility. Just for such purposes, fixing structures arose.

The main ligament of the uterus consists of plexuses of smooth muscle fibers and connective tissue, located radially to each other. The plexus surrounds the cervix in the region of the internal os. The ligament gradually passes into the pelvic fascia, thereby fixing the organ to the position of the pelvic floor. The vesicouterine and pubic ligamentous structures originate at the bottom of the front of the uterus and attach to the bladder and pubis, respectively.

The sacro-uterine ligament is formed by fibrous fibers and smooth muscles. It departs from the back of the neck, envelops the rectum on the sides and connects to the fascia of the pelvis at the sacrum. In a standing position, they have a vertical direction and support the cervix.

Supporting apparatus: muscles and fascia

The anatomy of the uterus implies the concept of "pelvic floor". This is a set of muscles and fascia of the perineum, which make it up and perform a supporting function. The pelvic floor consists of an outer, middle and inner layer. The composition and characteristics of the elements included in each of them are given in the table:

Anatomy of the female uterus - the structure of the pelvic floor

Layer	muscles	Characteristic
Outer	Ischiocavernosus	Steam room, located from the buttocks to the clitoris
	bulbous-spongy	Steam room, wraps around the entrance to the vagina, thereby allowing it to contract
	outdoor	Compresses the "ring" anus, surrounds the entire lower rectum
	Surface transverse	Weakly developed paired muscle. It comes from the ischial tuberosity from the inner surface and is attached to the tendon of the perineum, connecting with the muscle of the same name, which runs from the back side
Medium (urogenital diaphragm)	m. sphincter urethrae externum	Compresses the urethra
	Deep transverse	Drainage of lymph from internal genital organs Lymph nodes, to which lymph is sent from the body and cervix - iliac, sacral and inguinal. They are located at the place of passage and on the front of the sacrum along the round ligament. Lymphatic vessels located at the bottom of the uterus, reach lymph nodes waist and groin area. The common plexus of lymphatic vessels from the internal genital organs and rectum is located in the space of Douglas. Innervation of the uterus and other reproductive organs of a woman The internal genital organs are innervated by the sympathetic and parasympathetic autonomic nervous systems. The nerves going to the uterus are usually sympathetic. On their way, spinal fibers and structures of the sacral nerve plexus join. Contractions of the body of the uterus are regulated by the nerves of the superior hypogastric plexus. The uterus itself is innervated by branches of the uterovaginal plexus. The cervix usually receives impulses from the parasympathetic nerves. The ovaries, fallopian tubes, and adnexa are innervated by both the uterovaginal and ovarian plexuses. Functional changes during the monthly cycle The wall of the uterus is subject to changes both during pregnancy and during the menstrual cycle. in the female body is characterized by a combination of ongoing processes in the ovaries and uterine mucosa under the influence of hormones. It is divided into 3 stages: menstrual, postmenstrual and premenstrual. Desquamation (menstrual phase) occurs if fertilization does not occur during ovulation. The uterus, a structure whose anatomy consists of several layers, begins to shed the mucous membrane. Along with it, the dead egg comes out. After rejection of the functional layer, the uterus is covered only with a thin basal mucosa. Postmenstrual recovery begins. In the ovary, the corpus luteum is re-produced and a period of active secretory activity of the ovaries begins. The mucous membrane thickens again, the uterus prepares to receive a fertilized egg. The cycle continues continuously until fertilization occurs. When the embryo implants in the uterine cavity, pregnancy begins. Every week it increases in size, reaching 20 or more centimeters in length. The birth process is accompanied by active uterine contractions, which contributes to the oppression of the fetus from the cavity and the return of its size to prenatal. The uterus, ovaries, fallopian tubes, and adnexa together form the complex female reproductive organ system. Thanks to the mesentery, the organs are securely fixed in the abdominal cavity and protected from excessive displacement and prolapse. The blood flow is provided by a large uterine artery, and several nerve bundles innervate the organ.

The place where the fetus normally grows and develops after conception is the female uterus. This organ, in addition to the function of reproduction, plays an important role in the regulation of the menstrual cycle. The structure of the uterus allows it to grow and change along with the fetus until it is expelled during childbirth. Oddly enough, many women do not know what the uterus looks like and how its size changes during pregnancy. Consider these issues and what happens to her during and during pregnancy.

The uterus is the container for the developing fetus.

What is this organ

The uterus is an unpaired hollow muscular organ that is located between the bladder in front and the woman's rectum in the back. The diagram shows its location relative to other organs.

The uterus has physiological mobility.

A normal uterus has physiological mobility and is easily displaced relative to other organs. So, when the bladder is full, it goes backwards, and when the rectum is full, it moves anteriorly. During pregnancy, it grows and shifts upward, but after childbirth, it takes its original position.

Anatomical structure

The shape of a normal uterus resembles a pear, which is slightly flattened from front to back. Structurally, it is customary to distinguish:

1. Bottom. This upper part protrudes beyond the line of entry into it of the fallopian tubes.
2. Body. The outline resembles a triangle, which gradually narrows towards the neck.
3. Neck. It is a continuation of the body, but it is narrower and rounder. The outer part of the cervix protrudes into the vagina and is called the vaginal part. The area adjacent to the body is called the supravaginal part. If the average size of the uterus is 6-7 cm, then the length of its neck is about 2.5-3 cm.

The diagram shows its components.

The size and position of the body

On average, its dimensions in a woman of childbearing age are as follows: length 5-8 cm, width 3-4 cm, thickness within 2-3 cm. gr. Such changes are associated with hypertrophy of the muscle layer during pregnancy.

Its cavity is only 5-6 cm. This is relatively small in relation to its size. Such a small cavity is due to the powerful thick walls of the organ itself.

The normal uterus is located in such a way that its longitudinal axis runs parallel to the axis of the pelvic bones. Possessing physiological mobility, it can easily shift relative to adjacent structures, forming temporary bends. So, with an empty bladder, its bottom will stand forward, and when the bladder is stretched, on the contrary, it deviates back.

Important! A sharp and constant bending of the uterus is not the norm, but a pathological phenomenon.

What is the wall of the uterus and the structure of its cervix

The wall of the organ is represented by three layers:

• serous membrane;
• the muscular membrane is the main component of the wall, which is represented by unstriated fibers intertwining with each other in different directions;
• mucous membrane that lines the cavity of an organ. It is represented ciliated epithelium, in which lie different kinds glands.

The cervix is ​​the narrowest part of the uterus. The length of her neck is within 2-3 cm. Its canal opens into the vaginal cavity with a uterine opening, which forms the internal pharynx. In women who have not given birth, it is round or transverse, and in those who have given birth, it is in the form of a transverse slit with tears along the edges. During a visual examination, the specialist always evaluates the condition of the cervix and its internal pharynx. This data can tell him about problems with the woman's reproductive system.

How does this organ change during ovulation?

The fact that the size of the uterus grows during pregnancy is clear to everyone, but what happens to it during. Normally, before ovulation, the cervix is ​​dense and dry. During ovulation, under the influence of hormones, it becomes loose, preparing for conception. The mucus that covers the internal os becomes viscous and passes sperm more easily than on other days. The position of the cervix these days is lower than usual. All these changes are aimed at preparing the body of a woman for conception.

If conception does not occur during ovulation, then the woman begins menstruation. The internal os expands to expel blood clots and parts of the endometrium from it. This position of the cervix contributes to the infection during this period, if a woman does not observe personal hygiene, bathes in open water or pools.

After the cessation of menstruation, the internal os narrows again and a new layer of functional endometrium begins to recover in the uterus. It completely regenerates for the next ovulation and prepares for the implantation of the embryo.

Many women's forums talk about how you can determine the onset of ovulation by touch. They suggest taking into account the length of the neck, its consistency, position and other parameters. Nevertheless, we advise you to refrain from this manipulation. Incorrect and inept palpation of the cervix, at best, will not lead to anything, and at worst, after it, you will infect or damage the delicate mucosa. If you want to know about the onset of ovulation, then take a test or visit a gynecologist who knows how to properly palpate.

What happens to the uterus during pregnancy by week

During pregnancy, the size of the body changes rapidly. After the 8th month, it becomes oval-round, about 20 cm long. Separate muscle fibers increase not only qualitatively, but also quantitatively.

The growth of the uterus occurs throughout pregnancy. In the first weeks, it retains its pear-shaped shape and does not change, since the size of the fetus is very small.

In the second month, it becomes rounded and its size increases several times. Her weight is also growing, by the end of pregnancy, the norm is almost a kilogram.

At the appointment with the gynecologist at each scheduled examination, the doctor measures the height of the uterine fundus. This helps to predict the gestational age and to notice when it begins to descend in preparation for childbirth. The table below shows the normal height of the uterine fundus by week.

Questions to a specialist

Question: I learned that by the height of the fundus of the uterus, you can find out the duration of pregnancy. How does the height of the fundus of the uterus change by week?

Answer: The approximate height of the fundus of the uterus in centimeters is equal to the duration of your pregnancy by week. So, if it is 23 cm, then you are at the 23rd week of pregnancy.

Question: What is the normal length of the cervix and how does it change during childbirth?

Answer: The length of the cervix is ​​2.4-3 cm. During pregnancy, it lengthens by several centimeters. If the length of the cervix is ​​below certain values, then this can cause premature birth. On the eve of childbirth, the length of the cervix becomes less than a centimeter and the internal os begins to open. These signs indicate that labor will begin soon.

Question: If the length of the cervix is ​​rapidly decreasing, and in terms of delivery time is still far away, what should I do?

Answer: In different situations, the doctor may suggest different treatment: medicines, as well as the imposition of a pessary or sutures on the internal pharynx. The length of the cervix is ​​of great importance, it is especially important to monitor it in pregnant women after previous abortions.

The female reproductive system is a well-coordinated mechanism. Each organ in it is responsible for its functions. The normal shape and size of the uterus enable the fetus to firmly strengthen and continue its growth and development until the very birth.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General information

Uterus is a single hollow organ, the basis of the walls of which is smooth muscle. The organ serves to carry the fetus. The organ is located in the middle of the small pelvis, closer to its front wall.
The length of this organ in a woman of childbearing age is from 7 to 8 cm. Weight before the first birth is 40-50 grams, after birth up to 80 grams. It is similar in shape to a pear, turned with the narrow side down.
The organ is not rigidly fixed, therefore, under certain physiological conditions, it can move somewhat.

The walls of the uterus consist of three layers: outside parametrium (serous layer), followed by myometrium (muscular layer) and from the inside a mucous membrane called endometrium .

Cervix- this is the lower part of the organ that connects to the vagina, is its narrower part. The basis of the neck is collagen fibers, a certain amount of smooth muscles and elastic fibers.
On the cervical mucosa there are glands that produce their own mucus.

Condition before menstruation

Due to the fact that it is in this organ that the embryo and fetus are carried, cyclic processes take place in it during the menstrual cycle. In the first ten days of the cycle, changes occur in the uterus aimed at accepting the embryo: its mucous membrane becomes thicker, blood vessels branch and thicken. In the event that conception is not carried out, the mucous membrane is rejected and expelled from the uterus - menstruation begins.
Painful sensations before menstruation are due to the fact that the uterus is filled with blood as much as possible, and its walls swell.

Baby uterus (hypoplasia)

If the size of the organ does not correspond to age norms, the diagnosis is "hypoplasia". Hypoplasia is germinal, infantile ( children's) and adolescent.
With hypoplasia, most often the development of other genital organs also does not correspond to the age norm ( e.g. ovaries, labia).
Against the background of hypoplasia, dysmenorrhea can be observed ( pain during menstruation), amenorrhea ( irregularities and lack of menstruation).
You can suspect hypoplasia if the girl did not have menstruation before the age of 15. This situation requires the intervention of medicine.

Causes:
Hormonal disorders during puberty.

Treatment:

• Hormonal drugs
• Physiotherapy
• Special types of massage
• Special Diet.

Bend

In a healthy woman, the uterus is directed slightly forward. An obtuse angle should form between the neck and the body of the organ. Sometimes the uterus is displaced and bends back.

Causes:

• Inflammatory diseases
• Chronic constipation
• Urinary retention
• Weakness of the ligaments that support the uterus

Symptoms:

• Pain in the lower abdomen and lower back
• Pain during menstruation, prolonged bleeding
• Constipation.

Treatment depends on the cause of the disease and is most often conservative.

Condition during pregnancy

During pregnancy, the uterus constantly increases in size, along with this, the muscles that make up the walls of the organ become longer. The internal space of the organ is filled with fluid. In the third month of gestation, the volume of the uterus is approximately equal to the volume of a duck egg, and after another month it can already be felt ( if there is not too thick a layer of fat on the abdomen). In the sixth month, the bottom of the uterus is at the height of the navel, and in the ninth month it is closer to the lower extremity of the sternum.

Disclosure

The opening of the uterus is the first stage of childbirth. Under the influence of contractions of the uterine muscles, the pharynx opens so that it almost passes into the vagina. Only when the disclosure is complete, the period of attempts and expulsion of the fetus comes.
The stage of opening the pharynx is the longest stage of childbirth, the duration of which is individual.
An internal study is used to determine the degree of disclosure.

Increased tone

The most common pathology of pregnancy today is too high uterine tone.
Normally, the muscles that make up the walls of the uterus should be relaxed and this condition is called normotonus. If the muscle fibers contract, the pressure inside the organ increases - it creates hypertonicity.

Cause:

• Neglect of a healthy lifestyle
• Overwork
• Diseases of the uterus fibroids, endometriosis, inflammation).

Treatment:

• peace
• Taking papaverine or no-shpy
• Reception hormonal drugs (if the cause is a hormonal imbalance)
• Magnesium and vitamin intake AT 6 .

Stitches on the uterus

Modern surgeons prefer to make a transverse incision in the lower part of the uterus with a length of 11 - 12 cm. This tactic allows you to heal the wound faster, reduces the amount of blood lost.
The uterus is closed with a double row suture using completely absorbable materials, for example, dexon, vicryl, caproag.
According to doctors, up to 80% of women who have had a caesarean section can give birth on their own in the future. With such childbirth, it is very important that they pass without any stimulation. The risk of seam rupture is from 0.5 to 2% according to various sources. According to American doctors, out of 17.5 thousand births in women with scars on the uterus, only 5 babies could not be saved.
The younger the woman and the more time has passed since the caesarean section, the higher the chance of giving birth without complications.

Gap

One of the most severe complications of childbirth and pregnancy. Happens like when exposed external causes, and without them.

Causes:

• Too narrow pelvis
• Transverse presentation of the fetus
• Too big fruit
• Neoplasms in the pelvic organs
• Violation of the state of the uterine wall caused by inflammation, dystrophic processes
• Scars after previous caesarean sections.

If doctors suspect uterine rupture during childbirth, they immediately anaesthetize the woman with ether and thereby stop contractions. Next, an operation is performed to extract the fetus.

Condition after childbirth

After separation of the placenta, the uterus is greatly reduced. There is a certain amount of blood inside the organ, its walls are initially wrinkled, since the volume of the organ decreases very quickly, gradually smoothing out. Recovery ( involution) of the uterus occurs quite quickly, but the following factors can influence this process:

• Woman's age
• The course of childbirth
• General state
• Chronic diseases.

If after childbirth the weight of the uterus is approximately 1 kg, then after 14 days its weight is reduced by three times. When breastfeeding, the uterus contracts faster. You can also advise sleeping on your stomach in the first two - three days after childbirth.

Already ten days after childbirth, the mucous membrane of the organ is completely restored, cleared of blood clots. And only the area where the placenta was located heals by day 20.

Erosion (ectopia)

A very common disease, which is an ulcer on the mucous membrane of the cervix.

Cause:

• The development of a pathogenic infection
• Cervical injury
• Hormonal imbalance
• Beginning sexual activity before age 20
• Bad immunity.

Treatment:

• If there is an infection, antibiotics
• Chemical coagulants
• Ointments that restore the mucous
• Cryodestruction
• Laser coagulation
• Diathermocoagulation.

Myoma

A benign neoplasm that forms in the muscular layer of the uterine lining.

Factors predisposing to its development:

• Inflammatory processes
• abortion
• endometriosis
• Any surgical interventions (curettage, surgical care during childbirth).

Diagnostics:
Ultrasound examination.

Treatment:

• Medications
• Embolization of the uterine arteries
• Exposure to special types of ultrasound
• Organ amputation.

Cancer

Ranked first among oncological diseases among women. The presence of the human papillomavirus in the body creates favorable conditions for the development of cancer.
The disease at the beginning of development is asymptomatic, although there may be an unpleasant sensation in the process of copulation, scanty spotting, pulling pains in the lower abdomen.

Diagnostics:

• Cytology
• Schiller's test
• Histology.

Treatment surgical.

endometriosis

Growth of the mucous membrane of the uterus on other organs. More susceptible to the disease are women over the age of forty, especially those who have not had children.

Symptoms:
They are very diverse, sometimes absent altogether. The most commonly present are pain, menstrual irregularities, pain during intercourse, infertility, menorrhagia ( increased intensity and duration of menstruation).

Causes:

• genetic predisposition
• The individual structure of the fallopian tubes
• Immune failures.

Treatment:

• Medical
• Surgical
• Uterus removal.

Dysplasia

Changes in the mucous membrane of the cervix, preceding malignancy. Dysplasia can cover both superficial mucosal cells and deeper ones. With dysplasia, unlike erosion, there is no mechanical violation of integrity.

Cause:

• Human papilloma virus.

The likelihood of developing dysplasia in women who smoke, as well as in promiscuous women who have frequent abortions, increases.
Symptoms disease is absent.
Treatment can be performed both conservatively and surgically.

Cyst

A fairly common disease is a consequence of pseudo-erosion. With this disease, the glands located on the cervix become clogged and turn into cysts.
The disease is usually asymptomatic, it can be detected by a doctor during an examination.

Treatment:

• Removal of the cyst by surgery
• Laser therapy

polyps

Benign neoplasms of the cervix. Polyps appear most often on the external pharynx.
Polyps can develop pedunculated or non-pedunculated and are classified as adenomatous, glandular, and glandular-fibrous.
The disease is usually asymptomatic. Often combined with other gynecological diseases.

Diagnostics:
Detected during examination, colposcopy.

Treatment:
Surgical.

Leukoplakia

Increase in the thickness of the mucous membrane of the cervix. It may indicate a malfunction of the ovaries, as well as the presence in the body of the herpes simplex virus, human papillomavirus. Sometimes it is a companion of erosion.

Symptoms:

Usually absent, sometimes itching is observed.

Treatment:
Cauterization of the affected area.

ultrasound

This is a very widely used method for examining the uterus.
It is recommended if there are complaints of menstrual irregularities, pain in the lower abdomen, inability to conceive, uterine bleeding in the middle of the cycle, pain in sexual intercourse.
Ultrasound is performed both through the anterior abdominal wall and transvaginally.

May reveal:
Fibroids, endometriosis, cancer, violation of the structure, shape, size of the organ, as well as ovarian diseases.

Biopsy

This diagnostic method, which consists in taking a piece of tissue from the neck or from the body of an organ. Enables detection of cancer inflammatory processes. It is done from the 5th to the 7th day of the cycle, without anesthesia.

Types of biopsy:

• Puncture
• incisional
• Endoscopic
• Aspiration.

Advantages of the method:
It is done quickly, the procedure is simple, no anesthesia is required.

Cons of the method:
Sometimes there are unpleasant sensations, during the menopause there are technical difficulties in taking the material.
For 4 weeks after the procedure, sexual intercourse is prohibited.

Conization of the uterus- this is one of the varieties of biopsy. During the procedure, a piece of tissue in the form of a cone is removed.
The method is used both for treatment and for diagnosis. The procedure is carried out both inpatient and outpatient. But in the second case, after the procedure, you need to stay in the clinic for 1 to 4 hours under the supervision of a doctor.

Removal (Hysterectomy)

During the operation, the body of the uterus, ovaries and fallopian tubes are removed. The procedure is painful and is prescribed only in exceptional cases.

Hysterectomy indications:

• Cancer of the uterus and cervix
• Endometriosis in an uncontrolled form
• Fibroids in some cases
• Uterine prolapse
• Dysmenorrhea
• Severe inflammation of the pelvic organs.

Hysterectomy can be total the uterus and cervix are removed), partial ( only the upper part of the uterus is removed, the cervix is ​​not touched), as well as radical ( the uterus, cervix, upper segment of the vagina will be removed).

In pre-climacteric age, the operation is prescribed only in emergency cases, as it entails serious disruptions in the work of many organs and systems, as well as violations of the woman's psycho-emotional state.

Cauterization of erosion (diathermocoagulation)

The hot cauterization procedure is used only in the treatment of women who already have children, since after such a manipulation scars may remain that complicate childbirth. Recovery after the procedure lasts about 2 weeks. After cauterization, a woman can observe discharge ( bloody or clear). For better recovery after cauterization, you should refrain from:

• weight lifting
• Hot bath
• Sexual relations for a period of at least 2 weeks.

In the event that the discharge does not stop, you should visit a doctor. Perhaps another cauterization procedure will be scheduled and after the second cauterization, the recovery period lasts 4 weeks.

Cryodestruction- this is the same cauterization, but with liquid nitrogen. The procedure is more humane in relation to tissues, leaving almost no traces behind. Now the equipment for such a procedure is not uncommon.

Scraping

Scraping goals:

• polyp treatment, uterine bleeding, hyperplasia, as well as before intervention for the treatment of fibroids
• Diagnostics ( to clarify the existing diagnosis).

Curettage of the uterus is an extreme measure, which is resorted to when there is a special need.
The procedure is carried out using a hysteroscope. Assign to last days menstrual cycle.

Radio wave treatment

Radiosurgery is an operation in which the surgical instrument is a radioknife.

What can be treated?

• Coagulation of endometriosis foci
• Biopsy of the cervix
• Conization of the cervix
• Treatment of cervical erosion
• Removal of genital warts of the vulva.

What are the advantages of the technique:

• No blood loss
• Virtually painless procedure
• Short recovery period
• The operation itself takes a matter of minutes.

Cancer shot

The vaccine is effective against 4 types of papillomavirus, which create favorable conditions for the development of cervical cancer.
The duration of the vaccine is five years ( strong immunity).
You can vaccinate girls and girls under the age of 26, as well as guys under 17 ( in order not to become carriers of the virus).
The vaccine practically does not cause side effects except for local reactions.

Contraindications for vaccination:

• Pregnancy
• Neurological and somatic ailments
• Individual intolerance
• Increased body temperature.

Treatment of cancer with folk remedies

1. Grind in a meat grinder 150 gr. aloe leaves, mix with 250 gr. honey ( better than May), 270 ml Cahors. Keep 5 days in the refrigerator. Use for 5 days, 1 tsp. three times a day 60 minutes before a meal, add up to 1 tbsp. The duration of admission is from 21 to 45 days.

2. 2 tsp bedstraw herb brew 1 tbsp. boiling water, stand for 3 hours under a hood, pass through a sieve. Use for douching and consume a quarter cup three times - four times a day.

3. 1 tbsp burdock leaves pour 200 ml of boiling water, let cool, pass through a sieve, take orally 100 ml three times - four times a day.

Treatment of fibroids with folk remedies

1. Take the average bulb white, finely chopped, put into sterile gauze, tied with a strong thread in the form of a tampon and inserted into the vagina as deep as possible at night. Do the procedure daily for 4 weeks or longer until the fibromyoma disappears.

2. Take 25 partition wall made of walnuts, add half a glass alcohol, withstand 7 days and use 15 drops three times a day, diluted with a small amount of water. The duration of admission is 8 weeks.

3. Make a decoction of flax seeds, drink 50 ml of decoction three times a day for two weeks.

4. Take tops from carrots: two presses per liter of boiling water. Keep covered for 40 minutes. Use to relieve bleeding in fibroids.

Treatment of prolapse with folk remedies

1. Melissa tea: for 400 ml of boiling water 2 tbsp. raw materials. Keep in a thermos for 8 hours, drink two-thirds of a glass 60 minutes before meals.

2. 1 st. l. elecampane, 500 ml vodka withstand 10 days in the pantry. Use 1 tbsp. before breakfast.

3. Oregano and lemon balm 75 gr each, coltsfoot 100 gr. mix well, 2 tbsp. collection, pour 400 ml of boiling water in a thermos. Take 70 ml 60 minutes before a meal three times a day.

The internal female genital organs include: ovary, fallopian tube, uterus and vagina.

A) UTERUS(uterus, metra, hyster)

The uterus is an unpaired pear-shaped hollow muscular organ.

Functions of the uterus:

gestation;

Expulsion of the fetus during delivery.

The uterus is located in the pelvic cavity between the rectum and the bladder.

In this position, it is fixed by ligaments: wide, round, pubic-cervical and rectal-uterine, sacro-uterine.

The length of the uterus in an adult woman is 7-8 cm, width - 4 cm, thickness - 2-3 cm.

The mass of the uterus in nulliparous women ranges from 40 to 50 g, and in those who have given birth it reaches 80-90 g.

During pregnancy, the uterus rises from the pelvic cavity into the abdominal cavity and

at the 9th month it reaches the costal arches and the xiphoid process of the sternum. Towards the end of pregnancy, the uterus descends somewhat.

During pregnancy, the uterus increases, acquires an ovoid shape, its mass increases 20 times and reaches up to 1 kg by the end of pregnancy.

After childbirth, the uterus rapidly decreases in size and descends to the navel, on the 10th day it is at the level of the pubic symphysis.

Uterine surfaces:

front surface - cystic , facing the bladder

back surface - intestinal , facing the rectum.

There is a space between the posterior surface of the uterus and the rectum - douglas pocket (uterine rectal cavity). With perforation of the uterine wall, with ectopic pregnancy, injuries, with peritonitis, blood, pus, serous fluid can accumulate in this place, which leads to the development of inflammatory processes in the abdominal cavity and in the pelvic cavity.

The edges of the uterus(lateral)

Parts of the uterus:

1. DBut- this is the upper thickened convex part of the uterus, rising in the form of a vault above the openings of the fallopian tubes and forming angles with them - uterine horns.

2. Tate This is the middle section of the uterus.

3. Weyka- this is the lower narrowed part of the uterus, it is 1/3 of the length of the uterus and consists of 2 parts.

Parts of the cervix:

- supravaginal part - the upper part of the cervix, is 2/3 of the cervix;

- vaginal part (stigma of uterus) - the lower part of the cervix.

The place where the body of the uterus passes into the cervix is ​​narrowed and is called isthmus uterus .

The position of the uterus in the pelvis

The uterus has considerable mobility and, depending on the state of neighboring organs, can occupy a different position.

Normally, the bottom of the uterus is directed forward - the uterus is tilted anteriorly.

This position of the uterus is called anterior tilt. - anteversio , at the same time, the body of the uterus forms an angle with the cervix, open anteriorly - the bending of the uterus anteriorly - anteflexio .

uterine cavity

The uterine cavity on the frontal section has the shape of a triangle, with its apex facing down and passing into the narrow canal of the cervix.

Fallopian tubes open at the corners of the base of the triangle oviducts.

The top of the triangle is facing down and passes into the cervical canal - cervical canal .

The cervical canal at the top opens into the uterine cavity with the internal opening of the uterus - this internal os of the uterus.

At the bottom, the cervical canal opens into the vagina with the external opening of the uterus - outer cervical os , this opening of the uterus is limited by the lips: front and back(more subtle).

In a nulliparous woman, the external opening of the uterus (external os of the uterus) is round, and in a woman who has given birth, it has the shape of a transverse slit.

The wall of the uterus

The wall of the uterus is thick and consists of 3 membranes.

The lining of the uterine wall:

1.C mucous membrane (endometrium) - this is the inner membrane lining the uterus from the inside, covered with a single-layer cylindrical ciliated (ciliated) epithelium.

The mucous membrane has many uterine glands.

The endometrium has 2 layers:

The basal layer is the lower one, lies at the base;

The functional layer is the top (surface). It is rejected during menstruation.

2. Murethra (myometrium ) is the middle shell of the uterus, consists of 3 layers of smooth muscles - outer and inner longitudinal, middle - circular (circular).

The thick muscular membrane of the uterus ensures the expulsion of the fetus during delivery.

3.C erous membrane (perimetry) - this is the outer shell of the uterus, formed by the peritoneum, which covers the uterus from above, in front and behind (except for the lateral edges and part of the neck in front).

From the sides of the uterus, the anterior and posterior sheets of the peritoneum are connected and form a wide ligament of the uterus.

Around the cervix under the peritoneum there is an accumulation of adipose connective tissue - parametrium (peripheral fiber)

Inflammatory processes in the uterus: endometritis, myometritis, perimetritis, parametritis.

b) THE FALLOPIAN TUBES(tubae uterinae, salpinx)

Inflammation of the fallopian tubes is called salpingitis.

The fallopian tubes (fallopian tubes, oviducts) are paired cylindrical organs, 10–12 cm long and 2–4 mm in diameter.

The fallopian tubes are located in the pelvic cavity on both sides of the bottom of the uterus, in the upper edge of the broad ligament of the uterus.

The fallopian tubes start from the corners of the uterus, at first they are located at right angles to the uterus almost horizontally, then, having reached the pelvic wall, they are located in an arc around the lateral side of the ovary, forming a bend, and end at the medial surface of the ovary.

The narrow end of the fallopian tube opens into the uterine cavity, and the extended end into the peritoneal cavity next to the ovary. Thus, in women, the peritoneal cavity through the lumen of the fallopian tubes, the uterine cavity and the vagina communicates with the external environment.

The causative agents of genital infections and other microorganisms in the female reproductive system spread upward - through the vagina into the uterus, then into the fallopian tubes and ovaries. This can lead to inflammatory processes in the female genital organs and infertility.

Functions of the fallopian tubes:

Conduction of the egg from the ovary into the uterine cavity (therefore they are also called oviducts);

The fallopian tubes are the site of fertilization of the egg by the sperm.

Fallopian tube openings:

Abdominal opening (d 2 mm) - communicates it with the abdominal cavity;

The uterine opening (d 1 mm) - communicates it with the uterine cavity.

Parts of the fallopian tube:

1. In oronka - this is the part of the fallopian tube facing the abdominal cavity, has an abdominal opening surrounded by a large number of fimbriae (fimbriae), one of which is ovarian fimbria (fimbria ovarica) attached to the ovary (the egg moves through it into the fallopian tube).

2. A mpula - this is the longest and widest part of the fallopian tube, following the funnel, which accounts for almost half of its entire length (d 3 - 5 mm), has a curved shape.

3. Isthmus (isthmic part - from isthmus - isthmus) - this is the medial narrowest part of the fallopian tube (d 1.6–1.8 mm), located medially from the ampoule, approaches the corner of the uterus between its bottom and body.

4. Uterine part (interstitial - intraparietal) - this is a part of the fallopian tube, enclosed in the thickness of the uterine wall and opening into its cavity through the uterine opening of the tube.

Layers of the wall of the fallopian tube:

1. Mucous membrane - this is the inner membrane lining the tube from the inside, covered with a single-layer prismatic (cylindrical) ciliated ciliated epithelium, the cilia of which flicker towards the uterus.

The mucous membrane forms numerous branching folds, more developed in the funnel and ampulla, where they fill their entire lumen.

Part of the cells of the mucous membrane are devoid of cilia - secretory cells, they produce nutrients for the egg and sperm.

After an abortion, endometritis (postpartum or infectious), adhesions can form on the mucous membrane of the fallopian tubes and uterus, which lead to infertility and ectopic pregnancy, because. the egg cannot enter the uterine cavity.

2. M urethra - this is the middle shell of the fallopian tube, it thickens in the direction from the ampoule to the uterus, consists of 2 layers of smooth muscles - a thick inner circular and a thin outer longitudinal

3. With erous shell - this is the outer shell of the fallopian tube, formed by the peritoneum, which covers the fallopian tubes and the uterus from above and from the sides, forming a broad ligament of the uterus.

The anterior and posterior leaf of the broad ligament of the uterus, connecting under the fallopian tube, form the mesentery of the fallopian tube - mesosalpinx.

V) VAGINA(vagina)

Inflammation of the vagina is called vaginitis.

The vagina is an extensible tube 8-10 cm long, flattened in the anterior-posterior direction, which covers the cervix with its upper wide end, and with its lower end, penetrating through the urogenital diaphragm of the pelvis, opens into the vestibule hole vagina.

This hole in virgins is closed virgin spit (hymen) that separates the vestibule from the vagina. The hymen separates the external and internal female genital organs.

The hymen is a lunate or perforated plate, which is a double fold of the mucous membrane, which is torn during the first sexual intercourse, and its remnants atrophy.

ahead the vagina contains the bladder and urethra, behind- the rectum with which it fuses.

Secreted from the vagina anterior And back wall, in contact with each other.

The vaginal cavity is slit-like.

The walls of the vagina, covering the vaginal part of the cervix, form a domed depression around it, called vault of the vagina.

The vaginal vault is divided into anterior, posterior, and two lateral (right and left) vaults.

The posterior fornix of the vagina is the deepest, and material is taken from it for examination for gynecological smears. In gynecological smears, there are 4 degrees of purity of the vagina.

The vaginal wall is made up of three shells :

1) C mucous membrane- this is the inner lining that covers the inside of the vagina, lined with stratified squamous non-keratinized epithelium, forms numerous transverse vaginal folds. The mucous membrane of the vagina does not have glands.

Cytological smears of the vaginal mucosa allow you to examine the state of the epithelium, which depends on the hormonal background and the phases of the menstrual cycle.

The cells of the surface layer of the epithelium are rich in glycogen, which, under the influence of enzymatic processes, breaks down with the formation of lactic acid. This gives the vaginal mucus an acidic reaction, bactericidal against pathogenic microbes.

2) Muscular membrane- this is the middle shell, consists of 2 layers of smooth muscles - the inner circular and the outer longitudinal. At the top, the fibers of the muscular membrane of the vagina pass into the muscles of the uterus, below they are woven into the skeletal muscles of the perineum.

The striated skeletal muscles of the perineum around the opening of the vagina and the urethra form an arbitrary urethro-vaginal sphincter.

3) adventitial sheath- this is the outer shell of the vagina, consists of loose fibrous connective tissue, equipped with elastic and muscle fibers, contains the venous plexus and nerves.

Also around the vagina there is an accumulation of connective adipose tissue - paravaginal tissue.

G) OVARY(ovarium, oophorum)

The ovary is a paired female sex gland of mixed secretion, weighing 5-8 g. The ovary has an ovoid shape, somewhat flattened in the anteroposterior direction.

Near the ovaries are rudimentary formations - ovarian appendages.

Functions of the ovary:

Exocrine (exocrine) - the production of female germ cells - eggs.

Endocrine (intrasecretory) - the production of female sex hormones - estrogens and the hormone of the corpus luteum of the ovary - progesterone.

Inflammation of the ovaries is called oophoritis .

The ovary is located vertically on the side walls of the small pelvis, on both sides of the uterus, under the fallopian tubes.

Are fixed own And suspensory ligaments ovary. The peritoneum forms the mesentery of the ovary, with which the organ is attached to broad ligament of uterus.