 Section 32 of Gray's Anatomy. Part 5. This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. Recording by Bologna Times. Anatomy of the Human Body. Part 5 by Henry Gray. The male urethra. The female urethra. The male urethra. Urethra virilis. The male urethra extends from the internal urethral orifice in the urinary bladder to the external urethral orifice at the end of the penis. It presents a double curve in the ordinary relaxed state of the penis. Its length varies from 17.5 to 20 cm, and it is divided into three portions, the prostatic, membranous, and cavernous, the structure and relations of which are essentially different. Except during the passage of the urine or semen, the greater part of the urethral canal is a mere transverse cleft or slit, with its upper and under surfaces in contact. At the external orifice, the slit is vertical, in the membranous portion, irregular or stellate, and in the prostatic portion, somewhat arched. The prostatic portion, pars prostatica. The widest and most dilatable part of the canal is about 3 cm long. It runs almost vertically through the prostate from its base to its apex, lying near its anterior than its posterior surface. The form of the canal is spindle shaped, being wider in the middle than at either extremity, and narrowest below, where it joins the membranous portion. A transverse section of the canal, as it lies in the prostate, is horseshoe shaped, with the convexity directed forward. Upon the posterior wall or floor is a narrow longitudinal ridge, the urethral crest, veromontanum, formed by an elevation of the mucous membrane and its subjacent tissue. It is from 15 to 17 mm in length, and about 3 mm in height, and contains, according to cobalt, muscular and erectile tissue. When distended, it may serve to prevent the passage of the semen backward into the bladder. On either side of the crest is a slightly depressed fossa, the prostatic sinus, the floor of which is perforated by numerous apertures, the orifices of the prostatic ducts from the lateral lobes of the prostate. The ducts of the middle lobe open behind the crest. At the fore part of the urethral crest, below its summit, is a median elevation, the coliculus seminalis, upon or within the margins of which are the orifices of the prostatic utricle, and the slit-like openings of the ejaculatory ducts. The prostatic utricle, sinus popularis, forms a cul-de-sac about 6 mm long, which runs upward and backward in the substance of the prostate behind the middle lobe. Its walls are composed of fibrous tissue, muscular fibers and mucous membrane, and numerous small glands open on its inner surface. It was called by Weber the uterus masculinus, from its being developed from the united lower ends of the atrophied malaria ducts, and therefore homologous with the uterus and vagina in the female. The membranous portion, pars membranacea, is the shortest, least dilatable and, with the exception of the external orifice, the narrowest part of the canal. It extends downward and forward with a slight anterior concavity between the apex of the prostate and the bulb of the urethra, perforating the urogenital diaphragm about 2.5 cm below and behind the pubic. The hider part of the urethral bulb lies in opposition with the inferior fascia of the urogenital diaphragm, but its upper portion diverges somewhat from this fascia. The anterior wall of the membranous urethra is thus prolonged for a short distance in front of the urogenital diaphragm. It measures about 2 cm in length, while the posterior wall, which is between the two fascia of the diaphragm, is only 1.25 cm long. The membranous portion of the urethra is completely surrounded by the fibers of the sphincter urethrae membranaceae. In front of it, the deep dorsal vein of the penis enters the pelvis between the transverse ligament of the pelvis and the arcuate pubic ligament. On either side near its termination are the bulbul urethral glands. The cavernous portion, pars cavernosa, penile or spongy portion, is the longest part of the urethra and is contained in the corpus cavernosum urethra. It is about 15 cm long and extends from the termination of the membranous portion to the external urethral orifice. Commencing below the inferior fascia of the urogenital diaphragm, it passes forward and upward to the front of the symphysis pubis, and then in the flaccid condition of the penis it bends downward and forward. It is narrow and of uniform size in the body of the penis, measuring about 6 mm in diameter. It is dilated behind, within the bulb and again anteriorly, within the glands penis, where it forms the fossa navicularis urethrae. The external urethral orifice, orificium urethrae, externum medus urinarius, is the most contracted part of the urethrae. It is a vertical slit, about 6 mm long, bounded on either side by two small labiae. The lining membrane of the urethrae, especially on the floor of the cavernous portion, presents the orifices of numerous mucus glands and follicles situated in the submucous tissue, and named the urethral glands. Besides these are a number of small pit-like recesses, or lacunae, of varying sizes. Their orifices are directed forward, so that they may easily intercept the point of a catheter in its passage along the canal. One of these lacunae, larger than the rest, is situated on the upper surface of the fossa navicularis. It is called the lacuna magna. The bubble urethral glands open into the cavernous portion, about 2.5 cm, in front of the inferior fascia of the urogenital diaphragm. Structure. The urethra is composed of mucus membrane, supported by a submucous tissue, which connects it with the various structures through which it passes. The mucus coat forms part of the genitourinary mucus membrane. It is continuous with the mucus membrane of the bladder, ureters, and kidneys. Externally, with the integument, covering the glands penis, and is prolonged into the ducts of the glands which open into the urethra fizz, the bubble urethral glands and the prostate, and into the ductus deferentes and vesculae seminalis. Through the ejaculatory ducts. In the cavernous and membranous portions, the mucus membrane is arranged in longitudinal folds when the tube is empty. Small papillae are found upon it, near the external urethral orifice. Its epithelial lining is of the columnar variety, except near the external orifice, where it is squamous and stratified. The submucous tissue consists of a vascular erectile layer. Outside this is a layer of unstriped muscular fibers, arranged in a circular direction, which separates the mucus membrane and submucous tissue from the tissue of the corpus cavernosum urethrae. Congenital defects of the urethra occur occasionally. The one most frequently met with is where there is a cleft on the floor of the urethra, owing to an arrest of union in the middle line. This is known as hypospadius, and the cleft may vary in extent. The simplest and by far the most common form is where the deficiency is confined to the glands penis. The urethra ends at the point where the extremity of the prepuse joins the body of the penis in a small valve-like opening. The prepuse is also cleft on its undersurface and forms a sort of hood over the glands. There is a depression on the glands in the position of the normal metis. This condition produces no disability and requires no treatment. In more severe cases, the cavernous portion of the urethra is cleft throughout its entire length, and the opening of the urethra is at the point of junction of the penis and scrotum. The undersurface of the penis in the middle line presents a furrow lined by a moist mucus membrane, on either side of which is often more or less dense fibrous tissue stretching from the glands to the opening of the urethra, which prevents complete erection taking place. Great discomfort is induced during mixturition, and sexual connection is impossible. The condition may be remedied by a series of plastic operations. The worst form of this condition is where the urethra is deficient as far back as the perineum, and the scrotum is cleft. The penis is small and bound down between the two halves of the scrotum, so as to resemble a hypertrophied clitoris. The testes are often retained. The condition of parts therefore very much resembles the external organs of generation of the female, and many children the victims of this malformation have been brought up as girls. The house of the scrotum, deficient of testes, resemble the labia. The cleft between them looks like the orifice of the vagina, and the diminutive penis is taken for an enlarged clitoris. There is no remedy for this condition. A much more uncommon form of malformation is where there is an apparent deficiency of the upper wall of the urethra. This is named epispadias. The deficiency may vary in extent. When it is complete, the condition is associated with extraversion of the bladder. In less extensive cases, where there is no extraversion, there is an infundabiliform opening into the bladder. The penis is usually dwarfed and turned upward, so that the glands lie over the opening. Congenital structure is also occasionally met with, and in such cases, multiple structures may be present throughout the whole length of the cavernous portion. The female urethra. Urethra mulibris. The female urethra is a narrow, membranous canal about four centimeters long, extending from the internal to the external urethral orifice. It is placed behind the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downward and forward. It is slightly curved with the concavity directed forward. Its diameter, when undilated, is about six millimeters. It perforates the fascia of the urogenital diaphragm, and its external orifice is situated directly in front of the vaginal opening. And about 2.5 centimeters behind the glands clitoridus. The lining membrane is thrown into longitudinal folds, one of which, placed along the floor of the canal, is termed the urethral crust. Many small urethral glands open into the urethra. Structure. The urethra consists of three coats, muscular, erectile, and mucus. The muscular coat is continuous with that of the bladder. It extends the whole length of the tube, and consists of circular fibers. In addition to this, between the superior and inferior fascia of the urogenital diaphragm, the female urethra is surrounded by the sphincter urethrae membranesae, as in the male. A thin layer of spongy erectile tissue containing a plexus of large veins, intermixed with bundles of unstriped muscular fibers, lies immediately beneath the mucus coat. The mucus coat is pale. It is continuous externally with that of the vulva, and internally with that of the bladder. It is lined by stratified squamous epithelium, which becomes transitional near the bladder. Its external orifice is surrounded by a few mucus follicles. End of Section 32 Section 33 of Grey's Anatomy Part 5 This is a LibriVox recording. All LibriVox recordings are in the public domain. For more information or to volunteer, please visit LibriVox.org. Recording by Dr. Valerie Ross. Anatomy of the Human Body Part 5 by Henry Gray The male genital organs. Organa genitalia virilia. The male genitals include the testes, the ductus deferentes, the vesicularis seminalis, the ejaculatory ducts, and the penis, together with the following accessory structures, namely the prostate and the bulbo urethral glands. The testes and their coverings. The testes are two glandular organs which secrete the semen. They are suspended in the scrotum by the spermatic cords. At an early period of fetal life, the testes are contained in the abdominal cavity behind the parent neum. Before birth they descend to the inguinal canal, along which they pass with the spermatic cord. And, emerging at the subcutaneous inguinal ring, they descend into the scrotum, becoming invested in their course by coverings derived from the cirrus, muscular, and fibrous layers of the abdominal parietes, as well as by the scrotum. The coverings of the testes are the skin, cremaster, scrotum, dartos tunic, infundibula form fascia, intercural fascia, tunica vaginalis. The scrotum is a cutaneous pouch which contains the testes and parts of the spermatic cords. It is divided on its surface into two lateral portions by a ridge or raffae, which is continued forward to the under surface of the penis and backward along the middle line of the perineum to the anus. Of these two lateral portions, the left hangs lower than the right, to correspond with the greater length of the left spermatic cord. Its external aspect varies under different circumstances, thus under the influence of warmth and in old and debilitated persons it becomes elongated and flaccid, but under the influence of cold and in the young and robust it is short, corrugated, and closely applied to the testes. The scrotum consists of two layers, the integument and the dartos tunic. The integument is very thin of a brownish color and generally thrown into folds or rugae. It is provided with sebaceous follicles, the secretion of which has a peculiar odor, and is beset with thinly scattered crisp hairs, the roots of which are seen through the skin. The dartos tunic, tunica dartos, is a thin layer of non-striped muscular fibers, continuous around the base of the scrotum with the two layers of the superficial fascia of the groin and the perineum. It sends inward a septum which divides the scrotal pouch into two cavities for the testes and extends between the raffae and the under surface of the penis as far as its root. The dartos tunic is closely united to the skin externally, but connected with the sub-adjacent parts by delicate areolar tissue upon which it glides with the greatest facility. The intercural fascia, intercolumnar or external spermatic fascia is a thin membrane prolonged downward around the surface of the cord and testes. It is separated from the dartos tunic by loose areolar tissue. The cremaster consists of scattered bundles of muscular fibers connected together into a continuous covering by intermediate areolar tissue. The infundibula form fascia, tunica vaginalis comunus testis et foniculis bermatici is a thin layer which loosely invests the cord. It is a continuation downward of the transversalis fascia. The tunica vaginalis is described with the testes. Vessels and nerves. The arteries supplying the coverings of the testes are the superficial and deep external pudendal branches of the femoral, the superficial perineal branch of the internal pudendal and the cremasteric branch from the inferior epigastric. The veins follow the course of the corresponding arteries. The lymphatics end in the inguinal lymph glands. The nerves are the ilioinguinal and lumboinguinal branches of the lumbar plexus, the two superficial perineal branches of the internal pudendal nerve and the pudendal branch of the posterior femoral cutaneous nerve. The inguinal canal canalis inguinalis is described on page 418. The spermatic cord foniculis spermaticus extends from the abdominal inguinal ring where the structures of which it is composed converge to the back part of the testes. In the abdominal wall the cord passes obliquely along the inguinal canal lying at first beneath the obliquus internus and upon the fascia transversalis. But nearer the pubis it rests upon the inguinal and lacunar ligaments, having the aponeurosis of the obliquus externus in front of it and the inguinal falx behind it. It then escapes at the subcutaneous ring and descends nearly vertically into the scrotum. The left cord is rather longer than the right. Consequently the left testes hang somewhat lower than its fellow. Structure of the spermatic cord. The spermatic cord is composed of arteries, veins, lymphatics, nerves and the excretory duct of the testes. These structures are connected together by areolar tissue and invested by the layers brought down by the testes in its descent. The arteries of the cord are the internal and external spermatics and the artery to the ductus deference. The internal spermatic artery, a branch of the abdominal aorta, escapes from the abdomen at the abdominal inguinal ring and accompanies the other constituents of the spermatic cord along the inguinal canal and through the subcutaneous inguinal ring into the scrotum. It then descends to the testes and, becoming tortuous, divides into several branches, two or three of which accompany the ductus deference and supply the epididymus, anastomosing with the artery of the ductus deference. Others supply the substance of the testes. The external spermatic artery is a branch of the inferior epigastric artery. It accompanies the spermatic cord and supplies the coverings of the cord, anastomosing with the internal spermatic artery. The artery of the ductus deference, a branch of the superior vesicle, is a long slender vessel which accompanies the ductus deference ramifying upon its coats and anastomosing with the internal spermatic artery near the testes. The spermatic veins emerge from the back of the testes and receive tributaries from the epididymus. They unite and form a convoluted plexus, the plexus pimpiniformis, which forms the chief mass of the cord. The vessels composing this plexus are very numerous and ascend along the cord in front of the ductus deference. Below the subcutaneous inguinal ring, they unite to form three or four veins which pass along the inguinal canal and entering the abdomen through the abdominal inguinal ring coalesce to form two veins. These again unite to form a single vein which opens on the right side into the inferior vena cava at an acute angle and on the left side into the left renal vein at a right angle. The lymphatic vessels are described on page 713. The nerves are the spermatic plexus from the sympathetic joined by filaments from the pelvic plexus which accompany the artery of the ductus deference. The scrotum forms an admirable covering for the protection of the testes. These bodies lying suspended and loose in the cavity of the scrotum and surrounded by cirrus membrane are capable of great mobility and can therefore easily slip about within the scrotum and thus avoid injuries from blows or squeezes. The skin of the scrotum is very elastic and capable of great distention and on account of the looseness and amount of subcutaneous tissue the scrotum becomes greatly enlarged in cases of edema to which this part is especially liable as a result of its dependent position. The testes are suspended in the scrotum by the spermatic cords the left test is hanging somewhat lower than its fellow. The average dimensions of the testes are from 4 to 5 centimeters in length 2.5 centimeters in breadth and 3 centimeters in the anteroposterior diameter. Its weight varies from 10.5 to 14 grams. Each testes is of an oval form compressed laterally and having an oblique position in the scrotum. The upper extremity is directed forward and a little lateral word the lower backward and a little medial word the anterior convex border looks forward and downward the posterior or straight border to which the cord is attached the posterior border looks backward and upward. The anterior border and lateral surfaces as well as both extremities of the organ are convex, free, smooth and invested by the visceral layer of the tunica vaginalis the posterior border to which the cord is attached receives only a partial investment from that membrane lying upon the lateral edge of this posterior border is a long, narrow, flattened body named the epididymis the epididymis consists of a central portion or body an upper enlarged extremity the head, globus major and a lower pointed extremity the tail, globus minor which is continuous with the ductus deference the duct of the testis the head is intimately connected with the upper end of the testis by means of the efferent ductules of the gland the tail is connected with the lower end by cellular tissue and a reflection of the tunica vaginalis the lateral surface head and tail of the epididymis are free and covered by the cirrus membrane the body is also completely invested by it accepting along its posterior border while between the body and the testis is a pouch named the sinus of the epididymis digital fossa the epididymis is connected to the back of the testis by a fold of the cirrus membrane end of section 33 recording by Dr. Valerie Ross section 34 of Gray's Anatomy Part 5 this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org recording by Dr. Valerie Ross Anatomy of the Human Body Part 5 by Henry Gray the testis and their coverings appendages of the testis and epididymis on the upper extremity of the testis just beneath the head of the epididymis is a minute oval, sessile body the appendix of the testis heighteted of morgagni it is the remnant of the upper end of the mullerian duct on the head of the epididymis is a second small stalked appendage sometimes duplicated the appendix of the epididymis pedunculated heighteted and is usually regarded as a detached efferent duct the testis is invested by three tunics the tunica vaginalis tunica alveuginia and tunica vasculosa the tunica vaginalis tunica vaginalis propria testis is the cirrus covering of the testis it is a pouch of cirrus membrane derived from the saccus vaginalis of the peritoneum which in the fetus preceded the descent of the testis from the abdomen into the scrotum after its descent that portion of the pouch which extends from the abdominal inguinal ring to near the upper part of the gland becomes obliterated the lower portion remains as a shut sac which invests the surface of the testis and is reflected on to the internal surface of the scrotum hence it may be described as consisting of a visceral and a parietal lamina the visceral lamina or lamina visceralis covers the greater part of the testis and epididymis connecting the ladder to the testis by means of a distinct fold from the posterior border of the gland it is reflected on to the internal surface of the scrotum the parietal lamina or lamina parietalis is far more extensive than the visceral extending upward for some distance in front and on the medial side of the cord and reaching below the testis the inner surface of the tunica vaginalis is smooth and covered by a layer of endothelial cells the interval between the visceral and parietal lamina constitutes the cavity of the tunica vaginalis the obliterated portion of the sacus vaginalis may generally be seen as a fibrocellular thread lying in the loose areolar tissue around the spermatic cord sometimes this may be traced as a distinct band from the upper end of the inguinal canal where it is connected with the parietinium down to the tunica vaginalis sometimes it gradually becomes lost on the spermatic cord occasionally no trace of it can be detected in some cases it happens that the pouch of parietinium does not become obliterated but the sac of the parietinium may give rise to one of the varieties of oblique inguinal hernia in other cases the pouch may contract but not become entirely obliterated it then forms a minute canal leading from the parietinium to the tunica vaginalis the tunica albuginia is the fibrous covering of the testis it is a dense membrane of a bluish white color composed of bundles of white fibrous tissue which interlaces in every direction it is covered by the tunica vaginalis and at the points of attachment of the epididymis to the testis and along its posterior border where the spermatic vessels enter the gland it is applied to the tunica vasculosa over the glandular substance of the testis and at its posterior border is reflected into the interior of the gland forming an incomplete vertical septum called the mediastinum testis or corpus heimori the mediastinum testis extends from the upper extremity of the gland and is wider above than below from its front and sides numerous imperfect septa or trabeculi are given off which radiate toward the surface of the organ and are attached to the tunica albuginia they divide the interior of the organ into a number of incomplete spaces which are somewhat cone shaped being brought at their base at the surface of the gland and becoming narrower as they converge to the mediastinum supports the vessels induct of the testis in their passage to and from the substance of the gland the tunica vasculosa is the vascular layer of the testis consisting of a plexus of blood vessels held together by delicate ariolar tissue it clothes the inner surface of the tunica albuginia and the different septa in the interior of the gland and therefore forms an internal investment to all the spaces of which the gland is composed structure the glandular structure of the testis consists of numerous lobules their number in a single testis is estimated by Barris at 250 and by Krause at 400 they differ in size according to their position those in the middle of the gland being larger and longer the lobules are conical in shape the base being directed toward the circumference of the organ the apex toward the mediastinum each lobule is contained in one of the intervals between the fibrocepta which extend between the mediastinum testis and the tunica albuginia and consists of from one to three or more minute convoluted tubes the tubuli seminifere the tubules may be separately unraveled by careful dissection under water and may be seen to commence either by free secal ends or by anastomotic loops they are supported by loose connective tissue which contains here and there groups of interstitial cells containing yellow pigment granules the total number of tubules is estimated by louth at 840 and the average length of each is 70 to 80 centimeters their diameter varies from 0.12 to 0.3 millimeters the tubules are pale in color and early life but in old age they acquire a deep yellow tinge from containing much fatty matter each tubule consists of a basement layer formed of laminated connective tissue containing numerous elastic fibers with flattened cells between the layers and covered externally by a layer of flattened epithelioid cells within the basement membrane are epithelial cells arranged in several irregular layers which are not always clearly separated but which may be arranged in three different groups among these cells may be seen the spermatozoa in different stages of development lining the basement membrane and forming the outer zone is a layer of cubicle cells with small nuclei some of these enlarge to become spermatogonia the nuclei of some of the spermatogonia may be seen to be in process of indirect division or karyokinesis and in consequence of this daughter cells are formed which constitute the second zone the next layer is to be seen a number of larger polyhedral cells with clear nuclei arranged in two or three layers these are the intermediate cells or spermatocytes most of these cells are in a condition of karyokinetic division and the cells which result from this division form those of the next layer the spermatoblasts or spermatids the third layer of cells consists of the spermatoblasts or spermatids and each of these the spermatids are small polyhedral cells the nucleus of each of which contains half the usual number of chromosomes in addition to these three layers of cells others are seen which are termed the supporting cells or cells of sertoli they are elongated and columnar and project inward from the basement membrane toward the lumen of the tube as development of the spermatizoa precedes the latter group themselves around the inner extremities of the supporting cells the clear portion of the spermatid which is partly embedded in the supporting cell is differentiated to form the head of the spermatizoan while part of the cell protoplasm forms the middle piece and the tail is produced by an outgrowth from the double centriole of the cell ultimately the heads are liberated and the spermatizoa are set free the structure of the spermatizoa is described on pages 42 and 43 in the apices of the lobules the tubules become less convoluted assume a nearly straight course and unite together to form from 20 to 30 larger ducts of about 0.5 millimeters in diameter and these from their straight course are called tubuli recti the tubuli recti enter the fibrous tissue of the mediastinum and pass upward and backward forming in their ascent a close network of anastomosing tubes which are merely channels in the fibrostroma lined by flattened epithelium and having no proper walls this constitutes the reti testis at the upper end of the mediastinum the vessels of the reti testis terminate in from 12 to 15 or 20 ducts the ductuli efferentes they perforate the tunica albuginia and carry the seminal fluid from the testis to the epididymis their course is at first straight they then become enlarged and exceedingly convoluted and form a series of conical masses the coni vasculosi which together constitute the head of the epididymis each cone consists of a single convoluted duct from 15 to 20 centimeters in length the diameter of which gradually decreases from the testis to the epididymis opposite the bases of the cones the efferent vessels open at narrow intervals into a single duct which constitutes by its complex convolutions the body and tail of the epididymis when the convolutions of this tube are unraveled it measures upward of 6 meters in length it decreases in diameter and thickness as it approaches the ductus deference the convolutions are held together by fine areolar tissue and by bands of fibrous tissue the tubuli recti have very thin walls like the channels of the reti testis they are lined by a single layer of flattened epithelium the ductuli efferentes and the tube of the epididymis have walls of considerable thickness on account of the presence in them of muscular tissue which is principally arranged in a circular manner these tubes are lined by columnar ciliated epithelium peculiarities the testis developed in the lumbar region may be arrested or delayed in its transit to the scrotum cryptorchism it may be retained in the abdomen or it may be arrested at the abdominal inguinal ring or in the inguinal canal or it may just pass out of the subcutaneous inguinal ring without finding its way to the bottom of the scrotum when retained in the abdomen it gives rise to no symptoms other than the absence of the testis from the scrotum but when it is retained in the inguinal canal it is subjected to pressure and pain the retained testis is probably functionally useless so that a man in whom both testis are retained anarchism is sterile though he may not be impotent the absence of one testis is termed monarchism when a testis is retained in the inguinal canal it is often complicated with congenital hernia the funicular process of the peritoneum not being obliterated in addition to the cases above where the organ may rest in the descent of the testis this organ may descend through the inguinal canal but may miss the scrotum and assume some abnormal position the most common form is where the testis emerging at the subcutaneous inguinal ring slips down between the scrotum and the thigh and comes to rest in the perineum this is known as perineal ectopia testis with each variety of abnormality in the genital hernia or if a hernia be not actually present the funicular process is usually patent and almost invariably so if the testis is in the inguinal canal the testis finally reaching the scrotum may occupy an abnormal position in it it may be inverted so that its posterior or attached border is directed forward and the tunica vaginalis is situated behind fluid collections to these the term hydrocele is applied the most common form is the ordinary vaginal hydrocele in which the fluid is contained in the sac of the tunica vaginalis which is separated in its normal condition from the perineal cavity by the whole extent of the inguinal canal in another form the congenital hydrocele the fluid is in the sac of the tunica vaginalis but this cavity communicates with the general perineal cavity its tubular process remaining pervious a third variety known as an infantile hydrocele occurs in those cases where the tubular process becomes obliterated only at its upper part at or near the abdominal inguinal ring it resembles the vaginal hydrocele except as regards its shape the collection of fluid extending up to the cord into the inguinal canal fourthly the funicular process may become obliterated both at the abdominal inguinal ring and above the epididymis leaving a central un obliterated portion which may become distended with fluid giving rise to a condition known as the insisted hydrocele of the cord end of section 34 recording by Dr. Valerie Ross the ductus deference or the vast deference or the seminal duct the ductus deference the excretory duct of the testis is the continuation of the canal of the epididymis commencing at the lower part of the tail of the epididymis it is at first very tortuous but gradually becoming less twisted it ascends along the posterior border of the testis and medial side of the epididymis and as a constituent of the spermatic cord traverses the inguinal canal to the abdominal inguinal ring here it separates from the other structures of the cord curves around the lateral side of the inferior epigastric artery and ascends for about 2.5 cm in front of the external iliac artery it is next directed backward and slightly downward and crossing the external iliac vessels obliquely enters the pelvic cavity where it lies between the peritoneal membrane and the lateral wall of the pelvis and descends on the medial side of the obliterated umbilical artery and the obturator nerve and vessels it then crosses in front and reaching the medial side of this tube bends to form an acute angle and runs medial word and slightly forward between the fundus of the bladder and the upper end of the seminal vesicle reaching the medial side of the seminal vesicle it is directed downward and medial word in contact with it gradually approaching the opposite ductus here it lies between the fundus of the bladder and the rectum where it is enclosed together with the seminal vesicle and the recto vesicle portion of the fascia and opalvina lastly it is directed downward to the base of the prostate where it becomes greatly narrowed and is joined at an acute angle by the duct of the seminal vesicle to form the ejaculatory duct which traverses the prostate behind its middle lobe and opens into the prostatic portion of the urethra close to the orifice of the prostatic utricle which presents a hard and cord-like sensation to the fingers and is of cylindrical form its walls are dense and its canal is extremely small at the fundus of the bladder it becomes enlarged and tortuous and this portion is termed the ampola a small triangular area of the fundus of the bladder between the ductus deferentis laterally and the bottom of the recto vesicle excavation of peritoneum above is in contact with the rectum ductule aberrantis a long narrow tube the ductulus aberrantis inferior or vast aberrantis of haller is occasionally found connected with the lower part of the canal of the epididymis or with the commencement of the ductus deferentis its length varies from 3.5 to 35 cm and it may become dilated toward its extremity more commonly it retains the same diameter throughout and the structure is similar to that of the ductus deferentis occasionally it is found unconnected with the epididymis a second tube the ductulus aberrantis superior occurs in the head of the epididymis it is connected with the reti testis paradidymis or organ of geraldes this term is applied to a small collection of convoluted tubules situated in front of the lower part of the epididymis these tubes are lined with columnar ciliated epithelium and probably represent the remains of a part of the wolfian body structure the ductus deferentis consists of three coats number one an external or areolar coat number two a muscular coat which in the greater portion of the tube consists of two layers of unstriped muscular fiber and outer longitudinal at the commencement of the ductus there is a third layer consisting of longitudinal fibers placed internal to the circular stratum between it and the mucous membrane number three an internal or mucous coat which is pale and arranged in longitudinal folds the mucous coat is lined by columnar epithelium which is non ciliated throughout the greater part of the tube a variable portion of the testicular end of the tube and the rest of the superficial layer are ciliated next chapter the vesiculi seminalis or seminal vesicles the vesiculi seminalis are two lobulated membranous pouches placed between the fundus of the bladder and the rectum serving as reservoirs for the semen and secreting a fluid to be added to the secretion of the testes each sac is somewhat pyramidal informed of being directed backward upward and lateral word it is usually about 7.5 centimeters long but varies in size not only in different individuals but also in the same individual on the two sides the anterior surface is in contact with the fundus of the bladder extending from near the termination of the ureter to the base of the prostate the posterior surface rests upon the rectum from which it is separated by the recto vesicle fascia the vesicles diverge from each other and are in relation with the ductus deferentis and the terminations of the ureters and are partly covered by peritneum the lower extremities are pointed and converge toward the base of the prostate where each joins with the corresponding ductus deference to form the ejaculatory duct along the medial margin of each vesicle runs the ampoula of the ductus deference each vesicle consists of a single tube coiled upon itself giving off several irregular cecal diverticula the separate coils as well as the diverticula are connected together by fibrous tissue when uncoiled the tube is about the diameter of a quill and varies in length from 10 to 15 centimeters it ends posteriorly in a cul-de-sac its anterior extremity becomes constricted into a narrow straight duct which joins with the corresponding ductus deference to form the ejaculatory duct with its structure the vesiculi seminalis are composed of three coats an external or areolar coat a middle or muscular coat thinner than in the ductus deference and arranged in two layers an outer longitudinal and an inner circular an internal or mucus coat which is pale of a whitish brown color and presents a delicate reticular structure the epithelium is columnar and in the diverticula goblet cells are present which increases the bulk of the seminal fluid vessels and nerves the arteries supplying the vesiculi seminalis are derived from the middle and inferior vesicle and middle hemorrhoidal the veins and lymphatics accompany the arteries the nerves are derived from the pelvic plexuses the next chapter is the ejaculatory ducts or ductus ejaculatory eye the ejaculatory ducts are two in number one on either side of the middle line each is formed by the union of the duct from the vesicula seminalis with the ductus deference and is about two centimeters long they commence at the base of the prostate and run forward and downward between its middle and lateral lobes and along the sides of the prostatic utricle to end by separate slit like orifices close to or just within the margins of the utricle the ducts diminishing size also converge toward their terminations structure the coats of the ejaculatory ducts are extremely thin they are an outer fibrous layer which is almost entirely lost after the entrance of the ducts into the prostate a layer of muscular fibrous consisting of a thin outer circular and an inner longitudinal layer and mucous membrane end of section 35 recording by Dr. Valerie Ross section 36 of grays and anatomy part 5 this is a LibriVox recording all LibriVox recordings are in the public domain for more information or to volunteer please visit LibriVox.org reading by Bologna Times anatomy of the human body part 5 by Henry Gray the penis the penis is a pendulous organ suspended from the front and sides of the pubic arch and containing the greater part of the urethra in the flaccid condition it is cylindrical in shape but when erect assumes the form of a triangular prism with rounded angles one side of the prism forming the dorsum it is composed of three cylindrical masses of cavernous tissue bound together by fibrous tissue and covered with skin two of the masses are lateral and are known as the corpora cavernosa penis the third is median and is termed the corpus cavernosa urethra the corpora cavernosa penis form the greater part of the substance of the penis for their anterior three-fourths they lie in intimate opposition with one another but behind they diverge in the form of two tapering processes known as the crora which are firmly connected to the ramy of the pubic arch each cross begins by a blunt pointed process in front of the tuberosity of the ischium just before it meets its fellow it presents a slight enlargement named by cobalt the bulb of the corpus cavernosa penis beyond this point the cross undergoes a constriction and merges into the corpus cavernosa proper which retains a uniform diameter to its anterior end each corpus cavernosa penis ends abruptly in a rounded extremity some distance from the point of the penis the corpora cavernosa penis are surrounded by a strong fibrous envelope consisting of superficial and deep fibers the superficial fibers are longitudinal in direction and form a single tube which encloses both corpora the deep fibers are arranged around each corpus and formed by their junction in the median plane the septum of the penis this is thick and complete behind but it is imperfect in front where it consists of a series of vertical bands arranged like the teeth of a comb it is therefore named the septum pectiniforme the corpus cavernosum urethrae corpus spongiosum contains the urethra behind it is expanded to form the urethral bulb and lies in opposition with the inferior fascia of the urogenital diaphragm from which it receives a fibrous investment the urethra enters the bulb nearer to the upper than to the lower surface on the latter there is a median sulcus from which a thin fibrous septum projects into the substance of the bulb and divides it imperfectly into two lateral lobes or hemispheres the portion of the corpus cavernosum urethrae in front of the bulb lies in a groove on the under surface of the conjoined corporea cavernosa penis it is cylindrical in form and tapers slightly from behind forward its anterior end is expanded in the form of an obtuse cone flattened from above downward this expansion termed the glans penis is molded on the rounded ends of the corporea cavernosa penis extending farther on their upper than on their lower surfaces at the summit of the glands is the slit like vertical external urethral orifice the circumference of the base of the glands forms a rounded projecting border the corona glandus overhanging a deep retro glandular sulcus behind which is the neck of the penis for descriptive purposes it is convenient to divide the penis the root the body and the extremity the root eredics penis of the penis is tri-radiate in form consisting of the diverging corporea one on either side in the median urethral bulb each cross is covered by the ischiocavernosis while the bulb is surrounded by the bulbulcavernosis the root of the penis lies in the perineum and the fascia of colis in addition to being attached to the fascia in the pubic ramy it is bound to the front of the synthesis pubis by the fundiform and suspensory ligaments the fundiform ligament springs from the front of the sheath of the rectus abdominis and the linia alba it splits into two vesicule which encircle the root of the penis the upper fibers of the suspensory ligament the lower end of the linia alba and the lower fibers from the synthesis pubis together they form a strong fibers band which extends the upper surface of the root where it blends with the fascia of the organ the body corpus penis extends from the root to the ends of the corporea cavernosa penis and in it these corporea cavernosa are intimately bound to one another a shallow groove on the upper surface lodges the deep dorsal vein of the penis while a deeper and wider groove between them on the under surface contains the corpus cavernosa urethrae the body is ensheathed by fascia which is continuous above the fascia of scarpa and below with the dortus tunic of the scrotum and the fascia of colis the extremity is formed by the glands penis on the anterior end of the corpus cavernosa urethrae it is separated from the body by the constricted neck which is overhung by the corona glandus the integument covering the penis is remarkable for its thinness its dark color its looseness of connection with the deeper parts of the organ and its absence of adipose tissue at the root of the penis it is continuous with that scrotum and perineum at the neck it leaves the surface and becomes folded upon itself to form the prepuse or foreskin the internal layer of the prepuse is directly continuous along the line of the neck with the integument over the glands immediately behind the external urethral orifice it forms a small secondary reduplication attached along the bottom of the urethrae which extends from the metis to the neck this fold is turned the frenulum of the prepuse the integument covering the glands is continuous with the urethral mucus membrane at the orifice it is devoid of heres but projecting from its free surface are a number of small highly sensitive papulae scattered glands on the corona neck the preputial glands have been described they secrete a sebaceous material of very peculiar odor which probably contains casein and readily undergoes decomposition when mixed with discarded epithelial cells it is called smegma the prepuse covers a variable amount of the glands and is separated from it by a potential sac the preputial sac which presents two shallow one on either side of the frenulum structure of the penis from the internal surface of the fibrous envelope of the corpora cavernosa penis as well as from the sides of the septum numerous bands or cords are given off which cross the interior of these capora, cavernosa and all directions subdividing them into a number of separate compartments and giving the entire structure a spongy appearance these bands and cords are called trapeculae and consist of white fibrous tissue elastic fibers and plain muscular fibers in them are contained numerous arteries and nerves the component fibers which form the trapeculae are larger and stronger around the circumference than at the centers of the corpora cavernosa they are also thicker behind than in front or at the center than at the circumference their long diameters being directed transversely they are filled with blood and are lined by a layer of flattened cells similar to the endothelial lining of veins the fibrous envelope of the corpus cavernosum urethrae is thinner, whiter in color and more elastic than that of the corpora cavernosa penis the trapeculae are more delicate nearly uniform in size between them smaller than in the corpora cavernosa penis their long diameters for the most part corresponding with that of the penis the external envelope or outer coat of the corpus cavernosum urethrae is formed partly of unstriped muscular fibers and a layer of the same tissue immediately surrounds the canal of the urethrae vessels and nerves the arteries bringing the blood deep arteries of the penis and branches from the dorsal arteries of the penis which perforate the fibrous capsule along the upper surface especially near the four part of the organ on entering the cavernous structure the arteries divide into branches which are supported and enclosed by the trapeculae some of these arteries end in capillary network the branches of which open directly into the cavernous spaces tendril like appearance and form convoluted and somewhat dilated vessels which were named by moeller helicine arteries they open into the spaces and from them are also given off small capillary branches to supply the trapeculae structure they are bound down in the spaces by fine fibrous processes and are most abundant in the back part of the corpora cavernosa this is returned by a series of vessels some of which emerge in considerable numbers from the base of the glans penis and converge on the dorsum of the organ to form the deep dorsal vein others pass out on the upper surface of the corpora cavernosa and join the same vein some emerge from the under surface of the corpora cavernosa penis and receiving branches from the corpus cavernosa urethrae wind around the sides of the penis and in the deep dorsal vein but the greater number pass out at the root of the penis and join the prostatic plexus the lymphatic vessels of the penis are described on page 713 the nerves are derived from the pudendal nerve and the pelvic plexuses on the glans and bulb some filaments of the cutaneous nerves have peccinian bodies connected with them and according to Krause in peculiar end bulbs footnote 178 Staita, Comptes rendos du XII Congress Internationale de Medicine, Moscow, 1897 asserts that glans are never found on the corona glandis and that what have hitherto been mistaken for glans are really large papillae and footnote end of section 36 Chapter 37 of Grey's Anatomy Part 5 This is a LibriVox recording All LibriVox recordings are in the public domain For more information or to volunteer please visit LibriVox.org Recording by David Lawrence Anatomy of the Human Body Part 5 by Henry Grey 37 The Prostate Bulbul urethral glans 3C6 The Prostate Prostata Prostate Gland The Prostate is a firm partly glandular and partly muscular body which is placed immediately below the internal urethral orifice and around the commencement of the urethra it is situated in the pelvic cavity below the lower part of the symphysis pubis above the superior fascia and in front of the rectum through which it may be distinctly felt especially when enlarged it is about the size of a chestnut and somewhat conical in shape and presents for examination a base an apex an interior a posterior and two lateral surfaces the base is directed upward and is applied to the inferior surface of the bladder with the bladder wall the urethra penetrates it nearer its anterior than its posterior border the apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm surfaces the posterior surface fascia's posterior is flattened from side to side and slightly convex from above downward in its sheath and some loose connective tissue and is distant about 4 cm from the anus near its upper border there is a depression through which the two ejaculatory ducts enter the prostate this depression serves to divide the posterior surface into a lower, larger and an upper smaller part the upper smaller part constitutes the middle lobe of the prostate it varies greatly in size and in some cases is destitute of glandular tissue the lower, larger portion sometimes presents a shallow median furrow which imperfectly separates it into a right and a left lateral lobe these form the main mass of the gland and are directly continuous with each other behind the urethra in front of the urethra they are connected by a band which is named the isthmus it exists of the same tissues as the capsule and is devoid of glandular substance the anterior surface feces anterior measures about 2.5 cm from above downward but is narrow and convex from side to side it is placed about 2 cm behind the pubic symphysis from which it is separated by a plexus of veins and a quantity of loose fat it is connected to the pubic bone and it has a prosthetic ligaments the urethra emerges from this surface a little above and in front of the apex of the gland the lateral surfaces are prominent and are covered by the interior portions of the levatoris anni which are however separated from the gland by a plexus of veins the prostate measures about 4 cm transversely at the base 2 cm in its anterior diameter and 3 cm in its vertical diameter its weight is about 8 g it is held in its position by the pubic prosthetic ligaments by the superior fascia of the urogenital diaphragm which invests the prostate and the commencement of the membranous portion of the urethra and by the anterior portions of the levatoris anni which pass backwards from the pubis and embrace the sides of the prostate these portions of the levatoris anni from the support they afford to the prostate are named the levatoris prostatei the prostate is perforated by the urethra and the ejaculatory ducts the urethra usually lies along the junction of its interior with its middle third the ejaculatory ducts pass obliquely downward and forward through the posterior part of the prostate and open into the prostatic portion of the urethra the prostate is immediately enveloped by a thin but firm fibrous capsule distinct from that derived from the fascia endopalvina and separated from it by a plexus of veins this capsule is firmly adherent to the prostate and is structurally continuous with the stroma of the gland being composed of the same tissues vis non-striped muscle and fibrous tissue the substance of the prostate is of a pale reddish-gray color of great density and not easily torn it consists of glandular substance and muscular tissue the muscular tissue according to Kroliker constitutes the proper stroma of the prostate the connective tissue being very scanty and simply forming between the muscular fibers thin trabecula in which the vessels and nerves of the gland ramify the muscular tissue is arranged as follows immediately beneath the fibrous capsule is a dense layer which forms an investing sheath for the gland secondly around the urethra as it lies in the prostate is another dense layer of circular fibers continuous above with the internal layer of the muscular coat of the bladder and blending below with the fibers surrounding the membranous portion of the muscular tissue which decosate freely form meshes in which the glandular structure of the organ is embedded in that part of the gland which is situated in front of the urethra the muscular tissue is especially dense and there is here little or no gland tissue while in that part which is behind the urethra the muscular tissue presents a wide meshed structure which is densest at the base of the gland that is near the bladder and it is sponge like toward the apex of the organ the glandular substance is composed of numerous follicular pouches the lining of which frequently shows pepillary elevations the follicles open into elongated canals which join to form from 12 to 20 small excretory ducts they are connected together by areolar tissue supported by prolongations which are closed in a delicate capillary plexus the epithelium which lines the canals and the terminal vesicles is of the columnar variety the prosthetic ducts open into the floor of the prosthetic portion of the urethra and are lined by two layers of epithelium the inner layer consisting of columnar and the outer of small cubicle cells small colloid masses vessels and nerves the arteries supplying the prostate are derived from the internal pudental inferior vesicle and middle hemorrhoidal its veins form a plexus around the sides and base of the gland they receive in front the dorsal vein of the penis and end in the hypogastric veins the nerves are derived from the pelvic plexus 3C7 the bubble urethral glands glanduli bubble urethralis copers glands the bubble urethral glands are two small rounded and somewhat lobulated bodies of a yellow color about the size of peas placed behind and lateral to the membranous portion of the urethra between the two layers of the fascia of the urogenital diaphragm along the inter urethra membranase their existence is said to be constant they gradually diminish in size as age advances the excretory duct of each gland nearly 2.5 cm long passes obliquely forward beneath the mucous membrane and opens by a minute orifice on the floor of the cavernous portion of the urethra about 2.5 cm in front of the urogenital diaphragm structure it is made up of several lobules held together by a fibrous investment each lobule consists of a number of acine lined by columnar epithelial cells opening into one duct which joins with the ducts of other lobules outside the gland to form the single excretory duct End of Chapter 37 Section 38 of Grese Anatomy Part 5 This is a LibriVox recording All LibriVox recordings are in the public domain For more information or to volunteer please visit LibriVox.org Reading by Bologna Times Anatomy of the Human Body Part 5 by Henry Gray Female genital organs ovaries uterine tube Female genital organs ovaries uterine tube The female genital organs consist of an internal and an external group The internal organs are situated within the pulvis and consist of the ovaries the uterine tubes the uterus and the vagina The external organs are placed below the urogenital diaphragm and below and in front of the pubic arch They comprise the Mons pubis the Elabia majora at Manora pudendi bulbous vestibule and the greater vestibular glands The ovaries ovaria The ovaries are homologous with the testes in the male They are two nodular bodies situated one on either side of the uterus in relation to the lateral wall of the pulvis and attached to the back of the broad ligament of the uterus behind and below the uterine tubes The ovaries are of a different color and present either a smooth or a puckered uneven surface They are each about 4 cm in length 2 cm in width and about 8 mm in thickness and weigh from 2 to 3.5 g Each ovary presents a lateral and a medial surface an upper or tubal and a lower or uterine extremity and an anterior or mesovarion and a posterior free border It lies in a shallow depression named the ovarian fossa on the lateral wall of the pulvis This fossa is bounded above by the external iliac vessels in front by the obliterated umbilical artery and behind by the ureter The exact position of the ovary has been the subject of considerable difference of opinion and the description here given applies to the ovary of the Nola Paris woman The ovary becomes displaced during the first pregnancy and probably never again returns to its original position In the erect posture the long axis of the ovary is vertical The tubal extremity is near the external iliac vein To it are attached the ovarian fembria of the uterine tube and a fold of peritoneum of the ovary which is directed upward over the iliac vessels and contains the ovarian vessels The uterine end is directed downward toward the pelvic floor It is usually narrower than the tubal and is attached to the lateral angle of the uterus immediately behind the uterine tube by a rounded cord termed the ligament of the ovary which lies within the broad ligament and contains some non-striped muscular fibers in contact with the parietal peritoneum which lines the ovarian fossa The medial surface is to a large extent covered by the fembriated extremity of the uterine tube The mesovarian border is straight and is directed toward the obliterated umbilical artery and is attached to the back of the broad ligament by a short fold named the mesovarium Between the two layers and nerves pass to reach the hyalum of the ovary The free border is convex and is directed toward the ureter The uterine tube arches over the ovary running upward in relation to its mesovarian border then curving over its tubal pole and finally passing downward on its free border and medial surface Epulphuron, parivarium organ of Rosenmuller The epulphuron lies in the mesosal punks between the ovary and the uterine tube and consists of a few short tubals ductuli transversi which converge toward the ovary while their opposite ends open into a rudimentary duct the ductus lungitudinalis epulphuri duct of Gartner Peruferon consists of a few scattered rudimentary tubules best seen in the child situated in the broad ligament between the epulphuron and the uterus The ductuli transversi of the epulphuron and the tubules of the Porofuron are remnants of the tubules of the Wolfian body or meso nephros the ductus lungitudinalis epulphura epulphur is a persistent portion of the Wolfian duct In the fetus the ovaries are situated like the testes in the lumbar region near the kidneys but they gradually descend into the pelvis Structure The surface of the ovary is covered by a layer of columnar cells which constitutes the germinal epithelium of wall-diar The epithelium gives to the ovary a dull gray color as compared with the shining smoothness of the peritoneum epithelium of the peritoneum and the columnar cells which cover the ovary is usually marked by a line around the anterior border of the ovary The ovary consists of a number of vesicular ovarian follicles embedded in the meshes of a stroma or framework The stroma is a peculiar soft tissue abundantly supplied with blood vessels consisting for the most part of the cell with a small amount of ordinary connective tissue These cells have been regarded by some anatomists as unstriped muscle cells which, indeed, they most resemble by others as connective tissue cells On the surface of the organ this tissue is much condensed and forms a layer tunica albigenia composed of short connective tissue fibers with fusiform cells of the ovary may contain interstitial cells resembling those of the testes vesicular ovarian follicles graphian follicles Upon making a section of an ovary, numerous round transparent vesicles of various sizes are to be seen They are the follicles or ovisachs containing the ova Immediately beneath the superficial covering is a layer of stroma which are a large number of minute vesicles of uniform size about 0.25 mm in diameter These are the follicles in their earliest condition and the layer where they are found has been termed the cortical layer They are especially numerous in the ovary of the young child After puberty and during the whole of the child bearing period they are also found in the cortical layer and small numbers and also corporealutea the remains of follicles which have burst and are undergoing atrophy and absorption Beneath the superficial stratum other large and more or less mature follicles are founded embedded in the ovarian stroma These increase in size as they recede from the surface toward a highly vascular substance Zona vasculosa This stroma forms the tissue of the hylum by which the ovary is attached and through which the blood vessels enter it does not contain any follicles The larger follicles consist of an external fibrovascular coat connected with the surrounding stroma of the ovary by a network of blood vessels and an internal coat of nucleated cells called the membranogranulosa At one part of the mature follicle the cells of the membranogranulosa are collected into a mass which projects into the cavity of the follicle This is termed the discus proligerus and in it the ovum is embedded The follicle contains a transparent albuminous fluid The development and maturation of the follicles continue uninterruptedly from puberty to the end of the fruitful period of women's life while their formation commences before birth Before puberty the ovaries are small and the follicles contained in them are disposed in a comparatively thick layer in the cortical substance Here they present the appearance of a large number of minute closed vesicles Many, however, never attain full development but shrink and disappear At puberty the ovaries enlarge and become more vascular The follicles are developed in greater abundance and their ova are capable of fecundation Discharge of the ovum The follicles after attaining a certain stage of development gradually approach the surface of the ovary and burst The ovum and fluid contents of the follicle are liberated on the exterior of the ovary and carried into the uterine tube by currents set up by the movements of the cilia covering the mucous membrane of the fimbriac Corpus luteum After the discharge of the ovum the aligning of the follicle is thrown into folds and vascular processes grow inward from the surrounding tissue In this way the ovary is formed It consists at first of a radial arrangement of yellow cells with blood vessels and lymphatic spaces and later it merges with the surrounding stroma Vessels and nerves The arteries of the ovaries and uterine tubes are the ovarian from the aorta Each anastomosis freely and others which traverse the mesovarium and enter the hyalum of the ovary The veins emerge from the hyalum in the form of a plexus the pampiniform plexus The ovarian vein is formed from this plexus and leaves the pelvis in company with the artery The nerves are derived from the hypogastric or pelvic plexus and from the ovarian plexus the uterine nerves footnote 179 for a description of the ovum c-page 38 and footnote the uterine tube tuba uterina fallopian tube ovaduct The uterine tubes convey the ova from the ovaries to the cavity of the uterus They are two in number one on either side situated in the upper margin to the side of the pelvis Each tube is about ten centimeters long and is described as consisting of three portions One, the isthmus or medial constricted third Two, the ampule or intermediate dilated portion which curves over the ovary and three, the infundibulum with its abdominal ostium surrounded by fimbriae one of which the ovarium fimbriae the uterine tube is directed lateral as far as the uterine pole of the ovary and then ascends along the basalvarian border of the ovary to the tubal pole over which it arches finally it turns downward and ends in relation to the free border and medial surface of the ovary The uterine opening is minute and will only admit a fine bristle The abdominal opening is somewhat larger in connection with the fimbriae of the uterine tube or with the broad ligament close to them there are frequently one or more small pedunculated vessels These are termed the appendices vesculose Hidetids of morgani Structure The uterine tube consists of three coats cirrus, muscular and mucus The external or cirrus coat is peritoneal or muscular coat consists of an external longitudinal and an internal circular layer of non-striped muscular fibers continuous with those of the uterus The internal or mucus coat is continuous with the mucus lining of the uterus and at the abdominal osteum of the tube with the peritoneum it is thrown into longitudinal folds which in the ampula are much more extensive The lining epithelium is columnar and ciliated This form of epithelium is also found on the inner surface of the fimbriae which while on the outer or cirrus surfaces of these processes the epithelium gradually emerges from the endothelium of the peritoneum Fertilization of the ovum is believed to occur in the tube and the fertilized ovum is then normally passed on into the uterus The ovum however may adhere to and undergo development in the uterine tube giving rise to the commonest variety of ectopic gestation In such cases the amnion and corion are formed but a true vestigia is never present and the gestation usually ends by extrusion of the ovum through the abdominal osteum although it is not uncommon to needle cavity this being accompanied by severe hemorrhage and needing surgical interference End of Section 38 Section 39 of Grey's Anatomy Part 5 This is a LibriVox recording All LibriVox recordings are in the public domain For more information or to volunteer please visit LibriVox.org Recorded by Larianne Walden Anatomy of the Human Body Part 5 by Henry Gray The uterus is a hollow, thick walled, muscular organ situated deeply in the pelvic cavity between the bladder and rectum into its upper part the uterine tubes open one on either side while below its cavity communicates with that of the vagina When the ovum are discharged from the ovaries they are carried to the uterine cavity through the uterine tubes If an ovum be fertilized it is normally retained in the uterus until prenatal development is completed the uterus undergoing changes in size and structure to accommodate itself to the needs of the growing embryo After parturition the uterus returns almost to its former condition but certain traces of its enlargement remains It is necessary therefore to describe as the type form the adult virgin uterus and then to consider the modifications which are affected In this state the uterus is flattened enteroposteriorly and is piriform in shape with the apex directed downward and backward It lies between the bladder in front and the pelvic or sigmoid colon and rectum behind and is completely within the pelvis so that its base is below the level of the superior pelvic aperture Its upper part is suspended by the broad and the round ligaments while its lower portion is embedded in the fibrous tissue The long axis of the uterus usually lies approximately in the axis of the superior pelvic aperture but as the organ is freely movable its position varies with the state of distention of the bladder and rectum except when much displaced by a fully distended bladder it forms a forward angle with the vagina since the axis of the vagina corresponds to the axes of the cavity and inferior aperture of the pelvis The uterus measures about 7.5 cm in length 5 cm in breadth at its upper part and nearly 2.5 cm in thickness It weighs from 30 to 40 grams It is divisible into two portions On the surface about midway between the apex and base is a slight constriction known as the isthmus and corresponding to this in the interior is a narrowing of the uterine cavity of the uterus The portion above the isthmus is termed the body and that below the cervix The part of the body which lies above a plane passing through the points of entrance of the uterine tubes is known as the fundus body corpus uteri The body gradually narrows from the fundus to the isthmus The vesicle or anterior surface faciase vesicalis is flattened and covered by peritoneum which is formed the vesico uterine excavation The surface lies in apposition with the bladder The intestinal or posterior surface faciase intestinalis is convex transversely and is covered by peritoneum which is continued down onto the cervix and vagina It is in relation with the sigmoid colon from which it is usually separated by some coils of small intestine The fundus is convex in all directions and covered by peritoneum continuous with that on the vesicle and intestinal surfaces On it rests some coils of small intestine and occasionally the distended sigmoid colon The lateral margins Margot lateralis are slightly convex At the upper end of each the uterine tube pierces the uterine wall Below and in front of this point the round ligament of the uterus is fixed while behind it is the attachment of the ligament of the ovary These three structures lie within a fold of peritoneum which is reflected from the margin of the uterus to the wall of the pelvis and is named the broad ligament Cervix Cervix uteri neck The cervix is the lower constricted segment of the uterus It is somewhat conical in shape with its truncated apex directed downward and backward but is slightly wider in the middle and below Owing to its relationships it is less freely movable than the body so that the latter may bend on it The long axis of the cervix is therefore seldom in the same straight line as the long axis of the body The long axis of the uterus as a whole presents the form of a curved line with its concavity forward or in extreme cases may present an angular bend at the region of the ismus which connects through the interior wall of the vagina which divides it into an upper supravaginal portion and a lower vaginal portion The supravaginal portion Portio supravaginalis is separated in front from the bladder by fibrous tissue which extends also onto its sides and lateralward between the layers of the broad ligaments The uterine arteries reach the margins of the cervix and the perimeter runs downward and forward in it at a distance of about 2 cm from the cervix Posteriorly, the supravaginal cervix is covered by peritoneum which is prolonged below onto the posterior vaginal wall when it is reflected onto the rectum forming the recto uterine excavation It is in relation with the rectum from which it may be separated by coils of small intestine The vaginal portion of the cervix projects free into the anterior wall of the vagina between the anterior and posterior vornices On its rounded extremity is a small, depressed, somewhat circular aperture the external orifice of the uterus through which the cavity of the cervix communicates with that of the vagina The external orifice is bounded by two lips It projects lower than the posterior Normally both lips are in contact with the posterior vaginal wall Interior of the uterus The cavity of the uterus is small in comparison with the size of the organ The cavity of the body, cavum uteri, is a mere slit flattened enteroposteriorly It is triangular in shape the base being formed by the internal surface of the fundus between the orifices of the uterine tubes The apex by the internal orifice of the uterus through which the cavity of the body communicates with the canal of the cervix The canal of the cervix, canalis cervisus uteri is somewhat fusiform flattened from before backward and broader at the middle than at either extremity It communicates above through the internal orifice with the cavity of the body and below through the external orifice The wall of the canal presents an anterior and a posterior longitudinal ridge from each of which proceed a number of small oblique columns the palmate folds giving the appearance of branches from the stem of a tree To this arrangement the name Arborviti uterina is applied The folds on the two walls are not exactly opposed but fit between one another so as to close the cervical canal The total length of the uterine cavity from the external orifice to the fundus is about 6.25 centimeters Ligaments The ligaments of the uterus are eight in number One anterior, one posterior Two lateral or broad Two utero sacral and two round ligaments The anterior ligament consists of the vesico uterine fold of peritoneum which is reflected onto the bladder from the front of the uterus The posterior ligament consists of the rectovaginal fold of peritoneum which is reflected from the back of the posterior fornix of the vagina onto the front of the rectum It forms the bottom of a deep pouch called the recto uterine excavation which is bounded in front by the posterior wall of the uterus the supervaginal cervix and the posterior fornix of the vagina behind by the rectum and laterally by two crescentic folds on either side of the rectum to the posterior wall of the pelvis These folds are named the sacrogenital or recto uterine folds They contain a considerable amount of fibrous tissue and non-striped muscular fibers which are attached to the front of the sacrum and constitute the utero sacral ligaments The two lateral or broad ligaments ligamentum latum uteri pass from the sides of the uterus to the lateral walls of the pelvis Together with the uterus they form a septum across the female pelvis dividing that cavity into two portions In the anterior part is contained the bladder in the posterior part the rectum and in certain conditions some coils of the small intestine and a part of the sigmoid colon Between the two layers of each broad ligament are contained 1. The uterine tube superiorly 2. The round ligament of the uterus 3. The ovary and its ligament 4. The epioferin and paraoferin 5. Connective tissue 6. Unstriped muscular fibers and 7. Blood vessels and nerves The portion of the broad ligament which stretches from the uterine tube to the level of the ovary is known by the name of the mesosalpinx Between the fimbriated extremity of the tube and the lower attachment of the broad ligament is a concave rounded margin called the infundibulopelvic ligament The round ligaments ligamentum teres uteri are two flattened bands between 10 and 12 cm in length situated between the layers of the broad ligament in front of and below the uterine tubes Commencing on either side at the lateral angle of the uterus this ligament is directed forward upward and lateralward over the external iliac vessels and then passes through the abdominal inguinal ring and along the inguinal canal to the labium magis in which it becomes lost The round ligaments consist principally of muscular tissue prolonged from the uterus also of some fibrous and areolar tissue besides blood vessels, lymphatics and nerves enclosed in a duplicature of peritoneum which in the fetus is prolonged in the form of a tubular process for a short distance into the inguinal canal This process is called the canal of nook It is generally obliterated in the adult but sometimes remains pervious even in advanced life It is analogous to the sacchus vaginalis which precedes the descent of the testis In addition to the ligaments just described there is a band named the ligamentum transversalis callae maconrot on each side of the cervix uteri It is attached to the side of the cervix uteri into the vault and lateral fornix of the vagina and is continuous externally with the fibrous tissue which surrounds the pelvic blood vessels The form, size and situation of the uterus vary at different periods of life and under different circumstances In the fetus the uterus is contained in the abdominal cavity projecting beyond the superior aperture of the pelvis The cervix is considerably larger than the body At puberty the uterus is piriform in shape and weighs from 14 to 17 grams It has descended into the pelvis the fundus being just below the level of the superior aperture of this cavity The palmate folds are distinct and extend to the upper part of the cavity of the organ The position of the uterus in the adult is liable to considerable variation depending chiefly on the condition of the bladder and rectum When the bladder is empty the entire uterus is directed forward and is at the same time bent on itself at the junction of the body and cervix so that the body lies upon the bladder As the bladder fills the uterus gradually becomes more and more erect until with a fully distended bladder the fundus may be directed backward toward the sacrum During menstruation the organ is enlarged more vascular and the corpus is rounded its labia swollen and the lining membrane of the body thickened, softer, and of a darker color According to Sir J. Williams at each recurrence of menstruation a molecular disintegration of the mucous membrane takes place which leads to its complete removal only the bases of the glands embedded in the muscle being left At the cessation of menstruation a fresh mucous membrane is formed by a proliferation of remaining structures During pregnancy the uterus becomes enormously enlarged and in the eighth month reaches the epigastric region The increase in size is partly due to growth of pre-existing muscle and partly to development of new fibers After parturition the uterus nearly regains its usual size weighing about 42 grams but its cavity is larger than in the virgin state its vessels are tortuous or more defined The external orifice is more marked and its edges present one or more fissures In old age the uterus becomes atrophied and paler and denser in texture A more distinct constriction separates the body and cervix The internal orifice is frequently and the external orifice occasionally obliterated while the lips almost entirely disappear Structure is composed of three coats an external or cirrus a middle or muscular and an internal or mucous The cirrus coat tunica cirrosa is derived from the peritoneum It invests the fundus and the whole of the intestinal surface of the uterus but covers the vesicle surface only as far as the junction of the body and cervix In the lower fourth of the intestinal surface the peritoneum though covering the uterus is made with it being separated from it by a layer of loose cellular tissue and some large veins The muscular coat tunica muscularis forms the chief bulk of the substance of the uterus In the virgin it is dense, firm of a grayish color and cuts almost like cartilage It is thick opposite the middle of the body and fundus and thin at the orifices of the uterine tubes It consists of bundles of unstriped muscular fibers disposed in layers intermixed with areolar tissue blood vessels lymphatic vessels and nerves The layers are three in number external, middle and internal The external and middle layers constitute the muscular coat proper while the inner layer is a greatly hypertrophied muscularis mucosi During pregnancy the muscular tissue becomes more prominently developed the fibers being greatly enlarged The external layer placed beneath the peritoneum is disposed as a thin plane on the vesicle and intestinal surfaces It consists of fibers which pass transversely across the fundus and converging at each lateral angle of the uterus are continued on to the uterine tube the round ligament and the ligament of the ovary some passing at each side into the broad ligament and others running backward from the cervix into the sacrouterine ligaments The middle layer of fibers presents no regularity in its arrangement being disposed longitudinally obliquely and transversely It contains more blood vessels than either of the other two layers The internal or deep layer consists of circular fibers arranged in the form of two hollow cones the apices of which surround the arthuses of the uterine tubes their bases intermingling with one another on the middle of the body of the uterus At the internal arthus these circular fibers form a distinct sphincter The mucous membrane, tunica mucosa is smooth and closely adherent to the subjacent tissue It is continuous through the fimbriated extremity of the uterine tubes with the peritoneum and through the external uterine arthus with the lining of the vagina In the body of the uterus the mucous membrane is smooth, soft of a pale red color lined by columnar ciliated epithelium and presents, when viewed with a lens the arthuses of numerous tubular follicles arranged perpendicularly to the surface The structure of the corium differs from that of ordinary mucous membranes and consists of an embryonic nucleated and highly cellular form of connective tissue in which run numerous large lymphatics In it are the tube-like uterine glands lined by ciliated columnar epithelium They are of small size in the unimpregnated uterus but shortly after impregnation become enlarged and elongated presenting a contorted or waved appearance In the cervix the mucous membrane is sharply differentiated from that of the uterine cavity It is thrown into numerous oblique ridges which diverge from an anterior and posterior longitudinal raffae In the upper two-thirds of the canal the mucous membrane is provided by the glangular follicles which secrete a clear, discid alkylone mucous and in addition extending through the whole length of the canal is a variable number of little cysts presumably follicles which have become occluded and distended with retained secretion They are called the ovula nebothi The mucous membrane covering the lower half of the cervical canal presents numerous papillae The epithelium of the upper two-thirds is cylindrical and ciliated but below this it loses its cilia and gradually changes to stratified squamous epithelium close to the external orifice On the vaginal surface of the cervix the epithelium is similar to that lining the vagina that is stratified squamous Vessels and nerves The arteries of the uterus are the uterine from the hypogastric and the ovarian from the abdominal aorta They are remarkable for their torturous course in the substance of the organ and for their frequent anastomoses The termination of the ovarian artery meets that of the uterine artery and forms an anastomotic trunk from which branches are given off to supply the uterus their disposition being circular The veins are of large size and correspond with the arteries They end in the uterine plexuses In the impregnated uterus the arteries carry the blood to and the veins convey it away from the intravella space of the placenta The lymphatics are described on page 714 The nerves are derived from the hypogastric and ovarian plexuses and from the third and fourth sacral nerves End of section 39 Section 40 of Graze Anatomy Part 5 This is a LibriVox recording All LibriVox recordings are in the public domain For more information or to volunteer please visit LibriVox.org Recording by Roger Clifton Anatomy of the human body Part 5 by Henry Gray Section 40 The vagina The vagina extends from the vestibule to the uterus and is situated behind the bladder and in front of the rectum It is directed upward and backward Its axis forming with that of the uterus an angle of over 90 degrees opening forward Its walls are ordinarily in contact and the usual shape of its lower part on transverse section is that of an H The transverse limb being slightly curved forward or backward while the lateral limbs are somewhat convex towards the median line Its middle part has the appearance of a transverse slit Its length is 6 to 7.5 cm along its anterior wall and 9 cm along its posterior wall It is constricted at its commencement dilated in the middle and narrowed near its uterine extremity It surrounds the vaginal portion of the cervix uteri a short distance from the external orifice of the uterus Its attachment extending higher up on the posterior than on the anterior wall of the uterus To the recess behind the cervix the term posterior phoenix is applied while the smaller recesses in front and sides are called the anterior and lateral phoenixes Relations The anterior surface of the vagina is in relation with the fundus of the bladder and with the urethra Its posterior surface is separated from the rectum by the recto uterine excavation in its upper fourth and by the recto vesicle fascia in its middle two fourths The lower fourth is separated from the anal canal by the perineal body Its sides are enclosed between the lavatory's ani muscles As the terminal portions of the urethras pass forward and medial wood to reach the fundus of the bladder they run close to the lateral phoenixes of the vagina and as they enter the bladder are slightly in front of the anterior phoenix Structure The vagina consists of an internal mucous lining and a muscular coat separated by a layer of erectile tissue The mucous membrane, tunica mucosa is continuous above with that lining the uterus Its inner surface presents two longitudinal ridges one on its anterior and one on its posterior wall These ridges are called the columns of the vagina and from them numerous transverse ridges or rugae extend outward on either side These rugae are divided by furrows of variable depth giving to the mucous membrane the appearance of being studded over with conical projections or papulae They are most numerous near the orifice of the vagina especially before parturition The epithelium covering the mucous membrane is of the stratified squamous variety The submucous tissue is very loose and contains numerous large veins which by their anastomoses form a plexus together with smooth muscular fibres derived from the muscular coat It is regarded by Gusenbauer as an erectile tissue It contains a number of mucous crypts but no true glands The muscular coat, tunica muscularis consists of two layers an excel longitudinal which is by far the stronger and an internal cellular layer The longitudinal fibres are continuous with the superficial muscular fibres The strongest fasciculi are those attached to the recto-visical fascia on either side The two layers are not distinctly separable from each other but are connected by a bleak, decussating fasciculi which pass from the one layer to the other In addition to this, the vagina at its lower end is surrounded by a band of striped muscular fibres the bulbocavanosis External to the muscular coat is a layer of connective tissue carrying a large plexus of blood vessels The erectile tissue consists of a layer of loose connective tissue situated between the mucous membrane and the muscular coat Embedded in it is a plexus of large veins and numerous bundles of unstriped muscular fibres derived from the circular muscular layer The arrangement of the veins is similar to that found in other erectile tissues The external organs Parties, genitalies, externae, muleibris The external genital organs of the female are the mons pubis the labia majora et minora pudendae the clitoris the vestibule of the vagina the bulb of the vestibule and the greater vestibular glands The term pudendum or vulva as generally applied includes all these parts The mons pubis the labiorum anterior the rounded eminence in front of the pubic symphysis is formed by a collection of fatty tissue beneath the integument It becomes covered with hair at the time of puberty The labia majora the labia majora pudendae are two prominent longitudinal cutaneous folds which extend downward and backward from the mons pubis and form the lateral boundaries of a fissure or cleft the pudendal cleft or rhima into which the vagina and urethra are open Each labium has two surfaces an outer, pigmented and covered with strong, crisp hairs and an inner, smooth and beset with large sebaceous follicles Between the two there is considerable quantity of areola tissue fat and a tissue resembling the dartostunic of the scrotum besides vessels, nerves and glands The labia are thicker in front where they form by then meeting the anterior labial commissure Posteriorly, they are not really joined but appear to become lost in the neighbouring integument ending close to and nearly parallel with each other Together with the connecting skin between them they form the posterior labial commissure or posterior boundary of the pudendum The interval between the posterior commissure and the anus from 2.5 to 3 cm in length constitutes the perineum The labia majora correspond to the scrotum in the male The labia minora, labia minora pudendae nymphae are two small cutaneous folds situated between the labia majora and extending from the clitoris obliquely downward lateralward and backward for about 4 cm on either side of the orifice of the vagina between which and the labia majora they end In the virgin, the posterior ends of the labia minora are usually joined across the middle line by a fold of skin named the phrenulum of the labia or furshet Anteriorly, each labium minus divides into two portions The upper division passes above the clitoris to meet its fellow of the opposite side forming a fold which overhangs the gland's clitoridus and is named the propusium clitoridus The lower division passes beneath the clitoris and becomes united to its under surface forming, with its fellow of the opposite side, the phrenulum of the clitoris On the opposed surfaces of the labia minora are numerous sebaceous follicles The clitoris is an erectile structure homologous with a penis It is situated beneath the anterior labial commissure partially hidden between the anterior ends of the labia minora It consists of two corporecavenosa composed of erectile tissue enclosed in a dense layer of fibrous membrane united together along the medial surfaces by an incomplete fibrous pectiniform septum Each corpus is connected to the ramae of the pubis and ischium by a cross The free extremity, gland's clitoridus is a small rounded tubercle consisting of spongy erectile tissue and highly sensitive The clitoris is provided like the penis with a suspensory ligament and with two small muscles the ischiocavenosa which are inserted into the clura of the clitoris The vestibule, vestibulum vaginae The cleft between the labia minora and behind the glands clitoridus is named the vestibule of the vagina In it are seen the urethral and vaginal orifices and the openings of the ducts of the greater vestibular glands The external urethral orifice orificium urethrae externum urinary meatus is placed about 2.5 cm behind the glands clitoridus and immediately in front of that of the vagina It usually assumes the form of a short, sagittal cleft with slightly raised margins The vaginal orifice is a median slit below and behind the opening of the urethra Its size varies inversely with that of the hymen The hymen is a thin fold of mucous membrane situated at the orifice of the vaginal The inner edges of the fold are normally in contact with each other and the vaginal orifice appears as a cleft between them The hymen there is much in shape When stretched its commonest form is that of a ring generally broadest posteriorly Sometimes it is represented by a semilunar fold with its concave margin turned towards the pubis Occasionally it is cribiform or its free margin forms a membranous fringe It may be entirely absent or may form a complete septum across the lower end of the vagina The latter condition is known as an imperforate hymen It may persist after copulation so that its presence cannot be considered as a sign of virginity When the hymen has been ruptured small rounded elevations known as the carunculi hymenalis are found at its remains Between the hymen and the frenulum of the labia is a shallow depression named the navicular fossa The bulb of the vestibule bulbous vestibuli, vaginal bulb is the homologue of the bulb and adjoining part of the corpus cavernisum urethrae of the male and consists of two elongated masses of erectile tissue placed one on either side of the vaginal orifice and united to each other in front by a narrow median band turned the pars into media Each lateral mass measures a little over 2.5 cm in length Their posterior ends are expanded and are in contact with the greater vestibular glands Their anterior ends are tapered and joined to one another by the pars into media Their deep surfaces are in contact with the inferior fascia of the urogenital diaphragm Superficially they are covered by the bulbo cavernisus The greater vestibular glands glandulae vestibularis major botelini, botelin's glands are the homologues of the bulbo urethral glands in the male They consist of two small roundish bodies of a reddish-yellow colour situated one on either side of the vaginal orifice in contact with the posterior end of each lateral mass of the bulb of the vestibule Each gland opens by means of a duct about 2 cm long immediately lateral to the hymen in the groove between it and the labium minus End of section 40 Recording by Roger Clifton St. Albans, England