1. Normal And Abnormal
Development Of Female
Genital Tract
Dr Khalid Sait
FRCSC
A. Prof Gynecologist Oncologist

2. Embryology
 Baby sex established at the time of
fertilization ( sperm meet ovum )
 sperm 46 xy ovum 46 xx
(23x + 23 y) (23 x + 23 x)
Girl Boy

3. Gonadal sex
Testes / Ovaries
Gonadal sex
Testes / Ovaries
Genetic sex
XX / XY
Genetic sex
XX / XY
Internal
genitalia
Internal
genitalia
HormonesHormones
External
genitalia
External
genitalia

4. Embryology
 Gonads appear as genital ridges by proliferation of
coalemic epithelium(mesoderm)
 Primordal germ cell appear in the endodermal cell in the
wall of yolk sac , migrate along the mesentery of
hindgut and invade the genital ridges
 At 7 weeks the gonads of embryo:
indistinguishable male and female
( indifferent gonad)
 At 8 weeks if xx ----- Ovary
xy------- Testis

5. Embryology
Ovary
 Gonadal ovary : medullary cord degenerate and cortical cord
develop
 Germ cells ----oogonia
 11-12 w : onset of oogenesis
 20 w : 7 million germ cells in each ovary
 Birth : 2 millions
 Puberty : 40,000 primary oocytes remaining in the ovaries.
Only 400 ------------- secondary
oocytes and extended at ovulation once every month during menst.
Cycle.
 Descend of ovary is not an active migration, but result of rapid
growth of body and failure of gubernaculum to elongatee ( that why
its maintain blood supply from the aorta

6. Congenital Uterine Anomaly
 Precise incidence is unknown (range from 1-2 %)
 Clinical presentation:
1 Usually asymptomatic
2 Menstrual
disorder
3 Dysmenorrhea
4 Recurrent abortion ( decrease intrauterine volume and
vascularity, increase uterine irritability and cervical
incompetance )
5 Premature labor
6 Abnormal presentation
7 Primary infertility

7. Congenital Uterine Anomaly
 Diagnosis:
History
Pelvic exam
Hysterosalpingography
U/S
MRI
Laproscopy
Hysteroscopy
IVP or U/S (Exclude Renal anomaly )

8. Congenital Uterine Anomaly
 Treatment:
1- Double uterus (didelphic uterus): no need to treat.
2- Bicornate ut. --------- Strassmann procedure
( if indicated )
3- Ut. Septum --------- (BCP for dysmenorrhea ),
Tompkins metroplasty or Hysteroscopic resection of
septum )
4- Unicornate ut. -------- Surgery indicated if there is
blind horn which cause symptom----- surgical resection
of blind horn.

9. Mullerian Agenesis
 Mayer Custer Hauser Rokitansky Syndrome
 1: 4000
 Abscent upper vagina, cervix and uterus and
tubes
 Normal ovaries and vulva
 Associated with spine and renal anomaly
 Treatment:
McIndoe procedure
Self dilatation of vagina

10. Vaginal Agenesis
 1: 5000
 Normal Vulva
 Ass. With spine, renal and middle ear anomaly
 Treatment:
Karyotype, U/S - MRI ( only 5 % will have normal
functioning uterus)
Once patient sexually active
1- Gradual vaginal dilatation against vaginal dimple
(daily for 20-30 mint for few month with gradual dilators
size.
2- William procedure
3- Wharton and Macindo procedure

11.
Transverse Vaginal Septum
 Mid vagina usually
 May be partial or complete
 Presentation:
Primary amenorrhea
Dysparonia
 Treatment:
Surgical resection

12. Adult Equivalents of Embryonic Structures
Embryonic Structure Female
Indifferent gonad ovary
Cortex ovarian follicles
Medulla rete ovarii
Gubernaculum ovarian and round ligament of uterus
Mesonephric tubules epoophoron, paroophoron
Mesonephric Duct
appendix vesiculosa, duct of epoophoron, duct of Gartner,
ureter, pelvis, calices and collecting tubules
Paramesonephric Duct hydatid of Morgagni, uterine tube, uterus
Urogenital Sinus
urinary bladder, urethra, vagina,
urethral, paraurethral and greater vestibular glands
Sinus tubercle hymen
Phallus clitoris
Urogenital folds labia minora
Labioscrotal swellings labia majora

13. Imperforated Hymen
 Presentation:
Primary Amenorrhea
Pelvic mass
 Treatment:
Cuciate incision at hymen
 Follow up
Endometrosis
Vaginal adenosis