Dr: Azza Zaki

Dr: Azza Zaki

Primary sex
organ: ovary
Genital ducts:
Fallopian tube
 Uterus
Vagina
Accessory
glands:
Greater
vestibular
(Bartholin’s)
Copulatory organ
(external
genitalia):
Dr: Azza Zaki
The vulva
 The Ovaries
 They are the primary sex organs.
 Functions: 1-Exocrine function: produce ova
2-Endocrine function: secrete estrogen & progesterone
hormones.

Dr: Azza Zaki

 Location and Description
 Each ovary is oval
(almond) shaped,
measuring 3×2×1 cm.
 ovarian fossa:
 The ovary usually lies
against the lateral wall of
the pelvis in a depression
called the ovarian fossa,
bounded by the external
iliac vessels above and
by the obturator nerve,
the ureter & the internal
iliac vessels, behind. The
position of the ovary is
variable.
Dr: Azza Zaki
The ovary has: 1) 2 ends:
 Upper (tubal) end: is directed up & laterally & attached to:
 Ovarian fimbria of the Fallopian tube.
 Suspensory (infundibulo-pelvic) ligament of the ovary,
which is a peritoneal fold that forms the upper lateral part of
the broad ligament. It transmits the ovarian vessels &
nerves from the side wall of the pelvis to the broad ligament.
 Lower (uterine) end: is directed down & medially. It is attached
to the upper lateral angle of the uterus by the ligament of the
ovary.
2) 2 surfaces:
 Lateral surface: related to the parietal peritoneum of the lateral
pelvic wall & obturator nerve and vessels (in the floor of the
fossa).
 Medial surface: related to fimbriated end of Fallopian tube.
3) 2 borders:
 Posterior border: free.
 Anterior border: attached to the upper lateral part of broad
ligament by mesovarium (which transmits the ovarian nerves &
vessels to the hilum of the ovary).
Dr: Azza Zaki
 Ligaments Of The Ovary
1) Suspensory ligament of the ovary:
 It extends laterally from the tubal end
of the ovary to the side wall of the
pelvis.
 It is a peritoneal fold which transmits
the ovarian vessels, nerves &
lymphatics to the broad ligament.
2) Mesovarium:
 It is peritoneal fold that extends from
the upper layer of broad ligament to
the anterior border of the ovary.
 It transmits the ovarian vessels &
nerves to the ovary.
3) Ligament of the ovary:
 It is a fibromuscular cord that extends
from the uterine end of the ovary to
the lateral angle of the uterus.
Dr: Azza Zaki
 Blood Supply
Arteries
The ovarian artery arises
from the abdominal aorta
at the level of the first
lumbar vertebra.
Veins
The ovarian vein drains
into the inferior vena cava
on the right side and into
the left renal vein on the
left side.
Dr: Azza Zaki
Lymph Drainage
The lymph vessels of the ovary follow the
ovarian artery and drain into the para-aortic
nodes
Nerve Supply:
Parasympathetic: From pelvic splanchnic
nerves (S 2, 3, 4).
 Sympathetic: from T 10, 11.
The blood supply, lymph drainage, and
nerve supply of the ovary reach the ovary by
passing through the suspensory ligament of
the ovary. The vessels and nerves finally
enter the hilum of the ovary via the
mesovarium Dr: Azza Zaki
 The Fallopian (Uterine) Tubes
 2 tortuous tubes (about
10 cm long), open on
the superolateral angle
of the uterus.
 They have free end
open into the
peritoneal cavity close
to the ovary.
 Lie in the upper border
of the broad ligament
Dr: Azza Zaki
 Parts Of The Uterine Tube From Medial To Lateral
 Intramural (interstitial) part:
 It is the shortest (1 cm) and narrowest part.
 It passes through the wall of the superoateral angle of
the uterus to open into the uterine cavity.
 Isthmus:
 It is narrow and 2 cm in length .
 Ampulla:
 It is the longest (5 cm), thin-walled, tortuous
and widest part. It is the site of fertilization.
 Infundibulum (fimbriated end):
 It is 2cm in length and funnel-shaped.
 It pierces the broad ligament to open into the peritoneal
cavity near the ovary. Its margins carry fimbria which
spread over the medial surface of the ovary.
Dr: Azza Zaki
 Tubal ligation:
A simple and
effective method of
birth control is to
surgically ligate the
uterine tubes,
preventing
spermatozoa from
reaching ova.
 Conduct of the
ovum in the uterine
tube to the uterine
cavity is helped by:
ciliary movement of
mucosal lining &
peristaltic
movement of the
tube
Dr: Azza Zaki
 Blood Supply Of The Uterine Tube
 Arterial supply:
Medial 2/3: by the
uterine artery.
Lateral 1/3 : by the
ovarian artery.
 Venous drainage:
By veins accompanying
the arteries into the
uterine and ovarian
veins.
 Lymph drainage:
Most of the tubal Commonest site of fertilization is
lymphatics pass to the the ampulla of the uterine tube.tube
para-aortic L.Ns. Implantation of the embryo in the
Lymphatics of the isthmus uterine tube rather than the uterus
pass to the superficial can cause an ectopic pregnancy.
inguinal L.Ns. Dr: Azza Zaki
 Uterus
 It is a hollow pear-shaped
muscular organ.
 Location:
 It is located in the central
part of the pelvis:
 Anterior to the rectum
 posterosuperior
to the bladder.
Dimension: measuring
3×2×1 inches

Dr: Azza Zaki

 Parts Of The Uterus
1) Fundus:
 It is dome-shaped part that
lies above level of the
opening of the Fallopian
tubes.
 It is completely covered by
peritoneum. It is related to
coils of small intestine &
sigmoid colon.
2) Body:
 is the part extending from
level of opening of the
Fallopian tubes to the
constriction called isthmus.
It contains uterine cavity. It is
the site of implantation of the
zygote & also the site ofDr: Azza Zaki
menstruation.
3) Isthmus:
Slight constriction between the body and the cervix.
4) Cervix: it has supra-vaginal & vaginal parts
Supra-vaginal part:
Anteriorly: it is not covered by peritoneum and
related to the U.B.
Posteriorly: it is covered by peritoneum of Douglas
pouch which separates it from the rectum.
Laterally: it gives attachment to the broad ligament
and is related to the ureter and uterine vessels just
below the root of the broad ligament.
Vaginal part: is surrounded by the vaginal fornices.
Dr: Azza Zaki
The cavity of the uterine body is triangular in coronal section,
but it is a cleft in the sagittal plane. The cavity of the cervix, the
cervical canal, communicates with the cavity of the body
through the internal os and with that of the vagina through the
external os. Before the birth of the first child, the external os is
circular. In a parous woman, the vaginal part of the cervix is
larger, and the external os becomes
Dr: Azza Zaki a transverse slit
 Relations Of The Uterus
 Anteriorly: The body of the uterus is related anteriorly to
the uterovesical pouch and the superior surface of the
bladder. The supravaginal cervix is related to the superior
surface of the bladder. The vaginal cervix is related to the
anterior fornix of the vagina.
 Posteriorly: The body of the uterus is related posteriorly to
the rectouterine pouch (pouch of Douglas) with coils of
ileum or sigmoid colon within it.
 Laterally: The body of the uterus is related laterally to the
broad ligament and the uterine artery and vein. The
supravaginal cervix is related to the ureter. The vaginal
cervix is related to the lateral fornix of the vagina.
The uterine tubes enter the superolateral angles of the
uterus, and the ligament of the ovary (posterior) and round
ligament of the uterus (anterior) are attached to the uterine
wall just below this level.
Dr: Azza Zaki
Dr: Azza Zaki
Arterial by the uterine artery:
supply It is a branch of the anterior division of
internal iliac artery.
 It passes medially on the floor of the pelvis in
the root of the broad ligament crossing the
ureter, about 2 cm lateral to the cervix.
 It ascends along the side of the uterus in a
tortuous course between the 2 layers of the
broad ligament.
 It turns laterally below the Fallopian tube to
end by anastomosis with ovarian artery, which
also assists in supplying the uterus.
 It supplies: uterus + medial ¾ of Fallopian
tube + vagina.

Venous Each venous plexus is drained by a pair of

drainage uterine veins which ends into internal iliac
vein. Dr: Azza Zaki
Dr: Azza Zaki
 Dr: Azza Zakiof the uterus
Lymphatic drainage
Lymphatic  Fundus + upper part of the body +
drainage uterine tube  para-aortic L.Ns
 Lower part of the body  external
iliac L.Ns.
 Cornu of the uterus  its
lymphatics pass along the round
ligament of uterus into the superficial
inguinal L.Ns.
 Cervix  internal iliac & external
iliac & sacral L.Ns.
Nerve Sympathetic  from T12 & L1 (produce
supply uterine contraction & vasoconstriction).
 Parasympathetic  from S2, 3, 4.
(produce uterine relaxation &
vasodilatation).
Dr: Azza Zaki
 Peritoneal Covering Of The Uterus
The peritoneum
reflected from the
rectum to the upper part
of the vagina, forming
recto-uterine pouch,
then cover the posterior
surface of the uterus,
fundus, anterior surface
of the body of the uterus
,which is reflected at
the isthmus on the
upper surface of U.B.
forming the utero-
vesical pouch. So
anterior surface of the
cervix and vagina have
no peritoneal covering Dr: Azza Zaki
 Broad Ligament
It is a double-layered fold of peritoneum which
extends from the side of the uterus to the side wall of
the pelvis.
Parts of the broad ligament:
Mesosalpinx: the part
between Fallopian tube
& mesovarium & and
round ligament of ovary.
Suspensory ligament of
ovary: the part lateral to
the ovary.
Mesometrium: the
remaining medial lower
part on the side of the
uterus. Dr: Azza Zaki
Dr: Azza Zaki
 Broad Ligament
It has:1) 2 layers: upper (posterior) layer: is
related to the coils of small intestine, is connected
to the ovary by mesovarium & is pierced by the
lateral end of Fallopian tube
lower (anterior layer)
2) 4 borders:
 upper free border: its medial 4/5 surrounds
Fallopian tube its lateral 1/5 forms the suspensory
ligament of the ovary
 lower border: rests on the pelvic floor
 medial border: attached to the side of the uterus
 lateral border: attached to the side wall of the
Dr: Azza Zaki
pelvis
 Contents Of The Broad Ligament:
 2 tubes: 1-Fallopian tube: in the medial 4/5 of the
upper free border. 2- ureter at root of the ligament.
 2 ligaments: round ligament of ovary & round lig. of
uterus.
 2 arteries: 1)Uterine A. (in the root then along the
medial border then along the upper border).
 2)Ovarian A. (in the suspensory ligament of ovary).
 sympathetic nerve plexus plexus.
 2 embryological remnants: epioophoron &
paraoophoron.
 Connective tissue (parametrium) & lymphatics &
L.Ns.
Dr: Azza Zaki
 Positions Of The Uterus
 Normal position anteverted
anteflexed:
the long axis of the uterus is bent
forward on the
long axis of the vagina.This
position is referred to as
anteversion (90 degree) of the
uterus .
 the long axis of the body of the
uterus is bent forward at the level
of the internal os with the
long axis of the cervix.
This position is termed
anteflexion (170 degree)
of the uterus .
Dr: Azza Zaki
Abnormal position: retroverted, retroflexed
 the fundus and body of the uterus are bent
backward on the vagina so that they lie in
the rectouterine pouch (pouch of Douglas).
In this situation, the uterus is said to be
retroverted. If the body of the uterus is, in
addition, bent backward on the cervix, it is
said to be retroflexed. Leads to back pain.

Dr: Azza Zaki

 Supporting Factors Of Uterus
The uterus is supported
mainly by: A) muscles
1) the tone of the Pelvic
diaphragm (pelvic floor)
muscles: levator ani
muscles and coccygeus
muscle. resisting downward
push of uterus during
increased intra-abdominal
pressure.
2) Urogenital diaphragm: the
muscles of the deep
perineal pouch.
3) Perineal body: is a
fibromuscular body between
the vagina & anal canal;
receiving the insertions of all
perineal muscles. Thus,
maintains the integrity of the
Dr: Azza Zaki
pelvic floor.
 Levator Ani Muscle
 They form a broad muscular
sheet stretching across the
pelvic cavity,
 they support the pelvic viscera
and resist the intra-abdominal
pressure transmitted
downward through the pelvis.
 The medial edges of the
anterior parts of the levator ani
muscles are attached to the
cervix of the uterus by the
pelvic fascia.
 It is incomplete anteriorly to
allow passage of urethra and
vagina in female.
 Action: it supports and
maintains the pelvic viscera in
position. Dr: Azza Zaki
Some of the fibers of
levator ani are
inserted into a
fibromuscular
structure called the
perineal body This
structure is important
in maintaining the
integrity of the pelvic
floor; The perineal
body lies in the
perineum between the
vagina and the anal
canal. It thus supports
the vagina and,
indirectly, the uterus.
Dr: Azza Zaki
and the condensations
of pelvic fascia,
which form three
important
B) ligaments.
 The Transverse
Cervical,
 Pubocervical,
 and Sacrocervical
Ligaments
 These three ligaments
are attached to the
cervix and the vault of
the vagina and play an
important part in
supporting the uterus
and keeping the cervix
in its correct position Dr: Azza Zaki
 Ligaments of the cervix:
– Transverse cervical (Mackenrodt’s ) cardinal ligament:
 It is the main supporting factor of the uterus.
 It a fan-shaped ligament, which is formed of condensed
extraperitoneal tissue between the side wall of the
pelvis and side of cervix & vagina.
– Pubo-cervical ligament:
 It is a condensation of extraperitoneal tissue, which
extends from the front of cervix & upper part of vagina
to the back of the pubis, around the sides of the
urethra.
– Utero-sacral (sacrocervical) ligament:
 It is a condensation of extraperitoneal tissue, which
extends from the back of the cervix to the front of 2nd &
3rd pieces of sacrum, around the sides of the rectum.
Dr: Azza Zaki
4) The round ligament of the uterus,:
which represents the remains of the lower
half of the gubernaculum, extends
between the superolateral angle of the
uterus, through the deep inguinal ring and
inguinal canal, to the subcutaneous tissue
of the labium majus. It helps keep the
uterus anteverted (tilted forward) and
anteflexed (bent forward).
 The round ligament of the uterus and
5)the broad ligament are considered to play
a minor role in supporting the uterus.
Dr: Azza Zaki
 Uterine Prolapse
 Damage to the levatores ani muscles
or ligaments of the cervix during
childbirth or general poor body
muscular tone may result in downward
displacement of the uterus called
uterine prolapse. In advanced cases,
the cervix descends the length of the
vagina and may protrude through the
orifice. if the perineal body is damaged
during childbirth, prolapse of the pelvic
viscera may occur.
 Caesarean section: opening the
abdomen, when normal child birth is
not possible.
 Hysterectomy: removal of uterus in
Dr: Azza Zaki
case of cancer.
 Vagina
It is a fibromuscular tube extends upward &
backward from the vestibule to the cervix
It is copulatory organ in female & serve as a
passage for menstrual flow & child birth.
Its upper part
surrounding the
cervix forming
Anterior,
 posterior , right lateral
and left lateral fornices.
It is 8 cm long
vaginal opening may be
partially covered by theDr:hymen
Azza Zaki
 Relations
 Anterior wall: (7 cm)
 Not covered by peritoneum
 Its upper 1/3 is pierced by the cervix.
 Its middle 1/3 is related to the base of U.B.
 Its lower 1/3 is related to the urethra.
 Posterior wall: (9 cm)
 Its upper1/4 is covered by peritoneum which is reflected
to the rectum to form the recto-vaginal (Douglas pouch)
which contains coils of ileum
 Its middle 2/4 related to rectum.
 Its lower 1/4 is related to perineal body and anal canal.
 Lateral relations (from above downwards):
 Upper part: uterine artery & ureter.
 Middle part: levator ani (sphincter vaginae).
 Lower part : greater vestibular gland (in the perineum)
Dr: Azza Zaki
 Fornices of vagina:
 These are 4 pouches formed by the upper
part of vagina around the vaginal part of
cervix
 (2 lateral, 1 anterior & 1 posterior)
 The posterior fornix is the deepest one & the
only one covered by peritoneum
 Lateral one related to uterine artery & ureter.

Dr: Azza Zaki

Arterial It is supplied by:
supply  Uterine artery.
 Vaginal artery.
 Middle rectal artery.
 Internal pudendal artery.

Venous The vaginal veins form plexuses that drains into

drainage internal iliac vein.

Lymphatic Upper 1/3  external iliac L.Ns.

drainage Middle 1/3  internal iliac L.Ns.
Lower 1/3  superficial inguinal L.Ns.
Nerve  Upper 2/3 (pain insensitive) by autonomic fibers
supply  Sympathetic: L1, 2
 Parasympathetic: S 2, 3
 Lower 1/3 (pain
Dr: Azza Zaki
sensitive)  brs. of pudendal nerve.
Dr: Azza Zaki
 Supports of the Vagina
The upper part of the vagina is supported by:
 the levatores ani muscles
and the transverse cervical, pubocervical, and
sacrocervical ligaments. These structures are
attached to the vaginal wall by pelvic fascia.
The middle part of the vagina is supported by
the urogenital diaphragm.
The lower part of the vagina, especially the
posterior wall, is supported by the perineal body

Dr: Azza Zaki

 External Genitalia (Vulva)
 Mons pubis - Fatty area overlying the pubic
symphysis
 Covered with pubic hair after puberty
 Labia – skin folds
 Labia majora—hair-covered skin folds
 Labia minora—delicate, hair-free folds of skin
 Contain the vestibule: Greater vestibular glands
 Urethral orifice
 Vaginal orifice
 Clitoris located at the anterior regions of the labia
minora: composed of sensitive erectile tissue
Dr: Azza Zaki
External Genitalia (Vulva)

Dr: Azza Zaki

Dr: Azza Zaki