Anatomy of Female Genital System

SGD B8
Day 2
Case 1 : A 42 year-old woman is referred for vaginal sonography to rule out luteal cyst. The sonic probe is
placed in the anterior vaginal fornix and aimed anteriorly
1. hat is the normal position of the uterus and its relation to other structure in pelvic cavity!
The non-gravid "non-pregnant# uterus usually lies in the lesser pelvis$ with its body lying on the urinary
bladder and its cervix between the urinary bladder and rectum. Adult uterus is usually anteverted "tipped
anterosuperiorly relative to the axis of the vagina# and anteflexed "flexed or bent anteriorly relative to the
cervix$ creating the angle of flexion# so that its mass lies over the bladder
%elation of uterus :
Anteriorly "anteroinferiorly in its normal anteverted position#: the vesicouterine pouch and superior
surface of the bladder& the supravaginal part of the cervix is related to the bladder and is separated
from it by only fibrous connective tissue.
'osteriorly: the rectouterine pouch and the anterior surface of rectum&
(aterally: the peritoneal broad ligament and the fascial cardinal ligaments& the ureters
2. )ow much of the uterus can be felt per rectum!
*t normaly cannot palpable rectaly$ +ust can felt its wall to examine if there is any abnormality in there.
,. hat is the normal support of the uterus!
The principal supports of the uterus holding it in this position are both passive and active or dynamic.
-ynamic support of the uterus is provided by the pelvic diaphragm. *ts tone during sitting and standing and
active contraction during periods of increased intra-abdominal pressure "snee.ing$ coughing$ etc.# is
transmitted through the surrounding pelvic organs and the endopelvic fascia in which they are embedded.
'assive support of the uterus is provided by its position/the way in which the normally anteverted and
anteflexed uterus rests on top of the bladder. hen intra-abdominal pressure is increased$ the uterus is
pressed against the bladder
4. hy do you thin0 the uterus is in that position!
1. -escribe the ovaries$ uterine tubes$ uterus and broad ligaments!
Ovaries : The ovaries are almond-shaped and -si.ed female gonads in which the oocytes "female
gametes or germ cells# develop. They are also endocrine glands that produce reproductive
hormones. 2ach ovary is suspended by a short peritoneal fold or mesentery
Uterine tubes : The uterine tubes "formerly called oviducts or fallopian tubes# conduct the oocyte.
They are approximately 13 cm long and lie in a narrow mesentry called the mesosalpinx. They are
divided into 4 parts& infundibulum$ ampula. *sthmus$ uterine part
Uterus : The uterus "womb# is a thic0-walled$ pear-shaped$ hollow muscular organ. *t is located in
the lesser pelvis. Adult uterus is usually anteverted and anteflexed so that it les over the bladder.
Broad ligaments : The broad ligament of the uterus is a double layer of peritoneum "mesentery#
that extends from the sides of the uterus to the lateral walls and floor of the pelvis.This ligament
Anatomy of Female Genital System
SGD B8
Day 2
assists in 0eeping the uterus in position. The two layers of the broad ligament are continuous with
each other at a free edge that surrounds the uterine tube
4. -escribe the peritoneal relationship of the ovary and the uterine tubes
2ach ovary is suspended by a short peritoneal fold or mesentery$ the mesovarium. The
mesovarium is a subdivision of a larger mesentery of the uterus$ the broad ligament
The uterine lie in a narrow mesentery$ the mesosalpinx$ forming the free anterosuperior edges of
the broad ligaments
*t extend laterally from the uterine horns and open into the peritoneal cavity near the ovaries. *n
ovaries$ it is suspended in peritoneal cavity 5 not covered by peritoneum.
6. -escribe the walls$ fornices and immediate visceral relations of the vagina
The vagina is usually collapsed. The orifice is usually collapsed toward the midline so that its
lateral walls are in contact on each side of an anteroposterior slit. 7uperior to the orifice$ however$
the anterior and posterior walls are in contact on each side of a transverse potential cavity$ )-
shaped in cross section
The vaginal fornix$ the recess around the cervix$ has anterior$ posterior$ and lateral parts
Anteriorly to the fundus of the urinary bladder and urethra& laterally to the levator ani$ visceral pelvic
fascia$ and ureters& and posteriorly "from inferior to superior# to the anal canal$ rectum$ and
rectouterine pouch
8. To describe the blood supply and lymph drainage of the female genital tract
Ovaries and uterine tubules : receive a double "collateral# blood supply from the abdominal aorta
via the ovarian arteries and from the internal iliac arteries via the uterine arteries.
Uterus : receive blood from from the uterine arteries$ and collateral supply from the ovarian
arteries .The uterine veins enter the broad ligaments with the arteries and form a uterine venous
plexus on each side of the cervix. 9eins from the uterine plexus drain into the internal iliac veins.
Vagina : blood for superior part of the vagina derive from the uterine arteries. The arteries
supplying the middle and inferior parts of the vagina derive from the vaginal and internal pudendal
arteries. The vaginal veins form vaginal venous plexuses along the sides of the vagina and within
the vaginal mucosa .These veins are continuous with the uterine venous plexus as the uterovaginal
venous plexus and drain into the internal iliac veins through the uterine vein
:. To describe general anatomy$ vasculari.ation$ and lymphatic system of breast
The breasts "(. mammae# consist of glandular and supporting fibrous tissue embedded within a
fatty matrix$ together with blood vessels$ lymphatics$ and nerves. At the greatest prominence of the
breast is the nipple$ surrounded by a circular pigmented area of s0in$ the areola "(. small area#.
Arterial supply : ;edial mammary branches of perforating branches and anterior intercostal
Anatomy of Female Genital System
SGD B8
Day 2
branches of the internal thoracic artery$ (ateral thoracic and thoracoacromial arteries$ branches of
the axillary artery& 'osterior intercostal arteries$ branches of the thoracic aorta in the 2nd$ ,rd$ and
4th intercostal spaces.
Venous drainage : The venous drainage of the breast is mainly to the axillary vein$ but there is
some drainage to the internal thoracic vein
Lymph system : (ymph passes from the nipple$ areola$ and lobules of the gland to the subareolar
lymphatic plexus. Then 61<"lateral# of this plexus will drain into the axillary lymph nodes$ while the
remaining"medial# will drain into the parasternal lymph node&the opposite breast and for the inferior
=uadrants$ to the abdominal lymph node.
13. -escribe the anatomical feature of the female pelvis and its difference with the male pelvis
>ony 'elvis ;ale ?emale
@eneral structure Thic0 and heavy Thin and light
@reater pelvis "pelvis ma+or# -eep 7hallow
(esser pelvis "pelvis minor# Aarrow and deep$ tapering ide and shallow$ cylindrical
'elvic inlet "superior pelvic aperture# )eart-shaped$ narrow Bval and rounded& wide
'elvic outlet "inferior pelvic aperture# Comparatively small Comparatively large
'ubic arch and subpubic angle Aarrow "D63E# ide "F83E#
Bbturator foramen %ound Bval
Acetabulum (arge 7mall
@reater sciatic notch Aarrow "G63E#& inverted 9 Almost :3E
11. -escribe the pelvic diaphragm and perineum
The perineum refers to a shallow compartment of the body "perineal compartment# bounded by the
pelvic outlet and separated from the pelvic cavity by the fascia covering the inferior aspect of the
pelvic diaphragm$ formed by the levator ani and coccygeus muscles
The pelvic floor is formed by the bowl- or funnel-shaped pelvic diaphragm$ which consists of the
coccygeus and levator ani muscles and the fascias "(. fasciae# covering the superior and inferior
aspects of these muscles.The pelvic diaphragm lies within the lesser pelvis$ separating the pelvic
cavity from the perineum$ for which it forms the roof
The floor of the pelvis is formed by the pelvic diaphragm$ encircled by and suspended in part from
the pubic symphysis and pubic bones anteriorly$ the ilia laterally$ and the sacrum and coccyx
Anatomy of Female Genital System
SGD B8
Day 2
posteriorly