Anatomy of the female

reproductive system

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• Reproductive organs in a female are those concerned with;
• Copulation
• Fertilization
• Growth and development of foetus
• Subsequent exit during birth
• Broadly divided into;
• External genitalia
• Internal genital
• Accessory reproductive organs
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 External genitalia

 Collectively, the external genitals of the female are known as;

 Vulva
 Pudendum
 Consists of the following:-
 Mons pubis (veneris)
 Labia majora
 Labia minora
 Clitoris
 Hymen
 Vestibule
 Urethral opening
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 • Skene’s glands
• Greater Vestibular glands (Bartholin’s glands)
• It is bounded anteriorly by mons pubis, posteriorly
by rectum, laterally by genitocrural fold (btn genitalia
& thigh)
• The vulva area is covered by keretinized stratified
squamous epithelium

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 The Mons Pubis

• Also called Mons Veneris is rounded pad of

fatty Located anterior to the symphysis pubis
• Consists of pad of sub-cutaneous adipose
connective tissue deep to the skin
• The amount of fat increases during puberty and
decreases after menopause.
• The mons pubis becomes covered with coarse
pubic hairs during puberty, which also decrease
after menopause.
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 Labia Majora “Greater lips”
 Are comprised of 2 rounded fold of tissue
 Originate from the mons pubis and terminate into the perineum
 They form the lateral boundaries of the vulva and are approximately 7–
9 cm long and 2–4 cm wide, varying in size with height, weight, race,
age, parity, and pelvic architecture
 They are covered with squamous epithelium and contain sweat glands
 Beneath the skin is dense connective & adipose tissue
 Adipose tissue is richly supplied with venous plexus
 The round ligament terminate at the upper border of the labia majora

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• Are homologous to the scrotum of the male
• The skin on the outer convex surface is pigmented and
covered by hair follicles.
• Hair is distributed over their surfaces, extending superiorly
in the area of the mons pubis from one side to the other.
• The skin on the inner surface has sebaceous glands, but no
hair follicles

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• The lateral surfaces are adjacent to the medial surface of
the thigh, forming a deep groove when the legs are
together.
• The medial surfaces of the labia majora may oppose each
other directly or may be separated by protrusion of the
labia minora.
• The cleft that is formed by this opposition anteriorly is
termed the anterior commissure.
• Posteriorly, the cleft is less clearly defined and termed the
posterior commissure.

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 Arterial supply into the labia
majora comes from the internal
and external pudendal
arteries.
 Pudendal arteries branch off the
internal illiac artery
 Venous drainage : On each
side, labial veins connect with
the external pudendal vein,
terminating in the great
saphenous vein.
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 PudenDal arteries

 Group of arteries which

supply pelvic cavity
 Branch off the internal iliac
artery
 internal pudendal artery-
provide bld to the external
genitalia.
 the superficial external
pudendal artery,
 the deep external pudendal
artery

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• Lymphatic drainage:
From the upper two-
thirds of the left and right
labia majora, superficial
lymphatics pass toward
the symphysis and turn
laterally to join the medial
superficial inguinal
nodes.
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• Nerve supply:
• The iliohypogastric nerve originates from T12 and
L-1, divides into 2 branches:
• (1) the anterior hypogastric nerve- supplies the
superior portion of the labia majora and the mons
pubis.
• (2) the posterior iliac nerve, passes to the gluteal
area.
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 The ilioinguinal nerve
originates from L1 and
terminate in the upper
medial aspect of the labium
majora.
 The genitofemoral nerve
emerges from L1–L2 to
supply the dartos muscle
present within the labium
majus
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• Posterior femoral cutaneous nerve from posterior
divisions of S1 and S2 and the anterior divisions of
S2 and S3 supply the medial aspect of the thigh and
the labia majora.
• The pudendal nerve, composed primarily of S1, S2,
S3, and S4 branches sends small number of fibers to
the medial aspect of the labia majora.

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 The pudendal nerve
This is formed from S2–
4 spinal nerves
Courses along coccygeal
muscles
Exits through the greater
sciatic foramen at a
location posterior to the
sacrospinous ligament
and just closer to the
ischial spine
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• when injecting local anesthetic for a pudendal nerve
block, the ischial spine serves as an identifiable
landmark
• The pudendal nerve then runs beneath the
sacrospinous ligament and above the sacrotuberous
ligament as it reenters the lesser sciatic foramen to
course along the obturator internus muscle.

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• pudendal nerve leaves this canal to enter the
perineum and divides into three terminal branches.
• the dorsal nerve of the clitoris
• The perineal nerve runs superficial to the perineal
membrane
• divides into posterior labial branches and muscular branches
• serve the labial skin and the anterior perineal triangle
muscles

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 Labia Minora “Lesser lips”
The labia minora are 2 folds of skin that lie on both sides
of vestibule and measure approximately 5 cm in length and
0.5–1 cm in thickness.
The width varies according to age and parity, measuring 2–3
cm at its narrowest diameter to 5–6 cm at its widest, with
multiple corrugations over the surface.
 The labia minora begins at the base of the clitoris, where
fusion of the labia is continuous with the prepuce,
extending posteriorly and medially to the labia majora at the
posterior commissure.
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On their medial aspects superiorly beneath the clitoris, they
unite to form the frenulum and prepruce of the clitoris
adjacent to the urethra and vagina
The skin on the labia minora is smooth and pigmented. The
color and distention vary, depending on the level of sexual
excitement and the pigmentation of the individual.
The labia minora contain no hair follicles or sweat glands
Their folds contain connective tissue and adipose tissue
A deep cleft is formed on the lateral surface between the
labium majus and the labium minus.
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• Arterial: Superficial perineal artery, a branch of the
internal pudendal artery
• Venous: internal pudendal veins, that eventually
drains into the internal illiac vein
• lymphatic drainage terminates in the superficial
inguinal nodes and the external iliac chain
• Nervous supply: The innervation of the labia minora
originates from fibers that supply the labia majora and
from branches of the pudendal nerve
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 Clitoris
• The clitoris is 2 to 3 cm in length.
• It is homologous with the penis and is an erectile
organ.
• Unlike the penis, the clitoris is not traversed by the
urethra
• The clitoris is located posterior to the anterior labial
commissure, where the labia majora meet.
• It is usually hidden by the labia when it is flaccid.
• It is suspended by a suspensory ligament.

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 Cont.
▪The parts of the labia minora passing anterior to the clitoris
form the prepuce of the clitoris (homologous with the male
prepuce).
▪The parts of the labia passing posterior to the clitoris form
the frenulum of the clitoris, which is homologous with the
frenulum of the penile prepuce.
▪The clitoris, like the penis, it will enlarge upon tactile
stimulation, but it does not lengthen significantly.
▪It is highly sensitive and very important in the sexual arousal
of a female.

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• The blood supply to the clitoris is from its dorsal
artery, a terminal branch of the internal pudendal
artery
• As it enters the clitoris, it divides into 2 branches, the
deep and dorsal arteries.

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• The venous drainage is by pudendal plexus from the
labia minora, labia majora, and perineum, forming the
pudendal vein
• The lymphatic drainage of the clitoris coincides primarily
with that of the labia minora, the right and left sides having
access to contralateral nodes in the superficial inguinal
chain.

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• Nervous supply: The innervation of the clitoris is
through the terminal branch of the pudendal nerve.

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• Vestibule
• The vestibule is the space between the labia minora.
• The area of the vestibule is bordered by the labia minora
laterally, posterior commissure posteriorly, and by the
urethra and clitoris anteriorly. Inferiorly, it is bordered by
the hymenal ring
• The urethra, vagina, and ducts of the greater vestibular
glands open into the vestibule.

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 The External Urethral Orifice

• This median aperture is located 2 to 3 cm posterior to the

clitoris and immediately anterior to the vaginal orifice.
• On each side of this orifice are the openings of the ducts
of the paraurethral glands (Skene's glands).
• These glands are homologous to the prostate in the
male.

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 The Vaginal Orifice

• Also known as the introitus of the vagina

• Occupies the posterior two thirds of the vestibule
• This large opening is located inferior and posterior to
the much smaller external urethral orifice.
• The size and appearance of the vaginal orifice varies
with the condition of the hymen.

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 The Greater Vestibular Glands
(Bartholin's glands)
These glands are about 0.5 cm in diameter.
They are located on each side of the vestibule of
the vagina, posterolateral to the vaginal orifice.
From the anterior parts of the glands, slender
ducts open into the vestibule of the vagina on
each side of the vaginal orifice.
These glands secrete a small amount of
lubricating mucus into the vestibule of the vagina
during sexual arousal.
The greater vestibular glands are homologous
with the bulbourethral glands in the male.
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 The Lesser Vestibular Glands
• These are small glands on each side of the vestibule of
the vagina.
• They open into it between the urethral and vaginal
orifices.
• These glands also secrete mucus into the vestibule,
which moistens the labia and the vestibule

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• The blood supply to the vestibule is an extensive
capillary plexus that has anastomoses with the
superficial transverse perineal artery
• A branch comes directly from the pudendal
anastomosis with the inferior hemorrhoidal artery
• Venous drainage is extensive, involving the same
areas described for the arterial network.

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• Lymphatic drainage: The anterior portion,
including that of the external urethral meatus, drains
upward and outward with that of the labia minora
and the clitoris
• The portion next to the urethral meatus may join that
of the anterior urethra, which empties into the
vestibular plexus to terminate in the superficial
inguinal nodes, the superficial subinguinal nodes, the
deep subinguinal nodes, and the external iliac chain.
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• Nervous supply: The innervation of the vestibular
area is primarily from the sacral plexus through the
perineal nerve.

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 The perineum
• The perineum corresponds to the outlet of the pelvis
• It is lozenge shaped
• Anteriorly bound by pubic arch
• Posteriorly by coccyx
• Laterally by ischiopubic rami, ischial tuberosities and
sacrotuberous ligaments
• The perineum can be divided into two triangular parts by
drawing imaginary transverse line between the ischial
tuberosities
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• Anterior triangle – contains the external urogenital
organs (urogenital triangle)
• Posterior triangle – contains the termination of the
anal canal (anal triangle)

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• Urogenital triangle
• Bound by; Anteriorly & laterally by pubic sympysis
and the ischiopubic rami
• Divided into 2 compartments i.e superficial & deep
perrineal spaces
• Superficial muscles of the perineum
• Superficial transverse perineal muscle – arises from ischial
tuberosity and is inserted into perineal body

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 • Bulbospongiosus muscle aka bulbocavernosus – runs on
both sides of the vaginal orifice
• Ischiocavernosus muscle – arises from the inner surface of
the ischial tuberosity
• Nerve supply is derived from branchhes of the
pudendal nerve

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• The anal triangle
• The area includes the anal canal, anal sphincters
• Anal canal is attached posteriorly to the coccyx by
anococcygeal ligament
• Anal canal is surrounded by internal anal sphincter,
external anal sphincter & fibromuscular supporting
tissue

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• The proximal anal canal is lined with rectal mucosa
(columnar epithelium)
• Nerve innervation is derived from branches of the
pudendal nerve
• Vascular supply – the anarectum recieves its major blood
from;
• superior haemorrhoidal (terminal branch of the inferior
mesenteric ) artery
• Inferior haemorrrhoidal artery (branch of the internal iliac)
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• Venous drainage –
• Upper anal canal - terminal branches of the superior rectal
vein into the inferior mesenteric vein
• Lower anal canal – the inferior branch of the pudendal
vein into the iliac vein
• Lymphatic drainage – is by the external inguinal
lymph nodes

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 The perineal body

• Is a central point between the urogenital and the anal

triangles of the perineum
• It has interlacing muscle fibres from
bulbospongiosus, superficial transverse muscle, and
external anal sphincter
• Confers support to the pelvic structures

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 The pelvic floor

• Is a musculotendinous sheet that spans the pelvic outlet

• Consists of symmetrically paired levator ani muscle
• A sheath of variable thickness attached to the internal
surface of true pelvis
• Divided into parts according to their attachments
• Pubovisceral (pubococcugeus)
• Puborectal
• Illiococcygeus
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• Pubococcygeous is further divided into;
• Puboperinealis, pubovaginalis, puboanalis
• The muscles of the levator ani differ from most other skeletal
muscles
• They maintain tone, except during voiding, defecation
• Have the ability to contract quickly at the time of acute stress
e.g. cough, sneeze to maintain continence
• Distend considerably during parturition to allow the passage
of term foetus & contract after birth to resume normal
functioning
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• Innervation of the levator ani
• Superior surface – by sacral nerve roots S2-4
• Inferior surface – perineal branch of the pudendal nerve
• Vascular supply
• Branches of inferior gluteal artery, inferior vesiceral artery
and the pudendal artery

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 REFERENCES

• Marshall, J. E., Raynor, M. D., & Nolte, A. (Eds.).

(2016). Myles Textbook for Midwives 3E African Edition
E-Book: Myles Textbook for Midwives. Elsevier Health
Sciences.

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