FEMALE GENITAL TRACT

BASIC HISTOLOGY
DR JIBRAN AHMED MD.
• The genital tract consists of the Fallopian tubes, the uterus and the vagina, all of
which have the same basic structure, consisting of a wall of smooth muscle with an
inner mucosal lining and an outer layer of loose supporting tissue.
• The whole tract undergoes cyclical changes under the influence of ovarian
hormones which are released during the ovarian cycle.
• The cyclical changes which occur in the genital tract facilitate the entry of ova into
the Fallopian tube, the passage of spermatozoa through the uterine cervix and into
the Fallopian tube, the passage of the fertilised ovum into the uterus and the
implantation and development of the fertilized ovum in the mucosal lining
(endometrium) of the uterus.
• Implantation of a fertilised ovum results in secretion of hormones that inhibit the
ovarian cycle and produce changes in the genital tract necessary for fetal
development and parturition.
FALLOPIAN
TUBE
• The Fallopian tubes (also called uterine tubes or oviducts) carry ova from the surface of the ovaries to the
uterine cavity and are also the site of fertilisation by spermatozoa.
• The Fallopian tube is shaped like an elongated funnel and is divided anatomically into four parts as shown in
the diagram.
• At the time of ovulation, the infundibulum moves so as to overlie the site of rupture of the Graafian follicle.
Finger-like projections called fimbriae extending from the end of the tube envelop the ovulation site and direct
the ovum into the tube.
• Movement of the ovum along the tube is mediated by gentle peristaltic action of the longitudinal and circular
smooth muscle layers of the oviduct wall. This is aided by a current of fluid, propelled by the action of the
ciliated epithelium lining the tube.
• The mucosal lining of the Fallopian tube is thrown into a labyrinth of branching longitudinal folds, a feature
that is most prominent in the ampulla , which is the usual site of fertilisation. Note also, the muscular wall
and the vascular supporting tissue of the serosa , which is continuous with the broad ligament. The serosal layer
and broad ligament have a surface lining of mesothelium.
• Micrograph focuses on one of the mucosal folds of the ampulla. These have a branching core of vascular
supporting tissue and are invested by a single layer of tall columnar epithelial cells.
• The muscular wall has two layers, an inner circular and an outer longitudinal.
• The columnar cells of the epithelium are of three types: ciliated, non-ciliated secretory and intercalated cells.
• The non-ciliated cells produce a secretion that is propelled towards the uterus by the wave-like beating of the
cilia of the ciliated cells, carrying with it the ovum. This secretion probably also has a role in the nutrition and
protection of the ovum.
• The intercalated cells may be a morphological variant of the secretory cells. The ciliated cells are generally
shorter than the secretory cells, making the epithelial surface somewhat irregular in outline. Scattered
intraepithelial lymphocytes are also present.
The mucosal lining of the
Fallopian tube is thrown
into a labyrinth of
branching longitudinal
folds, a feature that is most
prominent in the ampulla ,
which is the usual site of
fertilisation.

Note also, the muscular

wall and the vascular
supporting tissue of the
serosa , which is
continuous with the broad
ligament
Micrograph focuses on one of the
mucosal folds of the ampulla.
These have a branching core of
vascular supporting tissue and are
invested by a single layer of tall
columnar epithelial cells
UTERUS
• The uterus is a flattened pear-shaped organ approximately 7cm long in the non-pregnant state. Its
mucosal lining, the endometrium, provides the environment for fetal development.
• The thick smooth muscle wall, the myometrium, expands greatly during pregnancy and provides
protection for the fetus and a mechanism for the expulsion of the fetus at parturition.
• The endometrium is variable in thickness, measuring between 1 and 5 mm at different stages of the
menstrual cycle. The myometrium makes up the bulk of the uterus, measuring up to about 20 mm
in a woman of reproductive age.
• In women of child-bearing age, the endometrial lining of the uterine cavity consists of a columnar
ciliated epithelium forming numerous simple tubular glands, supported by the cellular
endometrial stroma.
• Under the influence of oestrogen and progesterone secreted during the ovarian cycle, the
endometrium undergoes regular cyclical changes so as to offer a suitable environment for
implantation of a fertilised ovum.
• For successful implantation, the fertilised ovum requires an easily penetrable, highly vascular
tissue and an abundant supply of glycogen for nutrition until vascular connections are established
with the maternal circulation.
• The cycle of changes in the endometrium proceeds through three distinct phases: menstruation,
proliferation and secretion. These changes involve both the epithelium and supporting stroma.
THE MENSTRUAL PHASE
• The first day of menstruation is, by convention, taken as the first day of the cycle, simply because it is easily
identified.
• This is the phase of endometrial shedding that only occurs if there is failure of fertilisation and/or
implantation of the ovum.
• Progesterone production by the corpus luteum is inhibited by negative feedback on the anterior pituitary, thus
suppressing LH release and leading to involution of the corpus luteum. In the absence of progesterone, the
endometrium cannot be maintained.
• Reactivation of FSH secretion initiates a new cycle of follicular development and oestrogen secretion. This, in
turn, initiates a new cycle of proliferation of the endometrium from the endometrial remnants of the previous
cycle.

THE PROLIFERATIVE PHASE

• The endometrial stroma proliferates, becoming thicker and richly vascularised. The simple tubular glands
elongate to form numerous long, coiled glands that begin secretion coincident with ovulation.
• The proliferative phase is initiated and sustained until ovulation by the increasing production of oestrogens
from developing ovarian follicles.

THE SECRETORY PHASE

• Release of progesterone from the corpus luteum after ovulation promotes production of a copious, thick,
glycogen-rich secretion by the endometrial glands.
• A typical menstrual cycle is 28 days in length, although there is wide variation among normal women.
• Menstruation lasts on average 5 days. The proliferative phase continues until about the 14th day when
ovulation occurs and the secretory phase begins. The secretory phase culminates at the onset of menstruation
on about the 28th day.
• The endometrium is divided into three histologically and functionally distinct layers.
• The deepest or basal layer, the stratum basalis, adjacent to the myometrium, undergoes little change during
the menstrual cycle and is not shed during menstruation.
• The broad intermediate layer is characterized by a stroma with a spongy appearance and is called the
stratum spongiosum.
• The thinner superficial layer, which has a compact stromal appearance, is known as the stratum
compactum. The compact and spongy layers exhibit dramatic changes throughout the cycle and both are
shed during menstruation. These layers are jointly referred to as the stratum functionalis.
• The arrangement of the arterial supply of the endometrium has important influences on the menstrual cycle.
Branches of the uterine arteries pass through the myometrium and immediately divide into two different types
of arteries, straight arteries and spiral arteries. Straight arteries are short and pass a small distance into the
endometrium, then bifurcate to form a plexus supplying the stratum basalis.
• Spiral arteries are long coiled and thick-walled and pass to the surface of the endometrium, giving off
numerous branches which give rise to a capillary plexus around the glands and in the stratum compactum.
• Unlike the straight arteries, the spiral arteries are responsive to the hormonal changes of the menstrual cycle.
The withdrawal of progesterone secretion at the end of the cycle causes the spiral arteries to constrict and this
precipitates an ischaemic phase that immediately precedes menstruation.
THE MENSTRUAL PHASE
• In the absence of implantation of a fertilised ovum, degeneration of the corpus
luteum results in cessation of oestrogen and progesterone secretion. In turn, this
initiates spasmodic constriction in the spiral arterioles of the endometrial stratum
functionalis .
• The resulting ischaemia is initially manifest by degeneration of the superficial
layers of the endometrium and leakage of blood into the stroma.
• Endometrial stroma breaksdown and the endometrial glands collapse. These
features are indicative of early necrosis of glands and stroma. At high
magnification, nuclear debris of endometrial cells (apoptotic bodies) can be seen at
the onset of menstruation. These cells have died by apoptosis.
• Further ischaemia leads to degeneration of the whole stratum functionalis, which
is progressively shed as menses. Menses is thus composed of blood, necrotic
epithelium and stroma.
• Normally, menstrual blood does not clot due to the local release of inhibitory
(anticoagulant) factors and its expulsion is enhanced by uterine contractions.
• By day 3 to 4 of menstruation, most of the stratum functionalis has been shed and
proliferation of the basal layer of the endometrium has begun again.
 Endometrial stromal breakdown in the
menstrual phase, bleeding into the
stroma occurs with dense aggregates of
stromal cells.
 High power view of stromal cells
condensing into round aggregates.
At high magnification, nuclear debris of endometrial cells
(apoptotic bodies) can be seen at the onset of
menstruation. These cells have died by apoptosis
PROLIFERATIVE ENDOMETRIUM
• Early proliferative endometrium
• The relatively thin endometrium consists of the stratum basalis , stratum spongiosum and stratum compactum.
• The glands at this stage are fairly sparse and straight. As the glands, stroma and vessels proliferate, the
endometrium gradually becomes thicker.
• By day 5 to 6 of the cycle, the surface epithelium has regenerated. During the proliferative phase, the epithelial
cells acquire microvilli and cilia as well as the cytoplasmic organelles required for the secretory phase.
• At higher magnification in micrograph, the straight tubular form of the endometrial glands can be seen. At very
high magnification, the proliferating glandular epithelium is seen to consist of columnar cells with basally
located nuclei exhibiting prominent nucleoli.
• Mitotic figures can be seen, both in the epithelium and in the stroma. Note the highly cellular stroma which is
almost devoid of collagen fibres.

• Late proliferative stage

• The endometrium has doubled in thickness. Note that in contrast to the stratum functionalis , the appearance of
the stratum basalis is little changed when compared with the early proliferative phase.
• With further magnification, micrograph shows that the tubular glands are now becoming coiled and more
closely packed. At very high magnification in micrograph , mitotic figures are more prevalent in both the
glandular epithelium and the supporting stroma.
• The stroma is also somewhat oedematous at this stage.
• During the proliferative phase, there is a continuum of change that makes the precise dating of the cycle
inaccurate in histological specimens. Lymphocytes and occasional lymphoid aggregates are a normal feature of
late proliferative phase endometrium, but plasma cells are abnormal, indicating chronic infection (endometritis).
EARLY PROLIFERATIVE ENDOMETRIUM LATE PROLIFERATIVE ENDOMETRIUM
Low power view of proliferative
phase endometrium shows
regularly spaced glands with
round contour

Cellular blue appearance at low

power
This is the microscopic appearance
of normal proliferative
endometrium in the menstrual
cycle.

The straight tubular form of

the endometrial glands can be
seen.

At high magnification in
micrograph, the proliferating
glandular epithelium is seen to
consist of columnar cells with
basally located nuclei exhibiting
prominent nucleoli

Mitotic figures can be seen, both

in the epithelium and in the
stroma
SECRETORY ENDOMETRIUM

• Ovulation marks the onset of the secretory phase, although endometrial cell division continues for several
days. At low magnification in micrograph the coiled appearance of the glands is now more pronounced and
the endometrium approaches its maximum thickness.
• Under the influence of progesterone, the glandular epithelium is stimulated to synthesize glycogen. Initially,
the glycogen accumulates to form vacuoles in the basal aspect of the cells, thus displacing the nuclei towards
the centre of the now tall columnar cells. This basal vacuolation of the cells appears on day 16 and is the
characteristic feature of early secretory endometrium. Glycogen is an important source of nutrition for the
fertilised ovum.
• The late secretory phase is characterised by a saw-tooth appearance of the glands, containing copious thick
glycogen- and glycoprotein-rich secretions.
• At very high magnification , the cytoplasmic vacuoles can now be seen on the luminal aspect of the cell, and
the nucleus has returned to its basal position. These vacuoles contain glycogen and glycoproteins that are
secreted into the glandular lumen by apocrine-type secretion. Mitotic figures are absent.
• The stroma is by now at its most vascular and interstitial fluid begins to accumulate between the stromal cells.
• Endometrial stromal granulocytes, which are probably large granular lymphocytes, are found in the stroma at
this stage. These changes in secretory phase endometrium make more precise dating possible on histological
specimens than in the proliferative phase. Such examinations may be helpful in the investigation of infertility.
• At low magnification in
micrograph the coiled appearance
of the glands is now more
pronounced and the
endometrium approaches its
maximum thickness.

• Endometrium showing increasing

stromal edema
Here is early secretory endometrium.
The appearance with prominent
subnuclear vacuoles in cells forming
the glands
 The late secretory phase is characterised
by a saw-tooth appearance of the glands,
containing copious thick glycogen- and
glycoprotein-rich secretions.
At very high magnification , the cytoplasmic vacuoles can
now be seen on the luminal aspect of the cell, and the
nucleus has returned to its basal position.
This micrograph illustrates the surface
epithelium of the endometrium, which is
tall and columnar in form.

Some of the cells bear cilia

Stromal cells have plump, spindle-shaped

nuclei and scanty cytoplasm.

This specimen was obtained during the

secretory phase of the menstrual cycle at a
time when the stroma is quite
oedematous.

This can be seen in the clear spaces

between the spindle-shaped stromal cells.
POST-MENOPAUSAL ENDOMETRIUM

• After the menopause, the cyclical production of oestrogen and progesterone from the ovaries ceases
and the whole genital tract undergoes atrophy.
• The endometrium is thin, consisting only of the stratum basalis, and the glands are sparse and
inactive.
• In some women, the glands become dilated to form cystic spaces. The reason for this is unknown,
but this appearance is so common as to be considered a normal variant. The epithelium which lines
cystically dilated glands is often flattened.
• At higher magnifications the glandular epithelial cells are cuboidal or low columnar with no mitotic
figures or secretory activity.
• The stroma S is much less cellular and contains more collagen fibres than during the reproductive
years and no mitotic activity is seen.
• The myometrium also becomes atrophic after the menopause and the uterus shrinks to about half its
former size.
The glands become dilated to form cystic spaces.

This appearance is so common as to be considered

a normal variant.

The epithelium which lines cystically dilated

glands is often flattened.
At higher magnifications the glandular epithelial cells are cuboidal or low columnar with no mitotic
figures or secretory activity.
The stroma is much less cellular and contains more collagen fibres than during the reproductive
years and no mitotic activity is seen.
MYOMETRIUM
• The main bulk of the uterus
consists of smooth muscle, the
myometrium, which is composed
of interlacing bundles of long
slender fibres arranged in ill-
defined layers.
• This is readily seen in
micrograph , which contains
bundles of fibres in transverse ,
longitudinal and oblique sections
.
• Within the muscle, there is a rich
network of arteries and veins
which are supported by
collagenous supporting tissue.
• Micrograph shows detail of the
smooth muscle cells at high
magnification, highlighting the
closeness with which the muscle
fibres are packed.
UTERINE
CERVIX
• The uterine cervix protrudes into the upper vagina and contains the endocervical canal, linking the uterine
cavity with the vagina.
• The function of the cervix is to admit spermatozoa to the genital tract at the time when fertilisation is possible,
i.e. around the time of ovulation. At other times, including pregnancy, its function is to protect the uterus and
upper tract from bacterial invasion. In addition, the cervix must be capable of great dilatation to permit the
passage of the fetus during parturition.
• The endocervical canal is lined by a single layer of tall columnar mucus-secreting epithelial cells. Where the
cervix is exposed to the more hostile environment of the vagina , the ectocervix, it is lined by thick stratified
squamous epithelium as in the vagina and the vulva.The cells of the ectocervix often have clear cytoplasm due
to their high glycogen content.
• The junction between the ecto- and endocervical epithelium is quite abrupt and is normally located at the
external os, the point at which the endocervical canal opens into the vagina.
• The main bulk of the cervix is composed of tough collagenous tissue containing a little smooth muscle. At the
squamo-columnar junction, the cervical stroma is often infiltrated with leucocytes, forming part of the defence
against ingress of microorganisms.
• The mucus-secreting epithelial lining of the endocervical canal is thrown into deep furrows and tunnels. The
columnar mucus-secreting cells lining the ‘glands’ are shown. Note the leucocytic infiltrate in the superficial
stroma and the presence of leucocytes in the endocervical mucus on the surface. Some inflammation is
considered to be normal at this site.
• During the menstrual cycle, the endocervical epithelium undergoes cyclical changes in secretory activity. In the
proliferative phase, rising levels of oestrogen promote secretion of thin, watery mucus which permits the
passage of spermatozoa into the uterus around the time of ovulation. Following ovulation, the cervical mucus
becomes highly viscid, forming a plug that inhibits the entry of microorganisms (and spermatozoa) from the
vagina. This is particularly important should pregnancy occur.
• The endocervical canal is lined by a
single layer of tall columnar mucus-
secreting epithelial cells.

• Where the cervix is exposed to the more

hostile environment of the vagina , the
ectocervix, it is lined by thick stratified
squamous epithelium as in the vagina
and the vulva
VAGINA
• The wall of the vagina , consists of a mucosal layer lined by stratified squamous
epithelium , a layer of smooth muscle and an outer adventitial layer. In the relaxed
state, the vaginal wall collapses to obliterate the lumen, and the vaginal epithelium
is thrown up into folds. The fibrous lamina propria contains many elastin fibres,
has a rich plexus of small veins and is devoid of glands.
• The vagina is lubricated by cervical mucus, and mucus secreted by glands of the
labia minora. The smooth muscle bundles of the muscular layer are arranged in ill-
defined inner circular and outer longitudinal layers. The adventitial layer of the
vagina merges with the adventitial layers of the bladder anteriorly and rectum
posteriorly.
• The combination of a muscular layer and a highly elastic lamina propria and outer
adventitia permits the gross distension that occurs during parturition. Conversely,
after coitus, involuntary contraction of the smooth muscle layer ensures that a pool
of semen remains in the cervical region.
• Micrograph illustrates the stratified squamous epithelium that lines the vagina.
During the menstrual cycle, this epithelium undergoes cyclical changes in glycogen
levels.
• Throughout the cycle, the superficial cells produce glycogen that is anaerobically
metabolised by vaginal commensal bacteria to form lactic acid which inhibits the
growth of pathogenic microorganisms.