FEMALE REPRODUCTIVE

SYSTEM -ANATOMY
GLENDA PICHAY-RABINO,MD, FPOGS
 OVERVIEW

► Pelvis
► Pelvic floor
► External genitalia
► Internal genitalia
► Vessel and nerve and lymph
► Adjacent organs
A.PELVIS
PELVIS
► Pelvic trauma
► Pelvic Adhesions

-bands of scar tissue

B. External genitalia

mons pubis

Clitotis Labium
majus
Labium
Urethral orifice minus
Vaginal
Vaginal orifice
vestibule
Fossa
Perineal body navicularis

Anus
Vulva/ pudendum- term for externa
genitalia visible in the perineum
External organs description
1. Mons pubis Hair pattern-escutcheon in
female triangle,male-like
diamond
2.Labia majora 2 large , longitudinal
( scrotum in male) cutaneous fold . No hair
follicles but apocrine glands
3. Labia minora Nymphae-2 red cutaneous
( penile urethra in male) fold . Delicate, shorter and
thinner. Rich in sebaceous
gland but no hair
3. Hymen Thin perforatedmembrane in
the entrance of vagina
4. Clitoris Erectile organ at the superior
Function
Protection
Protection
Divides clitoris to superior-
prepuce, inferiorly –frenulum
Erectile tissue (nerve ending)
Disease
Lice
Atrophy at menopause
Infection can lead to
necrotizing fasciitis, cell
due to continuation of fa
anterior abdominal wall
Trauma
Imperforate hymen
clitoromegally
rgans description function disease

. vestibule Lowest portion of embryonic Opens the orifeces of

urogenital sinus. . Extends from urethra, vagina, ducts of
clitoris to posterior fourchette Bartholin’s glands

. urethra Membranous conduits for urine Passage of urine Urethral prolapse

from urinary bladder to the Urethral diverticula (urinary frequency,
vestibule urgency, dysuria)
p 2/3: stratified transitional
epithelium
D 1/3: stratified squamous epi

.Skenes Tubular gland adjacent to distal

land- urethra
araurethral
land
prostate in
Bartholin’sgland Vulvovaginal glands at 4 Bartholin’s duct
( cowper’s gland in and 8 oclock position cyst/abscess
male
Ducts- transitional epi
Glands - cuboidal
Vestibular bulb 2 elongated masses of
( bulb of the penis) erectile tissue. Each bulb
is immediately below the
bulbocavernosus
muscle . Distal end is
adjacent to bartholins
gland
External Genitalia
Female Perineum
External genitalia

►Enable sperm to enter

►Protect the internal genital organs from
infectious organism
C. Internal genitalia
 Internal genitalia
Vagina-thin
walled ,distensible
fibromuscular tube
1. strong canal of muscle
(7.5cm)
2. vaginal fornix
the circular cul-de-sac
formed around the cervix

4 regions: the anterior fornix,

the posterior fornix and 2
lateral fornices.
vagina

► L 3/d- close relationship with urogenital and pelvic diaphragm

► M3/d – supported by levator ani muscle
► Lower portion – cardinal ligaments
► No glands
► Vascular system- vaginal artery from uterine artery, internal iliac from uterine
and inferior vesical artery. Anastomosis of cervical branch of uterine artery to
form ZYGOS arteries.( branches of internal pudendal, inferior vesical and
middle hemorrhoidal). Venous drainage: vaginal, uterine and vesical veins.
► Nerve supply- ANS vaginal plexus and sensory fibers from pudendal nerve . Pain
fibers enters spinal cord in sacral segment 2-4
► Lymphatic drainage- U 3/d external iliac nodes, M 3/d common and internal
iliac nodes L 3/d common iliac, superficial inguinal and perirectal nodes
External Genitalia
 Internal genitalia
► Vagina
Infections
( Bacterial vaginosis,
Fungal)
Gartner’s duct cyst
Hemorrhage during trauma
(inferior gluteal and pudendal
arteries
Cystocele, rectocele-
weakness of endopelvic fascia
Cervix-greek word trachelos-
trachelectomy
-lower 1/3 of uterus. connects uterus
to vagina via endocervical canal
1. External os: opening of
endocervical canal to ectocervix
2. Internal os: indistinct upper limit
of endocervical canal
cervix

► 2.5-3 cm in diameter
► Small and round in nulligravid; gaping and wider ff delivery
► Arterial supply- descending branch of uterine artery, cervical arteries runs on
the lateral 3 and 9 oclock position and form the coronary artery.

Clinical correlation:
Bleeding on 3 and 9th o’clock position – ligated and sutured
Transformation zone –undergo dysplasia
TRANSFORMATION ZONE

Area between the old and new SCJ

where most abnormal changes occur
 Uterus- greek word-
hystera
1. Pear-shaped,thick- walled,
muscular organ.40-50 g,110g
2. Body and cervix:
3. Isthmus uteri
connect the body to cervix, 1cm
(non-pregnancy)
4. Layers of uterine wall
1) The serous layer (perimetrium)
2) The muscular layer
3) Endometrium
uterus

► Blood supply: uterine from hypogastric and ovarian arteries and veins from
aorta
► Lymphatic drainage: fundus and body- aortic,lumbar and pelvic nodes
surrounding iliac vessel –internal iliac nodes

► Hysterectomy-removal of the uterus

Uterine Artery
UTERINE pathology
►Intrauterine Adhesions: previous curettage of the uterine cavity,
usually during or shortly following a pregnancy (asherman’s syndrome)

►Leiomyoma: depending on their location, fibroids may decrease

the chance of conception and/or increase the miscarriage rate,
submucous fibroids, larger intramural fibroids (4 cm) and those
that distort the cavity

►Endometriosis: endometrial tissue grows outside uterus

Leiomyoma/fibriods
 Internal genitalia
Fallopian Tube-
superolateral portion of
uterus-greek salpinx
ANATOMY:
1) Interstitial portion:
2) Isthmic portion: narrow
3) Ampulla: wide and tortuous
4) Fimbria: funnel-shaped mouth
LAYERS:
5) Serous
6) Muscular: outer longitudinal and inner
circular
7) Mucous: ciliated columnar epithelium, coarse
longitudinal folds
Fallopian tubes

► Mesentery(mesosalpinx) –contains blood supply and nerves

► 10-14 cm
► Fertilization at the ampulla-tubes, contain longitudinal fold called plicae
► Blood supply: terminal branch of uterine and ovarian arteries anatomose in
the mesosalpinx. Lymphatic drainage internal iliac nodes and aortic nodes and
inferior vena cava. Sensory nerve T11-12 ans L1
 Fallopian Tube
► They count for 30-40% of cases of
female infertility, turning them in
the most frequent cause of female
infertility
► Increase incidence of salpingitis
► Obstructions occur at the distal or
proximal portion of the tube
► Distal obstruction > proximal
obstruction
► Frequent causes of tubal occlusion
include infection, prior surgery,
tubal spasm and pelvic
inflammatory disease. Ectopic
pregnancy,paratubal and
paraovarian cyst.
► OVARY 3-6 g ,1.5x2.5x 4cm
1. Anatomy
1) Paired organ, elliptic,large almond
2) The suspensory ligament of the
ovary(mesovarium) at the post. Aspect
of broad ligament
3) The ovarian ligament/infundibulopelvic
narrow ,short ,fibrous bands extend
from lower pole of ovary ( A/V/N)

2. Structure of ovary
1) Covered by cuboid or low columnar
epithelium
2) Consist of a cortex and a medulla
3) Cortex: oocytes in various stages of maturity.
4) Medulla: fibers, smooth muscle cells, blood
vessel, nerves.
Ovarian Artery
Ovarian anomalies:
► Ovarian anomalies
that usually contribute
to infertility are
mainly related with
hormonal disorders.
(PCOS)
► Other causes, the
anatomic ones,
include endometriosis.
► Ovarian cyst and
Carcinoma
 Vascular system of the pelvis
► Arteries- inferior mesenteric-3 cm above bifurcation –
colon,sigmoid and rectum
► Ovarian- aorta below renal vessel,
crosses anterior to the ureter enters
infundibulopelvic ligament,
unites with ascending branch of uterine artery in
mesovarium under suspensory ligament of the ovary
arteries

► Common iliac- bifurcation of aorta

at L4 5 cm in length before it divides
Into external iliac and hypogastric arteries
 Hypogastric Artery
Hypogastric/internal iliac- 3-
4 cm,
in close proximity to ureters
( anterior to ureter, post. to
vein. 2 branches:
9 Anterior trunk- 3 parietal
branches
( obturator, internal
pudendal and inferior
gluteal )
6 visceral: umbilical, middle
vescical,
inferior vescical, middle
hemorrhoidal uterine and
vaginal arteries.
Posterior trunk -3 parietal
branches- iliolumbar, lateral
sacral and superior gluteal
Uterine and vaginal

Uterine – from anterior division of hypogastric artery

courses medially to the isthmus of the uterus .
2 cm lateral to the endocervix it crosses over the ureter

Vaginal- arise from anterior trunk of hypogastric artery

or from uterine . Supplies blood to vagina, bladder
and rectum
Internal Pudendal Artery- branch of hypogastric artery,
supply branches to the rectum, labia, clitoris and perineum
Pelvis
Veins-venous drainage follows with the arteries except left vein empties
to left renal vein while right ovarian vein connects directly to inferior
vena cava
Lymph
Pelvic diaphragm and Ligaments

► Pelvic diaphragm/ endopelvic fascia -primary muscles are levator ani and coccygeus
- support of pelvic and pelvic floor
-compose of collagen, elastic tissue and
muscle(pubococcygeus, puborectalis and
iliococcygeous

► Urogenital diaphragm/triangular ligament- external and inferior to pelvic

diaphragm. It has 2 layers that cover the striated ,deep transverse perineal muscle
-function to support the urethra and
maintenance of urethrovesical junction
Pelvic Diaphragm
Ligaments- thickenings of retroperitoneal fascia . Consists
of blood, lymphatic vessels, nerves and fatty connective tissue

► Broad- thin, mesenteric- like double reflection from lateral pelvic wall to the
uterus and continuous to uterine serosa. Thus, uterus is contained within two
folds of peritoneum.
- Peritoneal folds enclose the loose, fatty connective
tissue----Parametrium
- contains oviduct, ovarian and round
ligaments,ureters, ovarian and uterine arteries and
veins parametrial tissue and remnants of mesonephric
duct
Broad Ligaments
► Cardinal/mackenrodt’s- lateral upper cervix and vagina to the pelvic wall
- maintains anatomic position of cervix and upper
vagina. Major support of cervix and uterus.
► Uterosacral- upper portion of the cervix posteriorly to the S3. Serve as minor
role in the support of the cervix
Nongenital pelvic organs

► 1. ureters
► 2. Urinary bladder
► 3. Rectum
Ureters
ureters

► Whitish muscular tube ,28-34 cm from renal pelvis to urinary bladder

► 2 segments: abdominal- 8-10 mm;pelvic segment- 4-6 mm
LOCATION OF URETERS
► Ureter is retroperitoneal in location goes along and in close proximity with
ovarian, uterine, obturator and superior vesical arteries
► Runs forward and medially from uterosacral to the base of broad ligament to
the cardinal ligaments. (1-2 cm lateral to the uterine cervix)
► Ureter run upward and medially in the vesical uterine ligament and enters
the bladder
Bladder

► Hallow muscular organ that lies between symphysis pubis and uterus
Other structures

► 1. Cul-desac of Douglas/recto-uterine pouch or fold- most caudal extend of

parietal peritoneum . Seperates uterus from large intestine. Easily accessible
in performing transvaginal surgical procedure.Posterior colpotomy in draining
abscess

► 2. Parametria- coats extraperitoneal fatty and fibrous connective tissues

adjacent to the uterus. Thickens during radiation, pelvic cancer, infection
and endometriosis

► 3. Paravesical and pararectal spaces- potential spaces useful in pelvic

lymphnode dissection and radical surgery
Cul De Sac of Douglas
Clinical correlation

► Landmarks in surgical anatomy

► Profuse hemorrhage- hypogastric ligation is needed to control bleeding
► Knowledge on pelvic lymphatics is important for gynecologic oncologist to
know the extent of spread for pelvic malignancy