ANATOMY OF FEMALE GENITAL

TRACT- II
Dr Anshu
Astt Prof
VAGINA

Fibro-musculo-membranous
sheath
4 walls- two lateral/ ant 7cm/
post 9cm
Ant & post walls apposed to
each other, lateral walls stiffer,
so looks ‘H’ shaped on Diameter of vaginal canal
transverse section 2.5cm, widest above,
Interior of the wall has narrowest at introitus
transverse rugae that helps in Directed upwards and
expansion of vagina backwards
Forms 45⁰ with the horizontal
in erect posture
• FORNICES: There are four fornices—
– Anterior
– Posterior
– Two lateral

Posterior fornix is closely

related to rectouterine pouch.
This proximity is clinically
useful.
Diagnostic-Culdocentesis
Therapeutic-Posterior
Colpotomy.
 VAGINA
• LAYERS:
1. Mucous coat- Str sq epith
2. Submucous layer- loose areolar ts
3. Muscular layer- inner circular/ outer long
4. Fibrous coat derived from endopelvic fascia
 VAGINA
• Vaginal epith is under action of sex hormones
• At birth upto 10- 14 d, the epithelium is str sq
epith, under the influence of maternal
estrogen circulating in the newborn
• Thereafter uptil prepuberty & in menopause
bc thin
• From puberty till menopause- str sq epith with
three distinct layers- basal, intermediate &
superficial cornified cells.
• Sup & intermediate cells contain glycogen
 VAGINA
• Fxn: 1. excre channel for menst bl & ut secr
2. organ for copulation
3. forms the birth canal of parturition
• Secr: normally- little secr
incr – mid mens/ just prior to mens
preg, sexual excitement
acidic pH (4.5-5.5)
estrogen
Glycogen lactic acid
(in exfoliated sq cells by Doderlein’s bacillus)
BLOOD SUPPLY
1. Cervicovaginal br
of ut
2. Vaginal art
3. Middle rectal
4. Internal
pudendal
VEINS:
Drain into int iliac &
int pudendal
 EXTERNAL GENITALIA
SYN:PUDENDUM, VULVA
• The pudenda commonly called vulva includes
structures visible externally from symphysis
pubis to perineal body. It includes
1)Mons Veneris
2)Labia majora
3)Labia minora
4)Vestibule
These all are visible on external examination.
MONS VENERIS :
MONS PUBIS
It is fat filled cushion
overlying symphysis
pubis. After puberty it
is covered with curly
hair distributed in a
triangular fashion
whose base is at
upper margin of
symphysis pubis and
tip ends at clitoris .
 LABIA MAJORA
Vulva is bounded on each side by
elevation of skin and subcutaneous
tissue, which forms labia majora.
They are continuous where they join
medially to form posterior
commissure in front of anus.
Inner surface of labia majora is
hairless.
The labia majora are covered with
squamous epithelium and contain
sebaceous glands , sweat glands and
hair follicles. Beneath the skin there
is dense connective tissue richly
supplied by venous plexus.
The round ligament terminates at its
anterior one third.
LABIA MINORA
Thick fold of skin devoid of fat
on either side of labia majora.
In nulliparous lady they are
only exposed when labia
majora is separated.
Anteriorly it is divided to
enclose the clitoris and unite
with each other in front and
behind the clitoris to form
prepuce and frenulum
respectively.
The lower portion of labia Labia minora do not contain hair
minora fuses to form follicles. They contain numerous
fourchette. sebaceous glands and tissues
 CLITORIS

Is a small cylindrical errectile body

measuring 2.5 cm situated
beneath the prepuce and above
the frenulum.
It has glans , corpus and crura.
Glans is < 0.5 cm in diameter and
is richly supplied by nerves .
Deep artery of clitoris supplies
clitoral body and dorsal artery of
clitoris supplis glans and prepuce
 VESTIBULE
A triangular space bounded
anteriorly by the clitoris ,
posteriorly by the fourchette , and
on either side by labium minus.
There are six openings into the
vestibule.
Urethral opening: It is situated
just infront of the vaginal orifice1-
1.5 cm below pubic arch.
Vaginal orifice: It lies in the
posterior end of vestibule. It is
incompletely closed by septum of
mucous membrane called hymen.
Paired openings of bartholin
gland and paraurethral skene
glands.
 BARTHOLIN GLANDS

•Also called greater vestibular

glands
•Measures 0.5 -1 cm
•Lie deep to inferior end of the
bulbo-cavernosus muscle
•Glands open distal to hymenal
ring at 5 O’ clock and 7 O’ clock
on the vestibule at the junction
of the anterior two third and
posterior one third of labia
minora.
 ARTERIAL SUPPLY OF VULVA
• Branches of internal pudendal ateries: 1) labial
artery 2)transverse perineal artery to the
vestibular bulb 3)deep and dorsal arteries to
the clitoris
• Branches of femoral artery : superficial and
deep pudendal artery.
 NERVE SUPPLY
• Anterosuperior part is through cutaneous
branches from the ilioinguinal and genital
branch of genital femoral nerve (L1, L2).
• Posteroinferior part by the pudendal
branches from posterior cutaneous nerve of
thigh (S2, S3, S4).
• Between these two group vulva is supplied by
labial and perineal branches of pudendal
nerve.
 LIGAMENTS
Round ligament
Infundibulo-
ligament
Utero-ovarian
ligament
Broad ligament
Cardinal ligament
Uterosacral
ligaments
URETHRA
From neck of bladder to the
external urethral meatus.
Length 4cm, diameter 6mm
Posterior urethro vesical
angle- bladder base forms an
angle of 100⁰ with the
posterior wall of the urethra
 RELATIONS OF URETHRA
• POSTERIOR: related to ant vaginal wall – loosely
separated in the upper 1/3rd but firmly adh in the
lower 1/3rd .
• ANTERIOR: posterior aspect of symp pubis- up 2/3 rd
separated by loose areolar ts, lower 1/3 rd att on
each side of the pubic rami by fibrous ts called the
pubourethral lig
• LATERALLY: as it passes thru the triangular lig,
surrounded by compressor urethrae
bulbocavernosus & vestibular bulb
 URETHRA
• GLANDS: paraurethral – tubular glands- open
into the lumen thru ducts. Of these ducts
called skene’s ducts are longer & open into the
post vaginal wall or into the vestibule
Skene’s glands- homologous to prostrate
SPHINCTERS OF
URETHRA

1. At
urethrovesical
jxn- involuntary
internal sph-
lissosph
2. Fibres of
detrussor conti
with wall of
urethra- invol
ms arranged in
crossed spirals
 SPHINCTERS
OF URETHRA
3. Sph urethrae-
ext ureth sph-
voluntary sph
4. Puborectalis
part of L. ani- in
lower 3rd of
urethra
UTERINE
LYMPHATICS
1. Fundus & adj body→
ov lymph
→paraaortic
2. Cornua→along
round lig→sup
inguinal
3. Rest of body→ext
iliac
4. Adjacent to cx→ cx
LN
CERVICAL
LYMPHATICS
Cervical lymp run in
the uterosacral lig

Drains into obturator,

internal & ext iliac &
sacral nodes
↓
Common iliac
↓
Para-aortic
 PELVIC LYMPHATICS
• FALLOPIAN TUBE & OVARY: intrinsic plexuses
situated in the mucosal & subperitoneal
layers- pass up along ov lymphatics to superior
lumbar group.
• VAGINA: intrinsic pl in mucosal & ms layers-
up 2/3rd → cervical LN
lower 1/3rd →inguinal / ext iliac nodes
SUPPORT OF THE UTERUS
A. PRIMARY SUPPORT

1. MUSCULAR SUPPORT

I. PELVIC DIAPHRAGM

II. PERINEAL BODY

III. UROGENITAL DIAPHRAGM

2. FIBROMUSCULAR SUPPORT
1. uterine axis
2. pubocervical ligament
3. transverse cervical ligament(mackenrodt’s ligament)
4. uterosacral ligament
5. round ligament of uterus
B. SECONDARY SUPPORT
-formed by folds of peritoneum

1. broad ligaments
2. uterovesical fold of peritoneum
3. rectovaginal fold of peritoneum
 ROUND LIGAMENT
• Paired, attached to cornua of the ut & courses
beneath the ant leaf of broad ligament to reach
the internal abd ring
• Traverses through the inguinal canal, and fuses
with the subcut ts of ant 1/3rd of labia majora
• Contains plain ms & conn ts & lymphatics from
the body of uterus which drain into the inguinal
group of LN
• Embryologically corresponds to gubernaculum
testis
 BROAD LIGAMENT
• Not true ligaments
• One on either side
• The double fold of peritoneum which extends
from lateral border of the ut to the lateral
pelvic wall
• Two layers- ant & post-
• The two layers are continuous at it’s upper
free border embracing the fallopian tubes
 BROAD LIGAMENT
• Ant leaf is reflected forwards at the int os as
uterovesical pouch
• Post leaf decends down to cover up 1/3rd of
post vaginal wall to form post layer of POD
 Parts of broad ligament
1. INFUNDIBULOPELVIC LIGAMENT
• The portion of broad ligament which extends
from the infundibulum of fallopian tube to
lateral pelvic wall
• Contains ov vs, nerves & lymphatics from the
ovary , fallopian tube & body of ut
Parts of broad ligament
2.MESOVARIUM: ovary att to post
layer of broad lig by this
Through this ov vs, nerves lymph
enter & leave the hilum
3.MESOSALPINX: part of br lig b/w
the fallopian tube & ovary
Contains utero-ov anastomotic vs
& vestigial remnants
4.MESOMETRIUM: part of br lig
below the mesosalpinx.
Longest portion related to lateral
border of ut.
 Contents of broad ligament
• Fallopian tube
• Uterine & ov arteries with their branches
• Nerves & lymphatics from ut, tubes & ovaries
• Proximal part of round lig
• Ovarian lig
• Parametrium – loose areolar ts, fat, terminal
part of ureter, uterine artery, paracervical
nerve & lymphatic plexus
• Vestigial str- gartner’s duct, epoophoron,
paroophoron
 MACKENRODT’S LIGAMENT
• Aka Cardinal/ Transverse cervical
• Originates from the condensation of parietal
fascia covering the obturator internus muscle
• Inserted laterally into supravaginal cervix &
upper part of lateral vaginal wall in a fan
shaped manner
• Function: stabilizes the cervix laterally at the
level of the ischial spines
 UTEROSACRAL LIGAMENTS
• Originates from periosteum of S2,3,4
• Inserted at the posterolateral surface of the
cervix at the level of internal os
• Function: primary suspensory ligaments of the
uterovaginal complex. Holds the cervix
posteriorly at the level of the ischial spines
THANKYOU