Anatomy of Female Reproductive System

Case: A 27 year old lady comes to your clinic with complaints of pain abdomen for 2 days and nausea and vomiting for 5days which is more in the morning. She also complains of increased frequency of micturition for a week. Her last menstrual period was 6 weeks back. On examination you find no abnormality except for slight breast tenderness. Per speculum and per vaginal examinations are normal. What investigation would you like to order the first?

Introduction

External genitalia

Internal genitalia

Vessel and nerve and lymph

Adjacent organs

Pelvis

Pelvic floor

External genitalia

Labia majora

• The venous drainage is extensive and forms a plexus with numerous anastomoses. Vulva hematoma

Vaginal vestibule

• Bordered by the labia minora laterally, by the urethra and clitoris anteriorly, by the hymenal ring inferiorly.

Internal genitalia

Vagina

1.Strong canal of muscle (7.5cm)

extend from the uterus to the vestibule of the external genitalia. its long axis is almost parallel with that of the lower part of the sacrum. the anterior wall of the vagina is 1.5-2cm shorter than the posterior wall.

2.vaginal fornix

the circular cul-de-sac formed around the cervix

4 regions: the anterior fornix, the posterior fornix and 2 lateral fornices.

Wall structure

• mucosal layer (stratified squamous epithelium)
• submucous area ( with a dense plexus of veins and lymphatics)
• muscular layer (3 layers)

• Uterus

Pear-shaped,thick-walled, muscular organ

Body and cervix:

Babyhood 1:2, manhood 2:1

Isthmus uteri

connect the body to cervix, 1cm (non-pregnancy)

Layers of uterine wall

The serous layer (perimetrium)

• Thin and firmly adherent over the fundous and most of the body
• Uterovesical pouch of the peritoneum
• Rectouterine pouch of the peritoneum (pouch of Douglas)

The muscular layer

• Outer layer (longitudinal fibers)
• Inner layer (interlaced and various directions)

The mucous layer (endometrium)

• Compact layer: response to hormones periodically, a single layer of ciliated columnar epithelium

• Spongy layer: response to hormones periodically. contains many tubular glands

• Basal layer: single layer of cells, no response to hormones periodically

Cervix

• lower 1/3 of uterus. connects uterus to vagina via endocervical canal
• External os: opening of endocervical canal to ectocervix
• Internal os: indistinct upper limit of endocervical canal

Ligaments

• Broad ligament
• Round ligament
• Cardinal ligament
• Utero-sacral ligament

Oviduct

Anatomy

Interstitial portion:

Isthmic portion: narrow

Ampulla: wide and tortuous

Fimbria: funnel-shaped mouth

Layers of wall

• Serous
• Muscular: outer longitudinal and inner circular
• Mucous: ciliated columnar epithelium, coarse longitudinal folds

Ovary

Anatomy

Paired organ, elliptic

The suspensory ligament of the ovary

The ovarian ligament

Structure of ovary

• Covered by cuboid or low columnar epithelium
• Consist of a cortex and a medulla
• Cortex: oocytes in various stages of maturity.
• Medulla: fibers, smooth muscle cells, blood vessel, nerves.

Vessel and lymph

Blood vessel

1.The ovarian artery

• Orginated as branches of the abdominal aorta, (vein left: left renal vein).
• Turn over the common iliac artery and ureter,descend into the pelvis. Enter into ovary through the mesovarium

2.The uterine artery

• a terminal branch of the hypogastric artery
• Cross the ureter near the cervix (2cm)
• Ascend along the lateral border of the uterus
• uterine body branch and cervix-vagina branch

Vaginal artery

Internal Pudendal artery

Lymph

• External genitalia
• superfical inguinal gland
• deep inguinal gland

Pelvic lymph

1.iliac lymph

internal iliac and external iliac, common iliac

2.Anterior Sacral lymph

3.Lumbar lymph: abdominal aorta

Adjacent organs

• Urethra
• Urinary bladder (uterovesical pouch)
• Ureter (Water under the bridge)
• Rectum (rectouterine pouch or pouch of Doughlas)
• Vermiform appendix

Pelvis

• Bony pelvis (True and False pelvis)

• Joints

Ligaments

1.Sacrospinous ligament

Extend from the lateral border of the sacrum and coccyx to the spine of the ischium

2.Sacrotuberous ligament

Extend from the posterior aspect of the lower 3 sacral vertebrae to the ischial tuberosity

Pelvic divisions (iliopectineal line )

1.False pelvis (pelvis major)

2.True pelvis (pelvis minor)

True pelvis is located below the iliopectineal line, bounded anteriorly by the pubic bones, posteriorly by the sacrum and coccyx, laterally by the ischium and a small segment of the ilium.

Bony birth canal

the Pelvic inlet, the pelvic out let and the pelvic cavity

Types of pelvis

1.The gynecoid type

round, slightly ovoid or elliptical inlet, adequate sacrosciatic notch, wide interspinous diameters(≥10cm). 52%-58.9%

2.The platypelloid type

distinct oval inlet. very wide subpubic arch. 5%

3.The anthropoid type

long, narrow, oval inlet, extended and narrow anterior and posterior segments, wide sacrosciatic notch, long , narrow sacrum. Straight side walls. 25%

4.The android type

elliptical inlet, equal anterior and posterior segments with slightly narrow anterior segment. 20%

Pelvic floor

• The tissues closing down the pelvic outlet (muscles and fasciae)

suspend and support the pelvic organs, such as uterus and bladder and rectum

• anterior part (urogenital triangle)

urethra and vagina pass through

• posterior part (anal triangle)

rectum pass through

Tissues

Outer layer

Bulbocavernosus muscle

Ischiocavernosus muscle

Superficial transverse perineal muscle

External anal sphincter

mid layer

urogenital diaphragm

Inner layer (pelvic diaphragm )

• the main support of the pelvic floor
• formed by the levator ani and coccygeus muscles and covering fasciae.
• Levator ani: pubococcygeus , iliococcygeus, pubovaginalis

Perineum

the tissues between vagina and anus.