1. Female Reproductive System

2. Lecture Objectives
Describe the peritoneal foldings on the pelvic viscera in the female.
Describe the structure of the female genital organs.
Describe the organs of the female urogenital triangle.
Describe the relationship, blood supply, innervation, and lymph drainage of all the above organs.

3. Female Reproductive System
Ovaries produce 2nd oocytes & hormones
Uterine tubes transport fertilized ova
Uterus where fetal development occurs
Vagina & external genitalia constitute the vulva
Mammary glands produce milk

4. The Ovary
Pair of organs, size of shelled almonds (2x4 cm) found in upper pelvic region
Regional histology
tunica albuginea is capsule of dense connective tissue
cortex is region just deep to tunica, contains follicles
medulla is deeper region
composed of connective tissue, blood vessels & lymphatics
germinal epithelium is simple epithelial covering over the ovary

5. Ovary Located on the lateral wall of the pelvis at the ovarian fossa
– Between the internal & external iliac vessels
Ovary is responsible on production of: oocytes & hormones (estrogen & progesterone)

6. Ovarian Ligaments
Mesovarium attaches ovaries to the posterior surface of broad ligament
Ovarian ligament (round ligament of ovaries) anchors ovary to uterus
Suspensory ligament
Between the mesovarium & lateral pelvic wall
Covers blood vessels to ovaries

7. Broad Ligament Two layers extension of the peritoneum
Superiorly – continuous free edge
Inferiorly – split to cover the pelvic floor
Extend from the uterus to the lateral pelvic wall on both sides
Parts
Mesosalpinx – below the uterine tube
Mesovareium – posteriorly
Mesometrium – below mesovarium
Suspensory ligament of the ovary – lateral to mesovarium

8. Broad Ligament Content Uterine tube Round lig. of the ovary
Round lig. of the uterus
Uterine & ovarian BVs, lymph vessels, & nerves
The epoophoron
In the mesosalpinx
Mesonephric remains
The paroophoron
In the mesometrium

9. Ovary Blood supply: Lymphatics: para aortic nodes – at L1
Ovarian aa. – aorta – at L1
Left ovarian v. – left renal v.
Right ovarian v. – IVC
Lymphatics: para aortic nodes – at L1
Nerve supply: aortic plexus
Blood & lymphatic vv. & nerves reach ovary via suspensory lig. – mesovarium

10. Uterine (Fallopian) Tubes
Narrow, 4 inch tube extends from ovary to uterus
Infundibulum is open, funnel‐shaped portion near the ovary
fimbriae are moving finger‐like processes
Ampulla is widest, central region of tube
Isthmus is narrowest portion joins uterus
Intramural part pierces the uterine wall

11. Uterine Tube Functions Fimbriae sweep oocyte into tube
Transport for oocyte, sperms, zygote
Fertilization site (usually ampulla)
Nutrition for fertilized oocyte

12. Uterine Tube Blood supply: Lymphatics: Nerve supply:
Uterine aa. – internal iliac
Ovarian aa. – aorta
Lymphatics:
Internal iliac & para aortic
Nerve supply:
Inferior hypogasrtic plexus

13. Uterus Site of menstruation & development of fetus Hollow pear shaped
3 inches long by 2 in. wide and 1 in. thick
Parts
Fundus above uterine tube
Body below uterine tube
Uterine cavity – triangular, slit like cavity
Isthmus between body & cervix
Cervix supravaginal & vaginal parts
Cervical canal
– Internal os & External os

14. Uterus: Relations Anteriorly (inferior to superior): Posteriorly:
anterior fornix, urinary bladder & uterovesical pouch
Posteriorly:
rectouterine pouch (pouch of Douglas) & sigmoid colon
Laterally (inferior to superior):
lateral fornix, ureters, uterine aa., round ligaments of ovary & uterus, uterine tube & broad ligament

15. Position of Uterus
Anteversion – anterior angle between uterus and vagina
Opposite ‐ retroversion
Anteflexion – anterior angle between body & cervix of uterus
Opposite – retroflexion
Usually the uterus is anteversed and anteflexed

16. Uterus Blood supply: Lymphatics: Nerve supply:
Uterine aa. – internal iliac
Cross ureters at level of internal os – ascend at the lateral walls of uterus
Ovarian aa. – aorta
Lymphatics:
Fundus – para aortic nodes
Body & cervix – internal & external iliac nodes
Some follow round lig. to superficial inguinal nodes
Nerve supply:
Inferior hypogasrtic plexus

17. Uterus: Ligaments Transverse cervical (cardinal) lig.
Pubocervical lig.
Sacrocervical lig.
Round lig. Of the uterus
– From uterus – broad lig. – inguinal canal – to subcutaneous tissue of labia majora

18. Hysterectomy Surgical removal of the uterus Indications for surgery
– endometriosis, ovarian cysts, excessive bleeding, cancer of cervix, uterus or ovaries
Complete hysterectomy removes cervix
Radical hysterectomy removes uterus, tubes, ovaries, part of vagina, pelvic lymph nodes and supporting ligaments

19. Vagina Passageway for birth, menstrual flow & intercourse Description
4 inch long fibromuscular organ traversing the pelvis & perineum
It is oriented upward and backward ending at uterus
Cervix enters the vagina anteriorly
Orifice partially closed with membrane (hymen)

20. Vagina The fornix is the sulcus surrounding the cervix Relations
Anterior, posterior & lateral fornices
Relations
Anteriorly – bladder & urethra
Posteriorly – rectouterine pouch, ampulla of rectum & perineal body & anal canal
Laterally – ureter, levator anai m.

21. Vagina Blood supply: Lymphatics: Nerve supply:
Vaginal a. – internal iliac
Vaginal branch of uterine a.
Vaginal plexus – internal iliac v.
Lymphatics:
Upper third– internal & external iliac nodes
Middle third – internal iliac
Lower third – superficial inguinal nodes
Nerve supply:
Inferior hypogasrtic plexus

22. Vagina: Support Structures
Upper part
Levator ani
Transverse cervical, pupocervical & sacrocervical ligaments
Middle part
Urogenital diaphragm
Lower part
Perineal body ‐ posteriorly

23. Vulva (External Genitalia)
Mons pubis ‐‐ fatty pad over the pubic symphysis
Labia majora
Analog to scrotum in male
Skin folds from the mons pubis anteriorly
Unit together posteriorly
Labia minora –
Hairless skin folds internal to the labia majora
Anteriorly – form the prepuce and the frenulum of clitoris
Posteriorly – fourchette (frenulum of labia minora)
Vestibule of the vagina
Space between the labia minora
Contains clitoris and the openings of:
Urethra – 1 in. posterior to clitoris
Vagina – posterior to urethral opening
Duct of the Greater vestibular glands (Bartholin’s glands)
Duct of the Paraurethral glands

24. Vulva Blood supply Lymphatics Nerve supply
Branches of the internal & external pudendal aa.
Lymphatics
Skin – superficial inguinal nodes
Nerve supply
Anteriorly
Ilioinguinal nn.
Genital branch of the genitofemoral nn.
Posteriorly
Branches of the perineal nn.
Branches of the posterior cutaneous nn. of the thigh

25. Greater vestibular glands
Small mucus secreting glands
Deep to the posterior part of the bulb of vestibule
It’s ducts open on the vestibule lateral to the vaginal opening
Paraurethral glands
Analog to the prostate gland in male
Open on the vestibule lateral to the urethral opening

26. Clitoris Analog of penis in male Structure Root Body – small
Left & right crura
Covered by ischiocavernosus mm.
Bulb of the vestibule
Two halves around vagina
Covered by bulbospongiosus mm.
Body – small
Corpora cavernosa
Corpus spongiosum
Glans
» At the apex of vestibule
» Prepuce

27. Clitoris Neurovascular and lymphatic supply as penis
Blood supply: branches of the internal pudendal a.
Deep aa. Of the clitoris – corpora cavernosa
Artery of the bulb of vestibule – corpus spongiosum
Dorsal artery of the clitoris
Lymphtics:
Skin – superficial inguinal nodes
Glans – internal iliac nodes
Nerve supply:
Dorsal nerve of the clitoris – pudendal n.
Parasympathetic – inferior hypogastric plexus