Introduction to Female Reproductive Anatomy

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Part 1 - The Basics

  • Ovaries
    • Primary sex organ, responsible for producing the egg cells (ovum), which are released each month in a process called ovulation
    • Intraperitoneal – egg is released into the peritoneal cavity and directed into the fallopian tubes

  • Fallopian/uterine tubes
    • Fimbriae – at the distal end of the fallopian tubes are finger-like projections which waft the egg released from the ovary into the tube
    • Four parts (distal to proximal):
      • Infundibulum
      • Ampulla – most common site for fertilisation
      • Isthmus – narrowest part of tube
      • Intrauterine part
  • Uterus
    • Fundus – portion of uterus above the point where the fallopian tubes join
    • Body – bulk of the uterus
    • Cervix– neck of the uterus
      • Protrudes into the vagina
      • Internal os – where cervix opens into uterine cavity above
      • External os – where cervix opens into vagina below
      • Fornices – recesses formed around the margin of the cervix where it protrudes into the vagina
        • 2 lateral fornices
        • Anterior fornix
        • Posterior fornix
    • Layers of the uterus
      • Perimetrium – outer serous connective tissue layer
      • Myometrium – thick smooth muscle layer
      • Endometrium – lining of the uterus
  • Vagina
    • Fibromuscular tube which runs between the vaginal orifice and the external os
    • Vaginal vault – superior internal end of vagina
    • Layers
      • Outer connective tissue layer
      • Middle muscular layer
      • Internal mucosa
  • Broad ligament
    • Sheet of peritoneum which drapes over the pelvic viscera
    • Forms “pouches”
      • Anteriorly: vesico-uterine pouch
      • Posteriorly: recto-uterine pouch (pouch of Douglas)

Part 2 - Ligaments

Fascia which lines the pelvic cavity, viscera and vessels condenses to form ligaments:

  • Uterosacral ligament – extends posteriorly from cervix to sacrum
  • Transverse cervical/cardinal ligament – extends laterally from cervix to pelvic side walls
  • Pubocervical ligament – extends anteriorly to pubic symphysis

Together with the levator ani muscle, these ligaments are crucial in supporting the uterus

Broad ligament

  • Flat sheet of peritoneum which drapes over the pelvic viscera
  • Attaches from the sides of the uterus to the pelvic side walls
  • Contains
    • Fallopian tubes  
    • Ovaries – attached to posterior aspect of broad ligament (mesovarium)
    • Ligaments
      • Suspensory ligament of ovary (not really contained as such, but formed by a fold of the broad ligament)
        • Also called the “infundibulopelvic ligament
        • Attaches to superior pole of ovary
        • Contains ovarian vessels and lymphatics
    • Ovarian ligament
      • Attaches to inferior pole of ovary
      • Connects ovary to uterus
      • Continues anteriorly on the uterus to form the round ligament:
    • Round ligament
      • Attaches laterally to the uterus and passes anteriorly in the broad ligament through the deep inguinal ring to enter the inguinal canal, terminating in the labium majus.
  • Vessels, lymphatics, nerves
    • Uterine and ovarian arteries

“Water under the bridge”

Beneath the broad ligament are the ureters. Above the ureters, the uterine arteries are carried within the broad ligament. The mnemonic “water under the bridge” can be used to remember this anatomical relationship, whereby the water flowing through the ureters runs underneath the bridge formed by the uterine arteries.

Part 3 - Blood supply and Axes of Uterus

  • Ovaries
    • Arterial supply: ovarian arteries
      • arise from abdominal aorta below renal arteries
    • Venous drainage: ovarian veins
      • Right ovarian vein – drains to inferior vena cava
      • Left ovarian vein – drains to left renal vein
    • Travel in suspensory (infundibulopelvic) ligament to superior pole of ovary
  • Uterus
    • Arterial supply: uterine artery
      • Arises from anterior division of internal iliac artery
      • Runs in base of broad ligament
      • Superiorly – forms anastomoses with ovarian arteries
      • Inferiorly – sends of branches to upper vagina and cervix
    • Venous drainage: uterine veins
      • Drain to internal iliac veins
      • Venous plexuses – networking of veins from vagina and bladder
  • Vagina
    • Arterial supply: branches of internal iliac artery
      • Vaginal, uterine, rectal, internal pudendal branches
    • Venous drainage: vaginal veins drain to venous plexuses, which drain to internal iliac veins

Axes of the uterus

  • Anteflexion: anterior flexion of the uterine body on the cervix at the internal os.
  • Anteversion: anterior angulation of the cervix with the vagina

Normal uterine position is anteverted and anteflexed.

Variation in uterine positions include:

  • Anteversion and anteflexion
  • Anteversion and retroflexion
  • Retroversion and anteflexion
  • Retroversion and retroflexion

Part 4 - External Genitalia

  • Labia majora
    • Run from mons pubis anteriorly (layer of adipose tissue lying over pubic symphysis) to perineum posteriorly (connected by posterior commissure)
  • Labia minora
    • Enclose an area called the vestibule
      • Vestibule contains the urethral orifice anteriorly, vaginal orifice (introitus) posteriorly
    • Anteriorly: labia minora bifurcate to form:
      • Lateral fold – join together in front of the clitoris, forming the prepuce (hood of the clitoris). Body of the clitoris lies deep to the prepuce.
      • Medial fold – join together behind the clitoris, forming the frenulum
    • Posteriorly: labia minora join to form the fourchette
  • Hymen
    • Thin membrane covering the vaginal orifice
    • In young girls this completely covers the vaginal orifice
    • Ruptured with first sexual intercourse/trauma, leaving remnants around orifice
  • Glands
    • Paraurethral glands – open either side of urethral orifice
    • Greater vestibular glands (Bartholin’s glands) – open either side of vaginal orifice
      • Secrete mucus which lubricates vagina