Female Reproductive System
A. Bony Pelvis
- 2 hip bones
- Sacrum
- Coccyx
- Divided by the pelvic brim into:
➢ False pelvis – part of lower abdomen
➢ True pelvis
- True Pelvis
➢ Pelvic Inlet
o Symphysis pubis ANTERIORLY
o Iliopectineal line LATERALLY
o Sacral promontory POSTERIORLY
➢ Pelvic Outlet
o Pubic arch ANTERIORLY
o Ischial tuberosities, sacrotuberous and
sacrospinous ligament LATERALLY
o Coccyx POSTERIORLY
- Joints:
➢ Sacroiliac
➢ Symphysis pubis: between 2 pubic bones
➢ Sacrococcygeal: movable, relaxed by
estrogen, progesterone, and relaxin
- Walls of the pelvis:
➢ Anterior Pelvic wall
o Formed by the pubic bones, pubic rami,
and symphysis pubis
➢ Posterior Pelvic wall
o Formed by sacrum, coccyx, pyriformis
muscle
➢ Lateral Pelvic wall
o Obturator membrane – passage of
obturator nerve and vessels
o Sacrotuberous ligament – sacrum, coccyx,
and posteroinferior iliac spine to ischial
tuberosity
o Sacrospinous ligament – sacrum, coccyx
to ischial spine
▪ STL and SSL – forms the greater and
lesser sciatic foramen
➢ Pelvic floor/diaphragm
o Levatores ani
▪ O: body of pubis, obturator internus
fascia, ischial spine
▪ I:
perineal
body
(anterior);
anococcygeal body (intermediate);
coccyx (posterior)
▪ N: 4th sacral, pudendal nerve
o Coccygeus
▪ O: ischial spine
▪ I: lower sacrum and coccyx
▪ N: 4th and 5th sacral nerve
o Allows passage of urethra and vagina
(females)
- Blood supply of the pelvis:
➢ Common iliac
o Ends at the pelvic inlet
o Divides into external and internal iliac
arteries at the level of sacroiliac joint
➢ External iliac
o Runs alongside the psoas muscle
o Follows the pelvic brim
o Branches:
▪ Inferior epigastric
▪ Deep circumflex iliac
o Passes under the inguinal canal to become
the femoral artery
➢ Internal iliac artery
o Passes through the greater sciatic
foramen
o Branch into anterior and posterior
divisions
o Anterior division:
▪ Umbilical – gives off the superior
vesical artery, supplies the upper portion
of bladder
▪ Inferior vesical artery (males) –
supplies the bladder base, prostate, and
seminal vesicles, branches off to supply
the vas deferens (artery of vas deferens)
▪ Middle rectal artery – supplies the
lower rectal muscles, anastomoses with
the superior and inferior rectal arteries
▪ Uterine artery (females) – crosses the
ureter superiorly, passes above the
lateral fornix of the vagina to reach the
uterus, anastomose with the ovarian
artery, gives off a vaginal branch
▪ Vaginal artery – supplies the vagina and
base of bladder (females)
▪ Obturator – along with the obturator
nerve, passes through the obturator
canal
▪ Inferior gluteal – passes through the
greater sciatic foramen
▪ Internal pudendal – also exits the
greater sciatic foramen, enters perineum
through the lesser sciatic foramen with
the pudendal nerve. Supplies the anal
canal and perineum
o Posterior Division:
▪ Iliolumbar – posterior to the external
iliac vessels, and iliopsoas
▪ Lateral sacral
▪ Superior gluteal – supplies the
perineum
➢ Ovarian Artery
o From abdominal aorta (L1 vertebra)
o Enters the suspensory ligament of the
ovary and the ovary via the mesovarium
o Crosses the external iliac artery via the
pelvic inlet
➢ Superior rectal artery
o Direct continuation of IMA (abdomen)
o Rectum and upper half of anal canal
➢ Median sacral artery
➢ Arteries of the True Pelvis:
o Internal iliac
o Superior rectal
o Ovarian
o Median sacral
- Venous drainage of the pelvis:
➢ External iliac vein
o Continuation of femoral vein
o Forms the common iliac vein with the
internal iliac vein
o Receives inferior epigastric and deep
circumflex iliac veins
➢ Internal iliac vein
o Forms the common iliac vein with the
external iliac vein
➢ Superior rectal vein
o Drains the upper part of rectum and anal
canal
o Forms the inferior mesenteric vein as it
crosses the internal iliac vein
➢ Ovarian vein (female)
o RIGHT: to the inferior vena cava
o LEFT: to left renal vein
➢ Median sacral
o Drains to either inferior vena cava or the
left common iliac vein
- Nerve Supply of the pelvis
➢ Sacral plexus
o Branches @ the greater sciatic foramen
▪ Sciatic nerve – LARGEST NERVE OF THE
BODY (L4,L5, S1-3)
▪ Superior gluteal – gluteus medius and
minimus + tensor fascia latae
▪ Inferior gluteal – gluteus maximus
▪ Nerve to quadratus – gemellus inferior
+ quadratus femoris
▪ Nerve to obturator – gemellus superior
+ obturator internus
▪ Posterior cutaneous nerve of thigh
o Branches to pelvis and perineum:
▪ Pudendal nerve (S2,3,4) – enters the
lesser sciatic foramen
▪ Nerve to piriformis
▪ Pelvic splanchnic nerve
o Perforating cutaneous nerve – supplies
the skin of ass
- Shapes of the pelvis/ Caldwell-Moloy
classification:
➢ Gynecoid
o Most common and most suitable for
normal delivery
o Bilog
➢ Platypelloid
o Oblong
➢ Anthropoid
o Mais
➢ Android
o Heart (nonanatomical)
PERINEUM
- Below the pelvic diaphragm
- Diamond shaped
- Boundaries:
➢ Symphysis pubis ANTERIORLY
➢ Tip of coccyx POSTERIORLY
➢ Ischial tuberosities LATERALLY
- Perineal Triangles
➢ Anterior – urogenital triangle
➢ Posterior – anal triangle
- Urogenital diaphragm
➢ Fills the gap of the pubic arch
➢ Sphincter urethrae and deep transverse
perineal fascia
- Perineal body
➢ Attached to the posterior margin of the
urogenital diaphragm, attachment site for
anterior fibers of levator ani muscle
- Perineal Pouches
➢ Superficial perineal pouch
o Potential space beneath the perineal skin
(site for hematoma)
o Boundaries:
▪ Colle’s fascia INFERIORLY
▪ Urogenital fascia SUPERIORLY
▪ Colle’s fascia to urogenital diaphragm
POSTERIORLY AND LATERALLY
➢ Deep perineal pouch
o Beneath the urogenital diaphragm
o Structures (female)
▪ Urethra
▪ Vagina
▪ Sphincter urethrae
▪ Deep transverse urogenital fascia
▪ Internal pudendal art, vein, and nerve
▪ Dorsal nerve of clit
FEMALE EXTERNAL GENITALIA
- Mons pubis
➢ Hairy part
➢ Escutcheon, triangular in females, diamond
in males
➢ Anterior and superior to symphysis pubis
- Labia Majora
➢ Yung nasa labas
➢ Homologous to scrotum
➢ Bilat
- Labia Minora
➢ Nymphae
➢ Inside the labia majora
➢ Forms the fourchette POSTERIORLY
➢ Prepuce SUPERIORLY
➢ Frenulum INFERIORLY
➢ Homologous to penile urethra and skin of
penis
➢ Yung tahong
- Hymen
➢ Yung napupunit
➢ Entrance of vagina
➢ Stratified squamous
- Clitoris
➢ Homologous to penis
➢ Erectile organ with 2 crura attached at
symphysis pubis, body with corpora cavernosa
and erectile tissue
- Three masses of Erectile Tissue:
➢ Bulb of vestibule
o Homologous to bulb of penis
o Divided by the vagina
o Beneath the urogenital diaphragm
covered by bulbospongiosus muscle
o Forms the clitoris as it unites anteriorly
➢ Right and left crura of the clitoris
o Corresponds to penile crura
o Covered by ischiocavernous muscle
- Vestibule
➢ Space between the labia minora
➢ Clitoris at the apex
➢ Urethral opening, vagina and vestibular
gland opening at floor
- Greater Vestibular Gland
➢ Mucus-secreting gland
➢ Open into the groove between the hymen
- Female Urethra
➢ Below the clitoris in front of the vagina
- Muscles of the female urogenital triangle:
➢ Superficial transverse perineal
o O: ischial tuberosity
o I: perineal body
o N: pudendal nerve, perineal branch
o A: fixes the perineum
➢ Bulbospongiosus
o O: pineal body
o I: corpus cavernosum fascia
o N: puedendal nerve, perineal branch
o A: sphincter of vagina, assist in clitoris
erection
➢ Ischiocavernosus
o O: ischial tuberosity
o I: same as bulbospongiosus
o N: same
o A: clitoris erection
➢ Deep transverse muscle
o O: ramus if ischium
o I: perineal body
o N: same
o A: same as superficial transverse
➢ Sphincter urethrae
o O: pubic arch
o I: surrounding the urethra
o N: same
o A: voluntary sphincter of urethra
FEMALE INTERNAL GENITALIA
- Ovaries
➢ Paired, light gray structure on the ovarian
fossa at the lateral wall of pelvis
➢ Attached to the broad ligament by the
mesovarium
➢ Cortex: where ovarian follicles are
➢ Medulla: nerve and blood vessels
➢ Ligaments of the ovaries:
o Suspensory ligament / infundibulopelvic
ligament
▪ Connects mesovarium to lateral pelvis
▪ Contains blood and lymph vessels and
nerves supplying the ovary
o Round ligament of ovary
▪ Part of upper gubernaculum
▪ From medial margin of ovary to lateral
wall of uterus
o Round ligament of uterus
▪ Remnant of lower gubernaculum
o Mesovarium
▪ Posterior part of broad ligament
▪ Contains the anastomotic branches of
ovarian and uterine artery, venous
plexuses, and lateral end of ovarian
artery
➢ Blood supply:
o Ovarian artery (from abdominal aorta)
o Ovarian vein
▪ Right: to inferior vena cava
▪ Left: to left renal vein
➢ Nerve supply:
o Aortic Plexus
➢ Lymphatic drainage:
o Para-aortic nodes at level of L1
- Uterus
➢ Fundus: above the uterine tube
➢ Body: beneath the uterine tube
➢ Cervical canal: to cervix
o Internal os: communicates with the uteris
o External os: communicates with the
vagina
➢ Anterversion: forward bending of uterus on
the long axis of vagina
➢ Anteflexion: forward bending of the uterus
on the cervix
➢ Retroversion: backward bending on long axis
➢ Retroflexion: backward bending on cervix
➢ Layers of the uterus:
o Serosal layer
▪ External layer
▪ Covered by visceral peritoneum except
anteriorly at the level of internal os
(pouch of Douglas)
o Muscular layer
▪ Outer and inner longitudinal
▪ Middle interlacing
o Endometrium
▪ Mucous membrane with tubular
glands
▪ Tall columnar epithelium
▪ Inner: stratum basale
▪ Outer:
stratum
functionale;
regenerative layer, degenerates every
menstrual cycle
- Uterine/fallopian tubes/oviducts
➢ Mucosal cells of oviducts:
o Ciliated epithelium
▪ Columnar cells
▪ At the ovarian end of oviduct
▪ 25% of mucosal cells
o Secretory cells
▪ Columnar cells
▪ At the isthmus
▪ 60% of cells
o Peg cells
▪ Narrow cells between secretory and
ciliated cells
➢ Part of the oviduct
o Infundibulum
▪ Funnel shaped
▪ Lateral end
▪ Contains fimbriae that sweeps the
ovum into the tube
o Ampulla
▪ Widest part
▪ Where fertilization occurs
o Isthmus
▪ Narrowest part
▪ Highly developed musculature
▪ Lateral to uterus / medial part of
oviduct
o Intramural/interstitial part
▪ Most medial portion
▪ Pierces the uterus
▪ Surrounded by myometrium
➢ Blood supply:
o Terminal branches of ovarian and uterine
artery
➢ Lymphatic drainage
o Internal iliac and para-aortic nodes
➢ Nerve supply:
o Superior and inferior hypogastric plexuses
(sympa and parasympa)
- Cervix/trachelos/neck
➢ Lower part of uterus where vagina is
attached obliquely in the middle
o Divides the cervix into:
▪ Upper
▪ Supravaginal – covered by peritoneum
posteriorly, anteriorly by parametrium
▪ Lower/portio vaginalis
➢ Cervical canal epithelium:
o Endocervical canal – single layer of
columnar epithelium, secretes mucus
o Portio vaginalis – stratified squamous,
nonkeratinized
o Exocervix – stratified squamous, site for
pap smear
o Squamocolumnar junction
▪ Abrupt transition from tall columnar to
stratified squamous between endocervix
and portio vaginalis
➢ Blood supply:
o Descending branch of uterine artery
o Coronary artery – encircles the cervix
o Azygos artery – longitudinally at the
middle of the anterior and posterior cervix
and vagina
▪ Severe postpartum bleeding
▪ 3 and 9 o’clock of the cervix
➢ Lymphatic drainage:
o Obturator
o Common iliac
o Internal iliac
o External iliac
o Visceral nodes of parametria
➢ Nerve supply
o S2 to S4
- Vagina
➢ Female genital canal
➢ 0.08 cm decrease in length every 10 years
o 0.17 cm decrease in menopause
➢ Upper half of vagina:
o Bladder ANTERIORLY
o Rectum POSTERIORLY
o Within the PELVIS
➢ Lower half:
o Within the PERINEUM
o Urethra ANTERIORLY
o Anal canal POSTERIORLY
➢ Upper(most) portion:
o Almost horizontal plane when standing
o 90 degrees between the vagina and axis of
uterus
o Curves towed the hollos of sacrum
➢ Layers of the vagina (histologic)
o Mucosa
–
stratified
squamous
nonkeratinized
o Lamina propia – fibrous connective tissue,
tunica layer
o Muscular layer – interlacing muscle fibers
(same as intermediate myometrium)
o Cellular areolar connective tissue –
contains blood vessels
➢ Supporting structures:
o Upper third:
▪ Levator ani
▪ Transcervical ligament
▪ Pubocervical ligament
▪ Sacrocervical ligament
o Middle third:
▪ Urogenital diaphragm
▪ Cardinal ligaments (lower)
▪ Lower levator ani
o Lower third:
▪ Perineal body
➢ Blood supply:
o Vaginal artery – from internal iliac artery
o Vaginal branch of uterine artery
o Azygos artery – branches of interna
pudendal, inferior vesical, and middle
hemorrhoidal artery
➢ Venous drainage:
o Pudendal veins – drains below the pelvic
floor
o Vaginal, uterine, vesical veins – upper and
middle vagina
o Vaginal veins drain to the internal iliac
vein
➢ Nerve supply:
o Autonomic nerves from the vaginal plexus
o Sensory nerves from the pudendal nerve
➢ Lymphatic drainage:
o Upper third: external iliac
o Middle third: common and internal iliac
o Lower third: common iliac, superficial
inguinal, and perirectal nodes
- LIGAMENTS OF THE FEMALE REPRODUCTIVE
SYSTEM
➢ Suspensory ligament
➢ Round ligament of ovary and uterus
➢ Cardinal ligament
o Transverse cervical ligament
o Thick base of broad ligament
o Main ligament that supports the uterus
and vagina to stay at the midline
➢ Uterosacral ligament
o Posterolateral attachment to the
supravaginal portion of cervix
o Forms the lateral boundaries of the pouch
of Douglas
➢ Broad ligament
o Winglike structure
o From lateral uterine margins to pelvic side
walls
o Mesosalpinx – below the fallopian tube
o Mesovarium – above the ovaries