Reference
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TEXT BOOK
Obstetrics & Gynecology (fifth edition)
 Author: Tamara L. Callahan, Aaron B .Caughey
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Williams Obstetrics
Berek & Novak's Gynecology
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Source: Lippincott Williams & Wilkins (LWW)
Anatomy of the
Female Reproductive System
Ai-Xia Liu
Women’s Hospital, School of Medicine,
Zhejiang University
Outline
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External genitalia
Internal genitalia
Adjacent organs
Bony pelvis
Pelvic floor
External Genital Organs(vulva)
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Mons pubis
Labia majora
Labia minora
Clitoris
Vestibule of the vagina
 External urethral
orifice
 Vestibule glands
 paraurethral
glands
(Skene’s glands)
 Bartholin's gland
vagina opening
 hymen
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External genitalia of adult female (parous)
Internal Genital Organs
Internal Genital Organs
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Vagina: extend from the
uterus to the vestibule
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The wall is composed of a
mucosal and a muscular layer
Function: sexual intercourse
organ, the passage way of labor
and menstrual blood
Fornix: divided into 4 regions
Posterior fornix
Fornix
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Uterus
A pear shaped, thick walled,
muscular organ
 Situated between bladder
and rectum
 7-8 cm long, 4-5 cm wide,
2-3 cm thick
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isthmus
Uterus
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Divided into 2 main portions
Body/Cervix
Ratio: adult, 2:1, infant, 1:2
 isthmus
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a transitional zone between body and cervix
 Special obstetrical significance (lower uterine segment)
 Internal orifice(os)
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anatomical internal os: narrowest position of the cavity
 histological internal os
the columnar epithelium changes into endometrium
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isthmus
uterus
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body (superior 2/3s)
 Fundus: the widest place of the corpus
 Lined with endometrium
cervix (inferior 1/3)
 Supravaginal portion
 Vaginal portion
 External cervical os
 Squamocolumnar junction
The cervical canal is covered
by columnar epithelium
 The surface of vaginal portion is
covered by squamous epithelium
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External cervical os
fundus
cavity
isthmus
corpus
cervix
fornix
External os
Anatomical os.
Histologic os.
Supra-vaginal
Vaginal part
vagina
Sagittal view
Coronary view
uterus
Position and Axis Direction
anteversion:
tipped forward
anteflexion: the fundus is pointing
forwards. The isthmus is bend.
retroversion
tipped backwards
retroflexion: the fundus is pointing
backwards. Anterior of uterus is
convex.
The wall of the uterus
perimetrium (serous): peritoneal covering
myometrium (muscular): the out layer, the inner layer
the endometrium(mucous): soft and spongy
1
2
The myometrium of the uterus:1. the out layer,
2. the inner layer
Ligaments
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4 pairs of ligaments
Round ligament
 Uterosacral ligament
 Cardinal ligament
(transverse ligament of cervix)
 Broad ligament
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ligaments
1. round ligament - attaches
anterior-inferiorly to uterotubal
junctions, pass in the broad
ligaments, end in labia majora.
They help to keep uterus in the
position of anteversion.
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Broad lig.
Round lig.
Cardinal lig.
Ligments of uterus
Ligaments
2. Broad ligament – arise from
the side of the uterus to the
lateral pelvic wall, provide
minimal support.
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Between two leaves of ligaments
there lies round ligaments,fallopian
tube, ovarian ligament, mesosalpinx,
infundibulum ligament, blood
vessles and nerves
3. Cardinal ligaments - extend
from cervix and lateral parts of
vaginal fornix to lateral walls of
pelvis.
Chief means of support and suspends
the uterus from the lateral walls of the
pelvis minor
Broad lig.
Round lig.
Cardinal lig.
Ligments of uterus
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Ligaments
4.Uterosacral ligaments –
arise from the sacral
fascia, and insert into
the posteroinferior
portion of the uterus at
about the level of the
isthmus. They provide
important support for
the uterus.
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Fallopian tube
serves to convey the ova to the uterus, running in the superior border of the broad
ligments (mesosalpinx).
divided into 4 parts:
interstitial portion: embodied within the muscular wall of uterus
isthmus: narrowest portion
ampulla: wide and tortuous
infundibulum: fringed by numerous diverging processes (open to cavity).
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Layers of the tube wall
serous
subserous
muscular
mucous: ciliated
columnar epithelium
Left and right tube uterine ostium in the hysteroscopy
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Ovary:
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Oval shaped, 2.5-5 cm long, 1.5-3 cm wide, 0.7-1.5 cm thick
Covered by cuboid or low columnar epithelium and white fibrial tissue,
no peritoneum corvered
Consists of cortex and medulla
cortex: contains oocytes in various stages of maturity
medulla: made up of blood vessels, nerves, lymphatic vessels, and
supporting tissue.
ligaments
 superior (tubal) end of ovary is connected to lateral wall of pelvis
by suspensory ligament of the ovary (infundibulum ligament)
 contains ovarian vessels and nerves
 ligament of ovary - connects inferior (uterine) end of ovary to
lateral angle of uterus
 Mesovarium: attach to the posteroanterior layer of the broad
ligament, connected with suspensory ligament
Hilum: vessels , nerves and lympatics enter the ovary
Ligaments of ovary
Douglas
pouch
uterovesical
pouch
Neighbor organs
ureter
Uterine artery
Water flows under a bridge
4
4
1
3
3
7
2
5
5
2
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Figure: internal organs in female pelvis. 1. uterus, 2. ovaries, 3. fallopian
tubes, 4. round ligaments, 5. utersacral ligaments, 6. rectouterine pouch
(pouch of Douglas) , 7.broad ligaments.
Blood supply for female genitalia
Arterial system
1. Ovarian artery: the chief
source of the blood for ovaries.
2. Uterine artery:
corpus branch
cervical-vaginal branch
3. Vaginal artery: main source
of the blood for the middle part
of vagina
4. Internal pudendal artery:
supply for superficial perineum,
labia majora, labia minora,
lower part of the vagina,
clitoris
The lymphatic drainage of pelvis
Internal iliac lymph node
Surround internal iliac vessels
 Receive afferents from pelvic viscera,
perineum, buttock and back of thigh
External iliac lymph nodes
 Lie along external iliac artery
 Receive afferents from lower limb and
some parts of pelvic viscera
Sacral lymph node
Common iliac lymph node
 Lie along common iliac artery
 Receive afferents from all the above
nodes
 Efferents pass to lumbar lymph node
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Lymphatic drainage:
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External genital organ lymph group:
1. superficial inguinal lymph nodes.
2. deep inguinal lymph nodes
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Pelvic lymph group:
1. iliac lymph group.
2. presacral lymph group.
3. lumbar lymph group.
The nerve of external genitalia
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Pudendal nerve
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Obstetric local anesthesia
Divided into 3 branches beside tuberosity
Inferior hemorrhoid nerve
 Dorsal nerve
 Perineal nerve
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The nerve of internal genitalia
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Sympathetic and parasympathetic nerves from
lumbar and sacral spinal cord
Sympathetic nerve are derived from Plexus
Sacral plexus
 Ovarian plexus
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