FEMALE GENITAL ORGANS
are divided into
• internal:
ovaries
uterine tubes
uterus
vagina
• external:
mons pubis
labia majora
labia minora
vestibule of vagina
clitoris
bulbus vestibuli
greater vestibular glands
INTERNAL FEMALE GENITAL ORGANS
OVARY
- is a reproductive organ and endocrine gland
- is located in the pelvic cavity
- it is applied on the lateral pelvic wall
- placed in the ovarian fossa – in front of the ureter
displaced during and after pregnancy
Ovary is attached to the posterior surface of the broad ligament of uterus
- it is ovoid in shape, flattened, mesuring 3x 1,5x 1 cm
-it has smooth surface before puberty, but uneven surface in adult (marked by growing
follicles)
ovoid in shape, ovary has surfaces, borders, extremities
• surfaces:
lateral surface – is oriented to the lateral pelvic wall
medial surface – is partly covered with the uterine tube
and is in contact with:
ileum and appendix - right ovary
sigmoid colon - left ovary
• borders:
free border
mesovarian border – this is attached to the broad ligament by
the mesovarium – contains vessels, nerves and embryonic remains (epoophoron,
paroophoron)
• extremities:
tubal extremity - is oriented superiorly
- it is covered with the fimbriae of uterine tube
suspensory ligament ascends from it upwards (contains ovarian vessels!!)
uterine extremity - is oriented inferiorly
- is attached to uterus by ligament of the ovary
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THE STRUCTURE OF THE OVARY
The surface of ovary is covered by
germinal epithelium - transition between it and the peritoneum is marked by white line around
the mesovarian border
tunica albuginea lies beneath the germinal epithelium
cortex contains ovarian follicles and corpora lutea embedded in the connective tissue
medulla - is a richly vascular connective tissue deep to the cortex
Blood supply: ovarian a. (arises from the abdominal aorta!)
Nerve supply: ovarian plexus (containing PS fibres from the vagus)
Lymph drainage: lumbar lymph nodes
UTERINE TUBE (FALOPIAN TUBE)
transmits ova from the ovary to the uterus
fertilisation occurs in the tube
- it is located in free border of the broad ligament of the uterus
- it is 10 – 15 cm long
one end opens into the uterus – uterine opening
opposite end opens into the pelvic part of the peritoneal cavity – abdominal opening
Relations:
Right tube- ileum, appendix
Left tube - sigmoid colon
uterine tube is subdivided into:
• infundibulum
• ampulla
• isthmus
• uterine part
● Infundibulum
- is funnel shaped expansion of the abdominal end
- the circumference of it is marked by fimbriae which are loosely applied on the ovarian
surface
ovarian fimbria – the longest of all, is firmly attached to the ovary
● Ampulla
- is thin-walled, tortuous, forms more than 1/2 of entire lenght of tube
● Isthmus
- is narrow, round, cord like, constitutes medial 1/3 of tube
● Uterine part
- is the narrowest, short part traversing the uterine wall
STRUCTURE
the wall of uterine tube is composed of:
mucous coat – lines interior, folded into numerous folds
muscular coat
serous coat – peritoneum
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Blood supply:
tubal branches of ovarian and uterine arteries
Nerve supply: pelvic autonomic plexus
Lymph drainage: lumbar lymph nodes
UTERUS
- is situated in the pelvic cavity
- connected to the lateral pelvic walls by a peritoneal fold – broad ligament
- it is placed between the urinary bladder and the rectum
separated from them by the vesicouterine and the rectouterine pouches
Uterus is pear shaped, flattened anteroposteriorly
- its position varies with the state of bladder and rectum
Uterus forms almost a right angle with the vagina –
- uterus is anteverted
uterus is subdivided into:
• body
• isthmus
• cervix
● Body
is wider superiorly, narrower inferiorly
has parts: fundus, surfaces, margins, horns
∗ fundus is upper wider convex part
∗ surfaces:
- vesical surface – directed to the urinary bladder, covered with the peritoneum,
separated from the bladder by the vesicouterine pouch
- intestinal surface – directed upwards and backwards - covered with the peritoneum
related to: coils of ileum
sigmoid colon
rectum - separated from the rectum by the rectouterine pouch
surfaces meet in
∗ margins – the broad ligament joins the margins to the lateral pelvic walls
margins and fundus meet in
∗ horns – here uterine tubes enter the uterus
Below the horns ligaments are attached:
- the round ligament (anteriorly)
- the ligament of ovary (posteriorly)
- body meets with the cervix in
● the isthmus
● the cervix
is lower narrower part of the uterus
- the cervix is less movable than the body (it is more fixed to the pelvic walls by ligaments)
- its axis forms with the axis of the body an angle opened anteriorly
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so that uterus is anteflexed
cervix is divided by attachment of the vagina into
upper – supravaginal portion and
lower – vaginal portion – this projects into the vagina and is encircled by circular space –
vaginal fornix
vaginal portion of cervix shows ostium of cervical canal
- ostium of uterus
- round in shape in nuliparous woman
- transverse slit – shaped in parous woman
here bordered by anterior and posterior lips
THE INTERIOR OF THE UTERUS
cavity of the body is flattened anteroposteriorly, triangular
uterine tubes open into it in the horns
the cavity is continuous inferiorly into
the canal of the cervix - fusiform in shape
inner surface is folded into the palmate folds
THE UTERINE WALL
is composed of mucous, muscular and serous coats
- mucous coat – endometrium
contains uterine glands which undergo regular monthly changes - menstrual cycle
- muscular coat – myometrium is composed of smooth muscles
- external layer – longitudinal fibres - are continued into
the ligaments of uterus (broad, round, sacrouterine and ligament of ovary)
- middle and
- internal layers – muscle fibres are arranged in all
directions (longitudinally, circularly, obliquely)
- serous coat – perimetrium is derived from the peritoneum
LIGAMENTS OF THE UTERUS - PARAMETRIUM
uterus is connected to the pelvic walls and neighbouring organs by a numbre of ligaments
1. to the lateral pelvic wall by:
BROAD LIGAMENT – this is a peritoneal fold containing
suspensory lig. of ovary (contains ovarian vessels)
ligament of ovary
round ligament of uterus = ligamentum teres – runs from the uterine horn to the labium
majus
TRENSVERSE LIGAMENT = ligamentum cardinale
- is placed in the lower part of the broad ligament
- extends from the cervix to the lateral pelvic walls
2. to the bladder and pubis by:
vesicouterine lig.
pubovesical lig.
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3. to the rectum and sacrum by:
rectouterine lig.
sacrouterine lig.
Blood supply: uterine a.
Nerve supply: pelvic autonomic plexus
Lymph drainage:internal iliac
lumbar and
inguinal lymph nodes (along the round ligament of the uterus)
VAGINA
extends from the uterus to the vestibule – here it opens as
vaginal orifice (situated behind the ext. uretral orifice)
vagina is situated behind the bladder and urethra
in front of the rectum
it is directed down and anteriorly (in right angle with the uterus – anteversion of the uterus)
Vagina is flattened anteroposteriorly
- it has anterior and posterior walls
- anterior wall is shorter than the posterior wall
- upper part of vagina surrounds vaginal portion of the cervix
to form vaginal fornix subdivided into
∗ the anterior fornix
∗ the posterior fornix (deeper) – this is covered with the peritoneum
separated from rectum by
the rectouterine pouch
lower part of vaginal wall is connected to the rectum by fibroareolar tissue – rectovaginal
septum – this is thickened inferiorly into the perineal body
VAGINAL WALL consists of:
- mucous membrane – folded on the ant. and post. walls into
the transverse ridges – rugae which form columns of vagina (columnae rugarum)
- muscular coat – external longitudinal and internal circular
- external layer of areolar tissue – connects vagina to bladder, urethra and rectum
- contains large plexuss of veins
Blood supply: vaginal branches from the uterine
middle rectal and
internal pudendal arteries
Nerve supply: pelvic autonomic plexus and Pudendal n.
Lymph drainage: internal iliac and inguinal lymph nodes
EXTERNAL FEMALE GENITAL ORGANS
MONS PUBIS
is a cutaneous eminence in front of pubic symphysis
composed of fatty tissue beneath the skin
at puberty – skin is covered with the hairs
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LABIA MAJORA
are two cutaneous folds containing fatty tissue
- extend from the mons to the perineal region
labia majora border pudendal cleft and meet in
anterior commissure and
posterior commissure
outer surface of labia majora is pigmented and covered with hairs!
inner surface of labia majora contains sebaceous glands
round ligament of uterus terminates in the labium majus
LABIA MINORA
are small cutaneous folds placed medially to the labia majora
- contain no fat!
anteriorly labia are divided into two portions to form:
the prepuce of clitoris and
the frenulum of clitoris
posteriorly labia meet in frenulum of labia minora
the skin of labia minora contains sebaceous glands
labia minora border the vestibule
VESTIBULE
is a space between the labia minora lined with the mucosa containing
minor vestibular glands
∗ external urethral orifice and
∗ vaginal orifice open into the vestibule
vaginal orifice in virgin is partly enclosed by mucous fold – hymen
ext. urethral orifice lies in front of the vaginal orifice!!
CLITORIS
It is a homologue of the penis
is an erectile structure between the labia minora anteriorly
is composed of:
crura of clitoris – are attached to pubis covered with the ischiocavernosus m.
crura join to form
body of clitoris which terminates as
glans of clitoris – this is covered with the prepuce of clitoris
BULB OF VESTIBULE
is homologous with the bulb of the penis
it is composed of two elongated masses of erectile tissue
- placed in the depths of the labia majora on sides of vaginal vestibule
- covered with the bulbospongiosus m.
the bulb is rounded posteriorly and narrowed anteriorly – here
bulbs are fused to form commissure of bulbs
GREATER VESTIBULAR GLANDS (of Bartholini)
are two in numbre, homologous with the bulbourethral glands in male
each gland is placed on the outer surface of urogenital diaphragm,
near the dorsal part of the bulb of vestibule
the duct of gland opens into the vestibule near the vaginal orifice
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Blood supply of external genital:
internal and external pudendal vessels
Nerve supply: mainly Pudendal n.
Lymph drainage: inguinal lymph nodes
THE BREASTS
exist in both sexes
in male – rudimentary
in female – rudimentary before puberty
- undergoes considerable development at puberty
- greatest development – during the pregnancy and lactation
the shape and size depends upon many factors – genetic, age, parity…
- located in the pectoral region
extends from the 2nd to the 6th ribs
from the parasternal to near mid-axillary lines
- axillary tail projects into the axillary fossa (towards pectoral lymph nodes)
- gland lies within the superficial fascia
on the pectoralis major m. and pectoral fascia
separated from it by retromammary space – filled with areolar tissue – retromammary fat
the nipple – cylindrical eminence near the centre of the breast
pink or light brown
contains smooth muscle fibres
- circular - erection
- longitudinal - retraction of the nipple
lactiferous ducts traverse the nipple, open on the summit
areola - surrounds the nipple
- becomes enlarged and darker in colour during the pregnancy and lactation
skin of areola – sebaceous areolar glands – protective lubricant for the skin of the nipple
during lactation
Inner structure:
15 – 20 lobes composed of lobules
lobes arranged radially
lobules and lobes are connected by areolar tissue
- intramammary
- praemammary (subcutaneous)
- retromammary fat
lactiferous ducts drain the lobes, converge radially towards the nipple
lactiferous sinuses – dilatations of ducts near the areola
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Blood supply: branches from - internal thoracic a.
- intercostal a.
- axillary - lateral thoracic a.
and corresponding veins
Nerves: 4th-6th intercostal nerves - ant. and lateral cutaneous branches
Lymph drainage: lymph vessels accompany blood vessels
- pectoral lymph nodes
- parasternal lymph nodes (deep thoracic)
- inferior deep cervical lymph nodes
THE PELVIS
the pelvic walls are formed by • bones and • muscles
• Pelvic bones: pubis, ischium, body of ilium, sacrum, coccyx
• MUSCLES OF THE PELVIS
1. muscles on the lateral and dorsal wall:
- obturator internus m.
- piriformis m.
2. muscles of the pelvic floor –
THE PELVIC DIAPHRAGM
- levator ani m.
- coccygeus m.
Levator ani m.: has two parts
- pubococcygeus
O: pubic bone
- iliococcygeus
O: obturator fascia
ischial spine
I: coccyx and
median raphe = perineal body
perineal body is lower thickened part
of the rectovesical septum in male
and rectovaginal septum in female
Function: - supports the pelvic organs
- sphincter ani externus m. is derived from it
- and levator prostatae m., puborectalis m.
NS: Pudendal n.
Coccygeus m.
O: ischial spine
I: sacrum, coccyx
F: helps levator ani to close the pelvic outlet
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NS: sacral plexus
FASCIAE OF THE PELVIS – PELVIC FASCIA
fasciae of the muscles – parietal fascia
fasciae of the pelvic organs – visceral fascia
PERINEAL MUSCLES – UROGENITAL DIAPHRAGM
- transversus perinei profundus
O: ramus of ischium and pubis
I: median raphe = perineal body
sphincter urethrae externus is derived from it
-transversus perinei superficialis
O: ischial tuberosity
I: perineal body
- ischiocavernosus
- bulbospongiosus
NS: Pudendal n.
F: - help to support pelvic organs
fascie of perineal muscles form – PERINEAL FASCIAE
ISCHIOANAL FOSSA (ISCHIORECTAL FOSSA)
is a triangular space under the pelvic diaphragm
borders:
superiorly (and medially) : pelvic diaphragm (levator ani m.)
laterally: ischium and pubis, obturator int. m.
inferiorly: perineal fascia – in the dorsal part of space
urogenital diaphragm – in the ventral part of space
contains - areolar fatty tissue
- Internal pudendal vessels, Pudendal n.
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