INTERNAL
GENITALIA OF
FEMALE
Dr Rania Gabr
Dr. Safaa
OBJECTIVES
1. Identify the uterus, its normal site, shape, parts, size
and position.
 2.
Discuss its peritoneal coverings and relations.
 3.
Discuss the uterine relations.
 4.
Determine the factors supporting the uterus.
 5.
Discuss its blood, nerve supply and lymphatic
drainage.
 6.
Enumerate the parts of the fallopian tube
 7.
Discuss its blood, nerve supply and lymphatic
drainage.
 8.
Discuss the site, size, shape, peritoneal covering and
relation of the ovary.

9. Enumerate the ligaments attached to the
ovary.
 10. Mention its blood & nerve supply and
lymphatic drainage.
 11. Discuss the site, position, length, peritoneal
covering and relation of the vagina.
 12. Mention its blood & nerve supply and
lymphatic drainage.

UTERUS

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This is a hollow, thickwalled, pear-shaped
muscular organ located
between the bladder and
the rectum (in nonpregnant women).
It is 7 to 8 cm long, 5 to 7
cm wide, and 2 to 3 cm
thick.
The non-gravid (not
pregnant) uterus usually
lies in the lesser pelvis,
•
1.
2.
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The uterus consists of 2 major
parts:
The expanded superior 2/3 is
known as the body
The cylindrical inferior 1/3 is
called the cervix (L. neck).
The entire uterus is normally
bent or inclined anteriorly
(anteverted).
The uterus is usually bent
anteriorly (anteflexed)
between the cervix and body.
•
•
It is frequently retroverted
(inclined posteriorly) in older
women.

Different parts of the uterine tube and the uterus. B. External os of the
cervix: (above) nulliparous; (below) parous. C. Anteverted position of the
uterus. D. Anteverted and anteflexed position of the uterus
THE FUNDUS OF THE UTERUS
The fundus of the uterus is the rounded superior
part of the body.
 It is located superior to the line joining the points
of entrance of the uterine tubes.
 The regions of the body where the uterine tubes
enter are called the cornua (L. horns).

THE CERVIX OF THE UTERUS
•
Is the cylindrical, narrow
inferior part of the uterus,
which has a:
1- Supravaginal part :
•
between the isthmus and the
vagina(isthmus of uterus the
constricted part of the uterus
between the cervix and the
body of the uterus),and a
2- Vaginal part :
• That protrudes into the
vagina and surrounds the
external os of the uterus.
• The supravaginal part
of the cervix is separated
from the bladder
anteriorly by loose
connective tissue and from
the rectum posteriorly by
the rectouterine pouch
• The cervix is mostly
fibrous, with a small
amount of smooth muscle
and elastin

1.
2.
The wall of the body of the uterus
consists of three layers
The outer serous coat called the
perimetrium, consists of peritoneum
The middle muscular coat called the
myometrium consists of 12 to 15 mm of
smooth muscle. The myometrium
increases greatly during pregnancy.
The main branches of the blood vessels
and nerves of the uterus are located in
this layer;
3. The inner mucous coat called
endometrium is firmly adherent to the
underlying myometrium.
• The endometrium is partly sloughed off
each month during menstruation.
• It lines only the body of the uterus
 The

•
•
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Ligaments of the Uterus
1- The Round Ligaments of the Uterus
These ligaments are 10 to 12 cm long and
extend from the lateral aspect of the uterus,
passing anteriorly between the layers of the
broad ligament.
They leave the abdominal cavity through the
inguinal canal and insert into the labia
majora.
2- The ligament of the ovary
Externally, attaches to the uterus
posteroinferior to the uterotubal junction
These two ligaments are vestiges of the
ovarian gubernaculum, related to the descent
of the gonad from its developmental position
on the posterior abdominal wall
 3-The
Uterosacral Ligaments
 pass superiorly and slightly
posteriorly from the sides of the
cervix to the middle of the sacrum;
they are palpable on rectal
examination
 4- Pubocervical ligament
 Two firm bands of connective tissue
that pass to the cervix from the
posterior surface of the pubis. They
are positioned on either side of the
neck of the bladder
 5- Transverse cervical or
(cardinal ligament)
 Are fibromuscular condensations of
pelvic fascia that pass to the cervix
and the upper end of the vagina
from the lateral walls of the pelvis.
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The Principal Support of the
Uterus
1- This is the pelvic floor, formed
by the pelvic diaphragm.
2- The pelvic viscera surrounding
the uterus and the visceral fascia
(endopelvic fascia) bind the pelvic
viscera together.
The two levator ani muscles, the
two coccygeus muscles, and the
muscles of the urogenital
diaphragm are particularly
important in supporting the
uterus.
3- The Transverse Cervical,
Pubocervical, and Sacrocervical
Ligaments play an important part
in supporting the uterus and
keeping the cervix in its correct
position.

•
•
•
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6- The Broad Ligament
The broad ligament of the
uterus is the wide fold of
peritoneum that connects
the sides of the uterus to the
walls and floor of the pelvis
The broad ligament holds the
uterus in its normal position.
The 2 layers of the broad
ligament are continuous with
each other at a free edge.
This is directed anteriorly and
superiorly to surround the
uterine tube.
•
•
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Laterally, the broad
ligament is prolonged
superiorly over the ovarian
vessels as the suspensory
ligament of the ovary.
The broad ligament
contains extraperitoneal
tissue (connective tissue
and smooth muscle) called
parametrium.
It gives attachment to the
ovary through the
mesovarium.
The mesosalpinx is a
mesentery supporting the
uterine tube.
 The
contents of the broad ligament include
the following:
•
•
•
Reproductive
• Uterine tubes
• ovary (some sources consider the ovary to be on
the broad ligament, but not in it.)
vessels
• ovarian artery (in the suspensory ligament)
• uterine artery
ligaments
• ovarian ligament
• round ligament of uterus
• suspensory ligament of the ovary
THE RELATIONSHIPS OF THE UTERUS
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•
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1- Anteriorly the body of the uterus is separated
from the urinary bladder by the vesicouterine
pouch.
2-Posteriorly the body of the uterus and the
supravaginal part of the cervix are separated from
the sigmoid colon by a layer of peritoneum and the
peritoneal cavity.
The uterus is separated from the rectum by the
rectouterine pouch (of Douglas).
•
•
•
The inferior part of this pouch is closely related to
the posterior part of the fornix of the vagina.
3- Laterally the relationship of the ureter to the
uterine artery is very important.
The ureter is crossed superiorly by the uterine
artery at the side of the cervix.
ARTERIAL SUPPLY OF THE UTERUS
•
•
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1- This is derived mainly from
the uterine arteries, which are
branches of the internal iliac
arteries.
They enter the broad
ligaments beside the lateral
parts of the fornix of the
vagina, superior to the
ureters.
At the isthmus of the uterus,
the uterine artery divides into
a large ascending branch
that supplies the body of the
uterus and a small
descending branch that
supplies the cervix and
vagina.
•
•
2- The uterus is also
supplied by the ovarian
arteries, which are
branches of the aorta.
The uterine arteries pass
along the sides of the
uterus within the broad
ligament and then turn
laterally at the entrance to
the uterine tubes, where
they anastomose with the
ovarian arteries.
VENOUS DRAINAGE OF THE UTERUS
•
•
The uterine veins
enter the broad
ligaments with the
uterine arteries.
They form a uterine
venous plexus on
each side of the
cervix and its
tributaries drain
into the internal iliac
vein.
LYMPHATIC DRAINAGE OF THE UTERUS


o
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The uterine lymphatic vessels
follow three main routes :
1- Most vessels from the uterine
fundus and superior uterine
body pass along the ovarian vessels
to the lumbar (caval/aortic)
lymph nodes, but some vessels
pass along the round ligament of the
uterus to the superficial inguinal
lymph nodes.
2- Vessels from most of the uterine
body pass within the broad
ligament to the external iliac
lymph nodes.
3- Vessels from the uterine cervix
pass along the uterine vessels, to the
internal iliac lymph nodes and
along the uterosacral ligaments to
the sacral lymph nodes.
INNERVATION OF THE UTERUS
•
The nerves of the uterus
arise from the inferior
hypogastric plexus, largely
from the part known as the
uterovaginal plexus.
•
•
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This lies in the broad ligament
on each side of the cervix.
Parasympathetic fibres are
from the pelvic splanchnic
nerves (S2-4), and sympathetic
fibres are from the above
plexus.
The nerves to the cervix form
a plexus in which are located
small paracervical ganglia.
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THE UTERINE TUBES
These are 10 cm long and 1
cm in diameter.
They extend laterally from the
cornua of the uterus.
The uterine tubes carry
oocytes from the ovaries and
sperm cells from the uterus to
the fertilization site in the
ampulla of the uterine tube.
The uterine tube also conveys
the dividing zygote to the
uterine cavity.
Each tube opens at its
proximal end into the cornua
or horn of the uterus.
•At its distal end, it opens
into the peritoneal cavity
near the ovary.
•The uterine tubes allow
communication between
the peritoneal cavity and
the exterior of the body.
•The uterine tube is
divided into 4 parts:
infundibulum, ampulla,
isthmus, and intramural
or uterine parts.
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The infundibulum is the funnel-shaped distal end that
opens into the peritoneal cavity through the abdominal
ostium. The finger-like processes of the infundibulum,
the fimbriae, spread over the medial surface of the
ovary; one large ovarian fimbria is attached to the
superior pole of the ovary. About 2 mm in diameter
The ampulla, the widest and longest part, making up
over half of its length, begins at the medial end of the
infundibulum.
The isthmus, the thick-walled part, enters the uterine
cornu. (about 2.5 cm)
The uterine part is the short intramural segment
that passes through the wall of the uterus and opens
through the uterine ostium into the uterine cavity at the
uterine horn.
THE MESOSALPINX
•
•
The uterine tubes lie in the free edges of the
broad ligaments of the uterus.
The part of the broad ligament attached to the
uterine tube is called the mesentery of the tube
or mesosalpinx
ARTERIAL SUPPLY OF THE UTERINE TUBES
•
•
The arteries to the tubes are derived from the
uterine and ovarian arteries.
The tubal branches pass to the tube between the
layers of the mesosalpinx.
VENOUS DRAINAGE OF THE UTERINE TUBES
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The veins of the tubes are arranged similarly to the arteries
and drain into the uterine and ovarian veins.
Lymphatic Drainage of the Uterine Tubes
The lymph vessels of the uterine tubes follow those of the
fundus of the uterus and ovary and ascend with ovarian
veins to the aortic lymph nodes in the lumbar region.
Innervation of the Uterine Tubes
The nerve supply of the uterine tubes comes partly from the
ovarian plexus of nerves and partly from the uterine plexus.
OVARIES


The almond-shaped ovaries
are typically located near the
attachment of the broad
ligament to the lateral pelvic
walls, suspended from both
by peritoneal folds, the
mesovarium from the
posterosuperior aspect of the
broad ligament and the
suspensory ligament of
the ovary from the pelvic
wall
The suspensory ligament
conveys the ovarian vessels,
lymphatics, and nerves to
and from the ovary and
constitutes the lateral part of
the mesovarium.
Peritoneal coverings
Because the ovary is
suspended in the
peritoneal cavity, the
oocyte expelled at
ovulation passes into the
peritoneal cavity but is
usually trapped by the
fimbriae of the uterine
tube and carried to the
ampulla.


The ovary also attaches
to the uterus by the
ligament of ovary,
which runs within the
mesovarium.
This ligament is a
remnant of the superior
part of the ovarian
gubernaculum of the
fetus and connects the
proximal (uterine)
end of the ovary to the
lateral angle of the
uterus, just inferior to
the entrance of the
uterine tube.
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Blood supply of the
ovary:
The ovarian arteries arise
from the abdominal aorta
Ovarian veins draining the
ovary form a pampiniform
plexus of veins in the broad
ligament near the ovary .
The veins of the plexus
merge to form a singular
ovarian vein, which leaves
the lesser pelvis with the
ovarian artery.
The right ovarian vein
ascends to enter the
inferior vena cava; the left
ovarian vein drains into
the left renal vein
 The
lymphatic vessels
from the ovary:
 join those from the
uterine tubes and fundus
of the uterus as they
ascend to the right and
left (caval/aortic) lumbar
lymph nodes
 Innervation:
 The
nerves descend
along the ovarian
vessels from the
ovarian plexus, and
from the uterine
(pelvic) plexus
•
•
•

V
AGINA
It extends from the cervix of the
uterus to the vestibule of the
vagina.
The vagina communicates
superiorly with the cervical canal
and opens inferiorly into the
vestibule of the vagina.
In the anatomical position, the
vagina descends anteroinferiorly.
The posterior wall is about 1 cm
longer than the anterior wall and
is in contact with the external
uterine ostium (external os).
•
•
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The vagina is located
posterior to the urinary
bladder and anterior to
the rectum and passes
between the medial
margins of the levator
ani
It pierces the urogenital
diaphragm with the
sphincter urethrae
muscle.
The posterior fibres of
the sphincter urethrae
muscle are attached to
the vaginal wall.
The cervix projects into
the superior part of the
anterior wall, separating
the walls of the vagina.
•
•
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The uterus lies almost at
a right angle to the axis
of the vagina (anteverted
position). This uterine
angle increases as the
urinary bladder fills.
The vaginal recess
around the cervix is
called the fornix
It is divided into
anterior, posterior, and
lateral parts.
The posterior part of the
fornix is the deepest and
is related to the
rectouterine pouch
 Four
muscles
compress the vagina
and act like sphincters:
pubovaginalis, external
urethral sphincter,
urethrovaginal sphincter,
and bulbospongiosus
Relations:
• Anteriorly: the fundus
of the urinary bladder
and urethra.
• Laterally: the levator
ani, visceral pelvic
fascia, and ureters.
• Posteriorly (inferior to
superior): the anal
canal, rectum, and
rectouterine pouch.
VASCULATURE OF VAGINA
 The
arteries supplying the superior part of the
vagina derive from the uterine arteries;
 the arteries supplying the middle and inferior
parts of the vagina derive from the vaginal arteries
and internal pudendal arteries
 The veins form the vaginal venous plexuses
along the sides of the vagina and within the vaginal
mucosa.
 These veins communicate with the uterine venous
plexus as the uterovaginal plexus and drain into the
internal iliac veins through the uterine vein.
 The
lymphatic vessels drain from the vagina
as follows :
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•
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Superior part: to the internal and external iliac
lymph nodes.
Middle part: to the internal iliac lymph nodes.
Inferior part: to the sacral and common iliac
nodes.
External orifice: to the superficial inguinal
lymph nodes.
INNERVATION OF THE VAGINA
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from the uterovaginal plexus.
This lies in the base of the broad ligament on each
side of the supravaginal part of the cervix.
The inferior nerve fibres from this plexus supply the
cervix and the superior part of the vagina.
The fibres supplying the vagina are derived from
the inferior hypogastric plexus and the pelvic
splanchnic nerves.
The inferior part of the vagina is supplied by the
pudendal nerve.
BARTHOLINS GLAND
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

Bartholin's glands (also
greater vestibular glands)
are two glands located slightly
posterior and to the left and
right of the opening of the
vagina.
They secrete mucus to lubricate
the vagina and are homologous
to bulbourethral glands in
males.
However, while Bartholin's
glands are located in the
superficial perineal pouch in
females, bulbourethral glands
are located in the deep perineal
pouch in males.
SKENE`S GLANDS
 also
known as the lesser vestibular
glands, female prostate
 The location of the Skene's gland is
the general area of the vulva, glands
located on the anterior wall of the
vagina around the lower end of the
urethra.
 It has been postulated that the
Skene's glands are the source of
female ejaculation.
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