ReferenceReference

TEXT BOOKTEXT BOOK Obstetrics & Gynecology (fifth edition)Obstetrics & Gynecology (fifth edition) Author: Tamara L. Callahan, Aaron BAuthor: Tamara L. Callahan, Aaron B ..

CaugheyCaughey Williams ObstetricsWilliams Obstetrics Berek & Novak's GynecologyBerek & Novak's Gynecology

Source: Lippincott Williams & Wilkins (LSource: Lippincott Williams & Wilkins (LWW)WW)

Anatomy of the Anatomy of the Female Reproductive Female Reproductive

SystemSystem

Ai-Xia LiuAi-Xia Liu

Women’s Hospital, School of Women’s Hospital, School of Medicine, Medicine,

Zhejiang UniversityZhejiang University

OutlineOutline External genitaliaExternal genitalia Internal genitaliaInternal genitalia Adjacent organsAdjacent organs Bony pelvisBony pelvis Pelvic floorPelvic floor

External Genital External Genital Organs(vulva)Organs(vulva)

Mons pubisMons pubis Labia majoraLabia majora Labia minoraLabia minora ClitorisClitoris Vestibule of the vaginaVestibule of the vagina

External urethral orifExternal urethral orificeice

Vestibule glandsVestibule glands paraurethral glands paraurethral glands

(Skene’s glands)(Skene’s glands) Bartholin's glandBartholin's gland

vagina opening vagina opening hymenhymen

External genitalia of adult female (parous)

Internal Genital Internal Genital OrgansOrgans

Internal Genital OrgansInternal Genital Organs Vagina: extend from the Vagina: extend from the

uterus to the vestibuleuterus to the vestibule The wall is composed of a The wall is composed of a

mucosal and a muscular layermucosal and a muscular layer Function: sexual intercourse Function: sexual intercourse

organ, the passage way of labor organ, the passage way of labor and menstrual bloodand menstrual blood

Fornix: divided into 4 regionsFornix: divided into 4 regions

Posterior fornixPosterior fornix

Fornix

UterusUterus A pear shaped, thick A pear shaped, thick

walled, muscular organwalled, muscular organ Situated between bladder Situated between bladder

and rectumand rectum 7-8 cm long, 4-5 cm wide, 7-8 cm long, 4-5 cm wide,

2-3 cm thick2-3 cm thick

isthmus

UterusUterus

Divided into 2 main portionsDivided into 2 main portions Body/CervixBody/Cervix Ratio: adult, 2:1, infant, 1:2Ratio: adult, 2:1, infant, 1:2 isthmus isthmus

a transitional zone between body and cervixa transitional zone between body and cervix Special obstetrical significance (lower uterine segment)Special obstetrical significance (lower uterine segment) Internal orifice(os)Internal orifice(os)

anatomical internal os: narrowest position of the cavityanatomical internal os: narrowest position of the cavity histological internal os histological internal os the columnar epithelium changes into endometriumthe columnar epithelium changes into endometrium

isthmus

uterusuterus body (superior 2/3s)body (superior 2/3s)

Fundus: the widest place of the corpusFundus: the widest place of the corpus Lined with endometriumLined with endometrium

cervix (inferior 1/3)cervix (inferior 1/3) Supravaginal portionSupravaginal portion Vaginal portionVaginal portion External cervical osExternal cervical os Squamocolumnar junctionSquamocolumnar junction

The cervical canal is coveredThe cervical canal is covered

by columnar epitheliumby columnar epithelium The surface of vaginal portion is The surface of vaginal portion is

covered by squamous epitheliumcovered by squamous epitheliumExternal cervical osExternal cervical os

uterus

fundus

cavity

corpus

cervix

fornix

vagina

isthmus

Supra-vaginal

Vaginal part

Coronary viewSagittal view

Anatomical os.Histologic os.

External os

anteversion:anteversion: tipped forwatipped forwardrd

retroversionretroversion tipped backwartipped backwardsds

retroflexion: the fundus is pointing backwards. Anterior of ute

rus is convex. anteflexion: the fundus is pointing forwards. The isthmus is b

end.

Position and Axis Position and Axis DirectionDirection

The wall of the uterusThe wall of the uterus

perimetrium (serous): peritoneal coveringperimetrium (serous): peritoneal covering

myometrium (muscular): the out layer, the inner layermyometrium (muscular): the out layer, the inner layer

the endometrium(mucous): soft and spongythe endometrium(mucous): soft and spongy

The myometrium of the uterus:1. the out layer, 2. the inner layer

1 2

LigamentsLigaments 4 pairs of ligaments4 pairs of ligaments

Round ligamentRound ligament Uterosacral ligamentUterosacral ligament Cardinal ligament Cardinal ligament (transverse ligament of cervix)(transverse ligament of cervix) Broad ligamentBroad ligament

ligamentsligaments

11. . round ligamentround ligament - attaches anter - attaches anterior-inferiorly to uterotubal juncior-inferiorly to uterotubal junctions, pass in the broad ligamenttions, pass in the broad ligaments, end in labia majora. They hels, end in labia majora. They help to keep uterus in the position p to keep uterus in the position of anteversion. of anteversion. Ligments of uterusLigments of uterus

Cardinal lig.

Round lig.

Broad lig.

LigamentsLigaments 2. Broad ligament2. Broad ligament – arise from th – arise from th

e side of the uterus to the lateral e side of the uterus to the lateral pelvic wall, provide minimal supelvic wall, provide minimal support.pport.

Between two leaves of ligaments thBetween two leaves of ligaments there lies round ligaments,fallopian tuere lies round ligaments,fallopian tube, ovarian ligament, mesosalpinx,be, ovarian ligament, mesosalpinx,

infundibulum ligament, bloodinfundibulum ligament, blood vessles and nervesvessles and nerves

3.3. Cardinal ligamentsCardinal ligaments - extend fro - extend from cervix and lateral parts of vagim cervix and lateral parts of vaginal fornix to lateral walls of pelvinal fornix to lateral walls of pelvis. s.

Chief means of support and suspends thChief means of support and suspends the uterus from the lateral walls of the pele uterus from the lateral walls of the pel

vis minorvis minor Ligments of uterusLigments of uterus

Cardinal lig.

Round lig.

Broad lig.

LigamentsLigaments4.Uterosacral ligaments4.Uterosacral ligaments – –

arise from the sacral fasarise from the sacral fascia, and insert into the pcia, and insert into the posteroinferior portion oosteroinferior portion of the uterus at about the f the uterus at about the level of the isthmus. Thlevel of the isthmus. They provide important suey provide important support for the uterus. pport for the uterus.

Fallopian tubeFallopian tube serves to convey the ova to the uterus, running in the superior border of the broad serves to convey the ova to the uterus, running in the superior border of the broad

ligments (mesosalpinx).ligments (mesosalpinx). divided into 4 parts:divided into 4 parts: interstitial portioninterstitial portion: embodied within the muscular wall of uterus: embodied within the muscular wall of uterus isthmusisthmus: narrowest portion: narrowest portion ampullaampulla: wide and tortuous: wide and tortuous infundibuluminfundibulum: fringed by numerous diverging processes (open to cavity).: fringed by numerous diverging processes (open to cavity).

Layers of the tube wallLayers of the tube wall serousserous subseroussubserous muscularmuscular mucous: ciliated columnmucous: ciliated column

ar epitheliumar epithelium

Left and right tube uterine ostium in the hysteroscopy

Ovary:Ovary: Oval shaped, 2.5-5 cm long, 1.5-3 cm wide, 0.7-1.5 cm thickOval 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, Covered by cuboid or low columnar epithelium and white fibrial tissue,

no peritoneum corveredno peritoneum corvered Consists of cortex and medullaConsists of cortex and medulla cortex: contains oocytes in various stages of maturitycortex: contains oocytes in various stages of maturity medulla: made up of blood vessels, nerves, lymphatic vessels, and supmedulla: made up of blood vessels, nerves, lymphatic vessels, and sup

porting tissue. porting tissue. ligamentsligaments

superior (tubal) end of ovary is connected to lateral wall of pelvis bsuperior (tubal) end of ovary is connected to lateral wall of pelvis by suspensory ligament of the ovary (infundibulum ligament)y suspensory ligament of the ovary (infundibulum ligament)

contains ovarian vessels and nervescontains ovarian vessels and nerves ligament of ovary - connects inferior (uterine) end of ovary to laterligament of ovary - connects inferior (uterine) end of ovary to later

al angle of uterusal angle of uterus Mesovarium: attach to the posteroanterior layer of the broad ligameMesovarium: attach to the posteroanterior layer of the broad ligame

nt, connected with suspensory ligamentnt, connected with suspensory ligament Hilum: vessels , nerves and lympatics enter the ovaryHilum: vessels , nerves and lympatics enter the ovary

Ligaments of ovaryLigaments of ovary

Neighbor organs

Douglas pouch uterovesica

l pouch

Water flows under a bridge

ureter

Uterine artery

1

22

33

44

5 5

6

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.

77

Arterial system1. Ovarian artery: the chief so

urce 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

Blood supply for female genitalia

The lymphatic drainage of pelvisThe lymphatic drainage of pelvisInternal iliac lymph nodeInternal iliac lymph node Surround internal iliac vesselsSurround internal iliac vessels Receive afferents from pelvic viscera, pReceive afferents from pelvic viscera, p

erineum, buttock and back of thigherineum, buttock and back of thighExternal iliac lymph nodesExternal iliac lymph nodes Lie along external iliac arteryLie along external iliac artery Receive afferents from lower limb and sReceive afferents from lower limb and s

ome parts of pelvic visceraome parts of pelvic visceraSacral lymph nodeSacral lymph nodeCommon iliac lymph nodeCommon iliac lymph node Lie along common iliac arteryLie along common iliac artery Receive afferents from all the above nodReceive afferents from all the above nod

eses Efferents pass to lumbar lymph nodeEfferents pass to lumbar lymph node

Lymphatic drainage: Lymphatic drainage: External genital organ lymph groupExternal genital organ lymph group: :

1. superficial inguinal lymph nodes. 1. superficial inguinal lymph nodes.

2. deep inguinal lymph nodes2. deep inguinal lymph nodes Pelvic lymph group: Pelvic lymph group:

1. iliac lymph group. 1. iliac lymph group.

2. presacral lymph group. 2. presacral lymph group.

3. lumbar lymph group.3. lumbar lymph group.

The nerve of external The nerve of external genitaliagenitalia

Pudendal nervePudendal nerve Obstetric local anesthesiaObstetric local anesthesia

Divided into 3 branches beside tuberositDivided into 3 branches beside tuberosityy Inferior hemorrhoid nerveInferior hemorrhoid nerve Dorsal nerveDorsal nerve Perineal nervePerineal nerve

The nerve of internal The nerve of internal genitaliagenitalia

Sympathetic and parasympathetic Sympathetic and parasympathetic nerves from lumbar and sacral nerves from lumbar and sacral spinal cordspinal cord

Sympathetic nerve are derived from Sympathetic nerve are derived from PlexusPlexus Sacral plexusSacral plexus Ovarian plexusOvarian plexus

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