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ANATOMY OF THE FEMALE REPRODUCTIVE TRACT

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A broad and accurate understanding of the female genital tract
and the menstrual cycle comprises 2 of the most important
basic concerns regarding the practice of OB/GYN
Female reproductive tract
o External genitalia
▪
All structures seen externally from pubis to perineum
o Internal genitalia
▪
Within pelvic cavity responsible for reproduction
o Bony pelvis

EXTERNAL GENERATIVE ORGANS
-

Known as a whole as the pudenda or vulva
10 parts:
1
...
Labia majora
3
...
Clitoris
5
...
Vestibule
7
...
Bartholin glands / greater vestibular glands
9
...
Paraurethral / Skene’s glands

1
...
Labia majora
A pair of fibro adipose tissues
7-8 cm x 2-3 cm x 1-1
...
Labia minora
2 flat reddish folds posterior to each labia majora
Merge anteriorly to form the prepuce (hood) of clitoris (superiorly) and the frenulum (inferiorly)
Hairless
Fuse posteriorly to form fourchette
Male homologue: ventral shaft of penis
(+) sebaceous, sweat glands
Rich in neural and vascular elements
Form the vestibule or opening of the vulva

4
...
Vestibule
6 openings
o Urethra
o Vagina
o Bartholin’s glands or ducts (2)
▪
Can be up to 1-1
...
Hymen
Elastic and collagenous tissue with varying thickness
Surrounds the vaginal opening
No glands or muscles
Not rich in fibers
Important in medico-legal cases, torn on coitarche (especially
on the posterior part)
Re-epithelize
forming
nodules
of
various
sizeshymenal/myrtiform caruncles
In multiparous, will form the myrtiform caruncles (from frequent coitus)

-

-

Imperforate hymen (rare)
o Vaginal orifice is occluded completely causing retention of
menstrual blood
o Do not do any intervention to a neonate because it will
close again, intervene during puberty when the female
starts menstruating
o Violaceous like dead blood
o Entrapment of menstrual blood inside
Correct it by doing an incision between the membranes

Dr
...
upper portion: mullerian duct
b
...


Vesicovaginal septum
o CT separating the bladder and urethra from the vagina
Rectovaginal septum
o Separates lower vagina and rectum
Rectouterine pouch/cul-de-sac of Douglas
o Separates upper fourth of the vagina from the rectum
FUNCTIONS:
o Excretory canal of the uterus
o Female organ of copulation
o Part of birth canal
Length:
o Anterior: 6 -8 cm
o Posterior: 7 – 10 cm
4 fornices: upper end of the vaginal vault
o 2 lateral, anterior and posterior
▪
Where we palpate pelvic organs, and gain surgical
access to the periteonal cavity (particularly posterior fornix)
o Posterior fornix: 7-10 cm (provide access to the peritoneum)
▪
Can access Cul-de-sac of Douglas
▪
Use gauge 13 or 16 to drain pus or blood through
this opening (culdocentesis)
o Anterior fornix: 6-8 cm
*vagina is longer posteriorly than anteriorly

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Vaginal mucosa
o With rugae, prominent on the lower third of vagina, for
distensibility
o Covered with stratified squamous epithelium
o No glands present (vaginal secretions are from the cervix
(discharges) and desquamation of the vagina

-

Vascular supply
o Upper 1/3: cervicovaginal branches of uterine artery
o Middle 1/3: inferior vesical artery
o Lower 1/3: middle rectal and internal pudendal artery

Perineal body
Functions:
o Anchors the anorectum
o Anchors the vagina
o Helps maintain urinary and fecal continence
o Maintains the orgasmic platform
o Prevents expansion of urogential hiatus
o Provides physical barrier between vagina and rectum

-

Levator ani muscles
•
Pubococcygeus/pubovisceral
o Pubovaginalis
o Puboperinealis
o Puboanalis
•
Puborectalis
•
Ileococcygeus muscles
b
...
Fascial covering
Urogenital diaphragm
o Superficial when in dorsal lithotomy and inferior when
upright
o Positioned external to pelvic diaphragm
o 3 parts:
a
...
Constrictor of the urethra
c
...
Uterus
In between the Urinary bladder and rectum
Any surgeries in the uterus may injure the related structures
like the bladder and the rectum (hence prior to any surgery we
always insert an IFC to monitor the urinary output)
2 unequal parts
o Body / corpus (triangular)
o Isthmus
o Cervix
▪
Lower fusiform
▪
Projects into the vagina
o Cornua
o Fundus
A
...
John Lorenz Beleno

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Potential morbidity
o Episiotomy may injure the perineal body
o Pudendal nerve injury assisted with concurrent perineal
body injury
4 x 4 cm in size
Usually injured during childbirth
Ways to prevent injury: well supported episiotomy
o Short perineal body: do mediolateral episiotomy

ANATOMY

Vaginal orifice
•
Surrounded by hymen (myrtiform caruncles)
•
Opening of the bartholin’s gland

2

ANATOMY OF THE FEMALE REPRODUCTIVE TRACT

▪
▪

Nullip vs
...
fishmouth
✓ Illustration comparing the size of uterus (ratio
between body of uterus to the cervix)
▪
Newborn 2:1
▪
4 year old 1:1
▪
Puberty 2:1
▪
Nulliparous 2:1
▪
Multiparous 3:1
▪
Postmenopausal 1: 1
B
...
Endometrium
o Responds to hormonal fluctuation
o Columnar epithelium
o Basal layer vs
...
Myometrium
o Smooth muscles
o 1
...
5 cm thick
o Very distensible and is able to accommodate the baby
o Marked hypertrophy during pregnancy
o Major portion of the uterus
3
...
Round ligament: not a supporting structure to the uterus
o From lateral portion of the uterus
o Arises below and anterior to origin of fallopian tube
o Extends outward into the inguinal canal
o Terminates into the labia majora (causes inguinal pain
when stretched)
o Made up of smooth muscles
o Important to know during ligation, mistaken as fallopian
tube, thereby causing failed family planning method
o First ligament ligated during TABHSO (total abdominal
hysterectomy)
b
...

o
o
o
o

Serosa / perimetrium
o Outermost layer continuous with the
broad ligament

*ENDOMETRIUM
•
Lines the uterine cavity in non-pregnant women
•
Thin, pink, velvet like membrane
•
Perforated by large number of minute ostia of the
uterine glands
•
0
...

o
o
o
o

Broad ligaments
Fold of peritoneum
Wing like structure
▪
Mesosalpinx: peritoneum overlying the fallopian
tube
▪
Mesoteres: around round ligament
▪
Mesovarium: over uteroovarian ligament
Infundibulopelvic ligament /suspensory ligament of ovary
▪
From fimbrial end to pelvic sidewall
▪
Through which ovarian vessels transverse
▪
Ureter forms the base of the broad ligament
Cardinal ligament (transverse cervical / Mackenrodt ligament)
mostly dense connective tissue
main support of the uterus and cervix
united to the supravaginal portion of cervix
uterine vessels and ureter are found within its broad base
▪
base of broad ligament – ureter is close to this area
•
about 2 cm lateral to the cervix, the uterine
artery crosses over the ureter
Uterosacral ligaments
posterolateral to supravaginal portion of the cervix
encircles rectum then inserts to the fascia over S2 and S3
lateral boundaries of the pouch of Douglas
provides minor cervical support

*During TABHSO (order of ligation of ligaments):
start with round ligament → infundibulopelvic ligament → uterine vessels → cardinal ligaments → uterosacral ligament →
amputate the cervix
2
...
John Lorenz Beleno

▪

Shape:
•
At birth: small oval opening
•
After delivery: fish-mouth, with anterior and
posterior lip
External os: portio vaginalis
•
Projects into the vaginal canal
Epithelium mucosa: one layer, columnar cells
•
Vaginal portion: squamous epithelium
Squamo-columnar junction: trauma, inflammation
•
Where cervical cancer starts
•
Where pap smear specimen is acquired because it is highly acidic, continuous trauma
and reparative state

ANATOMY

▪

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ANATOMY OF THE FEMALE REPRODUCTIVE TRACT

4-6 cm long, 5-8 mm diameter
most common site of ectopic pregnancy in the FT

o

-

Isthmus
▪
narrowest
▪
3-4 cm long, 2-3 mm diam
▪
most commonly ruptured part during ectopic pregnancy
o Interstitial / intramural
▪
nearest the hood of the uterus
▪
1-2 cm
▪
if the ectopic pregnancy is planted on this area, it is
called cornual pregnancy
▪
enclosed with the myometrium
▪
increased morbidity during ectopic pregnancy, possibility of doing hysterectomy
Ciliated columnar epithelium
Cilia moves towards the uterus
Not clinically palpable during bimanual exam
Cannot be seen during ultrasound
*only seen in hydro/pyosalpinx
Blood supply
o Uterine and ovarian artery/vein
Lymphatics
o Internal iliac and aortic nodes

3
...
5-5cm x 1
...
6-1
...
Cortex
▪
Dull white surface (tunica albuginea)
▪
Lined by a single layer of cuboidal epithelium or
germinal epithelium of Waldeyer
▪
Contains oocytes and developing follicles
▪
As early as 7th month intrauterine life: 6 million are
present
▪
At birth: around 2 million are viable
▪
During puberty/menarche: 400,000
▪
Perimenopausal: 8,000
▪
Only 400-500 can ovulate during a woman’s lifetime

o
o

ANATOMY

▪
▪

Left ovarian vein → left renal vein
Right ovarian vein → inferior vena cava

Male and Female Derivatives of Embryonic Urogenital Structures:
Male
Female
Scrotum
Labia majora
Ventral portion of penis
Labia minora
Penis
Clitoris
Gland
Glans
Corpora cavernosa penis
Corpora cavernosa penis
Corpus spongiosum
Corpus spongiosum
Prostate gland
Urethral and paraurethral gland
Prostatic utricle
Vagina
Bulbourethral glands (Cow- Greater vestibular glands (Barper’s)
tholin’s)
Seminal colliculus
Hymen
Appendix of testis
Uterus, cervix and fallopian
tubes
Gubernaculum testis
Round ligament of the uterus
BONY PELVIS
Gynecoid
o 50% of cases
Android
o Males
o Heart shaped
Platypelloid
o Flat shaped
o Wider transverse diameter than AP diameter
Anthropoid
o Oval
o Wider AP diameter than transverse diameter
Four bones
o Sacrum
o Coccyx
o 2 innominate bones
▪
Ilium
▪
Ischium

-

-

Medulla
▪
Central portion
▪
Composed of loose connective tissue
▪
Contain blood vessels and smooth muscle fibers
Blood supply
o Uterine and ovarian artery
o Originate directly from the aorta inferior to the renal artery
o Most frequently indentified at the infundibulo-pelvic ligament
Venous drainage

DR
...


4
Jlb_MD



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