Anatomy 5.

January 3, 2012
Dr. A.M. Quijano

Female Reproductive System (Gross)

OUTLINE
I. Female Reproductive System
II. Pelvic Cavity
III. Vagina
A. Functions
B. Location
C. Anatomical Relationships
D. Vaginal Fornices
E. Vaginal Support and Sphincters
F. Vaginal Neurovascular and
Lymphatic Supply
IV. Uterus
A. Functions
B. Location
C. Parts and Layers of Uterus
D. Uterocervical Proportion
E. Normal Uterine Position and
Uterine Support
F. Uterine Displacement and
Hysterectomy
G. Uterine Neurovascular and
Lymphatic Supply
V. Ovary
A. Functions
B. Location, Ovarian Surface and
Polarity
C. Vaginal Fornices
D.Vaginal Support and Sphincters

E. Vaginal Neurovascular and

Lymphatic Supply
VI. Uterine Tubes
A. Parts
B. Neurovascular and Lymphatic
Supply of Uterine Tubes
VII. External Genitalia
A. Mons Pubis
B. Labia Majora
C. Labia Minora
D. Clitoris
E. Vestibule
1. Vaginal Orifice
2. Urethral Meatus
3. Skenes Glands
4. Bartholins Glands
F. Neurovascular and Lymphatic
Supply of Female External Genitalia
VII. Accessory Organs
A. Placenta
B. Breast
C. Anatomical Relationships
D. Vaginal Fornices
E. Vaginal Support and Sphincters
F. Vaginal Neurovascular and
Lymphatic Supply

Objectives:
To discuss the GROSS ANATOMY of the FEMALE REPRODUCTIVE SYSTEM by:
o Naming the component parts: Internal; External Genitalia and Accessory glands
o Describing the shape, parts and anatomical relationships of each organ/part.
o Describing the normal position of the uterus and the various uterine support.
o Discussing the blood supply; venous; lymphatic drainage and nerve supply of
each organ
o Correlating the anatomical basis of some common clinical gynaecological
conditions
References:
Moore, Keith L., Dalley, Arhtur F., Agur, Anne M.R.: Clinically Oriented Anatomy, 6th
Ed. Philadelphia, Lippincott Williams and Wilkins, 2010
Cunningham, F. G., Leveno, Kennth J., Bloom, Steven L.: Williams Obstetrics , 22nd
Ed., New York, McGraw Hills, 2005
Evangelista-Sia, M.L.J.: Outline in Obstetrics: Textbook and Reviewer, 3rd Edition,
Quezon City, RMSIA Publishing, 2006
Quijano, A.M.: Gross Anatomy of the Female Reproductive System (A Slideshow),
2011 Edition, Quezon City
www.wikipedia.org
Legends:
Italicized text are according to Dr. Quijano during the lecture
Arial and non-italicized text are from reference books coming from Moores
Clinical Anatomy, and Willams OB
Calibri font are from old trans from previous years
Times New Roman text are Supplementary Information from Sias Outline in
Obstetrics and other reference as well

I. FEMALE REPRODUCTIVE ORGANS

Functions
o Production of female hormones
o Reproduction
Parts
o Internal Genitalia- located in the LESSER PELVIS
o External Genitalia- situated in the anterior part of the
PERINEUM
o Accessory Organs- mammary glands and placenta
Group 3A |Cy, CARA, Cring, Kenji

II. PELVIC CAVITY

REVIEW THE LECTURE ON PREVIOUS LECTURE BY DR. ELEVAZO
about the Pelvis and Perineum
PERINEAL BODY
o Collection of muscles and fibrous tissue located between the
vagina and rectum
o Where the superficial muscles of the perineum, the
bulbocavernous and levator ani muscles unite
o Its skin covered base is called perineum and it is often
lacerated during childbirth
o Composed of Superficial Perineal Muscles:
Bulbocavernous muscles extending from perineal body to
the vagina and clitoris and act like a sphincter to the vagina
and urethra
Ischiocavernous muscle which pass from ischial
tuberosities to the clitoris and provide transverse support to
the perineum
External anal sphincters surrounding the anal orifice
which controls passage of feces and flatus
Sphincter of the urethra which controls the flow of urine
UROGENITAL DIAPHRAGM
o The urogenital diaphragm or the lower pelvic consists of the
transverse perineal muscles that originates at the ischial
tuberosities and inserts at the perineal body.
o Its muscles support the anal canal during defecation, the vagina
during delivery and the urinary meatus, as well.
PELVIC DIAPHRAGM
o Levator Ani Muscles:
Pubococcygeus muscle is the deepest part of the pelvic
perineal body which passes from the pubis to the coccyx. It
surrounds the urethra, vagina and rectum. Damage to this
muscle will result in cystocele, rectocele and urinary stress
incontinence
Ileococcygeus muscles
Puborectalis muscles

III. VAGINA
Pliable, hollow, viscous, thin walled musculo-membranous tube
(7- 10 cm long)
Extends from the vulva upward and backward at 45 angle to
connect with the cervix at the superior end
Extends from the middle cervix of the uterus to the vaginal
orifice (opening at inferior end of vagina) or vestibule (cleft
between labia minora)
H-shaped in cross section
Vaginal canal is longer posteriorly, shorter anteriorly
Muscle and erectile tissue: very distensible (lined by rugae or
lateral vaginal sulci)
Has rugae:
o Which are transverse folds of skin in the vaginal wall that is
absent in childhood, appear after puberty and disappears at
menopause
o They are most numerous in nulliparous women and lessen with
each childbirth and advancing age
o The important function of this is to allow the vaginal canal to
stretch and enlarge considerably during delivery.

Page 1 of 10

 The vaginal canal has longitudinal folds of skin which also allows
the vaginal canal to enlarge during delivery in order to
accommodate the fetus. These longitudinal folds are called
VAGINAL COLUMN.
VAGINAL pH and Cervical Mucus
Vaginal pH before puberty is 6.8-7.2 which is alkaline and after
puberty is becomes acidic falling to pH 4.5. The vaginal change is
due to the fact that before puberty, a girl does not produce
substantial estrogen to stimulate cervical mucus secretion but with
the advent of puberty, her ovary begins to produce increasing
amounts of estrogen which stimulates mucus production in the
cervix.
Cervical mucus is rich in glycogen. The glycogen content of
vaginal mucus is converted to lactic acid by Doderlein bacilli (a
bacteria normally present in the vagina) making the vaginal
environment acidic- low vaginal pH helps control the growth of
pathogenic microorganisms that can cause vaginal infections.

o Urethrovaginal sphincter
o Bulbospongiosus- U-shaped muscle
CLINICAL CORRELATON
The external opening of the vagina is encircled by the
bulbocavernous muscle that acts as a voluntary sphincter. Kegels
exercise improves the tone of this muscle and helps to prevent
excessive lacerations during the birth of the baby

F. VAGINAL NEUROVASCULAR AND LYMPHATIC SUPPLY

Portion

Arterial
supply

Venous
drainage

Lymphatic
drainage

Upper
rd
3

Vaginal
branch
of
Uterine
arteries

External
and
internal
iliac
nodes

Middle
rd
3

Vaginal
artery
from
internal
iliac
artery

Vaginal
venous
plexus
continuous
with the
uterine
venous
plexus
(uterovaginal
venous
plexus) >
internal iliac
vein

A. FUNCTIONS
1. Excretory duct - serves as canal for menstrual flow
2. Birth canal - inferior part
3. Female genital canal - receives the penis and ejaculate during
sexual intercourse
4. Communicates superiorly with the cervical canal and
inferiorly with the vestibule of the vagina

B. LOCATION
Upper half: above the pelvic diaphragm (formed by levator ani
and coccygeous muscles)
levator ani composed of puborectalis, pubococcygeous,
iliococcygeous muscles
Lower half: within perineum

C. RELATIONSHIPS
Anteriorly: fundus of the urinary bladder and urethra
Laterally: levator ani, visceral pelvic fascia, ureters
Posteriorly (from inferior to superior): the anal canal, rectum,
and rectouterine pouch
The vaginal vault is the upper end of the vagina

D. VAGINAL FORNICES
recess around the cervix
has anterior, posterior and lateral parts
Posterior vaginal fornix- deepest part and is closely related
to the rectouterine pouch. Usually 10cm long and longer than
the anterior vaginal fornix (7cm). As a result, it is in this area that
vaginal secretions collect and semen pools.

Common
and
internal
iliac
nodes

Nerve
supply
Paucity
of free
nerve
endings
in upper
2/3
vaginal
plexus,
SNS:
T12-L2
PNS:
S2-S4

Common
iliac &
sacral
Sensory:
Vaginal
nodes
deep
branch
*Ext.
perineal
Pudendal
Lower
of
Orifice =
branches
rd
vein
3
Internal
superficial
of
pudendal
inguinal
pudendal
arteries
and
nerve
pectineal
nodes
Innervations to the vagina is provided by the uterovaginal plexus
of Lee Frankenhauser plexus and S1 to S3 nerves.
CLINICAL CORRELATON
Vaginismus, sometimes anglicized vaginism, is the German name
for a condition which affects a woman's ability to engage in any
form of vaginal penetration, including sexual intercourse, insertion
of tampons and/or menstrual cups, and the penetration involved in
gynecological examinations. This is the result of a reflex of
the pubococcygeus muscle, which is sometimes referred to as the
"PC muscle". The reflex causes the muscles in the vagina to tense
suddenly, which makes any kind of vaginal penetration
including sexual intercoursepainful or impossible.

E. VAGINAL SUPPORT AND SPHINCTERS

rd

Upper 3 : pull vagina upward

o Levator ani- main support of pelvic viscera
o Transverse cervical ligament- anchor lower cervix and upper
vagina to lateral pelvic wall
o Sacrocervical ligament- extend from cervix to sacrum
rd
Middle 3 : Urogenital diaphragm (muscle transversely disposed
across the subpubic arch)
o Perforated by urethra and vagina
rd
Lower 3 : Perineal body
4 muscles that COMPRESS the vagina and act as SPHINCTERS:
o Pubovaginalis
o External urethral sphincter
Group 3A |Cy, CARA, Cring, Kenji

Page 2 of 10

Figure 1. Ways to Assess Female Internal Genitalia:

Internal Examination- Digital examination, Bimanual Palation of Uterine
adnexia and Culdoscopy. Not in the picture is rectovaginal examination

IV. UTERUS
a.k.a Matres (Sp.), Bahay-bata (Tag.), Womb (Common
name, Eng.)
thick-walled, pear-shaped, hollow muscular organ
dynamic structure, variable in size, shape and dimension (8x 5x
2.5 cm in nulliparous women; weighs 90g in some books it
ranges from 50-70grams)

A. FUNCTION
Site for reception, retention & nutrition of the fertilized ovum
Provides power for expulsion of the fetus during childbirth; seal
torn blood vessels after delivery of placenta. Uterus has an intrinsic
motility which making it capable of contraction even if the nerves
that supply it are cut
Organ of menstruation

B. LOCATION
Lies in the lesser pelvis/ true pelvis, below the iliopectineal line
In transverse and lateral position marks the center of the pelvic
cavity
o Superior portion: convex, tilted forward
o Anterior portion: flat, facing downward and forward, rests on
bladder, not covered by peritoneum
o Posterior portion: convex, covered by peritoneum
The peritoneum will be reflected as the peritoneal pouch of
Douglas/ posterior cul de sac: lowest point of the abdominal
pelvic cavity in standing position
o Cervix: downward and back, rests on vagina, continuous with
uterus and vaginal canal
Posterior: covered by peritoneum
Internal: by internal os
o Peritoneum covers the upper posterior, internal to external os

C. PARTS AND LAYERS OR UTERUS

PARTS:
1. Uterine corpus/ Body corpus is the Latin term for body
a. Fundus
o Superior 2/3 of the uterus
o Dome-shaped; superior to the origin of fallopian tube
b. Body
Group 3A |Cy, CARA, Cring, Kenji

o between the layers of the broad ligament and is freely

movable
o Triangular-shaped cavity in coronal section; a slit-like area
on sagittal section
o Two surfaces: vesical and intestinal
c. Isthmus
o Demarcation between body and cervix
o Relatively constricted segment approx. 1cm long
o Site wherein uterine vessels will insert
o Important in doing hysterectomy
d. Uterine cavity
o 6cm in length from the external os to the wall of the
wall of the fundus
o Uterine horns: superolateral regions of the uterine
cavity where uterine tubes enter
o Continues inferiorly as the cervical canal which
extends from a narrowing inside the isthmus of the
uterine body (anatomical internal os) through the
supravaginal and vaginal parts of the cervix,
communicating with the lumen of the vagina through
the external os.
2. Cervix
rd
Cylindrical, relatively narrow inferior 3 of the uterus,
approx. 2.5 cm in length ; 2.5 in diameter
Extends from internal os to external os; Internal os which
opens after the corpus
Pierces the anterior wall of the vagina
Has many sebaceous glands that secretes a clear viscid and
alkaline mucus. Sometimes these glands are occluded giving
rise to non-pathogenic cyst-like structures called Nabothian
cyst.
divided into two parts:
a. Supravaginal: between the isthmus and vagina
b. Vaginal: protrudes into the vagina and is surrounded
by the external os of the uterus which is in turn
surrounded by the vaginal fornix
External os : Before childbirth, it is small and oval; after
childbirth it is a transverse slit
Parts of cervix: Internal os, Cervical Canal- which is a spindle
shaped area that is actually a continuation of the triangular
uterine cavity and located between the cervical opening; and
the external os
PAP SMEAR TEST
The Papanicolaou test (also called Pap smear, Pap test, cervical
smear, or smear test) is a screening test used to detect precancerous and cancerous processes in the endocervical
canal (transformation zone) of the female reproductive system.
Changes can be treated, thus preventing cervical cancer. The test
was invented by and named after the prominent Greek
doctor Georgios Papanikolaou. An anal Pap smear is an adaptation
of the procedure to screen and detect anal cancers.
Women should wait a few years after they first have intercourse
before they start screening. For example, United States Preventive
Services Task Force (USPSTF) recommends waiting three years.
American Congress of Obstetricians and Gynecologists (ACOG)
recommends starting screening at age 21 (since that is a few years
after initial sex for most American women). Many other countries
wait until age 25 or later to start screening. For instance, some
parts of Great Britain start screening at age 25.
INDICATED: for HPV screening. HPV is related to cervical
cancer.

Page 3 of 10

 3 layers of the uterine wall:

1. Perimetrium/serosa
Consists of peritoneum supported by a thin layer of
connective tissue
Attached to the broad ligament
2. Myometrium
Thickest; middle coat of smooth muscle
Where the main branches of the blood vessels and
nerves of the uterus are located
Superior portion is most muscular (myometrium thickness
decreases superoinferiorly)
Inner wall is more muscular than the outer wall
Anterior/posterior wall is more muscular than the lateral
wall
During menses, myometrial contractions may produce
cramping
o Cervix: Muscular tissue less than body of the uterus,
mostly fibrous and composed mainly of collagen with
a small amount of smooth muscle and elastin
3. Endometrium
Inner mucous coat
Firmly adherent to the underlying myometrium
Actively involved in the menstrual cycle, inner surface of
this coat is shed
Site of implantation of blastocyst
This part is most responsive to growth hormones.
Has two layers: Glandular and Basal layer (adjacent to
myometrium; give rise to new endometrium after
menstruation; Female Reproductive System: Histology)

D. UTEROCERVICAL PROPORTION
At birth: relatively large and has adult proportions (corpus to
cervical ration= 2:1) due to influence of maternal hormones
Pre-pubertal: childhood proportions, corpus and cervix are usually
equal in length (1:1), cervix greater in diameter
During puberty: grows rapidly in size, assuming adult dimensions
o Estrogen controls the size ratio between corpus & cervix
(increases uterus : cervix ratio)
In multiparous women it is 3:1
Postmenopausal: uterus is involuted and regress to childhood
proportions
E. UTERINE POSITION AND UTERINE SUPPORT
Anteroversoflexion
o Anteroversion- angle made by long axis of uterus with long axis
of vagina, normally 90
o Anteroflexion- angle made by long axis of uterine body with
long axis of cervix normally 170
o In the erect position and with the bladder empty, the uterus
lies in an almost horizontal plane.
Uterine Support
1. Tone of the pelvic floor: Dynamic or Active support
o This keeps the uterus from collapsing and falling through
vagina
a. Levator ani muscle
Main muscle of pelvic diaphragm forming a broad
muscular sheet stretching across the pelvic cavity
Effectively support the pelvic viscera and resist intraabdominal pressure transmitted downward through
pelvis

Group 3A |Cy, CARA, Cring, Kenji

b. Perineal Body
Broad muscular structure where some of the fibers of
the muscles are inserted
Important in maintaining the integrity of the pelvic
floor.
If damaged during childbirth- prolapsed of pelvic viscera
may occur
2. Uterine Ligaments: Passive Support
a. Broad ligament/ Peritoneal Ligament (2)
Supports the sides of uterus and assists in holding uterus
in anteroversion
The pampiniform plexus, a collection of several veins
located here.
Double layered fold of peritoneum extending from
lateral border of uterus to lateral pelvic wall
Floor of parametrium
Together with the uterus, form a septum that divides
the cavity of the lesser pelvis into 2 parts:
Anterior- contains urinary bladder
Posterior- contains rectum, terminal part of ileum and
part of sigmoid colon.
Structures within the broad ligament:
Uterine tubes- found in its free upper border
Round ligament of uterus and ligament of ovary
Uterine and ovarian blood vessels, nerves and
lymphatics
Epoophoron and Paraoophron- remnants of
mesonephros
3 parts:
Mesosalpinx (uterine tubes)
Mesovarium (ovary)
Mesometrium (uterus)
b. Round ligament (ligamentum teres) of the uterus: (2)
Extends between the superolateral angles of the uterus,
through the deep inguinal ring and inguinal canal and
inserts in the subcutaneous tissue of the labia majora
Course is the same as that of spermatic cord in males,
that is why this is the homologue of spermatic cord
Remnant and homologue of the gubernaculums in
males
Helps keep the uterus anterverted and anteflexed.
During pregnancy it hypertrophies giving stability to the
uterus.
c. Transverse cervical (Mackenrodts) or cardinal ligament (2)
Extends from sides of cervix uteri and lateral fornix of
vagina to lateral pelvic wall
Main support of the uterus, and damage to this ligament
causes uterine prolapsed.
d. Uterosacral/ Sacrocervical ligament
Extends from lower end of sacrum (from second and
third sacral vertebra) to cervix and upper end of vagina
(in some books, it pass on each side of rectum)
Forms two(2) ridges one on either side of rectouterine
pouch of Douglas
Help to keep the uterus in its normal position by
maintaining traction on the cervix
e. Pubocervical ligament
Cervix to anterior pubis
**NOTE: According to Snell, (c), (d) and (e) are subperitoneal
condensations of the pelvic fascia on the upper surface of the
levator ani muscle. They are attached to cervix and vault of vagina
and play an important role in supporting the uterus and keeping
cervix in correct position.

Page 4 of 10

3. Intraabdominal Pressure: Carrying heavy objects, constipation,

enlargement of pelvic viscera, valsalva maneuver increase
pressure, uterus pressed against urinary bladder

o Retrocession- slumping backward of the cervix and vaginal apex

to coccyx

F. UTERINE DISPLACEMENT AND HYSTERECTOMY

Uterine Displacement

Figure 5. Uterus in retrocession

o Anteflexion- bending forward of the body on the cervix;

common complication- urination

Figure 2. Normal Uterine position where;

Uterus and cervix with respect to vagina- anterverted (blue arrow) 90 and
Uterine corpus with respect to cervix- anteflexed (red arrow)

Retrodisplacement due to:

1. After parturition
a. Stretching ligaments
b. abdominal muscle tone
c. Perineal lacerations
2. Adhesions, tumors, infections
3. Age, muscle atrophy and loss of tone
o Retroverted Uterus- Occurs when the fundus and the body are
bent backward on the vagina so that they lie in the rectouterine
pouch.

Figure 6. Anteroflexed uterus

Procidentia Uteri or Uterine Prolapsed

o Abnormal in uterine support caused by damage to the last
three (3) uterine ligaments during child birth
o General poor body muscular tone
o In advance cases, the cervix descends the length of the vagina
and may protrude through orifice

Figure 7. from left to right: 1st and 2nd Degree of Procidentia Uteri
Figure 8. on the next page appearance of complete Procidentia Uteri

Fig. 3 Degree of Retroversion where:

1(green)- Cervix-corpus axis is anterior to vaginal axis
2 (blue)- Cervix- corpus axis is along the vaginal axis
3(red)- Cervix- corpus axis is beyond vaginal axis

o Retroflexion- posterior flexion/ bending of the body against the

cervix

Hysterectomy
Removal of the uterus by cutting all uterine ligaments

Figure 4. Retroflexed uterus

Group 3A |Cy, CARA, Cring, Kenji

Page 5 of 10

V. OVARY

Figure 10. Internal Female Genitalia

A. FUNCTION

Figure 9. Normal Uterine Position vs various Uterine Disposition;

Degree of Uterine Prolapse; and Hysterctomy

F. NEUROVASCULAR SUPPLY OF UTERUS

Uterine Artery
o Branch of the anterior division of the Internal Iliac Artery
o crosses over the ureter before reaching isthmus
Remember: Water (ureter) under the Bridge (uterine)
a. Main uterine artery- runs medially in the broad ligament;
anastomoses with ovarian a.
i. Arcuate arteries- beneath the serosa
ii. Radial branches- penetrate directly before entering the
endometrium; divide into:
1. Straight arterioles- short, only deep 1/3 ends as
horizontal, not affected by hormones, stable, maintains
continuous circulation in the basal layer
2. Spiral arterioles- reaches the endometrial surface and
responds to hormones; circulation for functional layer
b. Descending cervical branch- anastomoses with a branch of
vaginal a.
Venous Drainage of the Uterus
o Accompany corresponding arteries
o Corpus and cervix drain into the uterine veinsuterine venous
plexus internal iliac v.
o Fundus drain into ovarian v.
(R)- directly drains into IVC
(L)- left renal v. then IVC
Lymphatic Drainage
o Fundus and upper body drains into the para-aortic/ lumbar
nodes at L1 level and superior inguinal nodes
o Lower uterine and cervix drain into the internal and external
iliac nodes
Nerve Supply (fr. Inferior hypogastric plexus)
o Sympathetic (T12-L2) via lumbar splanchnic n.
o Parasympathetic (S2-S4) via pelvic splanchnic n.

Group 3A |Cy, CARA, Cring, Kenji

Pearl grayish white in color

Endocrine gland responsible for producing reproductive
hormones (estrogen and progesterone)
Female gonads where the oocytes develops
Almond-shaped and sized female gonads 3 x 1.5 x 0.75-cm

B. LOCATION, OVARIAN SURFACE AND POLARITY

Ovarian Fossa
Depression in the lateral walls of the pelvis
Bounded by external iliac vessel above and by internal iliac vessel
behind
Snell: position of the ovary varies and it is often found in the
pouch of Douglas/ rectouterine pouch
Due to the potential space, enlarging ovaries will go unnoticed
thus contributing to late diagnosis of ovarian cancer
Each ovary is suspended by a short peritoneal
fold/mesentery/mesovarium/ part of the broad ligament which is
not covered by the peritoneum
Suspensory Ligament of the ovary- continuous with the
mesovarium; at superolateral aspect of the ovary within the
peritoneal fold (ovarian neurovascular and lymphatic vessels)
Ovaries are suspended in the peritoneal cavity but not covered by
perineum. During ovulation, expelled oocyte passes into the
peritoneal cavity and it normally captured by fimbriae of the
infundibulum of the uterine tube and carried into ampulla.
Surface of ovary:
During puberty- it becomes progressively scarred and distorted
due to repeated rupture of ovarian follicles and discharge of
oocytes during ovulation
Scarring is less in women who have been on oral
contraceptives.
Poles (Extremities)
1. Tubal (superior extremity)
Near external iliac vessels
Related to ovarian fimbrae of uterine tube
Attached to the lateral pelvic wall by the suspensory
ligament of the ovary or infundibulum pelvic ligament
Part of the broad ligament extending between the
attachment of the mesovarium and lateral wall of the pelvis

Page 6 of 10

 The ovarian vessels, lymphatics, and nerves cross the pelvic

brim, passing to and fr. the superolateral aspect of the ovary
within this peritoneal fold
2. Uterine( inferior extremity)
Attached to lateral angle of the uterus by the ovarian
ligament
Represents the remains of the upper part of the
gubernaculum
Suspend medial ovary to lateral part of the uterus

VI. UTERINE TUBES

Also known as oviducts or fallopian tubes

About 10-12 cms long
Part of the UTERINE ADNEXA (together w/ OVARIES)
Pelvic Infections : STI (Sexually Transmitted Infections)
Function of fallopian tubes is exclusively for reproduction
o Receives the ovum from ovary
o Site of fertilization (usually in ampulla)
o Provides nourishment for the fertilized ovum and transports it to
the cavity of the uterus
o Conduit along which the spermatozoa travel to reach the ovum
Connects peritoneal cavity to uterine cavity
Lies in the upper border of the broad ligament
Suspended by the Mesosalpinx a narrow mesentery that forms
the free anterosuperior edges of the broad ligament

A. PARTS
1. Uterine part (Intramural / interstitial)
w/in uterine wall; opens into uterus at the uterine horn thru
uterine ostium

2. Isthmus
narrow; runs wavy course; thick-walled part of tube that enters
the uterine horn

3. Ampulla
widest, tortuous, longest; site of fertilization
4. Infundibulum
funnel-shaped distal end opens into peritoneal cavity via
abdominal ostium; terminal fimbriated portion; ovarian
fimbria;
Fimbria: finger-like projection at the end that spread over the
medial surface of the ovary. One large ovarian fimbria is
attached to the superior pole of the ovary; guides in the pick up
mechanism of uterine tube in process of ovulation

VENOUS DRAINAGE of UTERINE ADNEXA

o Ovarian v (along suspensory lig)
o Into the Pampiniform plexus- vine-like vessels where ovarian
vessel drains. It merge in to singular ovarian vein that leaves
lesser pelvis with the ovarian artery:
Right ovary- to inferior vena cava
Left ovary- to left renal vein
LYMPHATIC DRAINAGE
o Follow the follow the ovarian a. para-aortic nodes (R/L
Lumbar group of nodes)
o Follows the arterial vessels -> Lumbar (paraaortic) and internal
nodes
NERVE SUPPLY:
o Derived from the aortic plexus
o All pass over the pelvic inlet and cross the external iliac vessels
and reach the ovary by passing through the suspensory
ligament of the ovary, then enter the hilum of the ovary via the
mesovarium
o Sympathetic (T12- L2)
o Parasympathetic nerves (S2- S4) from inferior hypogastric
plexus
CLINICAL CORRELATION
Ectopic Pregnancy
o Implantation and growth of a fertilized ovum may occur
outside the uterine cavity in the wall of the uterine tube
o Eroding action of trophoblast quickly destroys the wall of the
tube
o Tubal abortion or rupture of the tube with the effusion of a
large quantity of blood go into the peritoneal cavity (common
result)
Tubal Ligation
o Ligation and division of uterine tubes, method of obtaining
permanent birth control
o The ova that discharged from the ovarian follicles degenerate
in the tube proximal to the obstruction
VII. EXTERNAL FEMALE GENITALIA
Also known as Pudendum or Vulva
FUNCTIONS:
o As sensory & erectile tissue for sexual arousal & coitus.
o To prevent entry of foreign material into the urogenital tract.
o To direct the flow of urine

B. NEUROVASCULAR SUPPLY OF UTERINE TUBES

ARTERIAL BLOOD SUPPLY of UTERINE ADNEXA
o Ovarian arteries main supply
main supply
arises from the abdominal aorta at level of L1
descends retroperitoneal, landmark: below the renal. A.
courses along suspensory ligaments
have two (2) branches: ovarian and tubal branches; both of
which will anastomose with the ascending branch of the
uterine a.
provides collateral circulation fr. abdominal and pelvic
sources to both structures
o Ascending branches of uterine aa.
branch of the internal iliac arteries
course along the medial aspect of the ovaries
o Marginal artery of Drummond Ovarian aa
Group 3A |Cy, CARA, Cring, Kenji

Figure 11. Internal Female Genitalia

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A. MON PUBIS (PUBIC MOUND)

Fatty mound, hairy
a.k.a Mons Veneris (Mound of Venus; Mountain of Love)
Rounded, fatty eminence anterior to the pubic symphysis, tubercles
and superior pubic rami
The eminence formed by a mass of fatty subcutaneous tissues
Fat increases at puberty and decreases after menopause

B. LABIA MAJORA
Enclose cleft

7-8cm in length, 2-3cm in width and 1-1.5cm in thickness and are

somewhat tapered at the lower extremities.
Embryologically it is homologous with the male scrotum
Prominent folds of skin that protects clitoris and urethral and
vaginal orifices.
Each labium majus are filled with a finger-like digital process of
loose subcutaneous tissue containing smooth muscle and the
termination of the round ligament of uterus
Passes inferoposteriorly from mons pubis toward anus
Lies on the sides of a central depression (narrow slit when thighs
are adducted) the pudendal cleft
Externally- an adult labia majora are covered with pigmented skin
containing many sebaceous glands and crisp pubic hair.
Internally- smooth, pink and hairless
Labia are thicker in front forming anterior commissure in midline
and behind the posterior commissure; interval between posterior
commisure and anus is called the gynecological perineum

C. LABIA MINORA

Thin skin, no hair, fat free, pinkish in color (rich in blood vessels)
Encloses vestibule
Increased sensory nerve endings
Enclosed in the pudendal cleft and immediately surround and close
over the vestibule of vagina
Core of spongy connective tissue containing erectile tissue at the
base and many small blood vessels
Anteriorly- two laminae
o Medial laminae- unite as frenulum of the clitoris
o Lateral- anterior to the glans forming prepuce
o In young women (virgins), the labia minora are connected
posteriorly by a small transverse fold, the frenulum of the labia
minora (fourchette)
No sweat glands but has many sebaceous glands
In nulliparous women, usually not visible behind the nonseparated
labia majora. In multiparous women, it is common for the labia
minora to project beyond the labia majora.

D. CLITORIS

An erectile organ where labia minora meet anteriorly

Approximately 2cm in length and less than 1cm in diameter
Parts : root, body & glans
Root: Made up of 3 erectile tissue
o Bulb of vestibule: covered by bulbospongiosus muscle
o Right and left crura becomes corpora cavernosa anteriorly
Body Corpora cavernous + corpora spongiosa; covered by
prepuce
Glans partly hidden by prepuce; most highly innervated part of
the clitoris and is densely supplied with sensory endings
The crura attach to the inferior pubic rami and perineal membrane,
deep to the labia.
Clitoris is not functionally related to the urethra or to urination;
just an organ of sexual arousal

Group 3A |Cy, CARA, Cring, Kenji

Highly sensitive and enlarges on tactile stimulation

E. VESTIBULE
Cleft between labia minora
Space surrounded by the labia minora where all orifices and ducts
(vaginal, urethral os and vestibular glands)open
External urethral orifice at 2-3cm posteroinferior to the glans and
anterior to vaginal orifice
At its side or on its lateral sides are openings of paraurethral glands
Ducts or opening of greater vestibular glands are located on the
upper, medial aspects of the labia minora at 5 and 7 oclock
positions relative to the vaginal orifice in the lithotomy position
Size and appearance varies with the appearance of hymen (a thin
anular fold of mucus membrane that partially occludes the vaginal
os. When ruptured, its remnants of hymen are called hymenal
caruncle which are visible.
Hymen has no established physiological function; a developmental
vestige and its condition often provides a critical evidence in cases
of child abuse and rape.
6 openings of the vestibule:
o Vagina (1)
o Urethral meatus (1)
o Opening of Bartholins ducts (2)
o Opening of Paraurethral/Skenes glands (2)

QUESTION: Which of the vestibular openings is/are highly or

very active?
a. Vaginal orifice
o Also known as introitus just below the urethral meatus
o Protected in virgins by hymen - thin,vascularized membrane
o Stratified Squamous Epithelium Non Keratinized
o Hymenal caruncle: hymenal tags after parturition
o Grafenberg or G-spot is a very sensitive area located at the
inner anterior surface of the vagina
G-SPOT
The Grfenberg Spot, often called the G-Spot, is a beanshaped area of the vagina. Many women report that it is
an erogenous zone which, when stimulated, can lead to
strong sexual arousal, powerful orgasms and female ejaculation.
The Grfenberg Spot is typically located one to three inches (2.5 to
7.6 cm) up the front (anterior) vaginal wall between the vaginal
opening and the urethra and is a sensitive area that may be part of
the female prostate.
b. Urethral meatus
o Opens in grove between hymen and labia minora
o Most frequently used of the 6 openings of the vestibule
c. Skenes Gland
o Posterolateral urethra or Paraurethral gland
o Opens on either side of urethral orifice (homologue of
prostate gland)
o Infection of either Skenes or Bartholins glands can cause
pain and abnormal discharge
d. Bartholins Glands
o a.k.a Greater Vestibular gland, Vulvoginal or Paravaginal
Glands
o Between hymen and labia minora; Covered by posterior part
of bulb of vestibule and labia majora
o Lateral to vaginal vestibule; located at inner side of vagina

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o Group of small oval symmetrical mucus secreting glands with

1 layer columnar cells and basal nuclei
o Supported in loose vascular connective tissue
o Main duct passes in and laterally, drain to vulvovaginal
glands
o Mainly columnar epithelium but becomes stratified squamous
epithelium as it nears opening
o It serve as lubrication for vaginal introitus and it is alkaline
which enhances sperm survival

F. NEUROVASCULAR AND LYMPHATIC SUPPLY OF THE VULVA

Arterial Supply and Venous Drainage of the Vulva]
o Internal Pudendal Arteries- skin, external genitalia, perineal
muscles
Labial arteries
o External Pudendal Arteries
o Internal Pudendal Veins- include Labial Vein
Nerve Innervation
o Anterior- derivative of lumbar plexus- ANTERIOR LABIAL
NERVE- from ilioingional nerve and the genital branch of the
genitofemoral nerve
o Posterior- derivative of sacral plexus-the perineal branch of the
posterior cutaneous nerve of the thigh laterally and the pudendal
nerve of the perineum
POSTERIOR LABIAL NERVES (terminal branches of
perineal nerve) supply the labia.
Deep and muscular br. of the perineal nerve supply vaginal os
and superficial perineal muscles
Dorsal nerve of clitoris- deep perineal muscle and sensation to
the clitoris
o Parasympathetic fibers via cavernous nerves from uterovaginal
nerve plexus- bulb of vestibule and erectile bodies of the clitoris.
Stimulation produces increased vaginal secretion, erection of
the clitoris and engorgement of erectile tissue in the bulbs of
the vestibule
Lymphatic Drainage
o Skin and anoderm inferior to the pectinate line plus inferiormost
vagina, vaginal os, vestibule drains to superficial inguinal
lymph node
o Clitoris vestibular bulb, and anterior labia minora- deep inguinal
lymph nodes or directly to the internal iliac lymph nodes
o Urethra- internal iliac or sacral lymph nodes

Materno-fetal organ with sponge like consistency

22 cm in diameter, 2.0 to 2.5 cm thick

Fetal or Inner surface: shiny, gray, translucent
Maternal or Outer surface: rough, dark maroon, divided into
cotyledons
Fetal membranes: gray, wrinkled. shiny, translucent
o Amnion - a membrane, continuous with and covering the fetal
side of the placenta that forms the outer surface of the
umbilical cord.
o Chorion - The outer membrane enclosing the embryo in
reptiles, birds, and mammals. In placental mammals it
contributes to the development of the placenta.

Figure 13. Fetal side of the placenta

Fetal side Faces the baby with the umbilical cord top right. The
white fringe surrounding its bottom is the remnants of the
amniotic sac (see Fig. 13)

VIII. ACCESSORY ORGANS

A. PLACENTA
Figure 14. Maternal Side of the Placenta

Maternal side - Displays side that connects to the uterine wall

(Fig. 14)

B. BREAST OR MAMMARY GLAND

nd

Figure 12. Placenta with a developing fetus

Group 3A |Cy, CARA, Cring, Kenji

th

From 2 to 6 rib, & sternum to midaxillary line

Nipple - conical prominence at the center of colored area called
areola.
Meant to provide the INFANT with the most ideal nourishment
after birth
External Structures
o Nipple or Mammary Papillae: located at the center of the
anterior surface of each breast. It has 15-20 openings connected
to the lactiferous ducts and in which milk flows out

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o Areola: the pigmented skin that surrounds the nipple. Both

nipple and areola have pigmented wrinkled skin
o Montgomery tubercles: glands in the areola that secrete an oily
substance that keeps the areola and nipple lubricated

Just a little vajayjay humor!!!

Internal Structures
o Lobes: 15 to 20 are found in each breast that are divided into
several lobules.
o Lobules: composed of clustered of acini cells.
o Acini cells: these are the milk secreting cells of the breasts that
are stimulated by prolactin hormone
o Lactiferous ducts: ducts that serve as passageways of milk
o Lactiferous sinus: dilated portions of the ducts located behind
the nipple that serve as reservoir of milk
Hormones that Affect the Mammary Glands
o Estrogen: stimulates development of the ductile structures of the
breast
o Progesterone: stimulates the development of the acinar
structures of the breast
o Human placental lactogen: promotes breast development during
pregnancy
o Oxytocin: let-down reflex. This hormone is inhibited by
progesterone
o Prolactin: stimulates milk production. This hormone is inhibited
by estrogen

REVIEW BREAST ON PREVIOUS LECTURES

Group 3A |Cy, CARA, Cring, Kenji

Page 10 of 10