Female Reproductive

System
 OBJECTIVES
1. To know the different parts of the female
reproductive system, as compared to the male
counterpart
2. To understand the relations of these organs to
neighboring structures
4. To enumerate the common clinical conditions of
these organs as to its embryology, anatomy and
histology
5. To know the recent technology used in its study
Broad Ligament

• Fold of peritoneum
that encloses uterus
• Extends from side of
uterus to lateral
pelvic wall and floor
• Uterine tubes found
in free edge
 Ovaries
• Ovarian surface
• Ovarian fossa
– Boundaries: iliac
Superior
end vessels
• 1.5 x 0.75 “
Inferior • Ligaments
end
- Broad
(mesovarium)
- suspensory
- round
Blood supply:
•Arteries – Ovarian (L2)
•Veins – Ovarian
(IVC & Renal)
Lymph drainage:
•para-aortic nodes (L1)
Nerve supply:
*aortic plexus
Clinical Notes:
1.Position
2.Cysts
- benign
- malignant

Technology:
1.Ultrasound
2.Laparoscopy
3.In vitro fertilization

* Genital ridge
Uterine Tubes
• 10-12 cm long
• Functions
– carry oocytes from
ovaries
– carry sperms from
uterus to ampulla
– conveys dividing
zygote to uterus
Uterine Tube
• Infundibulum
– abdominal ostium
– 20 to 30 fimbriae
• Ampulla
– widest & longest
• Isthmus
– narrowest part
• Intramural
- interstitial
Blood supply:
•Arteries – Ovarian
Uterine
•Veins –
Lymph drainage:
- internal iliac / para-aortic
Nerve supply:
- Autonomics of the inferior
hypogastric plexus
Clinical Notes:
1.PID
2. Ectopic pregnancy

Technology:
1.Tubal ligation
2.In vitro fertilization
3.Laparoscopy –
chromotubation

* Paramesonephric ducts
Eccyesis
 Uterus

Rectouterine
pouch • Located between
Vesicouterine
pouch bladder and rectum
• Anterior – bladder
• Posterior – rectum
• Lateral – adnexae
Uterus
• Two main portions
– body - superior two
thirds
– cervix - inferior third
• Isthmus
– junction between the
body and cervix
• Fundus
• Cornua
- Functions:
reception, retention, nutrition

- pear-shaped
- 3 x 2 x 1”
- triangular cavity
- thick muscular wall

- Arteries & Veins: uterine

- Lymph drainage:
* Fundus – para-aortic nodes
* Body & cervix – int & ext.
iliac; superficial
inguinal nodes
* Nerve supply – as the tubes
Uterine positions

Rectouterine
pouch
Vesicouterine
pouch
Uterine Ligaments
Suspensory
ligament
Ovarian ligament

Round
ligament
 Uterine Support
• Pelvic Diaphragm
– levator ani muscles
– coccygeus
• Urogenital diaphragm
• Cardinal ligament
LEVATOR < OBT. INT.
ANI • Uterosacral ligament
FASCIA • Pubocervical ligament
UG DIAPH

< PERINEAL
BODY
Vestigial Structures
Clinical Correlations:
1.Uterus at different ages
2.Pregnancy & labor
Cesarean section
3. Pelvic examination
4. Conditions:
* Prolapse / Procidentia
* Leiomyoma
* Malignancy
* Embryological
 Blood Supply of Female
Reproductive Tract
• Vagina
– vaginal artery
– internal pudendal a.
• Uterus
Ovarian a.

Uterine a.
– uterine artery
– ovarian artery
Vaginal a.
• Ovary
– ovarian artery
Internal pudendal a.
• Uterine tubes
– uterine & ovarian a.
Blood Supply to Female
Reproductive Organs
• Anastomoses of venous
plexuses
– vaginal
– uterine
– rectal
– pampiniform
• Venous drainage
– internal iliac veins
– ovarian vein
• right - inferior vena cava
• left- left renal vein
 Lymphatic Drainage
• External iliac nodes
– 8-10 in number
– drain bladder, male internal
Cisterna chyli
organs, uterus
Lumbar trunk • Internal iliac nodes
– from all pelvic viscera
Lumbar
nodes
– deep part of perineum
Common
iliac nodes Internal • Sacral lymph nodes
iliac nodes
Sacral
nodes
– from posterior pelvic wall,
External
iliac nodes rectum, prostate/cervix
 Lymphatic Drainage
• Common iliac nodes
– lateral group
• common iliac vessels
Cisterna chyli
• lymph from external &
Lumbar trunk internal nodes
– median group
Lumbar
nodes
• angle between vessels
Common • lymph directly from
iliac nodes Internal pelvic viscera
Sacral iliac nodes
nodes External • Lumbar aortic nodes
iliac nodes
– along abdominal aorta
– lymph from common iliac
nodes , fundus of uterus,
ovary & tubes
 Lymphatic Drainage

Lumbar aortic nodes

Cisterna chyli

Lumbar trunk
Lumbar trunk
Lumbar
nodes
Common

Cisterna Chyli
iliac nodes Internal
Sacral iliac nodes
nodes External
iliac nodes

Thoracic duct
Pelvic Autonomic System
• Superior hypogastric
plexus
– anterior to bifurcation of
aorta
– inferior prolongation of
intermesenteric plexus

• R&L hypogastric nerves

– mingle with pelvic
splanchnic ncerves
Pelvic Autonomic System
• Inferior hypogastric
plexus
– superior hypogastric
plexus and pelvic
splanchnic nerves
– surrounds internal iliac
artery

• Pelvic plexus
Pelvic Plexus
• Middle rectal plexus
– innervates rectum
• Vesical plexus
– innervates urinary
bladder
• Prostatic plexus
– innervates male
internal reproductive
organs
• Uterovaginal plexus
 Dissection
• Identify structures that enter and leave
the pelvis (ureter, internal iliac artery &
branches)
• Examine the peritoneal relationships in
both male and female pelves
– Note the formation of the pouches
• rectovesical
• rectouterine Vesico-
uterine
Recto-
uterine Rectovesical
pouch pouch
• vesicouterine pouch
 Dissection

– Identify all the different ligaments of each

individual pelvis that can be visualized
• posterior surface of anterior abdominal wall
• females
– uterosacral and cardinal ligaments
– broad , round, suspensory ligament
 Dissection
• Remove the peritoneum from the pelvic cavity
and inspect the pelvic viscera
– Pull the apex of the bladder upward and backward to easily
detach the bladder from the pelvic wall exposing the retropubic
space
• With a bone saw cut through the symphysis
pubis and retract it laterally
• Cut through the midline of the bladder
(Sagittal section) Inspect bladder wall