Female Reproductive System Anatomy

Female Genital System

• The female genital system consists of the uterus, ovaries, uterine tubes, and vagina.

Uterus

• The uterus is a pear-shaped, hollow organ located between the urinary bladder and rectum.
• It has a longitudinal axis that forms a right angle with the vagina (angle of anteversion) and is anteverted and anteflexed (AVF) at the level of the internal os.
• The uterus has a normal position, but can also be retroverted and retroflexed (RVF), which may cause prolapse in old, multiparous women.

Parts of the Uterus

• The fundus is the upper part of the uterus, completely covered by peritoneum, and related to coils of the ileum and sigmoid colon.
• The anterior surface is covered by peritoneum and related to the urinary bladder with the uterovesical pouch in between.
• The posterior surface is covered by peritoneum down to the cervix and the posterior fornix of the vagina with the rectovaginal pouch.
• The lateral borders have the uterine tubes entering the uterus, and the round ligament of the uterus is attached to it.

Cervix of the Uterus

• The cervix is one inch long and in diameter, more fixed due to strong ligaments attached to it.
• It projects through the anterior vaginal wall, which divides it into supravaginal and vaginal parts.
• The external os appears as a small circular opening in nulliparous women and a transverse slit in multiparous women.

Uterine Cavity

• The cavity of the body is a transverse slit in sagittal section and triangular in coronal section.
• The cervical canal communicates with the cavity of the body through the internal os and with the vagina through the external os.

Ligaments of the Uterus

• Peritoneal ligaments do not support the uterus.
• Fibromuscular ligaments play a crucial role in supporting the uterus and are mainly attached to the cervix.
• Examples include transverse cervical ligaments, uterosacral ligaments, pubocervical ligaments, and round ligaments of the uterus.

Broad Ligament

• The broad ligament is a peritoneal fold that attaches the uterus to the pelvic wall.
• It has an anterior (free) border, posterior (attached) border, medial border, and lateral border.
• Parts of the broad ligament include the mesovarium, suspensory ligament of the ovary, mesosalpinx, and mesometrium.

Arterial Supply, Venous Drainage, and Lymph Drainage of the Uterus

• Arterial supply: uterine artery
• Venous drainage: uterine venous plexus drains into uterine and vaginal veins
• Lymph drainage: fundus drains into para-aortic nodes, body drains into external iliac lymph nodes, and cervix drains into internal and external iliac lymph nodes and sacral lymph nodes

Vagina

• Relations of the vagina: anteriorly, it is related to the urethra and base of the bladder; posteriorly, it is related to the anal canal, rectum, and rectovaginal pouch; laterally, it is related to muscles of the urogenital diaphragm, sphincter vaginae, and Mackenrodt's ligament.

Arterial Supply, Venous Drainage, and Lymph Drainage of the Vagina

• Arterial supply: vaginal branches of the uterine artery, vaginal artery, middle rectal artery, and internal pudendal artery
• Venous drainage: vaginal venous plexus drains into vaginal veins and internal iliac veins
• Lymph drainage: lower part drains into superficial inguinal lymph nodes, and upper part drains into internal and external iliac lymph nodes

Uterine Tube

• The uterine tube is a pair of ducts that transmit the ovum from the ovary to the uterus.
• It lies in the medial 4/5 of the upper free border of the broad ligament and has a length of 10 cm.

Parts of the Uterine Tube

• Infundibulum: funnel-shaped with irregular processes called fimbriae
• Ampulla: longest, widest, and tortuous part, and the site of fertilization
• Isthmus: short, narrow, and forms the medial 1/5 of the tube
• Intramural part: shortest, narrowest, and opens into the superior angle of the uterine cavity

Supply of Uterine Tube

• Blood supply: medial 2/3 by uterine vessels, lateral 1/3 by ovarian vessels
• Nerve supply: medial 2/3 by uterine nerve plexus, lateral 1/3 by ovarian nerve plexus
• Lymphatic drainage: ascends with those of the fundus of the uterus and ovary to the lateral aortic lymph nodes

Ovary

• External features: 2 ends (superior/tubal and inferior/uterine), 2 surfaces (medial and lateral), and 2 borders (anterior and posterior)
• Ligaments of the ovary: round ligament of the ovary, mesovarium, and suspensory ligament of the ovary
• Blood supply and lymph drainage of the ovary: ovarian artery, ovarian vein, and lateral aortic lymph nodes