Female Genital System 2025 PDF

The Female Genital System Presented by: Dr: Samar M Abd El-Moneam Lecturer of human anatomy The lecture is voice recorded By the end of this lecture, student should know:  ovary Site : paired structure, each ovary lie in the s...

The Female Genital System Presented by: Dr: Samar M Abd El-Moneam Lecturer of human anatomy The lecture is voice recorded By the end of this lecture, student should know:  ovary Site : paired structure, each ovary lie in the side wall of pelvis within th ovarian fossa and completely covered with peritoneum Size: 3x2x1cm Shape: it is almond-shaped having 2 ends, 2 borders, 2 surfaces 2 ends: Upper (tubal) end: is directed up & laterally & attached to: Ovarian fimbria of the Falopiane tube and Suspensory (infundibulo-pelvic) ligament of the ovary Lower (uterine) end: is directed down & medially. It is attached to the upper lateral angle of the uterus by the ligament of the ovary. 2 surfaces: Lateral surface: related to the parietal peritoneum of the lateral pelvic wall & obturator nerve and vessels (in the floor of the fossa). Medial surface: related to fimbriated end of Fallopian tube. 2 borders: Posterior border: free. Anterior border: attached to the upper lateral part of broad ligament by mesovarium (which transmits the ovarian nerves & vessels to the hilum of the ovary). Ovarian fossa has the following boundaries: Infront &above: the external iliac vessels Behind: ureter and internal iliac vessels.  Ligaments of the ovary: Suspensory ligament of the ovary:It extends laterally from the tubal end of the ovary to the side wall of the pelvis at the external iliac vessels. It is a peritoneal fold which transmits the ovarian vessels, nerves & lymphatics to the broad ligament. Mesovarium:It is peritoneal fold that extends from the upper layer of broad ligament to the anterior border of the ovary. It transmits the ovarian vessels & nerves to the ovary. Ligament of the ovary:It is a fibromuscular cord that extends from the uterine end of the ovary to the lateral angle of the uterus. Arterial supply By the ovarian artery ➔ from abdominal aorta descends on psoas major, ureter, external iliac vessels to enter the suspensory ligament of the ovary ➔ then to the mesovarium ➔ then to the ovary. It also supplies the lateral part of the Fallopian tube where it anastomoses with the uterine artery. Venous drainage Rt. ovarian vein: drains into IVC. Lt. ovarian vein: drains into left renal vein. lymph drainage To para-aortic L.Ns. Nerve supply Parasympathetic: From pelvic splanchnic nerves (S 2, 3, 4). Sympathetic: from T 10, 11.  Fallopian tube Site: in the medial 4/5 of the upper free border of the broad ligament, extending from the superior angle of the uterus to the ovary on the side wall of the pelvis. Length: 10 cm. Course and relations Each tube runs upwards laterally & from the uterus to the side wall of the pelvis. Then, it curves backwards piercing the upper layer of the broad ligament to end on the medial surface of the ovary by the infundibulum. Along its whole course, it is related to coils of ileum & sigmoid colon. Intramural (uterine) part: It is the shortest ,narrowest part. It passes through the wall of the superoateral angle of the uterus to open into the uterine cavity. Isthmus: It is 2 cm in length, rounded, narrow and thick-walled. Ampulla: It is the longest (5 cm), thin-walled, tortuous and widest part. It is the site of fertilization. Infundibulum (fimbriated end): It is 2cm in length and funnel-shaped. It pierces the broad ligament to open into the peritoneal cavity near the ovary. Its margins carry fimbria which spread over the medial surface of the ovary. Arterial supply Medial 2/3: by the uterine artery. Lateral 1/3 : by the ovarian artery. Venous By veins accompanying the drainage arteries into the uterine and ovarian veins. Lymphatic Most of the tubal lymphatics drainage pass to the paraaortic L.Ns. Lymphatics of the isthmus pass to the superficial inguinal L.Ns.  Uterus Shape: pear-shaped hollow thick-walled muscular organ. Site: between the rectum posteriorly & Urinary bladder anteriorly size: 3 inch x 2inch x 1inch Divided into 3 parts Fundus: The part of uterus above the level of uterine tubes, no cavity Body: The part of uterus from the level of uterine tube to the level of the ismuth of uterus , cavity is triangular ,it is freely movable between the layers of broad lig Isthmus, Slight constriction between the body and the cervix. Cervix:the part below ismuth, cavity is fusiform, divided into supravaginal & vaginal parts  Relations of the uterus Fundus: completely covered by peritoneum Body: Anterior surface (vesical): Flat & related to urinary bladder. Directed downwards & forwards. Covered with peritoneum. Forms the posterior wall of the utero-vesical pouch. Posterior surface: Convex & related to terminal coils of ileum and sigmoid colon. Covered with peritoneum. Forms the anterior wall of the rectouterine pouch )Douglas pouch(. Lateral borders: It gives attachment to the broad ligament. The uterine artery ascends along it. It is penetrated above by the Fallopian tube. Its upper part gives attachment to: Round ligament of uterus in front of the fallopian tube. Ligament of ovary behind the Fallopian tube. Isthmus: Anteriorly: the peritoneum is reflected to form the utero-vesical pouch. Posteriorly: It is covered by peritoneum Cervix: Supra-vaginal part: Anteriorly: it is not covered by peritoneum and related to the U.B. Posteriorly: it is covered by peritoneum of Douglas pouch which separates it from the rectum. Laterally: it gives attachment to the broad ligament and is related to the ureter and uterine vessels just below the root of the broad ligament. Vaginal part: is surrounded by the vaginal fornices.  Supporting factors of uterus Position:It is located in the lesser pelvis between the rectum post and urinary bladder ant. Normally, the uterus is anteverted anteflexed anteverted: the whole uterus makes a right angle with the longitudinal axis of the vagina. anteflexed: the longitudinal axis of the body makes an angle = 170 with the longitudinal axis of cervix. Muscles: Pelvic diaphragm Urogenital diaphragm Perineal body Ligaments of the uterus: Ligaments of the body : Round ligament of uterus Ovarian ligament Broad ligament Ligaments of the cervix: Pubocervical ligament Uterosacral ligament Transverse cervical ligaments  Round ligament of uterus: from: It is attached to the upper part of lateral margin of body of uterus (in front of uterine tube). course: It passes forward and laterally between the 2 layers of the broad ligament to reach the side wall of the pelvis where it crosses over: Obturator nerve & vessels. Obliterated umbilical artery. External iliac artery & vein. It enters through the inguinal canal where it emerges from the superficial inguinal ring to attach to labia majora. Ligament of ovary: Fibromuscular cord between the uterine end of ovary and sup lat angle of uterus “Both these 2 ligaments represents the  Broad ligament: It is a double-layered fold of peritoneum extending from the side of the uterus to the side wall of pelvis. The broad ligament with the uterus forms transverse septum that divides the cavity of the lesser pelvis into 2 compartments: Ant compartment: U.B Post compartment: sigmoid colon ,rectum &coils of Ileum It has: 2 surfaces: lower (vesical) surface: *downwards & forwards*Related to urinary bladder upper (intestinal) surface: *upwards & backwards * related to the coils of small intestine, connected to the ovary by mesovarium is pierced by the lateral end of Fallopian tube 4 borders: upper free border *ant * : its medial 4/5 surrounds Fallopian tube, its lateral 1/5 forms the suspensory ligament of the ovary lower border * post attached*: attached the pelvic floor and uterine vessels run along this border and crosses the ureter 2cm lat to cervix medial border: attached to the side of the uterus, The uterine vessels ascend along this border between its 2 layers. lateral border: attached to the side wall of the pelvis it crosses over: Obturator nerve & vessels. Obliterated umbilical artery. External iliac artery & vein.  parts of broad ligament 1.Mesosalpinx: the part between the fallopian tube and attachment of mesovarium. Mesovarium: peritoneal fold connects the ovary to the sup layer of broad ligament, transmitting the ovarian nerve and vessels to ovary suspensory ligament of the ovary (infundibulopelvic lig): the upper lateral part of the broad ligament extending from the infundibulum of the uterine tube to the lateral pelvic wall, transmitting the ovarian vessels and nerves to mesovarium Mesometrium: the remaining lower medial part on the sides of the uterus 3 1 2 4 Contents of the broad ligament: 2 tubes: Fallopian tube: in the medial 4/5 of the upper free border. Ureter: in the root of broad ligament, 2 cm lateral to the cervix. 2 ligaments: ligament of ovary & round lig. of uterus. 2 arteries: Uterine A. (in the root then along the medial border then along the upper border). Ovarian A. (in the suspensory ligament of ovary). 2 sympathetic nerve plexus: uterovaginal & ovarian nerve plexus. 2 embryological remnants: epioophoron & paraoophoron. Connective tissue (parametrium) & lymphatics & L.Ns. Ligaments of the cervix Transverse cervical (Mackenrodt’s ) ligament: between the side wall of the pelvis and side of cervix & vagina. Pubo-cervical ligament: from the front of cervix & upper part of vagina to the back of the pubis, around the sides of the urethra. Utero-sacral ligament: from the back of the cervix to the front of S2 and S3, around the sides of the rectum. Arterial supply by the uterine artery: It is a branch of the anterior division of internal iliac artery. It passes medially on the floor of the pelvis in the root of the broad ligament crossing the ureter, about 2 cm lateral to the cervix. It ascends along the side of the uterus in a tortuous course between the 2 layers of the broad ligament. It turns laterally below the Fallopian tube to end by anastomosis with ovarian artery. It supplies: uterus + medial ¾ of Fallopian tube + vagina. Venous drainage The veins draining uterus form 2 venous plexuses along its lateral borders. Each venous plexus is drained by a pair of uterine veins which ends into internal iliac vein. Lymphatic drainage ❑ Fundus + upper part of the body + uterine tube ➔ para-aortic L.Ns ❑ Lower part of the body ➔ external iliac L.Ns. ❑ Cornu of the uterus (superior lateral angle)➔ its lymphatics pass along the round ligament of uterus into the superficial inguinal L.Ns. ❑ Cervix ➔ internal iliac & external iliac & sacral L.Ns. Nerve supply ❑Sympathetic ➔ from T12 & L1 (produce uterine contraction & vasoconstriction). ❑ Parasympathetic ➔ from S2, 3, 4. (produce uterine relaxation & vasodilatation).  vagina Site: It is fibro-muscular tube between the cervix and vestibule Size: 2.5cm diameter Direction:It is directed up & backwards forming a right angle with the uterus. Fornices:These are 4 pouches formed by the upper part of vagina around the vaginal part of cervix (2 lateral, 1 anterior & 1 posterior) The posterior fornix is the deepest one & the only one covered by peritoneum Relations: Anteriorly: (Not covered by peritoneum) Upper 1/3:cervix middle 1/3: base of bladder lower1/3: urethra Posteriorly: (upper1/4 is covered by peritoneum which is reflected to the rectum to form the recto-vaginal (Douglas pouch) containing coils of ileum and sigmoid colon middle ¼: - ampulla of rectum lower 1/4 - perineal body & - anal canal Laterally: -ureter - uterine artery - Laevator ani - greater vestibular glands Arterial supply -Uterine artery. – Vaginal artery. – Middle rectal artery. – Internal pudendal artery. These arteries Anastomose in front & behind the vagina to form anterior & posterior “azygos arteries”. Venous drainage The vaginal veins form plexuses that drains into internal iliac vein. Lymphatic Upper 1/3 ➔ external iliac L.Ns. drainage Middle 1/3 ➔ internal iliac L.Ns. Lower 1/3 ➔ superficial inguinal L.Ns. Nerve supply Upper 2/3 (pain insensitive) ➔ by autonomic fibers – Sympathetic: L1, 2 – Parasympathetic: S 2, 3 Lower 1/3 (pain sensitive) ➔ brs. of pudendal nerve.  External genitalia The external genitalia (vulva) are the organs of the female reproductive system located in the perineum, outside the pelvis. They include the following: Mons pubis : It is an elevation of skin over the symphysis pubis with underlying thick pad of fat. Labia majora: These are folds of skin with undelying fat pads which unite anteriorly to form the mons pubis. Labia Minora: These are two thin folds of skin located medial to the labia majora. They enclose the vestibule of vagina and the urethral opening Clitoris: It is a small erectile structure located into the anterior margin of the vestibule of vagina The clitoris is consisted of : body and two crura formed by two corpora cavernosa. Vestibule of Vagina:is an elliptical space between the labia minora. It contains urethral orifice anteriorly and vaginal orifice posteriorly. it also contains the openings of greater vestibular glands (of Bartholin), and paraurethral glands (of Skene).