Dr Sanjaya K Shrestha

External and internal genital organs

External – part of perineum
Internal genital organs:
•A pair of ovaries
•A pair of uterine/fallopian tubes
•Uterus
•Vagina

•Ovaries – homologous to testes – but much smaller

The Ovaries
- Female gonads – female gamates (oocytes) are formed in them

Position
-ovarian fossa- latera pelvic
wall
-Slight variation
- nulliparous – long axis –
vertical
- multiparous - horizontal
External features
•Young girls- before onset of
ovulation – smooth surface-
greyish pink in color

•After puberty- surfaces –

uneven, color- grey
•Two poles – upper tubal pole
- lower uterine pole
•Two borders-
- anterior- mesovarian border
- posterior- free border
•Two surfaces- lateral
- medial
 relations
eritoneal relatiions
Almost entirely covered by peritoneum
Uncovered area- along mesovarium (anterior) border – 2 laye
f peritoneum are reflected on to the posterior layer of broad
gament of uterus

Mesovarium
quamous epjithelium of mesovarium – continues with cubica
pith of ovary – transmits vessels and nerves
Suspensory ligament of ovary

 -infundibulopelvic lig
 Lateral part of broad
ligament – extending
from infundibulum of
uterine tube and the
upper pole of ovary to
the external iliac vessels
 Contains ovarian vessels
and nerves
 Ovarian arteries arise from aorta
Arterial supply
just below the renal artery-
descends over the posterior
abdominal wall – enters
suspensory lig- branches
through mesovarium

 Venous drainage
Form pampiniform plexus around
the artery – condenses into a
single ovarian v.- ascends on
the posterior abd wall- drains
into IVC on the rt side and into
lt renal v on the lt side
 lymphatic

 Lymphatics communicate
with that of uterine tube
and fundus of uterus –
ascend along ovarian
vessels – drain- lateral
aortic and preaortic nodes
Nerve supply
Ovarian plexus- derived
From renal, aortic and
hypogastric plexuses-
accompanies ovarian
artery –
Sympathetic(T10,T11)-
afferent for pain;efferent
as vasomotor
Parasympathetic(S2,3,4)
are vasodilator
Functions:

1. Production of oocytes – during reproductive life

(puberty-menopause), ~30yrs

Production of hormones
1. Oestrogen
2. progesterone
Uterine tubes
(fallopian tubes)
-tortuous ducts- convey oocyte
from ovary to uterus. Fertilization
usually takes place in the lateral
part of tube.
-position- free upper margin of
broad ligament
Dimensions
10 cm long
Lateral end opens into peritoneal
cavity- abdominal ostium
(3mm in diameter)
-
Parts:
1. Lateral end- like funnel-
infundibulum- finger-like processes –
fimbriae – fimbriated end
2. Ampulla- medial to infundibulum-
thin-walled, dilated and tortuous(6-
7cm), 4mm diam.; arches over upper
pole of ovary
3. Isthmus- narrow, rounded and cord-
like – medial 1/3rd (2-3cm)
4. Uterine or intramural part- 1cm, lies
within the wall of uterus- opens at the
superior angle of uterine cavity –
uterine ostium 1mm diam.
Blood supply:

Medial 2/3rd – uterine a.

Lateral 1/3rd – ovarian a.

Veins drain into pampiniform plexus

of ovary
Lymphatics

 Join lymphatics from

ovary – lateral and pre-
aortic nodes
 Lymphatics from
isthmus – accompany
round ligament of
uterus- drain into
superficial inguinal
nodes
Nerve supply

Sympathetic-
T10-L2 segments- from
hypogastric plexus- both
visceral afferent and efferent
fibers- vasomotor + peristalsis

Parasympathetic-
Vagus – lateral ½ of tube
Pelvic splanchnic n. from S2,3,4 –
medial ½ - inhibits peristalsis;
vasodilatation
 Clinical Anatomy

1. Salpingitis
2. Sterility – the most common cause in female- tubal blockage
– congenital or caused by infection
Patency investigation-
 Insufflation test(Rubin’s test)- air pushed into uterus –
fallopian tubes – peritoneal cavity- hissing or bubbling
sound – on auscultation over iliac fossa
 Hysterosalpingography- radiologic technique
3. Tubal pregnancy- tubal rupture
4. Tubectomy- family planning
5. Transport of ovum- tubal contraction; ciliary movement
The Uterus

Hystera
•A child-bearing organ in females,
situated in pelvis, between bladder
and rectum
•Thick-walled and firm
•Palpated bimanually during PV exami-
nation
•At the time of child-birth (parturition)
Contractions of muscle of the uterus
Result in expulsion of foetus
Size and shape
 Pyriform
 7.5cm long, 5cm broad,
2.5cm thick
 Weight- 30- 40 g
 Body- upper 2/3rd expanded
part
 Cervix- lower 1/3rd
cylindrical part
Normal position and
angulation
 Normally, long axis of cervix
forms 90 angle with the long
axis of vagina
 Anteversion- forward bending
of uterus relative to the vagina
 Uterus is also slightly flexed on
itself –antiflexion ~ 125
Communication
-Superiorly – uterine tubes
-Inferiorly- vagina

Body of uterus
-Fundus
-2 surfaces- anterior or vesical
- posterior or intestinal
- 2 lateral borders
Cervix of uterus
 Less mobile than body
 2.5cm , slightly wider in middle
 Lower part projects into anterior
wall of vagina – divides cervix
into supravaginal and vaginal
parts

Vaginal part of cervix

 Vaginal fornices- space

between vaginal wall and cervix

 External os- small, circular in

nulliparous – ant and post lips

in multiparous
 Cervical canal- fusiform in

shape
 Internal os
Supravaginal part of cervix
 Related - anteriorly- bladder
-posteriorly- rectouterine
pouch, containing coils of
intestines and rectum
-on each side – ureter, uterine
art., embedded in parametrium
(fibrofatty tissue betn 2 layers
of broad ligament and below is
called parametrium- it is
abundant in the cervix and
vagina)
Ligaments of uterus
Peritoneal ligaments
-peritoneal folds- do not provide support
to uterus
1. Anterior lig- uterovesical fold
2. Posterior lig- rectovaginal fold
3. Rt & lt broad lig – attached to
pelvic walls
-mesovarium
-mesosalpinx
-mesometrium
-suspensory lig of ovary
(infundibulopelvic lig)
Broad ligament contains:
1. Uterine tube
2. Round lig of uterus
3. Lig of ovary
4. Uterine vessels
5. Ovarian vessels
6. Uterovaginal and ovarian
nerve plexus
7. Epoophoron
8. Paroophoron
9. Lymph nodes and lumph
vessels
10. Dense c.t. or parametrium
Fibromuscular ligaments
1. Round ligament of uterus
2. Transverse cervical lig
3. Uterosacral lig
Supports of uterus
Primary supports
- Muscular or active supports
1. Pelvic diaphragm
2. Perineal body
3. Urogenital diaphragm
-
Fibromuscular or mechanical
supports
1. Uterine axis
2. Pubocervical lig
3. Transverse cervical lig
4. Uterosacral lig
5. Round lig of uterus

Secondary support
- Doubtful value
- Peritoneal folds
1. Broad lig
2. Uterovesical fold of peritoneum
3. Rectovaginal fold of peritoneum
Clinical anatomy
1. Retroverted uterus- in straight
line with vagina
2. Prolapse of uterus- weakening
of various supports of the
uterus
3. Intrauterine contraceptive
devices- prevent implantation
of fertilized ovum
4. Caesarian section
5. Hysterectomy
6. Hysterosalpingography
7. Ca cervis ~ commonest
malignancy ~ 11%, next Ca
breast~8%
8. Therapeutic dilatation of
cervix and curettage of
endometrium - DUB
The vagina
- Fibromuscular canal
- Female copulatory organ
- Vagina- sheath
- Extends from vulva to uterus
- Situated behind bladder and urethra in
front of rectum and anal canal
Direction
- In erect posture- upwards and
backwards – angle of 45 with uterus
Size and shape
- Ant wall- 8cm
- Post wall- 10cm
- Diameter- vault-5cm, lower
end~2.5cm
- Highly distensible- allows passage of
head of foetus
 Lumen- circular- upper end-
because protrusion of cervix
 Below cervix- ant and post

wall in contact- transverse

slit
Virgin
-lower end- partially closed- a
thin membrane- hymen
Non-virgin
- Hymen is represented by
rounded elevations around
vaginal orifice- caruncular
hymenale