Anatomy Of The Female

Genital System
• DR SAMER YAGHI
• CONSULTANT REPRODUCTIVE MEDICINE & INFERTILITY
( BARCELONA UNIVER SITY )
• CONSULTANT OBSTETRICS & GYNAECOLOGY ( JBOG)
External Female Structures
 Mons Pubis.

 Labia Majora & Minora.

 Clitoris.

 Vestibule.

 Perenium.
External Genatalia
• All the structures which are visible externally, surrounding the
urethral and vaginal openings, make the external female genitalia.
• These structures are collectively named the vulva.
• The boundaries of vulva include the mons pubis anteriorly, the
rectum posteriorly, and the genitocrural folds (thigh folds)
laterally.
• The vulva consists of the following organs: mons pubis, labia
minora and majora, hymen, clitoris, vestibule, urethra, Skene
glands,greater vestibular (Bartholin) glands, and vestibular
bulbs.
 Internal Genitalia
1. Vagina
2. Uterus
3. Fallopian tubes
4. Ovaries
Structures closely related to genital structures are:
1. Urethra and urinary bladder
2. Ureter
3. Pelvic colon
4. Rectum and anus.
The vulva
The vulva is the external female
genitalia and is composed of:
Mons pubis: The mons pubis is a thick,hair-covered, fatty and semi-rounded
area overlying the symphysis pubis.

The function of the fatty tissue in the mons pubis is to protect the woman’s
pubic area from bruising during the sex act.
Labia Majora:

The labia majora are two elongated, hair-covered, fatty skin folds
that enclose and protect the other organs of the external female
genitalia.

They contain apocrine, sebaceous and sweat gland.

They are analogous to the male scrotum.

Labia Minora:
o The labia Minora are two thick skin folds that contain no fat or hair.
o They protect the opening of the vagina and the urethra.
o The labia Minora normally have an elastic nature, which enables
them to distend and contract during sexual activity, and labour
and delivery.
o The labia Minora enclose the clitoris anteriorly.
o They also enclose the vagina and fused posteriorly forming
the fourchette.
o The labia Minora are homologous to the male penile urethra.
The Vestibule :
The vestibule is the area between the labia Minora, and consists of
the clitoris, urethral opening and the vaginal opening.
The clitoris is a short (2 cm) erectile organ at the top of the
vestibule, which has a very rich nerve supply and blood vessels.
The clitoris is made up of 2 Crura, which attach to the periosteum of
the Ischiopubic rami.
Its function is sexual excitation and it is very sensitive to touch.
Its anatomical position is similar to the position of the male
penis.
The Urethral Opening
The urethral opening is the opening of the urethra, which is a small
tubular structure that drains urine from the bladder.
A female urethra ranges in length from 3.5 to 5.0 cm (average 4 cm).
The vaginal opening is the entrance to the vagina.
Hymen is a thin and incomplete membrane covering the vaginal
orifice in a virgin.
A woman with intact hymen is said to be virgin.
CONTINUATION
The hymen has one or more openings.
The hymenal openings can be annular, crescent, septate or
cribriform.
The hymenal opening allows menstrual blood to escape during
menstruation.
The hymen is torn during intercourse and/or child birth.
The tags of torn hymen are known as ‘curunculae myrtiformes’.
 Bartholin’s gland and Skene’s gland:
Bartholin’s glands are responsible for secreting lubrication to the vagina, with
openings just outside the hymen, bilaterally, at the posterior aspect of the
vagina.
Each gland is small, similar in shape to a kidney bean.
The Bartholin’s duct is homologous to male Cowper’s duct.
The Skene’s glands also secrete lubrication at the opening of the urethra.
Vestibular bulbs:
The vestibular bulbs are 2 masses of erectile tissue that lie deep to the
bulbocavernosus muscles bilaterally.
Perineum
The skin-covered muscular area between the vaginal
opening and the anus is called the perineum.

It has strong muscles and its own nerve supply, and it

helps to support the contents of the pelvic cavity.
Vulval Blood supply & Lymphatic
drainage
The vulva is highly vascularised and it gets its blood supply from:
1. Vaginal artery which is a branch of internal iliac artery.
2. Superficial pudendal artery which is a branch of the femoral artery.
3. Vulval lymphatic drainage: The main drainage site of the vulva is
the superficial inguinal lymph nodes.
4. The lymphatic drainage extends to the deep inguinal lymph nodes, then
to external iliac lymph nodes and the common iliac lymph nodes.
5. There is a contralateral lymphatic drainage of the labia.
Internal female Genitalia
Vagina:
The vagina is the tube like passage connecting the vulva and the uterus.
The vagina is lined with rugae which allow it to expand during sexual intercourse
and childbirth.
The structure of the vagina is a network of connective, membranous, and erectile
tissues.
The vagina is always moist, the fluid being derived from cervical secretions and
Bartholin’s glands.
This fluid has an acidic reaction (pH 3.5–4.5) making it capable of resisting
infection .
The vagina is divided into four areas in relation to the cervix.
The four vaginal areas are called fornices.
1. Anterior fornix is shallowest of the fornices and the length of anterior vaginal
wall measures around 7.5–9 cm in an adult female.
2. Posterior fornix is the deepest of all fornices and the length of posterior vaginal
wall measures around 9–11 cm in adult female
3. Two lateral fornices
The relationship of the vagina with surrounding structures is :
1. Anteriorly there is the urethra and
urinary bladder.
2. Posteriorly there is perineal body, rectum and peritoneum of the Pouch of Douglas.
CONTINUATION
3. Laterally there are sphincter vaginae (pubococcygeal muscles act as
a sphincter for the vagina), Levator ani muscles, Bartholin’s glands.
The lateral fornix of the vagina is related to the ureter and uterine artery.
4. Superiorly is the cervix.

The vagina has three functions:

1. It is a receptacle for the penis, where sperm are deposited during sexual intercourse.
2. It is the outlet for the menstrual flow every month in the non-pregnant woman.
3. It is the passage way down which the baby passes at birth.
Vaginal blood ,lymphatic &
nerve
Vaginal blood supply:
The vagina gets its blood supply from the vaginal artery, branches of the pudendal
artery and twigs from middle and inferior rectal artery.
Vaginal lymphatic drainage: The lower one third of vagina has the same
lymphatic drainage as the vulva while upper two-thirds have the same
lymphatic drainage as that of cervix.
Nerve supply of vagina:
The nerve supply to the vagina is primarily from the autonomic nervous system.
 Sensory fibers to the lower vagina arise from the pudendal nerve, and pain fibers are
from sacral nerve roots.
 The uterus
 The uterus is the thick walled, hollow pear shaped female
reproductive organ that lies within the pelvis between the bladder and
the rectum.
 In an adult female it is 9 cm long, 3 cm thick and 6 cm broad at its
widest part.
 The average weight of a non pregnant, nulliparous uterus is approximately
40–50 g.
 A multiparous uterus may weigh slightly more than this, with an
upper limit of approximately 110 g.
 A menopausal uterus is small and atrophied and typically weighs
much less.
The uterus can be divided into 3 parts:
 Body:

The major portion, which is the upper two-thirds of the uterus (corpus uteri).
Body extends from the fundus to a constriction known as the isthmus which
corresponds with internal os of cervical canal.
 Fundus:

The domed area at the top of the uterus, above the insertion of the two
fallopian tubes.
Cervix:
Cervix lies below the isthmus.
The cervix may be subdivided in two parts:
1. A supravaginal portion superior to the limits of the vagina and
2. A vaginal portion, which projects into the cavity of the vagina.
The region between the body and cervix is referred to as the isthmus, a short
area of constriction.
During pregnancy, it is known as the “lower uterine segment.” The cavity of the
isthmus is called the “internal os.”
 The wall of the uterus has three layers
of tissue.
The wall of the uterus has three layers of tissue.
The perimetrium:
The outermost thin membrane layer covering the uterus.
The myometrium:
The thick, muscular, middle layer.
The endometrium:
The thin, innermost layer of the uterus, which thickens during the menstrual cycle.
This is the tissue that builds up each month in a woman of reproductive age, under the
influence of the female reproductive hormones.
There are two layers :a superficial functional layer which is shed monthly and a basal
layer which is not shed and from which new functional layer is regenerated.
• The cavity of the uterus is flattened and triangular and is around 6–7 cm
in length.
• The uterine tubes enter the uterine cavity bilaterally in the
superolateral portion of the cavity.
• The body of the uterus is usually angled forward in relation to the cervix
(anteflexion), while the uterus and cervix as a whole lean forward from
the upper vagina (anteversion).
• The normal anatomical position of uterus is anteflexion and anteversion.
• In about 15% women the uterus is retroverted and in most
instances retroversion is an asymptomatic variant of normality.
 The peritoneum is reflected from the front of uterus over the superior surface
of bladder and forms the uterovesical pouch.
 The posterior surface of the uterus is completely covered by peritoneum,
which passes down over the posterior fornix of the vagina into the pouch of
Douglas.
 Anteriorly peritoneum is reflected off the uterus at a much higher level into
the superior surface of bladder.
 The relationship of the uterus to its surrounding organs is as follows:
Anteriorly there is the uterovesical peritoneum and urinary bladder.
 Posteriorly there is pouch of Douglas and coils of intestine .
 Laterally is the parametrium.
 Uterine artery crosses over the ureter (water under the bridge) 2 cm lateral to
the cervix.
• Superiorly there are coils of intestine and omentum.
• Inferiorly is the vagina.
 Blood supply &Lymphatic
drainage
Blood supply of the uterus:
The uterus gets its main blood supply from the uterine artery which is branch of anterior division of
internal iliac artery.
The ovarian artery which is a branch of the abdominal aorta also nourishes the uterus.
The arteries anastomose along the fallopian tube.

Lymphatic Drainage
From the fundus and upper part of the body

1. Most of the lymphatic vessels drain into pre-aortic and lateral aortic lymph nodes following the
ovarian blood vessels.
2. A few lymphatic vessels from lateral angles drain into superficial inguinal lymph nodes passing along the
round ligamants of uterus.
 Uterine supports
 Uterine supports which prevent the uterus from prolapsing, are seen in pairs:
The cardinal ligaments, also known as transverse cervical ligaments or Mackenrodt’s ligaments.

These are strongest of all uterine supports.

The cardinal ligaments are essentially dense condensations of connective tissue around the venous and nerve
plexuses which extends from the pelvic side walls toward the genital tract.

Medially they are firmly fused with the fascia surrounding the cervix and upper part of the vagina.
They pass upwards and backwards towards the root of the internal iliac vessel.
These condensation of fibrous and elastic tissue, together with plain muscle fibers, are sometimes referred a
parametrium.
They support the upper vagina and cervix, helping to maintain, anteflexion.
Inferiorly they are continuous with the fascia on the upper surface of the levator ani muscle.
 Uterosacral ligaments:
• The uterosacral ligaments pass upwards and backwards from the posterior
aspect of the cervix toward the lateral part of the second piece of the sacrum.
• In their lower part they contain plain muscle along with fibrous tissue
and autonomic nerve fibres.
• In their upper part they dwindle to shallow peritoneal folds
• The ligaments divide the pouch of Douglas from the para rectal fossa from
each side.
Pubocervical ligaments are the weakest.
These are a pair of thin fibrous bands which extend from the cervix to the pubic bones
along the infero lateral surfaces of the bladder.
The ligaments pull the cervix forward countering the pull of uterosacral ligament
backwards.

Apart from the above mentioned ligaments there are other ligaments, the round
ligaments (Prevent the uterus from axial rotation and maintain its
anteflexion state) and the broad ligaments through which blood vessels nourishing
the uterus and fallopian tubes pass.
The levator ani muscles which act as pelvic floor support and prevent the uterus from
prolapsing.
 The cervix
The cervix connects the uterus and vagina, and projects into the upper vagina.
The ‘gutter’ surrounding the projection comprises the vaginal fornices—lateral,
anterior and posterior.
The cervix is 2.5 cm long.
Vaginal part is 1.25 cm and supravaginal part is 1.25 cm.
The endocervical canal is fusiform in shape between the external and internal os.
After child birth external os looses its circular shape and resembles a transverse
slit.
The epithelial lining of the canal is a columner mucous membrane with an
anterior and posterior longitudinal ridge.
There are numerous glands secreting mucus which becomes more abundant and less
viscous at the time of ovulation in mid cycle.

The vaginal surface of the cervix is covered with stratified squamous epithelium.
The squamo columner junction commonly does not correspond to the anatomical os.
This ‘tidal zone’ within which epithelial junction migrates at different stages of life, is
termed the transformation zone .
The shifting of the squamo columner junction is influenced by the estrogenic
stimulation.
In cases , where the cervix has under gone deep bilateral laceration during childbirth,
the resulting anterior and posterior lips tend to evert, exposing the glandular
epithelium of the canal widely.
This appearance is termed ectropion.
Lymphatic Drainage of cervix
On each side the lymphatic drain in three directions:
a. Laterally some vessels pass through parametric tissue and drain into external
iliac and obturator lymph nodes.
A few lymphatic vessels are intercepted by para cervical lymph nodes which are
situated at the crossing of the ureter and uterine artery.
b. Posterolaterally, the lymphatics pass along the lateral pelvic wall and drain
into internal iliac nodes.
c. Posteriorly some of the lymphatics pass along the uterosacral ligaments
and drain into sacral lymph nodes.
Fallopian tubes
There are two fallopian tubes each of which measures about 10 cm long.
Each fallopian tube is divided in four major parts:
Interstitial portion is the part of fallopian tube (1.25 cm) which is within uterine muscle.
The interstitial portion opens into the uterine cavity.
It is the narrowest part of the fallopian tube.
The isthmus extending out of the cornu for about 2.5–3 cm is also narrow.
Ampulla: It is thin walled, dilated and tortuous, and measures about 5 cm.
Infundibulum: It is trumpet like and about 1.25 cm long.
The bottom of the infundibulum presents pelvic ostium, then circumference of
which is provided within the fimbriae.
Blood supply
• The fallopian tube has a dual blood supply,
• The medial half from the tubal branch of uterine artery
and lateral half from the tubal branch of ovarian artery.
The ovary
 The ovaries form the gonads of the female.
Each ovary is ovoid structure measuring about 3.5 cm × 2 cm × 1.5 cm.
They are a dull white and are attached to the superior aspect of the broad
ligament by a short peritoneum fold called meso-ovarium.
Follicle or corpus leuteal cysts may be seen on surface of the ovary.
Its lateral border is free but anteriorly is attached to the broad ligament at the
hilum through which ovarian vessels and nerves enter or leave the organ.
 Medially the ovarian ligament connects it to the uterine cornu and
laterally ovarian fimbriae of the tube.
Blood supply &Lymphatic
drainage
The blood supply of ovary is through the ovarian artery, a branch of
abdominal aorta and uterine artery and numerous anastomosis.
The venous drainage is through the pampiniform plexus to the ovarian
veins.
The right ovarian vein drains into the inferior vena cava and left ovarian vein
drains into the left renal vein.
Lymphatic drainage:
Primarily through the aortic nodes.
Rarele they may drain through iliac lymph nodes.
Clinical aspects
• The endometrium and uterine cavity can be examined by hysteroscopy.
• The tubal ostia can be seen.
• Because the anterior and posterior wall are normally in contact, the cavity
must be inflated with gas or fluid to obtain an adequate view of surfaces.
• It is specially important to distinguish retroversion from anteversion
before introducing a sound or similar instrument into the uterine cavity to
avoid perforation of uterine wall.
• Because the uterus lies behind the bladder, and between the lower parts
of ureters, particular care must be taken not to damage these structures
during hysterectomy.
Clinical aspects
The transformation zone is typically the area where precancerous change
occurs.
This can be detected by microscopic assessment of cervical cytological
smear.
If the duct of a cervical gland is occluded, gland distends with mucous to
form a retention cyst (Nabothian follicle).

The tubes and ovaries often collectively called uterine adnexa and are so
intimately related that when the tube is inflamed the ovary is also affected
resulting I salpigo-oophoritis.
Clinical aspects
The ovary is most common site of endometriosis and rarely become
seat of extrauterine gestation.
Besides providing ova, it is an important endocrine gland producing estrogen,

Its histology and histogenesis is of interest in understanding of

complex varities of ovarian neoplasms.
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