FEMALE GENITAL TRACT Lecture – Anatomy Lectures – MBBS Lectures

The female internal genital organs include the ovaries, uterine tubes, uterus, and vagina.

ovaries

•The ovaries are almond-shaped female gonads in which the oocytes develop. It also produces estrogen and progesterone.

•There are three ligaments that are attached with the ovaries.

•Mesovarium: Each ovary is suspended by a short peritoneal fold or mesentery, the mesovarium, which is a part of the broad ligament of uterus.

•Suspensory ligament of ovary: Which extends between the mesovarium and the lateral pelvic wall and provides the path for the ovarian vessels lymphatics and nerves.

•Ovarian Ligament: which is the remanent of superior part of gubernaculum, connects the medial part of ovary to uterus. 

•The ovary usually lies against the lateral wall of the pelvis in a depression called the ovarian fossa, bounded by the external iliac vessels above and by the internal iliac vessels behind.

•But the position of the ovary is extremely variable.

•A thin fibrous capsule, the tunica albuginea, surrounds the ovaries. A modified area of peritoneum called the germinal epithelium covers this capsule externally.

•Because the ovary is suspended in the peritoneal cavity and its surface is not covered by peritoneum, the oocyte expelled at ovulation passes into the peritoneal cavity

Uterine tubes

• The uterine tubes (approximately 10 cm long) lie in a narrow mesentery, the mesosalpinx, forming the free anterosuperior edges of the broad ligaments.
• The tubes extend symmetrically posterolaterally to the lateral pelvic walls, where they arch anterior and superior to the ovaries in the horizontally disposed broad ligament.

1. The infundibulum is the funnel-shaped lateral end that projects beyond the broad ligament and overlies the ovary. The free edge of the funnel has several finger-like processes, known as fimbriae, which are draped over the ovary.
2. The ampulla is the widest part of the tube.
3. The isthmus is the narrowest part of the tube and lies just lateral to the uterus.
4. The intramural part is the segment that pierces the uterine wall.

•The uterine tube receives the ovum from the ovary and provides a site where fertilization of the ovum can take place (usually in the ampulla). It provides nourishment for the fertilized ovum and transports it to the cavity of the uterus. The tube serves as a conduit along which the spermatozoa travel to reach the ovum.

Blood supply of ovaries and uterine tubes

Nerve supply of ovaries and uterine tubes

uterus

•The uterus (womb) is a thick-walled, pear-shaped, hollow muscular organ. The embryo and fetus develop in the uterus.

•It measures about 8 cm long, 5 cm wide, and 2.5 cm thick. It is divided into the fundus, body, and cervix.

• The adult uterus is usually anteverted (tipped anterosuperiorly relative to the axis of the vagina) and anteflexed (flexed or bent anteriorly relative to the cervix, creating the angle of flexion) so that its mass lies over the bladder.
• When the bladder is empty, the uterus typically lies in a nearly transverse plane
• The position of the uterus changes with the degree of fullness of the bladder, rectum and stage of pregnancy.
• In some women, the fundus and body of the uterus are bent backward on the vagina so that they lie in the rectouterine pouch (pouch of Douglas). In this situation, the uterus is said to be retroverted. If the body of the uterus is, in addition, bent backward on the cervix, it is said to be retroflexed.

It is divided into the fundus, body, and cervix:

• The fundus is the part of the uterus that lies above the entrance of the uterine tubes.
• The body is the part of the uterus that lies below the entrance of the uterine tubes.
• The cervix is the low, narrow part of the uterus. It pierces the anterior wall of the vagina and is divided into the supravaginal and vaginal parts of the cervix.

• The cavity of the uterine body is triangular in coronal section, but it is merely a cleft in the sagittal plane.
• The uterine horns (L. cornua) are the superolateral regions of the uterine cavity, where the uterine tubes enter.
• The uterine cavity continues inferiorly as the cervical canal, which communicates with the cavity of the body through the internal os and with that of the vagina through the external os.

PERITONEAL REFLECTIONS

• The uterus is covered with peritoneum except anteriorly, below the level of the internal os, where the peritoneum passes forward onto the bladder.
• Laterally, a space exists between the attachments of the layers of the broad ligament. Which is a double layer of peritoneum (mesentery) that extends from the sides of the uterus to the lateral walls and floor of the pelvis.
• The two layers of the broad ligament are continuous with each other at a free edge that surrounds the uterine tube.

Walls of uterus

• Perimetrium—the serosa or outer serous coat—consists of peritoneum supported by a thin layer of connective tissue.
• Myometrium—the middle coat of smooth muscle— becomes greatly distended during pregnancy. The main branches of the blood vessels and nerves of the uterus are located in this coat. contraction of the myometrium is hormonally stimulated.
• Endometrium—the inner mucous coat—is firmly adhered to the underlying myometrium. The endometrium is actively involved in the menstrual cycle, differing in structure with each stage of the cycle.

Uterine Supports

•The uterus is supported mainly by the tone of the levator ani muscles and by local condensations of pelvic fascia, which form three important ligaments.

Passive support

• Levator Ani Muscles and Perineal Body:

They form a broad muscular sheet stretching across the floor of the pelvic cavity, and effectively support the pelvic viscera and resist the intra-abdominal pressure transmitted downward through the pelvis.

Some of the fibers of levator ani insert into a fibromuscular structure called the perineal body. This structure is important in maintaining the integrity of the pelvic floor.

The perineal body lies between the vagina and the anal canal. It is slung up to the pelvic walls by the levator ani and thus supports the vagina and, indirectly, the uterus.

• Broad ligament:

Provides attachment of the uterine wall to the floor and the lateral walls of the pelvis

• Round ligament of the uterus:

The round ligament of the uterus, which represents the remains of the lower half of the gubernaculum, extends between the superolateral angle of the uterus, through the deep inguinal ring and inguinal canal, to the subcutaneous tissue of the labium majus. It helps to keep the uterus anteverted and anteflexed.

Active support

• Transverse Cervical (Cardinal) Ligaments

The transverse cervical ligaments are fibromuscular condensations of pelvic fascia that pass to the cervix and the upper end of the vagina from the lateral walls of the pelvis.

• Pubocervical Ligaments

The pubocervical ligaments consist of two firm bands of connective tissue that pass to the cervix from the posterior surface of the pubis. They are positioned on either side of the neck of the bladder.

• Sacrocervical ligaments

The Sacrocervical ligaments consist of two firm fibromuscular bands of pelvic fascia that pass to the cervix and the upper end of the vagina from the lower end of the sacrum. They form two ridges, one on either side of the rectouterine pouch.

Changes in uterus during life time

• Prepubertal
• Pregnant
• Post menupausal

Blood supply of uterus

vagina

• The vagina is a muscular tube that extends upward and backward from the vulva to the uterus. It measures about 8 cm long and has anterior and posterior walls, which are normally in apposition.
• The cervix pierces the upper anterior wall of the vagina and projects downward and backward into the upper vagina. It is important to remember that the upper half of the vagina lies above the pelvic floor (i.e., in the pelvic cavity), whereas the lower half lies within the perineum.
• The vaginal orifice, external urethral orifice, and ducts of the greater and lesser vestibular glands open into the vestibule of the vagina.

• The area of the vaginal lumen that surrounds the cervix is divided into four archlike regions, or fornices: anterior, posterior, right lateral, and left lateral.
• The posterior vaginal fornix is the deepest part and is closely related to the recto-uterine pouch.

clinicals

• Ovary Position
• Ovarian Cysts
• Pelvic Inflammatory Disease
• Hysterosalpingography
• Ligation of Uterine Tubes
• Ectopic Tubal Pregnancy
• Uterine Prolapse
• Cervical Cancer
• Cervical Examination and Pap Smear
• Hysterectomy
• Vaginal Fistulae
• Culdoscopy and Culdocentesis
• Spinal Anesthesia

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