FEMALE REPRODUCTIVE SYSTEM

1. ANATOMY OF FEMALE
REPRODUCTIVE SYTEM

2. Parts of female reproductive system
The reproductive organ in female are those
which concerned with copulation, fertilization,
growth and development of fetus and its
subsequent exit to the outer world.
• External genitalia
• Internal genitalia

3. EXTERNAL GENTILIA
• The vulva
• Mons pubis
• Labia majora
• Labia minora
• Clitoris
• Urethral opening
• Vaginal opening
• Perineum

4. The Vulva .
• The vulva (pudendum) refers to the external female
genitalia.
Structures of the Vulva
• The vulva is a collective term for several anatomical
structures:
• Mons pubis – a subcutaneous fat pad located anterior to
the pubic symphysis. It formed by the fusion of the labia
majora.
• Labia majora – two hair-bearing external skin folds.
– They extend from the mons pubis posteriorly to the posterior
commissure (a depression overlying the perineal body).
– Embryologically derived from labioscrotal swellings

5. • Labia minora – two hairless folds of skin, which lie within
the labia majora.They fuse anteriorly to form the hood of the
clitoris and extend posteriorly either side of the vaginal
opening.
• They merge posteriorly, creating a fold of skin known as the
fourchette.
• Embryologically derived from urethral folds
• Vestibule – the area enclosed by the labia minora. It
contains the openings of the vagina (external vaginal orifice,
vaginal introitus) and urethra. Bartholin’s glands – secrete
lubricating mucus from small ducts during sexual arousal.
They are located either side of the vaginal orifice.

6. Clitoris – located under
the clitoral hood. It is
formed of erectile
corpora cavernosa
tissue, which becomes
engorged with blood
during sexual
stimulation.Embryologi
cally derived from the
genital tubercle
The major structures of the vulva (external
female genitalia)

7. Vascular Supply and Lymphatics
• The arterial supply to the vulva is from the
paired internal and external pudendal arteries
(branches of the internal iliac).
• Venous drainage is achieved via the pudendal
veins, with smaller labial veins contributing as
tributaries.
• Lymph drains to the nearby superficial
inguinal lymph nodes.

8. Nerve Innervation
• The vulva receives sensory
and parasympathetic
nervous supply.
• To describe the sensory
distribution, the vulva can
be divided into anterior and
posterior sections:
• Anterior – ilioinguinal
nerve, genital branch of the
genitofemoral nerve
• Posterior – pudendal nerve,
posterior cutaneous nerve
of the thigh. Cutaneous innervation the skin of the vulva
and perineum

9. APPLIED ANTOMY/CLINICAL
RELEVANCE
• The Bartholin’s glands (also
known as the greater
vestibular glands) can become
infected and inflamed – known
as bartholinitis.
• This is initially treated with
antibiotics, but occasionally
can be complicated by the
formation of a cyst or abscess.
In case of an infected cyst or
abscess, the only effective
treatment is surgical drainage
or excision of the lesion.
Right sided Bartholin’s cyst, caused by
blockage of the Bartholin’s gland ducts.

10. • Genital warts are benign growths of epithelium
caused by certain HPV types, such as 6 & 11.
They are highly infectious and are easily
transmitted between sexual partners through
sexual or even physical contact.

11. Perineum
• T he perineum is an anatomical region in the pelvis. It is
located between the thighs, and represents the most inferior
part of the pelvic outlet.
• The perineum is separated from the pelvic cavity superiorly
by the pelvic floor. This region contains structures that
support the urogenital and gastrointestinal systems – and it
therefore plays an important role in functions as such
micturition, defecation, sexual intercourse and childbirth.

12. Boundaries
• In clinical practice, the term
“perineum” is frequently used to
describe the area between the
external genitalia and the anus.
However, in anatomical terms, the
perineum is a diamond-shaped
structure.
• There are two main ways in which
the boundaries of the perineum can
be described. The anatomical
borders refer to its exact bony
margins, whilst the surface borders
describe the surface anatomy of the
perineum.
The perineum is located
between the thighs.

13. Surface Borders
• The surface boundaries are best shown
when the lower limbs are abducted, and
a diamond shape is depicted:
• Anterior – mons pubis in females, base
of the penis in males.
• Laterally – medial surfaces of the thighs.
• Posterior – superior end of the
intergluteal cleft.

14. Surface Borders
Anatomical and surface borders of the
perineum.

15. Anatomical Borders
The anatomical borders of the perineum are:
• Anterior – pubic symphysis.
• Posterior – tip of the coccyx.
• Laterally – inferior pubic rami and inferior
ischial rami, and the sacrotuberous ligament.
• Roof – pelvic floor.
• Base – skin and fascia.

16. Parts of perineum
• The perineum can be subdivided by
a theoretical line drawn transversely
between the ischial tuberosities. This split
forms the anterior
urogenital and posterior anal triangles.
• These triangles are associated with
different components of the perineum –
which we shall now examine in more
detail.

17. The anal aperture is located
centrally in the triangle
with the ischioanal fossae
either side. These fossae
contain fat and connective
tissue, which allow for
expansion of the anal canal
during defecation. They
extend from the skin of the
anal region (inferiorly) to
the pelvic diaphragm
(superiorly). Contents of the anal triangle.

18. Another important anatomical structure within
the anal triangle is the pudendal nerve, which
supplies the whole perineum with somatic
fibers.
Anal Triangle:
The anal triangle is the posterior half of the
perineum. It is bounded by the coccyx,
sacrotuberous ligaments, and a theoretical line
between the ischial tuberosities.

19. The main contents of the anal triangle are:
• Anal aperture – the opening of the anus.
• External anal sphincter muscle –
voluntary muscle responsible for opening
and closing the anus.
• Ischioanal fossae (x2) – spaces located
laterally to the anus.

20. Urogenital Triangle
• The urogenital triangle is the anterior half of the
perineum. It is bounded by the pubic symphysis,
ischiopubic rami, and a theorectical line between the
two ischial tuberosities. The triangle is associated with
the structures of the urogenital system – the external
genitalia and urethra.
• Structurally, the urogenital triangle is complex, with a
number of fascial layers and pouches. Unlike the anal
triangle, the urogenital triangle has an additional layer of
strong deep fascia; the perineal membrane. This
membrane has pouches on its superior and inferior
surfaces.

21. The layers of the urogenital triangle (deep to superficial)
• Superficial perineal pouch – a potential space
between the perineal membrane (superiorly) and the
superficial perineal fascia (inferiorly). It contains the
erectile tissues that form the penis and clitoris, and
three muscles – the ischiocavernosus,
bulbospongiosus and superficial transverse perineal
muscles. The greater vestibular glands (Bartholin’s
glands) are also located in the superficial perineal
pouch. The pouch is bounded posteriorly to the
perineal body.

22. • Deep perineal pouch – a potential space between the
deep fascia of the pelvic floor (superiorly) and the
perineal membrane (inferiorly). It contains part of the
urethra, external urethral sphincter, and the vagina in
the female. In males, it also contains the bulbourethral
glands and the deep transverse perineal muscles.
• Perineal membrane – a layer of tough fascia, which is
perforated by the urethra (and the vagina in the
female). The role of the membrane is to provide
attachment for the muscles of the external genitalia.

23. • Perineal fascia – a continuity of the abdominal fascia that
has two components:Deep fascia: covers the superficial
perineal muscles and protruding structures (e.g. penis &
clitoris).
• Superficial fascia is composed of a further two layers of
fascia:
– Superficial layer – continuous with Camper’s fascia of the anterior
abdominal wall
– Deep layer (Colles’ fascia) – continuous with Scarpa’s fascia of the
anterior abdominal wall
• Skin – The urethral and vaginal orifices open out onto the
skin.

24. The Perineal Body
• The perineal body is an irregular fibromuscular
mass. It is located at the junction of the urogenital
and anal triangles – the central point of the
perineum. This structure contains skeletal muscle,
smooth muscle and collagenous and elastic fibres.
• Anatomically, the perineal body lies just deep to
the skin. It acts as a point of attachment for
muscle fibres from the pelvic floor and the
perineum itself:

25. • Levator ani (part of the pelvic floor).
• Bulbospongiosus muscle.
• Superficial and deep transverse perineal muscles.
• External anal sphincter muscle.
• External urethral sphincter muscle fibres.
In women, it acts as a tear resistant body between
the vagina and the external anal sphincter,
supporting the posterior part of the vaginal wall
against prolapse

26. Neurovascular Supply
• The major neurovascular supply to the perineum is from
the pudendal nerve (S2 to S4) and the internal
pudendal artery.
• The pudendal nerve (along with the internal pudendal
artery and vein) travel along the inner surface of the
ischial tuberosities, through a “canal” formed by a
thickening of the obturator fascia (Alcock’s canal). The
pudendal neurovascular bundle courses downwards
through each ischioanal fossa and gives branches to
both the anal and genital triangle.

27. INTERNAL GENITALIA
The following are the parts
of internal genitalia
• Vagina
• Uterus
• Fallopian tubes
• Ovaries

28. Vagina
vagina: The vagina is a canal that
joins the cervix (the lower part of
uterus) to the outside of the
body.
Anatomical Position
• The vagina is closely related to
many of the organs in the pelvic
region:
• Anterior – bladder and urethra.
• Posterior – rectouterine pouch,
rectum and anal canal.
• Lateral – ureters and levator ani
muscle.
Sagittal section of the female pelvis, showing
the anatomical relations of the vagina.

29. Anatomical Structure
• The vagina is a fibromuscular tube with anterior and
posterior walls – these are normally collapsed and thus in
contact with one another.
• The shape of the vagina is not a round tunnel. In the
transverse plane it is more like an “H” lying on the side. At
the upper ending, the vagina surrounds the cervix,
creating two domes (fornices or vaults): an anterior and a
(deeper) posterior one.

30. • The posterior fornix is
important as it acts like a
natural reservoir for semen
after intravaginal ejaculation.
The semen retained in the
fornix liquefies in the next
20-30 mins, allowing for
easier permeation through
the cervical canal. The anterior and posterior vaginal fornices

31. Histology of the Vagina
• The vagina is composed of four histological layers (internal
to external):
• Stratified squamous epithelium – this layer provides
protection and is lubricated by cervical mucus (the vagina
itself does not contain any glands).
• Elastic lamina propria – a dense connective tissue layer
which projects papillae into the overlying epithelium. The
larger veins are located here.
• Fibromuscular layer – comprising two layers of smooth
muscle; an inner circular and an outer longitudinal layer.
• Adventitia – a fibrous layer, which provides additional
strength to the vagina whilst also binding it to surrounding
structures.

32. Vascular Supply and Lymphatics
The arterial supply to the vagina is
via the uterine and vaginal
arteries – both branches of the
internal iliac artery.
• Venous return is by the vaginal
venous plexus, which drains into
the internal iliac veins via the
uterine vein.
• Lymphatic drainage is divided
into three sections:
• Superior – drains to external iliac
nodes
• Middle – drains to internal iliac
nodes
• Inferior – drains to superficial
inguinal lymph nodes.

33. Nerve Innervations
• Innervation is predominantly from the autonomic
nervous system. Parasympathetic and sympathetic
nerves arise from the uterovaginal nerve
plexus (in turn a subsidiary of the inferior
hypogastric plexus).
• Only the inferior 1/5 of the vagina receives somatic
innervation. This is via a branch of the pudendal
nerve, the deep perineal nerve.

34. Applied anatomy
• A vaginal fistula is an open communication between the
vagina and one of the adjacent pelvic organs.
• It typically occurs as a result of prolonged labour (where
a Caesarean section is not available). As the fetus slowly
progresses down the vaginal wall, it exerts pressure –
obstructing the blood supply and causing tissue necrosis.
• There are three main types of vaginal fistulae:
• Vesicovaginal – abnormal communication with the
bladder. Urine enters the vagina.
• Urethrovaginal – abnormal communication with the
urethra. Urine only enters the vagina during urination.
• Rectovaginal – abnormal communication with the
rectum. Faecal matter can enter the vagina.

35. Uterus
• The uterus is a secondary sex organ. Secondary sex
organs are components of the reproductive tract that
mature during puberty under the influence of sex
hormones produced from primary sex organs (the
ovaries in females and the testes in males).
• They are responsible for the maintenance and
transportation of gametes

36. Anatomical Structure
• The uterus is a thick-walled
muscular organ capable of
expansion to accommodate a
growing fetus. It is connected
distally to the vagina, and laterally
to the uterine tubes.
• The uterus has three parts;
• Fundus – top of the uterus, above
the entry point of the uterine
tubes.
• Body – usual site for implantation
of the blastocyst.
• Cervix – lower part of uterus
linking it with the vagina. This part
is structurally and functionally
different to the rest of the uterus.

37. CERVIX
• The cervix is the lower portion of the
uterus, an organ of the female
reproductive tract. It connects the
vagina with the main body of the uterus,
acting as a gateway between them.
• Anatomically and histologically, the cervix
is distinct from the uterus, and hence we
consider it as a separate anatomical
structure.

38. Anatomical Structure
The cervix is composed of two regions;
the ectocervix and the endocervical
canal.
• The ectocervix is the portion of the
cervix that projects into the vagina. It
is lined by stratified squamous non-
keratinized epithelium. The opening in
the ectocervix, the external os, marks
the transition from the ectocervix to
the endocervical canal.
• The endocervical canal (or
endocervix) is the more proximal, and
‘inner’ part of the cervix. It is lined by
a mucus-secreting simple columnar
epithelium. The endocervical canal
ends, and the uterine cavity begins, at
a narrowing called the internal os.
The ectocervix, endocervical canal, and
their openings

39. Vascular Supply and Lymphatics
• The blood supply to the
uterus is via the uterine
artery. Venous drainage
is via a plexus in the
broad ligament that
drains into the uterine
veins.
• Lymphatic drainage of
the uterus is via the iliac,
sacral,
aortic and inguinal
lymph nodes. Posterior view of the arterial supply to
the female reproductive tract.

40. Applied anatomy
Cervicitis
• Cervicitis is chronic inflammation and infection of the
cervix, most commonly caused by Chlamydia
trachomatis or Neisseria gonorrhoeae.
• It is usually asymptomatic although pelvic pain,
vaginal discharge, postcoital bleeding and
dyspareunia may be present. Complications of
cervicitis include pelvic inflammatory disease, whilst
the potential blockage of mucus ducts and cyst
formation increases the risk of infertility by increasing
the hostility of the environment for sperm.

41. Cervical Cancer
• There are two main classifications of cervical
cancer:
• Squamous cell carcinoma – cancer of the
epithelial lining of the ectocervix.
• Adenocarcinoma – cancer of the glands found
within the lining of the cervix.

42. Anatomical Position of uterus
• The exact anatomical location of the uterus varies
with the degree of distension of the bladder. In the
normal adult uterus, it can be described as
anteverted with respect to the vagina, and
anteflexed with respect to the cervix:
• Anteverted: Rotated forward, towards the anterior
surface of the body.
• Anteflexed: Flexed, towards the anterior surface of
the body.
• Thus, the uterus normally lies immediately
posterosuperior to the bladder, and anterior to the
rectum.

43. Histological Structure
The fundus and body of the uterus are composed of
three tissue layers;
• Peritoneum – a double layered membrane,
continuous with the abdominal peritoneum. Also
known as the perimetrium.
• Myometrium – thick smooth muscle layer. Cells of
this layer undergo hypertrophy and hyperplasia
during pregnancy in preparation to expel the fetus at
birth.
• Endometrium – inner mucous membrane lining the
uterus. It can be further subdivided into 2 parts:

44. • Deep stratum basalis: Changes little
throughout the menstrual cycle and is not shed
at menstruation.
• Superficial stratum functionalis: Proliferates in
response to oestrogens, and becomes secretory
in response to progesterone. It is shed during
menstruation and regenerates from cells in the
stratum basalis layer.

45. Ligaments
• The tone of the pelvic floor provides the primary support
for the uterus. Some ligaments provide further support,
securing the uterus in place.
• They are:
• Broad Ligament: This is a double layer of peritoneum
attaching the sides of the uterus to the pelvis. It acts as a
mesentery for the uterus and contributes to maintaining it
in position.
• Round Ligament: A remnant of the gubernaculum
extending from the uterine horns to the labia majora via the
inguinal canal. It functions to maintain the anteverted
position of the uterus.
• Ovarian Ligament: Joins the ovaries to the uterus.

46. • Cardinal Ligament: Located at the base of the broad
ligament, the cardinal ligament extends from the
cervix to the lateral pelvic walls. It contains the
uterine artery and vein in addition to providing
support to the uterus.
• Uterosacral Ligament: Extends from the cervix to
the sacrum. It provides support to the uterus.

47. Vascular Supply and Lymphatics
• The blood supply to the
uterus is via the uterine
artery. Venous drainage
is via a plexus in the
broad ligament that
drains into the uterine
veins.
• Lymphatic drainage of
the uterus is via
the iliac, sacral,
aortic and inguinal
lymph nodes.
Posterior view of the arterial supply to the
female reproductive tract.

48. Nerve innervations
• Sympathetic nerve fibres of the uterus arise from the
uterovaginal plexus. This largely comprises the anterior
and intermediate parts of the inferior hypogastric
plexus.
• Parasympathetic fibres of the uterus are derived from
the pelvic splanchnic nerves (S2-S4).
• The cervix is largely innervated by the inferior nerve
fibres of the uterovaginal plexus.
• The afferent fibres mostly ascend through the inferior
hypogastric plexus to enter the spinal cord via T10-T12
and L1 nerve fibres.

49. Applied anatomy
• Endometriosis is the presence of ectopic
endometrial tissue at sites outside the uterus, most
commonly the ovaries and the ligaments of the
uterus.
• Fibroids are benign tumours of the myometrium
which affect 20% of menopausal women. They are
oestrogen dependent, enlarging during pregnancy
and with use of the contraceptive pill but regressing
after the menopause

50. • Endometrial carcinoma is the most common
malignancy of the female genital tract, most
often found during, or after, the menopause,
and characterized by abnormal uterine
bleeding.

51. Fallopian tubes
• The uterine tubes (or fallopian tubes, oviducts, salpinx)
are muscular ‘J-shaped’ tubes, found in the female
reproductive tract.
• They lie in the upper border of the broad
ligament, extending laterally from the uterus, opening
into the abdominal cavity, near the ovaries.

52. Anatomical Structure of fallopian
tube
• The fallopian tube is described as
having four parts (lateral to
medial);
• Fimbriae – finger-like, ciliated
projections which capture the
ovum from the surface of the
ovary.
• Infundibulum – funnel-shaped
opening near the ovary to which
fimbriae are attached.
• Ampulla – widest section of the
uterine tubes. Fertilization
usually occurs here.
• Isthmus – narrow section of the
uterine tubes connecting the
ampulla to the uterine cavity.

53. Vascular Supply and Lymphatics
The arterial supply to the uterine tubes
is via the uterine and ovarian
arteries. Venous drainage is via
the uterine and ovarian veins.
• Lymphatic drainage is via the iliac,
sacral and aortic lymph nodes.
• Innervation
• The uterine tubes receive both
sympathetic and parasympathetic
innervation via nerve fibres from
the ovarian and uterine (pelvic)
plexuses. Sensory afferent fibres
run from T11- L1.

54. Applied anatomy
Salpingitis is inflammation of the uterine tubes that is
usually caused by bacterial infection. It can cause
adhesions of the mucosa which may partially or
completely block the lumen of the uterine tubes.
This can potentially result in infertility or
an ectopic pregnancy.
Ectopic Pregnancy
• If the lumen of the uterine tube is partially
occluded, sperm may be able to pass through and
fertilise the ovum. However, the fertilised egg may
not be able to pass into the uterus, and can
implant in the uterine tube. This is known as an
ectopic pregnancy.
• An ectopic pregnancy is a medical emergency – if
not diagnosed early, the implanted blastocyst can
cause rupture and haemorrhage of the affected
tube.
Ectopic pregnancy.

55. Ovaries
• The female gonads are called the ovaries.
• The ovaries are paired, oval organs attached to
the posterior surface of the broad ligament of the
uterus by the mesovarium (a fold of peritoneum,
continuous with the outer surface of the ovaries).
• Neurovascular structures enter the hilum of the
ovary via the mesovarium.

56. Components of the Ovary
• The ovary has three main histological features:
• Surface – formed by simple cuboidal epithelium
(known as germinal epithelium). Underlying this layer
is a dense connective tissue capsule.
• Cortex – comprised of a connective tissue stroma
and numerous ovarian follicles. Each follicle contains
an oocyte, surrounded by a single layer of follicular
cells.
• Medulla – formed by loose connective tissue and a
rich neurovascular network, which enters via the
hilum of the ovary.

57. Cross section of an ovary.

58. Ligaments
• Two peritoneal ligaments attach to the ovary;
• Suspensory ligament of ovary – fold of
peritoneum extending from
the mesovarium to the pelvic wall. Contains
neurovascular structures.
• Ligament of ovary – extends from the ovary to
the fundus of the uterus. It then continues
from the uterus to the connective tissue of the
labium majus, as the round ligament of uterus.

59. The major ligaments of the ovary

60. Neurovascular Supply
Arterial supply: The main arterial
supply to the ovary is via the
paired ovarian arteries.
Venous drainage: it is achieved by
paired ovarian veins. The left
ovarian vein drains into the left
renal vein, and the right ovarian
vein drains directly into
the inferior vena cava.
Nervous supply :The ovaries
receive sympathetic and
parasympathetic innervations
from the ovarian and uterine
(pelvic) plexuses

61. Lymphatic Supply
• Lymph from the ovaries drains into the para-aortic
nodes.
Applied anatomy :
• Ovarian cysts are fluid-filled masses that may
develop in the ovary. They are most commonly
derived from ovarian follicles, reaching
approximately 2-2.5 cm.

62. • Most ovarian cysts are benign and develop during a
woman’s child-bearing years, however, some larger
cysts may cause problems such as bleeding and pain
and require surgical removal.
• Polycystic ovaries are characterized by hormone
dysfunction and multiple (over 10) ovarian cysts. It
is associated with infertility

63. • Ovarian tumours are another serious disorder. The
most common cancers arise from epithelial
components or germ cells. 90% of ovarian cancers
are derived from epithelium, these are
termed ovarian adenocarcinomas. Most germ cell
tumours are teratomas, which comprise cells from all
3 germ cell layers and are usually benign.