SUBJECT: ANATOMY
 
TOPIC: FEMALE GROSS REPRO
 
LECTURER: DR. JC REYES
 
DATE: NOVEMBER, 2010
 
 
FEMALE REPRODUCTIVE SYSTEM
BLOOD SUPPLY OF THE OVARY
Female: capable of producing ova/egg
1. Ovarian artery
- Counterpart of the testicular artery
OVARY
- Arising from the ABDOMINAL AORTA
- Almond shaped and size in female gonads
VENOUS DRAINAGE
- Covering: tunica albuginea
- Before puberty: smooth surface
1. Right ovarian vein
- After puberty: tough and scarred
- drains into the INFERIOR VENA CAVA
- Equipped with mature ovum
- Remnants of mature ovum is termed as CORPUS LUTEUM
2. Left ovarian vein
-yellow in color because structure is replaced with
- drains into the LEFT RENAL VEIN
cholesterol or lipids. After some time, it will degenerate
and will become whiter—called CORPUS ALBICANS then
CLINICAL SIGNIFICANCE
cycle repeats again
1. Polycystic ovarian cyst
- ovarian cyst fails to rapture
SUPPORTING LIGAMENTS
- usually cannot bear children
1. Broad ligament (mesovarium)
2. Ovarian endometriosis
- Pritoneal reflection that will separate the two cavities
- looks like a chocolate cyst/structure (yung picture na
- Covers the ovary
parang piyaya daw)
- Endometrial lining is implanted someplace else. In this
** MESOSALPHINX peritoneum covers the fallopian tube
case, it is implanted in the ovary
**MESOMETRIUMcovers the uterus
- Chocolate structureclotted blood secondary to ovarian
endometriosis
2. Suspensory ligament of ovary
- Still part of the broad ligament extending between the
**ENDOMETRIAL LINING responds to hormonal changes
attachment of the mesovarium and the lateral wall of the
(progesterone) which results to menstruation
pelvis
- Passageway of ovarian vessels, lymphatics and nerves
3. Ovarian cancer
- TERATOMAmeaning “monstrous tumor”
3. Round ligament of ovary
- contains the three germ layers (ectoderm, endoderm
- Represents the REMNANT OF THE GUBERNACULUM in
and mesoderm)
females
- ectodermal derivatives are very evident
- Connects the ovary to the lateral wall of the uterus
- The tumor is benign with a possibility to progress into
malignant tumor
**continues to become the round ligament of the uterus
FALLOPIAN TUBE/ UTERINE TUBE
**broad and suspensory are like one. (but actually they’re
two)
- aka OVIDUCT
- Paired uterine tubes
**uterus is bent anteriorly; fallopian tube is seen/extended
- positioned in the upper border of the uterus
posteriorly
- provides a connection to the abdominal cavity and
endometrial cavity
-also covered by the broad ligament but this time called
MESOSALPHYNX
- cavity of the fallopian tube will open into the abdominal
cavity
- part of the fallopian tube attached to the uterus is
attached to the ENDOMETRIAL CAVITY

**FALLOPIAN TUBE connection of the endometrial cavity

and abdominal cavity

FUNCTIONS OF THE FALLOPIAN TUBE

1. Receives the ovum from the ovary

2. Site of fertilization
- mature sperm meets the mature ovum
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 - sperm enters the egg CLINICAL SIGNIFICANCE
3. Inner lining of the fallopian tube provides nourishment
for the fertilized ovum 1. Ectopic Pregnancy
- can secrete substances that can nourish the egg or -Implantation of the developing fetus outside the
sperm endometrial cavity
4. Transport fertilized ovum to the uterine cavity - PROBLEM: structure cannot sustain the developing fetus
- inner lining of the fallopian tube is CILIATED especially when it is growing. The structure can rupture and
transporting fertilized ovum to endometrial cavity can cause severe bleeding
- patient’s manifestation: pale-looking and complains of
abdominal pain
** covered by broad ligament MESOSALPHINX
TYPES OF ECTOPIC PREGNANCY
4 PARTS OF THE FALLOPIAN TUBE 1. Ovarian pregnancy 0.4%
2. Ampullary pregnancy most common (92%)
1. Infundibulum 3. Isthmic pregnancy 0.4%
–Funnel shaped lateral end overlying ovary with finger like 4. Cornual pregnancy 2.5%
projections 5. Cervical pregnancy 0.1%
6.Infundibular (ostial/fibrial) pregnancy
**FIMBRIAE capable of capturing the extruded egg of the
ovary ** ABDOMINAL PREGNANCY fetus is implanted in the
intestine
**only ONE fimbriae is attached to the ovary
Example of Ectopic pregnancy in Ampulla
2. Ampulla widest part (dilated)

3. Isthmus narrowest part

4. Intramural part
–Structure that is embedded in the substance of the
uterine wall

BLOOD SUPPLY OF THE FALLOPIAN TUBE

1. Tubal branches of the ovarian artery

- Supplies the lateral portion of the fallopian tube

2. Tubal branches of the uterine artery

- Supplies the medial portion of the fallopian tube

**the tubal branches of the ovarian artery and uterine

artery will anastomose with one another to supply the
whole length of the oviduct
**NOTE: the OVARIAN ARTERY passes through the
suspensory ligament
2. Tubal ligation
-counterpart of vasectomy in males
-both sides should be ligated (bilateral ligation)
** BTL-bilateral tubal ligation

**the uterine artery has vaginal branch and ASCENDING UTERUS

BRANCH of which a part will supply the fallopian tube
- Thick walled pear shaped hollow muscular organ
- is ANTEVERTED
-tipped anterosuperiorly relative to the axis of the
vagina
-normal 90 degrees
- ANTEFLEXED
-flexed anteriorly relative to cervix
- Non-gravid (no child)  lies in the lesser pelvis with its
body lying on the urinary bladder; cervix is between the
rectum and urinary bladder

LAYERS OF THE UTERUS

1. Endometrium
–innermost lining that is very responsive to hormones
- outer layer is being shed off during menstruation
VENOUS DRAINAGE 2. Myometrium
–muscular structure
Tubal veins
- drains into the ovarian veins and uterine venous plexus 3. Perimetrium
–outermost layer serosa
**UTERINE VENOUS PLEXUS will drain into the uterine
vein then to the INTERNAL ILIAC VEIN
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PARTS OF THE UTERUS
STRUCTURES IN THE UTERINE CANAL
1. Uterine body 1. External Os
-broad part - opening of the cervix to the vagina
- upper 2/3
-aka CORPUS UTERI (corpus means body) 2. Cervical canal

2. Uterine Cervix: 3. Internal Os

-lower/inferior narrow portion of the uterus
-conical/cylindrical shape and protrudes through the upper
anterior wall of vagina
- first portion of the cervical canal
- connected to the endometrial canal
** ISTHMUS separates the uterine body and vagina

SURFACES OFTHE UTERINE BODY ** FORNIX spaces due to the impression of the cervix
(total of 4 fornices: 2 lateral, 1 anterior and 1 posterior)
1. Fundus
- rounded superior portion **ANTERIOR FORNIX related to uterovesical pouch
- dome-shaped structure **POSTERIOR FORNXI related to pouch of Douglas

2. Vesical
- related to the urinary bladder LIGAMENTS OF THE UTERINE CERVIX

3. Intestinal/ Posterior 1. Cardinal ligament/Transverse cervical ligament/

- closely related to rectum Mackenrodt’s ligament
- serves as a passageway of UTERINE ARTERY and UTERINE
4. Isthmus VEIN
- separates uterine body from the uterine cervix - anchors cervix on the sides
- constricted part - most important ligament in the in the uterine body

*in GRAVID TYPEfundic height is measured and the **CARDINAL LIGAMENT anchors uterine cervix to the pubic
length will correspond to a particular gestational age bone ANTERIORLY and to the sacrum POSTERIORLY

LIGAMENTS OF THE UTERINE BODY **the two ligaments (pubocervical and sacrocervical
ligaments) render the cervix immovable
1. Broad ligament of the uterus
- double layer of peritoneum 2. PUBOCERVICAL LIGAMENT anterior ligament which
connects cervix to pubis
- similar with the oviduct and ovary MESOMETRIUM
-will form 2 important pouches: 3. SACROCERVICAL LIGAMENT posterior ligament which
UTEROVESICAL POUCH –anterior space between connects cervix to sacrum
anterior uterus and superior urinary bladder

RECTOUTERINE POUCH or POUCH OF DOUGLAS

or POSTERIOR CUL DE SAC --more significant clinically in
especially if you encounter a patient with suspected ectopic
pregnancy. If pregnancy test is positive result and she has
abdominal pain and paleness

**IMPORTANCE OF THE POUCH OF DOUGLAS IN ECTOPIC

PREGNANCY blood will accumulate in the pouch of
Douglas. This can be a diagnostic for ectopic pregnancy
when blood is collected from this area

** CULDOCINTESIS needle is inserted at the posterior

fornix which will reach the pouch of Douglas. Used to
determine if something is wrong in the reproductive system
(example: ectopic pregnancy)

2. Round ligament of the uterus which is the

- remnant of the gubernaculum
-reason why uterus is anteverted and anteflexed
-continuation of the round ligament of the ovary
-attaches uterus to anterior pelvis

PARTS OF THE UTERINE CERVIX

1. Supravaginal part
–above vaginal part connected to uterine body
2. Vaginal part
- externally seen (superior part of the vagina)
- protrudes in the vaginal foramen

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 1. Submucosal can bleed
2. Intramural  benign
** TRANSITIONAL ZONEpart of the cervical lining 3. Intracavitary  can bleed
between the endocervix and ectocervix; similar with the Z- 4. Serosal benign
line of the esophagus

**ENDOCERVIX lining within cervical canal (simple 3.Uterine atony

columnar epithelium)
**ECTOCERVIX exposed in vagina (non-keratinized
stratified squamous epithelium
** IMPORTANCE: cervical cancer usually occurs in the
transitional zone. Repeated trauma can alter the epithelial
lining.
BLOOD SUPPLY OF THE UTERUS
1. UTERINE ARTERY with 2 branches:
- ASCENDING BRANCH  supplies ovary or fallopian
tube
- VAGINAL BRANCH supplies half of the cervix and also
the vagina
ASCENDING BRANCH OF THE UTERINE ARTERY
- Can be appreciated in cardinal ligament
- Supplies most of uterine body, fallopian tube and ovary
VAGINAL BRANCH OF THE UTERINE ARTERY
- male counterpart artery to ductus deferens
- Supplies upper part of the vagina, uterus and part of the
cervix
- after giving birth, uterus can become flaccid
- can result in severe bleed which can cause death
- MANAGEMENT: Press on the uterus to keep it tight.
- Other options: Drugs that can keep uterus in a contracted
state
4. Endometrial/uterine cancer
5. Cervical cancer
– majority of cervical cancers occur in the transitional zone
(SQUAMOCOLUMNAR JUNCTION)
– cancer is caused by HPV
VAGINA
- Musculomembranous tube (7-9 cm)
- Extends from cervix to the vestibule
- Serves as canal for menstrual fluid
- Forms the inferior part of the pelvic canal
- Superior end will receive the inferior end of the cervix
- Inferior end VAGINAL and URETHRAL ORIFICES and
OPENINGS OF VESTIBULAR GLANDS

VENOUS DRAINAGE

**inferior end is guarded by the hymen

VAGINAL HYMEN

- thin mucosal fold guarding the vaginal orifice

- perforated at the center in nulliparous/virgins
1. Uterine vein - HYMEN TEAR during first coitus
- directly drains into INTERNAL ILIAC VEIN - Direction of tear: POSTEROLATERAL or POSTERIOR

**RETROVERTED UTERUS lies posteriorly BLOOD SUPPLY OF THE VAGINA

** RETROFLEXED UTERUS posterior flexing 1. Uterine artery

- supplies the superior part of the vagina
CLINICAL SIGNIFICANCE
1. Uterine prolapse 2. Vaginal artery
- Common among elderly - supplies the middle and inferior portion of the vagina
- Sacrocervical and pubocervical ligaments are lax
3. External pudendal artery
2. Myoma
- Benign tumor in the uterus which is very responsive to VENOUS DRAINAGE
therapy
- Benign growth in myometrium; 1. Uterine venous plexus
- PROBLEM: ones close to the endometrium because of - drains into the uterine vein then drains into the internal
bleeding iliac vein
4 TYPES OF MYOMA

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**IMPERFORATED HYMEN
- Hymen is closed
- (+) hypogastric pain VESTIBULE
- Bulging hymen because blood from menstruation is
accumulated -Smooth triangular area
- Opening of the vagina on the inferior portion of the vagina
VESTIBULAR GLANDS
RELATIONS OF THE VESTIBULE
2 groups of gland: - Anteriorly clitoris
- greater vestibular gland - Posteriorly frenulum of the clitoris
- lesser vestibular glands - Laterally labia minora

GREATER VESTIBULAR GLAND BARTHOLIN’S GLAND COMPONENTS OF THE VESTIBULE

- Activated through foreplay 1. LABIA MINORA AREX

- Located slightly below at the opening of the vagina - located laterally
- Secretes mucus to provide vaginal lubrication - hairless compared to labia majora
- Homologous to BULBOURETHRAL GLAND in males
2. CLITORIS
**malfunctioning bartholin’s gland –painful sexual - CLITORAL HOOD/ CLITORAL PREPUCE hood covering
intercourse clitoris

LESSER VERTIBULAR GLAND ** CLITORAL FRENULUM lies posteriorly; forms the base
of the vestibule
- aka SKENE’S GLAND, PERIURETHRAL GLAND,
PARAURETHRAL GLAND, U-SPOT, FEMALE PROSTATE 3. FOURCHETTE  fusion of labia minora
- Homologous to male PROSTATE GLAND
- Located on the anterior vaginal wall
- Drains in the urethra and near the urethral orifice
- Highly variable anatomy (sometimes absent) CLINICAL SIGNIFICANCE
- Source of G-spot orgasm (Grafenburg spot) anterior only.
Posterior rectum is stimulated Genital warts/ Labial warts
- Closely related to the urethra

** BARTHOLIN’S ABSCESS (BARTHOLIN’S CYST) 

occluded bartholin’s duct opening
- management: incision and drainage

EXTERNAL GENITALIA

-aka VULVA

PARTS OF THE EXTERNAL GENITALIA

1. Mons pubis
- Rounded hair bearing skin anterior to the pubis

2. Labia Majora
- Prominent hair bearing folds of skin extending posteriorly
from the mons pubis to unite posteriorly with the midline
-counterpart in males: SCROTUM
-----END OF TRANX-----
3. VESTIBULE
-clitoris Note: All visuals were taken from Snell’s Clinical Anatomy
-labia minora 7th ed. If the pictures are not clear, please refer to the book.
-fouorchette Thank you!

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