FEMALE REPRODUCTIVE

SYSTEM
 • The reproductive tract in women is
contained mainly in the pelvic cavity and
perineum, although during pregnancy,
the uterus expands into the abdominal
cavity.
• Major components of the system consist
of:
■ an ovary on each side, and
■ a uterus, vagina, and clitoris in the
midline.
In addition, a pair of accessory glands (the
greater vestibular glands) are associated
with the tract.
 Ovaries
• Like the testes in men, the ovaries
develop high on the posterior
abdominal wall and then descend
before birth, bringing with them
their vessels, lymphatics, and
nerves.
• Unlike the testes, the ovaries do
not migrate through the inguinal
canal into the perineum, but stop
short and assume a position on the
lateral wall of the pelvic cavity.
 Ovaries

• The ovaries are the sites of egg

production (oogenesis).
• Mature eggs are ovulated into the
peritoneal cavity and normally
directed into the adjacent openings
of the uterine tubes by cilia on the
ends of the uterine tubes.
 Ovaries
• The ovaries lie adjacent to the lateral
pelvic wall just inferior to the pelvic
inlet.
• Each of the two almond-shaped
ovaries is about 3 cm long and is
suspended by a mesentery (the
mesovarium) that is a posterior
extension of the broad ligament.
 Ovarian ligament

• The inferior pole of the ovary is

attached to a fibromuscular band of
tissue (the ligament of the ovary),
which courses medially in the margin
of the mesovarium to the uterus and
then continues anterolaterally as the
round ligament of the uterus.
 Ovarian arteries
• In women, the gonadal (ovarian)
arteries originate from the
abdominal aorta at the level of L2
and then descend anterior to the
psoas major muscles to cross the
ureter at the level of L3 and then
cross the pelvic inlet and supply
the ovaries.
• They anastomose with terminal
parts of the uterine arteries.
 Ovarian arteries
• On each side, the vessels travel in the
suspensory ligament of the ovary (the
infundibulopelvic ligament) as they
cross the pelvic inlet to the ovary.
• Branches pass through the mesovarium
to reach the ovary and through the
mesometrium of the broad ligament to
anastomose with the uterine artery.
• The ovarian arteries enlarge
significantly during pregnancy to
augment the uterine blood supply.
 Ovarian veins

• Similar to testicular veins, right

ovarian vein drains into the inferior
vena cava and left ovarian vein drains
into the left renal vein.
 Uterine tubes
• The uterine tubes extend from each
side of the superior end of the body of
the uterus to the lateral pelvic wall and
are enclosed within the upper margins
of the mesosalpinx portions of the
broad ligaments.
• Because the ovaries are suspended
from the posterior aspect of the broad
ligaments, the uterine tubes pass
superiorly over, and terminate laterally
to, the ovaries.
 Uterine tubes
• Each uterine tube has an expanded
trumpet-shaped end (the
infundibulum), which curves
around the superolateral pole of
the related ovary.
• The margin of the infundibulum is
rimmed with small finger-like
projections termed fimbriae.
• The lumen of the uterine tube
opens into the peritoneal cavity at
the narrowed end of the
infundibulum.
 Uterine tubes
• Medial to the infundibulum, the
tube expands to form the ampulla
and then narrows to form the
isthmus, before joining with the
body of the uterus.
• The fimbriated infundibulum
facilitates the collection of
ovulated eggs from the ovary.
• Fertilization normally occurs in the
ampulla.
 Uterine tubes
• After ovulation, the unfertilized egg
is gathered by the fimbriae of the
uterine tube.
• The egg passes into the uterine
tube where it is normally fertilized
in the ampulla.
• The zygote then begins
development and passes into the
uterine cavity where it implants in
the uterine wall.
 Tubal Ligation
• A simple and effective method of birth
control is to surgically ligate (clip) the
uterine tubes, preventing spermatozoa
from reaching the ovum.
• This simple short procedure is
performed under general anesthetic.
• A small laparoscope is passed into the
peritoneal cavity and special equipment
is used to identify the tubes.
 Uterus
• The uterus is a thick-walled
muscular organ in the midline
between the bladder and rectum.
• It consists of a body and a cervix,
and inferiorly it joins the vagina.
• Superiorly, uterine tubes project
laterally from the uterus and open
into the peritoneal cavity
immediately adjacent to the
ovaries.
 Uterus
• The body of the uterus is flattened
anteroposteriorly and, above the
level of origin of the uterine tubes,
has a rounded superior end (fundus
of the uterus).
• The cavity of the body of the uterus
is a narrow slit, when viewed
laterally, and is shaped like an
inverted triangle, when viewed
anteriorly.
 Uterus
• Each of the superior corners of the
cavity is continuous with the lumen
of a uterine tube; the inferior
corner is continuous with the
central canal of the cervix.
• Implantation of the blastocyst
normally occurs in the body of the
uterus.
• During pregnancy, the uterus
dramatically expands superiorly into
the abdominal cavity.
 Cervix
• The cervix forms the inferior part of
the uterus and is shaped like a short,
broad cylinder with a narrow central
channel.
• The body of the uterus normally arches
forward (anteflexed on the cervix) over
the superior surface of the emptied
bladder.
• In addition, the cervix is angled
forward (anteverted) on the vagina so
that the inferior end of the cervix
projects into the upper anterior aspect
of the vagina.
 Cervix
• Because the end of the cervix is dome
shaped, it bulges into the vagina, and a
gutter, or fornix, is formed around the
margin of the cervix where it joins the
vaginal wall.
• The tubular central canal of the cervix
opens, below, as the external os, into
the vaginal cavity and, above, as the
internal os, into the uterine cavity.
 Carcinoma of the cervix and uterus
• Carcinoma of the cervix and uterus is a
common disease.
• Diagnosis is by inspection, cytology
(examination of the cervical cells),
imaging, biopsy, and dilation and
curettage (D&C) of the uterus.
• Carcinoma of the cervix and uterus may
be treated by local resection, removal of
the uterus (hysterectomy), and adjuvant
chemotherapy.
 Carcinoma of the cervix and uterus
• The tumor spreads via lymphatics to the
internal and common iliac lymph nodes.
• Many countries have introduced
screening programs for cervical cancer
where women are regularly called for
smear tests.
• The age of women included in the
screening population varies depending
on the country.
 Vagina
• The vagina is the copulatory organ
in women.
• It is a distensible fibromuscular
tube that extends from the
perineum through the pelvic floor
and into the pelvic cavity.
• The internal end of the canal is
enlarged to form a region called
the vaginal vault.
 Vagina
• The anterior wall of the vagina is
related to the base of the bladder
and to the urethra; in fact, the
urethra is embedded in, or fused
to, the anterior vaginal wall.
• Posteriorly, the vagina is related
principally to the rectum.
 Vagina
• Inferiorly, the vagina opens into
the vestibule of the perineum
immediately posterior to the
external opening of the urethra.
• From its external opening (the
introitus), the vagina courses
posterosuperiorly through the
perineal membrane and into the
pelvic cavity, where it is attached
by its anterior wall to the circular
margin of the cervix.
 Vagina
• The vaginal fornix is the recess
formed between the margin of the
cervix and the vaginal wall.
• Based on position, the fornix is
subdivided into a posterior fornix,
an anterior fornix, and two lateral
fornices.
• The vaginal canal is normally
collapsed so that the anterior wall
is in contact with the posterior
wall.
 Vagina
• By using a speculum to open the vaginal
canal, a physician can see the domed
inferior end of the cervix, the vaginal
fornices, and the external os of the cervical
canal in a patient.
• During intercourse, semen is deposited in
the vaginal vault.
• Spermatozoa make their way into the
external os of the cervical canal, pass
through the cervical canal into the uterine
cavity, and then continue through the
uterine cavity into the uterine tubes where
fertilization normally occurs in the ampulla.
 The recto-uterine pouch
• In women, the uterus lies between
the bladder and rectum, and the
uterine tubes extend from the
superior aspect of the uterus to the
lateral pelvic walls.
• As a consequence, a shallow
vesico-uterine pouch occurs
anteriorly, between the bladder
and uterus, and a deep
recto-uterine pouch (pouch of
Douglas) occurs posteriorly,
between the uterus and rectum.
 The recto-uterine pouch
• The recto-uterine pouch (pouch of
Douglas) is an extremely important
clinical region situated between
the rectum and uterus.
• When the patient is in the supine
position, the recto-uterine pouch
is the lowest portion of the
abdominopelvic cavity and is a site
where infection and fluids typically
collect.
 The recto-uterine pouch

• It is impossible to palpate this

region transabdominally, but it can
be examined by transvaginal and
transrectal digital palpation.
• If an abscess is suspected, it may
be drained through the vagina or
the rectum without necessitating
transabdominal surgery.
 Broad ligament

• The broad ligament is a sheet-like

fold of peritoneum, oriented in the
coronal plane that runs from the
lateral pelvic wall to the uterus,
and encloses the uterine tube in its
superior margin and suspends the
ovary from its posterior aspect.
 Broad ligament
• The uterine arteries cross the
ureters at the base of the broad
ligaments, and the ligament of the
ovary and round ligament of the
uterus are enclosed within the
parts of the broad ligament related
to the ovary and uterus,
respectively.
 Broad ligament
• The broad ligament has three parts:
■ the mesometrium, the largest part
of the broad ligament, which extends
from the lateral pelvic walls to the
body of the uterus;
■ the mesosalpinx, the most superior
part of the broad ligament, which
suspends the uterine tube in the
pelvic cavity; and
■ the mesovarium, a posterior
extension of the broad ligament,
which attaches to the ovary
 Broad ligament

• The peritoneum of the

mesovarium is continuous
with the ovarian surface
(germinal) epithelium.
• The ovaries are positioned
with their long axis in the
vertical plane.
 Broad ligament

• The ovarian vessels, nerves, and

lymphatics enter the superior pole of
the ovary from a lateral position and
are covered by another raised fold of
peritoneum, which with the structures
it contains forms the suspensory
ligament of the ovary
(infundibulopelvic ligament).
 Round ligament
• The round ligament of the
uterus passes over the pelvic
inlet to reach the deep inguinal
ring and then courses through
the inguinal canal to end in
connective tissue related to the
labium majus in the perineum.
 Uterine artery

■ The uterine artery is a branch of

the internal iliac artery and courses
medially and anteriorly in the base
of the broad ligament to reach the
cervix.
Along its course, the vessel crosses
the ureter and passes superiorly to
the lateral vaginal fornix.
 Uterine artery
■ Once the vessel reaches the cervix, it
ascends along the lateral margin of the
uterus to reach the uterine tube, where it
curves laterally and anastomoses with the
ovarian artery.
The uterine artery is the major blood
supply to the uterus and enlarges
significantly during pregnancy.
Through anastomoses with other arteries,
the vessel contributes to the blood supply
of the ovary and vagina as well.
Uterine artery
 Vaginal artery
■ The vaginal artery in women is the
equivalent of the inferior vesical artery
in men and, descending to the vagina,
supplies branches to the vagina and to
adjacent parts of the bladder and
rectum.
The vaginal artery and uterine artery
may originate together as a common
branch from the anterior trunk, or the
vaginal artery may arise
independently.