Female Reproductive System Lecture Notes

Learning Objectives

1. Describe the ovary with regard to its:

a. Location
b. Supports
c. Function
2. Describe the appearance of the ovary before puberty and following puberty
3. Describe the blood supply of the ovary
4. State the lymphatic drainage of the ovary
5. State the nerve supply of the ovary
6. Describe the parts of the fallopian (uterine) tube
7. Enumerate the functions of the uterine tube
8. State the blood supply, lymphatic drainage, and nerve supply of the uterine tube
9. Describe the uterus with regard to its location and parts
10.Describe the wall and cavity of the uterus
11.Describe an anteverted and anteflexed uterus
12.Describe the major supports of the uterus
13.Describe the minor supports of the uterus
14.State the blood supply, lymphatic drainage, and nerve supply of the uterus
15.State the anatomical basis of injury to the ureter during surgery on the uterus
16.Describe the vagina
17.Describe the vaginal fornix
18.Enumerate the functions of the vagina
19.State the clinical significance of the posterior fornix
20.Describe the parts of the clitoris:
a. Root crura and bulb
b. Body
21.Describe the labia majora
22.Describe the labia minora
23.Describe the vestibule
24.State the blood supply, lymphatic drainage, and nerve supply of the external genitalia
25.Describe the greater vestibular glands
26.Describe the lesser vestibular glands

Female Reproductive System

Internal Genitalia
o Ovaries
o Unterine tubes
o Uterus
o Vagina
External Genitalia
o Clitoris
o Mons pubis
o Labia majora and labia minora
o Vestibule of the vagina
Accessory Organs
 o Greater and lesser vestibular glands

Ovary

Located close to the lateral pelvic wall

Smooth external surface before puberty
Following puberty, becomes scarred due
to repeated discharge of ova during ovulation
Supports
o Suspensory ligament of the ovary
AKA infandibulum pelvic
ligament
Attached to upper, tubal end
Conveys ovarian vessels, lymphatics, and
nerves
Attaches the ovary to the
lateral ligament wall
o Proper ligament of the ovary
Connects the ovary to the uterus inferior to the entrance of the uterine tubes
Mesovarium- suspends the ovary from the posterior layer of the broad
ligament
Functions
o Production of the female germ cells, the ova
o Secretion of female sex hormones, estrogen and progesterone
Arterial Supply Ovarian Artery from the abdominal aorta
o Enters the pelvic inlet lateral to the ureters
o Enters the suspensory ligament of the ovary
Venous Drainage pampiniform plexus of veins merge to form single vein
o Right ovarian vein IVC
o Left ovarian vein left renal vein
Lymphatic Drainage lateral aortic (lumbar) nodes
Nerve Supply Ovarian Plexus of Nerves
o Accompanies ovarian artery
o Upper part from T10 & 11 spinal via branches from the renal and aortic plexus
o Lower part reinforced by superior and inferior hypogastric plexuses

Uterine Tube

Muscular tube located in the upper part of

the broad ligament
Parts:
o Infandibulum funnel-shaped lateral
end
Fimbriae draped over
the surface of the ovary
Abdominal ostium opening into
the peritoneal cavity
o Ampulla
Widest part
 Usual site of fertilization
o Isthmus narrowest part
o Intramural pierces the uterine
wall
Function
o To receive the ovum released by the
ovary
o As a conduit for the spermatozoa
to reach the ovum
o As a site of fertilization of the
ovum by the spermatozoa
o To provide nourishment for the
fertilized ovum
Arterial Supply - Tubal branches of the
ovarian and uterine arteries
Venous Drainage - correspond to the
arteries
Lymphatic Drainage - Internal iliac and
lumbar nodes
Nerve Supply inferior hypogastric
plexus

Ectopic Tubal Pregnancy

Ectopic pregnancies occur when the fertilized ovum

implants outside of the uterine cavity
Most cannot be sustained at extrauterine sites
A tubal ectopic pregnancy may proceed for
several weeks, but the enlargement can rupture the
tube and lead to acute, life-threatening bleeding,
often about 6 weeks after previous menstrual
period

Uterus

Hollow, thick-walled muscular organ

Upper 2/3 lies over the urinary bladder; lower 1/3 lies between the urinary bladder and
rectum
Parts:
 o Body
Upper 2/3
Fundus superior to the
entrance of the uterine
tubes
Isthmus just superior to
the cervix
o Cervix
Supravaginal part
Vaginal part
communicates with the
vagina
o External Os
Distal end
Nulliparous female circular (never delivered)
Parous female transverse (delivered)
Function

o To receive, retain, and

nourish the fertilized ovum
Structure
o Wall
Endometrium inner mucous membrane lining
Myometrium middle muscular layer; interlacing bundles of smooth muscle
and connective tissue
Perimetrium outer serous covering; peritoneum supported by connective
tissue
o Cavity
Uterine cavity cavity of the body
Cervical cavity cavity of the cervix
Internal os proximal end
 o Communicates
with the uterus
External os distal end
o Communicates with the vagina
Positions anteverted and anteflexed in majority of women
o Anteverted long axis of the body of the uterus is bent forward on the long axis of
the vagina at 90 degrees
o Anteflexed- long axis of the body of the uterus is bent forward on the long axis of
the cervix at 170 degrees
o Retroversion fundus and body of the
uterus are bent backward on the vagina
o Retroflexed body of the uterus is bent
backward on the cervix
Major Supports
o Levator ani muscles
Forms part of pelvic diaphragm
o Ligaments
Transverse cervical (cardinal, Mackenrodts)
ligament from the cervix and upper vagina to the
lateral pelvic walls
Sacrocervical
(uterosacral) ligament
from the cervix and
upper vagina to the
sacrum
Pubocervical ligaments
extends from the
cervix and vagina to
the pubic bones
Minor Supports broad ligament and
round ligament of the uterus
o Broad ligament from the
uterus to the lateral wall and
floor of the pelvic cavity
 o Parts
Mesovarium suspends the ovary
Mesosalpinx part by which the
uterine tube is suspended
Mesometrium major part
o Contents of the Broad Ligament
Uterine tube
Proper ligament of the
ovary
Round ligament of the uterus
Uterine vessels, nerves, and
lympathics
Ovarian vessels
Epoophoron and paraoophoron
remnants of mesonephros
o Round Ligament of the Uterus
From the uterus enters
the deep inguinal ring
Through the
inguinal canal into
the superficial
inguinal ring
Inserts to the labium
majora
Arterial Supply uterine artery and
ovarian artery
Venous drainage uterine venous
plexus
Lymphatic drainage lumbar and
internal iliac nodes
Nerve Supply inferior hypogastric plexus

Endometriosis

Endometrial glands and stroma outside the uterus

Can be painful and disabling
Locations: pelvic (ovary, uterine tube, broad ligament, peritoneal lining of uterus, rectum
or bladder) and extrapelvic (lungs)
Chocolate cyst of the ovary old dark brown blood collects over time from repeated
hemorrhage in a cystic space in the ovary

Tumors of the Myometrium (leiomyoma, myoma, fibroid)

Most common tumor in women

Vary in size from small nodules to massive tumors
Classified by location
Symptoms
o May be asymptomatic, even when extensive
o Abnormal bleeding (metrorrhagia long; menorrhagia profuse)
o Urinary frequency due to bladder compression
o Sudden pain due to disruption of blood supply
 o Impaired fertility
In pregnant women
o Spontaneous abortion
o Fetal malpresentation
o Unterine inertia
o Postpartum hemorrhage
Management
o Surgery
o Uterine artery embolization

Vagina

Musculomembranous tube
From the cervix to the vestibule
Vaginal fornix area in the superior end of the vaginal lumen around the protruding cervix
o Anterior fornix
o Lateral fornices
o Posterior fornix related to the rectouterine pouch
Functions:
o Genital canal
o Excretory duct for menstrual flow
o Part of birth canal
Arterial supply uterine, middle rectal, vaginal, and internal pudendal arteries (from the
anterior division of the internal iliac arteries)
Venous drainage vaginal venous plexus
Lymphatic drainage internal iliac nodes
Nerve Supply inferior hypogastric plexus (visceral) and pudendal nerve (somatic)

External Genitalia

Clitoris
o Parts root and body
Root made up of the bulb and the right and left crura
Crura of the clitoris
Covered by the
ischiocavernosus
muscle
Continue to the
body of the
clitoris as the
corpora
cavernosa
Bulb of the clitoris
Splits into two to
form the bulb of
the vestibule
Covered by the
bulbospongiosus
muscle
Body of the clitoris
2 corpora caverosa
 Glans of the clitoris

Labia Majora

Prominent skin folds that bound the pudendal cleft (the central depression where the labia
minora and the vestibule are found)
Fused anteriorly at the mons pubis and anterior commissure; posteriorly at the posterior
commissure
Filled with subcutaneous tissue containing smooth muscle, termination of the round
ligament of the uterus, and fat

Labia Minora

Fat-free, thin skin on the sides of the vestibule

Core of spongy connective tissue containing
erectile tissue and blood vessels
Anterior ends split prepuce of the clitoris and
frenulum of the clitoris
Posterior ends frenulum of the
labia minora

Vestibule

Contains the openings of the urethra, vagina,

and vestibular glands
External urethral orifice inferior to the
clitoris
Vaginal orifice size and appearance vary
with the condition of the hymen
Hymen mucous membrane
covering the vaginal orifice

Vulva

Blood supply mainly from branches of internal pudendal artery

Lymphatic drainage superficial inguinal and internal iliac nodes
Nerve supply
o Sensory: mainly from branches of pudendal nerve
 o Autonomic: inferior hypogastric plexus

Greater (Bartholins) Vestibular Glands

Located in the superficial perineal space

Ducts open into the vestibule
Homologous to the bartholins glands
Secrete mucus into the vestibule

Lesser Vestibular (Skenes) Glands

Located alongside the terminal

portion of the urethra
Ducts (Skenes) open between the urethral
and vaginal orifices
Secretions moisten the vestibule
and labia

Bartholin Cyst

Results from blockage of duct of the

gland
Painless swellings in the labia majora
May or may not be noticed
If symptomatic:
o Vulvar pain
o Dyspareunia pain during sex
o Pain on walking/sitting
Management:
o May be left alone
o Word catheter insertion
o Excision

Bartholin Abscess

Results from infection of Bartholin gland

Labia majora excruciatingly painful, red, swollen
May drain spontaneously -> hastened by warm moist dressings or sitz baths
Management:
o I&D
o Word catheter placement
o Marsupialization excision of the cyst and suturing
o Excision