Anatomy

1. Development and anatomy of
female genital tract with applied
anatomy

3. Development of female genital tract
• Indifferent Stage
• In the first stage of gonadal development, it is impossible to distinguish
between the male and female gonad. Thus, it is known as the indifferent
stage.
• The gonads begin as genital ridges – a pair of longitudinal ridges derived
from intermediate mesoderm and overlying epithelium. They initially do
not contain any germ cells.
• In the fourth week, germ cells begin to migrate from the endoderm lining
of the yolk sac to the genital ridges, via the dorsal mesentary of the
hindgut. They reach the genital ridges in the sixth week.
• Simultaneously, the epithelium of the genital ridges proliferates and
penetrates the intermediate mesoderm to form the primitive sex cords.
The combination of germ cells and primitive sex cords forms the indifferent
gonad – from which development into the testes or ovaries can occur.

4. • Ovaries
• In a female embryo, the XX sex
chromosomes are present. As there is
no Y chromosome, there is no SRY
gene to influence development.
Without it, the primitive sex
cords degenerate and do not form
the testis cords.
• Instead, the epithelium of the
gonad continues to proliferate,
producing cortical cords. In the third
month, these cords break up into
clusters, surrounding each oogonium
(germ cell) with a layer of epithelial
follicular cells, forming a primordial
follicle.

5. The Internal Genitalia
Indifferent Stage
In the first weeks of urogenital development, all
embryos have two pairs of ducts, both ending at
the cloaca. These are the:
•Mesonephric (Wolffian) ducts
•Paramesonephric (Mullerian) ducts
In the female, there are no Leydig cells to produce
testosterone. In the absence of this hormone,
the mesonephric ducts degenerate, leaving behind only a
vestigial remnant – Gartner’s duct.
Equally, the absence of anti-Mullerian hormone also allows
for development of the paramesonephric ducts. Initially,
these ducts can be described as having three parts:
•Cranial – becomes the Fallopian tubes
•Horizontal – becomes the Fallopian tubes
•Caudal – fuses to form the uterus, cervix and upper 1/3 of
the vagina.
The lower 2/3 of the vagina is formed by sinovaginal
bulbs (derived from the pelvic part of the urogenital sinus).
By Jonathan Marcus [CC BY-SA 3.0], from Wikimedia
Commons

6. External genitalia
• Female
• Oestrogens in the female embryo are responsible for external genital
development. The genital tubercle only elongates slightly to form
the clitoris.
• The urethral folds and genital swellings do not fuse, but instead form
the labia minora and labia majora respectively.
• The urogenital groove therefore remains open, forming
the vestibule into which the urethra and vagina open.

7. Descent of ovaries
While the gonads arise in the upper lumbar region, they are each tethered to the
scrotum or labia by the gubernaculum – a ligamentous structure formed from
mesenchyme
The ovaries initially migrate caudally from their origin on the posterior abdominal wall.
However they do not travel as far, reaching their final position just within the true pelvis.
The gubernaculum becomes the ovarian ligament and round ligament of the uterus.

8. • Mons pubis • Labia majora • Labia minora • Clitoris • Vestibule of the vagina
External urethral orifice Vestibule glands paraurethral glands (Skene’s glands)
Bartholin's gland vagina opening hymen
. MONS PUBIS The triangular mound of fatty tissue that covers the pubic bone
It protects the pubic symphysis During adolescence sex hormones trigger the
growth of pubic hair on the mons pubis.
. LABIA MAJORA Referred to as the outer lips They have a darker
pigmentation Protect the introitus and urethral openings Are covered with hair
and sebaceous glands Tend to be smooth, moist, and hairless Become flaccid
with age and after childbirth
LABIA MINORA Referred to as the “inner lips” Made up of erectile, connective
tissue that darkens and swells during sexual arousal Located inside the labia
majora They are more sensitive and responsive to touch than the labia majora
CLITORIS • Highly sensitive organ composed of nerves, blood vessels, and erectile
tissue • Located under the prepuce • It is made up of a shaft and a glans • Becomes
engorged with blood during sexual stimulation• Urethral opening is located directly
below clitoris
VAGINAL OPENING INTROITUS Opening may be covered by a thin sheath
called the hymen.
External genitalia

9. Internal genitalia
• Ovaries
• Fallopian tubes
• Uterus
• vagina

10. Ovaries
• Female gonads produces oocytes and hormones
• Lies in ovarian fossa on the lateral pelvic wall.
• Two poles: upper pole and lower pole , two
borders : anterior and posterior and two
surfaces: lateral and medial.
• Blood supply
• Arterial- via ovarian and uterine arteries
• Venous- pampiniform plexus into ovarian veins and
then into IVC
• Lymphatic drainage- lateral aortic and preaortic
nodes
• Nerve supply- ovarian plexus (SNS from T10, T11
and PNS from S2-4)

11. Fallopian tubes
• Situated at upper free margin of broad ligament of uterus.
• 10cm long
• Subdivisions-
• Infundibulum funnel shaped have finger like processes called as fimbriae
• Ampulla- medial to infundibulum, 6-7cm size, site of fertilization
• Isthmus- narrow, rounded, 2-3cm
• Uterine part- 1cm long with 1mm opening known as uterine ostium
• Blood supply
• Arterial- medial 2/3rd uterine artery and lateral 1/3rd ovarian artery
• Venous- uterine veins
• Lymphatic drainage- lateral aortic, preaortic , superficial inguinal
nodes
• Nerve supply- SNS – T10-L2 , PNS – Vagus and S2-4

12. Uterus
• Size and shape – pyriform shaped, 7.5cm long, 5cm
broad, 2.5cm thick. 30-40gm weight
• Position and angulation- anteversion - 90 degree angle
, anteflexion at level of internal os with 125 degree
angle
• Parts
• Fundus
• Body with ant and post surface
• Two lateral borders – provide attachment to broad ligament
• Cervix
• Blood supply- arterial- uterine and ovarian arteries,
venous plexus into uterine, ovarian, vaginal vein.
• Lymphatic drainage upper - aortic, sup inguinal ,
middle – external iliac, lower- internal iliac and sacral
• Nerve supply- SNS- T12, L1 , PNS S2-4

13. Vagina
The vagina connects the cervix to the external genitals • It is located
between the bladder and rectum.
Functions : • As a passageway for the menstrual flow • For uterine
secretions to pass down through the introitus • As the birth canal during
labor • With the help of two Bartholin’s glands becomes lubricated during
sexual intercourse.
• Walls – Ant : 7.5 cm – Post : 9cm – 2 lateral walls • Fornices : – Ant :
shallow – 2 lateral – Post : deep.
Blood supply- arterial- vaginal branch of IIA, uterine artery and middle and
internal pudendal arteries, Venous- into IIV via vaginal vein
Lymphatic drainage- upper- external iliac, middle- internal iliac, lower- sup
inguinal
Nerve supply- lower 1/3rd – pudenDal nerve, upper2/3rd - SNS- L1,2 PNS S2-4

14. Anatomical relations of the female reproductive tract to
the other pelvic organs
• Relations of Ovaries:
• Peritoneal Relations The ovary is almost
entirely covered with peritoneum, except
along the mesovarian or anterior border
where the two layers of the covering
peritoneum are reflected onto the
posterior layer of the broad ligament of the
uterus.
• The ovary is connected to the posterior
layer of the broad ligament by a short fold
of peritoneum, called the mesovarium
which transmits the vessels and nerves to
and from the ovary.

15. • Visceral Relations
• 1.Upper or tubal pole: It is broader than the lower pole, and is related to the
uterine tube and the external iliac vein. The right ovary may be related to the
appendix, if the latter is pelvic in position. The ovarian fimbria and the
suspensory ligament of the ovary are attached to the upper pole of the ovary.
• 2.Lower or uterine pole: It is narrower than the upper pole and is related to the
pelvic floor. It is connected, by the ligament of the ovary, to the lateral angle of
the uterus, posteroinferior to the attachment of the uterine tube. The ligament
lies between the two layers of the broad ligament of the uterus and contains
some smooth muscle fibres.

16. • 3.Anterior or mesovarian border: It is straight
and is related to the uterine tube and the
obliteratedumbilical artery. It is attached to
the back of the broad ligament of the uterus
by the mesovarium, and forms the hilus of the
ovary.
4.Posterior or free border: It is convex and is
related to the uterine tube and the ureter.
5.Lateral surface: It is related to the ovarian
fossa which is lined by parietal peritoneum.
This peritoneum separates the ovary from the
obturator vessels and nerve
6.Medial surface: It is largely covered by the
uterine tube. The peritoneal recess between
the mesosalpinx and this surface is known as
the ovarian bursa.
Relations of lateral surface of ovary to the
ovarian fossa

17. Uterine Tubes
• Course and Relations
• 1.The isthmus and the adjoining part of the
ampulla are directed posterolaterally in a
horizontal plane. Near the lateral pelvic wall, the
ampulla arches overthe ovary and is related to
its anterior and posterior borders, its upper pole
and its medial surface. The infundibulum
projects beyond the free margin of the broad
ligament.
• 2.The uterine tube lies in the upper free margin
of the broad ligament of the uterus. The part of
the broad ligament between the attachment of
the mesovarium and the uterine tube is known
as the mesosalpinx.

20. Vagina:

22. Clinical correlations
• Ovaries:
• Ovary may be absent on one or both sides, or may be duplicated
• Sometimes ovary contains cells that are capable of differentiating into
various tissues like bone, cartilage, hair, etc giving rise to teratoma
• Prolapse of ovaries
• Ovarian cysts
• Ovary Carcinoma

23. • Uterus and uterine tubes:
• Uterus may be in bicornuate, septate or
duplicated (didelphys)
• Uterus may be absent or rudimentary
• Uterine tubes may be absent , duplicated or
atresia may be there
• Uterus- common site for fibroids, endometriosis,
or cancer
• Uterine prolapse due to damage of perineal body.
• Salpingitis
• tubal blockage : to check patency -
hysterosalpingography
• tubal pregnancy
• Tubectomy: for family planning
• due to damage of perineal body
• Salpingitis, tubal blockage, tubal pregnancy,
tubectomy

24. • VAGINA:
Vaginal examination-
inspection, palpation by per vaginal digital examination
Vaginal lacerations due to rape , during childbirth and due to accidents.
Vaginitis: before puberty and after menopause due to thin epithelium.
due to trichomonas , monilial and gonococcal infections.
Prolapse of vagina.
Episiotomy :incision in posterolateral side of vagina to increase the size
of the outlet for the baby during delivery.

25. Thank you