1.
Anatomy and embryology of
female reproductive system
Haneen Salam
Hayder Qusay
Sama Qahir
Tabarak Ali
Hussein Ali
Anwer abdulkarim

2.
ANATOMY OF THE
FEMALE GENITAL
SYSTEM

3.
The external genitalia (vulva)
1. Mons pubis:
 a fibrofatty pad overlying the
symphysis pubis and covered
by skin & hairs.
2. Clitoris:
 a 0.5-3.5 cm erectile
cavernous structure below the
symphysis pubis.
formed of a small glans and
two corpora cavernosa.

4.
3. Labia Majora:
 The outer 2 skin folds,
raised by underlying adipose
tissue, and passing back from
the mons pubis to the
perineum. The outer skin is
covered by hairs while the
inner medial surface is
smooth, hairless and contains
sebaceous and sweat glands.
4. Labia Minora:
 two thin folds of modified
skin situated medial to the
labia majora.

5.
5. The Hymen:
a membrane, situated about 2 cm from the vestibule that
demarcates the external from the internal genital organs,
and partially closes the vaginal orifice to allow menstruation.
It ruptures during intercourse leaving remaining tags:
carunculae myrtifomes.

6.
6. Bartholin Glands: (Greater
Vestibular Glands):
bilateral compound racemose
glands
secrete mucus during sexual
excitement
situated deep in the labia
majora, at the junction of the
posterior and the middle thirds
Its duct is 2 cm long and opens
between the hymen and the
labium minus.

7.
7. Vestibule:
the area between the inner aspects of the labia minora and the fourchette.
Structures that open in the vestibule are:
Urethra
The Bartholin glands ducts.
The vagina.
8. Vestibular bulbs:
oblong masses of erectile tissue that lie on each side of the vaginal introitus
9. External urethral meatus:
a triangular slit in the anterior part of the vestibule below the clitoris in which
the urethra opens.
10. Skene’s duct:
2 blindly ending Para-urethral tubules which open in the floor of the urethra,
few millimeters form the external urethral meatus.

8.
 In the pre-pubertal vulva, no hair and little
adipose deposition
 during puberty pubic hair develops and
fat deposits within the labia.
 After menopause labia minora loses fat
and become thinner while vaginal opening
becomes smaller.

9.
THE VAGINA
A fibromuscular tube from the vulva
to the uterus forming an angle of 60°
with the horizontal plane.
Length:
anterior wall is 7 cm
posterior wall is 9 cm
Vaginal Fornices:
The cervix projects in the upper
blind end of the vagina that forms a
pouch (vaginal pouch) around the
cervix and is divided into four
fornices : two lateral, anterior and
posterior (deeper) fornices
The internal reproductive organs:

10.
Anatomical Relations of the Vagina
Anteriorly:
Upper 1/3: trigone of urinary bladder
Lower 2/3: urethra.
Posteriorly:
Upper 1/3: peritoneum of Douglas pouch.
Middle 1/3: ampulla of rectum.
Lower 1/3: the perineal body.
Laterally:
Lower end: Bulbocavernosus muscle,
vestibular bulb, and Bartholin gland.
1 cm above orifice: urogenital diaphragm
2½ cm above the orifice: levator ani muscle
with the pelvic fascia above it.
The lateral fornix gives attachment, to the lower
part of the cardinal ligaments.
The ureters pass through the cardinal
ligaments 1 cm lateral to the vagina.

11.
The epithelium is thick and rich with glycogen which
increases in post-ovulatory phase.
 The vagina is devoid of glycogen before puberty and after
menopause due to lack of estrogen.
 Doderlein’s bacillus is the normal vaginal flora that breaks
glycogen to form lactic acid and produce a PH around 4.5,
which protects the vagina by decreasing pathogenic bacterial
growth.
At birth the epithelium is well developed (maternal estrogen
influence). After few weeks the epithelium atrophies and PH
is 7, at puberty the reverse occurs and after menopause the
vagina shrinks and the epithelium atrophies.

12.
THE UTERUS

13.
• The uterus is like an
inverted pear tapering
inferiorly to the cervix and
situated entirely within the
pelvis (the non-pregnant
state).
• It is 7.5cm length, 5cm
width and 3cm thickness.
• It is slightly larger in the
multipara than in the
nullipara

14.
Divisions :
1. The corpus uteri:
• Body that lies above the internal os
• Cornu = the area of insertion of the
fallopian tubes
• Fundus lies above the insertion of
the tubes.
Three structures are attached to the
cornu
• round ligament anteriorly,
• Fallopian tube centrally,
• ovarian ligament posteriorly

15.
2. The isthmus:
• An area 4-5 mm in length
that lies between the
anatomical internal os
above, and the histological
internal os below. It is lined
by low columnar epithelium
and few glands.
• The isthmus expands during
pregnancy forming the lower
uterine segment (10 cm)
during the last trimester.

16.
3-The cervix:
• The elongated lower part of the uterus .
• Measuring 2.5-3.0 cm.
• Divided by the vaginal attachment into
supravaginal portion above and vaginal portion
(portio-vaginalis) below.
• The cervical canal is the cavity that communicates
above with the uterine cavity at the internal os and
below with the vagina at the external os.
• The external os is round in nulliparas and slit
shaped in multiparas.

17.
Relations of the Supravaginal cervix
Anteriorly:
Urinary bladder.
Posteriorly:
Forms the anterior wall of Douglas pouch.
Laterally:
1/2 an inch lateral to the internal os the ureter is
crossed by the uterine artery

18.
Position :
• The uterus is kept in an
anteverted anteflexed position
(AVF), with the external os lying
at the level of the ischial spines,
by the support of the cervical
ligaments, endopelvic fascia and
pelvic floor muscles (levator ani).
• Anteversion: The uterus is
inclined anteriorly to axis of the
vagina.
• Anteflexion: The body of the
uterus is bent forwards upon the
cervix.

19.
THE FALLOPIAN TUBE
• 2 tortuous tubes (10 cm in length)
lie in the free upper part of the
broad ligament.
• They blend medially with the cornu
of the uterus
• Laterally their free outer end curves
backwards towards the ovary.
• Their lumen communicates between
the uterine and the peritoneal
cavities.

20.
It has 4 parts:
1.The interstitial portion: lies within the wall of
uterus.
2.The isthmus: the narrow part adjoining the uterus.
3.The ampulla: the widest and longest part.
4.The fimbrial portion (infundibulum): opens into the
peritoneal cavity.

21.
THE OVARY
• The size and appearance of the ovaries depends on
the age and stage of the menstrual cycle; they are
small (1.5cm) in a child, they increase to adult size at
puberty due to proliferation of stromal cells and
follicle maturation (3cm length, 1cm width and 1cm
thickness) .
• After menopause they are small with wrinkled surface
since no active follicles are present.
• It is the only intra-peritoneal structure not covered by
peritoneum.

22.
Ovarian Attachments
Three attachments:
• The mesovarium: A peritoneal
fold that suspends the ovary to
the back of the broad
ligament.
• The infundibulopelivc
ligament: suspends the upper
pole of the ovary to the lateral
pelvic wall and carries the
ovarian vessels, nerves and
lymphatics.
• The ovarian ligament: attaches
the lower pole to the cornu of
the uterus.

23.
Vestigial structures:
Vestigial remains of the mesonephric ducts and tubules always
present in young children but are variable structures in adults.
•The epoophoron: a series of parallel blind tubules lie in
the broad ligament between the mesovarium and fallopian
tube.
• The paroophoron: a few rudimentary tubules situated in
the broad ligament between the epoophoron and the
uterus.
•The duct of Gartner: is the caudal part of the
mesonephric duct, it runs alongside the uterus to the
internal os.

24.
The pelvic muscles
• The pelvic diaphragm is a muscular partition
formed by the levator ani and coccygei, with
the pelvic fascia which covers their upper
and lower surfaces.
• It separates the pelvic cavity above from the
perineal region below
• Functions: support pelvic organs, and also
plays an important sphinteric function in
preventing urinary incontinence.

25.
The iliococcygeus:
ORIGIN: Posterior half of fascial line over
obturator internus and ischial spine.
INSERTION: Anococcygeal body.
Ischiococcygeus
Origin: ischial spine
Insertion: lateral border of
lower part of sacrum.
ORIGIN: Posterior surface of pubis and
anterior half of fascial line over obturator
internus.
INSERTION: Anococcygeal body.
Pubococcygeus

26.
Is made up of two layers of pelvic
fascia which fill the gap between the
descending pubic rami and lies
beneath levator ani muscles.
The deep transverse perineal
muscles lie between the two layers
and the diaphragm is pierced by the
urethra and vagina.
Urogenital diaphragm

27.
• This is a mass of muscular tissue lies
between the anal canal and lower third of the
vagina.
• Its apex is at the lower end of the
rectovaginal septum where the rectum and
posterior vaginal walls come in contact
• Its base extends from the fourchette to the
anus and covered with skin.
• It is the point of insertion of the superficial
perineal muscles and bounded above by
levator ani muscles where they come into
contact in the midline between posterior
vaginal wall and rectum.
The perineal body:

28.
Anteriorly the uterus is
covered with peritoneum only
as far as the level of internal
os, below this it is reflected
onto the bladder forming the
uterovescical pouch.
The supravaginal cervix below
this is separated from the
bladder by connective tissue.
The pelvic peritoneum

29.
• Posteriorly the peritoneum covers the
posterior surface of cervix and upper
third of posterior vaginal wall forming
the anterior boundary of the rectovaginal
pouch of Douglas then reflects to the
rectum.
• Where the front and sides are covered by
the peritoneum of rectovaginal pouch of
Douglas, the middle third only the front is
covered and the lower third have no
peritoneal covering and the rectum is
separated from the vagina by rectovaginal
fascial septum

30.
Ligaments
• Broad ligament (it is not a ligament but
a peritoneal fold).
• The ovarian ligament: lies beneath the
posterior layer of the broad ligament from
the medial pole of the ovary to the uterus just
below the point of entry of fallopian tubes.
• The round ligament: is the continuation of the
same structure and runs forward under the
anterior leaf of peritoneum to enter the
inguinal canal ending in the subcutaneous
tissue of labia majora

31.
THE PELVIC FASCIA
The PARIETAL PELVIC FASCIA lines the
wall of the pelvic cavity covering obturator
and pyramidalis muscles.
There is a thick tendinous arch on the side
wall of the pelvis from which levator ani
muscles arises and cardinal ligaments gain
lateral attachment.
It forms the upper layer of the urogenital
diaphragm

32.
Important parts of visceral fascia.
• The cardinal ligaments are 2 strong fan-shaped
fibromuscular bands passes from the cervix and
vaginal vault to the side wall of the pelvis; they
provide the essential support of the uterus and
vaginal vault.
• The uterosacral ligaments: run from the cervix and
vaginal vault to the sacrum.
• The bladder is supported laterally by condensation of
visceral pelvic fascia on each side and by a sheet of
pubocervical fascia which lies beneath it.

33.
Pelvic blood supply:
• 1.The ovarian artery arise from the aorta below the renal artery (because the
ovary develops on the posterior abdominal wall and later migrates to the
pelvis, it carries its blood supply from the abdominal aorta). The artery
divides into branches that supply the ovary and tube and then anastomoses
with the terminal branches of uterine artery

34.
• 2.The internal iliac artery begins at the bifurcation of
the common iliac artery, divides to anterior and
posterior branches: the branches that supply the pelvic
organs are all from the anterior division.
• a.The uterine artery provides main blood supply of the
uterus, from the base of the broad ligament it runs to
the upper part of the uterus to anastomose with ovarian
artery, in this part it send many branches into the
substance of the uterus. Also supply branches to the
ureter, cervix and upper vagina.
• b.The vaginal artery supply the vagina.
• c.The vescical arteries supply the bladder and terminal
ureter

35.
• d.The middle rectal artery arise in common
with the lowest vescical artery.
• e.The pudendal artery which leaves the pelvic
cavity through the sciatic foramen entering the
ischiorectal fossa giving the inferior rectal
artery, its terminal branches supply the
perineal and vulval arteries.
• 3.The superior rectal artery: a continuation of
inferior mesenteric artery that descends in the
base of the mesocolon, divides into two
branches supply the rectum.

36.
• The pelvic veins:
• Venous drainage from uterine, vaginal and
vescical plexus is chiefly into the internal
iliac veins.
• Venous drainage from rectal plexus is via
superior rectal veins to the inferior
mesenteric veins, and the middle and
inferior rectal veins to the internal pudendal
and then to iliac veins

37.
• The ovarian veins
begins in the
pumpiniform plexus
between the broad
ligament layers, the
right vein ends in the
inferior vena cava and
the left in the left renal
vein

38.
• The pelvic lymphatics:
• Lymphatic drainage from lower extremities, vulva
and perineal regions is filtered through inguinal
and superficial femoral nodes then along the deep
pathway on the side wall of the pelvis lateral to
major blood vessels forming the external iliac,
common iliac and para-aortic group of nodes.
Medially, another chain passes from the deep
femoral nodes through femoral canal to obturator
and internal iliac groups. The last group receives
lymphatic from upper vagina, cervix and body of
uterus.
• From the internal and common iliac nodes to para-
aortic chain and into the lumbar lymphatic trunks
and cisterna chyli where all the lymph is carried by
the thoracic duct to empty into the junction of left
subclavian and internal jugular veins.

39.
• Lymphatic drainage from genital tract:
• The lower third of the vagina drains to
the superficial lymph nodes while upper
two thirds join the lymphatics of the
cervix.
• The cervix mostly drains to the internal
iliac, obturator and external iliac nodes,
but also directly to common iliac and
lower para-aortic nodes.
• The ovaries and fallopian tubes drain to
para-aortic nodes, on the left they are
found around left renal pedicle while on
the right they flow into thoracic duct
(early spread of metastatic carcinoma

40.
Nerve supply of vulva and perineum:
• The pudendal nerve arise from the second,
third and fourth sacral nerves, passes along
the outer wall of ischio-rectal fossa gives
the inferior rectal branch and divides into
perineal nerve and dorsal nerve of clitoris.
The perineal nerve gives the sensory supply
of the vulva and also the anterior part of
external anal canal, levator ani and
superficial perineal muscles.
• The ilioinguinal and genitofemoral nerves
supply sensory fibers to mons and labia and
to first lumbar root. The posterior femoral
cutaneous nerve carries sensation from
perineum to the small sciatic nerve and thus
to the first, second and third sacral nerves.
Levator ani main supply is from third and
fourth sacral nerves.

41.
• Nerve supply of pelvic viscera:
• All pelvic viscera receive sympathetic and
parasympathetic innervations. Sympathetic
nerves from preaortic plexus continue with
those of superior hypogastric plexus which lies
in front of the last lumbar vertebra which then
divide and continue on each side with fibers
passing beside the rectum to join inferior
hypogastric (uterovaginal) plexus.
• Parasympathetic fibers from second, third and
fourth sacral nerves join uterovaginal plexus.
Fibers from (or to) bladder, uterus, vagina and
rectum join the plexus.
• The ovaries innervated by the ovarian plexus
which surrounds the ovarian vessels and join
the preaortic plexus high up