1.
EXTERNAL
GENITALIA
Britto.v
Lecturer in nursing

2.
INTRODUCTION
• The generative (reproductive ) organs in the
female are those concerned with copulation ,
fertilization, growth and development of the
fetus , its subsequent exit into the outer world
and nurture following birth. The generative
organs constitute the external genitalia , the
internal genital organs and the accessory
reproductive organs.

3.
EXTERNAL GENITALIA
• The vulva or pudendum includes all the visible
external genital organs in the perineum.
Vulva consists of the following:
• The mons pubis or mons veneris
• Labia majora (greater lips)
• Labia minora (lesser lips)
• Hymen
• Clitoris
• Vestibule
-Urethral openings and skene’s glands
-the vaginal orifice or introitus
-openings of Bartholin’s glands

4.
MONS VENERIS (MONS PUBIS):
• It is the pad of subcutaneous adipose
connective tissue lying over the symphysis
pubis.
• It is covered with pubic hair from the time of
puberty.

5.
LABIA MAJORA:
• These are two folds of fat and areolar tissue, covered
with skin and pubic hair on the outer surface.
• The inner surface of the labia majora are hairless.
• The labia majora are covered with squamous
epithelium and contain sebaceous glands, sweat
glands, and hair follicles.
• The adipose tissue is richly supplied with venous
plexus, which may produce haematoma, if injured
during childbirth.
• The labia majora arise from the mons veneris and
merge into the perineum behind.
• The round ligaments terminate at its upper borders.

6.
• Beneath the skin , there is dense connective tissue
and adipose tissue.
• The adipose tissue is richly supplied with venous
plexus which may produce haematoma, if injured
during childbirth.
• The labia majora are homologus to the scrotum in
the male.
• The round ligament terminates at its upper border.

7.
LABIA MINORS:
• These are two thin folds of skin lying between the
labia majora.
• Anteriorly they divide to enclose the clitoris;
posteriorly they fuse , forming the fourchette.
• It is usually lacerated during childbirth.
• Between the fourchette and the vaginal orifice is the
fossa navicularis.
• The labia minora do not contain hair folllicles.
• The folds contain connective tissue, numerous
sebaceous glands, erectile muscle fibers and
numerous vessels and nerve endings.

8.
CLITORIS:
• It is a small cyclindrical erectile body, measuring
about 1.5-2.5 cm situated in the most anterior part
of the vulva.
• It is a rudimentary organ corresponding to the male
penis, but differs basically in being entirely separate
from the urethra.
• It is attached to the under surface of the symphysis
pubis by the suspensory ligament.
• It is extremely sensitive and highly vascular and
plays a role in the orgasm of sexual intercourse.

9.
VESTIBULAR:
• It is a triangular space bounded anteriorly by
the clitoris, posteriorly by the fourchette and
on either side by labia minora. There are four
openings into the veatibule.
• Urethral opening & sken’s glands
• Vaginal orifice or introitus
• Openings of bartholins glands

10.
• Uretheral opening:
- The opening is situated in the midline just infront of the vaginal
orifice about 2.5 cm posterior to the clitoris .
- The skene’s glands open on either side of the uretheral orifice.
• The vaginal orifice or introitus:
- It occupies the posterior two-thirds of the vestibule and is of
varying size and shape.
- In virgins and nulliparae, the opening is closed by the labia minora,
but in parous women , it may be exposed.
- It is completely closed by a septum of mucous membrane, called
hymen.
- The membrane varies in shape, but is usually circular or crescentic
in virgins.
- The hymen is usually ruptured at the consummation of marriage.
- During childbirth , the hymen is extremely lacerated and is known
as the carunculae myrtiformes.
- On both side it is lined by stratified squamous epithelium.

11.
• Openings of bartholin’s glands:
- Ther are two bartholin’s glands (greater vestibular
glands), one on each side .
- They open on either side of the vaginal orifice and lie
in the posterior part of the labia majora.
- They are open on either side of the vaginal orifice and
lie in the posterior part of the labia majora.
- They are pea-shaped and yellowish white in color.
- During sexual excitement , it secretes abundant
alkaline mucus, which helps in lubrication.
- Each gland has a duct, which measures about two
centimetres and opens into the vestibule outside the
hymen.
- The duct is lined by columnar epithelium.

12.
BLOOD SUPPLY
• This comes from the internal and external
pudendal arteries.
• The blood drains through the corresponding
veins

13.
LYMPHATIC DRAINAGE
• Lymphatics drain into the inguinal lymph
nodes and internal iliac lymph nodes

14.
NERVE SUPPLY
• This is from the branches of pudendal nerve.
• Anterior part is supplied by the genito femoral
nerve and postero-inferior part by the
pudendal branches from the posterior
cutaneous nerve of thigh.
• The vulva is supplied by the labial and perineal
branches of the pudendal nerve.

15.
INTERNAL ORGANS
• The vagina
• The uterus
• The uterine tubes
• The ovaries
• Accessory reproductive organs

16.
INTERNAL GENITAL ORGANS
• THE VAGINA:
-vagina is a fibromusculo-membrane sheath connecting the uterine
cavity with the exterior at the vulva.
- It is a passage, which allows the escape of menstrual flow and
uterine secretions.
- It receives the penis and the ejected sperm during sexual
intercourse and provide an exit for the fetus during delivery.
- The canal is directed upward and backward forming an angle of 45
degrees with the horizontal in erect posture.
- The long axis of the vagina almost lies parallel to the plane of the
pelvic inlet and at right angles to that of the uterus.
- The diameter of the canal is about 2.5 cm , being wider in the upper
part and narrowest at the introitus.
- It has enough power of distensibility as evidence during childbirth.

17.
VAGINAL WALLS
- Vagina has an anterior , a posterior and two
lateral walls.
- The anterior and posterior walls are apposed
together but the lateral walls are
comparatively stiffer specifically at its middle
as such it looks H shaped on transverse
section .
- The length of the anterior wall is about 7cm
and that of the posterior wall is about 9cm.

18.
RELATIONS
- Anterior : in front lie the bladder and urethra , which
are closely connectd to the anterior vaginal wall.
- Behind : the pouch of douglas, the rectum and the
perineal body each occupy opprximately one-third of
the posterior vaginal wall.
- Lateral : beside the upper two-thirds are the pelvic
fascia and ureters, while beside the lower third are the
muscles of the pelvic floor.
- Superior : above the vagina lies the uterus.
- Inferior : below the vagina lies the external genitlia.

19.
STRUCTURE
- The posterior wall is 10cm long while the anterior wall is
only 7 cm because the cervix projects at the right angles
into its upper part.
- The upper part of the vagina is known as the vault.
- Where the cervix projects into it, the vault forms a circular
recess, which is described as its 4 fornices.
- The posterior fornix is the largest of these because the
vagina is attached to the uterus at a higher – level behind
than in front.
- The vaginal walls are pink in appeareance and thrown into
small folds known as rugae.
- These allow the vaginal walls to stretch during intercourse
and childbirth.

20.
LAYERS
- The lining of the vagina is made of squamous
epithelium.
- Beneath the epithelium lies a layer of vascular
connective tissue.
- The muscle layer has a weak inner coat of
circular fibres and a stronger outer coat of
longitudinal fibres.
- Pelvic fascia surrounds the vagina , forming a
layer of connective tissue.

21.
CONTENTS
- There are no glands in the vagina.
- It is moistened by mucous from the cervix and a
transudate , which seeps out from the blood vessels of
the vaginal wall.
- The vaginal fluid is strongly acid (p.H 4.5 cm) due to
presence of lactic acid formed by the action of
doderline’s bacilli on glycogen found in the squamous
epithelium of the lining.
- These bacilli are the normal inhabitants of the vagina.
- The acid deters the growth of pathogenic bacteria.

22.
BLOOD SUPPLY
- This comes from the branches of the internal
illaic artery and includes the vaginal artery
and a descending branch of the uterine artery.
- The blood drains through the corresponding
veins.

23.
LYMPHATIC DRAINAGE
- This is via the inguinal , the internal iliac and
the sacral glands.

24.
NERVE SUPPLY
- Sympathtetic and parasympathetic nerves
from the pelvic plexus supply the vagina.
- The pudendal nerve supplies the lower part.

25.
THE UTERUS
Position :
- It is situated in the cavity of the true pelvis,
behind the bladder and in front of the rectum.
- It means forward which is termed as
anteversion and it bends forwards on itself ,
which is termed as anteflexion.
- In standing positions , a womens uterus is in
horizontal position with the fundus resting on
the bladder.

26.
Relations
- Anterrior : the uterovesical pouch and the
bladder.
- Posterior : the rectouterine pouch of douglas
and the rectum.
- Lateral : the broad ligaments, the uterine
tubes and the ovaries
- Superior : the intestines
- Inferior : the vagina

27.
SUPPORTS
- The utreus is supported by the pelvic floor and
maintained in position by several ligaments.
- The transverse cervical ligaments extend from the sides
of the cervix to the sidewalls of the pelvis .
- They are known as the cardinal ligaments or the
mackenrodt’s ligaments.
- The uterosacral ligaments pass backward from the
cervix to the sacrum.
- The pubocervical ligaments pass forward from cervix
under the bladder to the pubic bones.
- The broad ligaments formed from the folds of
peritonium, which are draped over the uterine tubes.

28.
STRUCTURE
- The nonpregnant uterus is a hollow , muscular , pear- shaped organ
situated in the true pelvis.
- It is 7.5cm long, 5cm wide, and 2.5 cm deep.
- Each wall measures 1.25 cm . The uterus has the following parts:
- The body or corpus: makes up the upper two-thirds of the uterus
- The fundus: the domed upper wall between the insertions of the uterine
tubes.
- The cornua: the upper outer angles of the uterus where the fallopian
tubes join.
- The corpus or the body: lies between the openings of the tubes and the
isthumus.
- The cavtiy: a potential space between the anterior and posterior walls. It is
triangular in shape, the base of the triangle being uppermost.
- The isthumus : it is a narrow area between the cavity and the cervix, which
is 7mm long. It enlarges during pregnancy to form the lower uterine
segment.

29.
- The cervix: protrudes into the vagina. The upper
half which is above the vagina, is termed as the
supravaginal portion while the lower half is the
infravaginal portion.
- The internal os: it is the narrow opening between
he isthumus and the cervix.
- The external os: a small round opening at the
lower end of the cervix. After childbirth this is
seen as a transverse slit.
- The cervical canal: lies between the internal os
and externl os . The canal is a continuation of the
uterine cavity and is shaped like a spindle narrow
at each end and wider in the middle.

30.
LAYERS
The uterus has 3 layers , of which the middle layer is
the thickest. The from inside outwards are
endometrium , myometrium and perimetrium.
- Endometrium : this forms a lining of ciliated
epithelium on a base of connective tissue or
stroma. As there is no submucous layer , the
endometrium is directly apposed to the muscle
coat. In the uterine cavity , the endometrium is
constantly changing in thickness through the
menstrual cycle.

31.
• Myometrium : it consists of thick bundle of
smooth muscle fibres held by connective
tissues and are arranged in various directions.
It is thick in the upper part of the uterus and is
more sparse in the isthumus and cervix.
• Peritonium : it is a double serous membrane ,
an extension to the peritonium , which is
draped over the uterus , covering all but a
narrow strip on either side and the anterior
wall of the supravaginal cervix from where it is
deflected up over the bladder.

32.
BLOOD SUPPLY
-blood supply to the organs is thorugh the
uterine artery and ovarian artery.
- The uterine aretery is branch of the internal
iliac artery and enters at the level of the
cervix.
- The ovarian artery is a branch of the
abdominal aorta. It supplies the ovaries and
uterine tubes.
- The blood drains through corresponding veins.

33.
NERVE SUPPLY
• This is mainly from the autonomic nervous
system, the sympathetic and parasympathetic
system via pelvic plexus.

34.
FUNCTIONS
• The uterus serves to shelter the fetus during
pregnancy . It prepares for this possibility each
month. At the termination of pregnancy it
expels the uterine contents.

35.
THE UTERINE TUBES
• Position : the uterine tubes or fallopian tubes
extend laterally from the cornua of the uterus
towards the sidewalls of the pelvis. They arch
over the ovaries the fringed ends hovering
near the ovaries in order to receive the ovum.
They are attached to the broad ligament by
two layers of peritonium, called the
mesosalpinx. Each tube is about 10- 11.5 cm
long.

36.
RELATIONS
• Anterior , posterior and superior : the
peritoneal cavity and the intestines.
• Lateral : the sidewalls of the pelvis
• Inferior : the broad ligaments and the ovaries
• Medial : the uterus lies between the two
uterine tubes.

37.
SUPPORTS
• The uterine tubes are held in place by their
attachment to the uterus. The broad
ligaments and the infundibulopelvic ligaments
support them.

38.
STRUCTURE
• Length of each tube is 10cm. The lumen of the tube provides
a pathway to the peritoneal cavity. The uterine tube has 4
portions.
• THE INTERSTITIAL PORTION: it is 1.25cm long and lies within
the wall of the uterus. The lumen is 1cm wide.
• THE ISTHUMUS: the narrow part that extends from the uterus
and measures 2.5cm.
• THE AMPULLA: the wider portion that is 5cm long.
Fertilization usually occurs in ampulla.
• THE INFUNDIBULUM: the funnel- shaped , fringed end of the
tube , which is composed of many processes known as
fimbriae. One fimbria is attached to the ovary.
• THE INTRAMURAL PART: 1cm long and runs through the
uterine wall.

39.
BLOOD SUPPLY
• This is via the uterine and ovarian srteries,
returning by the corresponding veins.

40.
LYMPHATIC DRAINAGE
• This is to the lumbar glands.

41.
FUNCTIONS
• The uterine tube propels the ovum towards
the uterus, receives the spermatozoa as they
travel upward and provide a site for
fertilization.

42.
THE OVARIES
• POSITION :
-the ovaries or the or the female gonads are
situated one on each side of the uterus and
are attached to the back of the broad ligament
within the peritoneal cavity.

43.
RELATIONS
• Anterior : the broad ligaments.
• Posterior :the intestines.
• Lateral : the infundibulopelvic ligaments and
the sidewalls of the pelvis.
• Superior : the uterine tubes
• Medial : the uterus and the ovarian ligament.

44.
SUPPORTS
• The ovarian ligaments from above and the
infundibulopelvic ligaments laterally support
the ovaries. They are attached to the broad
ligament.

45.
STRUCTURE
• The ovary is almond shaped and is about 3cm long,
1.5cm wide and 1cm thick. It is composed of a medulla
and a cortex and is covered with germinal epitheilium.
The ovarian blood vessels , lymphatics and nerves pass
through medulla. The hilum (opening ) where the vessels
enter the ovary , is called the mesovarium.
• The cortex is the functioning part of the ovary. It contains
the ovarian follicles in different stages of development
surrounded by stroma . The outer layer is formed of
fibrous tissue and is known as the tunica albugenia.

46.
BLOOD SUPPLY
• The blood supply is from the ovarian arteries
and venous drainage through the ovarian
veins. The right ovarian through the ovarian
vein joins the inferior vena cava and the left
returns its blood to the left renal vein.

47.
LYMPHATIC DRAINAGE
• This is to the lumbar glands.

48.
NERVE SUPPLY
• This comes from the ovarian plexus.

49.
FUNCTIONS
• The ovaries produce ova and the hormones
estrogen and progestrone.

50.
ACCESSORY REPRODUCTIVE ORGANS
• BREASTS :
- The breasts are bilateral glandular structures,
which are concerned with lactation following
childbirth. The shape of breasts varies in women
and in different periods of life. They usually
extends from the second to the 6th rib in the
midclavicular line. They lie in the subcutaneous
tissue over the fascia covering the pectoralis
major and in some women beyond that over the
serrate anterior and external oblique.

51.
STRUCTURE
• The areola is situated about the centre of the
breast and is pigmented. It is about 2.5 cm in
diameter and has numerous sebaceous glands
over it. The nipple is a muscular projection
covered by pigmented skin. It is vascular and
surrounded by unstriped muscles that make it
erectile. The nipple contains about 15-20
lactiferous ducts and their openings. The whole
breast is embedded in the subcutaneous fat. The
fat is absent beneath the nipple and areola.

52.
BLOOD SUPPLY
• Blood supply to the breasts is from the
branches of the internal mammary artery, the
auxiliary artery and the intercostals arteries.
Superficial veins of the breasts drain into the
internal mammary veins. Veins emptying into
internal mammary, auxiliary and intercostals
veins serve deep breast tissue.

53.
NERVE SUPPLY
• The 3rd and 4th branches of the cervical plexus
provide the cutaneous nerve supply to the
upper breast and thoracic intercoastals nerves
to the lower breast.