Clinical Anatomy of Female Reproductive Organs

Female Reproductive Organs

Learning Outcomes

  • Describe anatomy of female external genitalia and related clinical applications.
  • Describe gross anatomy, blood supply, lymphatic drainage, and nerve supply of ovaries, uterine tubes, and uterus with clinical correlations.
  • Describe gross anatomy, blood supply, and lymphatic drainage of the female breast.
  • Describe microscopic structure of the ovary, uterine tube, uterus, and mammary gland.

Pelvis

  • False/Greater Pelvis: Above pelvic brim.
  • True/Lesser Pelvis: Contains internal organs (uterus, vagina, uterine tube, ovaries).

Female External Genitalia (Pudendum/Vulva)

  • Mons pubis: Fatty eminence anterior to pubic symphysis.
  • Labia majora: Folds of skin with subcutaneous fat, equivalent to scrotum.
  • Labia minora: Enclose vestibule.
  • Vestibule: Space between labia minora, openings of urethra & vagina.
  • Bulb of Vestibule: Along sides of vestibule, corresponds to bulb of penis.
  • Greater Vestibular Gland (Bartholin Gland).
  • Clitoris: Median rod-like structure, erectile mass for sexual arousal.

Female Perineum

  • Perineal Body: Fibro-muscular mass in midline between urethra and anus (1.25 cm in front of anus).
    • Six muscles converge and attach.
    • Rupture during delivery predisposes to prolapse; support is needed during childbirth.

Nerve Supply of External Genitalia

  • Ilioinguinal nerve, Genital branch of genitofemoral nerve (L1/L2): Skin of anterior 1/3rd of labia majora.
  • Posterior Scrotal or labial nerve: Posterior 2/3rd of labia majora & lateral part of urogenital skin.
  • Pudendal nerve (S2, S3, S4): Main nerve.
  • Uterus:
    • Sympathetic (T11-L3): Uterine contraction and vasoconstriction.
    • Parasympathetic (S2, S3, S4): Uterine inhibition and vasodilatation.

Uterus

  • Size: 7.5 cm long, 5 cm broad, 2.5 cm thick.
  • Position & Angulation: Anteversion (90 degrees), Anteflexion (125 degrees).
  • Location: Lesser Pelvis, oblique.
  • Parts: Body, Fundus, Cervix.
  • Peritoneal Relation:
    • Vesico-uterine Pouch: Between bladder and uterus.
    • Recto-uterine Pouch (of Douglas): Deepest part of peritoneal cavity.

Supports of the Uterus

  • Pelvic floor muscles (Levator Ani).
  • Perineal body.
  • Urogenital diaphragm.
  • Pubocervical ligaments.
  • Transverse cervical ligaments.
  • Uterosacral ligaments.
  • Round ligaments.
  • Broad ligament.

Blood Supply of the Uterus

  • Arterial: Uterine arteries (from internal iliac arteries), Ovarian arteries (during pregnancy).
  • Venous: Uterine and vaginal veins (to ovarian and internal iliac veins).
  • Lymphatic Drainage:
    • Cervix: External and Internal iliac lymph nodes, sacral nodes.
    • Lower part of body: External iliac lymph nodes.
    • Upper part of body, fundus, fallopian tubes: Pre-aortic, para-aortic lymph nodes, superficial inguinal lymph nodes.

Vagina

  • Upper end pierced by cervix, forming fornices (anterior, posterior, lateral).
  • Posterior fornix deeper.
  • Lymphatic drainage:
    • Upper & Middle 1/3: External & Internal Iliac nodes
    • Lower 1/3: Superficial Inguinal Lymph Nodes
    • Glans of Clitoris: Deep Inguinal nodes

Uterine Tube

  • Parts: Infundibulum, Ampulla (fertilization site), Isthmus, Intra-mural part.
  • Blood supply: Uterine and Ovarian arteries and veins.

Ovary

  • Location: Ovarian fossa on lateral pelvic wall.
  • Attachments: Mesovarium, Suspensory ligament, Ovarian Ligament.
  • Ovarian Fossa: Related to Ureter, Obturator artery & nerve.
  • Blood supply: Ovarian artery (direct branch from abdominal aorta).
  • Lymphatic drainage: Lateral aortic lymph nodes.
  • Histology:
    • Germinal epithelium, Tunica albuginea, Cortex, Medulla.
    • Ovarian follicles (primordial, primary, secondary, Graafian).
    • Corpus luteum, Corpus albicans.

Endometrium

  • Mucosal lining of uterus:
    • Stratum basale (basal 1/3).
    • Stratum functionalis (superficial 2/3, sheds during menstruation).
  • Cyclical changes during ovarian cycle:
    • Menstrual.
    • Proliferative.
    • Secretory.

Mammary Gland

  • Location: Beneath the skin, in front of Pectoral Fascia.
  • Structure: 15-20 lobules of glandular tissue drained by Lactiferous Ducts.
  • Suspensory ligaments (Cooper’s ligament): Support the gland.
  • Blood Supply : Lateral Thoracic branch from 2nd part of Axillary artery & Medial mammary branches from Perforating branches of (Internal Thoracic artery & Anterior Intercostal artery))
  • Lymphatic Drainage
    • 75% drains to Axillary Lymph nodes
    • 20%, mostly from medial quadrant drains to Parasternal (Internal Mammary) Lymph nodesor goes to opposite breast
    • 5% to the Posterior Intercostal Nodes