Internal genital organs in this study

• Uterus

• Uterine tubes/fallopian tubes

• Ovaries
Uterus--
– Internal organ of female reproductive system,
– Nidus for developing embryo,
– Situated in the true pelvis above the pelvic diaphragm,
between the urinary bladder and the rectum.
Uterus is a flattened pear shaped organ .
– approximately - 8 cm/5 cm /3 cm
 Axis and position of the uterus.
• Anteflexed-forward bending of its long axis,
• Anteverted –forward bending of the long axis of
uterus in relation to the long axis of the vagina,
• Dextroverted--The long axis is slightly tilted to the
right. ( or to the left)
• Dextrorotated--Uterus is slightly rotated to the
right. (or to the left).
 Structure of the uterus
Muscular organ with a thin cavity.
Uterine walls consists of
– Myometrium ---smooth muscle
- Endometrium---inner lining,
- Serous coat ---outer covering (visceral peritoneum).
 Parts of uterus
• Fundus— part above the entrance of the fallopian tubes.
• Cornua -- area at the entrance of the uterine tubes
• Body -- below the level of cornua,
• Isthmus and cervix -- part below the body,
-- Cervix opens into the vagina.
Part of cervix is clasped by vagina forming;
- supravaginal and vaginal parts of cervix.

The space around the vaginal part

is the fornix.
Uterine cavity – space in the body of the uterus
Cervical canal -- space in the cervix,
Internal Os ----- uterine opehing of the cervical canal
External Os ----- vaginal opening of the cervical canal,
-- level of the ischial spines
-- circular in nullipara
-- transverse
t in multipara
 Surfaces of the uterus—
•Intestinal surface - usually coils of intestine rest on it
•Vesical surface– in relation to urinary bladder,
 Borders of the uterus----—Right and Left,
The round ligaments of the uterus and ligaments of
the ovary are attached near the cornua.
Peritoneal reflections & topographical relations
The peritoneum from the borders of uterus form the
broad ligaments, upto the lateral walls of the pelvis
(in two layers).
Broad ligament has two layers.
Structures between the layers;
• Parametrium--condensed pelvic fascia
• Mesosalpinx-- upper part, with fallopian tubes
with related vessels and nerves,
• Mesovarium—in the posterior layer, where the
ovarian veseels and nerves pass to the ovary

Broad ligament
continued
• Suspensory ligament of the ovary– superolateral
part of broad ligament, ovarian vessels pass in it,

• Uterine vessels & lymphatics run along the lower

part of the broud ligament and close to the uterine
borders.

Broad ligament
continued
• Ligament of the ovary
• Round ligament of the uterus
• Epoophoron
• Paroophoron
 Blood supply
• Uterine arteries- from the internal iliac arteries,
• Each uterine artery passes in the broad ligament along its
lower border towards the cervix , here it is in close relation to
the ureter.
• Then runs upwards along the uterine borders.
• Branches…vaginal, uterine, tubal and ovarian branches.
Venous drainage of uterus –internal iliac veins via
the utero-vaginal plexus.
Lymphatic drainage of the uterus -
– Internal iliac
– External iliac
– Pre-sacral
– Superficial inguinal
• Nerve supply to uterus---
– myometrium is sensitive to hormones

– Autonomic nerves supply …from pelvic plexus

Sympathetic - T12 and L1.

- vasoconstrictor
- afferent
- may also be motor to the myometrium
Parasympathetic - pelvic splanchnic..S,2,3/4.
afferents from cervix
Hysterosalpingogram
 Clinical aspects.

Proximity of ureters to cervix and uterine

vessels – care to be taken to protect the
ureters at hysterectomy.
Retroverted uterus - abnormal position,
uterine axis bends backwards on vaginal axis.
In early pregnancy anteriorly directed cervix can
compress bladder-neck against the pubis, leading
to retention of urine.
• Developmental abnormalities
• Tumours, Etc
Fallopian tubes
 Fallopian tube
• Located - in the upper margin of the mesosalpinx
• About 10 cm ,
• Opens-into uterine cavity = uterine ostium ,
• Opens-into peritoneal cavity = abdominal ostium.
 Parts of the fallopian Tube
Infundibulum----Fimbriated end,
Ampulla,
Isthmus,
Intramural -
 Fallopian Tubes contd.

Infundibulum-----
• funnel shaped,
• has finger like processes called – fimbriae-close to
the ovary.
• one of the fimbrae is attached to the ovary-
ovarian fimbria.
 Fallopian tube. Contd.
Ampulla
• thin walled,
• more than half the length of fallopian tube,
• has a tortuous lumen due to folded lining,
• fertilization of the ovum usually occurs in this part .
 Fallopian tubes cntd.
Isthmus

About 1/3 the length of the fallopian tube,

Has a narrow lumen.

 Fallopian tubes cntd.

Intra mural / uterine part--

• with in the uterine wall,
• about 1cm in length,
• opens into the uterine cavity.
 Blood supply of the fallopian
f Tube

• Tubal branch of ovarian artery & tubal branch of

uterine artery.
• Venous drainage - into ovarian and uterine veins.
Lymphatics of the fallopian tubes
• Para aortic lymph nodes
• Internal iliac lymph nodes
• Inguinal lymph nodes from intramural part.
 Nerve supply to the fallopian tubes;

Sympathetic - from T10 to L 1. contraction of smooth

muscle of the tubes and blood vessels,

Fallopian tubes are sensitive to touch and cutting

Para sympathetic – pelvic spanchnic.

 Fallopian Tubes contd.
Clinical aspects
– Tubal ligation,
– Infection----Salpingitis,
– Tubal pregnancy ….Ectopic gestation. Etc.
 Ovary

• There are two ovaries-- right and left,

• Located in the ovarian fossa – on the parietal peritonium of
the pelvis –close to the pelvic aspect of the acetabulum.
• Related to ovarian fossa are;
External iliac vessels superiorly, *
Ureter and intennal iliac vessels inferiorly, *
Obturator nerve crosses the floor. *

* retro peritoneal.
 Structure of the ovary
• Almond shaped (ovoid) 3/2/1. cm.
• Surfaces
– medial
– lateral
• Borders,
– Anterior
– Posterior
• Poles
– tubal pole--close to fimbria of the uterine tube
– Uterine pole – lig. of the ovary is attached to it,
• Firm to touch.
Ovary is covered by peritoneum only near its hilum,
 Attachments of the ovary,
Ovary is attached to the posterior layer of the
Broad ligament by mesovarium.
 Attachments of the ovary continued

• Suspensory ligament of the ovary– superolateral

part of broad ligament, ovarian vessels pass in it,
 Attachments of the ovary continued
• Ligament of the ovary / ovarian ligament
Remnant of the gubernaculum extends between
the ovary and the uterus.
 Arterial supply of the ovary.
o Ovarian artery from the abdominal aorta (level of L2)
• descends on the psoas major muscle to the suspensory
ligament of ovary then to the mesovarium to reach the ovary.
• gives a tubal branch to anastamoses with the tubal branch of
uterine artery.
o Ovary is also supplied by ovarian branch of uterine artery.
Venous drainage of the ovary--

• Venous channels form - pampiniform plexus,

– Union of these channels form ovarian veins,

• Right ovarian vein joins the inferior vena cava,

• Left one joins the left renal vein.

Lymphatics from the ovaries reach para-aortic lymph
nodes -- at the origin of the ovarian arteries.
 Nerve Supply to Ovaries.
Ovarian function is under the control of hormones,

Autonomic nerves…
• Sympathetic --Aortic plexus-T10 & T11segments
vasoconstrictor
afferent
(pain referred to umbilical region)

• Parasympathetic-- Inferior hypogastric plexus --

vasodilator.
 Clinical Aspects
• Ovaries may be palpated per vaginal examination,
• Pain from pelvic peritoneum is referred to the
medial aspect of the thigh or to the area of knee
(obturator nerve,)
• Pain at the time of ovulation --mittelschmerz
• Ovary can herniate into the sac of inguinal hernia
• Ovarian pain can mimic the pain related to
vermiform Appendix, ( right side )
• Ovarian masses
• Ovaries prolapsed into the pouch of Douglas may
cause dyspareunia (painful coitus). Etc.
End of topic
Begining of
troubles
 The Uterus
Objectives
• Shape,
• Size,
• Axis and position,
• Structure and function,
• Peritoneal reflections
• Topography,
Supports of uterus,
• Radiological study histology and
• Blood supply, embryology will be
• Lymphatic drainage, done in other lectures.
• Nerve supply,
• Clinical aspects.
 Fallopian tube
Objectives
• Location
• Length
• Uterine ostium ,
• Abdominal ostium.
• Descriptive parts
• Role in fertilization
• Blood supply
• Lymphatic drainage
• Nerve supply
• Contrast study
• Clinical aspects.
 Peritoneal reflections & topographical relations.
The parietal peritoneum from anterior abdominal wall

urinary bladder

vesical surface and the fundus of uterus forming---uterovesical

pouch

intestinal surface of the uterus

supravaginal part of the cervix

upper part of vagina(posterior fornix).

Then the peritoneum reflects backwards onto the upper

part of the rectum – forming rectouterine pouch.
Pouch of Douglas--- close proximity to the posterior fornix is
a direct access to peritoneal cavity.
OVARIAN Function will be dealt with in
other lectures.