EXTERNAL GENITALIA,

PELVIC ANATOMY
THE FEMALE EXTERNAL
GENITALIA (THE VULVA)
The external female genitalia consists
of the following structures:
1. The mons pubis or mons
veneris.
- It is a pad of fat lying over they
symphysis pubis.
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 - Covered by pubic hair from puberty

2. The labia majora (greater lips)

- Two folds of fat and areola tissue,
covered with skin and public hair on the
outer surface.

- Arise in the mons veneris and merge into

the perineum behind.

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3. The labia minora (Lesser lips)
- Two thin folds of skin lying between the
labia majora, Anteriorly they divide to
enclosed the clitoris; posteriorly they fuse,
forming the four chette.

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4. The clitoris
- Small rudimentary organ, corresponding to
the male penis.

- Extremely sensitive and highly vascular.

- Plays a part in the orgasm of sexual

intercourse.

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 THE VESTIBULE
5. The vestibule
- Area enclosed by the labia minora in
which are situated the openings of the
urethra and the vagina.

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6. The Urethral orifice
- Lies 2.5 cm posterior to the clitoris.

- On either side lie the opening of

skene’s ducts, two small blind-ended
tubules 0.5 cm long running within the
urethral wall.

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7. The Vaginal Orifice (Introitus of the vagina)
Occupies the posterior 2/3 of the vestibule.

8. Bartholins glands
- Open on either side of the vaginal orifice
and lie in the posterior part of the labia
majora.
- Secrete mucus which lubricates the vaginal
opening.
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 THE PELVIC ORGANS
• Functions
- Passage of menstrual flow
- Coitus
- Birth canal

• Position
- runs from the vestibule to the cervix
- passes upwards and backwards into the pelvis
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• Relations
Anterior – lies the bladder and the urethra.

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Posterior – pouch of douglas
- rectum
- perineal body
(each occupy appro. 1/3 of the posterior vaginal
wall.)

• Lateral – upper 2/3 – pelvi foxia and the

ureters which pass behind the cervix.

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• Superior – the uterus
• Inferior – the external genitalia

Structure
- posterior wall longer than anterior wall.
anterior wall 7.5 cm long.
posterior wall 10 cm long.

- pink in colour
- Drawn into small folds known as rugae 11
 Layers
- Lined by squamous epithelium beneath it
being a layer of vascular connective tissue
- Muscle layer – divided into 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.

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 Contents
- Moistened by mucus from the cervix and a
transudate from the vaginal wall blood
vessels.

- Inspite of the alkaline mucus, the vaginal fluid

is strongly acid (Ph 4.5) due to the presence
of lactic acid formed by the action of
Dolderleins bacilli on glycogen in the
squamous epithelium. Lactobacilli are normal
inhabitants of the vagina. The acid deters
the growth of pathogenic bacteria. 13
 THE UTERUS
Position
- Situated in the cavity of the true pelvis

Relations
• Anterior – utero-visical pouch and the bladder

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• Posteriorly – recto-uterine pouch of Douglas
and the rectum.
• Lateral – broad ligaments, fallopian tubes and
the ovaries.
• Superior – intestines
• Interior – vagina

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• Supports
- the uterus is supported by the pelvic floor
and maintained in position by several
ligaments of which those at the level of the
cervix are the most important.

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 Ligaments
• The transverse cervical ligaments
(cardinal ligaments or macKenrodt’s
ligaments) fan out from the sides of the
cervix to the side walls of the pelvis.
• The uterosacral ligaments – pass
backwards from the cervix to the sacrum.
• The pubocervical ligaments pass forwards
from the cervix, under the bladder to the
pubic bones
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 Ligaments cont….
• The broad ligaments
- forward from the folds of peritoneum which
are draped over the fallopian tubes.
• The round ligaments
- little value as supports but tends to maintain
the anteverted position of the uterus.
• The ovarian ligaments

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 Structures
- Non-pregnant uterus is a hollow, muscular
pear shaped organ situated in the true pelvis.

- It is 7.5 cm long, 5 cm wide and 2.5 cm in

depth. Each wall being 1.25cm thick.

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The uterus consists of the following parts
• The body or corpus – upper 2/3.
• The fundus
• The cornua
• The cavity
• The isthmus ~ 7mm long form the lower
uterine segment in pregnancy.

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• Cervix or neck – supravaginal portion
- infravaginal portion

Layers
The uterus has three layers of which the middle
muscle layer is by far the thickest.

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• The endometrium
- lining of ciliated epithelium (mucus
membrane) on a base of connective tissue or
stroma.
- epithelial cells dip down to form glands
which secrete an alkaline mucus.

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- The cervical endometrium – epithelial cells
are tall and columnar in shape and the mucus
– secreting glands are branching racemose
gland.
Cervical endometrium is thinner than that of
the body and is folded into a pattern known
as the arbor vitae (tree of life) – thought to
assist the passage of the sperm.

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• The myometrium
Its fibres run in all directions and interlace to
surround the blood vessels and lymphatics
which pass to form the endometrium.

Outer layer – formed of longitudinal fibres

which are continuos with those of the
fallopian tube, the uterine ligaments and the
vagina.

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• In the cervix, the muscle fibres are
embedded in collagen fibres which
enable it to stretch in labour.

• The perimetrium – double serous

membrane.

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 THE FALLOPIAN TUBES OR
UTERINE TUBES
• Functions
- ovum transport
- provides a site of fertilisation
- supplies the fertilized ovum with nutrition
during its continued journey to the uterus.

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• Position
- extend laterally from the cornua of the
uterus forward the side walls of the pelvis.

Relations
Anterior, posterior and superior – peritoned
cavity and the intestines.

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Lateral – side walls of the pelvis
Inferior – broad ligaments and ovaries
Medical – uterus lies between the two fallopian
tubes.

Supports

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• Layers
The lining – is a mucus membrane of ciliated
cubical epithlium. Lining has goblet cells
which produce a secretion containing
glycogen to nourish the ovum. Beneath the
lining is a layer of vascular connective tissue.

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• The muscle coat
Consists of two layers, an inner circular layer
and an outer longitudianal layer both of
smooth muscles. The tube is covered with
peritoneum.

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 THE OVARIES
• Functions
- produce ova
- produce the hormones oestrogen and
progesterone
• Position
- attached to the back of the broad ligament
within the peritoreal cavity

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• Relations
Anterior – the broad ligaments
Posterior – the intestines
Lateral – the infundibulopelvic ligaments and
the side walls of the pelvis.
Superior – the fallopian tubes
Medial – the uterus and the ovarian ligaments

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• Supports
- ovarian ligaments medially
- the infundibulopelvic ligament laterally.

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• Structures
The ovary is composed of a medulla and
cortex, covered with germinal epithelium.

 The Medulla – made of fibrous tissue,

ovarian blood vessels, lymphatics and nerves
through it.

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 Cortex
- functioning part of the ovary.
- contains ovarian follicles
- outer layer formed of fibrous tissue known
as the tunica albuginea.
- over the tunica albuginea lies the germiral
epithelium, which is a modification of the
peritoneum.

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 THE PELVIC FLOOR

The pelvic floor is formed by the soft tissues

which fill the outlet of the pelvis.
The most important is the strong pelvic
diaphragm through which the urethra, the
vagina and the anal canal pass.

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 Functions

- supports the weight of the abdominal and

pelvic organs
- Its muscles are responsible for the voluntary
control of micturitian and defaecation.
- Play an important role in sexual intercourse
- Influences the passive movements of the
fetus through the birth canal and relaxes to
allow its exit from the pelvis.

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 Muscle layers
• The superficial layer – composed of five
muscles:
a) the external anal sphincter surrounds the
anus and attached behind by a few fibres to
the coccyx.
b) the transverse perineal muscles pass from
the ischial tuberosities to the centre of the
perineum.

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c) The bulbocavernosus muscle – pass from the
perineum forwards around the vagina to the
corpora cavernosa of the clitoris just under
the pubic arch.

d) The ischiocavernosus muscle – pass from the

ischial tuberosities along the pubic arch to the
corpora cavernosa.

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e) The membranous sphincter of the urethra is
composed of muscle fibres passing above and
below the urethra and attached to the public
bones. It is not a true sphincter.

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• The deep layer
- composed of three parts of muscles which
together are knows as the levator ani
muscles. They are so called because they lift
or elevate the anus. Each levator ani muscle
(left or right) consist of the following:

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a) The pubococcygeus muscle – pass from
pubis to the coccyx with a few fibres
crossing over in the perineal body to form
its deepest part.
b) The iliococcygeus muscle – pass from the
fascia covering the obturator interuus
muscle (the while line of pelvic fascia) to
the coccyx.

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c) The ischiococcygeus muscle – passes from
the ischial spine to the coccyx, infront of the
sacrospinous ligament

The perineal body

- Pyramid of muscle and fibrous tissue situated
between the vagina and the rectum.

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