REVIEW OF ANATOMY AND

PHYSIOLOGY OF HUMAN
REPRODUCTIVE SYSTEM:
FEMALE AND MALE
PRESENTED BY:
Ms. Sweta K. Gaude
M.Sc.(N) 1st year
SDM INS
FEMALE REPRODUCTIVE
SYSTEM:
FEMALE PELVIS
 The pelvis is a basin-shaped structure that
support the vertebral column & protects the
abdominal organs.
FUNCTION OF PELVIS:
 The main function of the pelvis is in
movements of the body especially in walking,
running, sitting & kneeling.
 The female pelvis is adapted for childbearing
with more rounded & wider brim than the
male pelvis.
 The pelvis contains & protects the
reproductive organs, the bladder & rectum.
 While sitting, the weight of the body is taken
on by ischial tuberosities.
 It helps in transmitting weight of the bodyto
the legs.
BONES OF THE PELVIS:
The bones of the pelvis are:
1) The innominate bones: further made up of
three parts: The ilium
The ischium
The pubis
2) One sacrum
3) One coccyx
JOINTS OF THE PELVIS
 Sacroiliac joint
 Sacrococcygeal
 Pubic symphysis joint
 Lumbosacral joint

LIGAMENTS OF PELVIC:
 Sacroiliac ligaments
 Sacrospinous ligaments
 Sacrotuberous ligaments
 Symphysis pubis ligaments
 Sacrococcygeal ligament
LANDMARKS OF PELVIS
1) Sacral promontory
2) Ala or wing of the sacrum
3) Sacroiliac joint
4) Iliopectineal line
5) Iliopectineal eminence
6) Superior ramus of the pubic bone
7) Upper inner border of the pubic bone
8) Upper inner border of the symphysis pubis
DIAMETERS OF THE PELVIS:
1) True pelvis
2) False pelvis

TRUE PELVIS:
 True pelvis is the part of the pelvis important
in childbirth & lies below the pelvic inlet.
 It is divided into 3 parts: inlet or pelvic brim,
cavity & outlet.
PELVIC INLET(BRIM)
 The bony landmarks of pelvic inlet (upper
pelvic strait or superior strait) from
symphysis pubis to sacral promontory .
 Its shape is that of a transverse oval, with a
slight posterior constriction caused by
promontory of sacrum.
DIAMETERS OF THE PELVIC
INLET:
 ANTERIOR-POSTERIOR DIAMETER:
 True conjugate (anatomical conjugate,
conjugate Vera) (11cm).
 Obstetric conjugate (10cm).
 Diagonal conjugate (12cm).
 Oblique diameters
 Transverse diameter
MEASUREMENT OF DIAGONAL
CONJUGATE:
 The patient is placed in the dorsal position.
 Using asepsis, two fingers of gloved right hand are introduced
into the vagina & moved upwards along the anterior sacral
curve after depressing the elbow & the wrist.
 The area at which the bone recedes from the fingers is the
sacral promontory
 Using index finger of the left hand, a marking is made over the
gloved index finger of right hand.
 In a normal, pelvis, the sacral promontory is not felt or at best
it can be felt with difficulty.
 The internal fingers are removed & the distance between the
marking & the tip of middle finger measured with a metal or
any scale is diagonal conjugate.
 Obstetric conjugate is then calculated by deducing 1.5cm from
it.
PELVIC CAVITY
DEFINITION:
 The pelvic cavity is the space between the
plane of inlet (brim) above & the plane of
outlet (the narrow pelvic plane) below.
 It forms a curved canal with a shallow
anterior wall measuring 4cm, deep lateral
wall 7.5cm & a deep posterior wall
measuring 11.5cm.
 It is almost round in shape.
 It has got two planes.
 They are:
1) Plane of Greatest Pelvic Dimensions Of The Pelvic:
 The mid-plane, bounded in front by the Centre of
the posterior surface of pubic symphysis & behind
by the junction of the second & third sacral
vertebrae & laterally by the obturator foramina &
ischial bone over middle of acetabulum.
 It represents the roomiest part of the pelvic cavity.
 Its shape is round.
 Diameter: Anterior-posterior: 12cm, Oblique:12cm,
Transverse: 12cm (All its diameter are 12cm).
2) Plan Of Least Pelvic Dimensions Of The Pelvic
Cavity (Mid Pelvic):
 The narrow pelvic plan is the imaginary flat surface
bounded in front by the lower border of the
symphysis pubis, laterally by the tips of the ischial
spines & posteriorly by the junction of fourth &
fifth sacral vertebrae or sometimes the lower
border of the last sacral vertebra depending upon
the configuration of the pelvis.
 Its shape is that of an antero-posterior oval.
PELVIC OUTLET
 The pelvic outlet is a lozenge-shaped space
bounded in front by the lower border of
symphysis pubis; laterally by ischia-pubic
rami, ischial tuberosities & the sacrotuberous
ligaments; posteriorly by the tip of sacrum
(or coccyx, if it is not pushed back).
OBSTETRIC OUTLET:
 Obstetric outlet is a shallow bony segment bounded above
by the narrow pelvic plane of least pelvic dimensions &
below by the anatomical outlet.
 It should be clearly distinguished from the anatomical
outlet.
PELVIC AXIS:
 The axis of mid-plane of the cavity is represented by a line,
the direction of which is intermediate between those of the
brim & the outlet.
 By uniting the axes of the 3 planes of the brim, mid-cavity
& outlet, a line is formed which traverses through the
centre of the canal of the bony pelvis.
 It forms a curve, concave anteriorly, & directed at first
downwards & backwards (axis of brim), then gradually more
& more forwards until it reaches the axis of the outlet.
 This line is known as the anatomical axis of the pelvis or
TYPES OF PELVIS:
FEMALE ORGANS OF
REPRODUCTION
 The female reproductive organs are
concerned with copulation, fertilization,
growth & development of fetus.
 The organs are classified into:

 External Genitalia
 Internal Genitalia
 Accessory reproductive organs
EXTERNAL GENITALIA
THE VULVA OR PUDENDUM:
 It includes all the visible external genital organs in the
perineum.
 Vulva consists of the following:
 The mons pubis
 Labia majora
 Labia minora
 Hymen
 Clitoris
 Vestibular bulbs
 It is therefore bounded anteriorly by mons pubis, posteriorly by
the rectum, laterally by the genitocrural fold.
 The vulvar area is covered by Keratinized stratified squamous
epithelium.
MONS VENERIS (MONS PUBIS)
 Itis the pad of subcutaneous adipose
connective tissue lying in front of the pubis &
in the adult female is covered by hair.
 The hair pattern (escutcheon) of most
women is triangular with the base directed
upwards.
 Or it is rounded hairy subcutaneous fatty
mass over symphysis pubis.
LABIA MINORA (LABIA MAJUS)
 Labia majora are two 7x2x1 cm fibro fatty
folds of skin on each side covered with
stratified squamous epithelium.
 They fuse over mons pubis anteriorly &
extend to merge into the perineum
posteriorly joining medially to form the
posterior commissure & usually gape widely
in multiparous women.
 They are richly supplied with blood vessels
(rich plexus of veins), lymphatic & nerves.
LABIA MINORA (LABIUM MINUS)
 Labia minora are two delicate folds of skin lacking
hair follicles, about 5cm long & 0.5-1cm thick
within the labia majora on either side of the
pudendal cleft.
 They are moist, devoid of fat & reddish
resembling mucus membrane often projecting
beyond the labia majora in multiparous women.
 Anteriorly, they split to enclose the clitoris.
 Inferiorly, they fuse in midline forming the
fourchette.
 They contain connective tissues, erectile muscle
fibres & are richly supplied with sebaceous
glands, blood vessels & nerves.
CLITORIS:
 The clitoris is the main female erectile
structure being 2cm in length & is composed
of a highly sensitive glans (0.5cm), a corpus
& two crura.

VESTIBULA:
 Vestibule is a triangular area between labia
minora, clitoris & fourchette with four
openings namely; urethra, vagina & two
ducts of the Bartholin glands.
A) EXTERNAL URETHRAL ORIFICE
(METUS OR OPENING):
 External urethral orifice is a midline antero-posterior
slit in the vestibule just in front of vaginal orifice.
 Paraurethral ducts (Skene’s ducts) usually open in the
urethra.

B) VAGINAL ORIFICE (INTROITUS):

 Vaginal orifice is a median slit behind urethral
opening.
 In most virgin women, the vaginal opening is usually
hidden by the overlapping labia minora &
incompletely guarded by the hymen.
 It gets dilated on coitus & childbirth.
C) HYMEN:
 It is a septum of mucus membrane which usually gets
ruptured during first coital act or during sternous
activity.
 The hymen gets badly torn at parturition to form
different sized cicatrized nodules known as carunculae
myrtiformes or hymenal tags.

D) BARTHOLIN’S GLANDS AND THEIR DUCTS:

 Bartholin’s glands & their ducts are two pea-sized oval
secretory glands situated at 4 & 8 o’clock position
posterior to vestibular bulbs in the superficial perineal
pouch.
 Their ducts (2 cm long) open in the groove between
hymen & labium minus on the sides of the vestibule.
E) VESTIBULAR BULBS:
 Vestibular bulbs are bilateral elongated (3x2x1 cm)
masses of erectile tissue situated one on either side
of vaginal orifice in front of Bartholin’s glands.
BLOOD SUPPLY:
 Is through internal pudendal artery (main arterial
supply) & superficial & deep external pudendal
branches of femoral artery & corresponding veins.
NERVE SUPPLY:
 Is mainly from the anterior division of the second,
third & fourth sacral spinal nerves through pudendal
nerve (S2,3,4) which is the main nerve of the pelvic
floor & perineum.
INTERNAL GENITAL ORGANS:
The internal genital organs in female include:
 VAGINA
 Uterus
 Fallopian tubes
 The ovaries
VAGINA:
 Vagina is a musculomembranous tube which
connects uterine cavity to introitus at vulva.
 It forms the lowermost part of internal
genital tract & provides canal for menstrual
blood outflow from uterus, coitus &
childbirth.
 Vaginal canal is 2.5 cm wide.
 It is widest (3.5 cm) at its uppermost part &
narrowest at the lower end (introitus) but is
very distensible as seen during coitus &
parturition.
VAGINAL WALLS:
 It has four walls-an anterior wall (6-8 cm long), a
posterior wall (7-10cm long) & two lateral walls.
 The anterior & posterior walls normally lie in
contact, with only slight space, near the lateral
margins.
 Vagina has the appearance of letter ‘H’ in cross
section.
 Vaginal fornices are recesses at the vaginal vault
formed due to protrusion of cervix into vagina.
 There are 4 fornices-one anterior (shallowest),
two lateral & one posterior (deepest) called
recto-uterine pouch or culde-sac or pouch of
Douglas.
CLINICAL SIGNIFICANCE:
I. The internal pelvic organs can be palpated
through the fornices.
II. The posterior fornix (pouch of Douglas)
provides surgical access to peritoneal
cavity as culdocentesis (needling) in cases
of suspected ruptured ectopic gestation &
colpotomy in cases of pelvic abscess.
STRUCTURE:
There are 4 layers in vagina from inside to
outside:
1) Mucus Membrane: is non-cornified stratified
squamous epithelium with rugae but is
devoid of secreting glands.
2) Submucus layer of connective tissue
3) Muscular layer (inner circular & outer
longitudinal muscle)
4) Fibrous (adventitial) layer derived from
endopelvic fascia.
BLOOD SUPPLY:
 The arteries involved are :
1) Cervico-vaginal branch of the uterine
artery
2) Vaginal artery- a branch of anterior division
of internal iliac or in common origin with
the uterine
3) Middle rectal
4) Internal pudendal
 VEINS:

Drain into internal iliac & internal pudendal

veins.
LYMPHATICS:
 On each side, the lymphatic's drain into-
1) Upper one-third –internal iliac group
2) Middle on-third up to hymen-internal iliac
group
3) Below the hymen-superficial inguinal
group.
NERVE SUPPLY:
 The vagina is supplied by sympathetic &
parasympathetic from the pelvic plexus.
 The lower part is supplied by the pudendal
nerve.
UTERUS
 The uterus is a hollow pea-shaped (pyriform)
muscular organ situated in the pelvic cavity
between the bladder anteriorly & the rectum
posteriorly.

POSITION, SIZE, & SHAPE:

 The normal position of uterus is of anteversion
& anteflexion.
 Uterus is 8cm long, 5cm wide, 1.25-2.5cm thick
(3x2x1 inches) & weighs 50-80g.
PARTS OF UTERUS:
1) Body or corpus
2) Isthmus
3) Cervix
RELATIONS:
a) Anteriorly
b) Posteriorly
c) Laterally
BODY:
1) Perimetrium
2) Myometrium
3) Endometrium
BLOOD SUPPLY:
Arterial Supply:
 The blood supply is from the uterine arteries
one on each side.
 The artery arises directly from the anterior
division of the internal iliac or in common
with superior vesical artery.
VEINS:
 The venous channels correspond to the
arterial course & drain into internal iliac
veins.
LYMPHATIC DRAINAGE:
 Lymphatic drainage from the uterine body is to the
internal iliac glands while from the cervix is to the
internal iliac, obturator & external iliac nodes.

NERVES:
 The nerve supply of the uterus is derived principally
from the sympathetic system & partly from the
parasympathetic system.
 Sympathetic components are from T5 to T6 (motor)
& T10 to L1 spinal segments (sensory).
CERVIX:
 Cervical stroma is mainly made of collagen, elastin &
proteoglycan with very few (10%) smooth muscle
cells.
 It is divided into two parts.
 The part inside external OS is endocervix with single
layer of mucin secreting columnar epithellium which
secrets mucus & forms mucus plug during pregnancy.
 The part of cervix outside external OS is ectocervix
which is lined by non-kerantinised stratified squamous
epithelium.
 Hence, external os is the site of squamo-columnar
junction.
 The external os in a nulliparous cervix is pinpoint
while in a multiparous cervix it is transverse slit.
FALLOPIAN TUBE
 Fallopian tubes are paired hollow muscular
tubes one on either side of the uterus.
 SIZE: Each fallopian tube is about 10cm long
& 1 cm board at ampullary part.
 From medial to lateral side, it is divided into
four parts.
PARTS: (4)
1) Interstitial or intramural portion:
 Interstitial is the narrowest part embodied in
the uterine wall & measures 1.25cm in
length & 1mm in breadth.
2) Isthmus:
 Isthmus is a straight to tortuous thick part
which measures 2.5cm in length & 1-2 mm in
diameter.
 Tubal sterilizations are usually done in this
part.
3) AMPULLA:
 Ampulla is the tortuous & wide lateral half of the
tube.
 It is 5cm in length with its lumen measuring 1-2 mm
medially & 6 mm at outer end.

4) INFUNDIBULUM:
 Infundibulum is a funnel-shaped opening of the distal
end of Fallopian tube being 1.25 cm in length & 3mm
in width.
 It has varying number of processes called fimbriae,
with one big fimbria, the ovarian fimbria (or fimbriae
ovarica) which picks up the ovum during ovulation.
STRUCTURE:
 Fallopian tube has 3 layers.
 They are serous layer, muscle layer & mucus
membrane thrown into longitudinal folds.
 It is lined with tall columnar nonciliated
secretory cells with intervening ciliated
columnar cells.
FUNCTION:
I. The tube is site for fertilization.
II. Transportation of gametes.
III. Nurtures the zygote.

CLINICAL SIGNIFICANCE:
a) Implantation may rarely occur in the
fallopian tube resulting in an ectopic
pregnancy.
BLOOD SUPPLY:
ARTERIAL SUPPLY:
 Is from the uterine & ovarian.

VENOUS DRAINAGE:
 Is through the pampiniform plexus into the ovarian
veins.
LYMPHATICS:
 The lymphatics run along the ovarian vessels to para-
aortic nodes.
NERVE SUPPLY:
 The nerve supply is derived from the uterine & ovarian
nerves. The tube is very much sensitive to handlling.
DEVELOPMENT:
 The tube is developed from the upper vertical part of
th
OVARY
 The ovary, located one on either side, is a
solid, flat, ovoid sex gland or gonad.
 It is responsible for maturation, storage &
release of germ cell (ovulation) & production
of sex hormones estrogen & progesterone
(steroidogenesis) mainly during the
reproductive period of a woman.
 Ovary meassures 3x2x2 cm & weighs 5-10g
(average 7g) during reproductive period.
POSITION
 The ovaries are usually situated in the upper
part of pelvic cavity in a slight depression on
the lateral wall of pelvic between external &
internal iliac vessels called the ovarian fossa
of Waldeyer.
 Ovaries are intraperitoneal structures.
 Each ovary is connected to the posterior
layer of the broad ligament by a short fold of
peritoneum called the mesovarium.
RELATIONS(5)
MESOVARIUM OR ANTERIOR BORDER:
 A fold of peritoneum from the posterior leaf
of the broad ligament is attached to the
anterior border through which the ovarian
vessels & nerves enter the hilum of the
gland.
POSTERIOR BORDER:
 Is free & is related to the tubal ampulla.
 It is separated by the peritoneum from the
ureter & the internal iliac artery.
MEDIAL SURFACE:
 Is related to fimbrial part of the tube.

LATERAL SURFACE:
 Is in contact with the ovarian fossa on the lateral
pelvic wall.
THE FOSSA IS RELATED:
 Superiorly to the external iliac vein, posteriorly to
the ureter & internal iliac vessels & laterally to the
peritoneum separating the obturator vessels &
nerves.
STRUCTURE
 The structure from outside to inside is
surface epithelium (germinal epithelium).
 The cortex contains all forms of ovarian
follicles & secretes the estrogen-
progesterone hormone & produces ovum &
medulla.
BLOOD SUPPLY
ARTERIAL SUPPLY:
 Is from the ovarian artery, a branch of the
abdominal aorta.
VENOUS DRAINAGE:
 Is through pampiniform plexus, to form the
ovarian veins which drain into inferior vana
cava on the right side & left renal vein on
the left side.
LYMPHATICS:
 Through the ovarian vessels drain to the para-aortic
lymph nodes.
NERVE SUPPLY:
 Sympathetic supply comes down along the ovarian
artery from T10 segment.
 Ovaries are sensitive to manual squeezing.

DEVELOPMENT:
 The ovary is developed from the cortex of the
undifferentiated genital ridges by about 9 th week;
the primary germ cells reaching the site migrating
from the dorsal end of yolk sac.
PELVIS
 Pelvis is composed of bony pelvis & soft
tissues.
 Soft pelvis is further divided into pelvis side
walls & pelvic floor.
MUSCLES OF THE PELVIS:
1) Pubococcygeus
2) Iliococcygeus
3) Coccygeus (ischiococcygeus) muscle
NERVE SUPPLY
 The pelvic floor is innervated by:
1) A branch from the fourth sacral nerve.
2) A branch from the inferior rectal nerve or
from perineal division of pudendal nerve
(S2,3,4). Coccygeuns is supplied by a
branch from fourth & fifth sacral nerves.
PERINEUM
ANATOMMICAL PERINEUM:
 The perineum is a diamond-shaped space that
lies below the pelvic floor.
 Its boundaries are as follows:

1) Superiorly: The pelvic floor is made up of the

levator ani & the coccygei muscles.
2) Laterally: From anterior to posterior the bones
& ligaments that make up the pelvic outlet are
subpubic angle, ischiopubic rami, ischial
tuberosities & sacrotuberous ligaments.
3) Inferiorly: The skin & facia
4) Posteriorly: Coccyx
 Perineum is divided into two triangular spaces by a
transverse band of transverse perineal muscle & the
base of the urogenital diaphragm.
 The anterior triangle is the urogenital triangle while
the posterior triangle is named the anal triangle.
UROGENITAL TRIANGLE
 The urogenital triangle is bounded by the
following.
1) Anteriorly: by the subpubic angle.
2) At the side: By the ischiopubic rami & the
ischial tuberosities
3) Posteriorly: By the transverse perineal
muscles & the base of the urogenital
diaphragm.
ANAL TRIANGLE
 The anal triangle is bounded anteriorly by
the transverse perineal muscles & the base
of the urogenital diaphragm, laterally by the
ischial tuberosities & the sacrotuberous
ligaments & posteriorly by the coccyx.
 Anal triangle is measure about 4cm x 4cm
with the base covered by the perineal skin.
 The apex is pointed & is continuous with the
rectovaginal septum.
 Muscles-Bulbospongiosus
OBSTETRIC PERINEUM
 The pyramidal-shaped median raphe
between anus & vagina where the pelvic
floor & the perineal muscles & fascia meet is
called the obstetric perineum.
 The following muscles meet to form this
structure.
1) Sphincter ani externus
2) Two levator ani muscle
3) Superficial & deep transverse perineal
muscles
4) Bulbocavernosus muscle.
BLOOD SUPPLY
Arterial supply:
a) Branches of internal pudendal artery-the chief
being labial, transverse perineal, artery to the
vestibular bulb & deep & dorsa arteries to the
cllitoris.
b) Branches of femoral artery-sperficial & deep
external pudendal.
VEINS:
 The veins form plexuses & drain into:

a) Internal pudendal vein

b) Vesical or vaginal venous plexus
c) Long saphenous vein.
BREASTS
 Breasts are bilateral exocrine sweat glands
concerned with lactation following
childbirth.
 Each breast usually extends from the second
to sixth rib in the mid-clavicular line from
lateral margin of sternum to anterior axillary
line.
 It lies in the subcutaneous tissue over the
fascia covering the pectoralis major muscles.
STRUCTURE (NON-LACTATING
BREASTS)
 The areola is the central pigmented area
2.5cm in diameter with sweat & modified
sebaceous glands (Montogomery’s glands).
 It contains few involuntary muscles.
 The nipple (an erectile organ) is a projecting
skin structure 1-2 cm in length.
 It lies at the center of areola.
BREAST SUBSTANCE
 Breast substance consists of glandular tissue & stroma.
 Each breast is divided into 15-20 lobes by fibrous tissue
septa which radiates from the center.
 Each lobe consists mainly of fibro-fatty tissue.
 The glandular tissue mainly contains duct system in non-
lactating breast.
 Each lobe is drained by one lactiferous duct.
 The duct is lined by cubical epithelium which becomes
stratified squamous near its opening.
 Each duct divides & sub-divides ultimately ending in 10-100
alveoli.
 Each alveolus is lined by columnar epithelium where milk
secretion occurs.
 Myoepithelial cells which are longitudinal striated cells
STROMA
 Fibro-connective tissue & fatty tissue (main
bulk) pack up the breast in between duct-
alveolar system.
 Bands of fibrous tissue called suspensory
ligaments of cooper extends from skin to
deep fascia in between lobes.
BLOOD SUPPLY
1) Intercostal arteries
2) Perforating branches of internal mammary artery
3) Lateral thoracic & sometimes external mammary
branches from axillary artery.
NERVE SUPPLY:
 Anterior & lateral cutaneous branches of fourth,
fifth & sixth thoracic nerves supply breasts.
 Sympathetic run along these nerves.
 Nipple & areola are richly supplied with nerves with
touch receptors.
THANK YOU