Anatomy and Embryology of the

Female Reproductive System

Gynaecology Lecture


September 28
th
2009

By

Abdel-Fattah Salem, M.D., F.R.C.O.G.
The Bony Pelvis
Sex differences in the pelvis
Female
Iliac blades more vertical
Iliac fossa shallower
Sacrum broader
Sub-pubic arch 80-85:
Ischiopubic rami narrower
Obturator foramen
traiangular
Greater sciatic notch wider
Greater anteroposterior
diameters


Male
Iliac crest rugged


Sub-pubic arch 50-60:

Obturator foramen ovoid
Ischial spines closer

Cavity longer and more
conical


Normal Pelvic Shape in Females
The brim is round
Sacral promontory is not prominent
The angle of inclination is about 55: to the
horizontal
The cavity is shallow with straight, non-converging
walls
The sacrum is smoothly curved
In the outlet the sacro-scieatic notches are wide
and shallow


Normal Pelvic Shape in Females(continued)
The sacrum does not project forwards

The ischial spines are not prominent

The pubic arch is wide and domed

The sub-pubic angle is about 90:

The inner tuberous diameter is wide accommodating four
knuckles of the average-sized hand with ease

Pelvic Diameters (cm)

Antero-posterior Oblique Transverse
Brim 11-11.5 12.5

Cavity 12

Outlet 12.5 11-11.5

12 12 12
12




12




12
Angle of Inclination
Uteropelvic axes
Anatomy of the female
reproductive organs
External Genitalia
Referred to collectively as the
vulva
Blood Supply: Internal pudendal artery

Nerve Supply: Pudendal nerve (sensory)

Lymphatic Drainage: via the inguinal nodes

Muscular
Canal
Extends from
cervix to
vulva
Anterior to
Rectum
Posterior to
bladder
Epithelial
Lining
Rugated,
stratified
squamous
Separated by
cervix into;
Anterior
fornix
Posterior
fornix
Lateral fornix
Vagina
Vagina (continued)
Blood Supply;
- Uterine artery
- Inferior pudendal artery
- Inferior vesical artery
- Middle rectal artery

Lymphatic Drainage;
- Lower 1/3 Vulva
- Upper 2/3 Cervix
Uterus
Muscular
Organ
Thick walled

Between bladder
and rectum
Consists
of 2
parts;
Uterine Corpus

Cervix
Blood
Supply
Uterine Corpus:
Uterine artery

Cervix: Cervical branch
of uterine artery
Uterine Support
Uterus supported by;
- Pelvic Diaphragm
- Pelvic Organs
- 4 paired sets of ligaments


Round Uterosacral Cardinal Broad
Round Ligament
Anterior surface of uterus

Labia majora
Start
End
Inginal canal
Broad Ligament
Paths
through
Keeps uterus anteverted
Function
Uterosacral Ligament
Origin Sacral Fascia

Insertion Posterior Inferior Uterus

Functions

-Mechanical Support -Contains autonomic nerves
Cardinal Ligament
Origin: Lateral pelvic wall

Insertion: Lateral cervix and vagina

Function;
- Mechanical support
- Prevent prolapse
Broad Ligament
Origin: Lateral pelvic wall

Insertion: Sides of uterus

Structures coursing through broad ligament;
- Fallopian tubes
- Round ligament
- Ovarian ligament
- Nerves, vessels, lymphatics
Fallopian Tubes
8-14 cm muscular tubes extending laterally from
uterus
Consists of 4 segments;
- Interstitial - Isthmic
- Ampullary - Infundibular
Ends with fimbriae at the ovary
Mesosalpinx is a peritoneal fold that attaches the
fallopian tubes to the broad ligament
Blood supply: Uterine and ovarian arteries
Ovaries
Consists of 2 parts;
- Cortex contains ova
- Medulla contains blood vessels

Mesovarium is a peritoneal fold that attaches the
ovary to the broad ligament

Blood supply: ovarian arteries (branch of aorta)

Left ovarian vein drains into left renal vein
Embryology
Gonadal differentiation
Ovarian differentiation

Determined by presence of
two X chromosomes

Located on short arm of X
chromosome

Absence of short arm of X
chromosome results in
ovarian agenisis
Testicular differentiation
TDF induces differentiation
Determined by presence of
cell surface antigen (H-Y)

Gene for H-Y antigen
located close to TDF gene
In Females In Males
Development of the ovary
25
th
Day
Germ cells
originate
from;
Primitive
hind gut
30
th
Day
Germ cells
migrate to;
Root of
mesentry
At birth
At puberty
Number of
follicles;
2 million
300,000
Development of the ovary (continued)
The coelomic epithelium proliferates and forms the
genital ridges
At early stages the primitive gonads consist of mesoderm
covered by coelomic epithelium
Germ cells migrate from the root of mesentry to the
genital ridge
Epithelium growing into the genital ridges forms the sex
cords
Germ cells and most of the sex cords remain in the
superficial part to form the ovarian cortex
Some of the sex cord cells form the ovarian medulla

Mullerian Duct
Also known as paramesonephric duct
The 2 mullerian ducts extend caudally until they reach
the urogenital sinus at 9 weeks gestation
The blind end projects into the posterior wall of the
sinus to become the mullerian tubercle
Lower ends of ducts fuse in the midline to form the
uterus and cervix
The thick muscular walls of the uterus and cervix
develop from proliferation of the mesenchyme
The cephalic ends of the ducts remain separated to
form the fallopian tubes


Development of the Vagina
Develops from an area of marked growth of the
mullerian tubercle also known as vaginal plate
The vaginal plate grows in all dimensions greatly
increasing the distance between the cervix and the
urogenital sinus
The upper 4/5
th
of the vagina is formed from the
Mullerian duct
The lower 1/5
th
of the vagina is formed from the
urogenital sinus


Development of external genitalia
The primitive cloaca is divided by a transverse
septum into;
- anterior urogenital portion
- posterior rectal portion

The genital folds and the genital swellings are
then formed by the proliferation of mesoderm
around the end of the urogenital sinus
The bladder and urethra form from the
vesicourethral portion of the urogenital sinus
External Genitalia
Genital tubercle enlarges
slightly Clitoris

Genital folds Libia
minora

Genital swelling
Libia majora
Genital tubercle enlarges
substantially Penis

Genital folds fuse
Penile urethra

Genital swelling
Scrotum
In Females In Males
Uterine Anomalies




Absence of Uterus Fusion Anomalies
Absence of the Uterus
Fusion anomalies of the uterus
Incidence;
-Overall; not uncommon
- Lesser degrees of defects are quite common
Minor fusion defects are asymptomatic
Possible presenting symptoms;
- Repeated abortion
- Persistent transverse lie of the fetus in late pregnancy
- Uterus didelphysis (double uterus) may lead to obstructed
labour
- Profound bleeding from rupture of rudimentary horn
consequent to implantation of the fetus
Agenesis of one Mullerian duct Unicornuate uterus
Incomplete fusion of Mullerian duct Double, arcuate or
septate uterus
Fusion anomalies of the uterus
Vaginal Anomalies





Absence of vagina Vaginal Septum
- Longitudinal
- Transverse

Absence of vagina
Generally associated with absence of uterus which
presents with 1: amenorrhea

Rarely; uterus maybe present and vagina absent

Secondary sexual characters + primary amenorrhea
ANATOMICAL DEFECTS such as;
- imperforate hymen
- absent vagina
Absence of vagina (treatment)
Meticulous search for urinary anomalies

Use of dilators in cases of absent uterus

McIndoe and Read operation; the created vagina
is then lined by either;
- split-skin graft
- amnion

Williams operation (vulvovaginoplasty)

Treatment; cruciate surgical incision
Imperforate hymen
Imperforate hymen/
Transverse vaginal septum
Called hydrocolpos

Fluid consists of cervical
and endometrial mucous
or in rare instances urine
accumulated through a
vesicovaginal fistula
proximal to the
obstruction.

Called hematocolpos

Presenting with acute
retention of urine

Primary amenorrhea
In newborns After puberty


A doctor who cannot take a good
history and a patient who cannot
give one are in danger of giving
and receiving bad treatment.

Author Unknown

Thank You