Download broad ligament of the uterus

INTERNAL
GENITALIA OF
FEMALE
Dr Rania Gabr
OBJECTIVES
1. Identify the uterus, its normal site, shape, parts, size
and position.
 2.
Discuss its peritoneal coverings and relations.
 3.
Discuss the uterine relations.
 4.
Determine the factors supporting the uterus.
 5.
Discuss its blood, nerve supply and lymphatic
drainage.
 6.
Enumerate the parts of the fallopian tube
 7.
Discuss its blood, nerve supply and lymphatic
drainage.
 8.
Discuss the site, size, shape, peritoneal covering and
relation of the ovary.

9. Enumerate the ligaments attached to the
ovary.
 10. Mention its blood & nerve supply and
lymphatic drainage.
 11. Discuss the site, position, length, peritoneal
covering and relation of the vagina.
 12. Mention its blood & nerve supply and
lymphatic drainage.

UTERUS



This is a hollow, thickwalled, pear-shaped
muscular organ located
between the bladder and
the rectum (in nonpregnant women).
It is 7 to 8 cm long, 5 to 7
cm wide, and 2 to 3 cm
thick.
The non-gravid (not
pregnant) uterus usually
lies in the lesser pelvis,
The uterus consists of 2 major parts:
1. The expanded superior 2/3 is known as the body
2. The cylindrical inferior 1/3 is called the cervix (L.
neck).
•
•
•
•
The uterus is usually bent anteriorly (anteflexed)
between the cervix and body.
The entire uterus is normally bent or inclined
anteriorly (anteverted).
It is frequently retroverted (inclined posteriorly) in
older women.

Different parts of the uterine tube and the uterus. B. External os of the
cervix: (above) nulliparous; (below) parous. C. Anteverted position of the
uterus. D. Anteverted and anteflexed position of the uterus
THE FUNDUS OF THE UTERUS
The fundus of the uterus is the rounded superior
part of the body.
 It is located superior to the line joining the points
of entrance of the uterine tubes.
 The regions of the body where the uterine tubes
enter are called the cornua (L. horns).

THE CERVIX OF THE UTERUS
•
•
•
Is the cylindrical, narrow inferior part of the
uterus, which has a:
1- supravaginal part :
between the isthmus and the vagina(isthmus of
uterus the constricted part of the uterus
between the cervix and the body of the
uterus),and a
•
•
•
•
2- vaginal part :
that protrudes into the vagina and
surrounds the external os of the uterus.
The supravaginal part of the cervix is
separated from the bladder anteriorly by
loose connective tissue and from the
rectum posteriorly by the rectouterine
pouch
The cervix is mostly fibrous, with a small
amount of smooth muscle and elastin
The
wall of the body of the uterus
consists of three layers
1. The
outer serous coat called the perimetrium,
consists of peritoneum
2. The
middle muscular coat called the
myometrium consists of 12 to 15 mm of smooth
muscle. The myometrium increases greatly
during pregnancy. The main branches of the
blood vessels and nerves of the uterus are
located in this layer;
3. The
•
inner mucous coat called endometrium is
firmly adherent to the underlying myometrium.
The endometrium is partly sloughed off each
month during menstruation.
 The

•
•

•
•
Ligaments of the Uterus
1- The Round Ligaments of the Uterus
These ligaments are 10 to 12 cm long and extend from the
lateral aspect of the uterus, passing anteriorly between the
layers of the broad ligament.
They leave the abdominal cavity through the inguinal canal
and insert into the labia majora.
2- The ligament of the ovary
Externally, attaches to the uterus posteroinferior to the
uterotubal junction
These two ligaments are vestiges of the ovarian
gubernaculum, related to the descent of the gonad from its
developmental position on the posterior abdominal wall
 3-
•
•
•
•
The Broad Ligament
The broad ligament of the uterus is the wide fold
of peritoneum that connects the sides of the uterus
to the walls and floor of the pelvis
The broad ligament holds the uterus in its normal
position.
The 2 layers of the broad ligament are continuous
with each other at a free edge.
This is directed anteriorly and superiorly to
surround the uterine tube.
•
•
•
•
Laterally, the broad ligament is prolonged
superiorly over the ovarian vessels as the
suspensory ligament of the ovary.
The broad ligament contains extraperitoneal tissue
(connective tissue and smooth muscle) called
parametrium.
It gives attachment to the ovary through the
mesovarium.
The mesosalpinx is a mesentery supporting the
uterine tube.
 The
contents of the broad ligament include
the following:
•
•
•
Reproductive
• Uterine tubes
• ovary (some sources consider the ovary to be on
the broad ligament, but not in it.)
vessels
• ovarian artery (in the suspensory ligament)
• uterine artery
ligaments
• ovarian ligament
• round ligament of uterus
• suspensory ligament of the ovary
 4
The Uterosacral Ligaments
pass superiorly and slightly posteriorly from the sides of the
cervix to the middle of the sacrum; they are palpable on
rectal examination
 The
Principal Support of the Uterus
1- This is the pelvic floor, formed by the pelvic diaphragm.
 2- The pelvic viscera surrounding the uterus and the visceral
fascia (endopelvic fascia) bind the pelvic viscera together.
 The two levator ani muscles, the two coccygeus muscles, and
the muscles of the urogenital diaphragm are particularly
important in supporting the uterus.

THE RELATIONSHIPS OF THE UTERUS
•
•
•
1- Anteriorly the body of the uterus is separated
from the urinary bladder by the vesicouterine
pouch.
2-Posteriorly the body of the uterus and the
supravaginal part of the cervix are separated from
the sigmoid colon by a layer of peritoneum and the
peritoneal cavity.
The uterus is separated from the rectum by the
rectouterine pouch (of Douglas).
•
•
•
The inferior part of this pouch is closely related to
the posterior part of the fornix of the vagina.
3- Laterally the relationship of the ureter to the
uterine artery is very important.
The ureter is crossed superiorly by the uterine
artery at the side of the cervix.
ARTERIAL SUPPLY OF THE UTERUS
•
•
•
•
•
1- This is derived mainly from the uterine arteries, which are
branches of the internal iliac arteries.
They enter the broad ligaments beside the lateral parts of the
fornix of the vagina, superior to the ureters.
At the isthmus of the uterus, the uterine artery divides into a
large ascending branch that supplies the body of the uterus
and a small descending branch that supplies the cervix and
vagina.
2- The uterus is also supplied by the ovarian arteries, which
are branches of the aorta.
The uterine arteries pass along the sides of the uterus
within the broad ligament and then turn laterally at the
entrance to the uterine tubes, where they anastomose with
the ovarian arteries.
VENOUS DRAINAGE OF THE UTERUS
•
•
The uterine veins enter the broad ligaments
with the uterine arteries.
They form a uterine venous plexus on each
side of the cervix and its tributaries drain
into the internal iliac vein.
LYMPHATIC DRAINAGE OF THE UTERUS
The uterine lymphatic vessels follow three main routes :
 1- Most vessels from the uterine fundus and superior
uterine body pass along the ovarian vessels to the lumbar
(caval/aortic) lymph nodes, but some vessels pass along
the round ligament of the uterus to the superficial
inguinal lymph nodes.

o
•
2- Vessels from most of the uterine body pass within the
broad ligament to the external iliac lymph nodes.
3- Vessels from the uterine cervix pass along the uterine
vessels, to the internal iliac lymph nodes and along the
uterosacral ligaments to the sacral lymph nodes.
INNERVATION OF THE UTERUS
•
The nerves of the uterus arise from the inferior
hypogastric plexus, largely from the part known as the
uterovaginal plexus.
•
•
•
•
This lies in the broad ligament on each side of the cervix.
Parasympathetic fibres are from the pelvic splanchnic
nerves (S2-4), and sympathetic fibres are from the above
plexus.
The nerves to the cervix form a plexus in which are located
small paracervical ganglia.
THE UTERINE TUBES
•
•
•
•
•
•
•
•
These are 10 cm long and 1 cm in diameter.
They extend laterally from the cornua of the uterus.
The uterine tubes carry oocytes from the ovaries and sperm
cells from the uterus to the fertilization site in the ampulla
of the uterine tube.
The uterine tube also conveys the dividing zygote to the
uterine cavity.
Each tube opens at its proximal end into the cornua or horn
of the uterus.
At its distal end, it opens into the peritoneal cavity near the
ovary.
The uterine tubes allow communication between the
peritoneal cavity and the exterior of the body.
The uterine tube is divided into 4 parts: infundibulum,
ampulla, isthmus, and intramural or uterine parts.
•
•
•
•
The infundibulum is the funnel-shaped distal end that
opens into the peritoneal cavity through the abdominal
ostium. The finger-like processes of the infundibulum,
the fimbriae, spread over the medial surface of the
ovary; one large ovarian fimbria is attached to the
superior pole of the ovary. About 2 mm in diameter
The ampulla, the widest and longest part, making up
over half of its length, begins at the medial end of the
infundibulum.
The isthmus, the thick-walled part, enters the uterine
cornu. (about 2.5 cm)
The uterine part is the short intramural segment
that passes through the wall of the uterus and opens
through the uterine ostium into the uterine cavity at the
uterine horn.
THE MESOSALPINX
•
•
The uterine tubes lie in the free edges of the
broad ligaments of the uterus.
The part of the broad ligament attached to the
uterine tube is called the mesentery of the tube
or mesosalpinx
ARTERIAL SUPPLY OF THE UTERINE TUBES
•
•
The arteries to the tubes are derived from the
uterine and ovarian arteries.
The tubal branches pass to the tube between the
layers of the mesosalpinx.
VENOUS DRAINAGE OF THE UTERINE TUBES
•
•
•
•
•
The veins of the tubes are arranged similarly to the arteries
and drain into the uterine and ovarian veins.
Lymphatic Drainage of the Uterine Tubes
The lymph vessels of the uterine tubes follow those of the
fundus of the uterus and ovary and ascend with ovarian
veins to the aortic lymph nodes in the lumbar region.
Innervation of the Uterine Tubes
The nerve supply of the uterine tubes comes partly from the
ovarian plexus of nerves and partly from the uterine plexus.
OVARIES

The almond-shaped ovaries are typically located near the
attachment of the broad ligament to the lateral pelvic walls,
suspended from both by peritoneal folds, the mesovarium
from the posterosuperior aspect of the broad ligament and
the suspensory ligament of the ovary from the pelvic wall
The suspensory ligament conveys the ovarian vessels,
lymphatics, and nerves to and from the ovary and
constitutes the lateral part of the mesovarium.
 Peritoneal coverings
 Because the ovary is suspended in the peritoneal cavity, the
oocyte expelled at ovulation passes into the peritoneal cavity
but is usually trapped by the fimbriae of the uterine tube
and carried to the ampulla.

 The
ovary also attaches to the uterus
by the ligament of ovary, which
runs within the mesovarium.
 This
ligament is a remnant of the
superior part of the ovarian
gubernaculum of the fetus and
connects the proximal (uterine)
end of the ovary to the lateral
angle of the uterus, just inferior to
the entrance of the uterine tube.
 Blood
 The
supply of the ovary:
ovarian arteries arise from the abdominal aorta
 Ovarian
veins draining the ovary form a
pampiniform plexus of veins in the broad ligament
near the ovary .
 The
veins of the plexus merge to form a
singular ovarian vein, which leaves the lesser
pelvis with the ovarian artery.

The right ovarian vein ascends to enter the
inferior vena cava; the left ovarian vein
drains into the left renal vein
 The
lymphatic vessels from the ovary:
 join those from the uterine tubes and
fundus of the uterus as they ascend to the
right and left (caval/aortic) lumbar lymph
nodes
 Innervation:
 The
nerves descend along the
ovarian vessels from the ovarian
plexus, and from the uterine (pelvic)
plexus
VAGINA
•
•
•

It extends from the cervix of the uterus to the
vestibule of the vagina.
The vagina communicates superiorly with the
cervical canal and opens inferiorly into the
vestibule of the vagina.
In the anatomical position, the vagina descends
anteroinferiorly.
The posterior wall is about 1 cm longer than the anterior
wall and is in contact with the external uterine ostium
(external os).
•
•
•
•
The vagina is located posterior to the
urinary bladder and anterior to the rectum
and passes between the medial margins of
the levator ani muscles.
It pierces the urogenital diaphragm with
the sphincter urethrae muscle.
The posterior fibres of the sphincter
urethrae muscle are attached to the vaginal
wall.
The cervix of the uterus projects into the
superior part of the anterior wall,
separating the walls of the vagina.
•
•
•
•
The uterus lies almost at a right
angle to the axis of the vagina
(anteverted position). This uterine
angle increases as the urinary
bladder fills.
The vaginal recess around the
cervix is called the fornix
It is divided into anterior, posterior,
and lateral parts.
The posterior part of the fornix is
the deepest and is related to the
rectouterine pouch
 Four
muscles compress the vagina and act
like sphincters:
pubovaginalis, external urethral sphincter,
urethrovaginal sphincter, and
bulbospongiosus
Relations:
• Anteriorly: the fundus of the urinary
bladder and urethra.
• Laterally: the levator ani, visceral pelvic
fascia, and ureters.
• Posteriorly (inferior to superior): the anal
canal, rectum, and rectouterine pouch.
VASCULATURE OF VAGINA
 The
arteries supplying the superior part of the
vagina derive from the uterine arteries;
 the arteries supplying the middle and inferior
parts of the vagina derive from the vaginal arteries
and internal pudendal arteries
 The veins form the vaginal venous plexuses
along the sides of the vagina and within the vaginal
mucosa.
 These veins communicate with the uterine venous
plexus as the uterovaginal plexus and drain into the
internal iliac veins through the uterine vein.
 The
lymphatic vessels drain from the vagina
as follows :
•
•
•
•
Superior part: to the internal and external iliac
lymph nodes.
Middle part: to the internal iliac lymph nodes.
Inferior part: to the sacral and common iliac
nodes.
External orifice: to the superficial inguinal
lymph nodes.
INNERVATION OF THE VAGINA
•
•
•
•
•
from the uterovaginal plexus.
This lies in the base of the broad ligament on each
side of the supravaginal part of the cervix.
The inferior nerve fibres from this plexus supply the
cervix and the superior part of the vagina.
The fibres supplying the vagina are derived from
the inferior hypogastric plexus and the pelvic
splanchnic nerves.
The inferior part of the vagina is supplied by the
pudendal nerve.
BARTHOLINS GLAND



Bartholin's glands (also
greater vestibular glands)
are two glands located slightly
posterior and to the left and
right of the opening of the
vagina.
They secrete mucus to lubricate
the vagina and are homologous
to bulbourethral glands in
males.
However, while Bartholin's
glands are located in the
superficial perineal pouch in
females, bulbourethral glands
are located in the deep perineal
pouch in males.
SKENE`S GLANDS
 also
known as the lesser vestibular
glands, female prostate
 The location of the Skene's gland is
the general area of the vulva, glands
located on the anterior wall of the
vagina around the lower end of the
urethra.
 It has been postulated that the
Skene's glands are the source of
female ejaculation.
THANK YOU