Anatomy of female reproductive system

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Female reproductive anatomy includes:

External genitalia (vulva)
Mons pubis, labia majora and minora, clitoris, vestibule, hymen, vestibular bulbs, and greater vestibular (Bartholin) glands.
Vagina
A fibromuscular canal extending from the vulva to the cervix. It has anterior, posterior, and lateral fornices around the vaginal portion of the cervix.
Uterus
A pear-shaped pelvic organ with fundus, body, isthmus, and cervix. Its wall has three layers: perimetrium, myometrium, and endometrium. Major supports include the pelvic diaphragm, cardinal ligaments, uterosacral ligaments, and round ligaments.
Uterine (fallopian) tubes
Four parts: infundibulum with fimbriae, ampulla, isthmus, and intramural/uterine part. Fertilization most commonly occurs in the ampulla.
Ovaries
Paired gonads located on the lateral pelvic wall. They produce ova and hormones. Key attachments are the ovarian ligament, suspensory ligament of the ovary, and mesovarium.
Blood supply, lymphatics, and nerves
Includes ovarian and uterine vessels, internal iliac branches, para-aortic and pelvic lymph-node drainage, and autonomic plus pudendal nerve supply.
Pelvic relations and applied anatomy
Relations to bladder, ureters, rectum, peritoneal pouches, and clinically relevant sites such as the pouch of Douglas.

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https://www.ncbi.nlm.nih.gov/sites/books/NBK554601

Anatomy of the Female Reproductive System

Introduction

The female reproductive system consists of organs that produce ova (female gametes), secrete sex hormones, receive sperm, provide the site for fertilization and implantation, support fetal development, and enable childbirth. It is divided into external genital organs and internal genital organs.

Definition

The female reproductive system is the group of external and internal organs concerned with reproduction. The external genitalia are collectively called the vulva, while the internal genital organs include the vagina, cervix, uterus, uterine tubes, and ovaries. NCBI anatomy reference

Diagram of uterus, uterine tubes, ovaries, cervix, and vagina

Diagram showing the parts of the uterus, vagina, uterine tubes, and ovaries. The Developing Human: Clinically Oriented Embryology, p. 92.

Classification

1. External genital organs

The external female genitalia are called the vulva. They include:

Mons pubis
Labia majora
Labia minora
Clitoris
Vestibule of vagina
External urethral opening
Vaginal opening or introitus
Hymen
Greater vestibular glands (Bartholin glands)
Paraurethral glands (Skene glands)

The vulva protects the openings of the urinary and reproductive tracts and contributes to sexual arousal.

2. Internal genital organs

A. Vagina

The vagina is a fibromuscular canal extending from the vulva to the cervix.

Length: approximately 7-9 cm anteriorly and 9-11 cm posteriorly
It lies posterior to the urethra and urinary bladder and anterior to the rectum.
Its upper end surrounds the vaginal part of the cervix, forming anterior, posterior, and two lateral fornices.
Functions:
- Receives penis and semen during sexual intercourse
- Passage for menstrual flow
- Forms the lower part of the birth canal

B. Uterus

The uterus is a hollow, muscular, pear-shaped organ situated in the pelvis between the urinary bladder and rectum.

Parts

Fundus: Dome-shaped upper part above the openings of the uterine tubes
Body: Main central part
Isthmus: Narrow segment between body and cervix
Cervix: Lower cylindrical part projecting into the vagina

Normal position

Usually anteverted and anteflexed:
- The uterus bends forward over the bladder.
- The body is bent forward in relation to the cervix.

Layers of uterine wall

Perimetrium: Outer serous covering
Myometrium: Thick smooth-muscle layer, important in labor
Endometrium: Inner mucosal lining that undergoes cyclical menstrual changes and receives the implanted embryo

Functions

Menstruation
Implantation and nourishment of the embryo
Growth and protection of the fetus
Expulsion of the fetus during childbirth

C. Uterine tubes

The uterine tubes, also called fallopian tubes or oviducts, extend laterally from the upper part of the uterus toward the ovaries. Each is about 10-12 cm long.

Parts of each uterine tube

Infundibulum: Funnel-shaped lateral end
Fimbriae: Finger-like projections that help collect the ovum
Ampulla: Widest and longest part
Isthmus: Narrow medial part
Intramural or uterine part: Part within the uterine wall

Importance: Fertilization usually occurs in the ampulla. NCBI tubal anatomy

D. Ovaries

The ovaries are paired female gonads, almond-shaped and located on the lateral wall of the pelvis.

Functions

Produce ova
Secrete hormones, mainly estrogen and progesterone

Attachments

Ovarian ligament: Connects ovary to uterus
Suspensory ligament of ovary: Connects ovary to the lateral pelvic wall and contains ovarian vessels
Mesovarium: Short peritoneal fold attaching the ovary to the broad ligament

Supporting Ligaments of the Uterus

The uterus is supported mainly by pelvic floor muscles and fascial ligaments:

Pelvic diaphragm, especially levator ani muscles
Transverse cervical or cardinal ligaments
Uterosacral ligaments
Pubocervical ligaments
Round ligaments of uterus, which help maintain anteversion
Broad ligaments, which are peritoneal folds but do not provide major mechanical support

Blood Supply

Organ	Main arterial supply	Venous drainage
Ovary	Ovarian artery from abdominal aorta	Right ovarian vein to inferior vena cava; left ovarian vein to left renal vein
Uterus	Uterine artery, branch of internal iliac artery	Uterine venous plexus to internal iliac veins
Vagina	Vaginal artery and branches of uterine artery	Vaginal venous plexus to internal iliac veins
Vulva	Internal pudendal artery	Internal pudendal veins

The uterine artery crosses superior to the ureter near the cervix. This is clinically remembered as: “water under the bridge” - the ureter passes beneath the uterine artery.

Lymphatic Drainage

Ovaries and uterine tubes: Para-aortic (lumbar) lymph nodes
Body of uterus: External iliac lymph nodes
Fundus of uterus: May drain along the round ligament to superficial inguinal nodes
Cervix: Internal iliac and sacral lymph nodes
Upper vagina: Internal iliac nodes
Lower vagina and vulva: Superficial inguinal lymph nodes

Nerve Supply

Internal reproductive organs receive autonomic fibers through the inferior hypogastric plexus.
The vulva and lower vagina receive somatic sensation mainly through the pudendal nerve.
Pain from the upper uterus and ovaries may be referred to lower abdominal or lumbar regions; pain from the lower vagina and vulva is generally more localized.

Applied Anatomy

Ectopic pregnancy most often occurs in the ampulla of the uterine tube.
Pelvic inflammatory disease may damage the uterine tubes and cause infertility or ectopic pregnancy.
The pouch of Douglas or rectouterine pouch is the lowest part of the peritoneal cavity in a standing female and can collect fluid or blood.
During hysterectomy, the ureter is at risk because it passes close to and beneath the uterine artery.
Weakness of the pelvic supports can result in uterine prolapse.

The main anatomical components are the vulva externally and the vagina, cervix, uterus, uterine tubes, and ovaries internally, as outlined in Sabiston Textbook of Surgery, “Female Reproductive and Pelvic Anatomy.”

Uterine cancer diagnostic evaluations with purpose

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NCI endometrial cancer diagnosis tests biopsy transvaginal ultrasound staging

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https://www.cancer.gov/types/uterine/hp/endometrial-treatmen…

Uterine Cancer: Diagnostic Evaluations and Their Purpose

Uterine cancer usually refers to endometrial cancer, a cancer arising from the inner lining of the uterus. Less commonly, it may arise from the uterine muscle or connective tissue, called uterine sarcoma. The most frequent warning symptom is abnormal uterine bleeding, particularly bleeding after menopause.

Diagnostic Evaluations

Evaluation	Purpose
History taking	Identifies symptoms and risk factors. Important symptoms include postmenopausal bleeding, irregular heavy bleeding, watery or blood-stained vaginal discharge, and pelvic pain. Risk factors include obesity, diabetes, prolonged estrogen exposure, tamoxifen use, and Lynch syndrome.
General and pelvic examination	Evaluates the vulva, vagina, cervix, uterus, and adnexa. It may detect uterine enlargement, a pelvic mass, cervical involvement, vaginal spread, or another source of bleeding. A normal examination does not exclude endometrial cancer.
Transvaginal ultrasonography (TVUS)	Uses a vaginal ultrasound probe to examine the uterus and measure endometrial thickness. Its purpose is to assess abnormal bleeding, identify thickened endometrium, polyps, fibroids, or an intrauterine mass, and help decide whether tissue sampling is needed. It supports evaluation but does not confirm cancer. NCI screening guidance
Endometrial biopsy or sampling	A thin catheter, commonly a Pipelle device, is passed through the cervix to obtain endometrial tissue. This is the main outpatient test to confirm or exclude malignancy and identify hyperplasia, cancer type, and often tumor grade. A tissue sample is necessary for a definitive diagnosis. NCI diagnostic evaluation
Dilation and curettage (D&C)	The cervix is dilated and endometrial tissue is scraped or suctioned. It is used when an office biopsy is inadequate, impossible, or negative despite persistent suspicious bleeding. Its purpose is to obtain a larger tissue sample for histopathology.
Hysteroscopy with directed biopsy	A thin telescope is introduced through the cervix to view the uterine cavity directly. It detects focal lesions such as polyps or localized tumors that may be missed by blind biopsy, and allows a targeted biopsy. Berek & Novak’s Gynecology notes that hysteroscopy provides information not obtained by blind endometrial sampling.
Histopathological examination	A pathologist examines biopsy or curettage tissue under a microscope. Its purpose is to establish the diagnosis, determine histological type, such as endometrioid, serous, or clear-cell carcinoma, determine tumor grade, and identify features relevant to prognosis and treatment.
Cervical cytology (Pap test)	Primarily screens for cervical cancer, not uterine cancer. Its purpose in this context is to detect an abnormal cervix or occasionally reveal abnormal endometrial cells that prompt further endometrial evaluation. It cannot rule out endometrial cancer.
MRI of pelvis	Helps assess the local extent of confirmed disease, especially depth of myometrial invasion, cervical stromal involvement, and adjacent pelvic-organ involvement. Its purpose is preoperative staging and surgical planning, not primary confirmation of cancer.
CT scan of chest, abdomen, and pelvis	Used especially for high-grade, advanced, or symptomatic disease. It evaluates enlarged lymph nodes, lung, liver, peritoneal, or other distant metastases.
PET-CT scan	Not routinely needed for every patient at initial diagnosis. It may be used if recurrent or metastatic disease is suspected, to identify metabolically active lymph-node or distant metastases.
Blood tests: CBC, renal and liver function tests	Do not diagnose uterine cancer. Their purpose is to assess anemia caused by bleeding, establish baseline organ function, and determine fitness for imaging, surgery, chemotherapy, or radiotherapy.
CA-125	Not a routine diagnostic test for all endometrial cancers. It may be measured in selected high-risk cases, such as serous carcinoma or suspected extrauterine spread, to support assessment and later monitoring.
Molecular testing of tumor tissue	Tests may include mismatch-repair protein immunohistochemistry or microsatellite instability testing, p53 testing, and POLE mutation analysis. Their purpose is to refine prognosis, identify possible Lynch syndrome, classify risk, and guide decisions about adjuvant or systemic therapy. The NCI encourages molecular classification when feasible. NCI treatment reference
Surgical staging	After cancer is confirmed, total hysterectomy with removal of both tubes and ovaries is generally performed when appropriate. Sentinel lymph-node biopsy or lymph-node assessment, peritoneal washings in selected cases, and assessment of other tissues determine the true extent of spread and final FIGO stage.

Key Point

Endometrial biopsy is the definitive diagnostic test.
Ultrasound and imaging can identify suspicious findings and assess spread, but they cannot replace histopathological confirmation from endometrial tissue.

Simple Diagnostic Sequence

Abnormal uterine bleeding, especially postmenopausal bleeding
History, pelvic examination, and transvaginal ultrasound
Endometrial biopsy
Hysteroscopy with directed biopsy or D&C if biopsy is inadequate or suspicion remains
Histopathology and molecular testing
MRI, CT, or PET-CT when indicated for staging
Surgical staging for confirmed operable disease

There is no routine screening test for asymptomatic average-risk women. Evaluation is directed by symptoms, particularly abnormal bleeding. NCI screening overview

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