Female Reproductive Anatomy

Overview

• Female reproductive anatomy: ligaments
  • broad ligament of uterus
    • connects uterus, Fallopian (uterine) tubes, and ovaries to lateral walls and floor of pelvis
    • mesosalpinx
      • a subdivision of broad ligament that suspends Fallopian (uterine) tubes
    • mesovarium
      • a subdivision of broad ligament that suspends ovaries
    • mesometrium
  • round ligament of uterus 
    • connects fundus of uterus to labia majora
    • within broad ligament
    • enters deep ring, passes through inguinal canal, and exits superficial ring
    • a derivative of lower part of gubernaculum
  • cardinal ligament of uterus 
    • aka transverse cervical (Mackenrodt’s) ligament of uterus
    • connects cervix and lateral parts of fornix of vagina to lateral pelvic walls
    • contains uterine artery/vein
      • uterine artery via anterior division of internal iliac artery
  • sacrospinous ligament
    • connects ischial spine to sacrum, lies superior to the pudendal nerve (S2-4)
      • pudendal nerve block through sacrospinous ligament 
  • ovarian ligament
    • connects ovary to uterus 
  • suspensory ligament of ovary
    • connects ovary to lateral walls of pelvis
    • contains ovarian artery/vein, nerves, and lymphatics
      • ovarian artery via abdominal aorta
• Female reproductive anatomy: pouches of pelvis
  • vesicouterine pouch
    • a peritoneal sac between bladder and uterus
  • rectouterine pouch (of Douglas)
    • a peritoneal sac between uterus and rectum
    • lies behind posterior fornix of vagina
    • lowest portion of peritoneal cavity
• culdocentesis is aspiration of fluid from rectouterine pouch by a needle puncture of posterior fornix of vagina

Blood Supply

• Arterial supply
  • ovarian artery passes just over the ureter 
  • “bridge over troubled waters”
• Venous drainage
  • left ovarian vein → left renal vein → inferior vena cava (IVC) 
• right ovarian vein → inferior vena cava (IVC)

Lymphatic Drainage

• Lymphatic drainage
  • lumbar (para-aortic) lymph nodes
    • ovary
    • fundus of uterus
  • superficial inguinal lymph nodes
    • vulva
    • superolateral uterus (via round ligament of uterus)
  • internal iliac (hypogastric) lymph nodes
    • upper vagina
    • middle vagina
    • body of uterus
    • cervix
  • external iliac (obturator) lymph nodes
    • upper vagina
    • body of uterus
    • cervix
  • sacral lymph nodes
    • lower vagina