The paired fallopian tubes extend from the ovaries to the uterus. The luminal diameter of the uterine tubes is very narrow and, in fact, is only as wide as a human hair.

• Infundibulum and fimbriae. The infundibulum is the funnel-shaped, peripheral end of the uterine tube. The infundibulum has fingerlike projections called fimbriae. The fimbriated end of the uterine tube is not covered by peritoneum, which provides open communication between the uterine tube and the peritoneal (pelvic) cavity. In contrast to the male reproductive system, where the tubules are continuous with the testes, the uterine tubes are separate from the ovaries. Oocytes are released (ovulation) into the peritoneal cavity. The beating of the fimbriae may create currents in the peritoneal fluid, which carry oocytes into the uterine tube lumen.
• Ampulla. The ampulla is a region of the uterine tube where fertilization usually occurs.
• Isthmus. The isthmus is the constricted region of the uterine tube where each tube attaches to the superolateral wall of the uterus.

Uterus

The uterus is a pear-shaped organ located in the female pelvis between the urinary bladder anteriorly and the rectum posteriorly. The average dimensions are approximately 8 cm long, 5 cm across, and 4 cm thick.

The uterus is a hollow organ that functions to receive and nourish a fertilized oocyte until birth. Normally, the uterus is flexed anteriorly, where it joins the vagina; however, the uterus may also be retroverted (flexed posteriorly). The pelvic and urogenital diaphragms support the uterus. The uterus consists of the following subdivisions:

• Fundus. The rounded superior surface between the uterine tubes.
• Body. The main part of the uterus located between the uterine tubes and isthmus. The lumen of the uterus is triangular in the coronal section and continuous with the uterine tubes and vaginal canal.
• Isthmus. The narrow region between the body and the cervix.
• Cervix. The outlet that projects into the vagina. The internal os is the junction of the cervical canal and the uterine body; the external os communicates with the vaginal canal.
• Arterial supply.
  • From branches of the anterior division internal iliac artery (uterine arteries) and aorta (ovarian arteries). The uterine artery occasionally gives off the vaginal artery (although this is usually a separate branch of the internal iliac artery), which supplies the upper vagina, and the arcuate arteries, which surround the uterus. It then further branches into the radial arteries, which penetrate the myometrium to provide blood to all layers, including the endometrium.

• Once these vessels reach the endometrial level, they branch into the basal arteries and spiral arteries, which support the specialized functions of each layer. The basal arteries are not responsive to hormones; they support the basal endometrial layer, which provides the proliferative cells for endometrial growth. The spiral arteries supply the functionalis layer and are uniquely sensitive to steroid hormones. In ovulatory cycles in which pregnancy does not occur, menses results following constriction of these terminal arteries, causing endometrial breakdown with desquamation of the glands and stroma.

Broad Ligament

The uterine tubes and uterus are covered by a layer of peritoneum on the anterior, superior, and posterior surfaces.. Inferior to the uterine tube and lateral to the uterus, the peritoneal membrane is fused into a double layer called the broad ligament.

• Mesosalpinx. The uterine tubes course along the upper edge of the broad ligaments. This portion of the broad ligament is called the mesosalpinx.
• Suspensory ligament of the ovary. The ovarian arteries and veins course between the double layers of the broad ligament. This portion of the broad ligament is called the suspensory ligament.
• Round ligament. The round ligament is a fibrous cord that courses from the uterus through the deep inguinal ring and inguinal canal, exits the superficial inguinal ring, and attaches to the labia majora. The round ligament courses between the double layers of the broad ligament.
• Ovarian ligament. This ligament is a fibrous cord that connects the ovary to the uterine body.
• Mesovarium. The ovary is partially covered by a separate posterior fold of the broad ligament called the mesovarium.
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The vagina serves as the inferior region of the birth canal. It also serves as the passageway for the sloughed endometrium that results from menstruation and is the receptacle for the penis during sexual intercourse. The recesses between the cervix and the vaginal wall are known as the fornices. The vascular and lymphatic supply for the vagina is as follows (Figure 14-2A and B):

• Vascular supply. Receives blood supply from the vaginal branches of the uterine artery and the internal iliac artery.
• Lymphatic drainage. Lymph drains in two directions. The lymphatics from the upper region drain into the internal iliac nodes. Lymphatics from the lower region of the vagina drain into the superficial inguinal nodes.

A. External female genitalia. B. Sagittal section as seen through the female pelvis. C. Erectile muscles and tissues in the female. D. Coronal section of the female perineum.

 

The deep perineal space is located between the superior and inferior fascia of the urogenital diaphragm See: Picture. The urogenital diaphragm stretches between the paired pubic rami and the ischial rami. The urethra and the vagina pierce the urogenital diaphragm. The urogenital diaphragm consists of the deep transverse perineal muscle and the internal urethral sphincter, both of which are covered by fascia (superior and inferior fascia of the UG diaphram). The perineal branch of the internal pudendal nerve innervates both muscles. The space also contains the internal pudendal vessels and the pudendal nerve.

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The perineal body is a fibromuscular mass located at the center of the perineum, between the anus and vagina. The perineal body serves as an attachment site for the superficial and deep perineal muscles and the bulbospongiosus, levator ani, and external anal sphincter muscles.