Anatomy of the Female Reproductive System

Let us begin with the recap of the female genital tract starting from the inferior end and working our way up superiorly:

• The vulva is the external female reproductive organ and is composed of the following parts:
  • Labia Majora - the prominent longitudinal cutaneous fold that is similar to skin and is composed of stratified squamous epithelium that is keratinized with skin appendages, sweat glands, sebaceous glands, hair, etc.
  • Labia Minora - two small cutaneous folds within the labia majora that has a thin outer layer, a non-keratinized inner layer, no hair and fewer glands
  • Bartholin’s glands - Located in the 4 O’clock and 8 O’clock positions; they are composed of 3 types of epithelium = Mucous columnar (the glands themselves are composed of this), Transitional (the ducts that drains the glands; they tend to be mixed though), and Squamous (their opening into the vestibule which has the same epithelium)
  • Vestibule - space that contains openings of Bartholin’s glands, vagina, and urethra for a total of 4 orfices
     

The vagina is both an external and internal female reproductive organ that extends from the vulva to the uterus; upper 1/3 is from fused Mullerian ducts while the lower 2/3 is from the urogenital sinus; composed of non-keratinized squamous cell epithelium with lots of glycogen seen histologically as spaces
 

• The cervix is the neck of the uterus, the organ of gestation
  • Outer portion or exocervix is formed from stratified squamous epithelium that is not keratinized under normal circumstances; looks like the vagina
  • Inner portion or endocervix is composed of mucinous, columnar epithelium
  • Transformation zone is the part of the cervix between the original squamocolumnar junction  (transition from squamous to mucinous columnar) and the current squamocolumnar junction = moves up during a woman’s life (squamous epithelium creeps over the mucinous columnar in a process known as squamous metaplasia; may be due to the fact that the squamous epithelium is a tougher one and are more tolerant in this high-traffic area) = key area for precancers and cancers and area where most of the HPV-related lesions occur
  • Hormonally active so may be atrophic in elderly women

  Now for the history and mythology of the “mysterious” uterus. How fascinating! Anyway, I could only jot down that the “spongy cervix was once thought to be a respiratory organ”, and that it “migrated in and out of the abdomen”. Obviously proven true… *sarcasm*

   

  When you use a speculum, your viewpoint is from below the uterus. The only structure you can see is the cervix of the uterus. The rest of the uterus is in the pelvic cavity in the lower abdomen. In this lecture, we’ll talk about the parts of the uterus as three separate entities – the cervix, the endometrium (uterine lining) and the myometrium.

  When describing the uterus to a patient, you can say that it looks like an upside down test tube with a pear on top. The bottom part of the test tube is the cervix and the pear is the uterus. 

  The lateral view of the uterus is show above. You can see the urinary bladder, rectum, vagina, and tilted-forward anteverted uterus. The anteverted uterus is the normal position but it doesn’t have to be the only normal one. A variant is the tilted-backward retroverted uterus. Remember, the retroverted uterus is not a pathologic condition but a variant of the norm.

   

  The pelvic exam is performed to form a 3D mental image of the uterus. If the woman is not too heavy, you can also feel the ovaries. The point of the exam? To feel for any masses in the uterus and ovaries. 

  For those fortunate to have gone through the GTA already, you’ll know how this works. You place one finger in the vagina and the other hand is on the abdomen to keep the uterus down.

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