Property of Department of Obstetrics & Gynecology, Faculty of Medicine, University of Zagazig, Egypt

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3. Topographic anatomyTopographic anatomy
2 lines divide the abdomen into:2 lines divide the abdomen into:
• 2 vertical lines:2 vertical lines: (Right and left) extending
from mid clavicular to mid inguinal points
dividing the abdomen into 3 planes.
• 2 Horizontal lines:2 Horizontal lines: The first passing through
the lower costal margin (Subcostal plane),
while the second is the Inter-tubercular plane.

4. Topographic anatomyTopographic anatomy
The abdomen is divided into 9 quadrants:The abdomen is divided into 9 quadrants:
• Right and left hypochondrium
• Right and left lumbar
• Right and left iliac
• Epigastrium
• Umbilical and
• Hypogastrium (or supra pubic regions).

6. PerineumPerineum
• Boundaries:Boundaries:
Inferior pubic ligament  Pubic ramus  Ischeal
tuberosity  Sacrotuberous ligament Tip of
coccyx.
• Divisions:Divisions:
By imaginary line passing
between the 2 Ischeal
tuberosities:
1) Anterior division:1) Anterior division: Uro-
genital triangle.
2) Posterior division:2) Posterior division: Anal
triangle.

7. Blood supply of PerineumBlood supply of Perineum
4. Dorsal a. of clitoris4. Dorsal a. of clitoris
5. Deep a. of clitoris5. Deep a. of clitoris
2. Artery of the bulb2. Artery of the bulb
3. Labial a.3. Labial a.
1. Inferior rectal a1. Inferior rectal a
Internal pudendal a.Internal pudendal a.

9. PudendumPudendum
The vulva consists of:The vulva consists of:
1.1. The mons pubisThe mons pubis
2.2. The labia ( majoraThe labia ( majora
and minora)and minora)
3.3. External urethalExternal urethal
meatusmeatus
4.4. The clitorisThe clitoris
5.5. VestibuleVestibule

10. PudendumPudendum
Mons Pubis:
A mass of fat covered by skin and hair that
overlies the symphysis pubis.
Labia Majora:
2 rounded mass of tissues
covered by skin
Originates in mons pubis
and terminates in
perineum.

11. Deep Structures:Deep Structures:
1.1. Skin:Skin: Thin.
2.2. Tunica dartos:Tunica dartos: Poorly
developed muscle layer.
3.3. Fascia:Fascia: Thin layer.
4.4. Sweat and SebaceousSweat and Sebaceous
glands:glands: Numerous.
Arterial Supply:Arterial Supply:
Internal & external pudendal
arteries
PudendumPudendum

12. PudendumPudendum
Clitoris:Clitoris:
The clitoris is homologous
to the penis and consists
of 2 small erectile bodies
terminating into glans
clitoris.

13. Labia Minora:Labia Minora:
2 folds of thin flaps of non-keratinized pigmented
skin within labia majora.
• Anteriorly:Anteriorly: Divide into 2 flaps unites above
clitoris to form the prepuce.
• Posteriorly:Posteriorly: The 2 labia unit to form a sharp
fold of skin called the fourchette
Arterial Supply:Arterial Supply:
1. Superficial perineal artery
2. Dorsal artery of clitoris
PudendumPudendum

14. VestibuleVestibule
A) External Urethral Meatus:A) External Urethral Meatus:
Present in the anterior part of
the vestibule.
• Skene`s tubulesSkene`s tubules are 2
para-urethral ducts which
opens in the floor of
urethra

15. VestibuleVestibule
 After delivery, the
hymen is destroyed
leaving the Carunculae
Hymenalis.
B) Hymen:B) Hymen:
 A fold of mucous membrane at the vaginal
orifice covered by squamous epithelium on
both sides.
 It has one or more opening to allow escape of
menstrual blood.
Hymen

16. VestibuleVestibule
B) Hymen - Types:B) Hymen - Types:

17. VestibuleVestibule
C) Vestibular Bulbs:C) Vestibular Bulbs:
They are 2 collections of
erectile tissue surrounding
the vaginal orifice.

18. VestibuleVestibule
D) Bartholin Glands:D) Bartholin Glands:
 They are 2 glands, lies in
the posterior third of labia
majora just inferior and
lateral to bulbo-cavernosus
muscle.
 It is composed of racemose
gland. The acini lined by
single layer of columnar
epithelium, while the duct is
lined by transitional
epithelium.

19. Muscles of external genitaliaMuscles of external genitalia
1) Bulbo-Cavernosus muscle:1) Bulbo-Cavernosus muscle:
Arise from the middle of the perineal body and
terminate into clitoris
2) Ischeo-Cavernosus muscle:2) Ischeo-Cavernosus muscle:
Arise from the ischeal tuberosity and terminate
into the base of clitoris.
3) Transversus muscle:3) Transversus muscle:
Arise from ischeal tuberosity and inserted into the
central tendon of perineum.

20. Muscles of external genitaliaMuscles of external genitalia

22. The VaginaThe Vagina
Position:Position:
It lies between the
bladder and urethra
anteriorly while the
rectum and anal canal
lies posteriorly.
It is directed upwards
and backwards.
Canal, which connects the uterus with theCanal, which connects the uterus with the
vestibulevestibule

23. The VaginaThe Vagina
Vaginal walls:Vaginal walls:
Anterior wall:Anterior wall:
7.5 cm longs and directly related to bladder base
and urethra.
Posterior wall:Posterior wall:
Longer than the anterior wall (9 cm long) and
related to:
 Upper 1/3:Upper 1/3: Covered by peritoneum of
Douglas pouch.
 Middle 1/3:Middle 1/3: Related to rectum.
 Lower 1/3:Lower 1/3: Separated from the anal canal by
the perineal body

24. The VaginaThe Vagina
Fornices of vagina:Fornices of vagina:
The upper vagina surrounds the cervix to form
vaginal fornices.

25. Histology of the VaginaHistology of the Vagina
1) Vaginal mucosa:1) Vaginal mucosa:
 It is thrown into folds or rugae, which allows
distension of vagina, lined by stratified squamous
epithelium containing glycogen.
 Doderlein`s Bacilli break down glycogen into
lactic acid, the reaction of vagina is acidic (PH 4-5)
 Estrogens stimulate deposition of glycogen into
vaginal mucosa.
 Mucosa does not contain glands but the vagina is
kept moist by serous transudation from its wall.
Vaginal rugae

26. Histology of the VaginaHistology of the Vagina
2) Submucosal layer:2) Submucosal layer:
A layer of connective tissue containing elastic
fibers
3) Muscular layer:3) Muscular layer:
Outer longitudinal and inner circular smooth
muscle layers

28. Levator anii muscleLevator anii muscle
Origin:Origin:
Body of pubis, white line,
inner surface of ischeal
spines.
Insertion:Insertion:
The muscles of both sides
meet together forming
the greater part of pelvic
floor and become
differentiated into 3 parts

29. Levator anii muscleLevator anii muscle
1. Pubo-coccygeous: Arise from the body of
pubic bone and meet its opposite side in the
mid-line, it is pierced by the urethra, vagina,
and rectum.
2. Ilio-coccygeous: Arise from white line to be
inserted into the coccyx.
2. Ischeo-coccygeous: Arise from ischeal
spines and inserted into the coccyx and last
piece of sacrum.

30. Levator anii muscle - DivisionsLevator anii muscle - Divisions
Ilio-coccygeousIlio-coccygeous
Ischeo-coccygeousIscheo-coccygeous
UrethraUrethra
VaginaVaginaPubo-coccygeousPubo-coccygeous
RectumRectum

31. Levator anii muscle - RelationsLevator anii muscle - Relations
Upper Surface (Pelvic):Upper Surface (Pelvic):
• Pelvic diaphragm (Superficial fascia).
• Urinary bladder, vagina, rectum, and broad
ligament.
Lower Surface (Perineal):Lower Surface (Perineal):
• Pelvic fascia (Inferior fascia).
• Forms the medial wall of ischeo-rectal fossa.

32. Levator anii muscle - RelationsLevator anii muscle - Relations
Anterior border:Anterior border:
Separated from opposite muscle by space occupied
by the urethra and vagina
Posterior border:Posterior border:
Close to coccyx.
Action:Action:
1. Supports the pelvic organs.
2. Sphincters for the urethra, vagina, and rectum
3. Internal rotation of the head.

34. The UterusThe Uterus
A hollow muscular organ, which lies betweenA hollow muscular organ, which lies between
the urinary bladder and rectumthe urinary bladder and rectum
Dimensions:Dimensions:
• LengthLength = 3 inches.
• Transverse diameterTransverse diameter = At the fundus 2 inches
and at the cervix = 1 inches.
• Antero-posterior diameterAntero-posterior diameter = 1 inch.
Divisions:Divisions:
• The fundusThe fundus is the free rounded part.
• The bodyThe body of uterus.
• Cervix:Cervix: which opens into the vagina.

35. The Fundus of UterusThe Fundus of Uterus
• Convex in all directions and covered by
peritoneum which is continuous with the
surfaces of the body.
• It is related to coils of ileum.

36. The Fundus of UterusThe Fundus of Uterus
• Fallopian tubes:Fallopian tubes: one on
each side joins the uterus
at the fundus.
• Ovarian ligament:Ovarian ligament:
Attached below and behind
the fallopian tubes.
• Round ligament:Round ligament:
Attached below and infront
the fallopian tubes.

37. Body of uterusBody of uterus
Narrows from the fundus to cervix, its junction
with the cervix is called isthmus and covered
by peritoneum on both sides.
• Flattened
• Related to upper surface of
bladder.
• It’s peritoneal covering is
reflected at the junction of the
body with the cervix to the
superior the surface of
bladder to form the utero-
vesical pouch
Anterior wall (Vesical)Anterior wall (Vesical)

38. Body of uterusBody of uterus
• Curved.
• Related to coils of ileum.
• It’s peritoneal covering
extends on the back of
cervix and 1/3 of vagina,
then reflected to cover the
rectum to form the recto-
vaginal pouch.
Posterior wall (Intestinal)Posterior wall (Intestinal)

39. Cervix of uterusCervix of uterus
About 1 inch long and 1
inch width, the
cervix project
through the anterior
vaginal wall of
vagina which divide
it into 2 portions:2 portions:
1.1.Supra-vaginal portionSupra-vaginal portion
2.2.Portio-vaginalisPortio-vaginalis

40. Structure of the body of uterusStructure of the body of uterus
1. Endometrium
2. Myometrium
3. Peritoneal coat

41. Ligaments attached to uterusLigaments attached to uterus
(1) Ovarian ligament:
Connect the lower pole of
the ovary to the cornu of
uterus.
(2) Round ligament:
Attached from the cornu of
uterus close to fallopian
tube.
Then passes forwards and
laterally through the
inguinal canal to be
inserted into labia
majora.

42. (3) Broad ligament:
A fold of peritoneum extends from the lateral
wall of uterus to lateral pelvic wall, one on
each side.
Ligaments attached to uterusLigaments attached to uterus

43. Contents:Contents:
1. Uterine tube: Running in the free border.
2. Ligament of the ovary.
3. Proximal part of round ligament.
4. Uterine artery: running along the lateral border
of uterus and finally passe below the fallopian
tube to anastomose with the ovarian artery.
5. Ovarian vessels.
6. Epoophron and paraoophron.
7. Extra peritoneal fat.
Ligaments attached to uterusLigaments attached to uterus

44. Divisions:Divisions:
1. Mesosalpinx.
2. Mesometrium.
3. Suspensory ligament.
Ligaments attached to uterusLigaments attached to uterus
2
1
3

45. (4) Cervical ligaments: 3 pairs of ligaments:
1. The transverse ligament: or "Mackenrodt`s"
2. Uterosacral ligament
3. Pubo-cervical ligament
Ligaments attached to uterusLigaments attached to uterus

46. 1. The transverse ligament:
"Mackenrodt`s""Mackenrodt`s"
Extends from lateral sides of supra-vaginal cervix
and vaginal vault and passes laterally to be
inserted in the white line at the lateral pelvic
wall
Cervical ligamentsCervical ligaments

47. 2. Uterosacral ligament:
Extends from supra-vaginal cervix and vaginal
vault and pass backwards surrounding the
rectum to be inserted in the rectum and the
third piece of sacrum.
3. Pubo-cervical ligament:
Extends from the supra-vaginal cervix and
vaginal vault to pass beneath the bladder
surrounding the urethra to be inserted into the
back of symphysis pubis.
Cervical ligamentsCervical ligaments

48. Cervical ligamentsCervical ligaments

50. • The Fallopian tube (Oviduct) is a vital
structure extending between the uterus and the
ovary
• It is 10-12 cm in length
Fallopian tubesFallopian tubes

51. Fallopian tubesFallopian tubes
The tube is dThe tube is divided into 4 parts:ivided into 4 parts:
(1) Interstitial (Intramural) part:(1) Interstitial (Intramural) part: Begins at the
cornu and penetrate the myometrium, it is 1 cm
in length
(2) Isthmus:(2) Isthmus: It is straight and narrow, 2 cm in
length
(3) Ampulla:(3) Ampulla: It is the largest and longest part of
the tube, 5 cm in length
(4) Fimbria (Infundibulum): It is trumpet
shaped, and has an abdominal opening (ostium)
surrounded by finger like process (fimbria)It is
3-5 cm in length

52. Blood Supply:Blood Supply:
Uterine artery branches at the fundus to give the
uterine branch for the tube which runs in the
mesosalpinix to supply the proximal 2/3 and
anastomose with the tubal branch from the
ovarian artery.
Fallopian tubesFallopian tubes

54. OvaryOvary
The ovary is almond shaped, grayish pink in color
It has a smooth surface before puberty, with age
advance the surface become irregular and
puckered
Dimensions:Dimensions: 3 x 2 x 1 cm in 3 dimensions

55. Surfaces:Surfaces:
1.1. Upper pole:Upper pole: attached
to lateral pelvic wall
by infundibulo-pelvic
ligament.
2.2. Lower pole:Lower pole: attached
to cornu of uterus by
ovarian ligament.
3.3. Anterior Surface:Anterior Surface: attached to peritoneum of
posterior surface of broad ligament
4.4. Posterior Surface:Posterior Surface: Free and related to tubal
fimbria.
OvaryOvary

56. Structure:Structure: divided into 3divided into 3
regionsregions..
1.Hilum:1.Hilum: Where the blood
vessels, lymphatic and
nerves enter.
2.Medulla:2.Medulla: Connective
tissue core contains
blood vessels,
lymphatic and nerves.
3.Cortex:3.Cortex: Contains primary follicles in various
degrees of development
The ovary is covered byThe ovary is covered by tunica albuginea,tunica albuginea, whichwhich
is a dense connective tissue.is a dense connective tissue.
OvaryOvary

57. Blood Supply:Blood Supply: Ovarian artery arises from the
anterior wall of abdominal aorta. Branches of
the uterine artery anastemose with the tubal
branch from the ovarian artery.
OvaryOvary
OvarianOvarian
arteryartery

59. Urinary BladderUrinary Bladder
Position:Position:
• Hallow muscular organ,
which lay behind the
symphysis pubis and
anterior to the uterus and
broad ligament.
• Its form, size and position
vary with the amount of
urine.
• When empty, it is pyramid in shape, having a base,
vertex (apex), superior surface and 2 convex infero-
lateral surfaces.

60. Urinary BladderUrinary Bladder
Blood Supply:Blood Supply:
1.1. Hypogastric arteryHypogastric artery 
Umbilical artery 
Superior vesical artery.
2.2. Middle vesical artery:Middle vesical artery:
Arise from superior
vesical or umbilical
artery.
3.3. Inferior vesical artery:Inferior vesical artery:
From hypogastric
artery.
1
23

62. Female UrethraFemale Urethra
• Length: 4 cm.
• Wider and more dilatable than male urethra, it
begins at the bladder neck and descends
downwards and forwards
• It traverses the deep and
superficial perineal
pouches and opens into
the vestibule in front of
vaginal orifice.

63. Pelvic part of ureterPelvic part of ureter
• 15-20 cm longs.
• It enters the pelvis by
crossing the external
iliac vessels, obturator
nerve and vessels.
• Then passes downwards
and backwards along the
lower border of internal
iliac artery to the level
of ischeal spines.

64. Pelvic part of ureterPelvic part of ureter
• Then it curves forward
and medially below the
root of broad ligament to
reach the postero-
superior angle of the
bladder.
• It passes close to the
upper end of vagina
where it is crossed by
uterine vessels.
ureterureter

65. Dangerous points of the ureterDangerous points of the ureter
During gynecological operations the ureter isDuring gynecological operations the ureter is
liable for injury in the following sites:liable for injury in the following sites:
1. At clamping of infandibulo-pelvic ligamentinfandibulo-pelvic ligament
2. At clamping of utero-sacral ligamentutero-sacral ligament.
3. At clamping of uterine arteryuterine artery
4. Removal of broad ligament tumorsbroad ligament tumors or cervicalcervical
fibroidfibroid that displaces the ureter from it’s
normal position.
5. During closing the peritoneum of the pelvicperitoneum of the pelvic
floorfloor after hysterectomy.
6. Vaginal operations for prolapseoperations for prolapse.

66. Methods for protecting the uretersMethods for protecting the ureters
1.1. I.V.PI.V.P before operations, the ureter is liable for
displacement by pelvic pathology
2.2. Ureteric catheterizationUreteric catheterization during operation to
allow ureteric palpation.
3.3. Direct exposureDirect exposure of the ureter at the pelvic brim
posterior to the infandibulo-pelvic ligament of
the ovary after mobilization of the colon to
follow its course downwards.
4.4. PedicelsPedicels andand ligamentsligaments should be clamped
under vision.
5.5. Subcapsular removal of fibroidsSubcapsular removal of fibroids as the ureter
lies outside its capsule.

68. Pelvic (Sigmoid) ColonPelvic (Sigmoid) Colon
• It is a continuation of the descending colon at the
pelvic brim.
• Finally it curves backwards to end at the 3rd piece of
sacrum where it continue as the rectum.

69. RectumRectum
• Ends at the ano-rectal angle where it continues
as the anal canal.
• Blood supply:Blood supply: Superior, middle and inferior
hemorroidal arteries

71. Blood Supply of the pelvisBlood Supply of the pelvis
Median Sacral arteryMedian Sacral arteryMedian Sacral arteryMedian Sacral artery Superior Rectal arterySuperior Rectal arterySuperior Rectal arterySuperior Rectal artery
Ovarian arteryOvarian arteryOvarian arteryOvarian artery Internal Iliac arteryInternal Iliac arteryInternal Iliac arteryInternal Iliac artery
Arterial SupplyArterial SupplyArterial SupplyArterial Supply

72. Internal iliac artery - BranchesInternal iliac artery - Branches
A) From Posterior DivisionA) From Posterior Division
(Parietal branches)(Parietal branches)
1. Ilio-lumbar artery
2. Lateral sacral artery
3. Superior Gluteal artery
2
1
3

73. Internal iliac artery - BranchesInternal iliac artery - Branches
B) From anterior Division:B) From anterior Division:
a. Parietal branches:a. Parietal branches:
1. Obturator artery
2. Internal pudendal artery
3. Inferior Gluteal arteries.
b. Visceral branches:b. Visceral branches:
1. Umbilical artery  Superior vesical
artery
2. Middle Rectal artery
3. Uterine artery
4. Vaginal artery Inferior vesical artery

74. Blood SupplyBlood Supply
of the pelvisof the pelvis

75. Blood Supply of Female genitalBlood Supply of Female genital