16 The Uterus/Fallopian Tubes/Ovaries


16 The Uterus/Fallopian Tubes/Ovaries


▪Anatomy of the Uterus General Facts

General Facts

  • pear shaped

  • weight 30–120g, length 7–9cmlong (nullipara: 6–8cm)


  • Defends against organisms invading the uterine cavity and the abdominal space.

  • Ensures the passage of sperm.

  • Contains and nourishes the embryo.

  • Expels the fetus during childbirth.


  • vaginal portion

  • cervix

  • body

  • fundus

  • isthmus


  • Flexion = inclination between longitudinal axis of the cervix and body of the uterus

  • Normal: anteflexion (axis of the body is almost horizontal when the woman is standing, cervical axis is pointing dorsocaudally)

  • Version = inclination of the cervical axis to the longitudinal axis

  • Normal: anteversion (cervical axis is tipped forward)

  • Position = position of the vaginal portion in the pelvic space

  • Normal: vagina at the height of the interspinal line in the center of the pelvis or slightly to the left

Factors Affecting the Location

  • condition of the uterine support structure

  • degree of fullness in the urinary bladder and rectum

  • processes of shrinking and displacement in the lesser pelvis

Projection onto the Wall of the Torso

  • lower third of the uterus: immediately above the symphysis

  • supravaginal part of the cervix: sacrococcygeal joint

Topographic Relationships

  • peritoneum

  • urinary bladder

  • rectum

  • vagina

  • small intestinal loops

  • sigmoid colon

  • fallopian tube

  • ovary

  • ureter

  • uterine artery and vein


  • pelvic floor (levator ani)

  • suspensory ligament of the ovary-proper ligament of the ovary-round ligament of the uterus

  • broad ligaments/plica lata

  • sacrouterine and rectouterine ligaments

  • vesicouterine ligament



Uterine artery (from the internal iliac artery) anastomosed with the ovarian artery (from the aorta).


Uterine vein and diverse plexus that run into the internal iliac vein.

Lymph Drainage

  • lumbar lymph nodes

  • superficial inguinal lymph nodes

  • external iliac lymph nodes

  • obturator lymph nodes


  • sympathetic nervous system from T10 to L2 via the splanchnic nerves to the celiac/superior and inferior mesenteric ganglions and renal plexus

  • With vessels (ovarian artery) or as independent nerve fibers, the nerves run to the hypogastric and uterovaginal plexus.

  • Postganglionic supply from the four sacral ganglions and the ganglion impar is under discussion.

Sacral parasympathetic nervous system (S2-S4) to the inferior hypogastric plexus and uterovaginal plexus

▪Anatomy of the Ovaries

General Facts

  • Size: 4cm long, 2cm wide, 1cm thick.

  • Weight: 6-8g.


The ovaries are the female sex glands. In addition, they produce estrogens, progestogens, and steroids.


In the standing female, the ovaries lie on top of the broad ligament (posterior) and between the suspensory ligament of the ovary and the proper ligament of the ovary in an infolding of peritoneum.

The longitudinal axis runs virtually craniocaudal.

The ovary sits higher in nulliparas than in multiparas. It lies in a depression (ovarian fossa) with borders formed by the following structures:

  • obturator internus (lateral)

  • external iliac vein (anterior)

  • umbilical artery, obturator artery, obturator nerve (caudal)

  • ureter, internal iliac vessels (cranioposterior)

Topographic Relationships

  • ovarian fossa

  • peritoneum

  • psoas fascia (via the insertion of the suspensory ligament of the ovary)

  • ileum

  • ovarian vessels

  • uterine artery

  • cecum (right ovary)

  • appendix (right ovary)

  • piriformis (in multiparas)

  • obturator nerve

Projection onto the Wall of the Torso

The ovaries project onto the abdominal wall in a line on the anterosuperior iliac spine (ASIS)–upper edge of the symphysis, slightly medial to the edge of the psoas.


  • Suspensory ligament of the ovary (from ovary to ileum and psoas fascia): this ligament leads the ovarian vessels and nerves to the ovary.

  • Proper ligament of the ovary (from ovary to angle of the tube): it contains a branch of the uterine artery.

  • Peritoneal cover with mesovarium: it also covers the two upper ligaments.



  • uterine artery (from the internal iliac artery)

  • ovarian artery (aorta)


  • ovarian vein: on the right drains into the inferior vena cava; on the left drains into the left renal vein and then

  • inferior vena cava

  • uterine vein and diverse plexus that run into the internal iliac vein

Lymph Drainage

Lumbar lymph nodes.


  • sympathetically, the ovaries are supplied by the same segments as the uterus.

  • vagus nerve

Movement Physiology according to Barral


The uterus is highly mobile, its position dependent on the menstrual cycle, the state of fullness in the urinary bladder and rectum, and the position of the small intestinal loops.

Filled Urinary Bladder

The uterus is pressed posteriorly.

Filled Rectum

The uterus is pressed anteriorly.

Filled Rectum and Urinary Bladder

The uterus is pressed superiorly.


The uterus is pressed inferiorly.

Lateral displacement occurs as the result of scarring.

The fallopian tubes are also very mobile: the fimbriae perform rhythmic movements in three planes at the start of ovulation.

To transport the oocyte, we see both segmental and peristaltic contractions of the entire fallopian tube as well as movements of the fimbriae and cilia in the tube.

The position of the ovary depends on the movements of the uterus.



Similar to the urinary bladder: during the expiratory phase, we see a movement posterosuperiorly; during the inspiratory phase the movement is in the opposite direction.


Left ovary: rotation in a clockwise direction and slightly superior.

Right ovary: rotation in a counterclockwise direction and slightly superior.


The reproductive hormones are subject to a hormonal regulatory circuit with the hypothalamus, hypophysis, and ovaries serving as hormonal glands.


The hypothalamus produces luteinizing hormone (LH)-releasing hormone (LHRH), which stimulates the adenohypophysis to produce and release gonadotropic hormones.


Follicle-Stimulating Hormone

The follicle-stimulating hormone (FSH) has the following effects in the ovary:

  • maturation of the follicles

  • formation of estradiol receptors.

  • production of estradiol from testosterone (in the testicles, it stimulates spermatogenesis)

Luteinizing Hormone

The luteinizing hormone (LH) has the following effects in the ovary:

  • production of estrogen and progesterone

  • changes in the follicular wall that lead to ovulation (in the testicles, it stimulates testosterone synthesis)

Human chorionic gonadotropin (hCG) in the placenta roughly corresponds to LH.

Hormones of the Ovaries


Most estrogens are formed in the ovary. The starting molecule is cholesterol, which through several intermediary steps is transformed into testosterone. This is then turned into estradiol in yet another conversion. Estrogens are also produced in other tissues from androgens (see below), and they are also formed in the testicles.

The phase of estrogen production coincides with the phase of follicular maturation.

The effect is as follows:

  • stimulates growth of the female reproductive organs

  • regeneration and growth of the endometrium

  • secretion of thin, spinnable, clear, alkaline mucus (facilitates the inflow of sperm)

  • promotes the movement of the fallopian tubes and their production of secretions

  • epithelial growth in the vagina; also partially responsible for a normal vaginal environment

  • stimulates the growth of the mammary glands

  • formation of subcutaneous fat deposits (female body shape)

  • promotes formation of secondary sexual characteristics (growth of pubic hair, pigmentation of the nipples and vulva)

  • lifts the mood


This is formed only in the ovaries and placenta from cholesterol. Progesterone production occurs during the luteal phase.

The effect is as follows:

  • transforms the endometrium which is proliferating under the influence of estrogen

  • production of thick cervical mucus that is impermeable to sperm

  • epithelial cells in the vagina are discharged repeatedly

  • lowers tonicity in the uterine muscles and reduces uterine contractions–immobilizes the uterus during pregnancy

  • under the influence of progesterone, we see a general drop in tonicity of the smooth muscles

  • stimulates the growth of the mammary glands

  • progesterone causes a rise in body temperature of 0.4-0.6°C

In conclusion, we can say that estrogens prepare the body for conception and progesterone prepares it for pregnancy.

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Jul 12, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on 16 The Uterus/Fallopian Tubes/Ovaries

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