Ovaries

The ovaries are two small oval structures, each about 2 × 4 × 1.5 cm, lying deep within the female pelvis just lateral to, and behind, the uterus. They are loosely attached to the uterus by a connective tissue band, the ovarian ligament (Fig. 9.1). To the practitioner performing a bimanual exam, they feel much like almonds sliding between the examiner’s palpating fingers. After menopause, they may not be palpable at all.

The ovarian artery arises from the aorta just below the renal artery and is the ovary’s major source of blood. The ovarian artery courses through the retroperitoneal space of the abdomen in close proximity to the ureter. Blood draining the ovaries traverses the ovarian veins. The ovarian veins empty into the vena cava on the right and the renal vein on the left. This anatomic difference in venous drainage is important; the more lateral position of the left ovarian vein makes it more susceptible to obstruction and thrombus formation, especially in pregnancy. The lymphatic drainage of the ovary feeds into the lumbar (para-aortic) nodes.

The functions of the ovaries are to produce mature ova for fertilization and to generate large quantities of steroid hormones.

Fallopian tubes

These are bilateral hollow structures that attach to the uterus at each cornua (corner). The fallopian tube is divided anatomically and functionally into three sections: the cornua, isthmus and fimbria. The cornual section is contained within the muscular wall of the uterus and provides a stable, strong connection with this organ. Fertilization occurs in the isthmus, a long, narrow, pencil-like portion of the fallopian tube. The fimbriated, or fluted, end of the tube is its most distal portion. The fimbria are finger-like distal projections of the fallopian tubes. They display continual sweeping-like activity and are known to reach into the cul-de-sac of the female pelvis to retrieve ovulated eggs that fall behind the uterus.

The fimbria of the fallopian tube are not enclosed within the parietal peritoneum of the broad ligament and hence communicate with the abdominal cavity. This anatomic connection creates the potential for foreign matter that enters the vagina (i.e., bacteria, sperm and chemicals) to gain access to the abdominal cavity by traversing the cervical canal, uterus and fallopian tube. This has important implications for exposure of the intraperitoneal cavity to carcinogens and for intraperitoneal spread of infections ascending through the reproductive tract (Chapters 42 and 46–48, respectively).

The blood supply to the fallopian tube is largely through the ovarian vessels, although anastomoses with ascending branches of the uterine artery occur within the broad ligament. The lymphatic drainage of the tube follows that of the ovary into the para-aortic nodes.

The functions of the fallopian tube include transporting sperm and eggs to the site of fertilization within the tube and returning the fertilized zygote to the uterine cavity for implantation.

Together with the ovaries, the fallopian tubes are covered with a layer of parietal peritoneum known as the broad ligament. This forms a double-thickness draping structure that is bounded superiorly by the round ligament of the uterus. The broad ligament connects the uterus, fallopian tubes and ovaries to the pelvic sidewall just lateral to these structures. It contains important blood vessels, including the uterine arteries and veins.