The Uterine Tubes

The uterine tubes (also called fallopian tubes or oviducts) serve as the conduit of the oocyte from the ovary to the uterus (image). Each of the two uterine tubes is close to, but not directly connected to, the ovary and divided into sections. The isthmus is the narrow medial end of each uterine tube that is connected to the uterus. The wide distal infundibulum flares out with slender, finger-like projections called fimbriae. The middle region of the tube, called the ampulla, is where fertilization often occurs. The uterine tubes also have three layers: an outer serosa, a middle smooth muscle layer, and an inner mucosal layer. In addition to its mucus-secreting cells, the inner mucosa contains ciliated cells that beat in the direction of the uterus, producing a current that will be critical to move the oocyte.

Following ovulation, the secondary oocyte surrounded by a few granulosa cells is released into the peritoneal cavity. The nearby uterine tube, either left or right, receives the oocyte. Unlike sperm, oocytes lack flagella, and therefore cannot move on their own. So how do they travel into the uterine tube and toward the uterus? High concentrations of estrogen that occur around the time of ovulation induce contractions of the smooth muscle along the length of the uterine tube. These contractions occur every 4 to 8 seconds, and the result is a coordinated movement that sweeps the surface of the ovary and the pelvic cavity. Current flowing toward the uterus is generated by coordinated beating of the cilia that line the outside and lumen of the length of the uterine tube. These cilia beat more strongly in response to the high estrogen concentrations that occur around the time of ovulation. As a result of these mechanisms, the oocyte–granulosa cell complex is pulled into the interior of the tube. Once inside, the muscular contractions and beating cilia move the oocyte slowly toward the uterus. When fertilization does occur, sperm typically meet the egg while it is still moving through the ampulla.

If the oocyte is successfully fertilized, the resulting zygote will begin to divide into two cells, then four, and so on, as it makes its way through the uterine tube and into the uterus. There, it will implant and continue to grow. If the egg is not fertilized, it will simply degrade—either in the uterine tube or in the uterus, where it may be shed with the next menstrual period.

This anterior view shows the relationship of the ovaries, uterine tubes (oviducts), and uterus. Sperm enter through the vagina, and fertilization of an ovulated oocyte usually occurs in the distal uterine tube. From left to right, LM × 400, LM × 20. (Micrographs provided by the Regents of University of Michigan Medical School © 2012)

The open-ended structure of the uterine tubes can have significant health consequences if bacteria or other contagions enter through the vagina and move through the uterus, into the tubes, and then into the pelvic cavity. If this is left unchecked, a bacterial infection (sepsis) could quickly become life-threatening. The spread of an infection in this manner is of special concern when unskilled practitioners perform abortions in non-sterile conditions. Sepsis is also associated with sexually transmitted bacterial infections, especially gonorrhea and chlamydia. These increase a woman’s risk for pelvic inflammatory disease (PID), infection of the uterine tubes or other reproductive organs. Even when resolved, PID can leave scar tissue in the tubes, leading to infertility.

Fallopian Tubes

There are two uterine tubes, also called Fallopian tubes or oviducts. There is one tube associated with each ovary. The end of the tube near the ovary expands to form a funnel-shaped infundibulum, which is surrounded by fingerlike extensions called fimbriae. Because there is no direct connection between the infundibulum and the ovary, the oocyte enters the peritoneal cavity before it enters the Fallopian tube. At the time of ovulation, the fimbriae increase their activity and create currents in the peritoneal fluid that help propel the oocyte into the Fallopian tube. Once inside the Fallopian tube, the oocyte is moved along by the rhythmic beating of cilia on the epithelial lining and by peristaltic action of the smooth muscle in the wall of the tube. The journey through the Fallopian tube takes about 7 days. Because the oocyte is fertile for only 24 to 48 hours, fertilization usually occurs in the Fallopian tube.

Uterus

The uterus is a muscular organ that receives the fertilized oocyte and provides an appropriate environment for the developing fetus. Before the first pregnancy, the uterus is about the size and shape of a pear, with the narrow portion directed inferiorly. After childbirth, the uterus is usually larger, then regresses after menopause.

The uterus is lined with the endometrium. The stratum functionale of the endometrium sloughs off during menstruation. The deeper stratum basale provides the foundation for rebuilding the stratum functionale.

Vagina

The vagina is a fibromuscular tube, about 10 cm long, that extends from the cervix of the uterus to the outside. It is located between the rectum and the urinary bladder. Because the vagina is tilted posteriorly as it ascends and the cervix is tilted anteriorly, the cervix projects into the vagina at nearly a right angle. The vagina serves as a passageway for menstrual flow, receives the erect penis during intercourse, and is the birth canal during childbirth.

A number of female reproductive structures are exterior to the body. These include the breasts and the vulva, which consists of the mons pubis, clitoris, labia majora, labia minora, and the vestibular glands (Figure; Table).

Figure. The reproductive structures of the human female are shown. (credit a: modification of work by Gray's Anatomy; credit b: modification of work by CDC)

The breasts consist of mammary glands and fat. Each gland consists of 15 to 25 lobes that have ducts that empty at the nipple and that supply the nursing child with nutrient- and antibody-rich milk to aid development and protect the child.

Internal female reproductive structures include ovaries, oviducts, the uterus, and the vagina (Figure; Table). The pair of ovaries is held in place in the abdominal cavity by a system of ligaments. The outermost layer of the ovary is made up of follicles, each consisting of one or more follicular cells that surround, nourish, and protect a single egg. During the menstrual period, a batch of follicular cells develops and prepares their eggs for release. At ovulation, one follicle ruptures and one egg is released. Following ovulation, the follicular tissue that surrounded the ovulated egg stays within the ovary and grows to form a solid mass called the corpus luteum. The corpus luteum secretes additional estrogen and the hormone progesterone that helps maintain the uterine lining during pregnancy. The ovaries also produce hormones, such as estrogen.

The oviducts, or fallopian tubes, extend from the uterus in the lower abdominal cavity to the ovaries, but they are not in contact with the ovaries. The lateral ends of the oviducts flare out into a trumpet-like structure and have a fringe of finger-like projections called fimbrae. When an egg is released at ovulation, the fimbrae help the nonmotile egg enter into the tube. The walls of the oviducts have a ciliated epithelium over smooth muscle. The cilia beat, and the smooth muscle contracts, moving the egg toward the uterus. Fertilization usually takes place within the oviduct and the developing embryo is moved toward the uterus. It usually takes the egg or embryo a week to travel through the oviduct.

Sterilization in women is called a tubal ligation; it is analogous to a vasectomy in males in that the oviducts are severed and sealed, preventing sperm from reaching the egg.

The uterus is a structure about the size of a woman’s fist. The uterus has a thick muscular wall and is lined with an endometrium rich in blood vessels and mucus glands that develop and thicken during the female cycle. Thickening of the endometrium prepares the uterus to receive the fertilized egg or zygote, which will then implant itself in the endometrium. The uterus supports the developing embryo and fetus during gestation. Contractions of the smooth muscle in the uterus aid in forcing the baby through the vagina during labor. If fertilization does not occur, a portion of the lining of the uterus sloughs off during each menstrual period. The endometrium builds up again in preparation for implantation. Part of the uterus, called the cervix, protrudes into the top of the vagina.

The vagina is a muscular tube that serves several purposes. It allows menstrual flow to leave the body. It is the receptacle for the penis during intercourse and the pathway for the delivery of offspring.

Female Reproductive Anatomy

Table.