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Female Anatomy and Reproductive System

• Anatomy Diagram

External Female Anatomy

Internal female anatomy.

• Breast Anatomy
• Related Conditions

Female anatomy includes the internal and external structures, including those responsible for hormones, reproduction, and sexual activity.

The female reproductive system is essential for hormone regulation, sexual pleasure, pregnancy , breastfeeding , and more.

The main parts of the female anatomy can be broken up into external and internal parts. These include external genitalia, internal organs and structures, and breasts (which have internal and external parts).

A Note on Gender and Sex Terminology

Verywell Health acknowledges that  sex and gender  are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

The word “female” is used throughout this article to refer to anatomical reproductive classification and people assigned female at birth based on visible reproductive organs. Some people who identify as women do not have the anatomy depicted, while others who have the anatomy depicted do not identify as women and may use different terminology to refer to their anatomy.

Female Anatomy Diagram

This labeled diagram and detailed descriptions below explain the location of specific parts to the female reproductive and urinary systems.

The vulva is made up of the structures outside the vaginal opening. These external structures include:

• Mons pubis : The mons pubis is the rounded, fleshy area on the front of the pelvic bone (the lower belly area) where pubic hair usually grows. 
• Labia majora : The labia majora are the fleshy outer folds of protective skin located on each side of the vaginal opening. They cover and protect the more delicate external genital organs. "Labia" is the Latin word for lips. The labia majora is often referred to as the outer lips.
• Labia minora : The labia minora are skinfolds that are just inside the labia majora. In some people, the labia minora extends past the labia majora. Together these majora and minora skin folds are sometimes referred to as bifolds. The two parts of the inner fold meet at the bottom, called the fourchette.
• Clitoris : The clitoris sits at the top of the vulva, above the urethral opening. A fold of skin called the clitoral hood covers most of the clitoris, leaving only the tip (nub) visible. The rest of the clitoris is a spongy shaft that goes back several inches inside the body.  
• Urethral opening : The urethra is the tube that carries urine from the bladder to the outside of the body. Its opening is located below the clitoris, directly above the vaginal opening. 
• The vaginal opening : The vaginal opening is located between the urethra and the anus.
• Bartholin glands : Bartholin glands sit on both sides inside the vaginal opening. They release secretions that lubricate the vagina to make sexual intercourse more comfortable.
• Skene's glands : The Skene's glands are located on either side of the urethra. They lubricate the urethral opening. Skene’s glands are sometimes called "the female prostate." Some scientists think these glands are responsible for "female ejaculation" or " squirting " during sexual arousal.

Functions of the Vaginal Opening

The vaginal opening is where:

• Menstrual blood leaves the body
• Sexual intercourse for reproduction and/or pleasure occurs
• A baby exits the body during vaginal birth 

The rest of the female genitalia are inside the vaginal opening. These internal structures of female anatomy include the following:

• Vagina : The vagina is a muscular canal that connects the cervix to the outside of the body. Parts of the vagina are made of collagen and elastin, which help it expand during sexual stimulation and childbirth.
• Cervix : The cervix is the end of the uterus that sits within the top of the vagina. It may play a role in lubrication. Contact between the penis and cervix during sexual intercourse may be pleasurable for some but painful for others. During childbirth, the cervix dilates so the baby can move out of the uterus, into the vagina, and out of the body.
• Uterus : The uterus is located in the lower belly area between the hips (pelvis), through the vagina just past the cervix. It's also called the womb. The uterus is where a fetus develops during pregnancy. The uterus has three layers. The middle muscular layer is one of the strongest muscles in the body.
• Ovaries : The ovaries are small organs located on both sides of the pelvis. They play an important role in female hormone production and produce eggs during ovulation.
• Fallopian tubes : The fallopian tubes connect the ovaries to the uterus on each side. Hairlike structures called cilia guide the egg from the ovary to the uterus.
• Hymen : The hymen is a thin tissue that sits at the vaginal opening. It has no known biological function. The hymen becomes more elastic with age and breaks or ruptures at some point in a person's life. While sexual activity is one way this can happen, a broken hymen is not evidence of sexual activity.

How Many Eggs Do I Have?

At birth, the ovaries are loaded with about 1 million to 2 million eggs. But most will eventually die off naturally via a process known as atresia. At the time of your first period, around 300,000 to 500,000 eggs remain in the ovaries. By age 37, you can expect to have around 27,000 eggs. This reserve will continue to decrease significantly throughout your life.

Female Breast Anatomy 

The breast contains multiple structures within it, including:

• Adipose tissue : Each breast has fatty ( adipose ) tissue that is used to store extra energy.
• Lobules : There are 15 to 20 sections called lobules in the fatty tissue. They are attached to ducts that can produce milk. 
• Milk ducts : The milk ducts are internal structures that go to the areola and nipple, which are the outer portion of the breast. 
• Areola and nipples : The areola is the darker area on the outside of the breast that surrounds the nipple in the center.

Functions of Female Body Parts

The various parts of the female anatomy serve different functions, which include hormone production, sexual arousal, conception, and pregnancy.

Hormonal Changes

Estrogen and progesterone are the primary female hormones produced by the reproductive system. Hormone production increases at puberty, giving a person the ability to menstruate and conceive.

Female hormones also promote vaginal lubrication and increase sexual desire.

Sexual Arousal

Female anatomy is designed for both intimacy and conception. The vulva, vagina, and breasts are sensitive to being touched, which helps with sexual arousal.

The role of the clitoris is just for sexual pleasure. It has many sensitive nerve endings that respond to touch. When you're aroused, the clitoris tissue gets bigger—just like erectile swelling in the penis.

Where is the G-spot?

Researchers are not sure if a person's erotic G-spot is an actual structure or a sensitive area in the vagina. You can try to find the G-spot by inserting a finger (palm up) a few inches into your vagina. Then, curl your finger in a “come here” motion to see if that stimulates the tissue there.

Conception and Pregnancy 

During ovulation, an ovary releases an egg that travels to a fallopian tube, where it stays for a brief period. If a sperm from semen introduced during penile-vaginal intercourse swims to the egg and joins it, fertilization ( conception ) occurs.

This creates a zygote, which evolves further as it finds its way to the uterus, where it implants. This is what develops into an embryo. Fertilization can happen hours or days after sexual intercourse.

If the egg is not fertilized and pregnancy does not occur, the uterine lining sheds instead. This part of the menstrual cycle is known as your period. Most people who menstruate have a cycle every 28 to 31 days, in the absence of pregnancy, but this varies depending on how often they ovulate.

Health Conditions That Affect Female Anatomy

A number of medical concerns are associated with female reproductive system. Some of these are related to directly to the functions of female anatomy and others are conditions that are common to other areas of the body as well.

Common medical conditions related to female anatomy include:

• Endometriosis
• Uterine fibroids
• Uterine cancer
• Interstitial cystitis
• Polycystic ovary syndrome (PCOS)
• Sexually transmitted infections

The internal and external structures of the female anatomy make up the reproductive system. External areas of the female anatomy include the vulva. The internal anatomy includes the vagina, uterus, and fallopian tubes.

Female breasts include both internal and external structures.

These female organs, channels, and types of tissue play important roles in sexual arousal, intercourse, conception, pregnancy, and childbirth.

UC San Diego Health. Anatomy of the Vulva .

Lee M, Dalpiaz A, Schwamb R, Miao Y, Waltzer W, Khan A. Clinical pathology of Bartholin’s glands: A review of the literature . Curr Urol . 2015;8(1):22-25. doi:10.1159/000365683

Rodriguez F, Camacho A, Bordes S, Gardner B, Levin R, Tubbs R. Female ejaculation: An update on anatomy, history, and controversies. Clinical Anatomy . 2020;34(1):103-107. doi:10.1002/ca.23654

UC San Diego Health.  Anatomy of Female Pelvic Area .

Giovannetti O, Tomalty D, Gilmore S, et al. The contribution of the cervix to sexual response: an online survey study .  The Journal of Sexual Medicine . 2023;20(1):49-56. doi:10.1093/jsxmed/qdac010

Library of Congress Biology and Human Anatomy. What is the strongest muscle in the body ?

Mishori R, Ferdowsian H, Naimer K, Volpellier M, McHale T. The little tissue that couldn’t – dispelling myths about the Hymen’s role in determining sexual history and assault. Reprod Health . 2019;16(1). doi:10.1186/s12978-019-0731-8

American College of Obstetricians and Gynecologists.  Female age-related fertility decline .

Johns Hopkins Medicine. Anatomy of the breasts .

Kothari C, Diorio C, Durocher F. The importance of breast adipose tissue in breast cancer . Int J Mol Sci . 2020;21(16):5760. doi:10.3390/ijms21165760

Cappelletti M, Wallen K. Increasing women's sexual desire: The comparative effectiveness of estrogens and androgens .  Horm Behav . 2016;78:178-193. doi:10.1016/j.yhbeh.2015.11.003

National Library of Medicine. Anatomy, Abdomen and Pelvis: Female External Genitalia .

Vieira-Baptista P, Lima-Silva J, Preti M, Xavier J, Vendeira P, Stockdale CK. G-spot: Fact or Fiction?: A Systematic Review .  Sex Med . 2021;9(5):100435. doi:10.1016/j.esxm.2021.100435

Center for Disease Control and Prevention. Common Reproductive Health Concerns for Women .

By Brandi Jones, MSN-ED RN-BC Jones is a registered nurse and freelance health writer with more than two decades of healthcare experience.

Written by Louisa Thompson

Last updated May 29, 2022 • 53 Revisions •

The vagina is an organ of the female reproductive tract. It is a distensible muscular tube which extends posterosuperiorly from the external vaginal orifice to the cervix.

It has several roles within the female reproductive system:

• Sexual intercourse – receives the penis and ejaculate, assisting in its transport to the uterus.
• Childbirth  – expands to provide a channel for delivery of a newborn from the uterus.
• Menstruation  – serves as a canal for menstrual fluid and tissue to leave the body.

In this article, we will look at the anatomy of the vagina – its structure, innervation, vascular and lymphatic supply.

Fig 1 Overview of the female reproductive tract.

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Anatomical position.

The vagina is closely related to many of the organs in the pelvic region:

• Anterior – bladder and urethra.
• Posterior – rectouterine pouch, rectum and anal canal.
• Lateral – ureters and levator ani muscle.

Fig 2 Sagittal section of the female pelvis, showing the anatomical relations of the vagina.

Anatomical Structure

The vagina is a fibromuscular tube with anterior and posterior walls – these are normally collapsed and thus in contact with one another.

The shape of the vagina is not a round tunnel. In the transverse plane it is more like an “H” lying on the side. At the upper ending, the vagina surrounds the cervix, creating two domes (fornices or vaults): an anterior and a (deeper) posterior one.

The posterior fornix is important as it acts like a natural reservoir for semen after intravaginal ejaculation. The semen retained in the fornix liquefies in the next 20-30 mins, allowing for easier permeation through the cervical canal.

Fig 3 The anterior and posterior vaginal fornices

Histology of the Vagina

The vagina is composed of four histological layers (internal to external):

• Stratified squamous epithelium – this layer provides protection and is lubricated by cervical mucus (the vagina itself does not contain any glands).
• Elastic lamina propria – a dense connective tissue layer which projects papillae into the overlying epithelium. The larger veins are located here.
• Fibromuscular layer – comprising two layers of smooth muscle; an inner circular and an outer longitudinal layer.
• Adventitia – a fibrous layer, which provides additional strength to the vagina whilst also binding it to surrounding structures.

Vascular Supply and Lymphatics

The arterial supply to the vagina is via the uterine and vaginal arteries – both branches of the internal iliac artery .

Venous return is by the vaginal venous plexus, which drains into the  internal iliac veins  via the uterine vein.

Lymphatic drainage is divided into three sections:

• Superior – drains to external iliac nodes
• Middle – drains to internal iliac nodes
• Inferior – drains to superficial inguinal lymph nodes.

Fig 4 Posterior view of the arterial supply to the female reproductive tract.

Innervation

Innervation is predominantly from the autonomic nervous system. Parasympathetic and sympathetic nerves arise from the uterovaginal nerve plexus  (in turn a subsidiary of the inferior hypogastric plexus).

Only the inferior 1/5 of the vagina receives somatic innervation. This is via a branch of the pudendal nerve , the deep perineal nerve .

Clinical Relevance

Vaginal (obstetric) fistulae.

A vaginal fistula  is an open communication between the vagina and one of the adjacent pelvic organs.

It typically occurs as a result of prolonged labour (where a Caesarean section is not available). As the fetus slowly progresses down the vaginal wall, it exerts pressure – obstructing the blood supply and causing tissue necrosis.

There are three main types of vaginal fistulae:

• Vesicovaginal – abnormal communication with the bladder. Urine enters the vagina.
• Urethrovaginal  – abnormal communication with the urethra. Urine only enters the vagina during urination.
• Rectovaginal – abnormal communication with the rectum. Faecal matter can enter the vagina.

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The Female Reproductive System Produces Eggs, Facilitates Fertilization, and Supports the Developing Embryo

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The female reproductive system includes external and internal genitalia. The vulva and its structures form the external genitalia. The internal genitalia include a three-part system of ducts: the uterine tubes, the uterus, and the vagina. This system of ducts connects to the ovaries, the primary reproductive organs. The ovaries produce egg cells and release them for fertilization. Fertilized eggs develop inside the uterus.

1. Generating Eggs: Ovaries Are the Female Gonads

The ovaries are two almond-shaped structures that sit on either side of the uterus, connected to the uterine tubes. They produce oocytes (egg cells), as well as estrogen, progesterone, and other hormones. Egg cell production, or oogenesis, begins with the primordial follicles. As girls reach puberty, each ovary contains thousands of these follicles, and each follicle contains a primary oocyte. When follicles mature, some primary oocytes become secondary oocytes. By the time of ovulation there is only one mature follicle remaining. The rest of the follicles deteriorate. During ovulation (about once a month), the dominant follicle bursts and releases its secondary oocyte. The oocyte travels into the uterine tube, where it can be fertilized.

2. Egg Cells from the Ovaries Move Through the Uterine Tubes

The uterine tubes (also called Fallopian tubes or oviducts ) connect the ovaries to the uterus. The walls of each tube have an external serous layer, a middle muscular layer, and an internal mucous layer that is continuous with the inner lining of the uterus. Each uterine tube can be divided into three parts: The infundibulum is open to the abdomen. A constricted section called the isthmus connects with the uterus. Finally, an intermediate, dilated portion, the ampulla , curves over the ovary. Egg fertilization usually occurs in the ampulla. The eggs then travel through the isthmus into the uterus.

3. The Uterus Expands As an Embryo Becomes a Fetus

The uterus is a pear-shaped organ located in the pelvic cavity between the bladder and the rectum. It is a hollow organ with thick, muscular walls. The uterine tubes lead from the ovaries into the upper part of the uterus (one tube on each side). The lower part of the uterus constricts into a segment called the cervix , which leads to the vagina. During menstruation, the inner lining of the uterus is shed. When a woman becomes pregnant, however, the fertilized egg embeds itself in the uterine wall and menstruation is prevented. The uterus expands dramatically as the egg develops into an embryo and then a growing fetus.

4. The Vagina: A Tunnel with Three Core Functions

The vagina extends down from the cervix, the lower part of the uterus, to the vestibule, which is part of the vulva and the external genitalia. It sits behind the bladder and in front of the rectum. An inner mucous membrane lines the smooth muscle walls of the vagina. This lining, like the inner layer of the uterine tubes, is continuous with the mucous lining of the uterus. The vagina has three core functions: it carries menstrual flow outside the body, it receives the male penis during sexual intercourse, and it serves as a birth canal during labor.

5. The Vulva Comprises the External Female Genitalia

The structures of the vulva facilitate sexual intercourse and provide the entrance to and outlet for the internal genitalia. They include the labia minora and labia majora, the mons pubis, the clitoris, the greater vestibular glands, and the vestibule of the vagina. The vestibule includes two openings: the smaller urethral orifice allows urine to exit (as part of the urinary system). The larger vaginal orifice is the entrance to the vagina.

Download Female Reproductive System Lab Manual

External Sources

Female reproductive system terms from the Des Moines University Online Medical Terminology Course.

FAQ about cervical cancer screening from the American College of Obstetricians and Gynecologists.

Visible Body Web Suite provides in-depth coverage of each body system in a guided, visually stunning presentation.

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Author: Christina Loukopoulou, MSc • Reviewer: Declan Tempany, BSc (Hons) Last reviewed: October 30, 2023 Reading time: 16 minutes

The vagina is part of the internal genitalia of the female reproductive system . The internal female sex organs form a pathway, the internal female genital tract, composed of the vagina, uterus , the paired uterine tubes and ovaries . The vagina serves a multitude of functions. It facilitates menstruation, childbirth and sexual intercourse, as it is the copulatory organ in females. Additionally, it plays a significant role in human female sexuality and sexual pleasure. This article will explore the gross and histologic anatomy of the vagina and its functions while also reviewing related clinical conditions.

Upper two thirds of vagina

Lower third of vagina, vaginal opening, blood supply, innervation, sexual intercourse, menstruation, parturition, sexually transmitted infections, cervicovaginal (pap) smear, bartholin’s cyst, vaginal prolapse.

The vagina is a distensible fibromuscular tube extending from the pelvic cavity (true pelvis) through the pelvic floor to the perineum. The cervix protrudes into its proximal end, which is enlarged and forms the vaginal fornix (vaginal vault). The vagina opens into the vaginal vestibule of the vulva (vaginal opening) at its distal end.

The vagina tilts posteriorly between the urethra and rectum , with the urethra bound to its anterior wall. If standing, the vaginal tube will point in a superoposterior direction to form a 45 degree angle with the uterus and an about 60 degree angle to the horizontal. However, the exact angle is variable depending on individual anatomy and with contents of the bladder and colon. Due to this tilting, the posterior wall of the vagina (8 to 10 centimeters (3 to 4 inches)) is longer than its anterior wall (7.5 centimeters (2.5 to 3 inches)).

Gross anatomy

Anatomically, the base of the bladder and the urethra is related to the anterior wall of the vagina, while, posteriorly, the vagina is related to the rectum. Internally, the cervix protrudes into the proximal end of the vagina forming an enlarged recess between its lower margin and the vaginal wall. This blind-ended space is called vaginal fornix . There is a large posterior part of vaginal fornix, a smaller anterior part in addition to two small lateral parts.

At the lower end of the vagina (lower third) are vaginal rugae , which allow for expansion of the luminal surface of the vaginal wall during childbirth. While the vagina itself does not have glands, it is lubricated by mucus from the cervical glands found above it, a process which is hormonally controlled. Upon sexual arousal, vaginal secretions can also come from the uterus, or a minuscule amount from the greater vestibular glands (of Bartholin). Engorgement of vaginal blood vessels during arousal also results in increased blood flow/pressure which causes fluid, known as vaginal transudate, to be pushed from the vasculature of the lamina propria onto the vaginal surface through transudation (i.e. escape of liquids via pores or breaks in the cell membranes); 

Colloquially, the word 'vagina' is often incorrectly used to refer to the vulva . Anatomically, the vagina is the fibromuscular canal between the hymen and cervix, however in non-medical contexts (e.g. legally in court) it is considered to include the vulva (between the labia).

The vulva includes all of the external genital organs seen outside of the body, which include:

• the mons pubis (Latin for “pubic mound”)
• labia majora (outer lips)
• labia minora (inner lips)
• the external openings of the urethra and vagina.

At the vulva, the vaginal orifice (the introitus) may be partially covered by a membrane formed by inward folding mucosa known as the hymen. This is a thin mucosal structure found posterior to the urethra that [partially or completely] covers the entrance to the vagina. It is surrounded by the vaginal vestibule, which is exposed with spreading of the labia. The hymen stretches across the vaginal lumen and is normally incomplete to allow for passage of menstrual flow. It can be perforated during sexual intercourse, insertion of menstrual products, such as tampons, or during childbirth. Hymenal caruncles are small firm reddish nodules located around the vaginal orifice in adult women; they are remnants of the hymen. The hymen is often crescent-shaped in preadolescent females, but many shapes are possible.

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The wall of the vagina is thin and distensible, consisting of four distinct layers (from outermost to innermost):

• an adventitial (fibrous) layer , providing additional strength and structural support to the vagina, merging with the bladder (anteriorly) and rectum (posteriorly),
• a muscular layer (made of smooth muscle), which has an inner circular and outer longitudinal layer,
• a layer of lamina propria which is rich in elastic fibers and does not contain any secretory glands,
• a mucosal layer composed of stratified squamous, non-keratinizing epithelium . This type of epithelial lining maintains the moisture of the vaginal canal and protects it from infection. While the vagina itself does not have any secretory glands, its surface is moistened by cervical secretions.

The vaginal mucosa is continuous with that of the uterus. Its inner surface presents two longitudinal ridges, one on the anterior and one on the posterior vaginal wall. These ridges are called the vaginal columns and form numerous transverse ridges, the vaginal rugae. The lower part of the anterior column of the vaginal rugae forms a prominent ridge in relation with the urethra, which is called the urethral carina of the vagina .

Vasculature of the vagina is primarily supplied by an arterial plexus derived by the vaginal artery and uterine artery , which area branches of the anterior division of the internal iliac artery . These two arteries anastomose to form azygos arteries of the vagina, which run longitudinally anterior and posterior to the vagina. Abundant venous plexuses are situated in the muscular and mucosal layers of the vaginal wall, often colloquially referred to as the spongy layer of the vagina, hinting that the vaginal rugae can be regarded as a discrete layer of erectile tissue similar to the corpus spongiosum of the penis. These venous plexuses drain into the internal iliac veins.

Ready to test yourself  on the structures of the uterus and vagina?

There is a higher concentration of nerve endings near the entrance of the vagina (lower third) that provides sexual pleasure when stimulated, and women may also derive pleasure from a feeling of closeness and fullness during sexual intercourse.

Autonomic efferent innervation to the upper two thirds of the vagina is supplied through the uterovaginal plexus containing both sympathetic and parasympathetic fibers. Sympathetic efferent fibers from the lumbar splanchnic nerves ( lumbar outflow ) travel first through the superior hypogastric plexus, and then through the bilateral hypogastric nerves to reach the inferior hypogastric plexuses, and finally the uterovaginal plexus.

Parasympathetic efferent fibers to the uterovaginal plexus originate from the pelvic splanchnic nerves (S2-S4) ( sacral outflow ).

Autonomic efferent innervation to the lower third of the vagina is carried through the pelvic splanchnic nerves (S2-S4).

General visceral afferent (GVA) fibers from the upper vagina travel through the pelvic splanchnic nerves to the sacral plexus . Afferent fibers from the lower vagina are carried by the pudendal nerve .

Somatic sensation exists primarily in the distal one third of the vagina and is also carried by general somatic afferent fibers within the pudendal nerve to the sacral plexus.

Despite the scientific examinations of vaginal wall innervation showing no consistent or single areas with greater nerve ending densities, some women do have a greater density of nerve endings in the anterior vaginal wall that can lead to heightened sensitivity and pleasure when the anterior wall is stimulated. Therefore, it is in the anterior wall that the vaginal erogenous zone is located (commonly referred to as the ‘ G-spot ’ or Gräfenberg spot). In these examples, the outer third of the vagina near the opening will have more nerve endings, making it more sensitive to touch than the deeper and inner two-thirds of the vagina. Functionally, this is most likely the case so that childbirth will be significantly less painful, since increased nerve endings throughout would otherwise equate to more pain.

During sexual intercourse (coitus) and sexual arousal, the vagina will expand in both length and width. While the upper two-thirds of the vagina expands and lengthens, the uterus will rise into the greater pelvis, with the cervix being elevated above the vaginal floor. Semen is deposited in the vaginal fornix. Spermatozoa then travel to the external os of the cervix, traversing the cervical canal and uterine cavity to reach the ampulla of the uterine tube, where fertilization normally takes place.

During menstruation , the vagina allows passage and expulsion of the endometrium , which is shed on a monthly basis at the end of the follicular phase. Throughout the menstrual cycle, the epithelium will undergo subtle changes, where the rate of desquamation will be higher during the progesterone phase than during the estrogen phase.

During childbirth , the vagina expands to allow the baby to pass through and provides pulsatile contractions to assist the downward passage of the baby. A healthy vagina of a woman of childbearing age is acidic with a pH range of 3.8 to 4.5 due to the degradation of glycogen to lactic acid by enzymes secreted by the Döderlein's bacillus , which is part of the normal flora of the vagina. The acidity functions to retard and prevent growth of various strains of pathogenic microbes. An increased acidity can be caused by bacterial overgrowth, as in bacterial vaginosis, trichomoniasis, or the rupturing of membranes during pregnancy. The ecosystem of a healthy vaginal microbiota consists majorly of the Lactobacillus species , but under stress or disturbances (hormonal or physical), changes can occur that upset the healthy balance of microorganisms that protect its host and result in undesirable outcomes, such as vaginosis or yeast infections.

Learn more about the anatomy and function of the female reproductive system with our articles, video tutorials, quizzes and labeled diagrams.

Clinical notes

Common infections and diseases that can affect the vagina include candidal vulvovaginitis, vaginitis, vaginismus, sexually transmitted infections (STIs) or cancer.

Vaginitis is an inflammation of the vagina, and is attributed to several vaginal diseases.

Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are often caused by:

• human papillomavirus (HPV)
• genital herpes
• trichomoniasis

It is therefore recommended by health care providers to appreciate safe sex practices (male or female condoms), while engaging in sexual activity to prevent transmittance of these STIs and STDs.

For women of childbearing age, it is recommended to receive cervical screens ( Pap smear tests and HPV vaccines ). Cervical cancer can be prevented if caught early enough through cervical screening or prophylactically by HPV vaccines. It is recommended for women to begin Pap smear tests starting around 21 years old until 65 years of age, with frequency varying from 3 to 5 years depending on age, genetics, or environmental factors. Vaginal cancer is a very rare condition that is related more to old age, and its symptoms include abnormal vaginal bleeding or vaginal discharge.

If there is a lump obstructing the vaginal opening, it is commonly due to a Bartholin’s cyst, which occurs when a greater vestibular gland (of Bartholin’s) is blocked and the gland becomes inflamed. Sometimes, bacterial infection can be associated, but the cysts are not sexually transmitted. Antibiotics are not generally needed, and treatment will depend on the severity of symptoms.

As women get older, or if there weakened pelvic muscles from trauma or childbirth, vaginal prolapse can occur. Vaginal prolapse, or vaginal vault prolapse, is characterized by a part of the vaginal canal protruding (prolapsing) from the opening of the vagina. In the case of a prolapse due to childbirth, the rectum, uterus, or bladder pushes on the vagina. Severe cases result in the vagina protruding out of the body.

Kegel exercises can be observed to strengthen the pelvic floor, and can help prevent or remedy vaginal prolapse.

References:

• Standring,S. (2015) Gray's Anatomy: The Anatomical Basis of Clinical Practice. 41st edn. Amsterdam: Elsevier.
• Saladin, K. (2015) Anatomy & Physiology: The Unity of Forma and Function. 6th edn. New York: McGraw-Hil.l
• Gilroy, A.M.,MacPherson, B.R., Ross, L.M. andSchuenke, M. (2018) Atlas of Anatomy. 2nd edn. New York: Thieme.
• Waugh, A., Grant, A. and Ross, J.S. (2018) Ross & Wilson Anatomy and Physiology in Health and Illness. 13th edn. Amsterdam: Elsevier.
• Drake, R.L., Vogl, A.W., Mitchell, A.W.M. (2020) Gray’s Anatomy for Students. 4th edn. Amsterdam: Elsevier.

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Anatomy And Physiology Of The Female Genital System

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Presentation on theme: "Anatomy And Physiology Of The Female Genital System"— Presentation transcript:

FEMALE REPRODUCTIVE ANATOMY

Female Reproductive Organs

The Female Reproductive System

Female Reproduction Ova- Female reproduction cells stored in the ovaries Estrogen (Hormone)- Organs mature, pubic and armpit hair, regulates release of.

Menstrual cycle By: Dr. Zeinab Hakim

Section 18.3 The Female Reproductive System Objectives

The Female Reproduction System

Menstrual cycle Lecture 2.

Chapter 3 Female Sexual Anatomy and Physiology

Female Reproductive System

FEMALE REPRODUCTIVE ANATOMY& PHYSIOLOGY

The female reproductive system also enables a woman to: have sexual intercourse protect and nourish the fertilized egg until it is fully developed The.

Pathophysiology The Female Reproductive System Dr. HANA OMER

The Female Reproductive system

“Female Reproductive System”

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

Female Internal Genital Organs

The internal genital organs form a pathway (the genital tract). This pathway consists of the following:

Vagina (part of the birth canal), where sperm are deposited and from which a baby can emerge

Cervix (the lower part of the uterus), where sperm enter and which opens (dilates) when a pregnant woman is ready to gives birth

Uterus, where an embryo can develop into a fetus

Fallopian tubes (oviducts), where sperm can fertilize an egg after traveling through the cervix and uterus

Ovaries, which produce and release eggs

Sperm can travel up the tract, and eggs down the tract.

Internal Female Reproductive Anatomy

The hymen is a ring of tissue located just inside the opening of the vagina (see figure External Female Genital Organs ). The hymen usually encircles the opening. Rarely, it completely covers the opening (called an imperforate hymen), making it impossible for menstrual blood to pass. In such cases, a procedure is done to open the hymen. The hymen may tear at the first attempt at sexual intercourse, or it may be soft and pliable and not tear. The hymen may also be torn during exercise or insertion of a tampon or diaphragm. Tearing usually causes slight bleeding. When the hymen tears, it may be unnoticeable or may form small tags of tissue around the vaginal opening.

The vagina is a soft, stretchable tube of muscle tissue about 4 to 5 inches long in an adult woman. It connects the external genital organs to the uterus. The upper part of the vagina is wider and surrounds the cervix (the lower part of the uterus). Some types of birth control (such as a diaphragm or vaginal ring) or drugs are inserted here.

The vagina has a central role in sexual activity and reproduction. It is the passageway for the following:

Sperm to the egg to the uterus and fallopian tubes

Menstrual bleeding or a baby to the outside.

Because the vaginal tissue is soft, its walls can stretch open for examination by a doctor, for sexual intercourse, or for childbirth. After menopause , the vagina becomes less stretchy because estrogen levels decrease. This change can cause pain.

The vagina is lined with a mucous membrane, kept moist by fluids produced by cells on its surface and by secretions from glands in the cervix. A small amount of these fluids may pass to the outside as a clear or milky white vaginal discharge, which is normal. During a woman's reproductive years, the lining of the vagina has folds and wrinkles. Before puberty and after menopause, the lining is smooth.

Uterus and cervix

The uterus is a thick-walled, muscular, pear-shaped organ located in the middle of the pelvis, behind the bladder, and in front of the rectum. The uterus is anchored in position by several ligaments. The main function of the uterus is to sustain a developing fetus.

The uterus consists of the following:

The main body (corpus)

The cervix is the lower part of the uterus, which protrudes into the upper part of the vagina. During a pelvic examination , doctors can examine the cervix using a speculum (a metal or plastic instrument that spreads the walls of the vagina apart). Like the vagina, the cervix is lined with a mucous membrane.

Sperm can enter and menstrual blood can exit the uterus through a channel in the cervix (cervical canal). The cervical canal is usually narrow, but during labor, the canal widens to let the baby through.

The cervix is usually a good barrier against bacteria. However, the bacteria that cause sexually transmitted diseases can enter the uterus through the cervix during sexual intercourse.

Did You Know...

The channel through the cervix is lined with cells and glands that secrete mucus. This mucus is thick and impenetrable to sperm until just before ovulation. At ovulation, the mucus becomes clear and elastic (because the level of the hormone estrogen increases). As a result, sperm can swim through the mucus into the uterus to the fallopian tubes, where fertilization can take place.

Almost all pregnancies result from intercourse that occurs during the 3 days before ovulation. However, pregnancies sometimes result from intercourse that occurs up to 6 days before ovulation or during the 3 days after ovulation. For some women, the time between a menstrual period and ovulation varies from month to month. Consequently, pregnancy can occur at different times during a menstrual cycle .

The corpus of the uterus, which consists of muscle tissue, can stretch to accommodate a growing fetus. Its muscular walls contract during labor to push the baby out through the cervix and the vagina. During the reproductive years, the corpus is twice as long as the cervix. After menopause, th uterus and cervix are about the same length.

As part of a woman's reproductive cycle (which usually lasts about a month), the lining of the corpus (endometrium) thickens. If the woman does not become pregnant during that cycle, most of the endometrium is shed and bleeding occurs, resulting in the menstrual period.

How Many Eggs?

Fallopian tubes

The two fallopian tubes, which are about 4 to 5 inches (about 10 to 13 centimeters) long, extend from the upper edges of the uterus toward the ovaries. The tubes do not directly connect with the ovaries. Instead, the end of each tube flares into a funnel shape with fingerlike extensions (fimbriae). When an egg is released from an ovary, the fimbriae guide the egg into the opening of a fallopian tube.

The fallopian tubes are lined with tiny hairlike projections (cilia). The cilia and the muscles in the tube's wall propel an egg downward through the tube to the uterus. The fallopian tube is the usual site of fertilization of the egg by the sperm. After fertilization, the fertilized egg enters the uterus and implants there.

The ovaries are usually pearl-colored, oblong, and about the size of a walnut. They are attached to the uterus by ligaments. In addition to producing female sex hormones ( estrogen and progesterone ) and some male sex hormones, the ovaries produce and release eggs. The developing egg cells (oocytes) are contained in fluid-filled cavities (follicles) in the wall of the ovaries. Each follicle contains one oocyte.

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Female genital system

Systema genitale femininum.

Antoine Micheau

The female genital organs consist of an internal and an external group.

The  internal organs  are situated within the pelvis, and consist of the  ovaries , the  uterine tubes , the uteru s, and the  vagina. 

The  external organs  are placed below the urogenital diaphragm and below and in front of the pubic arch. They comprise the vulva with  mons pubis , the  labia majora et minora pudendi, the  clitoris , the  bulbus vestibuli,  and the  greater vestibular glands.

Comparative anatomy in animals

• Female genital organs

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Congenital Anomalies of the Female Genital Tract: A Comprehensive Review

Swati m dahiphale.

1 Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND

Jyotsana Potdar

Neema acharya, garapati jyotsna, rahul desale.

2 Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND

This comprehensive review provides an in-depth examination of congenital anomalies of the female genital tract, explicitly focusing on the American Society for Reproductive Medicine (ASRM) Müllerian Anomalies Classification. The classification system is crucial for standardizing communication and guiding accurate diagnoses in clinical practice. The review explores the diverse clinical presentations, etiological factors, and diagnostic modalities associated with these anomalies. Management strategies, ranging from conservative approaches to advanced reproductive technologies, are discussed in the context of individualized treatment plans based on the ASRM classification. The psychosocial impact of female genital tract anomalies is thoroughly examined, emphasizing the importance of holistic care and patient-centered approaches. Looking toward the future, the review outlines emerging research areas, including advances in diagnosis techniques, innovative treatment modalities, and genetic studies. It ultimately underscores the need for a comprehensive understanding of physical and psychosocial dimensions, offering insights for healthcare professionals to navigate this complex landscape and improve the lives of affected individuals.

Introduction and background

Congenital anomalies of the female genital tract encompass various structural irregularities that arise during embryonic development. These anomalies may involve the uterus, cervix, fallopian tubes, and vagina, manifesting as deviating from the typical anatomical configuration. The exploration of these congenital anomalies is crucial for clinicians, researchers, and healthcare professionals to comprehend the intricate nature of female reproductive health [ 1 - 2 ].

Understanding female genital tract anomalies is paramount in reproductive medicine, gynecology, and obstetrics. These anomalies can profoundly impact reproductive outcomes, influencing fertility, pregnancy, and childbirth [ 3 - 5 ]. These structural irregularities may also contribute to a spectrum of gynecological issues, affecting menstrual health, urinary and bowel function, and overall quality of life for affected individuals. Recognizing the clinical implications of these anomalies is essential for providing optimal patient care and guiding therapeutic interventions [ 6 ].

This comprehensive review aims to delve into the intricate landscape of congenital anomalies of the female genital tract, thoroughly examining their classification, epidemiology, etiology, clinical presentation, diagnosis, and management. The primary objectives of this review are to synthesize existing knowledge, highlight recent advancements in the field, and provide clinicians and researchers with a comprehensive resource for understanding and navigating the complexities associated with female genital tract anomalies. By addressing these objectives, we strive to contribute to the ongoing discourse on reproductive health, thereby fostering informed decision-making in clinical practice and guiding future avenues of research.

Classification of congenital anomalies

American Society for Reproductive Medicine (ASRM) Müllerian Anomalies Classification

The American Society for Reproductive Medicine (ASRM) has developed a comprehensive classification system for Müllerian anomalies, providing a standardized framework for categorizing variations in the female genital tract. This classification system aids in clinical diagnosis, treatment planning, and communication among healthcare professionals [ 3 , 7 ]. The following are the main classes within the ASRM Müllerian Anomalies Classification 2021 (Figure ​ (Figure1 1 ).

Open access journal under a CC-BY license. Contributed by the American Society for Reproductive Medicine [ 3 ]

Epidemiology

Prevalence of Female Genital Tract Anomalies

The prevalence of female genital tract anomalies is estimated to be around 4-6.9% [ 8 ]. However, specific anomalies may have different prevalence rates. For example, the imperforate hymen has an epidemiology of 1:1000-2000 in female individuals, while Müllerian agenesis has an epidemiology of 1/5000 in female individuals [ 9 ]. These anomalies are being diagnosed more frequently due to advances in imaging techniques, and they are present in about 7% of the general population, with an even higher prevalence in the infertile population [ 10 ].

Age and Ethnicity Patterns

The occurrence of female genital tract anomalies often exhibits age and ethnicity patterns. Some anomalies may become more apparent or symptomatic during certain life stages, such as adolescence, when individuals may experience menstrual irregularities or difficulties with sexual intercourse. The age at which women seek reproductive assistance or become pregnant may also influence the identification of these anomalies [ 11 ]. Moreover, variations in the prevalence of female genital tract anomalies among different ethnic groups have been documented. Genetic factors, including variations in the expression of specific genes related to reproductive organ development, may contribute to these ethnic disparities. Further research is necessary to elucidate the genetic and environmental factors that underlie the observed variations in prevalence among diverse populations [ 12 ].

Association With Other Medical Conditions

Female genital tract anomalies may be associated with other medical conditions, either congenital or acquired. For instance, anomalies such as uterine septum or bicornuate uterus may coexist with renal anomalies in a condition known as the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Understanding these associations is crucial for comprehensive patient care and may impact treatment strategies [ 13 ]. Additionally, specific genetic syndromes, such as Turner syndrome, may be associated with gonadal dysgenesis and contribute to the overall spectrum of female genital tract anomalies. Exploring these associations is essential for providing holistic care and identifying potential underlying genetic or syndromic etiologies [ 7 ].

Etiology and pathogenesis

Genetic Factors

Hox genes: The Hox gene family, recognized for its pivotal role in determining body segment identity during embryonic development, is crucial in forming the female reproductive organs. These genes contribute to the precise patterning and differentiation of tissues, including the Müllerian ducts, which give rise to the uterus and other reproductive structures. Disruptions in the expression or function of Hox genes have been implicated in various congenital anomalies, particularly uterine malformations. Understanding the intricate regulatory role of Hox genes is fundamental to unraveling the molecular basis of reproductive organ development and associated anomalies [ 14 ].

WNT signaling pathway: The WNT signaling pathway, a key player in embryonic development, is significant in Müllerian duct formation. This pathway governs critical cellular processes, influencing cell fate determination and tissue differentiation. Aberrations in the WNT signaling pathway have been linked to uterine anomalies, emphasizing the importance of precise genetic regulation in developing female reproductive structures. Investigating the molecular intricacies of WNT signaling provides valuable insights into the complex cascade of events that shape the embryonic Müllerian ducts and contribute to the formation of the uterus [ 15 ].

Homeobox A10 (HoxA10) and homeobox A11 (HoxA11): HoxA10 and HoxA11 are specific members of the Hox gene family that play a central role in uterine organogenesis. These genes regulate cell differentiation, proliferation, and tissue patterning during the development of the uterus. Mutations or altered expression levels of HoxA10 and HoxA11 have been associated with uterine anomalies, underscoring the critical role of these specific regulatory genes in normal uterine development. Elucidating the precise molecular mechanisms controlled by HoxA10 and HoxA11 contributes to our understanding of the genetic basis of uterine malformations. It provides potential targets for therapeutic interventions to correct these anomalies at the molecular level [ 16 ].

Environmental Factors

Maternal smoking and drug exposure: Maternal smoking and exposure to certain drugs during pregnancy, certain SSRIs like Fluvoxamine, Lexapro, Paxil, Prozac, Symbyax, and Zoloft have emerged as significant factors associated with an elevated risk of congenital anomalies, including those affecting the female genital tract. The impact of these substances on embryonic development can disrupt the intricate processes of organ formation, potentially leading to structural abnormalities in reproductive organs. The vulnerability of the developing fetus to the teratogenic effects of smoking and certain drugs underscores the importance of public health initiatives aimed at reducing maternal exposure to these risk factors. Understanding the specific mechanisms by which these substances influence female genital tract development is crucial for designing preventive strategies and promoting maternal and fetal well-being [ 17 ].

Maternal diabetes: Maternal diabetes, particularly when present during the critical period of organogenesis, has been identified as a significant risk factor for congenital anomalies, including those affecting the female genital tract. The developing female reproductive organs may be particularly susceptible to the effects of maternal hyperglycemia, which can disrupt normal developmental processes. Glycemic control during pregnancy becomes paramount in mitigating the risk of congenital anomalies. Close monitoring and management of maternal diabetes aim to provide optimal conditions for fetal development and reduce the potential impact on the female genital tract. Insights into the specific pathways through which maternal diabetes influences organogenesis can inform targeted interventions and enhance prenatal care strategies to minimize the risk of congenital anomalies in affected individuals [ 18 ].

Hormonal Influences

Anti-Müllerian hormone (AMH): AMH, primarily produced by the developing testes in males, is a critical regulator in the regression of the Müllerian ducts during male fetal development. In females, the absence or altered regulation of AMH may contribute to the persistence of Müllerian structures, leading to congenital anomalies in the female genital tract. Anomalies such as uterine malformations or vaginal septa may result from incomplete regression or abnormal development of the Müllerian ducts. Investigating the nuanced interplay between AMH and the female reproductive tract during embryogenesis provides valuable insights into the molecular mechanisms underlying these anomalies, potentially informing targeted therapeutic strategies or interventions [ 19 ].

Estrogen and progesterone: Balanced levels of estrogen and progesterone are paramount for the normal development of the female reproductive organs. During critical periods of embryogenesis, hormonal imbalances can disrupt the intricate processes involved in forming the female genital tract. Deviations from the optimal hormonal milieu may lead to structural abnormalities affecting the uterus, cervix, or other reproductive structures. Understanding the specific effects of estrogen and progesterone on cellular differentiation, tissue patterning, and organogenesis is essential for unraveling the complex etiology of congenital anomalies in the female genital tract. Insights into hormonal influences contribute to developing targeted interventions to restore hormonal balance and potentially prevent or correct anomalies during the early stages of fetal development [ 20 ].

Teratogenic Agents

Thalidomide and diethylstilbestrol (DES): Historical instances involving thalidomide and DES serve as poignant reminders of the teratogenic potential associated with certain medications. Thalidomide, prescribed in the late 1950s and early 1960s for morning sickness, resulted in severe limb anomalies and other congenital disabilities when taken during pregnancy. Similarly, DES, a synthetic estrogen prescribed to prevent miscarriages between the 1940s and 1970s, was later linked to reproductive tract anomalies and an increased risk of clear cell adenocarcinoma in female offspring. These examples underscore the critical importance of vigilance and thorough assessment of drug safety during pregnancy. Insights gained from these historical incidents have contributed to enhanced regulations and awareness, emphasizing the need for rigorous testing and cautious prescribing practices to safeguard fetal development and prevent congenital anomalies [ 21 ].

Clinical presentation

Asymptomatic Cases

A notable characteristic of congenital anomalies of the female genital tract is that a significant proportion of affected individuals may remain asymptomatic. In these cases, the anomalies are often incidentally discovered during routine pelvic examinations, imaging studies, or investigations for unrelated health concerns. Asymptomatic individuals may not experience noticeable disruptions in reproductive or gynecological function, and the anomalies may only become apparent when seeking medical attention for unrelated reasons [ 2 ].

Reproductive Issues

Infertility: Female genital tract anomalies exert a significant impact on fertility, influencing the intricate processes of conception and implantation. Structural variations within the uterus and cervix pose challenges to successful conception, with uterine anomalies like septate or bicornuate uterus altering the spatial dynamics of the uterine cavity. These variations can impede the optimal conditions required for the implantation of a fertilized egg, thereby affecting the chances of achieving a viable pregnancy. Anomalies such as the unicornuate uterus and uterine didelphys are also associated with an increased risk of infertility, emphasizing the importance of a thorough understanding of the specific anatomical challenges each anomaly presents. Managing infertility in the context of female genital tract anomalies requires a tailored approach that addresses the underlying structural factors influencing reproductive success [ 1 ].

Recurrent pregnancy loss: Certain congenital anomalies elevate the risk of recurrent pregnancy loss, creating additional hurdles for individuals aspiring to build a family. Anomalies like septate uterus or bicornuate uterus can disrupt the regular vascular supply to the uterine lining, contributing to recurrent miscarriages. Addressing these structural abnormalities becomes paramount in the management of recurrent pregnancy loss, as interventions aimed at correcting uterine anomalies can enhance the likelihood of a successful pregnancy. Understanding the intricate relationship between female genital tract anomalies and recurrent pregnancy loss informs clinical decision-making, guiding healthcare providers in implementing targeted interventions to optimize reproductive outcomes for individuals facing these challenges [ 22 ].

Menstrual Disorders

Congenital anomalies of the female genital tract can influence menstrual patterns and contribute to menstrual disorders. Women with septate uterus or other structural anomalies may experience abnormal uterine bleeding, dysmenorrhea, or irregular menstrual cycles. The presence of a transverse vaginal septum can lead to obstructive symptoms, causing difficulties in the standard passage of menstrual flow [ 23 ].

Urinary Tract and Bowel Symptoms

Urinary symptoms: Female genital tract anomalies, particularly those involving the uterus, can manifest in urinary symptoms due to their anatomical proximity to the bladder. Anomalies such as a septate uterus or other uterine abnormalities may exert pressure on the adjacent bladder, resulting in urinary symptoms such as increased frequency, urgency, or incontinence. The altered anatomy can disrupt the normal spatial relationship between the uterus and bladder, leading to functional disturbances. In more complex cases, such as cloacal anomalies involving the fusion of the urinary and reproductive tracts, shared channels may result in intricate urinary manifestations. Understanding the interplay between female genital tract anomalies and urinary symptoms is crucial for comprehensive patient care and may guide appropriate interventions to alleviate these symptoms [ 24 ].

Bowel symptoms: Female genital tract anomalies can contribute to bowel symptoms, mainly when anomalies affect the rectovaginal septum or involve complex conditions such as cloacal anomalies. Anomalies affecting the rectovaginal septum may lead to symptoms such as constipation or difficulties with bowel movements. The presence of a transverse vaginal septum, for example, can cause obstructive symptoms that impact bowel function [ 25 ]. Cloacal anomalies, characterized by the fusion of the rectum, vagina, and urinary tract, may result in shared channels and complex interactions affecting bowel function. A comprehensive understanding of these anatomical relationships is essential for healthcare providers to address bowel symptoms effectively and improve the overall quality of life for individuals with female genital tract anomalies [ 25 ].

Medical History and Physical Examination

Medical history: Initiating the diagnostic process for congenital anomalies of the female genital tract begins with a comprehensive medical history. This essential step involves gathering pertinent information such as menstrual history, reproductive experiences, any instances of infertility or recurrent pregnancy loss, and details regarding urinary or bowel symptoms. Uncovering the patient's medical background provides valuable insights into potential underlying causes and aids in formulating a practical diagnostic approach. Furthermore, thoroughly examining family history is crucial to identifying genetic factors contributing to these anomalies, allowing for a more holistic understanding of the patient's condition [ 26 ].

Physical examination: A detailed physical examination, including a meticulous pelvic examination, is indispensable in diagnosing congenital anomalies of the female genital tract. This examination serves to assess both the external and internal genital anatomy. Specific physical findings, such as the presence of a transverse vaginal septum, abnormal cervical configuration, or the identification of a vaginal dimple, provide valuable clues pointing toward particular anomalies. The examination may also extend to assess for associated anomalies in other organ systems, offering a comprehensive understanding of the patient's overall health. The insights gained from the physical examination contribute to developing a targeted diagnostic plan, guiding subsequent imaging and laboratory investigations for a precise and tailored diagnosis [ 27 ].

Imaging Techniques

Ultrasound: Ultrasonography, particularly transvaginal ultrasound, is a fundamental imaging modality in evaluating female genital tract anomalies. This non-invasive technique enables high-resolution visualization of the uterus, cervix, and ovaries, offering valuable insights into their structural integrity. While less detailed, transabdominal ultrasound can complement the assessment in some instances. Ultrasound is particularly adept at detecting uterine anomalies, including septate or bicornuate uterus, and contributes to evaluating ovarian function. This imaging modality is an initial and often essential step in the diagnostic process, guiding subsequent investigations and informing treatment decisions [ 28 ].

MRI: MRI emerges as a powerful and versatile tool for characterizing the intricate anatomy of the female reproductive organs. With its exceptional soft tissue contrast, MRI is particularly valuable in delineating complex anomalies such as uterine didelphys or septate uterus. It provides detailed information about the extent of structural variations, aiding in treatment planning, especially before surgical interventions. MRI's ability to capture three-dimensional images enhances diagnostic precision, making it a cornerstone in the diagnostic armamentarium for female genital tract anomalies [ 29 ].

Hysterosalpingography (HSG): HSG involves the injection of contrast material into the uterine cavity and fallopian tubes, followed by X-ray imaging. This procedure is instrumental in assessing the morphology of the uterus and fallopian tubes. HSG can reveal abnormalities such as a septate uterus or blockages in the fallopian tubes, providing crucial information for both diagnostic and therapeutic purposes. It is commonly employed as part of the infertility workup, offering insights into potential factors contributing to reproductive challenges and guiding subsequent management strategies. The dynamic nature of HSG allows for real-time observation of contrast flow, enhancing its utility in assessing tubal patency and uterine cavity abnormalities [ 30 ].

Laboratory Tests

Hormonal assays: Hormonal assays, encompassing assessments of estrogen, progesterone, and anti-Müllerian hormone (AMH) levels, play a pivotal role in gaining insights into the hormonal milieu and ovarian function. These tests contribute to the comprehensive evaluation of the endocrine status, offering valuable information about the regulatory mechanisms governing the female reproductive system. Hormonal imbalances detected through these assays may be associated with specific congenital anomalies of the female genital tract and can influence reproductive outcomes. By providing a snapshot of the hormonal environment, these assays aid healthcare providers in tailoring treatment strategies and addressing potential endocrine-related factors contributing to reproductive challenges [ 31 ].

Genetic testing: Genetic testing assumes significance, particularly in cases where there is suspicion of underlying genetic syndromes or when multiple family members are affected by female genital tract anomalies. Various genetic testing modalities may be employed, including karyotyping, fluorescence in situ hybridization (FISH), or molecular genetic testing to identify specific gene mutations associated with these anomalies. The results of genetic testing not only contribute to a precise diagnosis but also have implications for family planning and genetic counseling. Understanding the genetic basis of female genital tract anomalies enables healthcare providers to offer more personalized and targeted care, focusing on addressing the underlying genetic factors that may contribute to these conditions [ 32 ].

Management and treatment

Conservative Approaches

Observation: In instances where female genital tract anomalies are asymptomatic or do not significantly impact reproductive function, a conservative approach involving observation may be deemed appropriate. This approach recognizes that not all anomalies require active intervention, and careful monitoring through regular imaging and clinical assessments allows healthcare providers to track any changes over time. Observation is a valuable strategy for cases where the anomaly is stable, not causing discomfort or functional impairment, and where the potential benefits of intervention do not outweigh the risks. This approach aligns with the principle of providing individualized care that considers each patient's unique circumstances and preferences [ 2 ].

Hormonal therapy: Hormonal therapy emerges as a viable option in cases where hormonal imbalances are identified or anomalies are associated with specific hormonal dysregulation. This therapeutic approach aims to regulate menstrual cycles, alleviate symptoms, and optimize reproductive outcomes. For instance, in the context of uterine anomalies affecting endometrial receptivity, hormonal therapy may be employed to create a more conducive environment for implantation. The targeted use of hormones, such as estrogen or progesterone, can address specific challenges related to the hormonal milieu, contributing to improved reproductive function. Hormonal therapy is often tailored to the patient's needs, with close monitoring to assess its efficacy and make adjustments as necessary. This approach exemplifies a proactive, patient-centered strategy for managing female genital tract anomalies [ 33 ].

Surgical Interventions

Hysteroscopic septum resection: Hysteroscopic septum resection represents a minimally invasive surgical procedure designed to correct anomalies such as a septate uterus or other uterine septa. During this procedure, a hysteroscope is introduced through the cervix into the uterine cavity, providing direct visualization for the surgeon. The septum is excised using specialized instruments, facilitating the restoration of a more normal uterine configuration. Hysteroscopic septum resection is particularly valuable for improving reproductive outcomes by creating an environment conducive to implantation. This minimally invasive approach often results in shorter recovery times and reduced postoperative discomfort compared to traditional surgical interventions [ 34 ].

Vaginoplasty: Vaginoplasty is a surgical intervention designed to address anomalies such as vaginal agenesis or transverse vaginal septum. This procedure involves the creation or reconstruction of the vaginal canal, aiming to enhance sexual function and enable the passage of menstrual flow. The choice of specific vaginoplasty techniques depends on the anomaly's nature and individual patient circumstances. Vaginoplasty plays a crucial role in improving the quality of life for individuals with congenital anomalies affecting the vagina, providing both functional and cosmetic benefits [ 35 ].

Uterine anomaly repair: Surgical correction of uterine anomalies, such as bicornuate or unicornuate uterus, may be considered in cases where the anomaly is associated with recurrent pregnancy loss or infertility. These procedures involve reconfiguring the uterine shape to optimize reproductive function. The choice of a specific surgical approach depends on factors such as the type and severity of the uterine anomaly. Uterine anomaly repair is geared towards improving the likelihood of successful pregnancies by addressing structural abnormalities that may hinder proper implantation and fetal development. This surgical intervention is an integral component of a comprehensive treatment plan for individuals seeking to overcome reproductive challenges associated with uterine anomalies [ 36 ].

Assisted Reproductive Technologies (ART)

In vitro fertilization (IVF): assisted reproductive technologies (ART), notably IVF, offer a valuable option for individuals with specific female genital tract anomalies. IVF involves the fertilization of an egg with sperm outside the body, followed by the transfer of the resulting embryo into the uterus. This method is a powerful tool to overcome anatomical challenges within the female reproductive tract, providing a pathway to successful pregnancy. By bypassing certain structural obstacles, such as uterine anomalies, IVF enhances the chances of successful fertilization, implantation, and, ultimately, a healthy pregnancy. This approach is particularly beneficial for individuals facing infertility related to anatomical variations within the female genital tract [ 26 ].

Surrogacy: Surrogacy emerges as a consideration in cases where uterine anomalies significantly impact the ability to carry a pregnancy to term. This alternative involves another woman, the surrogate, carrying the pregnancy on behalf of the intended parents. Surrogacy provides a viable solution for individuals with uterine factors that may affect gestation, offering the opportunity to experience parenthood despite challenges related to the female reproductive tract. The collaborative nature of surrogacy involves careful legal and ethical considerations to ensure the well-being of all parties involved. This option serves as an avenue for individuals and couples to realize their dream of building a family when traditional pregnancy may be compromised due to structural anomalies in the uterus [ 37 ].

ASRM Müllerian anomalies classification and clinical Implications

Significance of ASRM Classification

ASRM Müllerian Anomalies Classification 2021 holds significant clinical implications. This classification system aims to standardize terminology, facilitate communication, and simplify searches in scientific databases. ASRM Müllerian Anomalies Classification is a valuable framework for clinicians, researchers, and healthcare professionals in diagnosing and managing female genital tract anomalies. Its significance lies in providing a standardized system for consistent communication, accurate diagnosis, and improved understanding of the various anomalies. The ASRM classification categorizes anomalies based on anatomical features, identifying specific types and guiding appropriate interventions [ 38 ].

Standardized communication: The ASRM classification system promotes clear, standardized communication within the healthcare community. By providing a structured framework for describing female genital tract anomalies, this classification facilitates seamless interdisciplinary collaboration. Healthcare providers across various specialties can use a common language to convey information about specific anomalies, ensuring that accurate and pertinent details are conveyed consistently. This standardized communication enhances the efficiency of healthcare delivery, promoting effective coordination among professionals involved in the diagnosis, treatment, and management of female genital tract anomalies [ 39 ].

Accurate diagnosis: The ASRM classification system is a valuable tool for accurate diagnoses of specific female genital tract anomalies. Through this system, healthcare providers can precisely identify the type and severity of an anomaly, allowing for a more nuanced understanding of the patient's condition. Accurate diagnosis is paramount in tailoring personalized treatment plans that address each individual's unique needs and challenges. The ASRM classification not only aids in identifying the primary anomaly but also assists in recognizing any associated features or complications. This precision in diagnosis contributes to informed decision-making and facilitates proactive interventions, ultimately improving the overall quality of care for individuals with female genital tract anomalies [ 40 ].

Impact on Treatment Planning

Individualized treatment approaches: The ASRM classification system provides a foundation for developing more individualized and targeted treatment approaches for female genital tract anomalies. By categorizing anomalies into distinct classes, healthcare providers can tailor interventions to address the specific challenges associated with each type of anomaly. This individualized approach recognizes the unique circumstances of each patient, considering factors such as the type and severity of the anomaly, the patient's reproductive goals, and any coexisting medical conditions. Tailoring treatment plans based on the ASRM classification enhances the precision and effectiveness of interventions, increasing the likelihood of successful outcomes and optimizing the overall quality of care for individuals with female genital tract anomalies [ 40 ].

Optimizing reproductive function: Treatment planning guided by the ASRM classification is designed to optimize reproductive function for individuals with female genital tract anomalies. For example, surgical correction of uterine anomalies, informed by the specific classification, may enhance the chances of successful conception and a healthy pregnancy. This approach recognizes that the impact of anomalies on reproductive function varies widely, and interventions must be tailored accordingly. Individualized treatment plans can be particularly crucial in cases where anomalies coexist or where additional factors, such as hormonal imbalances, contribute to reproductive challenges. By optimizing reproductive function through targeted interventions, healthcare providers strive to improve the overall reproductive outcomes and enhance the well-being of individuals affected by female genital tract anomalies [ 41 ].

Considerations for Reproductive Outcomes

Reproductive counseling: The ASRM classification system plays a vital role in guiding reproductive counseling for individuals with female genital tract anomalies. By categorizing anomalies into distinct classes, healthcare providers can effectively communicate the potential impact of specific anomalies on fertility and pregnancy outcomes. This counseling is crucial for supporting individuals in making informed decisions about their reproductive journey. Through clear and standardized communication facilitated by the ASRM classification, healthcare providers can discuss the unique challenges associated with each anomaly class, address concerns, and guide available options. Reproductive counseling enables individuals to make decisions aligned with their goals and values, empowering them to navigate the complexities of family planning with a comprehensive understanding of their situation [ 36 ].

Risk assessment for complications: The ASRM classification system enables healthcare providers to conduct a more nuanced risk assessment for complications associated with female genital tract anomalies. Different classes of anomalies carry varying risks, including the potential for recurrent pregnancy loss or preterm birth. By categorizing anomalies and understanding their implications, healthcare providers can assess these risks more accurately. This knowledge empowers providers to implement preventive measures or interventions tailored to the individual's situation, optimizing reproductive outcomes and minimizing the likelihood of complications. The ability to assess risks associated with specific classes of anomalies enhances the precision of medical guidance and contributes to a comprehensive and personalized approach to reproductive care [ 39 ]. 

Psychosocial impact

Quality of Life Issues

Body image and self-esteem: Individuals with visible genital tract anomalies often contend with challenges related to body image and self-esteem. Societal norms and expectations regarding physical appearance can exacerbate these challenges, leading to feelings of self-consciousness and impacting overall self-perception. The visibility of genital anomalies may evoke societal judgments or comparisons, contributing to a sense of being different or outside conventional beauty standards. This can have profound psychosocial implications, potentially influencing relationships, confidence, and the overall well-being of individuals. Cultivating a positive body image and self-esteem is crucial, and support from healthcare professionals and mental health services can play a pivotal role in addressing these challenges [ 42 ].

Sexual function and intimacy: Anomalies affecting the reproductive organs can have a significant impact on sexual function and intimacy. Pain or discomfort during sexual intercourse may be associated with specific anomalies, affecting the overall quality of the sexual experience. The challenges these anomalies pose may influence intimacy's emotional and physical aspects. Open communication between individuals and their healthcare providers is essential to address concerns related to sexual function and intimacy. Tailored interventions, including medical treatments or counseling, can contribute to improving sexual well-being and fostering healthy intimate relationships [ 43 ].

Social stigma and disclosure: Stigmatization and societal misconceptions surrounding female genital tract anomalies may contribute to feelings of isolation. Whether to disclose one's condition to others becomes a complex consideration, balancing the desire for understanding and support with concerns about potential judgment. Social stigma may arise from cultural taboos or limited awareness about these conditions, further complicating the disclosure process. Addressing societal misconceptions through education and advocacy efforts can contribute to reducing stigma creating a more supportive environment for individuals with genital tract anomalies. Mental health support, including counseling or support groups, can provide a safe space for individuals to navigate these challenges [ 44 ].

Fertility-related stress: For individuals desiring children, fertility-related stress becomes a significant aspect of the psychosocial impact. The challenges associated with conception, potential fertility treatments, and the risk of adverse reproductive outcomes may contribute to heightened stress levels and emotional strain. The uncertainty surrounding fertility can evoke feelings of frustration, sadness, or anxiety. Comprehensive support, including fertility counseling, mental health services, and educational resources, can help individuals cope with fertility-related stress. Addressing the psychosocial impact of fertility challenges is integral to holistic care, promoting emotional well-being alongside medical interventions [ 44 ].

Psychological and Emotional Aspects

Anxiety and depression: Coping with the diagnosis and management of female genital tract anomalies can significantly increase levels of anxiety and depression. The emotional impact stems from the uncertainty surrounding reproductive outcomes, the potential need for medical interventions, and societal pressures related to body image and fertility. Individuals may experience heightened stress as they navigate the complexities of their condition. Healthcare providers play a crucial role in recognizing and addressing the psychological aspects of these challenges, offering emotional support, and connecting individuals with appropriate mental health resources [ 45 ].

Impact on relationships: The psychosocial impact of female genital tract anomalies extends to interpersonal relationships, including those with partners, family members, and friends. Open communication about the challenges associated with these conditions is crucial for maintaining supportive relationships and addressing any relational strain. Partners may also experience their emotional responses to the diagnosis, and fostering understanding and empathy is essential. Supportive environments that encourage dialogue and shared decision-making contribute to the emotional well-being of individuals and their loved ones [ 46 ].

Reproductive grief: Individuals facing difficulties with fertility or experiencing recurrent pregnancy loss may grapple with reproductive grief. The emotional toll of unsuccessful attempts at conception and the loss of pregnancies can lead to profound feelings of sadness, frustration, and grief. Acknowledging and validating these emotions is essential for providing compassionate care. Healthcare providers can play a role in supporting individuals through the grieving process, offering resources for emotional support, and guiding them toward appropriate mental health services [ 47 ].

Coping mechanisms and support: Developing effective coping mechanisms and accessing emotional support are integral components of managing the psychological and emotional aspects of female genital tract anomalies. Support from healthcare providers, mental health professionals, and support groups can provide individuals with the tools to navigate the emotional challenges associated with their condition. Encouraging healthy coping strategies, such as mindfulness, counseling, or peer support, empowers individuals to build resilience and address the impact on their mental well-being. A multidisciplinary approach that integrates medical care with psychosocial support enhances the overall quality of care for individuals facing female genital tract anomalies [ 48 ].

Future directions and research

Advances in Diagnosis Techniques

3D imaging and virtual reality: Future developments in the field may witness the integration of advanced imaging technologies, such as three-dimensional (3D) ultrasound and virtual reality (VR), offering a more detailed and immersive visualization of female genital tract anatomy. These technologies can potentially revolutionize the diagnostic process, providing healthcare professionals with enhanced insights into the structural nuances of anomalies. 3D imaging and VR can contribute to improved accuracy in diagnosis and offer surgeons valuable information for preoperative planning. This technological integration may redefine the standards of care by providing a more comprehensive and interactive understanding of female genital tract anomalies [ 49 ].

Artificial intelligence (AI) in imaging analysis: Incorporating AI into imaging analysis is poised to play a significant role in diagnosing female genital tract anomalies. AI algorithms can efficiently process and analyze imaging data, assisting in identifying and classifying anomalies with high accuracy. By automating certain aspects of image interpretation, AI has the potential to improve diagnostic efficiency, reduce interpretation errors, and enhance overall precision. Integrating AI-based tools into the diagnostic workflow holds promise for optimizing the use of imaging modalities in assessing female genital tract anomalies [ 50 ].

Functional imaging techniques: Future advancements may explore the application of functional imaging techniques, such as functional MRI (fMRI), to gain insights into the physiological aspects of the female reproductive organs. Beyond structural considerations, functional imaging can provide information about the dynamic functionality of the reproductive system. Understanding the functional implications of anomalies can contribute to a more comprehensive approach to diagnosis and treatment planning. Functional imaging techniques have the potential to elucidate how anomalies impact physiological processes, guiding healthcare providers in tailoring interventions that address both structural and functional aspects of female genital tract anomalies [ 51 ].

Emerging Treatment Modalities

Regenerative medicine and tissue engineering: Advances in regenerative medicine and tissue engineering represent a promising frontier for developing innovative treatment modalities for female genital tract anomalies. These strategies involve leveraging the principles of regenerative biology to stimulate the regeneration or reconstruction of damaged or absent tissue in the female genital tract. This holds particular promise for conditions such as vaginal agenesis or structural deficiencies, where regenerating functional tissue is essential. Regenerative medicine approaches may offer novel therapeutic options that restore normal anatomy and function, potentially transforming the treatment landscape for certain female genital tract anomalies [ 52 ].

Gene therapy and molecular interventions: Molecular and gene therapy may emerge as a frontier for addressing genetic factors contributing to female genital tract anomalies. Targeted approaches could involve modifying gene expression or correcting genetic mutations associated with these anomalies. By intervening at the molecular level, gene therapy offers the potential for more precise and personalized treatments. Understanding the genetic underpinnings of specific anomalies may open avenues for therapeutic interventions that address the root causes, potentially transforming the landscape of treatment for individuals with genetic predispositions to female genital tract anomalies [ 53 ].

Non-invasive therapies: Exploring non-invasive therapies, such as focused ultrasound or other targeted energy modalities, represents a novel approach to correcting certain female genital tract anomalies. These non-invasive interventions aim to provide alternatives to traditional surgical procedures, potentially reducing invasiveness and optimizing patient outcomes. Non-invasive therapies may offer advantages such as shorter recovery times, minimized risk of complications, and improved patient experience. Investigating and developing non-invasive modalities for the correction of female genital tract anomalies reflects a commitment to advancing patient-centric care and expanding the array of available treatment options [ 54 ].

Genetic and Molecular Research

Genetic profiling and precision medicine: Advances in genetic profiling techniques can potentially revolutionize our understanding of the genetic underpinnings of female genital tract anomalies. Genetic profiling allows for a more comprehensive analysis of an individual's genetic makeup, uncovering specific variations that may contribute to anomalies. This knowledge forms the basis for precision medicine, where treatment strategies can be tailored to the unique genetic profile of each patient. Precision medicine in the context of female genital tract anomalies involves personalized interventions that consider the individual's genetic factors, paving the way for more targeted and effective treatments [ 55 ].

Epigenetic studies: Exploring epigenetic factors influencing the development of female genital tract anomalies adds a layer of complexity to our understanding of these conditions. Epigenetic studies investigate how environmental influences interact with genetic factors through mechanisms that regulate gene expression. Unraveling the epigenetic landscape may provide insights into the etiology of female genital tract anomalies and identify potential therapeutic targets. Understanding the interplay between genetics and epigenetics enhances our ability to comprehend the multifaceted nature of these anomalies. It may open avenues for interventions that address both genetic and environmental factors [ 56 ].

Biomarkers for reproductive outcomes: Ongoing research focuses on identifying biomarkers associated with reproductive outcomes in individuals with female genital tract anomalies. Biomarkers are measurable indicators that can provide valuable information about the likelihood of successful conception, guide treatment decisions, and assess the impact of interventions on fertility. The discovery of reliable biomarkers holds the potential to refine prognostic assessments, allowing healthcare providers to offer more accurate predictions regarding reproductive outcomes. This area of the research aligns to enhance predictive capabilities and tailor interventions to optimize fertility and reproductive success in individuals with female genital tract anomalies [ 57 ].

Conclusions

This comprehensive review explored the intricate realm of congenital anomalies of the female genital tract, shedding light on key findings and implications for clinical practice. The ASRM Müllerian Anomalies Classification has emerged as a pivotal tool, providing a standardized framework for communication and precise diagnosis. Our exploration of clinical presentations, etiological factors, diagnostic modalities, and management strategies underscores the need for a holistic approach that considers physical and psychosocial aspects. As we navigate the complexities of female genital tract anomalies, it is evident that future directions in research hold tremendous potential. Advances in diagnosis techniques, emerging treatment modalities, and ongoing genetic and molecular investigations offer hope for improved precision in diagnostics, expanded therapeutic options, and the growth and development of personalized medicine in this field. As healthcare professionals strive to integrate these advancements into practice, a patient-centered approach will be paramount, guided by informed decision-making and clear communication. Moreover, continued research into advanced imaging technologies, regenerative medicine, and genetic studies will further contribute to understanding and managing these anomalies, ultimately enhancing the quality of care and outcomes for affected individuals.

Acknowledgments

I want to express my deep appreciation for the integral role of artificial intelligence (AI) tools like Grammarly, Paperpal, and ChatGPT in completing this research paper. Incorporating AI technologies has significantly elevated the efficiency and depth of our analysis, adding a layer of sophistication to our study. By utilizing advanced algorithms and machine learning techniques, we were able to process extensive datasets with unprecedented speed, allowing for a more comprehensive exploration of intricate patterns and trends.

The authors have declared that no competing interests exist.

Author Contributions

Concept and design:   Swati M. Dahiphale, Jyotsana Potdar, Neema Acharya, Garapati Jyotsna, Rahul Desale, Saloni .

Acquisition, analysis, or interpretation of data:   Swati M. Dahiphale, Jyotsana Potdar, Neema Acharya, Garapati Jyotsna, Rahul Desale, Saloni .

Drafting of the manuscript:   Swati M. Dahiphale, Jyotsana Potdar, Neema Acharya, Garapati Jyotsna, Rahul Desale, Saloni .

Critical review of the manuscript for important intellectual content:   Swati M. Dahiphale, Jyotsana Potdar, Neema Acharya, Garapati Jyotsna, Rahul Desale, Saloni .

Supervision:   Neema Acharya, Rahul Desale, Saloni .

• Case Report
• Open access
• Published: 22 August 2024

Cellular angiofibroma of the female pelvic cavity: a case report

• Li Chen 1 ,
• Gumuyang Zhang 1 &
• Hao Sun 1 , 2  

BMC Urology volume  24 , Article number:  176 ( 2024 ) Cite this article

30 Accesses

Metrics details

Cellular angiofibroma is a rare benign mesenchymal tumor that mostly occurs in the genital area. Its occurrence outside this region, particularly in the pelvis, is extremely rare. To our knowledge, this study reports the first case of cellular angiofibroma occurring in the pelvic cavity, except for one case reported in the retroperitoneum.

Case presentation

A 25-year-old female patient with chronic, intermittent, dull pain in the lower abdomen that lasted for several months was referred to our clinic. Imaging studies revealed a tumor in the pelvic cavity anterior to the bladder. The radiographic characteristics of this tumor indicated a hypervascular nature, suggesting the possibility of a pheochromocytoma or a neuroendocrine tumor. The patient underwent surgical excision of the lesion. To date, no recurrence has been observed four months after excision.

Conclusions

Cellular angiofibroma, although rare in the pelvic cavity, should be considered in the differential diagnosis of hypervascular pelvic space-occupying lesions. Immunohistochemical staining can help confirm the diagnosis of this condition. Treatment is generally straightforward, involving local excision of the tumor followed by postoperative monitoring.

Peer Review reports

Introduction

Cellular angiofibroma (CA) is a rare benign mesenchymal tumor that was first documented by Nucci et al. in 1997 [ 1 ]. It predominantly occurs in the genital area. CA commonly affects females in the vulva and vagina, while it affects males in the groin and scrotum. Although CA is rarely found in the pelvis, it has been reported in the retroperitoneum [ 2 , 3 , 4 ]. CA affects both genders, but it is more common in women, particularly those in their fifties [ 5 ]. The tumor manifests as a gradually growing mass and is often asymptomatic, although it may cause pain in some patients [ 6 ].

In this report, we present a rare and clinically atypical case of a 25-year-old woman with CA located anterior to the bladder in the pelvis. Additionally, we detailed the characteristics, imaging findings, histopathologic features, and treatment of the patient. To our knowledge, this is the second reported case of cellular angiofibroma occurring in a female pelvis.

• Case report

This case report was approved for publication by the institutional review board. All of the patient details were anonymized to ensure patient confidentiality.

A 25-year-old female patient with intermittent, dull pain in the lower abdomen for several months was referred to our outpatient clinic. She had regular menstrual cycles with no significant past medical or gynecological history.

The patient underwent computed tomography urography (CTU) in our clinic, along with a complete blood count, blood pressure and glucose monitoring, a 24-hour catecholamine assay, and biochemical examinations for tumor marker profiling. The results of these laboratory tests were within the normal range, and tumor markers, such as carbohydrate antigen (CA) 125, CA19-9, carcinoembryonic antigen (CEA), squamous cell carcinoma antigen, neuron-specific enolase, and lactate dehydrogenase (LDH)-199 were also within the established normal range. The CTU revealed an elliptical soft tissue density in the pelvic cavity, anterior to the bladder, measuring approximately 50 mm × 38 mm × 35 mm. The lesion had a relatively well-defined border with heterogeneous density on non-contrast imaging, characterized by multiple small cystic low-density areas. In addition, its solid component had a CT value of approximately 56 Hounsfield units (HU). During the arterial phase of the contrast-enhanced scanning, the lesion was significantly enhanced with a CT value of 149 HU, particularly within the small cystic areas. It was also significantly enhanced at the tail-like projections. In the portal venous and delayed phases, sustained enhancement with slightly reduced intensity was observed in the lesion, with multiple tortuous and dilated arteries and veins surrounding it. The CT values of the lesion were approximately 122 HU and 101 HU during the venous and delayed phases, respectively. This mass was found close to the anterior wall of the bladder, clearly demarcated from the bladder and adjacent bowel. The mass effect caused a posterior displacement of the anterior bladder wall (Figs.  1 and 2 ). Based on these findings, our institution’s preliminary diagnosis was pheochromocytoma or neuroendocrine tumor. Consequently, the patient underwent robot-assisted laparoscopic pelvic tumor resection, and the tumor was completely removed.

Microscopic examination of the specimen showed a spindle cell tumor with dense cellularity, abundant eosinophilic cytoplasm, mild nuclear atypia, and a highly vascularized stroma with areas of hyaline degeneration. Immunohistochemical (IHC) staining revealed cytoplasmic positivity for CD34, smooth muscle actin (SMA), and β-catenin, while desmin, CD117, S-100, and DOG-1 were negative, with a Ki-67 index of 5% (Fig.  3 ). Based on the immunohistochemical results, the final diagnosis was confirmed as CA, and no tumor recurrence was observed during the four-month postoperative follow-up period, as confirmed by a repeat CT cross-sectional imaging.

The depicted images are as follows: ( A ) the non-contrast phase, ( B ) the arterial phase, ( C ) the portal venous phase, and ( D ) the delayed phase. The tumor exhibits a well-defined border with a heterogeneous composition. Its solid components were significantly enhanced during the contrast-enhanced scans, with a slight decrease in enhancement intensity over the phases

( A ) Coronal reformatted imaging of the tumor clearly delineated from the surrounding bowel and bladder, exerting significant pressure on them. ( B ) Volume rendering technique reconstruction reveals abundant vascularity within the tumor

A (magnification ×250): the hematoxylin-eosin staining specimen shows a spindle cell tumor with dense cellularity, abundant eosinophilic cytoplasm, mild nuclear atypia, and a highly vascularized stroma, with areas of hyaline degeneration. B (magnification ×100): immunohistochemical staining reveals cytoplasmic positivity for CD34. C (magnification ×100): IHC staining revealed cytoplasmic positivity for β-catenin. D (magnification ×100): IHC staining revealed negative for S-100

Although studies have reported tumors occurring in the genital region, the etiology of CA is not fully understood [ 7 ]. Lane et al. reported a possible link between long-term estrogen therapy and CA development [ 8 ]. Some researchers have also proposed that CA arises from the differentiation of fibroblasts or myofibroblasts. Fluorescence in situ hybridization and other analytical methods have been used to reveal deletions in the chromosomal region 13q14 in cases of CA, spindle cell lipomas, and mammary and vaginal myofibromatous tumors [ 9 ]. The similar histopathological features observed in this study suggest a potential link between these tumors [ 10 ].

Although CA mainly affects the vulvar, vaginal, and scrotal regions, rare cases have been reported in the oral mucosa, male pelvis, subcutaneous tissue of the chest wall, nasopharynx, retroperitoneum, and anorectal region [ 11 , 12 , 13 , 14 , 15 ]. CA is a well-circumscribed benign mesenchymal tumor, often located in the superficial soft tissues of the trunk [ 6 ]. Most cases of CA present as asymptomatic subcutaneous nodules, except for those in the nasopharynx and retroperitoneum. In the nasopharyngeal region, the tumor manifests as frequent epistaxis (nosebleeds) and persistent nasal congestion [ 12 ], whereas retroperitoneal tumors cause pain in the iliac fossa [ 2 ]. In this report, we presented the second known case of CA in a female pelvis with atypical clinical characteristics, manifesting only as mild lower abdominal pain.

The histopathological changes in CA include the presence of a well-circumscribed tumor located within the dermis and lacking a capsule [ 7 ]. In most patients, the neoplastic cellular component is predominant, with short, bluntly rounded spindle-shaped nuclei and sparse cytoplasm with indistinct cell borders. Additionally, medium-sized, thick-walled blood vessels with hyaline degeneration, slender collagen fiber bundles, and enlarged histiocytic cells are prevalent in this condition. Pseudo-vascular clefts may occasionally be observed, and mature adipocytes are often present. Similar to other tumors, focal cellular atypia was described in this report, and sarcomatous changes were also identified. IHC revealed that the tumor cells exhibited diffuse vimentin positivity, and CD34 was positive in most cases [ 7 ]. In female patients, some tumor cells showed partial positivity for estrogen receptor and progesterone receptor, while SMA, desmin, and S-100 were generally negative. However, in male patients, SMA, muscle-specific actin, and desmin may show partial positivity. The Ki-67 proliferation index is low.

CA often appears as a well-circumscribed, hypervascular tumor on CT or MRI images, with no other specific radiographic findings. It requires differentiation from the following conditions. ① Spindle cell lipoma: This tumor predominantly occurs in the posterior neck, shoulder, and upper back of males. The tumor comprises mature adipocytes and slender spindle cells in varying proportions, with myxoid degeneration in the stroma forming pseudo-vascular spaces. Spindle cells are CD34 positive, mature adipocytes are S-100 positive, and both are consistently negative for the Rb protein. Advancements in genetic testing are increasingly employing MDM2 detection to differentiate spindle cell lipoma, which typically lacks MDM2 gene expression, from malignant liposarcoma [ 16 ]. ② Angiomatoid fibrous histiocytoma: An uncommon soft tissue tumor of intermediate malignancy that commonly occurs in the external genitalia and perineal region, histologically characterized by multi-cellular and hypocellular areas, with prominent myxoid changes in the hypocellular areas. The tumor cells are epithelioid or spindle-shaped, clustered around blood vessels, and often multinucleated, with transparent or pink cytoplasm. They show strong positivity for desmin and vimentin. Angiomatoid fibrous histiocytoma is well-described to display a spectrum of variant histomorphologies, such as prominent myxoid stroma prompting, which often harbored a FET family gene EWSR1- CREM fusions [ 17 ]. ③ Retroperitoneal neurofibroma: It is located along the sympathetic ganglia in the paravertebral region. These tumors are well-circumscribed and variable in size, showing positivity for S-100. ④ Aggressive angiomyxoma: This tumor, often 10 cm or larger in diameter, exhibits infiltrative growth. It is composed of small spindle or stellate cells with lightly stained cytoplasm set within a myxoid matrix. These tumor cells express SMA and desmin. Additionally, based on accumulated case reports, Fluorescence In Situ Hybridization (FISH) analysis indicates that a chromosomal aberration at 12q15 results in the rearrangement of the high mobility group protein A2 (HMGA2) gene in nearly half of aggressive angiomyxoma cases [ 18 ]. Although its underlying mechanism remains unclear, it provides clues for distinguishing this tumor. ⑤ Labial Leiomyoma: This tumor consists of fascicles of spindle cells with well-defined cytoplasmic borders and cigar-shaped nuclei, which are positive for SMA [ 19 ].

Diagnosing CA based on clinical symptoms and imaging findings before surgery is challenging due to the absence of specific signs. Definitive diagnosis depends on needle biopsy or surgical excision followed by pathological examination. However, CT or MRI can indicate the extent of the tumor and guide the best surgical approach for complete lesion removal.

In summary, CA, although rare in the pelvic cavity, should be considered in the differential diagnosis of hypervascular pelvic space-occupying lesions. Most cases of CA exhibit benign behavior and are easily excised without showing atypia, and follow-up studies show low recurrence and no metastatic potential [ 20 , 21 , 22 ]. However, Hanae et al. suggested that previous research might have underestimated the recurrence or metastasic potential of CA, particularly in specific populations such as pregnant women, emphasizing the need for long-term follow-up studies [ 2 ]. The limitation in this case is the short follow-up period.

Data availability

The data used during the current study are available from the corresponding author of reasonable request.

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We thank LetPub (www.letpub.com.cn) for its linguistic assistance during the preparation of this manuscript.

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Department of Radiology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

Li Chen, Gumuyang Zhang & Hao Sun

National Center for Quality Control of Radiology, Beijing, China

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L. C. and G. Z. contributed to writing original draft preparation. H. S. contributed to the idea design of the paper and the modification of the final draft. All authors reviewed the manuscript.

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Correspondence to Gumuyang Zhang or Hao Sun .

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Chen, L., Zhang, G. & Sun, H. Cellular angiofibroma of the female pelvic cavity: a case report. BMC Urol 24 , 176 (2024). https://doi.org/10.1186/s12894-024-01566-w

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Received : 04 July 2024

Accepted : 13 August 2024

Published : 22 August 2024

DOI : https://doi.org/10.1186/s12894-024-01566-w

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