Adnexa is a medical term meaning “attached structures.” It refers to the parts that sit next to and support a major organ. You’ll most often hear it in gynecology, where the uterine adnexa includes the ovaries and fallopian tubes, but the term also applies to structures around the eye and even the skin. If you saw “adnexa” on an imaging report or heard it during an appointment, it was almost certainly referring to the area around your uterus.
The Uterine Adnexa
In gynecology, the uterine adnexa refers to everything attached to the uterus on either side: the ovaries, the fallopian tubes, and the connective tissue that holds them in place. These supporting tissues include the mesosalpinx (which suspends the fallopian tube) and the mesovarium (which anchors the ovary). Together, these structures are critical for reproduction. The ovaries release eggs and produce hormones, while the fallopian tubes carry eggs from the ovaries toward the uterus.
When a doctor says “left adnexa” or “right adnexa,” they’re talking about the ovary, fallopian tube, and surrounding tissue on that side. The term is useful in medicine because problems in this area often involve more than one structure at a time, and imaging can’t always pinpoint exactly which one is affected.
Other Uses of the Term
Outside of gynecology, you may encounter the term in two other contexts. The ocular adnexa includes the eyelids, the tear drainage system, the tear gland, the conjunctiva (the thin membrane lining the inner eyelid), and the soft tissue filling the eye socket. Essentially, it covers everything around the eyeball except the eye itself and the optic nerve.
In dermatology, skin adnexa (also called skin appendages) refers to structures that develop from the skin’s outer layer during fetal life: hair follicles, nails, sweat glands, and oil-producing sebaceous glands. These form starting around the third month of fetal development.
What an Adnexal Mass Means
The most common reason people encounter the word “adnexa” is on an ultrasound report describing an adnexal mass. This simply means something was seen in the area near the uterus. It does not automatically mean cancer. In fact, most adnexal masses are benign.
In women of reproductive age, the most common findings are functional cysts, which are a normal part of ovulation. These include simple cysts and hemorrhagic cysts that typically resolve on their own within a few menstrual cycles. Teratomas (also called dermoid cysts) are another common benign finding and are the most frequent type of germ cell tumor. Endometriomas, sometimes called “chocolate cysts,” result from endometriosis and are also benign.
In postmenopausal women, most adnexal masses are still benign. Cystadenomas (fluid-filled growths on the ovary) and simple cysts are common and generally harmless. However, the risk of malignancy is higher after menopause. Roughly 37.6% of adnexal masses in postmenopausal women turn out to be malignant, compared to about 7.9% in premenopausal women. Ovarian cancer remains the leading cause of death from gynecologic cancers in developed countries, which is why doctors take adnexal masses seriously even though most are harmless.
How Adnexal Masses Are Evaluated
Transvaginal ultrasound is the primary tool for evaluating an adnexal mass. The characteristics that matter most are the cyst’s size, whether it has a single chamber or multiple chambers, whether its walls are smooth or irregular, whether it contains solid components or small projections called papillations, and whether it shows significant blood flow on color Doppler imaging.
A smooth, fluid-filled cyst with a single chamber and no solid areas is almost certainly benign, especially if it’s under 3 centimeters. Features that raise concern include irregular walls, solid areas within the cyst, four or more papillary projections, heavy blood flow on Doppler, or the presence of fluid in the abdomen (ascites). Radiologists use a standardized scoring system called O-RADS to categorize masses from almost certainly benign (score 2) to high risk for malignancy (score 5).
Adnexal Torsion
One urgent condition involving the adnexa is torsion, where the ovary and sometimes the fallopian tube twist on their supporting tissue, cutting off blood supply. This causes sudden, severe pelvic pain, usually on one side, along with nausea and vomiting. Some women experience intermittent cramping pain for days or even weeks before a full torsion episode, likely from the structures twisting and untwisting.
Risk factors include excess mobility of the adnexa from an unusually long fallopian tube or its supporting tissue, and the presence of an ovarian mass that adds weight. Torsion is diagnosed based on symptoms and ultrasound findings, particularly an enlarged ovary with reduced or absent blood flow on color Doppler. The pain is often out of proportion to what a physical exam reveals. Torsion is a surgical emergency because the ovary can lose viability if blood flow isn’t restored promptly.
Adnexal Surgery
When an adnexal mass needs to be removed, the procedure depends on what’s involved. An adnexectomy removes the ovary and fallopian tube on one side. It’s commonly performed laparoscopically (through small incisions) and is effective for relieving pain. In studies of patients who had laparoscopic adnexectomy for pain-related conditions, 33 out of 35 reported significant pain relief.
Not every mass requires removing the entire ovary. Teratomas, for instance, can often be removed while preserving the rest of the ovary, which is especially important for younger patients who want to maintain fertility. The approach depends on the mass’s characteristics on imaging, the patient’s age, menopausal status, and whether there’s concern about malignancy.