How does female genital tuberculosis develop? 1. Blood-borne transmission: It is the main way of transmission. The tuberculosis bacterium spreads through the bloodstream to the internal genital organs, starting with the fallopian tubes and gradually spreading to the endometrium and ovaries. Infection of the cervix, vagina and vulva is rare. 2. Direct spread: When tuberculous pelvic inflammatory disease, caseous lesions of mesenteric lymph node tuberculosis rupture or extensive adhesions of intestinal and bladder tuberculosis occur with internal genital organs, tuberculosis bacilli can spread directly to the surface of genital organs. Tuberculosis of the fallopian tubes often coexists with peritoneal tuberculosis, which may be preceded by tuberculosis of the fallopian tubes and then spread to the peritoneum or vice versa. 3. Lymphatic transmission: TB bacilli are transmitted from the abdominal visceral lymphatic system to the genital organs, such as mesenteric lymphatic TB, which can be transmitted retrogradely to the internal genital organs through lymphatic vessels, which is rare because of the need for retrograde dissemination. 4. Primary infection: The possibility of direct infection of the female genital organs with tuberculosis and the formation of primary lesions is still debated. Patients with male genitourinary tuberculosis (e.g., epididymal tuberculosis) directly infect their sexual partners through sexual intercourse, forming primary vulvar or cervical tuberculosis.