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Anatomy & Physiology Of Female Reproductive System

Dr. Aida Abd El-Razek

Learning Objectives
Define

the terms listed. Identify the female external reproductive organs. Explain the structure of the bony pelvis. Explain the functions and structures of pelvic floor.

Introduction

External Female Structures


Collectively,

the external female reproductive organs are called the Vulva.

External Female Structures


Mons

Pubis. Labia Majora & Minora. Clitoris. Vestibule. Perineum

Mons Pubis
Is rounded, soft fullness of subcutaneous fatty tissue, prominence over the symphysis pubis that forms the anterior border of the external reproductive organs. It is covered with varying amounts of pubic hair.

Labia Majora & Minora


The

labia Majora are two rounded, fleshy folds of tissue that extended from the mons pubis to the perineum.

It

is protect the labia minora, urinary meatus and vaginal introitus.

Labia Minora
It

is located between the labia majora, are narrow. The lateral and anterior aspects are usually pigmented. The inner surfaces are similar to vaginal mucosa, pink and mois. Their rich vascularity.

Clitoris.
The

term clitoris comes from a Greek word meaning key. Erectile organ. Its rich vascular, highly sensitive to temperature, touch, and pressure sensation

Vestibule.
Is

oval-shaped area formed between the labia minora, clitoris, and fourchette. Vestibule contains the external urethral meatus, vaginal introitus, and Bartholins glands.

Perineum
Is

the most posterior part of the external female reproductive organs. It extends from fourchette anteriorly to the anus posteriorly. And is composed of fibrous and muscular tissues that support pelvic structures.

Internal Female Structures


Vagina

Uterus
Fallopian Ovaries

tubes

Fallopian tubes
The

two tubes extended from the cornu of the uterus to the ovary. It runs in the upper free border of the broad ligament. Length 8 to 14 cm average 10 cm Its divided into 4 parts.

1. Interstitial part
Which

runs into uterine cavity, passes through the myometrium between the fundus and body of the uterus. About 1-2cm in length.

2. Isthmus
Which

is the narrow part of the tube adjacent to the uterus. Straight and cord like , about 2 3 cm in length.

3. Ampulla
Which

is the wider part about 5 cm in length.

Fertilization

occurs in the

ampulla.

4. Infundibulum
It

is funnel or trumpet shaped. Fimbriae are fingerlike processes, one of these is longer than the other and adherent to the ovary. The fimbriae become swollen almost erectile at ovulation.

Functions
Gamete

transport (ovum pickup, ovum transport, sperm transport). maturation of gamete post ovulate oocyte maturation, sperm capicitation.

Final

Fluid

environment for early embryonic development. of fertilized and unfertilized ovum to the uterus.

Transport

Ovaries
Oval

solid structure, 1.5 cm in thickness, 2.5 cm in width and 3.5 cm in length respectively. Each weights about 48 gm.

Ovary

is located on each side of the uterus, below and behind the uterine tubes

Structure of the ovaries


Cortex

Medulla
Hilum

Ovaries and Relationship to Uterine Tube and Uterus

Figure 2814

Function of the ovary


Secrete

estrogen & progesterone. of ova

Production

Uterus
The

uterus is a hollow, pear shaped muscular organ. uterus measures about 7.5 X 5 X 2.5 cm and weight about 50 60 gm.

The

Its

normal position is anteverted (rotated forward and slightly antiflexed (flexed forward)

The

uterus divided into three parts

1. Body of the uterus


The

upper part is the corpus, or body of the uterus The fundus is the part of the body or corpus above the area where the fallopian tubes enter the uterus. Length about 5 cm.

2. Isthmus
A

narrower transition zone. Is between the corpus of the uterus and cervix. During late pregnancy, the isthmus elongates and is known as the lower uterine segment.

3. Cervix
The

lowermost position of the uterus neck. The length of the cervix is about 2.5 t0 3 cm.

The

os, is the opening in the cervix that runs between the uterus and vagina. The upper part of the cervix is marked by internal os and the lower cervix is marked by the external os.

Layers of the uterus


Perimetrium. Myometrium. Endometrium.

1. Perimetrium
Is

the outer peritoneal layer of serous membrane that covers most of the uterus.

Laterally,

the perimetrium is continuous with the broad ligaments on either side of the uterus.

2. Myometrium
Is

the middle layer of thick muscle. Most of the muscle fibers are concentrated in the upper uterus, and their number diminishes progressively toward the cervix.

myometrium contains three types of smooth muscle fiber

The

Longitudinal fibers (outer layer)


Which

are found mostly in the fundus and are designed to expel the fetus efficiently toward the pelvic outlet during birth.

Middle layer figure-8 fibers


These

fiber contract after birth to compress the blood vessels that pass between them to limit blood loss.

Inner layer circular fibers


Which

form constrictions where the fallopian tubes enter the uterus and surround the internal os Circular fibers prevent reflux of menstrual blood and tissue into the fallopian tubes.

Promote

normal implantation of the fertilized ovum by controlling its entry into the uterus. And retain the fetus until the appropriate time of birth.

3. Endometrium
Is

the inner layer of the uterus. It is responsive to the cyclic variations of estrogen and progesterone during the female reproductive cycle every month.

The two or three layers of the endometrium are: *Compact layer *The basal layer *The functional or Sponge layer this layer is shed during each menstrual period and after child birth in the lochia

Anatomical relation of the uterus


Anterior------------Bladder Posterior-----------The rectum and Douglas pouch Lateral------------- The broad ligaments ,F. T& ovaries Superior-----------The intestines. Inferior------------- The Vagina

The Function of the uterus


Menstruation

----the uterus sloughs off the endometrium.


---the uterus support fetus and allows the fetus to grow.

Pregnancy

Labor

and birth---the uterine muscles contract and the cervix dilates during labor to expel the fetus

Vagina
It

is an elastic fibro-muscular tube and membranous tissue about 8 to 10 cm long. Lying between the bladder anteriorly and the rectum posteriorly.

The

vagina connects the uterus above with the vestibule below. upper end is blind and called the vaginal vault.

The

The

vaginal lining has multiple folds, or rugae and muscle layer. These folds allow the vagina to stretch considerably during childbirth.

The

reaction of the vagina is acidic, the pH is 4.5 that protects the vagina against infection.

Anatomical relation of the vagina


Anterior------------Urethra and bladder Posterior-----------Perineal body &rectum and Douglas pouch Lateral------------- Pelvic floor muscles Superior-----------The cervix. Inferior------------- The vulva

Functions of the vagina


To

allow discharge of the menstrual flow. As the female organs of coitus. To allow passage of the fetus from the uterus.

Support structures
The

bony pelvis support and protects the lower abdominal and internal reproductive organs.

Muscle,

Joints and ligaments provide added support for internal organs of the pelvis against the downward force of gravity and the increases in intra-abdominal pressure

Bony Pelvis
Bony

Pelvis Is Composed of 4 bones:

1. Two hip bones. 2. Sacrum. 3. Coccyx.

1. Two hip bones.


Each

or hip bone is composed of three bones:

*Ilium *Ischium *Pubis

*Ilium
It

is the flared out part. The greater part of its inner aspect is smooth and concave, forming the iliac fossa. The upper border of the ilium is called iliac crest

*Ischium
It

is the thick lower part. It has a large prominence known as the ischial tuberosity on which the body rests while sitting.

Behind

and little above the tuberosity is an inward projection the ischial spine.

2. Sacrum
Is

a wedge shaped bone consisting of five vertebrae. The anterior surface of the sacrum is concave The upper border of the first sacral vertebra known as the sacral promontory

3. Coccyx.
Consists of four vertebrae forming a small triangular bone.

Pelvic Joints
There

are four pelvic joints:

* One Symphysis pubis * Two sacro-iliac joints * One sacro-coccygeal joint

Ligaments
total of 10 ligaments stabilize the uterus within the pelvic cavity.
A

Four

paired ligaments Broad, round, uterosacral, cardinal Two single ligaments anterior (pubocervical) and posterior (rectovaginal)

Types of Pelvis
1. Gynecoid, or normal female pelvis is round and adapted for the function of childbirth. Its inlet, cavity, and outlet are in better proportion, the pubic arch is wide and the coccyx is more movable than android pelvis.

2. Android pelvis or male type pelvis which has a heart-shaped outlet 3. anthropoid, which oval shaped. 4. platypelloid, which has a wide transverse outlet, kidney shaped.

Blood Supply
The

uterine blood supply is carried by the uterine arteries, which are branches of the internal iliac artery. These vessels enter the uterus at the lower border of the broad ligament, near the isthmus of the uterus.

Cyclical Changes in Endometrium


Basilar zone remains relatively constant Functional zone undergoes cyclical changes:
in response to sex hormone levels produce characteristic features of uterine cycle

Appearance of Endometrium during Uterine Cycle

Figure 2820

LH

FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Phase

Luteal Phase

Estrogen Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

The Uterine Cycle


Also called menstrual cycle Is a repeating series of changes in endometrium Lasts from 21 to 35 days:
average 28 days

Uterineto hormones Responds Cycle


of ovarian cycle: Menses and proliferative phase:
occur during ovarian follicular phase
occurs during ovarian luteal phase

LH

FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Secretory phase:

Follicular Phase
Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Is the degeneration of functional zone: occurs in patches Is caused by constriction of spiral arteries: reducing blood flow, oxygen, and nutrients
Weakened arterial walls rupture releasing blood into connective tissues of functional zone Degenerating tissues break away, enter uterine lumen Entire functional zone is lost through cervical os and vagina

Menses

LH

FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Phase

Luteal Phase

Estrogen Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Menstruation

Is the process of endometrial sloughing Lasts 17 days Sheds 3550 ml blood

LH

FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Phase
Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Epithelial cells of uterine glands multiply and spread across endometrial surface restore integrity of uterine epithelium Further growth and vascularization completely restores functional zoneOccurs at same time as enlargement of primary and secondary follicles in ovary Is stimulated and sustained by estrogens secreted by developing ovarian follicles

The Proliferative Phase


LH

2 4 6 8

FSH
10 12 14 16 18 20 22 24 26 28

Follicular Phase
Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Endometrial glands enlarge increase secretion Arteries of uterine wall elongate and spiral through functional zone Begins at ovulation Persists as long as corpus luteum remains intact Peaks about 12 days after ovulation Generally lasts 14 days

The Secretory Phase

LH

FSH
2 4 6 8

10 12 14 16 18 20 22 24 26 28

Follicular Phase
Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26

Menarche Menopause

The first uterine cycle Begins at puberty (age 1112)

The termination of uterine cycles Age 4555

Amenorrhea
Primary amenorrhea:
failure to initiate menses interruption of 6 months or more caused by physical or emotional stresses

Transient secondary amenorrhea:


Is an elastic, muscular tube that xtends between cervix and vestibule 7.59 cm long and highly distensible
Cervix:
projects into vaginal canal

The Vagina

Fornix:
is shallow recess surrounding cervical protrusion

3 Functions of the Vagina


Passageway for elimination of menstrual fluids Receives spermatozoa during sexual intercourse Forms inferior portion of birth canal
.1 .2 .3

The Vaginal Wall


Contains a network of blood vessels:
and layers of smooth muscle

Is moistened by:
secretions of cervical glands water movement across permeable epithelium

The Hymen

Is an elastic epithelial fold:


that partially blocks entrance to vagina ruptured by sexual intercourse or tampon usage

Vaginal Muscles
2 bulbospongiosus muscles:
along either side of vaginal entrance cover vestibular bulbs

Vestibular Bulbs
Are masses of erectile tissue:
on either side of vaginal entrance

Have same embryological origins as corpus spongiosum of penis

The Mammary Glands


Secrete milk to nourish an infant (lactation) Are specialized organs of integumentary system Are controlled by:
hormones of reproductive system placenta

Figure 2823a

Mammory glands lie in pectoral fat pads deep to skin of chest Nipple on each breast:
contains ducts from mammary glands to surface

Areola:
reddish-brown skin around each nipple

Mammory glands consist of lobes:


each containing several secretory lobules separated by dense connective tissue

Suspensory Ligaments of the Breast


Bands of connective tissue Originate in dermis of overlying skin Areolar tissue separates:
mammary gland complex from underlying pectoralis muscles

Mammary gland ducts leave lobules, converge, and form single lactiferous duct in each lobe

Female Reproductive Cycle Hormonal Control


Involves secretions of pituitary gland and gonads Forms a complex pattern that coordinates ovarian and uterine LH cycles
FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Phase Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Development
Begins with FSH stimulation Monthly:
some primordial follicles develop into primary follicles thecal cells produce androstenedione
Is a steroid hormone, an intermediate in synthesis of estrogens and androgens, and absorbed by granulosa cells and converted to estrogens

LH

FSH
2 4 6 8

As follicles enlarge:

10 12 14 16 18 20 22 24 26 28

Follicular Phase
Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26

Estrogen Synthesis
Androstenedione is converted to testosterone Enzyme aromatase converts testosterone to estradiol - CH Estrone and estriol are synthesized from androstenedione -CH

Estrogen Function
Stimulates bone and muscle growth Maintains female secondary sex characteristics, ie body hair distribution and adipose tissue deposits Affects central nervous system (CNS) activity (especially in the hypothalamus, where estrogens increase the sexual drive) Maintains functional accessory reproductive glands and organs Initiates repair and growth of endometrium
.1 .2

.3

.4

.5

Progesterone Function
maintains secondary sex characteristics maintains uterine walls for pregnancy.
.1 .2

Hormones and Body Temperature


Monthly hormonal fluctuations affect core body temperature:
during luteal phase:
progesterone dominates estrogen dominates basal body temperature decreases about 0.3C

during follicular phase:


Basal Body Temperature


The resting body temperature Measured upon awakening in morning

Hormonal Regulation of the Female Reproductive Cycle


LH

FSH
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Follicular Phase Estrogen

Luteal Phase

Progesterone
2 4 6 8 10 12 14 16 18 20 22 24 26 28

Figure 2826a, b

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