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1. Anatomy and physiology of female reproductive system prepared by Debiso Erjino

2. Introduction The reproductive organ in female are those which concerned with copulation fertilization growth and development of fetus and its subsequent exit to the outer world prepared by Debiso Erjino

3. Introduction…. The female RS is designed to carry out several function It produces the female egg cells called ova/oocytes Transport ova to the site of fertilization Conception/Implantation-the initial stage of pregnancy If fertilization and/or implantation does not take place the system is designed to menstruate In addition female RS produce sex hormones that maintain the reproductive cycle prepared by Debiso Erjino

4. The female reproductive system consists of external and internal organ. External genitalia ; clitoris, labia majora,labia minora , monus pubis,bartholin glands Internal organ ; uterus, ovary, vagina and uterine(fallopian) tube In non pregnant state the internal reproductive organ are situated in true pelvis The external genital organ has three main functions; Enabling sperm to inter the body Protecting the internal genital organ Provide sexual pleasure

5. External Genitalia Mons pubis – is a pad of fatty tissue situated in front of the symphysis pubis. It is covered by skin and pubic hair which develop at the time of puberty and appears triangular in distribution. The mons pubs contains oil secreting(sebaceous)glands that releases substance that are involved in sexual attraction. Purpose – protect the junction of the pubic bone from trauma. Clitoris :- is small extremely sensitive erectile structure situated with in the folds of the prepuce and frenum . It is about 2.5 cm long and is composed of two corpora cavernose . It consists of the glands, body and two crura . It is analogue to the penis in male and highly vascularized

6. External … Labia majora (Greater lips)- are two large rounded folds of fatty tissue covered by skin which meet anteriorly at the mons pubis . It is covered with pubic hair on the outer surface at puberty. is comparable to scrotum Contains sebaceous glands, sweet glands , which produce lubricants and hair follicle Labia minora (lesser lips ) – are two thin smaller folds of skin lying longitudinally with the labia majora . Pink color due to rich in blood vessels. The area they in close is known as the vestibule - Anteriorly they divided in to two folds. The upper folds surround the clitoris and unite to form the prepuce . The two lower folds are attached to undersurface of the clitoris and are known as the frenulum . Posteriorly, the labia minora unite to form a thin fold of skin, the fourchette

7. External Genitalia vestibules :- is a triangular space bounded anteriorly by the clitoris, posterior by the fourchette and on either side by labia minus. openings in to the vestibule 1.The urethral meatus – lies 2.5 cm below the clitoris. 2.The vaginal orifice ( introitus ) – occupies the lower two thirds of the vestibule lying between the labia minora . 3.The bartholin’s ducts and glands:- are situated in the superficial perineal pouch posterior to the vestibular bulb. It secretes abundant alkaline mucus during sexual excitement which helps in lubrication. 4.Vestibuler bulb:- are bilateral masses of erectile tissues situated beneath the mucus membrane called vestibule. Each bulb lies on either side of the vaginal orifice deep to the labia majora and minora and anterior to bartholin’s glands.

8. Hymen Hymen- is a thin membrane which covers the introitus in virgin. Hymen may be lacerated by disease ,injury, masturbation or physical exercise. for this reason the state of hymen is not a conclusive indication of virginity. It has d/t shape. Crescent or lunar hymen; a half moon above or below Imperforate hymen labial hymen Micro perforate hymen subseptate Septate hymen fimbriated Annular hymen Cribriform hymen denticular

9. External Genitalia… Blood supply :- The vulva is supplied with blood from two main arteries The femoral artery in the upper part of the thigh. The internal pudendal artery running along the pubic arch. The blood drains through corresponding veins. Lymphatic drainage :- some drainage in to the inguinal glands and some is in to the external iliac glands. Never supply :- is from the branches of pudendal nerve and the perineal nerve.

10. Internal genitalia The vagina Is a tube (canal) which extends from the vulva to the uterine cervix. It is longer in posterior wall (10cm) than anterior (7cm). 2.5 cm in diameter The vault of the vagina is divided in to four fornices by the projection of the cervix Anterior Posterior Two lateral fornices The posterior fornix is the largest The vaginal walls are pink in appearance and thrown in to small folds known as rugae Structures Vaginal wall is composed of four layers. - The layers from in to out wards are : i . Mucus coat lined by stratified squamous epithelium. ii. Sub mucous layer iii. Muscular layer – inner circular and outer longitudinal iv. Fibrous coat

11. The vagina… Contents There are no glands situated in the wall of the vagina The vagina contains a small amount of fluid which is derived from two sources; Alkaline mucus which secrete from the glands of the cervix, The vaginal blood vessels which allow serous fluid to transude through the vaginal wall into its lumen. The vaginal fluid is acidic in reaction having a PH of about 4.5 during reproductive life(lactobacilli) Relations Anterior – the bladder and the urethra Posterior - lowest 2/3 perineal body - Middle third rectum -Upper third pouch of Douglas. Lateral - upper 2/3 pelvic fascia at the base of the broad ligament. Lowest third -two levator ani muscles - bulbo-cavernosus muscles. Superior – Uterine cervix Inferior – hymen and the structures of the vulva

12. Vagina Blood supply Arterial supply from the vaginal, the uterine (descending branch), the middle haemorrodial , the inferior vesical and pedundial arteries The vein drains in a corresponding manner. Lymphatic drainage The lowest 2/3 drain to the horizontal inguinal groups along with those of the vulva. Upper 1/3 drain to the internal iliac and sacral glands. Nerve supply is from the sympathetic and pelvic splanchnics nerves Functions Entrance for spermatozoa Exit for menstrual flow and products of conception Helps to support the uterus Organs for sexual intercourse Prevent from infection

13. The Uterus Is a hollow, flattened, muscular pear shaped organ situated between the bladder and rectum in non pregnant state. It is normally anteverted and ante flexed It measures 8cm in length 5cm width and 2-3 cm thick. Its weight is approximately 50gm .

14. The Uterus… It consists of the following parts. a) Body or corpus Comprise the upper 2/3 of the uterus Lies between the isthmus and the opening of the fallopian tubes. b) Cervix Forms the lower third of the uterus and measures about 2.5 cm in length. It is conical in shape The cervix projects through the anterior wall of the vaginal which divides it in to an upper is the supravaginal portion and lower is the infravaginal portion. SUPRA VAGINAL CERVIX – lies out side and above the vagina Superiorly it meets the border of the uterus at the isthmus. Is separated in front from the bladder by parametrium . Posteriorly it is covered by the peritoneum.

15. The Uterus… INFRAVAGINAL CERVIX- is the part which projects in to the anterior vaginal wall between the anterior and posterior fornices . c) The internal os -opens in to the cavity of the uterus It dilates during labor. In competence of the cervix at this level results in spontaneous abortion. d) The external os – opens in to the vagina at the lower end of the cervical canal. e) The cervical canal – lies between the internal and external os It is fusiform in shape.

16. The Uterus… FUNCTIONS OF THE CERVIX It helps to prevent infection entering the uterus. It dilates and withdraws during labor to enable vaginal delivery of the fetus and placenta . Clinical correlates transformation zone ( squamocolumnar junction) Progress of labour(cervical dilitations ) Abortions(cervical circleage ) Paracervical block Sample(biopsy )

17. The Uterus… f) The funds- is the domed upper wall between the insertions of the fallopian tubes. g) The cornua - are the upper outer angles of the uterus where the fallopian tubes join. h) The cavity- is a potential space between the anterior and posterior walls It is triangular in shape the base of the triangle being upper most. i) The isthmus- is a narrow area between the cavity and the cervix which is 7 mm long. It enlarges during pregnancy to form the lower uterine segment.

18. The Uterus … STRUCTURES The mucous membrane (tunica mucosa) – Endometrium Forms a lining of ciliated epithelium on a base of connective tissue or stroma . The epithelial cells are cubical in shape and dip down to form glands which secrete alkaline mucus 2.The muscular coat (tunica muscularis )- Myometrium . It is thick in the upper part of the uterus and is more sparse in the isthmus and cervix. Its fibers are outer longitudinal, middle interlacing oblique and inner circular. Its muscle fibers are embedded in collagen fibers which enable to stretch in the labor

19. The Uterus… 3.The serous coat (tunica serosa)- Perimetrium ( mesometrium ). Is derived from the peritoneum; it invests the fundus and the whole of the intestinal surface of the uterus, covers the vesical surface as only far as the junction of the body and cervix.

20. The Uterus… The form, size and situation of the uterus vary at different periods of life and under different circumstances. In the fetus :- the uterus is contained in the abdominal cavity projecting beyond the superior aperture of the pelvis. The cervix is considerably larger than the body. At puberty- it is pyriform in shape and weights from 14 to 17 gm. In the adults - the position of the uterus depends on the condition of the bladder and rectum. When the bladder is empty the entire uterus is directed forward and is at the same time bent on itself at the junction of the body and cervix, so that the body lies up on the bladder. as the bladder fills the uterus gradually becomes more and more erect until with a fully distended bladder the fundus may be directed back ward toward the sacrum.

21. The Uterus… During menstruation :- the uterus is enlarged, more vascular, and its surface rounder; the external orifice is rounded, its labia swollen, and the lining membrane of the body thickened, softer, and of a darker color. During pregnancy- the uterus becomes enormously enlarged. By 12 th week of pregnancy it rises out of the pelvis and becomes abdominal organs, by 38-40 th week it reaches the xiphisternum . It is not longer anteverted and anteflexed but it is becoming vertical. At full term the uterus is 30cm in length, 23 cm wide and 20cm thick. Its weight has increased from 50gm to 1000gm.

22. The Uterus… After parturition - the uterus nearly regains its usual size, weighinig about 50gm ; but the cavity is larger than in the virgins state, its vessels are tortuous, and its muscular layers are more defined; the external orifice is more marked, and its edges present one or more fissures. In old age - the uterus becomes atrophied, and denser in texture, a more distinct separates the body and cervix. The internal orifice is frequently, and the external orifice occasionally, obliterated, while the lips almost entirely disappear.

23. The Uterus… FUNCTION OF THE UTERUS To prepare a bed for the fertilized ovum. To nourish the fertilized ovum for the gestation period To expel the product of conception at full term. To involutes following child birth Clinical correlates Congenital anomalies Amenhhorea Implantations Uterine CA Contraceptives ……………….

24. FALLOPIAN TUBES Are paired structures which are attached with the lateral angle of uterine cavity. They run along the upper margin of the broad ligament and 10 cm in length. It has four portions 1.The interstitial portion - is 1.25 cm long and lies within the wall of the uterus. Its lumen is 1mm wide

25. FALLOPIAN TUBES… 2.The isthmus – is another narrow part which extends for 2.5 cm from the uterus. It acts as reservoir for spermatozoa because its temperatures is lower than other. 3.The ampulla - is the wider portion where fertilization usually occurs & it is 5 cm in length. 4.The infundibulum - is the funnel shaped fingered end which is composed of many processes know as fimbriae .

26. FALLOPIAN TUBES… RELATIONS Anterior, posterior and superior the peritoneal cavity and the intestine Lateral the side walls of the pelvis. Inferior the broad ligaments and ovaries. Medial the uterus.

27. FALLOPIAN TUBES… LAYERS OF THE FALL0PIAN TUBE It consists of three coats 1.The external or serous coat is the peritoneum . 2.Middle or muscular coat- consists of inner circular and outer longitudinal layer of smooth muscles which helps for peristaltic movement of the fallopian tube. 3.The internal or mucous coat-is line by columnar and ciliated epithelium. Beneath the lining is a layer of vascular connective tissue.

28. FALLOPIAN TUBES… SUPPORT - by the infundibulo pelvic ligaments. These ligaments are formed from folds of the broad ligament and run from the infundibulum of the tube to the side walls of the pelvis. Blood supply :- is via the uterine and ovarian arteries; venous return is by the corresponding veins. Lymphatic drainage - is in to the lumbar gland. NERVE SUPPLY – is from the ovarian plexus.

29. FALLOPIAN TUBES… FUNCTIONS Propels the ovum towards the uterus. Receives the spermatozoa as they travel up wards Provides a site for fertilization Supplies the fertilized ovum with nutrition during its continued journey to the uterus.

30. THE OVARIES Are two nodular bodies which produce ova and hormones estrogen and progesterone. POSITION They are attached to the back of the broad ligament within the peritoneal cavity Size 3 cm in length, 2 cm in width and about 1 cm in thickness and weight from about 6gm.

31. Menstrual Cycle prepared by Debiso Erjino

32. Inrtoduction After birth, the gonads are quiescent until they are activated by gonadotropins from the pituitary to bring about the final maturation of the reproductive system. The onset of the menstrual cycle, begins at puberty and ceases at menopause prepared by Debiso Erjino

33. Cont.. This period of final maturation is known as adolescence called puberty puberty is the period when the endocrine and gametogenic functions of the gonads first develop to the point where reproduction is possible . In girls, the first event is Thelarche : the development of breasts Pubarche : the development of axillary and pubic hair Menarche : the first menstrual period. prepared by Debiso Erjino

34. Cont… This is the stage of life at which secondary sexual characteristics appear. Girls begin dramatic development and maturation of reproductive organs at approximately age 12 to 13 years prepared by Debiso Erjino

35. Cont… Although the mechanism that initiates this dramatic change is not well understood, the hypothalamus under the direction of the central nervous system may initiate or regulate mechanism set to turn on gonadal functioning at this age. prepared by Debiso Erjino

36. Cont… In girls pubertal changes typically occur in the order of: Marked physical growth Increase in the transvers diameter of the pelvis Breast development Growth of pubic and axillary hair Vaginal secretion/Menarche prepared by Debiso Erjino

37. Cont… The normal reproductive years of the female are characterized by: Monthly rhythmical changes in the rates of secretion of the female hormones physiological changes in the ovaries and other sexual organs. This rhythmical pattern is called the female monthly sexual cycle or, the menstrual cycle. prepared by Debiso Erjino

38. Cont… Menstruation (period) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina The menstrual cycle is characterized by the rise and fall of hormones Menstruation is triggered by falling progesterone levels and is a sign that pregnancy has not occurred. prepared by Debiso Erjino

39. Cont… The length of menstrual cycle varies greatly among women (ranging from 21 to 35 days) average length 28 days Amount 30-80ml Duration 1-5 days average 3 days The blood is arterial(85%)oxygenated the rest 10 15 % is deoxygenated Color dark red and non clotted in nature Occurs average age 13 years(9-17years) It is the hallmark(features) of reproductive year prepared by Debiso Erjino

40. Cont… The four body structure that are involved in the normal physiology of the menstrual cycle are • The hypothalamus • The pituitary gland • The ovaries • The uterus prepared by Debiso Erjino

41. A, Reproductive Hormones The development and integration of regular, cyclic , and spontaneous menstrual cycles involves the interaction among hypothalamic, pituitary , and ovarian hormones It stimulates maturation of the Graafian follicle and its production of estradiol prepared by Debiso Erjino

42. Phases of menstrual cycle OVARIAN CYCLE CONSISTS OF Follicular phase (day 1-14) Ovulation (day 14) Luteal phase(day 14-28 ) UTERINE CYCLE CONSISTS OF Menstruation (day 1-5) Proliferative phase (day 6-8) Secretory phase (14-28) prepared by Debiso Erjino

43. prepared by Debiso Erjino

44. prepared by Debiso Erjino

45. H o r m o ne Fun c tion Sou r ce G nRH (G o n a d o t r o phin Relea s ing H o r m o ne) C o nt r o ls pitui t a ry sec r etion H y p o thal a m us FSH ( f o llicl e - s ti m u l at ing h o r m o ne) C a uses i m m a tu r e follicle to de v el o p inc r e a ses est r og en sec r etion, sti m ul a tes new ga m ete for m a tion a nd de v el o p m ent o f uterine w a ll a f t er m enstru a tion. Pi t uitary g l a nd (cont r o lled by h y p o thal a m us) LH (lu t eini z ing h o r m o ne) Sti m ul a tes fur t her de v el o p m ent o f oo c y te a nd f o llicle, sti m ul a tes ov ul a tion, inc r e a ses p r og est e r o ne sec r e t ion, a ids de v el o p m ent o f c o rpus luteu m . Pi t uitary g l a nd (cont r o lled by h y p o thal a m us) prepared by Debiso Erjino 5/28/2024

46. Est r ogen Stimulates thickening of ute r ine w al l , maturat i on of ooc y t e , d ev e lopment of f e male sex chara c t e r i stics, in h ibits FSH s e c r et i on, inc r eas e s LH s e c r et i on. Ova r ian fol l i c l e , co r p u s luteum ( c ont r ol l ed by FSH) P r ogest e r one Stimulates thickening of ute r ine w al l , stimulates fo r mation of mamma r y d u cts Corp u s luteum ( c ont r ol l ed by LH) HCG (Human C h or i onic Gona d ot r opi n )         5/28 / 2024 P r ev e nts co r p u s luteum f r om d isinteg r ating, stimulates est r ogen and p r ogest e r one se c r et i on f r om co r pu s lute u m. Embr y onic m e mbranes plac e nta             1 prepared by Debiso Erjino