Review Anatomy and Physiology of Reproductive system.pptx

The presentation gives an overview and function of the reproductive system

1. Review Anatomy and Physiology of female Reproductive system By Esther Chauluka

2. objectives Review the anatomy and physiology of female reproductive organ

3. Female reproductive system

4. External Female Structures The vulva includes mons veneris, labia majora, labia minora, clitoris, vestibule and conventionally the perineum. These are all visible on external examination. It is, therefore, bounded anteriorly by the mons veneris, laterally by the labia majora and posteriorly by the perineum

5. External Female Repr . Structures MONS VENERIS (MONS PUBIS): It is the pad of subcutaneous adipose connective tissue lying in front of the pubis and, in the adult female, is covered by hair. LABIA MAJORA: They are continuous where they join medially to form the posterior commissure in front of the anus. The inner surface of the labia majora are hairless. The labia majora are homologous with the scrotum in the male. LABIA MINORA Labia minora are two thick folds of skin, devoid of fat, on either side just within the labia majora. Except in the parous women, they are only exposed when the labia majora are separated.

6. External Female Repr . Structures CLITORIS: Clitoris is a small cylindrical erectile body, measuring about 2. cm situated in the most anterior part of the vulva. It consists of glans, a body and two crura. Clitoris is an analog to the penis in the male, but it differs basically in being entirely separate from the urethra. VESTIBULE Vestibule is a triangular space bounded anteriorly by the clitoris, posteriorly by the fourchette and on either side by labium minus

7. Internal Female Structures The internal genital organs in female include vagina, uterus, fallopian tubes, and the ovaries. These organs are placed internally and require special instruments for inspection.

8. Internal Female Structures The vagina: is a fibromusculomembranous sheath communicating the uterine cavity with the exterior at the vulva. It constitutes the excretory channel for the uterine secretion and menstrual blood. It is the organ of copulation and forms the birth canal of parturition.

9. Internal Female Structures The uterus: is a hollow pyriform muscular organ situated in the pelvis between the bladder in front and the rectum behind. It has got the following parts. Body or corpus Isthmus Cervix

10. Internal Female Structures… The uterine tubes: are paired structures, measuring about 10 cm (4") and are situated in the medial three-fourth of the upper free margin of the broad ligaments. The important functions of the tubes are—(1) transport of gametes, (2) to facilitate fertilization, and (3) survival of zygote through its secretion

11. Internal Female Structures… The ovaries: are paired sex glands or gonads in female which are concerned with: i . Germ cell maturation, storage and its release. ii. Steroidogenesis. Each gland is oval in shape and pinkish gray in color and the surface is scarred during reproductive period.

12. Puberty Puberty is the transition from childhood to the final stage of maturation that allows for reproduction. Puberty is believed to begin with disinhibition of the pulsatile gonadotropin-releasing hormone (GnRH) secretion from the hypothalamus (mechanism is unknown).

13. Secondary Sex Characteristics Development of the secondary sexual characteristics proceeds in the following order: 1 . Thelarche (breast budding). Average age 10 years. Due to increase in estradiol . 2 . Pubarche (axillary and pubic hair growth). Average age 11 years. Due to increase in adrenal hormones. 3 . Menarche ( first menses). Average age 12 years. Due to increase in estradiol .

14. Secondary Sex Characteristics Tanner Stages: The Tanner stages of development refer to the sequence of events of breast and pubic hair development. Stage 1: Prepubertal child. Stages 2–4: Development stages. Stage 5: Adult.

15. Menstrual cycle The menstrual cycle is the cyclical changes that occur in the female reproductive system. The hypothalamus, pituitary, ovaries , and uterus interact to allow ovulation approximately once per month (average 28 days [+/–7 days]). The following description is based on a 28-day menstrual cycle. Many follicles are stimulated by follicle-stimulating hormone (FSH ), but the follicle that secretes more estrogen than androgen will be released.

16. Menstrual cycle … This dominant follicle releases the most estradiol so that its positive feedback causes an LH surge . Average menses = 4 days. More than 7 days is abnormal. Blood loss in menstruation averages 30–50 mL and should not form clots ; > 80 mL is an abnormally high amount of blood loss.

17. Ovarian cycle Ovarian cycle (usually 28 days) 1. Follicular phase – FSH begins development of the follicle; days 1-13 2. Ovulation – LH causes release of the egg into the uterine tube; day 14 3. Luteal phase – corpus luteum forms from remains of Graafian follicle; days 15-28 A) produces estrogen and progesterone in preparation for implantation & inhibin to inhibit further follicle maturation

18. Ovarian cycle If no implantation occurs, corpus luteum degenerates, hormone production ceases, and menses & follicular maturation begin a) The resulting structure is referred to as the corpus albicans , which will eventually degenerate 2) If implantation occurs, human chorionic gonadotropin ( hCG ) is produced by the developing embryo to maintain the corpus luteum until the placenta develops

19. Uterine cycle Uterine cycle (usually 28 days) 1. Menses – sloughing off of the uterine lining; days 1-5 2. Proliferative phase – prior to ovulation; endometrium thickens and develops more blood vessels in preparation for implantation; days 6-13

20. Secretory phase – after ovulation; uterine lining produces estrogen and progesterone in preparation for implantation; days 15-28 If no implantation occurs, the cycle starts over and menses begins again If implantation occurs, the cycle will stop until the end of the pregnancy

21. Menopause Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity. It is the point of time when last and final menstruation occurs. The clinical diagnosis is confirmed following stoppage of menstruation (amenorrhea) for twelve consecutive months without any other pathology. As such, a woman is declared to have attained menopause only retrospectively

22. ORGAN CHANGES Ovaries shrink in size, become wrinkled and white. The vulva shows features of atrophy. The labia becomes flattened and the pubic hair becomes scantier. The end result is a narrow introitus . ‰breast fat is reabsorbed and the glands atrophy. The nipples decrease in size. Ultimately, the breasts become flat and pendulous.

23. ORGAN CHANGES Bladder and urethra undergo similar changes to those of the vagina. The epithelium becomes thin and is more prone to damage and infection. There may be dysuria , frequency, urge or even stress incontinence. ‰Loss of muscle tone leads to pelvic relaxation, uterine descent and anatomic changes in the urethra and neck of the bladder.

24. MENOPAUSAL SYMPTOMS Vasomotor symptoms Urogenital atrophy Osteoporosis and fracture Cardiovascular disease Cerebrovascular diseases Psychological changes Skin and hair Sexual dysfunction Dementia and cognitive decline .

25. Treatment Nonhormonal Treatment Lifestyle modification: This includes physical activity (weight bearing), reducing high coffee intake, smoking and excessive alcohol. There should be adequate calcium intake (300 mL of milk), reducing medications that causes bone loss (corticosteroids). Nutritious diet: Balanced with calcium and protein is helpful . Supplementary calcium: Daily intake of 1–1.5 g can reduce osteoporosis and fracture .

26. Treatment Exercise : Weight bearing exercises, walking and jogging. Vitamin D: Supplementation of vitamin D3 ( 1500–2000 IU/day ) along with calcium can reduce osteoporosis and fractures. Exposure to sunlight enhances synthesis of cholecalciferol (vitamin D3) in the skin . Cessation of smoking and alcohol. Bisphosphonates prevent osteoclastic bone resorption . It improves bone density and prevents fracture. Calcitonin inhibits bone resorption by inhibiting osteoclasts. Selective estrogen receptor modulators (SERMs) are tissue specific in action. Of the many SERMs, raloxifene has shown to increase bone mineral density, reduce serum LDL and to raise HDL2 level.

27. Nonhormonal therapy Clonidine, an α2 adrenergic agonist may be used to reduce the severity and duration of hot flashes . Paroxetine, venlafaxine a selective serotonin reuptake inhibitor , is effective to reduce hot flashes (both the frequency and severity ) Gabapentin is an analog of gamma-aminobutyric acid (GABA ). It is effective to control hot flashes Soy protein is also found effective to reduce vasomotor symptoms . Soy protein acts as SERM. Vitamin E reduces hot flash (25%).

28. Hormonal therapy The HT is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency . Indications of Hormone Therapy Relief of menopausal symptoms Relief of vasomotor symptoms Prevention of osteoporosis To maintain the quality of life in menopausal years.

29. Hormones 1. Pituitary (Anterior) A) Releases LH & FSH Control sex cell maturation and production of female sex hormones 2. Ovaries A) Estrogens 1) Actually a group of hormones 2) Estradiol is the most common 3) Have a number of functions

30. Hormones Enlargement of vagina, uterus, uterine tubes, and ovaries b) Responsible for secondary sex characteristics i) Development of the breasts and mammary glands ii) Increased deposits of adipose, mostly in breasts, thighs, and buttocks iii) Increased blood flow to skin

31. Hormones B) Progesterone 1) Promotes changes in the uterus 2) Involved with mammary gland maturation 3) Regulates hormones of the anterior pituitary 3. Adrenal Gland A) Androgens (“weak testosterone”)

32. Hormones 1) Secreted by the adrenal cortex 2) Physical changes depends on its concentration a) Low concentrations i) Results in narrow shoulders and broad hips b) High concentrations i) Cause increased hair growth in axillary and pubic regions 3) Also responsible for female libido

33. Questions