Female Reproductive System

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Chapter 8

• Female Reproductive System

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Introduction

• The female gamete is the ovum (egg)
• The ovum is produced in the female gonad
• Ovaries
• Ovum leaves the ovary, travels down the fallopian
  tube to the uterus
• If sperm are present in the fallopian tube
  fertilization may occur
• The embryo then has a 40 week gestation period
• The embryo is termed fetus after the 2nd month of
  pregnancy

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Introduction

• Ova mature and are released from the ovaries
• This begins at the onset of puberty and continues
  until menopause
• Puberty
• secondary sex characteristics begin to develop
• Menopause
• Cessation of fertility
• Diminishing hormone production

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Introduction

• Women are born with all of the eggs (ova) they
  will possibly release
• Puberty signifies that the eggs are mature and
  they begin to leave the ovary
• If an egg becomes fertilized it may grow and
  develop in the uterus

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Introduction

• If fertilization occurs various hormones are
  released from the ovary and placenta
• If there is no fertilization the resulting
  hormone changes cause the menstruation to occur
• Bleeding and shedding of the uterine wall

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Introduction

• Estrogen and progesterone are the hormones
  important for pregnancy and menstruation
• The pituitary gland releases the hormones needed
  for the function of the ovaries, breasts, and
  uterus
• This is located at the base of the brain

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Introduction

• Gynecology
• Study of the female reproductive system
• Obstetrics
• Specialty concerned with pregnancy and delivery
  of the fetus
• Neonatology
• Study and treatment of the newborn child

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Anatomy

• Ovaries
• The female gonads
• Almond shaped organs in the lower abdomen
• Produce ova (eggs) and hormones
• Fallopian tubes
• Leads from each ovary to the uterus

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Anatomy

• Uterus
• aka the womb
• Muscular organ located between the urinary
  bladder and rectum
• This is where the embryo develops

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Anatomy

• Uterus
• Divided into three parts
• Fundus
• The upper portion
• Corpus
• The middle portion
• Cervix
• The lower neck portion

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Anatomy

• Cul-de-sac
• Midway between the uterus and rectum
• Often examined for the presence of cancerous
  growth
• Vagina
• Tube extending from the uterus to the exterior of
  the body

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Anatomy

• Bartholin glands
• Two small round glands on either side of the
  vaginal orifice
• Helps to lubricate the vagina
• Clitoris
• Similar to the penis in males
• Composed of erectile tissue
• Anterior to vaginal orifice and urethral meatus

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Anatomy

• Perineum
• Region between the vaginal orifice and rectum
• Can be torn during childbirth and cause injury
• Episiotomy is often performed before delivery and
  sewn together afterwards

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Anatomylateral view
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Anatomyvulva

• Vulva
• The external genitalia
• Consists of
• Labia majora
• The outer lips of the vagina
• Labia minora
• The smaller inner lips
• Hymen
• Mucous membrane that partially covers the
  entrance to the vagina
• Clitoris
• Bartholin Glands

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Anatomyvulva
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Anatomyovaries

• Utero-ovarian ligament
• Located on either side of the uterus
• Holds the ovaries in place
• Graafian follicles
• Thousands contained in each ovary
• Each follicle contains an ovum
• Ruptures to release ovum when mature

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Anatomyovaries

• Once ovum is released the graafian follicle fills
  with blood and yellow, fat like material
• Then called corpus luteum
• Ovulation
• Release of ovum from ovary

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Anatomyfallopian tubes

• Fallopian tube
• 5 ½ in. long duct
• Runs from ovary to uterus
• End has finger like structures called fimbriae
• These catch the ovum and pull it into the tube
• This is where fertilization will occur

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Anatomyfallopian tubes

• Takes 5 days for the ovum to pass through the
  fallopian tube
• It is during this time that fertilization is most
  likely to occur
• If the egg remains unfertilized it disintegrates
  in a day or two

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Anatomyuterus

• Uterus
• Pear shaped organ
• Muscular walls
• Mucous membrane lining filled with blood vessels
• Divided into three parts
• Fundus
• Corpus
• Cervix

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Anatomyuterus

• Uterus (cont.)
• Endometium
• Specialized epithelial mucosa
• Myometrium
• Muscular layer
• Uterine serosa
• Outer membranous tissue
• Serosa is outer most layer of any organ in the
  abdomen or thorax

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Anatomyvagina

• Cervical opening leads to the vagina
• 3 in. long
• Leads to the outside of the body

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Anatomyanterior view
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Anatomybreast

• Breasts are accessory organs to reproduction
• They are located on the upper anterior region of
  the thorax
• Breasts are mammary glands composed of
• Glandular tissue
• Contains milk glands
• Develop in response to hormones from ovaries
  during puberty

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Anatomybreast

• Composed of (cont)
• Fibrous and fatty tissue
• Lactiferous ducts
• Carry milk from glandular tissue
• Sinuses
• Carry milk to nipple

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Anatomybreast

• Composed of (cont.)
• Nipple
• Called mammary papilla
• Small opening for the milk to pass through
• Areola
• Dark pigmented area around the nipple
• During pregnancy breasts reach their full
  development
• Hormones from the pituitary gland stimulate
  lactation after parturition

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Anatomybreast
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Anatomybreast
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Menstruation

• Menstruation begins during puberty
• This is called menarche
• Menstration is happens in cycles
• Each cycle is divided into 28 days
• These days are grouped into 4 time periods

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Menstrual Cycle

• Days 1-5
• Menstrual period
• Period when fluid discharge is present
• Composed of endometrial cells, glandular
  secretions, and blood

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Menstrual Cycle

• Days 6-12
• Endometrium begins to repair itself
• Estrogen is released by maturing graafian
  follicles
• Maturing ovum finishes growth during this period

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Menstrual Cycle

• Days 13-14
• Graafian follicle ruptures
• Ovum leaves the ovary and travels slowly down the
  fallopian tube
• Rupturing process is known as ovulation

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Menstrual Cycle

• Days 15-28
• Empty follicle fills with yellow material and
  becomes corpus luteum
• Corpus luteum functions as endocrine organ
• Secretes estrogen and progesterone
• These stimulate building the lining of the uterus
  for pregnancy

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Menstrual Cycle

• Days 15-28 (cont.)
• If fertilization does not occur production of
  hormones ceases
• This can cause premenstrual symptoms
• Depression
• Breast tenderness
• Irritability
• Known as premenstrual syndrome (PMS)
• About 5 days after hormone cessation, endometrium
  breaks down and menstrual cycle begins again

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Menstrual Cycle
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Pregnancy

• When fertilization occurs the ovum implants in
  the endometrium
• The corpus luteum continues to produce
  progesterone and estrogen
• This supports the vascular and muscular
  development of the uterine lining
• Placenta forms within the uterine wall

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Pregnancy

• Placenta derived from maternal endometrium and
  the chorion
• Outermost membrane surrounding the embryo
• Amnion is the innermost embryonic membrane
• Holds fetus suspended in the amniotic cavity

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Pregnancy
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Pregnancy

• The amnion and amniotic fluid normally rupture
  during labor
• This is when a womans water breaks
• Maternal and fetal blood never mix during
  pregnancy
• The placenta acts as a filter for nutrients,
  oxygen and waste

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Pregnancy

• Placenta produces its own hormone
• Human chorionic gonadotropin (HCG)
• This is what is tested for with home pregnancy
  tests
• After the baby is delivered the placenta is
  expelled
• This is known as the afterbirth

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Pregnancy
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Pregnancy
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PathologyCervix

• Carcinoma of the cervix
• Cervical cancer
• More common in women who
• Have coitus at early age
• Have multiple sex partners
• History of STDs
• Evidence of HPV
• Detection via Pap smear
• Treatments include conization, hysterectomy, or
  radiation therapy

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PathologyCervix

• Endometriosis
• Endometrial tissue found in abnormal locations
• Can cause
• Dysmenorrhea
• Pelvic pain
• Infertility
• Dyspanreunia
• Treatment ranges from symptomatic relief of pain
  to hysterectomy

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PathologyOvaries

• Ovarian Carcinoma
• Ovarian cancer
• Accounts for more deaths than those of the cervix
  and uterus combined
• Usually discovered in advanced stages
• Treatment includes surgery, radiotherapy and
  chemotherapy

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PathologyOvaries

• Ovarian Cysts
• Typically benign
• Occasionally cysts need to be removed to
  distinguish between benign and malignant tumors

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PathologyFallopian Tubes

• Pelvic Inflammatory Disease (PID)
• Leading causes are gonorrhea and chlamydial
  infection
• Can be repetitive which can lead to adhesions and
  scarring within the fallopian tubes
• Increases risk of ectopic pregnancy and
  difficulty getting pregnant

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PathologyFallopian Tubes

• PID (cont.)
• SS
• Vaginal discharge
• Pain in the abdomen (LLQ RLQ)
• Fever
• Tenderness on palpation of the cervix
• Antibiotics are used as treatment

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PathologyBreast

• Carcinoma of the breast
• Tumor will typically spread to lymph nodes in
  axilla first
• Once introduced to lymph nodes cancer may spread
  to other body organs
• Tumor is usually removed as primary treatment
• Early detection important

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PathologyBreast

• Carcinoma of the breast (cont.)
• Should perform self examination every month
  starting about age 20
• About 211,000 new cases expected in the US each
  year
• About 1,600 men expected to develop breast cancer

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PathologyPregnancy

• Ectopic Pregnancy
• Implantation of fertilized egg anywhere besides
  normal uterine location
• Occurs in about 1 of pregnancies
• About 90 of those occur in the oviducts
• Other sites include oviducts and abdominal cavity
• All are surgical emergencies

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Clinical Tests

• Pap Smear
• Physician uses a vaginal speculum, wooden spatula
  and cotton swab to take secretions from cervix
  and vagina
• Microscopic analysis is then performed on the
  sample
• Recommended for every woman over 18 years of age,
  or under if sexually active

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Clinical Tests

• Pregnancy test
• Can be blood or urine
• Detects presence of HCG
• Mammography
• X-rays of the breast to screen for cancer
• Recommended around age 50 for a baseline and
  every 1 2 years after

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Clinical Procedures

• Tubal Ligation
• A sterilization process
• Fallopian tubes are burned or cut, and then tied
  off
• A small incision is made in the abdomen and a
  laparoscope is inserted through which
  instrumentation can be inserted

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Clinical Procedures

• Cesarean Section
• C section
• Removal of fetus by abdominal incision
• Indications
• Cephalopelvic disproportion
• Hemorrhage
• Fetal distress
• Breech or shoulder presentation