the female reproductive system final

GOOD MORNING

FEMALE REPRODUCTIVE SYSTEM

FEMALE REPRODUCTIVE SYSTEM

SARASIVATHY EDDIAHSARASIVATHY EDDIAH

KETUA JURURAWAT KETUA JURURAWAT PENGAJARPENGAJAR

THE FEMALE REPRODUCTIVE SYSTEM

The Female Reproductive Organs are divided into:1. External genitalia2. Internal genitaliaExternal GenitaliaConsists of the vulva.Internal GenitaliaConsists of the:1. Vagina2. Uterus3. Two Fallopian tube4. Two Ovaries

EXTERNAL GENITALIAVulva consists of:1. Mons pubis/Mons veneris2. Labia Majora3. Labia minora4. Vestibule5. Clitoris6. Hymen7. Vestibular glands/Bartholin’s gland8. Perineum

The vulva protects the internal structures of the female reproductive system.

EXTERNAL GENITALIA

STRUCTURES OF THE VULVA

MONS PUBIS

• Is a mound of fatty tissue that covers the symphysis pubis.

• Covered by skin.

• Hair grows on the Mons pubis at puberty and becomes less on reaching menopause (45-55 years)

LABIA MAJORA

• Two large folds of fatty tissue and skin.

• Starts at the Mons veneris and joins at the skin of the perineum.

• Contains numerous sebaceous glands and fibrous tissue.

EXTERNAL GENITALIA

LABIA MINORA

• Two small folds of skin, lies between the labia majora.

• Pink in colour.

• Contains numerous sebaceous and sweat glands to smoothen the surface.

• Blood and nerve supply is very abundant.

LABIA MINORA

Superior part of the labia minora is divided into:

1. Upper fold is known as prepuce.

2. Lower fold is known as frenulum.

• Both the labia minora and the labia majora join at the perineum and is known as fourchette.

EXTERNAL GENITALIA

CLITORIS

• Small structure which lies between the prepuce and the frenulum.

• 1cm long.

• Contains sensory nerve endings and erectile tissues same as in the penis in the male.

• It is attached to the symphysis pubis by a set of ligaments known as the suspensory ligaments.

• Blood and nerve supply is very abundant.

EXTERNAL GENITALIA

VESTIBULE

• Cleft between the labia minora is known as the vestibule.

• Contains 2 openings for the urethra and the vagina.

• Urethra lies 1.6cm below the clitoris and contains two ducts known as skema’s tubule.

VESTIBULE

• The vaginal opening lies two-thirds below the clitoris.

• Covered by the hymen.• The vestibular glands known as the

Bartholin’s gland lie one on each side near the vaginal opening.

• They secrete mucus that keeps the vagina moist especially during sexual activity.

HYMEN

• Thin layer of mucous membrane.

• Partially occludes the openings of the vagina.

• Allows flow of menstrual flow.

• Hymen is made up of elastic tissue.

• Lined by stratified squamous epithelium on both surfaces.

VESTIBULAR GLANDS/BARTHOLIN’S GLAND

• Lie one on each side near the vaginal opening.

• Size of a small pea.• Have ducts.• They secrete mucus that keeps the vagina

moist especially during sexual activity.• Blocked Bartholin’s gland cause

Bartholin cyst.

EXTERNAL GENITALIA

PERINEUM

• Area extending from the base of the labia minora to the anal canal.

• Triangular in shape.

• Made up of connective tissue, muscles and fat and covered by skin.

• Gives attachment to the muscles of the pelvic floor.

EXTERNAL GENITALIA

BLOOD SUPPLY

Arterial supply

• Is by the internal pudendal arteries that branches from the internal iliac arteries and external pudendal arteries that branches from the femoral arteries.

Venous drainage

• Forms a large plexus which drains into the internal iliac veins.

LYMPH AND NERVE SUPPLY

Lymph drainage

• Is through the superficial inguinal nodes.

Nerve supply

• Is by branches of the pudendal nerves.

INTERNAL GENITALIAVagina• Fibromuscular canal/tube lined with stratified

squamous epithelium.

• Forms a canal from the vulva to the cervix.

• Lies in the true pelvis.

• Lies in between the bladder in front and the rectum behind.

• Anterior wall is 7.5cm long and the posterior wall is 9cm long.

• Inferior part opens as the vaginal opening.

INTERNAL GENITALIA

• Superior part runs obliquely upwards to meet the neck of cervix at an angle of 90 degrees and backwards at an angle of 45 degrees.

• There are 4 fornix where the vagina meets the cervix:

1.Anterior fornix in front of the cervix.

2.Posterior fornix behind the cervix.

3.Two lateral fornix at the side of the cervix.

STRUCTURE OF THE VAGINAL WALL

• The vaginal wall is pink in colour.

• The vagina has three layers:

1. Outer covering of elastic and areolar tissue. It has abundant blood and nerve supply.

2. Middle layer of smooth muscle.

3. Inner layer of stratified squamous epithelium that forms ridges or rugae. The function of the rugae is to stretch the vaginal wall during child birth.

STRUCTURE OF THE VAGINAL WALL

• Vagina has no secretory glands but the surface is kept moist by cervical secretions.

• The vaginal wall is rich in glycogen.• Between puberty and menopause,

Lactobacillus acidophilus bacteria (Doderlien’s bacillus) are normally present here.

• This bacteria secretes lactic acid, which maintains the pH of the vagina at 4.9 and 3.5.

• This acidity inhibits the growth of microorganisms and reduces infection.

BLOOD SUPPLYArterial supply

• Is by the arterial plexus derived from the uterine and vaginal arteries, which are branches of the internal iliac arteries.

Venous drainage

• A venous plexus drains into the internal iliac veins.

LYMPH AND NERVE SUPPLY

Lymph drainage

• Is through the superficial and deep iliac glands.

Nerve supply

• Is by the parasympathetic fibres from the sacral outflow and the sympathetic fibres from the lumbar outflow.

FUNCTION OF THE VAGINA

1. Female sexual organ and receives

seminal cells during coitus.

2. Birth canal.

3. Allows the flow of menstruatuion.

INTERNAL GENITALIA - UTERUS

• Hollow muscular pear shaped organ.

• About 7.5cm long, 5cm wide and 2.5cm thick.

• Weighs about 30-40grams.

• Lies in the true pelvis, in front of the bladder and the rectum behind.

• Position is anteverted and anteflexed.

• Divided into the fundus, body and the cervix.

FUNDUS

• Dome-shaped part of the uterus.

• Two fallopian tubes are situated on each end of the fundus.

• The angle where the fallopian tubes meet the fundus is known as the cornua.

BODY

• This is the main part and forms 2/3 of the uterus.

• Cavity forms a triangle.

• Terminates in the narrow cervix.

• The constricted region between the body and the cervix is the isthmus.

CERVIX

• Forms the lower 1/3 of the uterus.

• This is the junction between the uterus and the vagina.

• It is 2.5cm long and 1.5cm thick.

• The interior of the cervix, the cervical canal, opens into the vagina.

CERVIX

• It has two openings known as the internal os and the external os.

• Internal os communicates with the uterus, while the external os communicates with the vagina.

• The canal between the two os is known as the cervical canal.

CERVIX

• There are 4 fornix where the vagina meets the cervix.

• The Epithelial layer in the innermost lining of the cervix is made up of folds and is known as arbor vitae. This layer helps to propel the sperm upwards.

ANATOMICAL RELATIONSHIP OF THE UTERUS WITH THE OTHER

ORGANS

1. Anteriorly – Bladder

2. Posteriorly – Rectum and the pouch of Douglas

3. Lateral – Fallopian tube, Ovary, Broad Ligament, Round Ligament

4. Superiorly – Small intestine

5. Inferiorly – Vagina

MICROSCOPIC STRUCTURE OF THE UTERUS

The walls of the uterus are composed of three layers of tissue:

• Endometrium

• Myometrium

• Perimetrium

ENDOMETRIUM

• Consists of columnar epithelium containing a large number of mucus-secreting tubular glands.

• These glands secrete alkaline secretions and glycogen.

• The endometrium is divided functionally into 2 layers.

Endometrium

• The functional layer or the superficial layer is shed during menstruation.

• The basal layer is the layer from which a fresh functional layer is regenerated during each cycle.

• The thickness and vascularity of the endometrium changes regularly according to the stages of the menstrual cycle.

MYOMETRIUM

• Thickest layer of the uterine wall.• Mass of smooth muscle interlaced with

areolar tissue, blood vessel and nerves.Arranged in 3 layers of muscle fibres:

1. Inner layer• Contains circular muscle fibres arranged

around the cornua and lower part of the uterus.

• Allows the dilatation of the cervix during labour.

MYOMETRIUM

2. Middle layer• Contains oblique and longitudinal muscle fibres

arranged around the blood vessels.• Help in the 1st and 2nd stage of labour.• They contract and retract to push the baby out.• During the 3rd stage of labour, the muscles

fibres become more shorter and thicker due to retraction.

• They interveave around the blood vessels to control bleeding.

3. Outer layer• Contains longitudinal and oblique muscle

fibres.

PERIMETRIUM

• Outer layer of peritoneum.• Anteriorly it extends over the fundus and

the body where it is folded on the upper surface of the urinary bladder.

• This forms the Vesico-uterine pouch.

PERIMETRIUM

• Posteriorly it extends over the fundus, the body and the cervix, then it continues on to the rectum to form the Recto-uterine pouch or pouch of Douglas.

• Laterally only the fundus is covered. • The peritoneum forms a double fold with the

uterine tubes in the upper free border called the broad ligament.

• The broad ligament attaches the uterus to the sides of the pelvis.

CERVIXMICROSCOPIC STRUCTURE

• The endometrium layer in the cervix is thinner than in the uterus.

• It has more collagen fibres than muscle fibres.• It does not shed during the menstrual cycle.• 2/3 of the upper part of the cervix is made up of

columnar epithelium.• It is made up of folds and is known as arbor vitae.

This layer helps to propel the sperm upwards.• The cervical glands only secrete alkaline secretions.

CERVIXMICROSCOPIC STRUCTURE

• The thickness of this alkaline secretions change according to the menstrual cycle but becomes more thick during pregnancy and is known as the operculum (plug).

• This plug prevents ascending infection from the vagina to the uterus.

• 1/3 of the lower part of the cervical canal is lined with stratified squamous epithelium tissue.

• The site where this layer meets the layer of squamous columnar epithelium is the site where Cancer of the cervix always occurs.

SUPPORTS OF THE UTERUS• The uterus is supported in the pelvic cavity by

organs, muscles of the pelvic floor and ligaments that suspend it from the walls of the pelvis. These supporting ligaments are:

Two Broad ligaments• Formed by a double fold of peritoneum.• One on each side of the uterus.• Hang down the uterine tube as though draped

over them.• Lateral ends are attached to the sides of the

pelvis.

SUPPORTS OF THE UTERUS

Two Round ligaments

• Bands of fibrous tissues.

• Lie between the two broad ligaments.

• One on each side of the uterus.

• Pass to the sides of the pelvis, the through the inguinal canal to end by fusing with the labia majora.

• Maintains the uterus in the anteverted and anteflexed position.


Two Uterosacral ligaments

• Originate from the posterior walls of the cervix and vagina and extend backwards, one on each side of the rectum to the sacrum.


Two Transverse cervical ligaments

• Also known as the cardinal ligaments.

• Extend one from each side of the cervix and vagina to the side walls of the pelvis.

The Pubocervical fascia

• Extends forwards from the transverse cervical or cardinal ligaments and attached to the posterior surface of the pubic bone.

LIGAMENTS OF THE UTERUS

FUNCTION OF THE UTERUS

1. Menstruation

2. Site for fertilization and embedding of the egg.

3. To protect the fetus during pregnancy.

4. Contract to expel the baby.

5. Control bleeding after birth of baby.

BLOOD SUPPLY

Arterial blood supply to the uterus

• Uterine and ovarian arteries.

Venous supply

• Uterine and ovarian veins.

BLOOD SUPPLY

LYMPH DRAINAGE AND NERVE SUPPLY

Lymph drainage

• Internal iliac nodes

• Aortic lymph nodes

Nerve supply

• Sympathetic and parasympathetic.

FALLOPIAN TUBES

• Narrow muscular tube.

• Attached at the cornua of the uterus with the lumen opening into the uterine cavity.

• Lie in the upper boarder of the broad ligament.

• Narrow at the cornua but widens slowly like a trumpet towards the ovary.

• Divided into the interstitial, isthmus, ampulla and the infundibulum.

FALLOPIAN TUBES

Interstitial

• The narrowest part of the fallopian tubes.

• The diameter of the lumen is 1mm.

Isthmus

• Narrow and short.• 2.5cm in length from the uterus and 1cm from

the interstitial.

FALLOPIAN TUBES

Ampulla

• 5cm in length from the isthmus.

• Broader, wider and long.

• Fertilization occurs here.

FALLOPIAN TUBESIndifundibulum• The end point of the fallopian tube.• 2.5cm in length.• End of each tube has finger-like projections

called fimbriae.• Function of the fimbriae is to catch the ovum

during ovulation.• The longest of the fimbriae is known as the

ovarian fimbria as it is in close association to the ovaries.

STRUCTURE OF THE FALLOPIAN TUBE

Consists of three layers of tissue:

1. Innermost layer

• Lined by ciliated epithelium.

• Function to sweep the ovum.

• Consists of mucus secreting goblet cells that also supply nutrition.

• Has a mid-layer of connective tissue that is very vascular.

LINING OF FALLOPIAN TUBE


2. Middle layer

• Consists of smooth muscles.

• Peristaltic movement helps to propel the ovum towards the uterus.

• Consists of 2 layers: inner layer of circular muscle fibres and outer layer of longitudinal muscle fibres.


3. Outer layer

• Peritoneal covering.

• Draped over the tubes.

ANATOMICAL ASSOCIATION OF THE FALLOPIAN TUBE

1. Anterior, posterior and superior – peritoneal cavity and the

intestines.

2. Laterally – side wall of the pelvis.

3. Inferior – broad ligament.

4. Medial – Uterus

FUNCTION OF THE FALLOPIAN TUBE

1. Propels the ovum to the uterine cavity by peristaltic and ciliary movement.

2. Fertilization of ovum takes place in the ampulla of the fallopian tube.

BLOOD, LYMPH AND NERVE SUPPLY TO THE FALLOPIAN TUBES

Blood supply • Uterine and ovarian arteries.Venous supply• Uterine and ovarian veins.Lymph drainage• Lumbar nodesNerve supply• Ovarian plexus

OVARY

• Are the female gonads or glands.• Two ovaries which lie on either side of the

uterus near the infundibulum.• Lies in the true pelvis.• Attached to the upper part of the uterus by the

ovarian ligament and to the posterior part of the broad ligament by the mesovarium.

• Have irregular borders.• Are 3cm long, 2cm broad, 1cm thick and weigh

5-8 grams.

ATTACHMENT OF THE OVARY

• To the upper part of the uterus by the ovarian ligament.

• To the posterior part of the broad ligament by the mesovarium.

• To the broad ligament below the fallopian tube by the mesosalphinx.

• To the sides by the infundibular ligaments.

• To the fallopian tube by the fimbriae.

STRUCTURE OF THE OVARY

Consists of the medulla and the cortex.Medulla• Lies in the centre.• Consists of fibrous tissue, blood vessels and

nerves.• Blood vessels, nerves and lymphatic vessels

pass to the ovary through the mesovarium.• Provides attachment and nutrition to the

cortex.

STRUCTURE OF THE OVARY

Cortex

• Outer layer.

• Surrounds the medulla.

• Consists of connective tissue or stroma covered by germinal epithelium.

• Contains ovarian follicles, each of which contains an ovum.

OVARY IN DIFFERENT STAGES

• A women is born with 350-400 thousands of ovarian follicles but only around 400 mature and can be fertilized.

• Before puberty, the immature follicles are known as primordial follicles.

• During puberty, every 28 days, one ovarian follicle matures and is known as the graffian follicle.


• This occurs under the influence of the Follicular Stimulating Hormone from the anterior pituitary gland.

• Hormone oestrogen is produced during the process when the follicle matures.

• The matured follicle ruptures and releases its ovum.

• This process is called ovulation.

• The empty graffian follicle that is empty is known as the corpus luteum.


• The corpus luteum produces the hormone progesterone under the influence of the Luteinising Hormone.

• The corpus luteum functions for 11-14 days if the ovum is fertilized.

• It then produces the hormone human chorionic gonadotrophin (hcg).

• HCG stimulates the corpus luteum to produce progesterone for the first three months of pregnancy.

• The corpus luteum degenerates if fertilization does not take place and is then known as corpus albicans. Menstruation then takes place.

DEVELOPMENT OF OVARIAN FOLLICLE

BLOOD AND NERVE SUPPLY TO THE OVARY

Blood supply

• Ovarian arteries.

Venous supply

• Ovarian veins.

Nerve supply

• Sympathetic and Parasympathetic nerve.

.

FUNCTION OF THE OVARY

1. Produce ovum.

2. Produce the hormones oestrogen and progesterone

SUMMARY OF FEMALE REPRODUCTIVE ORGANS

HYPOTHALAMUS

Releases Gonadotrophins

Anterior Pituitary Glands

Follicular Stimulating Hormone Luteinising Hormone

Ovarian Follicle Corpus Luteum

Oestrogen Progesterone

SUMMARY OF THE STAGES OF DEVELOPMENT OF THE

OVUM AND THE ASSOCIATED HORMONES

PUBERTY• Age at which the internal reproductive organs

reach maturity.• This is called menarche.• This occurs due to influence of the Follicular

Stimulating Hormones and Luteinising Hormone from the Anterior Pituitary Glands.

• The age of puberty varies between 10 and 14 years.

• A number of physical and psychological changes occur:

• Uterus, fallopian tubes and ovaries reach maturity.

PUBERTY

• Menstrual cycle and ovulation begins.

• Breasts develop and enlarge.

• Pubic and axillary hair begins to grow.

• Increase in the rate of growth in height.

• Widening of the pelvis.

• Increase in the amount of subcutaneous fat.

DEFINITION OF MENSTRUATION

• Flow of blood due from the vagina to the breakdown of the endometrium layer of the uterus.

• The average length of the menstrual cycle is about 28 day, lasting usually about 4 days.

Definition of menopause• Stage when cessation of menstruation and

ovulation occurs.• Occurs between the ages of 45-55 years.

PHASES OF THE MENSTRUAL CYCLE

1. Menstrual phase

2. Regenerative phase

3. Proliferative phase

4. Secretory phase

MENSTRUAL PHASE

• When the ovum is not fertilized, the corpus luteum starts to degenerate.

• The level of progesterone decreases.

• The breakdown of the functional layer of the endometrium occurs.

• Shed as menstruation for 5-7 days.

REGENERATIVE PHASE

• Starts 3 days after menstruation.

• The endometrim is regenerated.

• Takes about 4 days.

• Stimulated by the hormone oestrogen.

PROLIFERATIVE PHASE

• Starts on the 5th day after menstruation.

• The endometrium continues to regenerate and becomes thick.

• Regeneration occurs from the basal layer until it is 3.5mm thick.

• Influence by hormone oestrogen.

SECRETORY PHASE

• Influence by the hormone progesterone.• The endometrium becomes more thick and

oedematous.• The secretory glands produce increased

amounts of watery mucus.• Blood vessels become more torturous.• Endometrium becomes very vascular and soft

to receive the ovum if fertilization occurs.• This phase last for 14 days.

CONTENTS OF MENSTRUATION

Contains secretions from:

1. Endometrial glands

2. Endometrial cells

3. Blood from broken capillaries

4. Unfertilised ovum

BREASTS OR MAMMARY GLANDS

• Accessory glands of the female reproductive system.

• Also exists in the male in a rudimentary form.

• Female breasts are small and immature until puberty.

FEMALE BREAST

BREASTS OR MAMMARY GLANDS

• Develop after puberty under influence of oestrogen and progesterone.

• These hormones influence further growth during pregnancy.

• Hormone prolactin from the anterior pituitary gland stimulates the production of milk.

• Hormone oxytocin from the posterior pituitary gland stimulates the release of milk.

FEMALE BREAST

LOCATION AND SIZE OF THE BREAST

• Lies in front of the pectoris major muscle.

• Lies horizontally at the 2nd till the 6th ribs at the lateral part of the sternum.

• Attached by the fascia of the pectoris muscle.

• Size depends on the amount of adipose tissue and not on the glandular tissue.

• Function does not depend on size.

STRUCTURE OF THE BREAST

• Consists of glandular, fibrous and fatty tissue.• Each breast consists of about 20-30 lobes of

glandular tissue.• The lobules consist of a cluster of alveoli which

open into small ducts.• The alveoli are lined by acini cells which

produce milk.• These ducts unite to form large excretory ducts

called lactiferous ducts.• The lactiferous ducts converge towards the

centre of the breast.


• Here they form dilatations or reservoirs for milk called lactiferous sinus.

• From the lactiferous sinus, a narrow duct opens to the surface at the nipple to form the ampulla.

• Ampulla is the store for milk.• Fibrous tissue supports the glandular tissue and ducts.• Fat covers the surface of the glands and between the

lobes.• The breasts are held in place by the suspensory

ligaments or the Cooper’s ligaments.


Nipple• Small conical eminence at the centre of

the breast.• Surrounded by a pigmented area called

areola.• Made up of dense connective tissue and

smooth muscle fibres.

NIPPLE

• Also contains a lot of blood vessels and sensitive nerve endings.

• On the surface of the areola are numerous sebaceous glands called Milk Montgomery’s tubercles.

• These help to lubricate the nipple during lactation

BLOOD, LYMPH AND NERVE SUPPLY

Arterial blood supply to the breast• Axillary, mammary and intercostals arteries.Venous supply• Axillary and mammary veins.Lymphatic drainage• Axillary lymph vessels and nodes• May also drain through the internal mammary nodes

if the superficial route is blocked.Nerve supply• From the branches from the 4th, 5th and 6th thoracic

nerve containing sympathetic nerve fibres.

FUNCTION OF THE BREAST

1. Produce milk.

Physiology of milk production

Consists of three stages:

1. Production of milk - lactation

2. Flow of milk

3. Secretion of milk

PRODUCTION OF MILK - LACTATION

• High levels of oestrogen prevents the secretion of prolactin.

• Level of oestrogen falls after delivery.

• The anterior pituitary gland stimulates the secretion of hormone prolactin.

• Prolactin reacts on the acini cells to produce milk.

• Milk flows to the alveoli.

• As it collects in the alveoli, it is slowly pushed towards the lactiferous ducts.

FLOW OF MILK

• Milk release is controlled by oxytocin secreted by the posterior pituitary gland.

• Oxytocin causes the smooth muscles in the breast to contract.

• This expels the milk from the alveoli to the ampulla.

SECRETION OF MILK

• When the baby suckles the breasts, it compresses on the ampulla.

• Milk stored under the areola in the ampulla is the pushed into the baby’s mouth.

NEURO HORMONAL REFLEX

• The suckling of the child stimulates the many touch receptors around the mother’s nipple.

• An impulse is send to the anterior pituitary gland in the hypothalamus.

• The anterior pituitary gland stimulates the secretion of hormone prolactin.

• Prolactin reacts on the acini cells to produce milk.

NEURO HORMONAL REFLEX

• When the alveoli are full of milk and the level of prolactin in the blood is high, another impulse is send to the posterior pituitary gland in the hypothalamus.

• The posterior pituitary gland releases oxytocin into the blood.

• The oxytocin stimulates the smooth muscles to contract and release of milk.

CANCER BREAST

MASTECTOMY

FETUS IN UTERO

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the female reproductive system final

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