Female reproductive tract Bongkot Chakornbandit, MD. OB-GYN, HPC 10 Ubon Ratchathani

Pelvis Innominate bone –Ilium –Ischium –Pubis Sacrum coccyx

Perineum

Anal triangle Urogenital triangle

Labia majora Loose CNT Hair follicle Sebaceous gland Sweat gland –Eccrine gland –Apocrine gland

Labia minora Thinner than labia majora Anterior fold form hood of clitoruis Attachment of inferior surface  posterior fourchette Sebaceous gland (protect from irritant) No hair follicle, no sweat gland

Bartholin duct opening

Vagina Hollow fibromuscular tube Hormone sensitive Axis –Upright : almost horizontal –Lithotomy : posterior toward sacrum Anterior 6-9 cm., posterior 8-12 cm. Rugae : distensibility Lubrication : - transudate - cervical & Bartholin gland

Cervix Exocervix External os Endocervical canal Internal os Transformation zone

Cervical eversion –Early childhood –Pregnancy –OCP Cervical mucus : hormonal influence

Uterus Fibromuscular organ Vary in size & shape ~ 8 x 5 x 2.5 cm. Part of Uterus –Isthmus –body –Fundus –cornu

Endometrial cavity –Triangular shape –Mucosal surface Myometrium –Interlacing smooth muscle fiber

Fallopian tube 7 – 14 cm. 4 parts –Interstitial –Isthmus –Ampulla –Fimbria (infundibulum)

Ovaries paired gonadal structures Varies in size (from hormone production), up to 5 x 3 x 3 cm. Cortex : specialized stroma & folloicles Medulla : fibromuscular tissue & blood vessels

Blood supply

Nerve supply

PHYSIOLOGY OF REPRODUCTION

GnRH HPO axis H hypothalamus P pituitary O ovarian Axis

Uterine cycle Menstrual phase –shedding Proliferative phase –thickening Secretory phase –Strengthening

Normal menstruation Endometrium + enzyme Fibrinolysis 50% shedding in first 24 hr. Cycle 21 – 45 d Duration ~ 4 – 7 d Amount ~ 30 – 80 ml. ( ml.)

Pubertal development Tanner developed a scale for sexual maturity rating : Tanner stage 5 classes based on breast and pubic hair

Tanner stage of breast I.Prepubertal –No palpable breast tissue II.Breast bud –Visible & palpable mound of breast tissue III.Breast elevation –Growth & elevation of entire breast IV.Areola mound –Secondary mound V.Adult contour –Mature in contour & proportion

Tanner stage of breast I.Prepubertal –No sexual hair II.Presexual hair –Coarse, long, crinkly hair along labia majora III.Sexual hair –Coarse, curly hair extend to mon pubis IV.Mid-escutcheon –Adult hair in thickness & texture V.Female escutcheon –Extend onto thigh