The Female Reproductive System 16 The Female Reproductive System

Learning Objectives After completing this chapter, you will be able to: Define and spell the word parts used to create terms for the female reproductive system Identify the major organs of the female reproductive system and describe their structure and function

Learning Objectives (cont.) After completing this chapter, you will be able to: Break down and define common medical terms used for symptoms, diseases, disorders, procedures, treatments, and devices associated with the female reproductive system Build medical terms from the word parts associated with the female reproductive system

Learning Objectives (cont.) After completing this chapter, you will be able to: Pronounce and spell common medical terms associated with the female reproductive system

The Female Reproductive System Produces the female sex cells, or female gametes; the female gametes are the egg cells, called the ova or oocytes Also provides support for the developing embryo and fetus once fertilization has occurred and makes the process of internal fertilization possible 5

Prefixes a- = without, absence of dys = bad, abnormal, difficult, painful endo- = within intra- = within peri- = to be around, about pre- = before syn- = together, joined 6

Combining Forms aden/o = gland cervic/o = cervix, neck colp/o = vagina culd/o = cul-de-sac cyst/o = sac, bladder 7

Combining Forms (cont.) episi/o = vulva gynec/o, gyn/o = woman hydr/o = water hyster/o = uterus leuk/o = white 8

Combining Forms (cont.) mamm/o, mast/o = breast men/o, menstru/o = month, menstruation metr/o, metr/i = uterus my/o = muscle 9

Combining Forms (cont.) oophor/o, ovari/o = ovary ov/o = egg perine/o = perineum pelv/i, pelv/o = pelvis, washbasin py/o = pus rect/o = straight, erect, rectum 10

Combining Forms (cont.) salping/o = tube son/o -= sound thel/i = nipple trachel/o = cervix, neck uter/o = womb, uterus vagin/o = sheath, vagina vulv/o = vulva 11

Suffixes -al, -ary = pertaining to -an = pertaining to -atresia = closure; absence of a normal body opening -centesis = surgical puncture to aspirate fluids -graphy = process of recording 12

Suffixes -ial = pertaining to -rrhaphy = suturing -pexy = surgical fixation, suspension -salpinx = trumpet, fallopian tube -stomy = surgical creation of an opening 13

Anatomy and Physiology The primary organs of the female reproductive system are the ovaries Other organs support embryonic and fetal development and the internal process of fertilization. They are the fallopian tubes, uterus, vagina, external genitalia, and mammary glands 14

Figure 16.1: Female reproductive organs 15

The Ovaries Are the female gonads. They produce the female gametes (ova) and the female sex hormones, estrogens, and progesterone They are paired, almond-shaped organs located opposite one another against the walls of the pelvic cavity 16

The Ovaries (cont.) Each ovary is covered by a layer of cells and is internally divided into a cortex and medulla The cortex contains numerous sac-like ovarian follicles that are in various stages of development 17

The Ovaries (cont.) Each ovarian follicle contains a single ovum The total number of ova that are present in a female’s lifetime are present in the ovaries at birth, in an immature state Ova mature and are released on a monthly cycle called the ovarian cycle; the release is called ovulation 18

The Ovaries (cont.) During this event, the ovum bursts out of a mature ovarian follicle, or graafian follicle, through the ovarian wall and into the peritoneal cavity From there, the ovum is usually drawn into a fallopian tube The ovarian cycle begins at the onset of puberty and ends about 40 years later at menopause 19

Figure 16.2: Ovary 20

The Fallopian Tubes Are a pair of narrow tubes located along each side of the pelvic cavity wall; they are also called uterine tubes or oviducts Each tube extends about 10cm between an ovary and the uterus and is lined with a ciliated mucous membrane 21

The Fallopian Tubes (cont.) The beating of the cilia create a current of mucus that draws an ovulated ovum inside the tube If fertilization occurs, it usually happens within the upper one-third of a fallopian tube 22

The Uterus Is a pear-shaped organ about the size of a woman’s clenched fist It is suspended above the floor of the pelvic cavity by ligaments, located between the urinary bladder and rectum It is separated from the rectum by a space called the rectouterine pouch 23

The Uterus (cont.) The uterus consists of an upper, dome- shaped fundus; a central body that receives the two fallopian tubes; and a lower, narrow cervix Internally, the space within the body is the uterine cavity and that within in the cervix is the cervical canal The cervical canal opens into the vagina via the external os 24

The Uterus (cont.) The wall of the uterus includes an inner layer rich in blood vessels called the endometrium The endometrium provides an implantation site for the embryo and thickens to form part of the placenta once implantation occurs 25

The Uterus (cont.) The endometrium changes on a monthly cycle by increasing and decreasing thickness This cycle is called the menstrual cycle and occurs approximately every 28 days Menses or menstruation begins when the outer layer of the endometrium breaks away, causing bleeding from the uterus 26

Figure 16.3: Ovary The uterus and nearby structures Source: Icon Learning Systems 27

The Vagina Is a thin-walled, tube-shaped organ about 8—10 cm long and functions as the passage between the cervix of the uterus and the outside of the body The uterus sheds blood during menstruation through the vagina and semen travels to the uterus from the vagina 28

The Vagina (cont.) Also known as the birth canal because a baby passes through the vagina during vaginal childbirth At the end that receives the cervix, its wall curves around to form a shallow pocket called the fornix 29

The Vagina (cont.) The vagina’s opening to the outside is known as the vaginal orifice In young females, the mucous membrane may extend across the opening, forming a thin barrier called the hymen The hymen contains blood vessels and tends to bleed when it is first penetrated or ruptured 30

Female External Genitalia Structures located outside the vagina They are collectively known as the vulva and include: Mons pubis Labia majora Labia minora 31

Female External Genitalia (cont.) They are collectively known as the vulva and include: Vestibule Clitoris Bartholin’s glands Perineum 32

Figure 16.4: The female external genitalia Source: Icon Learning Systems 33

The Mammary Glands Are the organs that produce milk for infant nourishment Located in the breasts, they consist of tissue that is modified from sweat glands The breasts of both males and females contain an external, heavily pigmented areola that surrounds a centrally located nipple 34

The Mammary Glands (cont.) An adult female mammary gland undergoes enlargement during puberty, directing fat tissue to accumulate between the skin and muscle layer 35

The Mammary Glands (cont.) Each adult gland consists of 15 to 20 lobes that radiate around the nipple Each lobe contains small chambers that house alveolar glands The alveolar glands produce milk when a woman is lactating, which is under hormone control 36

Figure 16.5: The mammary glands Source: Icon Learning Systems 37

Word Roots cervic = cervix, neck mamm = breast men = month, menstruation metr = uterus ov = egg 38

Word Roots (cont.) perine = perineum uter = womb, uterus vagin = sheath, vagina 39

Other Important Terms Alveolar glands Bartholin’s glands Clitoris Estrogens Fallopian tubes Fornix Follicles Hymen Infundibulum Labia majora Labia minora Mons pubis Rectouterine pouch Vestibule Vulva 40

Medical Terms Gynecology Gynecologist The study of diseases of the female reproductive system Gynecologist A physician who specializes in gynecology 41

Symptoms and Signs Amenorrhea Dysmenorrhea Hematosalpinx Absence of menstrual discharge; also called menostasis Dysmenorrhea Pain during menstruation Hematosalpinx Blood in a fallopian tube 42

Symptoms and Signs (cont.) Hydrosalpinx Water accumulation in a fallopian tube Leukorrhea White or yellow discharge from the uterus Mastalgia Pain in the breast 43

Symptoms and Signs (cont.) Menometrorrhagia Irregular or excessive bleeding other than during menstruation Menorrhagia Excessive bleeding during menstruation Metrorrhagia Bleeding from the uterus at any time other than during normal menstruation 44

Symptoms and Signs (cont.) Metrorrhea Discharge of mucus or pus from the uterus Oligomenorrhea Abnormally reduced discharge during menstruation Pyosalpinx Pus within a fallopian tube 45

Diseases and Disorders Adenomyosis An abnormal condition of glandular tissue growth within muscle; in the female, it refers to growth of the endometrium into the muscular layer of the uterus Amastia Absence of a breast 46

Diseases and Disorders (cont.) Bartholin’s adenitis Inflammation of Bartholin’s gland; also known as bartholinitis Breast cancer A malignant tumor arising from breast tissue; the most common form is called an infiltrating ductal carcinoma 47

Figure 16.6: Breast cancer 48

Diseases and Disorders (cont.) Carcinoma in situ (CIS) of the cervix The precancerous form of cervical cancer Cervical cancer A malignant tumor arising from the cervix; the most common form is squamous cell carcinoma 49

Figure 16.7: Cervical cancer 50

Diseases and Disorders (cont.) Cervical intraepithelial neoplasia Abnormal development of cells within the cervix, resulting in tumor formation, which has the potential of becoming cancerous; abbreviated CIN Cervicitis Inflammation of the cervix 51

Diseases and Disorders (cont.) Dermoid cyst Benign tumor arising from ovarian tissue composed of abnormal embryonic tissue Dyspareunia Difficult or painful sexual intercourse 52

Diseases and Disorders (cont.) Endocervicitis Inflammation of the inner lining of the cervix Endometrial cancer A malignant tumor arising from endometrial tissue of the uterus, it is one form of uterine cancer 53

Figure 16.8: Endometrial Cancer 54

Diseases and Disorders (cont.) Endometriosis An abnormal condition of the endometrium, in which endometrial tissue grows in various locations in the pelvic cavity, including on the fallopian tubes, uterus, and ovaries 55

Diseases and Disorders (cont.) Endometritis Inflammation of the endometrium Fibrocystic breast disease Formation of one or more benign cysts in the breast 56

Figure 16.9: Endometriosis 57

Figure 16.10: Fibrocystic breast disease 58

Diseases and Disorders (cont.) Fibroid tumor Benign tumor containing fibrous tissue that arises from the myometrium of the uterus, commonly referred to as fibroids, the condition is also called myoma of the uterus, fibromyoma, and leiomyoma 59

Figure 16.11: Fibroid tumors 60

Diseases and Disorders (cont.) Fistula An abnormal passage from one hollow organ to another; a rectovaginal fistula occurs between the vagina and rectum, and a vesicovaginal fistula occurs between the bladder and vagina 61

Figure 16.12: Fistula 62

Diseases and Disorders (cont.) Gynopathic Pertaining to a disease of women Hysteratresia Closure of the uterus, resulting in an abnormal obstruction in the uterine canal Mastitis Inflammation of the breast 63

Diseases and Disorders (cont.) Mastoptosis Condition of a sagging breast Myometritis Inflammation of the myometrium Oophoritis Inflammation of an ovary Ovarian cancer A malignant tumor arising from an ovary 64

Diseases and Disorders (cont.) Parovarian cyst A cyst of a fallopian tube Pelvic inflammatory disease Inflammation of the female organs within the pelvic cavity, generally including the ovaries, uterus, and fallopian tubes, usually caused by bacteria 65

Diseases and Disorders (cont.) Perimetritis Inflammation of the perimetrium Polymastia Presence of more than two breasts 66

Diseases and Disorders (cont.) Premenstrual syndrome A collection of symptoms, including tension, irritability, painful breasts, edema, and headache, which usually strike during the 10 days preceding menstruation Prolapsed uterus Displacement of the uterus resulting in a downward location, often crowding into the vagina; also called hysteroptosis 67

Figure 16.13: Prolapsed uterus 68

Figure 16.13 (continued): Prolapsed uterus 69

Diseases and Disorders (cont.) Salpingitis Inflammation of the fallopian tube Salpingocele Hernia of the fallopian tube 70

Diseases and Disorders (cont.) Toxic shock syndrome An infectious disease characterized by a rapid onset of symptoms including high fever, skin rash, diarrhea, vomiting, and myalgia, followed by hypotension, leading to shock and in severe cases, death; it has been linked to non-cotton tampon use and is usually caused by Staphylococcus aureus 71

Diseases and Disorders (cont.) Vaginitis Inflammation of the vagina, which is also known as colpitis; in a common form known as atrophic vaginitis, the usual symptoms of redness and swelling are accompanied by thinning of the vaginal wall and loss of moisture, usually due to a depletion of estrogens 72

Diseases and Disorders (cont.) Vulvovaginitis Inflammation of the vulva and vagina 73

Figure 16.14: Vaginitis 74

Figure 16.14 (continued): Vaginitis 75

Cancers of Female Organs Form the greatest type of threat to health and life among women They include cancers of the uterus, breast, and ovaries Cancers of the uterus, including cervical cancer, are the most common reproductive cancers in women between ages 15—40 76

Cancers of Female Organs (cont.) Uterine cancer is very lethal because most women fail to develop symptoms until later in the disease Symptoms include vaginal bleeding, pelvic pain, and vaginal discharge The most effective screening test is a Pap smear, although new techniques, including Cancer Antigen-125 Tumor Marker, have created additional diagnostic tools 77

Cancers of Female Organs (cont.) The primary risk factor for cervical cancer is a history of multiple sex partners It is believed that early treatment of precancerous lesions known as cervical intraepithelial neoplasia, or CIN, as detected by Pap smears, may prevent progression to cancer 78

Cancers of Female Organs (cont.) Without treatment, this precancerous stage often progresses quickly into a severe cervical dysplasia, followed by progression into carcinoma in situ (CIS) of the cervix Early treatment of cervical cancer includes removal of part of the cervix in a cervical conization procedure 79

Cancers of Female Organs (cont.) Treatment of more advanced cancers involves hysterectomy, radiation therapy, and chemotherapy Endometrial cancer is slightly less common than cervical cancer 80

Cancers of Female Organs (cont.) Endometrial cancer is common among women age 50—70 and appears to occur more frequently among women treated with hormone replacement therapy (HRT) Endometrial cancer is aggressive, and there is no satisfactory screening test Its symptoms include irregular bleeding, and diagnosis usually requires a biopsy 81

Cancers of Female Organs (cont.) Treatment involves a hysterectomy, followed by radiation therapy Breast cancer is the second most common type of cancer in women, after cancers of the uterus About 80% of all breast cancers are a form called infiltrating ductal carcinoma (IDC) 82

Cancers of Female Organs (cont.) The most common diagnostic tool for diagnosing breast cancers is mammography, often followed by a breast biopsy for confirmation If the cancer remains within the mammary ducts, it is a noninvasive tumor and can be easily treated by a lumpectomy 83

Cancers of Female Organs (cont.) If the cancer spreads to surrounding lymph nodes, the cancer quickly becomes aggressive, requiring more invasive procedures, including radical mastectomy or modified radical mastectomy, which are followed by radiation therapy and chemotherapy 84

Cancers of Female Organs (cont.) The chance of developing ovarian cancer is 1 in 70 for U.S. women About 85% of ovarian cancers arise from epithelial cells within the ovary A procedure like transvaginal sonography (TVS) can detect ovarian cancer early, but there is a high incidence of false-positive results 85

Cancers of Female Organs (cont.) If the cancer is detected early, treatment is usually successful Many cases of ovarian cancer are not diagnosed until the disease has progressed 86

Cancers of Female Organs (cont.) When ovarian cancer is detected later, aggressive treatments like salpingo-oophorectomy and total hysterectomy, followed with aggressive chemotherapy, become necessary Unfortunately, these treatments are last-ditch efforts to save the patient and are accompanied by additional risks 87

Treatments, Procedures, and Devices Anterior and posterior colporrhaphy Surgical repair of a protrusion of the bladder against the anterior vaginal wall and protrusion of the rectum against the posterior vaginal wall Biopsy Removal of a tissue sample for microscopic evaluation, which may be done by aspiration biopsy, endoscopic biopsy, excisional biopsy, or needle biopsy 88

Figure 16.15: Biopsy The various forms of gynecological biopsy are shown. 89

Figure 16.15 (continued): Biopsy The various forms of gynecological biopsy are shown. 90

Treatments, Procedures, and Devices (cont.) Cancer Antigen-125 Tumor Marker A blood test that is used to provide evidence for ovarian cancer, which measures the levels of a protein produced by cancer cells Cervical conization Removal of the cone-shaped portion of the cervix 91

Treatments, Procedures, and Devices (cont.) Cervicectomy Excision of the cervix; also called trachelectomy Colpoperineorrhaphy Suture of the vagina and perineum to correct tears 92

Treatments, Procedures, and Devices (cont.) Colpoplasty Surgical repair of the vagina Colporrhaphy Suture of the vagina Colposcopy Endoscopic examination of the vagina using a modified endoscope called a colposcope 93

Treatments, Procedures, and Devices (cont.) Culdocentesis Surgical puncture into the pelvic cavity to remove fluid from the rectouterine pouch Culdoscopy Endoscopic examination of the space between the rectum and uterus, called Douglas’ cul-de-sac, using a modified endoscope, called a culdoscope 94

Figure 16.16: Culdocentesis and culdoscopy 95

Treatments, Procedures, and Devices (cont.) Dilation and curettage Dilation of the cervix and scraping of the endometrium, in order to control bleeding, obtain a tissue sample for biopsy, or remove polyps Endometrial ablation The use of lasers, electricity, or heat to destroy the endometrium, followed by its removal; used to treat abnormal bleeding 96

Treatments, Procedures, and Devices (cont.) Episioperineoplasty Surgical repair of the vulva and perineum Episorrhaphy Suture of the vulva to correct a tear Episotomy Incision of the vulva and perineum to prevent tearing during childbirth 97

Treatments, Procedures, and Devices (cont.) Gynecology The study of diseases of women Gynecologist A physician specializing in women’s diseases Hormone replacement therapy Clinical treatment that includes the replacement of naturally produced hormones with synthetic hormones as a treatment for menopause 98

Treatments, Procedures, and Devices (cont.) Hymenectomy Excision of the hymen Hymenotomy Incision into the hymen Hysterectomy Excision of the uterus, which may include surrounding structures; also called uterectomy 99

Treatments, Procedures, and Devices (cont.) Hysteropexy Surgical fixation of the uterus Hysterosalpingography X-ray procedure that produces an x-ray image of the uterus and fallopian tubes after injection of a radiopaque contrast medium, called a hysterosalpingogram 100

Figure 16.17: Alternative forms of surgeries involving the uterus, ovaries, and fallopian tubes 101

Figure 16.17 (continued): Alternative forms of surgeries involving the uterus, ovaries, and fallopian tubes 102

Figure 16.17 (continued): Alternative forms of surgeries involving the uterus, ovaries, and fallopian tubes 103

Figure 16.17 (continued): Alternative forms of surgeries involving the uterus, ovaries, and fallopian tubes 104

Figure 16.18: Hysterosalpingography 105

Treatments, Procedures, and Devices (cont.) Hysterosalpingo-oophorectomy Excision of the uterus, fallopian tubes, and ovaries, when the excision occurs through the abdomen and is bilateral Hysteroscopy Endoscopic examination of the uterine cavity using a modified endoscope called a hysteroscope 106

Treatments, Procedures, and Devices (cont.) Laparoscopy Endoscopic examination of the abdominal or pelvic cavity with a modified endoscope called a laparoscope Mammography X-ray procedure that produces an x-ray image of the breast, called a mammogram 107

Figure 16.19: Laparoscopy 108

Figure 16.19 (continued): Laparoscopy Source: Custom Medical Stock Photo, Inc. 109

Figure 16.20: Mammography Sources: (a) Robin Nelson/PhotoEdit, Inc. 110

Figure 16.20: Mammography Sources: (b) Peter Arnold, Inc. 111

Treatments, Procedures, and Devices (cont.) Mammoplasty Surgical repair of the breasts, resulting in the enlargement or reduction of breast size or removal of a tumor 112

Treatments, Procedures, and Devices (cont.) Mastectomy Excision of a breast; in a simple mastectomy, one entire breast is removed, leaving underlying muscles and lymph nodes intact; a radical mastectomy is the removal of the entire affected breast, the underlying chest muscles, and local lymph nodes; 113

Treatments, Procedures, and Devices (cont.) Mastectomy (cont.) A modified radical mastectomy is removal of the affected breast and lymph nodes of the underarm, leaving muscle intact; a lumpectomy is the removal of the cancerous lesions only, in order to conserve the breast 114

Figure 16.21: Mastectomy 115

Figure 16.21 (continued): Mastectomy 116

Treatments, Procedures, and Devices (cont.) Mastopexy Surgical fixation of the breast, which is usually performed to elevate pendulous breast tissue Myomectomy Excision of a myoma, or fibroid tumor, from the uterus Oophorectomy Excision of an ovary 117

Treatments, Procedures, and Devices (cont.) Panhysterectomy Excision of the uterus, ovaries, and fallopian tubes, which are removed through an abdominal incision; a radical hysterectomy is a similar procedure, in which the lymph nodes, upper portion of the vagina, and surrounding tissues are also removed 118

Treatments, Procedures, and Devices (cont.) Papanicolau smear A diagnostic procedure in which a sample of cells from the cervix and vagina are removed and examined microscopically for abnormalities; mainly used to screen for cervical cancer; also called Pap smear or Pap test 119

. Figure 16.22: Pap smear 120

Treatments, Procedures, and Devices (cont.) Perineorrhaphy Suture of the perineum to correct a tear Salpingectomy Excision of a fallopian tube Salpingo-oophorectomy Excision of a fallopian tube and an ovary, usually from the same side 121

Treatments, Procedures, and Devices (cont.) Salpingostomy Surgical creation of an opening through the wall of a fallopian tube, often to treat ectopic tubal pregnancy 122

Treatments, Procedures, and Devices (cont.) Sonohysterography Ultrasound procedure that records an image of the uterus with the use of sound waves, called a sonohysterogram and used to evaluate the postoperative status of polyps, myomas, and adhesions of the uterus Trachelorrhaphy Suture of the cervix wall 123

Treatments, Procedures, and Devices (cont.) Transvaginal sonography Ultrasound procedure in which a probe is inserted into the vagina to record images of the uterus, ovaries, fallopian tubes, and surrounding structures, performed to diagnose ovarian tumors or cysts, monitor pregnancy, and to monitor ovulation for treating infertility Tubal ligation Sterilization procedure by ligating the fallopian tubes 124

Figure 16.23: Tubal ligation 125

Treatments, Procedures, and Devices (cont.) Vaginal speculum Instrument for opening the vaginal orifice to permit visual examination of the vagina and beyond Vulvectomy Excision of the vulva 126

Figure 16.24: Vaginal speculum Source: Simon Fraser/Science Photo Library/Photo Researchers Inc. 127

Abbreviations A&P repair bx CA-125 CIN CIS D&C 128

Abbreviations (cont.) ERT FBD GYN HRT HSG Pap smear (test) 129

Abbreviations (cont.) PID PMS TAH/BSO TSS TVS 130