Applied Female Reproductive Physiology and the Anatomy of the Female Genitourinary System From material provided by Professor Michael Chapman Modified February 2013

Laparoscopic view of pelvis

Tubal Dye Studies

Normal Female Pelvis

ENDOMETRIOSIS

Cervical polyp

CERVICAL CANCER

External Genitalia (Female)

The Pelvic Floor

Course of the Ureter in Females

Female Menstrual Cycles

Window of Receptivity Implantation Changes in during cycle uterine lining ENDOMETRIAL CYCLE

The Development of the Female WHAT MAKES A GIRL, A GIRL?

The Development of the Female XX vs XY Chromosomal Determination

The Development of the Female Action through specific genes on X differentiation OvariesMullerian ducts tubes, uterus,upper 1/3 vagina

The Development of the Male specific genes on Y chromosome (eg SRY-1) differentiation testis AMH/MIF testosterone Mullerian duct suppression Internal genitalia prostate,seminal vesicles, vas, epididymis, descent of testes no uterus,tubes, upper vagina

Abnormal Sexual Development -Chromosomal abnormalities -Androgen receptor defects -Enzyme deficiencies -Exogenous/endogenous hormone exposure -Anatomical abnormality

Chromosomal abnormality Turner’s Syndrome Gonadal dysgenesis

Turner’s Syndrome Chromosomes 45 XO Short stature, low hairline, webbed neck, primary amenorrhoea 1:5000 females but common aneuploidy in miscarriage Normal female external & internal genitalia but with streak ovaries Will “menstruate” on The Pill Can carry a pregnancy if primed with E2 and PROG and donated egg/embryo

Chromosomal abnormality Klinefelter’s Sydrome

Klinefelter’s Syndrome Chromosomes 47 XXY Tall sometimes with gynaecomastia 1:750 males but may never be detected Normal male external genitalia but with small, soft testes and ↓testosterone Commonly infertile with azospermia Can be assisted to fatherhood using IVF/ICSI if any sperm can be found

Gene defect Kallmann’s Syndrome

Chromosomes can be 46XY or 46XX Absence of GnRH from the hypothalamus results in... Hypogonadotrophic hypogonadism Also have anosmia 1:4,000 males and 1:12,000 females Have male or female genitalia but will not enter puberty Can be treated with sex steroids or FSH/LH

Androgen receptor defect Testicular feminisation Androgen insensitivity syndrome

Androgen Insensitivity Syndrome Chromosomes 46XY Classically a result of absent androgen receptors so all cells are unresponsive to testosterone Have female external genitalia but absent uterus and vagina and undescended testes Present with primary amenorrhoea but good breast development, absent pubic hair Testes are usually surgically removed But what do you tell these girls?

Endogenous androgen excess Congenital adrenal hyperplasia

Congenital Adrenal Hyperplasia Chromosomes can be 46XY or 46XX A block in cortisol synthesis causes ↑ACTH and ↑androgens by the adrenals Females will exhibit virilization Babies have fused labia and clitoramegaly May require urgent identification and treatment with cortisol etc soon after birth

For further information on disorders of sexual development... Consult “Intersex” on Wikipedia

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