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

4. Pelvis Innominate bone –Ilium –Ischium –Pubis Sacrum coccyx

6. Perineum

7. Anal triangle Urogenital triangle

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

11. 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

13. Bartholin duct opening

16. 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

18. Cervix Exocervix External os Endocervical canal Internal os Transformation zone

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

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

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

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

25. 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

27. Blood supply

28. Nerve supply

30. PHYSIOLOGY OF REPRODUCTION

31. GnRH HPO axis H hypothalamus P pituitary O ovarian Axis

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

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

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

39. 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

40. 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