1. Anatomy & Physiology Of Female Reproductive System
Dr. Aida Abd El-Razek

2. Learning Objectives Define the terms listed.
Identify the female external reproductive organs.
Explain the structure of the bony pelvis.
Explain the functions and structures of pelvic floor.

3. Introduction

4. External Female Structures
Collectively, the external female reproductive organs are called the Vulva.

5. External Female Structures
Mons Pubis.
Labia Majora & Minora.
Clitoris.
Vestibule.
Perineum

6. Mons Pubis It is covered with varying amounts of pubic hair.
Is rounded, soft fullness of subcutaneous fatty tissue, prominence over the symphysis pubis that forms the anterior border of the external reproductive organs.
It is covered with varying amounts of pubic hair.

7. Labia Majora & Minora
The labia Majora are two rounded, fleshy folds of tissue that extended from the mons pubis to the perineum.
It is protect the labia minora, urinary meatus and vaginal introitus.

8. Labia Minora It is located between the labia majora, are narrow.
The lateral and anterior aspects are usually pigmented.
The inner surfaces are similar to vaginal mucosa, pink and mois.
Their rich vascularity.

9. Clitoris. The term clitoris comes from a Greek word meaning key.
Erectile organ.
It’s rich vascular, highly sensitive to temperature, touch, and pressure sensation

10. Vestibule.
Is oval-shaped area formed between the labia minora, clitoris, and fourchette.
Vestibule contains the external urethral meatus, vaginal introitus, and Bartholins glands.

11. Perineum
Is the most posterior part of the external female reproductive organs.
It extends from fourchette anteriorly to the anus posteriorly.
And is composed of fibrous and muscular tissues that support pelvic structures.

13. Internal Female Structures
Vagina
Uterus
Fallopian tubes
Ovaries

15. Fallopian tubes
The two tubes extended from the cornu of the uterus to the ovary.
It runs in the upper free border of the broad ligament.
Length 8 to 14 cm average 10 cm
Its divided into 4 parts.

17. 1. Interstitial part
Which runs into uterine cavity, passes through the myometrium between the fundus and body of the uterus. About 1-2cm in length.

18. 2. Isthmus
Which is the narrow part of the tube adjacent to the uterus.
Straight and cord like , about 2 – 3 cm in length.

19. 3. Ampulla Which is the wider part about 5 cm in length.
Fertilization occurs in the ampulla.

20. 4. Infundibulum It is funnel or trumpet shaped.
Fimbriae are fingerlike processes, one of these is longer than the other and adherent to the ovary.
The fimbriae become swollen almost erectile at ovulation.

21. Functions
Gamete transport (ovum pickup, ovum transport, sperm transport).
Final maturation of gamete post ovulate oocyte maturation, sperm capicitation.

22. Fluid environment for early embryonic development.
Transport of fertilized and unfertilized ovum to the uterus.

23. Ovaries
Oval solid structure, 1.5 cm in thickness, 2.5 cm in width and 3.5 cm in length respectively. Each weights about 4–8 gm.
Ovary is located on each side of the uterus, below and behind the uterine tubes

24. Structure of the ovaries
Cortex
Medulla
Hilum

25. Ovaries and Relationship to Uterine Tube and Uterus
Figure 28–14

26. Function of the ovary Secrete estrogen & progesterone.
Production of ova

27. Uterus The uterus is a hollow, pear shaped muscular organ.
The uterus measures about 7.5 X 5 X 2.5 cm and weight about 50 – 60 gm.

28. Its normal position is anteverted (rotated forward and slightly antiflexed (flexed forward)
The uterus divided into three parts

29. 1. Body of the uterus
The upper part is the corpus, or body of the uterus
The fundus is the part of the body or corpus above the area where the fallopian tubes enter the uterus.
Length about 5 cm.

30. 2. Isthmus A narrower transition zone.
Is between the corpus of the uterus and cervix.
During late pregnancy, the isthmus elongates and is known as the lower uterine segment.

31. 3. Cervix The lowermost position of the uterus “neck”.
The length of the cervix is about 2.5 t0 3 cm.

32. The os, is the opening in the cervix that runs between the uterus and vagina.
The upper part of the cervix is marked by internal os and the lower cervix is marked by the external os.

33. Layers of the uterus
Perimetrium.
Myometrium.
Endometrium.

35. 1. Perimetrium
Is the outer peritoneal layer of serous membrane that covers most of the uterus.

36. Laterally, the perimetrium is continuous with the broad ligaments on either side of the uterus.

37. 2. Myometrium Is the middle layer of thick muscle.
Most of the muscle fibers are concentrated in the upper uterus, and their number diminishes progressively toward the cervix.

38. The myometrium contains three types of smooth muscle fiber

39. Longitudinal fibers (outer layer)
Which are found mostly in the fundus and are designed to expel the fetus efficiently toward the pelvic outlet during birth.

40. Middle layer figure-8 fibers
These fiber contract after birth to compress the blood vessels that pass between them to limit blood loss.

41. Inner layer circular fibers
Which form constrictions where the fallopian tubes enter the uterus and surround the internal os
Circular fibers prevent reflux of menstrual blood and tissue into the fallopian tubes.

42. Promote normal implantation of the fertilized ovum by controlling its entry into the uterus.
And retain the fetus until the appropriate time of birth.

43. 3. Endometrium Is the inner layer of the uterus.
It is responsive to the cyclic variations of estrogen and progesterone during the female reproductive cycle every month.

44. The two or three layers of the endometrium are:
*Compact layer
*The basal layer
*The functional or Sponge layer this layer is shed during each menstrual period and after child birth in the lochia

45. Anatomical relation of the uterus
Anterior Bladder
Posterior The rectum and Douglas pouch
Lateral The broad ligaments ,F. T& ovaries
Superior The intestines.
Inferior The Vagina

46. The Function of the uterus
Menstruation ----the uterus sloughs off the endometrium.
Pregnancy ---the uterus support fetus and allows the fetus to grow.

47. Labor and birth---the uterine muscles contract and the cervix dilates during labor to expel the fetus

48. Vagina
It is an elastic fibro-muscular tube and membranous tissue about 8 to 10 cm long.
Lying between the bladder anteriorly and the rectum posteriorly.

49. The vagina connects the uterus above with the vestibule below.
The upper end is blind and called the vaginal vault.

50. The vaginal lining has multiple folds, or rugae and muscle layer
The vaginal lining has multiple folds, or rugae and muscle layer. These folds allow the vagina to stretch considerably during childbirth.

51. The reaction of the vagina is acidic, the pH is 4
The reaction of the vagina is acidic, the pH is 4.5 that protects the vagina against infection.

52. Anatomical relation of the vagina
Anterior Urethra and bladder
Posterior Perineal body &rectum and Douglas pouch
Lateral Pelvic floor muscles
Superior The cervix.
Inferior The vulva

53. Functions of the vagina
To allow discharge of the menstrual flow.
As the female organs of coitus.
To allow passage of the fetus from the uterus.

54. Support structures
The bony pelvis support and protects the lower abdominal and internal reproductive organs.

55. Muscle, Joints and ligaments provide added support for internal organs of the pelvis against the downward force of gravity and the increases in intra-abdominal pressure

56. Bony Pelvis 2. Sacrum. 3. Coccyx. Bony Pelvis Is Composed of 4 bones:
1. Two hip bones.
2. Sacrum.
3. Coccyx.

57. 1. Two hip bones. *Ischium *Pubis
Each or hip bone is composed of three bones:
*Ilium
*Ischium
*Pubis

58. *Ilium It is the flared out part.
The greater part of its inner aspect is smooth and concave, forming the iliac fossa.
The upper border of the ilium is called iliac crest

59. *Ischium It is the thick lower part.
It has a large prominence known as the ischial tuberosity on which the body rests while sitting.

60. Behind and little above the tuberosity is an inward projection the ischial spine.

61. 2. Sacrum Is a wedge shaped bone consisting of five vertebrae.
The anterior surface of the sacrum is concave
The upper border of the first sacral vertebra known as the sacral promontory

62. Consists of four vertebrae forming a small triangular bone.
3. Coccyx.
Consists of four vertebrae forming a small triangular bone.

63. Pelvic Joints * Two sacro-iliac joints * One sacro-coccygeal joint
There are four pelvic joints:
* One Symphysis pubis
* Two sacro-iliac joints
* One sacro-coccygeal joint

64. A total of 10 ligaments stabilize the uterus within the pelvic cavity.

65. Four paired ligaments
Broad, round, uterosacral, cardinal
Two single ligaments anterior (pubocervical) and posterior (rectovaginal)

66. Types of Pelvis
1. Gynecoid, or normal female pelvis is round and adapted for the function of childbirth. Its inlet, cavity, and outlet are in better proportion, the pubic arch is wide and the coccyx is more movable than android pelvis.

67. 2. Android pelvis or male type pelvis which has a heart-shaped outlet
3. anthropoid, which oval shaped.
4. platypelloid, which has a wide transverse outlet, kidney shaped.

68. Blood Supply
The uterine blood supply is carried by the uterine arteries, which are branches of the internal iliac artery. These vessels enter the uterus at the lower border of the broad ligament, near the isthmus of the uterus.

74. Cyclical Changes in Endometrium
Basilar zone remains relatively constant
Functional zone undergoes cyclical changes:
in response to sex hormone levels
produce characteristic features of uterine cycle

75. Appearance of Endometrium during Uterine Cycle
Figure 28–20

76. FSH LH Follicular Phase Luteal Phase Estrogen Progesterone 2 4 6 8 1012 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

77. The Uterine Cycle Also called menstrual cycle
Is a repeating series of changes in endometrium
Lasts from 21 to 35 days:
average 28 days

78. Uterine Cycle Responds to hormones of ovarian cycle:
Menses and proliferative phase:
occur during ovarian follicular phase
Secretory phase:
occurs during ovarian luteal phase 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

79. Menses FSH Is the degeneration of functional zone: occurs in patches
Is caused by constriction of spiral arteries:
reducing blood flow, oxygen, and nutrients 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH
Weakened arterial walls rupture releasing blood into connective tissues of functional zone
Degenerating tissues break away, enter uterine lumen
Entire functional zone is lost through cervical os and vagina

80. Menstruation Is the process of endometrial sloughing Lasts 1–7 days
Sheds 35–50 ml blood 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

81. The Proliferative Phase
Epithelial cells of uterine glands multiply and spread across endometrial surface restore integrity of uterine epithelium
Further growth and vascularization completely restores functional zoneOccurs at same time as enlargement of primary and secondary follicles in ovary
Is stimulated and sustained by estrogens secreted by developing ovarian follicles 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

82. The Secretory Phase Endometrial glands enlarge increase secretion
Arteries of uterine wall elongate and spiral through functional zone
Begins at ovulation
Persists as long as corpus luteum remains intact
Peaks about 12 days after ovulation
Generally lasts 14 days 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

83. Menarche Menopause Amenorrhea The first uterine cycle
Begins at puberty (age 11–12)
Menopause
The termination of uterine cycles
Age 45–55
Amenorrhea
Primary amenorrhea:
failure to initiate menses
Transient secondary amenorrhea:
interruption of 6 months or more
caused by physical or emotional stresses

84. The Vagina
Is an elastic, muscular tube that xtends between cervix and vestibule
7.5–9 cm long and highly distensible
Cervix:
projects into vaginal canal
Fornix:
is shallow recess surrounding cervical protrusion

85. 3 Functions of the Vagina
Passageway for elimination of menstrual fluids
Receives spermatozoa during sexual intercourse
Forms inferior portion of birth canal
The Vaginal Wall
Contains a network of blood vessels:
and layers of smooth muscle
Is moistened by:
secretions of cervical glands
water movement across permeable epithelium

86. The Hymen Vaginal Muscles Vestibular Bulbs
Is an elastic epithelial fold:
that partially blocks entrance to vagina
ruptured by sexual intercourse or tampon usage
Vaginal Muscles
2 bulbospongiosus muscles:
along either side of vaginal entrance
cover vestibular bulbs
Vestibular Bulbs
Are masses of erectile tissue:
on either side of vaginal entrance
Have same embryological origins as corpus spongiosum of penis

87. The Mammary Glands Secrete milk to nourish an infant (lactation)
Are specialized organs of integumentary system
Are controlled by:
hormones of reproductive system
placenta
Figure 28–23a

88. Mammory glands consist of lobes:
Mammory glands lie in pectoral fat pads deep to skin of chest
Nipple on each breast:
contains ducts from mammary glands to surface
Areola:
reddish-brown skin around each nipple
Mammory glands consist of lobes:
each containing several secretory lobules
separated by dense connective tissue

89. Suspensory Ligaments of the Breast
Bands of connective tissue
Originate in dermis of overlying skin
Areolar tissue separates:
mammary gland complex
from underlying pectoralis muscles
Mammary gland ducts leave lobules, converge, and form single lactiferous duct in each lobe

90. Female Reproductive Cycle Hormonal Control
Involves secretions of pituitary gland and gonads
Forms a complex pattern that coordinates ovarian and uterine cycles 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

91. Follicular Development
Begins with FSH stimulation
Monthly:
some primordial follicles develop into primary follicles
As follicles enlarge:
thecal cells produce androstenedione
Is a steroid hormone, an intermediate in synthesis of estrogens and androgens, and absorbed by granulosa cells and converted to estrogens 2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH

92. Estrogen Synthesis Androstenedione is converted to testosterone
Enzyme aromatase converts testosterone to estradiol - CH
Estrone and estriol are synthesized from androstenedione -CH

93. Estrogen Function Stimulates bone and muscle growth
Maintains female secondary sex characteristics, ie body hair distribution and adipose tissue deposits
Affects central nervous system (CNS) activity (especially in the hypothalamus, where estrogens increase the sexual drive)
Maintains functional accessory reproductive glands and organs
Initiates repair and growth of endometrium

94. Progesterone Function
maintains secondary sex characteristics
maintains uterine walls for pregnancy.

95. Hormones and Body Temperature
Monthly hormonal fluctuations affect core body temperature:
during luteal phase:
progesterone dominates
during follicular phase:
estrogen dominates
basal body temperature decreases about 0.3°C
Basal Body Temperature
The resting body temperature
Measured upon awakening in morning

96. Hormonal Regulation of the Female Reproductive Cycle2 4 6 8 10 12 14 16 18 20 22 24 26 28
Follicular Phase
Luteal Phase
Progesterone
Estrogen
FSH LH
Figure 28–26a, b