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

4. Laparoscopic view of pelvis

5. Tubal Dye Studies

6. Normal Female Pelvis

8. ENDOMETRIOSIS

11. Cervical polyp

13. CERVICAL CANCER

14. External Genitalia (Female)

21. The Pelvic Floor

22. Course of the Ureter in Females

24. Female Menstrual Cycles

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

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

27. The Development of the Female XX vs XY Chromosomal Determination

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

29. 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

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

31. Chromosomal abnormality Turner’s Syndrome Gonadal dysgenesis

32. 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

33. Chromosomal abnormality Klinefelter’s Sydrome

34. 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

35. Gene defect Kallmann’s Syndrome

36. 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

37. Androgen receptor defect Testicular feminisation Androgen insensitivity syndrome

38. 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?

39. Endogenous androgen excess Congenital adrenal hyperplasia

40. 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

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

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