Lectured by: Dr. Dexter Santos  
Female Reproduction Physiology Transcribed by: Alyana Francesca B. Marquino & Alex Dumlao

   

 
  Sexual  Differentiation  

 
• Ambiguous  genitalia    
  o If  patient  has  an  ambiguous  genitalia,  the  gonadal  
• Gestational  week  9:  ovaries  begin  to  develop   sex  of  the  patient  needs  to  be  checked  in  order  to  
  determine  the  sex  
  Genetic  Abnormalities  
• Klienfelter’s  Syndrome  
o Males  with  extra  X  chromosome  (XXY)  
o Phenotypically  males  but  exhibiting  female  features  
o Infertile  
o Less  facial/  body  hair    

 
 
 
Anatomy  of  Female  
  Tract    

 
• Turner’s  Syndrome  
o Females  with  only  1  X  chromosome  (monosomy  X)  
o Almost  phenotypically  female  
o Some  manifestations:  
v Excess  skin  folds  
v Widely  spaced  nipples    
v No  mestruation   *   Reproduction   begins   with   the   development   of   the   ova   in  
v Poorly  developed  breasts   the   ovaries.   A   single   ovum   is   expelled,   every   monthly   sexual  
v Short  stature   cycle,  from  an  ovarian  follicle  into  the  abdominal  cavity  near  
  the   open   fimbriated   ends   of   the   fallopian   tubes.   This   ovum  

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will   pass   throught   the   fallopian   tubes   to   the   uterus.   And   if   v Secondary   oocyte   is   suspended   in   the  
fertilization   is   successful,   the   ovum   will   be   implanted   in   the   metaphase  of  meiosis  II  (second  arrest)  
uterus  and  will  develop  into  a  fetus.    
 
• Ovaries   Hormones  and  Hormonal  Regulation  
 
o houses  thr  ova  
o secretes  female  hormones   • GnRH  (Gonadotropin  releasing  hormone)  
• Fallopian  Tubes  (Uterine  tubes)   o Hypothalamic  releasing  hormone  
o Fimbriated  ends  to  “catch”  the  ovum   • FSH  (Follicle  stimulating  hormone)  
• Uterus   o Stimulates   granulosa   cells   to   provide  
o The   ovum   is   implanted   where   it     develops   into   a   nourishment  for  the  developing  ovum  
embryo/  fetus     o Anterior  pituitary  sex  hormone  
• Clitoris   • LH  (Luteinizing  Hormone)  
o Homologue  of  the  penis  in  males     o Anterior  pituitary  sex  hormone  
• Cervix     o Stimulates  theca  cells  to  produce  androgens  
• Vagina   • Estrogens  (B-­‐  estradiol,  estorne,  estriol)  
• Labium  majora  and  minora   o Ovarian   hormone   secreted   in   response   to  
the  anterior  pituitary  sex  hormones  
*  At  birth,  there  is  finite  number  of  ova,  appr.  1-­‐2  million  but  
• Progestin  (Progesterone)  
only  about  400-­‐500  will  mature  throughout  the  reproductive  
o Ovarian   hormone   secreted   in   response   to  
years  of  a  female  
the  anterior  pituitary  sex  hormones  
*Suspended  in  Prophase  of  Meiosis  1  (first  arrest)   o Has  a  thermogenic  effect  

• Cross  section  of  the  Ovary   *   these   hormones   are   secreted   at   different   rates   during  
different  parts  of  the  female  monthly  sexual  cycle  

 
o Primordial  Follicle  
v Primary   oocyte   is   surrounded   by   a   single  
layer  of  granulosa  cells    
v Immature,   requiring   2   or   more   cell   divisions  
before  it  can  be  fertilized  by  a  sperm  
o Granulosa  cell    
v Provides  nourishment    
v Secretes   oocyte-­‐   maturation   inhibiting  
factor    
o Theca   cellls:   additional   layer   that   produces  
hormones  as  well  (androgens)    
o Corpus  luteum     • This   diagram   shows   a   feedback   regulation   of   the  
v Granulosa   and   theca   cells   transform   to   hypothalamic  –  pituitary  –  ovarian  axis.    Inhibin  has  a  
lutein  cells  after  ovulation   negatove   feedback   effect   on   the   anterior   pituitary  
o Ovulation  

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 while   Estrogens   and   Progestins   elicit   a   positive   and   a   v Increase   in   the   external   genitalia,   with  
negative  feedback  on  the  anterior  pituitary.   fat   deposition   in   the   mons   pubis   and  
• Inhibin  –  homologue  of  sertoli  cells  in  males   labia  majora  area      
o Vaginal   epithelium   changes   from   cuboidal   to  
stratified  non  keratinizing  (this  is  to  prepare  for  
the  sexual  act)    
v More  resistant  to  trauma  and  infection    
o Proliferation   of   endometrial   stroma   and  
endometrial  glands  
o Fallopian  tubes  
v increase   glandular   epithelium,   ciliated  
epithelial  cells,  enhanced  ciliary  action  (  
helps  in  propeling  the  fertilized  ovum)  
o Breast  
v development  of  stroma  
v growth  of  ductal  system  
  v increased  fat  deposition    
*This   diagram   shows   the   interaction   of   theca   cells   and  
granulosa   cells     for   the   production   og   estrogens.   Theca   cells  
under   the   control   of   LH   produces   androgens   that   diffuses   in  
the   granulosa   cells.   FSH   acts   on   the   granulosa   cell   by  
stimulating  aromatase  to  convert  androgens  to  estrogens.    

• Aromatase    
o converts   androgens   to   estrogen     in   granulosa  
cells    ,  adrenal  glands  and  adipose  tissue  
o can  be  inhibited:  
v Anastrazole    
v Letrozole    
v Exemestane   • Constitutional  Effects  
v Treatment  of  Hormone  –  responsive  breast   o Bones  
cancers     v Decreased   osteoclastic   activity  
(through  osteoprotegerin)  
 
Estrogens   o Increased   bone   growth,   but   earlier   closure   of  
  the  epiphysis  of  long  bones  
• Premenopausal:  secreted  mainly  by  ovaries   o Effect   on   epiphysis   stronger   than   the   effect   of  
• Post  menopausal:  adrenal  cortex   testosterone  in  males  
• Pregnancy:   placenta   produces   large   quantities   of   § Result:   Females   will   have   a   shorter  
estrogen   height  than  in  males  
o Increased  protein  deposition  for  growth  
• Adipose  tissues:  contain  aromatase  enzyme  
v Estrogen   cause   a   slight   increase   in   total  
• B-­‐Estradiol:  major  estrogen  
body  protein  which  is  accounted  for  by  
• Functions:  
a   slight   nitrogen   balance   when  
o Proliferation   and   growth   of   tissues   of   the   sex  
estrogen  is  administered  
organs  
o Increased   fat   deposition   in   the   subcutaneous  
o Constitutional  effects  
(thighs,  buttocks,  breasts)  
o Metabolic  effects  
o Skin  
 
v Soft   smooth   skin,   warmer   and   more  
Effects  of  Estrogen  on  Sex  Organs  
  vascular  
 
• During  Puberty    
o Increase   in   size   of   ovaries,   fallopian   tubes,    
uterus,  and  vagina  

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• Metabolic  Effects    
o Sodium  and  water  retention  by  kidney  tubules  
(similarity  to  adrenocortical  hormones)  
o Increases  over-­‐all  metabolic  rate  
o Estrogens:  metabolized  in  the  liver  (sulfates  and  
glucoronides)  
v Patients  with  Liver  Failure:  
gynecomastia  and  telangiectasias  
 

  Progestins    
  *  If  GnRH  is  steady,  puberty  does  not  happen  
• Major  progestin:  Progesterone  
• Promote  secretory  changes  in  endometrium  (preparation  
for  implantation)  
• Decreases   frequency   and   intensity   of   uterine  
contractions  during  conception    
• Increased  secretion  by  the  fallopian  tubes  
o Secretions   are   important   for   nutrition   of   the  
fertilized,   dividing   ovum   as   it   traverses   the  
fallopian  tube  before  implantation  
• Breasts  
o Develops   the   lobules   and   alveoli   of   breast   in  
preparation   for   milk   production   (which   is  
stimulated  by  prolactin)  
o Causes   the   alveolar   cells   to   proliferate,   enlarge    
and  become  secretory  in  nature.    
o It  does  not  cause  the  alveoli  to  secrete  milk   *  Estrogen  starts  to  increase  during  puberty    
o Causes   it   to   swell   because   of   secretory   *  Peak:  ~25  years  of  age  
development   as   well   as   increased   fluid   in   the   *  Gradually  declines  until  the  time  of  menopause  
tissue   *  Menopause  happens  to  40-­‐50  years  of  age  

   
Pubertal  Events   The  Sexual  Cycle  
   
• Puberty   Sexual  cycle  –  Different  cycles  involving  different  organs  
o The  start  of  adult  sexual  life   and  different  hormones,  also  known  as  the  Menstrual  
o Gradual  increase  of  gonadotropic  hormone   Cycle  
release  by  pituitary    
o Menarche:  onset  of  menstrual  cycles     “As  early  as  now  remember  this  by  heart  especially  if  you  
§ 11  –  16  years  old   want  to  become  an  obstetrician”  -­‐DS  
o Pituitary  stimulated  by  GnRH  from    
hypothalamus     • Hormonal  cycle  
o GnRH  secretion  in  females  are  secreted  in  a   • Ovarian  cycle  
pulsatile  manner   o Follicular  cycle  
o Ovulation  
o Luteal  Phase  
• Uterine  Cycle  
o Proliferative  phase  
o Secretory  phase  
• Cycle  length:  28+  7  days  
• Day  14-­‐28:  More  constant  interval  compared  to  Day  1-­‐14  

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   v Corpus  luteum  secretes  progesterone,  
estrogen  and  inhibin  
v Negative  feedback  to  anterior  
pituitary  and  hypothalamus  
v Lowest  level  of  FSH  and  LH  3-­‐4  
days  before  menstruation  
o Corpus  luteum  regression:  
v Regresses  2  days  before  
menstruation.  If  no  fertilization  
occurs.  (Blastocyst  secretes  hCG  
that  maintains  the  corpus  luteum)  
v Menstruation  then  ensues  after  
loss  of  hormonal  support  
o Follicular  phase:  
Ø FSH  and  LH  resumption    
Ø Progressive  increase  in  
estrogen  
*The  midline  of  the  presented  photo  above  shows  when  
Ø Estrogen  –  (+)  feedback  on  
ovulation  occurs,  which  is  Day  14.  
anterior  pituitary  to  cause  an  
*  You  have  your  hormones  involve  in  where  the  first  half  of   LH  surge  (theory)  
the  cycle  FSH  and  LH  is  dominant.  Right  before  ovulation  you    
can  see  a  spike  in  the  LH.  There  is  also  an  increase  in  estrogen  
during  the  first  half  of  the  menstrual  cycle.  

*  After  ovulation  your  gonadotropins  (FSH  and  LH)  and  

estrogen  goes  down,  the  major  hormone  during  the  second  
half  is  the  progesterone.  

 
 
• Ovarian  Changes  
o Follicular  Phase:  
Ø Enlargement  of  ovum  
Ø 6-­‐12  primary  follicles  each  month  
(only  1  destined  to  develop  to  full  
maturity)  
Ø Proliferation  of  granulosa  cells  and  
theca  cells  
Ø Follicular  fluid  accumulation  leads  
  to  formation  of  an  antrum  
Ø Mature  follicle  around  1.5cm  
• Hormonal  Changes   diameter  
o After  Ovulation:   o Ovulation:  

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 Ø Ovum  with  mass  of  granulosa  cells   • Period  when  sexual  cycle  ceases  
called  corona  radiate   • Ovarian  hormone  production  diminishes  and  
o Luteal  Phase:  
eventually  stops  
Ø Theca  interna  and  granulosa  cells  
• Cause:  Burning  out  of  ovaries  as  primordial  ova  
à  lutein  cells  (corpus  luteum)  
Ø Theca  lutein  secretes  progesterone   diminish  in  number  
and  androgens  à  estrogens  via   • Increased  levels  of  FSH  and  LH  
aromatase  enzyme  in  granulosa   • Symptoms:  fatigue,  anxiety,  hot  flushes,  irritability,  
cells   vaginal  dryness.  
Ø Granulosa  cells  à  estrogen  and  
progesterone  
 
• Uterine  changes  
o Day  1-­‐5:  Menstrual  Phase  
v Withdrawal  of  hormones    
v Coiling  of  spiral  arteries  
v Endometrium  necroses  and  
eventually  sloughs  off.  
o Day  6-­‐14:  Proliferative  phase  
v Gradual  thickening  of  the  
endometrium  
v Endometrial  glands  increase  in  size    
v Ovulation  
o Day  14-­‐28:  Secretory  phase    
v Further  increase  in  thickness  of  the  
endometrium   *This  diagram  shows  the  total  rates  of  gonadotropic  
v Increase  in  blood  supply   hormone  secretion  thrpughout  the  sexual  life  of  both  a  
male  and  a  female.  It  shows  that  there  is  an  abrupt  
*Glands  form  secretions  (glycogen,  fructose,  glucose)  in  
increase  in  gonadotropic  hormones  during  the  
anticipation  of  the  fertilized  ovum  
menopause  stage  in  females.    

 
The  Female  Sexual  Act  and  Regulation  of  Fertility  
 
• Parasympathetic  signals  during  arousal  causes  lubrication  
of  the  female  genital  tract  
• Excitement  à  plateau  à  orgasm  

• Importance  of  Orgasm:  

o Causes  rhythmic  contraction  of  uterus  that  can  

facilitate  entry  of  sperm  

o Causes  temporary  dilatation  of  cervix  

o Multiple  orgasms:  increase  chance  of  fertilization?  

• Anorgasmia  
o inability  to  achieve  orgasms  despite  sexual  
  stimulation  
o cause  personality  anxiety,  distress,  and  
  Menopause   relationship  prob  
  o underlying  cause  is  multifactorial  
 

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• Female  Sexual  Dysfunction  
o estrogen  treatment  (local  treatment)  
o avoid  alcohol  
o counseling  and  communication  
o lubricants  and  devices  
o Meds:  Filbanserin    
o Initially  an  antidepressant    
o May  increase  sexual  desire/  libido  
 
Regulation  of  Fertility  
 

• Rhythm  method  
o Predicting  the  time  of  ovulation  
o Day  14-­‐28  (after  ovulation)  is  constant  
o Avoidance  of  intercourse  4  days  before  and  3  days   *If  this  method  is  going  to  be  used,  there  is  a  need  to  check  
after  ovulation   for  the  temperature  everyday  to  check  for  this  abrupt  increase  
o Effectiveness  lies  in  the  regularity  of  cycle   in  temperature.    
 
• Monitoring  of  cervical/vaginal  discharge  
o Thick  and  opaque:  infertile  days  
o Thin  and  stringy:  peri-­‐ovulation  days  
o Due  to  the  increasing  estrogen  levels  before  
ovulation  à  increase  cervical  discharge  and  change  
in  consistency  
o “Billings”  method  (Dr.  John  Billings)  
 
• Surgical  Methods  
o Vasectomy  
o Tubal  Ligation  

END OF TRANSCRIPTION

• Hormonal  strategy:  the  pills   Past E Questions:

o Giving  exogenous  estrogens  and/or  progestins   1. This  hormone  is  mainly  responsible  for  the  
inhibit  the  preovulatory  LH  surge  and  therefore   development  of  the  ductal  system  of  the  breast?  
inhibits  ovulation   A. Progesterone  
• Hormonal  strategy:  depot  hormones   B. Estrogen  
o Injected  every  3  months   C. Prolactin  
o Progestin  only  formulation   D. Oxytocin    
• Body  Temperature  Monitoring    
o Increase  in  basal  body  temperature  at  the  time  of   2. Turner‟s  syndrome  is  characterized  by:  
ovulation   A. Short  stature  
B. Poorly  developed  breasts  
o Thermogenic  effect  of  progesterone  
C. Widely  spaced  nipples  
D. All  of  the  above  
E. A  and  B  only  
 
3. The  luteal  phase  of  the  ovarian  cycle  corresponds  to  
this  phase  of  the  uterine  cycle?  
A. Secretory  

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 B. Proliferative    
C. Follicular  
D. Estrogenic  
4. The  two  hormones  associated  with  the  initiation  of  
ovulation?  
A. Estrogen  and  Progesterone  
B. Progesterone  and  LH  
C. Estrogen  and  LH  
D. Progesterone  and  FSH  
 
5. Which  hormone  has  a  themogenic  effect?  (this  
serves  as  a  basis  for  the  temperature  monitoring  
method  of  the  regulation  of  fertility)?  
A. Estrogen  
B. Progesterone  
C. Prolactin  
D. FSH  
 
6. In  post-­‐  menopausal  women,  where  is  estrogen  
synthesized?  
A. Adipose  tissue  
B. Adrenal  glands  
C. Granulosa  cells  
D. All  of  the  above  
E. A  and  B  only  
7. During  the  secretory  phase  of  the  uterine  cycle:  
A. The  endometrium  stores  glycogen  and  nutrients  
B. The  endometrium  further  thickens  
C. Blood  supply  increases  and  arteries  become  
more  tortous    
D. All  of  the  above  
E. A  and  B  only  
 
References:  
• Powerpoint  presentation  
• Lecture  Notes  
• Crammer’s  Unite  Transcription  
• Past  E  (Batch  2018)  
• Guyton  and  Hall  Textbook  of  Medical  Physiology  
Chapter  81    
 
 
“Mistakes  are  proof  that  you’re  trying.”  
 
“God’s  plans  will  always  be  greater  and  more  
beautiful  than  all  your  disappointmentd.”  

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