ANATOMY AND PHYSIOLOGY

REPRODUCTIVE SYSTEM

Functions of the Reproductive System

1. Production of Gametes.
2. Fertilization.
3. Development and nourishment of a new individual.
4. Production of reproductive hormones.

The reproductive role of the female is much more complex than that of the male. Not only must she
produce the female gametes (ova), but her body must also nurture and protect a developing fetus during 9
months of pregnancy.

Female Reproductive Organs the female reproductive system has both external and internal
components:

EXTERNAL COMPONENTS

MONS VENERIS

 Pad of adipose tissue located over the symphysis

pubis, the pubic bone joint. The purpose of the
mons veneris is to protect the junction of the
pubic bone from trauma.

LABIA MINORA

 Two hairless folds of connective tissue

 Before menarche, these folds are fairly small; by
childbearing age, they are firm and full; after menopause, they atrophy and again become much
smaller. Normally the folds of the labia minora are pink; the internal surface is covered with
mucous membrane, and the external surface with skin.

LABIA MAJORA

 Enclose a region called the vestibule, which contains the external openings of the urethra.
 Two folds of adipose tissue covered by loose connective tissue and epithelium that are positioned
lateral to the labia minora. Covered by pubic hair, the labia majora serve as protection for the
 external genitalia and the distal urethra and vagina. They are fused anteriorly but separated
posteriorly.

VESTIBULE

 Is the flattened, smooth surface inside the labia. The openings to the bladder (the urethra) and the
uterus (the vagina) both arise from the vestibule.

CLITORIS

 Is a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of
the labia minora.
 It is covered by a fold of skin, the prepuce.
 The clitoris is sensitive to touch and temperature and is the center of sexual arousal and orgasm in
a woman.
 Arterial blood supply for the clitoris is plentiful.
 Hooded by a prepuce and is composed of sensitive erectile tissue that becomes swollen with
blood during sexual excitement.

SKENE GLAND (Paraurethral gland)

 Are located just lateral to the urinary meatus, one on each side.
 Their ducts open into the urethra.

BARTHOLIN GLAND (vulvovaginal glands)

 Are located just lateral to the vaginal opening on both sides.

 Their ducts open into the distal vagina. Secretions from both of these glands help to lubricate the
external genitalia during coitus.
 Their ducts open into the distal vagina. Secretions from both of these glands help to lubricate the
external genitalia during coitus.

FOURCHETTE

 Is the ridge of tissue formed by the posterior joining of the two labia minora and the labia majora.
 This is the structure that is sometimes cut (episiotomy) during childbirth to enlarge the vaginal
opening.
 Posterior to the fourchette is the perineal muscle or the perineal body. Because this is a muscular
area, it is easily stretched during childbirth to allow for enlargement of the vagina and passage of
the fetal head. Many exercises suggested for pregnancy (such as Kegel’s, squatting, and tailor-
sitting) are aimed at making the perineal muscle more flexible to allow easier expansion during
birth without tearing of this tissue.
HYMEN

 Is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood.
 It is often torn during the time of first sexual intercourse. However, because of the use of tampons
and active sports participation, many girls who have not had sexual relations do not have intact
hymens at the time of their first pelvic examination.

THE VULVAR BLOOD SUPPLY

 The blood supply of female external genitalia is mainly from the pudendal artery and a portion is
from the inferior rectus artery. Venous return is through the pudendal vein. Pressure on this vein
by the fetal head during pregnancy can cause extensive back pressure and development of
varicosities (distended veins) in the labia majora and in the legs.
THE VULVAR NERVE SUPPLY

 The anterior portion of the vulva derives its nerve supply from the ilioinguinal and genitofemoral
nerves (L1 Level). The posterior portions of the vulva and vagina are supplied by the pudendal
nerve (S3 Level).
 Luckily, at the time of birth, normal stretching of the perineum causes a temporary loss of
sensation to the area, limiting the amount of local pain felt during childbirth.

INTERNAL COMPONENTS

OVARIES

 The ovaries are approximately 4 cm

long by 2 cm in diameter and
approximately 1.5 cm thick, or the
size and shape of almonds. Ovaries
are located close to and on both
sides of the uterus in the lower
abdomen. The function of the two
ovaries (the female gonads) is to
produce, mature, and discharge ova
(the egg cells). The ovaries are held
suspended and in close contact with
the ends of the fallopian tubes by
three strong supporting ligaments
attached to the uterus or the pelvic wall.
 It produces, matures, and discharges ova (the egg cells)
 Three principal division of Ovaries:
1. Protective layer of surface epithelium
2. Cortex, where the immature (primordial) oocytes mature into ova and large amounts of
estrogen and progesterone are produced.
3. Central medulla, which contains the nerves, blood vessels, lymphatic tissue, and some smooth
muscle tissue.

FALLOPIAN TUBE

 The fallopian tubes arise from each upper corner of the uterine body and extend outward and
backward until each open at its distal end, next to an ovary. Fallopian tube conveys the ovum
from the ovaries to the uterus and to provide a place for fertilization of the ovum by sperm.

Fallopian tube is anatomically divided into four separate parts:

1. The interstitial portion
 the most proximal division
 is that part of the tube that lies within the uterine wall.

2. The isthmus
 is the next distal portion.
 the portion of the tube that is cut or sealed in a tubal ligation, or tubal sterilization
procedure.

3. The ampulla
 is the third and also the longest portion of the tube.
 it is in this portion that fertilization of an ovum usually occurs.

4. The infundibular portion

 is the most distal segment of the tube.
 it is approximately 2 cm long and is funnel shaped.

UTERUS

 The uterus is a hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the
bladder and anterior to the rectum. With maturity, a uterus is approximately 5 to 7 cm long, 5 cm
wide, and, in its widest upper part, 2.5 cm deep.
 The function of the uterus is to receive the ovum from the fallopian tube; provide a place for
implantation and nourishment; furnish protection to a growing fetus; and, at maturity of the fetus,
expel it from a woman’s body.

Three Divisions of Uterus:

1. The body of the uterus
 is the uppermost part and forms the bulk of the organ. During pregnancy, the body of
the uterus is the portion of the structure that expands to contain the growing fetus.

2. The isthmus of the uterus

  is a short segment between the body and the cervix. During pregnancy, this portion
also enlarges greatly to aid in accommodating the growing fetus. It is the portion of
the uterus that is most commonly cut when a fetus is born by a cesarean birth.

3. The cervix
 is the lowest portion of the uterus. It represents approximately one third of the total
uterus size and is approximately 2 to 5 cm long.

Uterine and Cervical Coats

 Uterine and Cervical Coats- the uterine wall consists of three separate coats or layers of
tissue:

1. The endometrium layer of the uterus

 is the one that is important for menstrual function. It grows and becomes so
thick and responsive each month under the influence of estrogen and
progesterone that it is capable of supporting a pregnancy.

2. The myometrium (muscle layer of the uterus)

 is composed of three interwoven layers of smooth muscle, the fibers of which
are arranged in longitudinal, transverse, and oblique directions. It also holds
the internal cervical as closed during pregnancy to prevent a preterm birth.
When the uterus contracts at the end of pregnancy to expel the fetus, equal
pressure is exerted at all points throughout the cavity because of its unique
arrangement of muscle fibers. After childbirth, this interlacing network of
fibers is able to constrict the blood vessels coursing through the layers,
thereby limiting the loss of blood in the woman.

3. The perimetrium (outermost layer of the uterus)

 serves the purpose of adding strength and support to the structure.
Uterine Blood Supply

 The large descending abdominal aorta divides to form

two iliac arteries; main divisions of the iliac arteries
are the hypogastric arteries. This further divide to
form the uterine arteries and supply the uterus.
Because the uterine blood supply is not far removed
from the aorta, it is copious and adequate to supply the
growing needs of a fetus.
 As an additional safeguard, after supplying the ovary
with blood, the ovarian artery (a direct subdivision of
the aorta) joins the uterine artery as a fail-safe system
to ensure that the uterus will have an adequate blood
supply. The blood vessels that supply the cells and
lining of the uterus are tortuous against the sides of the
uterine body in nonpregnant women.
  As a uterus enlarges with pregnancy, the vessels “unwind” and so can stretch to maintain
an adequate blood supply as the organ enlarges. The uterine veins follow the same
twisting course as the arteries; they empty into the internal iliac veins.
 An important organ relationship to be aware of is the association of uterine vessels and
the ureters. The ureters from the kidneys pass directly in back of the ovarian vessels, near
the fallopian tubes.
 As shown in Figure 5.7, they cross just beneath the uterine vessels before they enter the
bladder. This close anatomic relationship has implications in procedures such as tubal
ligation, cesarean birth, and hysterectomy (removal of the uterus), because a ureter may
be injured by a clamp if bleeding is controlled by clamping of the uterine or ovarian
vessels.

Uterine Nerve Supply

 The uterus is supplied by both efferent (motor) and afferent (sensory) nerves.
 The efferent nerves arise from the T5 through T10 spinal ganglia. The afferent nerves
join the hypogastric plexus and enter the spinal column at T11 and T12.
Uterine Supports

 The uterus is suspended in the pelvic cavity by several ligaments that also help support
the bladder and is further supported by a combination of fascia and muscle. Because it is
not fixed, the uterus is free to enlarge without discomfort during pregnancy.
Uterine Deviations

 Several uterine deviations (shape and position) may interfere with fertility or pregnancy.
In the fetus, the uterus first forms with a septum or a fibrous division, longitudinally
separating it into two portions. As the fetus matures, this septum dissolves, so that
typically at birth no remnant of the division remains.
Positional deviations of the uterus that are commonly seen include:
1. Anteversion - the entire uterus tips far forward.
2. Retroversion - The entire uterus tips far back.
3. Anteflexion - The body of the uterus is bent sharply forward at the junction with the cervix.
- Minor variations of these positions do not tend to cause reproductive problems. Extreme
abnormal flexion or version positions may interfere with fertility because the sharp bend can
block the deposition or migration of sperm.

VAGINA

 The vagina is a hollow, musculo-membranous canal located posterior to the bladder and anterior
to the rectum. Its function is to act as the organ of intercourse and to convey sperm to the cervix
so that sperm can meet with the ovum in the fallopian tube. With childbirth, it expands to serve as
the birth canal.
 The vagina is lined with stratified squamous epithelium similar to that covering the cervix. It has
a middle connective tissue layer and a strong muscular wall.
 The blood supply to the vagina is furnished by the vaginal artery, a branch of the internal iliac
artery. Vaginal tears at childbirth tend to bleed profusely because of this rich blood supply.