The Reproductive System

Definition of Terms
 Obstetrics = a branch of medicine that deals with the
care of women during pregnancy, labor, and the period of
recovery following childbirth.
 It is derived from the Greek word obstare, which means “to keep
watch”
 Gynecology = is the study of female reproductive
organs and diseases affecting it.
 Andrology = is the study of the male reproductive
organs
 Pediatrics = the branch of medical science concerned in
children and their illness.
 It is derived from the Greek word pais meaning “child”.
 Neonatology =the branch of medicine concerned with
the development and disorders of newborn babies.
Reproductive Development
 Sexual Health = is not just an absence of disease,
dysfunction, or infirmity but a condition of physical,
emotional and psychological well-being.
 Gonad = is a body organ that produces the cells
necessary for reproduction (the ovary in females, the
testis in males)
Puberty
 is the stage of life at which secondary sex changes begin.
Role of Testosterone:
 Responsible for muscular development, physical growth,
and the increase in sebaceous gland secretions that cause
typical acne in both boys and girls during adolescence.
 Initiates adrenarche (pubertal changes in testes,
scrotum, penis, prostate, and seminal vesicles; the
appearance of male pubic, axillary, and facial hair;
laryngeal enlargement with its accompanying voice
change; and maturation of spermatozoa).
 Androgens are produced by the adrenal gland and the
testes in males.
 Androgens are produced by the adrenal gland and the
ovaries in females.
 Role of Estrogen:
 Release is triggered by FSH, ovaries in
females excrete a high level of
estrogen.
 Influences the development of uterus,
fallopian tubes, and vagina; typical fat
distribution; hair patterns; and breast
development.
 Thelarche = the beginning of breast
development; which usually starts 1 to 2
years before menstruation.
 Menarche = the beginning of
menstruation
 Onset: 9 – 17 years old
 Average: 12.4 years
Secondary Sex Characteristics in Girls:
 Growth spurt
 Increase in the transverse diameter of the pelvis
 Breast development
 Growth of pubic hair
 Onset of menstruation
 Growth of axillary hair
 Vaginal secretions
Secondary Sex Characteristics in Males:
 Increase in weight
 Growth of testes
 Growth of face, axillary, and pubic hair
 Voice changes
 Penile growth
 Increase in height
 Spermatogenesis = production of sperm
Anatomy and Physiology of the
Reproductive System
Male Reproductive System
External structures:
1. Scrotum = is a rugated, skin-covered, muscular
pouch suspended from the perineum.
 Function: supports the testes and helps regulate the
temperature of the sperm.
 In very cold weather, the scrotal muscle contracts
to bring the testes closer to the body.
 In very hot weather, or in the presence of fever, the
muscle relaxes, allowing the testes to fall away from
the body.
External structures:
 In this way, the temperature of the testes can remain as
even as possible to promote the production and
viability of sperm. Spermatozoa do not survive at a
temperature as that of the internal body, so the
location of the testes outside the body, where the
temperature is about 1OF lower than the body
temperature, provides protection for sperm survival.
External structures:
2. Testes = are two ovoid
glands, 2 to 3 cm wide, that
rest in the scrotum.
 Leydig cells = are interstitial
cells located in each of the
lobule of testes
RESPONSIBLE FOR THE
PRODUCTION OF
TESTOSTERONE
 Sertoli cells =PRODUCES
SPERMATOZOA
Testes
 Testes in a fetus first form
in the pelvic cavity then
descend late in
intrauterine life, about the
34th to 38th week of
pregnancy, into the scrotal
sac.
 Many preterm babies
still have undescended
testes, or testes still
remain in the pelvic
cavity (cryptorchidism).
Testes
 Luteinizing hormone = is RESPONSIBLE FOR THE
RELEASE OF TESTOSTERONE from the leydig cells.
 Follicle-stimulating hormone = is responsible for the
release of androgen-binding protein (ABP) that
combines with testosterone to promote sperm
formation.
 The left testis is slightly larger than the other and is
suspended slightly lower in the scrotum than the other.
 This is due to slightly longer spermatic cord in the
left scrotum.
 Normal testes feel firm and smooth, and are egg-
shaped.
Penis
Penis
 Glans penis = is a bulging,
sensitive ridge of tissue at the
distal end of the penis. At birth,
it is protected by the prepuce.
 Prepuce = a retractable casing of
skin that protects the glans
penis. This is surgically removed
during circumcision. Also known
as “foreskin”.
Internal structures:
 Epididymis = a tightly
coiled tube responsible
for conducting sperm
from the tubule to the vas
deferens. It is the storage
of immature sperm, and a
part of the alkaline fluid
(semen, or seminal fluid
that contains a basic sugar
and protein) that will
surround sperm at
maturity is produced by
the cells lining the
epididymis.
Epididymis
Epididymis
 Sperm are immobile and incapable of fertilization as they
pass through or are stored at the epididymis level.
 It takes at least 12 to 20 days for them to travel the
length of the tube, and a total of 65 to 75 days for them
to reach full maturity.
 Sperm is capable of surviving for 72 hours inside the
woman’s body.
 Aspermia = absence of sperm
 Oligospermia = fewer than 20 million sperm per
milliliter
Vas deferens
 or the ductus deferens
 is an additional hollow
tube surrounded by
arteries and protected by a
thick fibrous coating, which
altogether, are referred to
as the spermatic cord. It
carries sperm from the
epididymis through the
inguinal canal into the
abdominal cavity, where it
ends at the seminal vesicles
and the ejaculatory ducts
below the bladder.
Vas Deferens
 Sperm completely matures as they pass through the
vas deferens. They are still not mobile at this point.
 This is the site severed during vasectomy to prevent
passage of sperm, a popular means of male birth
control.
Seminal vesicles
 are two convoluted pouches
that lie along the lower
portion of the bladder and
empty into the urethra by
ejaculatory ducts. These glands
secrete a viscous alkaline
liquid with a high sugar,
protein, and prostaglandin
content.
 Sperm become increasingly
motile because this added
fluid surrounds them with a
more favorable pH
environment.
Prostate gland
 is a chestnut-size gland
that lies just below the
bladder and allows the
urethra to pass through
the center of it, like the
hole in a doughnut.
 Function: to secrete a
thin, alkaline fluid, which,
when added to the
secretion from the
seminal vesicles, further
protects sperm by
increasing the naturally
low pH level of the
urethra.
Bulbourethral glands
 or Cowper’s glands lie beside the prostate gland and
empty by short ducts into the urethra. They supply one
more source of alkaline fluid to help ensure the safe
passage of spermatozoa.
Semen
 Semen, therefore, is derived from the prostate gland
(60%), the seminal vesicles (30%), the epididymis (5%),
and the bulbourethral glands (5%).
Urethra
 is a hollow tube leading from the base of the bladder,
which, after passing through the prostate gland,
continues to the outside through the shaft and glans
of the penis.
Female Reproductive System
Anatomy and Physiology of the Female
Reproductive System
Female Reproductive System
 External Structures: Vulva or pudenda = refers
to the structures that form the female external
genitalia.
A. Mons veneris or mons pubis = is a pad of adipose
tissue located over the symphysis pubis, the pubic
bone joint.
It is covered by a triangle of coarse, curly hairs known
as “escutcheon”.
Function: to protect the junction of the pubic bone
from trauma.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
B. Labia majora = are two folds of tissue, fused
anteriorly but separated posteriorly, which are
positioned lateral to the labia minora and
composed of loose connective tissue covered by
epithelium and pubic hair.
 Function: serves as protection for the external genitalia;
they shield the outlets to the urethra and vagina.
 Gapes widen every after childbirth.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
C. Labia minora = just posterior to the mons veneris
spreading two hairless folds of connective tissue that
joins anteriorly to form prepuce and posteriorly to
form fourchette.
 Normally, the folds of labia minora are pink in color; the
internal surface is covered with mucus membrane, and the
external surface is covered with skin. The area is abundant
with sebaceous glands.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
D. 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; is sensitive
to touch and temperature; and it is the center of sexual
arousal and orgasm in a woman.
 Arterial blood supply for the clitoris is plentiful. When
the ischiocavernosus muscle surrounding it contracts
with sexual arousal, the venous outflow for the clitoris
is blocked and this leads to clitoral erection.
Female Reproductive System
Cultural Differences:
 In nations which allow it, young girls approaching
puberty may be circumcised or have their clitoris
removed with the labia minora excised as well (clitoral
mutilation). Aside from being a very painful procedure,
female circumcision can lead to contractions and
scarring of the vulva that makes vaginal childbirth
difficult because the vagina is unable to expand with
birth.
FEMALE GENITALIA MUTILATION
 TYPE 1 CLITORIDECTOMY
 TYPE 2 EXCISION-partial or total removal of clitoris and
labia majora
 TYPE 3 INFIBULATION-narrowing of the vaginal opening
through the creation of a covering seal.
 TYPE 4-PRICKING,PIERCING,INCISING, SCRAPING
AND CAUTERIING THE GENITAL AREA

 DEINFIBULATION-refers to the practice of cutting open

the sealed vaginal opening
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
E. Skene glands (paraurethral glands) = located
on each side of the urinary meatus; their ducts open
into the urethra.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
F. Bartholin glands (vulvovaginal glands) = are
located on each side of the vaginal opening with ducts
that open into the proximal vagina near the labia
minora and hymen.
 Secretions from both of these glands help to lubricate
the external genitalia during coitus.
 The alkaline pH of their secretions also helps to
improve sperm survival in the vagina.
 If the Skene glands or the Bartholin glands (the most
common site) become infected, they swell, feel tender,
and produce a serous discharge.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
G. Fourchette = is the ridge of tissue formed by the
posterior joining of the labia minora and the labia
majora. This is the structure that sometimes tears
(laceration) or is cut (episiotomy) during childbirth
to enlarge the vaginal opening.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
H. Perineum = posterior to the fourchette, a
muscular area that is capable of stretching during
childbirth to allow enlargement of the vagina and
passage of the fetal head.
 Many exercises suggested for pregnancy (such as Kegel
exercises, squatting, and tailor sitting) are aimed at
making the perineal muscle as flexible as it can be to
allow for optimum expansion during birth and to
prevent tearing of this tissue.
Anatomy and Physiology of the
Reproductive System
Female Reproductive System
I. Hymen = is a tough but elastic semicircle of tissue
that covers the opening to the vagina during
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 can also have
torn hymens at the time of their first pelvic
examination.
 Hematocolpometra = a girl who has an imperforate
hymen that it does not allow for the passage of
menstrual blood from the vagina.
Hymen
Female Reproductive System
J. 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 the development
of varicosities (distended veins) in the labia majora and
in the legs.
Female Reproductive System
J. Vulvar nerve supply = the anterior portion of
the vulva derives its nerve supply from the
ilioinguinal and genitogemoral nerves (L1 level). The
posterior portions of the vulva and the vagina are
supplied by the pudendal nerve (S3 level).
Internal Structures:
Female Reproductive System
A. Ovaries = are approximately 3 cm long by 2 cm in
diameter and 1.5 cm thick, or the size and shape of
almonds. They are grayish-white and appear pitted,
with minute indentations on the surface.
 Function: to produce, mature, and discharge ova (egg
cells). In the process of producing ova, the ovaries also
produce estrogen and progesterone and initiate and
regulate menstrual cycles.
 Organ of ovulation, oogenesis, and hormone
production.
Female Reproductive System
 If the ovaries are removed before puberty (or are
nonfunctional), the resulting absence of estrogen normally
produced by the ovaries prevents maturation and
maintenance of secondary sex characteristics; in addition
pubic hair distribution will assume a more male than
female pattern. After menopause, or cessation of ovarian
function, the uterus, breasts, and ovaries all undergo
atrophy (reduction in size) because of lack of estrogen.
Female Reproductive System
 The decrease in estrogen can also lead to osteoporosis,
or weakness of bones, because without estrogen, calcium
tends to withdraw from the skeleton. This can result in
serious spinal, hip, and wrist fractures. Because
cholesterol is incorporated into estrogen, a decrease in
the production of estrogen may also allow cholesterol
levels to rise and result in atherosclerosis (artery disease)
in older women.
Female Reproductive System
 Ovaries are not covered by a layer of peritoneum, and so
ova can escape from them and enter the uterus by way of
the fallopian tubes.
Female Reproductive System
 The division of reproductive cells (Gametes)
 Immature egg cells (oocytes) differ from all body cells in the
number of chromosomes their nuclei contain. All other human
cells, have 46 chromosomes: 22 pair of autosomes (paired
matching chromosomes) and one pair of sex chromosomes
(two X sex chromosomes in the female, and an X and a Y sex
chromosome pair in the male. In contrast to this, reproductive
cells (both ova and spermatozoa) have only half the usual
number of chromosomes. This is so that, when sperm and egg
combine (fertilization), the new individual formed will not have
twice the needed number, but rather 46 chromosomes. The
way reproductive cells divide is what causes this change in
chromosome number.
Female Reproductive System
B. Fallopian tubes = also called “oviduct”, arise from
each upper corner of the uterine body and extend
outward and backward until each opens at its distal
end, next to an ovary.
 The fallopian tubes are approximately 10 cm long in a
mature woman.
 Function: to convey the ovum from the ovaries to the
uterus and to provide a place for fertilization of the
ovum by the sperm.
Female Reproductive System
 Four separate parts of fallopian tubes:
 Interstitial portion = the most proximal division, is the
part of the tube that lies within the uterine wall. This
portion is only about 1 cm in length; its lumen is only 1
mm in diameter.
Female Reproductive System
 Four separate parts of fallopian tubes:
 Isthmus = the next distal portion, is about 2 cm in
length and like in the interstitial tube, remains
extremely narrow. This is the portion of tube that is cut
or sealed in a tubal ligation, or tubal sterilization
procedure.
Female Reproductive System
 Ampulla = is the third and also the longest portion of
the tube. It is about 5 cm in length and is the portion of
the tube where fertilization of an ovum usually occurs.
Female Reproductive System
 Infundibulum = is the most distal segment of the tube. It
is about 2 cm long, funnel shaped, and covered by
fimbria (finger-like projections) that help to guide the
ovum into the fallopian tube.
Female Reproductive System
 The lining of the fallopian tubes is composed of
mucus membrane, which contains both mucus-
secreting and ciliated (hair-covered cells). The mucus
produced may also serve as a source of nourishment
for the fertilized egg, because it contains protein,
water, and salts.
Female Reproductive System
 Because the fallopian tubes are open at their distal
ends, a direct pathway exists from the external genital
organs, through the vagina to the uterus and tubes, to
the peritoneum. This open pathway is what makes
germ spread from the perineum through the uterus
and tubes to the pelvic cavity leading to peritonitis
(infection of the peritoneum). For this reason, during
labor and birth, vaginal examinations are done with
sterile technique to ensure no organisms can enter
by this route.
Female Reproductive System
B. Uterus = also known as the “womb”, is a hollow,
muscular, pear-shaped organ located in the lower
pelvis, posterior to the bladder and anterior to the
rectum.
 During childhood, it is
about the size of an olive;
the cervix is the largest
portion and the uterine
body is the smallest part.
Uterus
 When a girl reaches about 8 years of age, an increase
in the size of the organ begins. This growth is so slow,
however, the young woman is closer to 17 years old
before the uterus reaches it adult size and changes its
proportions so that body cavity, not the cervix, is its
largest portion. Small uterine size may be a
contributing factor to the number of low-birth weight
babies typically born to adolescents younger than this
age.
Uterus
 Function: 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 the woman’s body.
Three divisions of the uterus:
 Body of the uterus (corpus) = the uppermost part and
forms the bulk of the organ. The lining of the cavity is
continuous with the fallopian tube, which enter at its
upper aspects (the cornua). The fundus is the
uppermost part of the corpus.
Three divisions of the uterus:
 During pregnancy, the body of the uterus is the portion
of the structure that expands to contain the growing
fetus. The fundus is the portion that can be palpated
abdominally to determine the amount of uterine
growth during pregnancy, to measure the force of
uterine contractions during labor, and to assess that the
uterus is returning to its nonpregnant state after
childbirth.
Three divisions of the uterus:
 Isthmus = is a short segment between the body and the
cervix. In the nonpregnant uterus, it is only 1 to 2 mm
in length. During pregnancy, this portion also enlarges
greatly to aid in accommodating the growing fetus. It is
the portion where the incision most commonly is made
when a fetus is born by a cesarean birth. It is
considered as “the lower uterine segment” during
pregnancy.
Three divisions of the uterus:
 Cervix = is the lowest portion of the uterus. It
represents about one third of the total uterine size and
is approximately 2 to 5 cm long. Its central cavity is
termed as cervical canal. The opening of the canal at the
junction of the cervix and isthmus is the internal
cervical os; the distal opening to the vagina is the
external cervical os. The level of the external os is at
the level of the ischial spines.
Uterine and cervical coats:
 Endometrium = an inner layer of mucous membrane
 Myometrium = a middle layer of muscle fibers
 Perimetrium = an outer layer of connective tissue
Uterine and cervical coats:
 The endometrium layer of the uterus is formed of
two layers of cells and is the one important for
menstrual function because it is dramatically
influenced by both estrogen and progesterone. It
grows and becomes so thick and responsive each
month under the influence of estrogen and
progesterone that it becomes capable of supporting
a pregnancy. If pregnancy does not occur, this is the
layer that is shed as the menstrual flow.
Uterine and cervical coats:
 The endometrium layer of the uterus is formed of
two layers of cells and is the one important for
menstrual function because it is dramatically
influenced by both estrogen and progesterone. It
grows and becomes so thick and responsive each
month under the influence of estrogen and
progesterone that it becomes capable of supporting
a pregnancy. If pregnancy does not occur, this is the
layer that is shed as the menstrual flow.
Uterine and cervical coats:
 The mucus membrane that lines the cervix is termed
the endocervix. Continuous with the endometrium,
these cells are also affected by hormones, although
their changes are more subtle. A responsibility of such
cells is to secrete mucus to provide an alkaline.
Lubricated surface to reduce the acidity of the upper
vagina and to aid the passage of spermatozoa through
the cervix.
Uterine and cervical coats:
 At the point in the menstrual cycle when estrogen
production is at its peak, as much as 700 mL of mucus
per day is produced. During pregnancy, so much
mucus is produced, the endocervix becomes plugged
with mucus, forming a seal to keep out ascending
infections (the operculum).
Cervix
 Both the lower outer surface of the cervix and the
internal cervical canal are lined not with a mucus
membrane but with a stratified squamous epithelium,
similar to that lining the vagina. Locating the point at
which this tissue changes from epithelium to mucous
membrane (squamocolumnar junction) is important when
obtaining a Papanicolaou smear (a test for cervical
cancer), because this tissue interface is often the origin of
cervical cancer.
Uterine and cervical coats:
 The myometrium, of 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. This intertwining
network of fibers is what offers extreme strength to the
organ so when the uterus contracts at the end of
pregnancy to expel the fetus, equal pressure is exerted at
all points throughout the cavity.
Uterine and cervical coats:
 Another function of the myometrium is to constrict
the fallopian tubes at the point they enter the fundus,
preventing regurgitation of menstrual blood into the
tubes.
 Myomas, or benign fibroid (leiomyoma) tumors that
can interfere with conception or birth arise from the
myometrium.
Uterine and cervical coats:
 The purpose of the perimetrium is to add further
strength and support to the organ.
Uterine blood supply
 The large descending
abdominal aorta divides to
form two iliac arteries; these
then form the hypogastric
arteries and the uterine
arteries, which supply the
uterus.
 The ovarian artery is a
branch of the abdominal
aorta, leaving near the renal
artery. It supplies the ovary
and uterine tube before
joining the uterine artery.
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 a number of ligaments that
also help support the bladder; it is
further supported by a combination
of fascia and muscle.
 Transverse cervical ligaments = fan out
from the sides of the cervix to the
side walls of the pelvis. They are
sometimes known as the “cardinal
ligaments” or “Mackenrodt’s
ligaments”.
Uterine supports
 Uterosacral ligaments = pass
backwards from the cervix to the
sacrum.
 Pubocervical ligaments = pass forwards
from the cervix, under the bladder, to
the pubic bones.
Uterine supports
 Broad ligaments = are formed from the folds of
peritoneum, which are draped over the uterine tubes.
They hang down like a curtain and spread from the
sides of the uterus to the side walls of the pelvis.
Uterine supports
 Round ligaments = have
little value as a support
but tend to maintain the
anteverted position of
the uterus; they arise
from the cornua of the
uterus, in front of and
below the insertion of
each uterine tube, and
pass between the folds of
the broad ligament,
through the inguinal
canal, to be inserted into
each labium majus.
Uterine supports
 Ovarian ligaments = also
begin at the cornua of
the uterus but behind
the uterine tubes and
pass down between the
folds of the broad
ligament to the ovaries.
Uterine deviations:

 Bicornuate uterus = the

oddly shaped “horns” at
the junction of the
fallopian tubes. Any of
these malformations
may decrease the ability
to conceive or to carry
a pregnancy to term.
Uterine deviations:

 Ordinarily, the body of the uterus tips slightly forward.

Positional deviations of the uterus that are commonly
seen include:
 Anteversion = the entire uterus tips far forward
 Retroversion = the entire uterus tips far back
 Anteflexion = the body of the uterus is bent sharply
forward at the junction with the cervix
 Retroflexion = the body of the uterus is bent sharply
backward just above the cervix.
 Extreme abnormal
flexion or version
positions may
interfere with
fertility because the
sharp bend can
block the deposition
or migration of
sperm.
Vagina
 is a hollow, musculomembranous canal located posterior
to the bladder and anterior to the rectum. It extends
from the cervix of the uterus to the external vulva.
 Function: to act as the organ of intercourse and to convey
sperm to the cervix. It expands with childbirth to serve
as the birth canal.
Vagina
 When a woman lies on her
back, as she does for a pelvic
examination, the course of
vagina is inward and
downward. Because of this
downward slant and the
angle of the uterine cervix,
the length of the anterior
wall of the vagina is about 6
to 7cm and the length of the
posterior wall is 8 to 9cm.
Vagina
 The posterior fornix serves as a place for the pooling of
semen after coitus; this allows for a large number of
sperm to remain close to the cervix and encourages
sperm migration into the cervix.
 Normally the walls of the vagina contain many folds or
rugae that lie in close approximation to each other. These
folds make the vagina very elastic and able to expand so
much that, at the end of pregnancy, a full-term baby can
pass through without tearing.
Vagina
 Bulbocavernosus muscle = is a
circular muscle at the external
opening of the vagina that acts
as a voluntary sphincter.
Relaxing and tensing this
external vaginal sphincter
muscle a set of number of
times each day (Kegel exercise)
makes it more supple for birth
and helps maintain tone after
birth.
Vagina
 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. The same rich blood supply, however, is also
the reason any vaginal trauma at birth heals rapidly.
Vagina
 Doderlein bacillus = a normally present bacterium inside
the vagina that breaks down glycogen into lactic acid. This
causes the usual pH of the vagina to be acid, a condition
detrimental to the growth of pathologic bacteria, so even
though vagina connects directly to the external surface,
infection of the vagina does not readily occur.
 Advise the woman not to use vaginal douches or sprays as a daily
hygiene measures so they do not clear away this natural acid
medium because this would invite infection.
 After menopause, the pH of the vagina changes and becomes
closer to 7.5 or slightly alkaline, one reason vulvovaginitis
infections occur more frequently in women in this age group.
Accessory organ
 Mammary glands = or the breasts
 Thelarche = the beginning of breast development which
usually starts 1 to 2 years before menstruation. The
increase in size of the breast during puberty occurs
mainly because of the estrogen.
 Gynecomastia = an increase breast size at puberty
especially to obese male.
Mammary glands

 Breasts are located anterior to

the pectoral muscle.
 Milk glands of the breasts are
divided by connective tissue
partitions into appropriately 20
lobes. All of the glands in each
lobe produce milk by acinar cells
and deliver it to the nipple via a
lactiferous duct.
Mammary glands
 The nipple has approximately 20 small openings through
which milk is secreted. An ampulla portion of the duct,
located just posterior to the nipple, serves as a reservoir
for milk before breastfeeding.
 The nipple is composed of smooth muscle capable of
erection on manual or sucking stimulation. On
stimulation, it transmits sensations to the posterior
pituitary gland to release oxytocin, which then acts to
constrict milk glands and push milk forward into the
ducts that lead to the nipple (a let-down reflex).
Mammary glands
 The skin surrounding the nipples is darkly pigmented
out to about 4 cm and termed the areola. The area
appears rough on the surface because it contains many
sebaceous glands, called Montgomery tubercles. These
sebaceous glands keep the nipple supple and help
prevent nipples from cracking and drying during
lactation.
Mammary glands
 The blood supply to the breasts is profuse because it
is supplied by large thoracic branches of the axillary,
internal mammary, and intercostal arteries. This
effective blood supply is necessary so milk glands can
be supplied with nutrients and fluid to make possible
a plentiful supply of milk for breastfeeding.
Activity:
 Create a teaching plan to be used in a group setting for a
teenage girls including normal anatomy and physiology
and the process of reproduction from the point of
ovulation.