Female Reproductive System

Female Reproductive System

Structure of the Female Reproductive
System
 The Breasts – Mammary glands

• They are modified sweat glands capable of secreting milk to nurture the infants.
• The breasts are located on the anterior chest wall, over the pectoral muscles.
• They are composed of glandular tissue, with supporting adipose tissue, and fibrous
connective tissue.
• At the center of each breast is a nipple composed of erectile tissue.
• The dark pigmented area surrounding the nipple is the areola.
• The Montgomery glands on the areola give it a rough appearance and help in lubricating
the nipple during the lactating period
• Internally, there is presence of the glandular lobes radiating from the nipple that
produce milk during lactation.
• The milk produced is carried to the nipple through the lactiferous ducts.
• Around the outer edges, the adipose tissue surrounds the glandular lobes supported by
the connective tissue.
• It is the adipose tissue that gives the breast its shape.
The Breasts – Mammary glands
The External Genitalia
The External Genitalia
The External genitalia
The Internal Genitalia
The Vagina
The Uterus
The Uterus
The Fallopian Tubes
The Ovaries
Puberty
The Menstrual Cycle
The Menstrual Cycle
 The Menstrual Cycle

• If fertilization does not

occur, the corpus
luteum shrinks and
dies, the uterine lining
breaks down, and
menstruation sets in
starting the next
menstrual cycle.
The Menstrual Cycle
PMS – Premenstrual syndrome
 Fertilization

• Fertilization or conception occurs when the sperm comes

in contact with and Penetrates the ovum.
• The time frame when fertilization can occur after ovulation
is usually brief, Maybe up to 24 hours – in the first one-
third portion of the fallopian tube.
• Fertilized ovum, called the zygote, continues to travel down
the oviduct.
• As the zygote travels down the oviduct, it starts dividing
first into 2-cell stage and then 4-cell stage and by the time
it reaches the uterus it forms a 8-cell morula.
• Within the uterus, further cell division occurs, and by the
end of the eighth or ninth day of fertilization, a developed
blastocyst burrows into the uterine lining where it remains
throughout the pregnancy and continues to grow and
develop.
 Pregnancy

• The pregnancy period is also referred as the gestation period and

lasts around 38 to 42 weeks.
• This time period is divided into 3 trimesters – Each trimester around
13 weeks long.
• The product of conception is referred to as the embryo from second
through eighth week and a fetus from the ninth week through to the
end of pregnancy or termination of pregnancy.
 Changes during pregnancy

• Changes during pregnancy –

• Amenorrhea.
• Changes in the uterus.
• Changes in the cervix – The Chadwick’s sign and the Goodell’s sign.
• Changes in the breasts.
• Changes in blood pressure.
• Changes in urination (glucose in urine).
• Changes in posture and skin.
• Changes in weight.
 Pregnancy – Fetal membranes

• During pregnancy, there are 4 fetal membranes that are formed

within the uterus –
• The chorion
• The amnion
• The yolk sac
• The allantois
• The chorion is the outermost layer and encompasses the fetus and
the amnion, and it is covered with chorionic villi until the 8th week,
after which the membrane smoothens out.
Pregnancy – Fetal membranes
 Pregnancy – Fetal membranes

• The amnion is a strong, thin-walled membranous sac that envelops

the growing fetus and is supplied with nutrients by the amniotic fluid.
• As the gestation progresses, the amnion expands and completely fills
the chorionic sac.
• The yolk sac is a primitive structure that disappears around the 20th
week of gestation – it merges with the fetus to form the primitive gut.
• The yolk sac supplies the embryo with oxygen and nutrients until the
formation of the placenta – the yolk sac is also the first site of
hematopoiesis
 Pregnancy – Fetal membranes

• The allantois develops into a fibrous cord, the urachus which runs
from the fetal bladder to the umbilicus.
• The urachus is patent and fetal urine is secreted through the
umbilicus.
• The yolk sac and allantois merge with the fetus forming a part of the
fetus itself.
• The chorion and the amnion are discarded after birth when their
usefulness has ended.
 The Amniotic fluid

• Amniotic fluid is a clear, slightly yellowish liquid that surrounds the

fetus during pregnancy – it also contains some fetal cells.
• Amniotic fluid cushions the fetus against sudden blows or movements
– it also allows for movement of the fetus and symmetric
musculoskeletal development.
• Amniotic fluid volume is the greatest at 34 weeks’ gestation – around
800 ml.
 Pregnancy – The placenta

• The placenta is a temporary organ of pregnancy that provides for fetal

respiration, nutrition, and excretion. It also secretes many hormones
like the HCG necessary for sustaining pregnancy.
• The maternal side of the placenta is attached to the uterine wall and
has a “beefy” red appearance.
• The fetal side has a slightly grayish, shiny appearance consisting of
arteries and veins intertwined to form the umbilical cord, serving as
the lifeline between the mother and the fetus.
The Placenta
The placenta & Umbilical cord
 Pregnancy & Child birth
• As the embryo develops into the fetus, the risk of miscarriage decreases.
• The uterus starts expanding and starts stretching towards the thoracic cavity.
• All major organs continue to develop and grow until the fetus is completely viable.
 Pregnancy & Child birth

• The Estimated Date of Delivery (EDD) or Estimated Date of

Confinement (ECC) is calculated using the last menstrual period (LMP)
as the reference.
• The woman may experience irregular, mild contractions – The
Braxton Hicks Contractions, in preparation for labor.
• At the end of the gestation period, when the fetus is fully viable, labor
sets in.
 Pregnancy & Child birth

Labor is of 3 stages –
• Stage 1 – Uterine contractions begin and continues through the
dilatation of the cervix.
• Stage 2 – Complete dilation of the cervix takes place leading to the
birth of the infant.
• Stage 3 – Placenta and associated membranes (afterbirth or
secundines) are expelled.
 Pregnancy & child birth

• An invasive birthing procedure is

called as C – section or
Cesarean.
• Indications:
• Long/ difficult labor.
• Cephalopelvic disproportion.
• Fetal distress.
• Irregular fetal presentations .
 Pregnancy & child birth

• The 6-week period after birth of the infant is referred as the

puerperium period or the postpartum period.
• If the fetus is expelled from the uterus before it is viable, it is termed
as abortion.
• Abortions may be – Spontaneous (Miscarriage). Induced.
 Pregnancy & child birth

• Health care workers use specialized terminology to describe a

woman’s obstetrical history.
• Gravid means pregnant.
• Nulligravida - No pregnancies.
• Primigravida -1 pregnancy.
• Secundigravida - 2 pregnancies.
• Nullipara - No deliveries of viable offspring
2nd & 3rd Trimester
Vaginal delivery (NVD/SVD)
Contraception
 Contraception
OCP Cervical Cap
 Contraception

Diaphragm IUD
Contraception

Tubal ligation
 Vocabulary

• Adnexa: Accessory parts of the uterus; the fallopian tubes and ovaries.
• Amnion: Innermost membrane around the developing embryo.
• Areola: Dark-pigmented area around the breast nipple.
• Bartholin glands: Small exocrine glands at the vaginal orifice. Cervix:
Lower, neck-like portion of the uterus.
• Chorion: Outermost layer of the two membranes surrounding the
Embryo; it is part of the placenta.
• clitoris: Organ of sensitive erectile tissue anterior to the urinary
meatus.
• Coitus: Sexual intercourse; copulation.
 Vocabulary

• Corpus luteum: Empty graafian follicle that secretes estrogen and

progesterone after release of the egg cell; literally means yellow (luteum) body
(corpus).
• Cul-de-sac: Region within pelvis, midway between the rectum and the uterus.
• Embryo: Stage in development from fertilization. Union of the sperm and
ovum (fusion of the two nuclei occurs).
• Endometrium: The inner mucous membrane lining the uterus.
• Estrogen: Hormone produced by the ovaries; responsible for female secondary
sex characteristics and buildup of the uterine lining during the menstrual cycle.
• Fallopian tubes: Ducts through which the egg travels into the ovary; uterine
tubes; oviducts.
 Vocabulary

• Fertilization: Union of the sperm and the ovum (fusion of the two nuclei
occurs). Fetus: The embryo from the third month (after eight weeks) to birth.
• Fimbriae: Finger-like ends of the fallopian tubes.
• Follicle-stimulating hormone: Hormone produced by the pituitary gland;
stimulates maturation of the ovum.
• Gamete: Sex cell; sperm or ovum.
• Genitalia: Reproductive organs; also called genitals.
• Gestation: Pregnancy.
• Gonads: Organs in the male and female that produces gametes; ovaries and
testes.
• Graafian follicle: Developing sac enclosing each ovum within the ovary.
Only about 400 of these sacs will mature in a woman’s lifetime.
 Vocabulary

• Human chorionic gonadotropin (HCG): Hormone produced by the

placenta to sustain pregnancy by stimulating the mother’s ovaries to
produce estrogen and progesterone.
• Hymen: Mucous membrane partially or completely covering the
vaginal orifice.
• Labia: Lips of the vagina; labia majora are the larger, outermost
lips, and labia minora are the smaller, innermost lips.
• Lactiferous ducts: Tubes that carry milk within the breast.
• Luteinizing hormone (LH): Hormone produced by the pituitary
gland; promotes ovulation.
 Vocabulary

• Menarche: The beginning of the first menstrual period during

puberty. Menopause: Gradual ending of the menstrual function.
• Menstruation: The monthly shedding of the uterine lining; menses
means month.
• Myometrium: The muscle layer lining the uterus. Orifice: An opening.
• Ovaries: Organs in the female lower abdomen that produce ova and
Hormones; female gonads. The ovaries are almond shaped and
about the size of large walnuts.
• Ovulation: Release of the ovum from the ovary.
• Ovum: Egg cell; female gamete.
 Vocabulary

• Papilla: A small nipple-shaped projection or elevation. The mammary

Papilla is the nipple of the breast.
• Parturition: Act of giving birth.
• Perimetrium: The membrane surrounding the uterus.
• Perineum: In females, the area between the anus and the vagina.
• Placenta: Vascular organ that develops during pregnancy in the uterine
wall and serves as a communication between the maternal and the fetal
bloodstreams.
• Progesterone: Hormone produced by the corpus luteum in the ovary and
the placenta of pregnant woman. Progesterone means hormone (one) for
(pro) pregnancy (gester).
 Vocabulary

• Puberty: Beginning of the fertile period when gametes are

produced and secondary sex characteristics appear.
• Uterine tubes: Fallopian tubes or oviducts.
• Uterus: Womb; muscular organ in which the embryo develops. The
upper portion is the fundus; the middle portion is the corpus; and the
lower, neck portion is the cervix. Vagina: A tube extending from the
uterus to the exterior of the body.
• Vulva: External genitalia of the female; includes the labia, hymen, and
the clitoris.
 Neonatology

• The Care of the neonate

• The fetus is continuously monitored for signs of distress during the
labor process.
• Immediately following delivery of the head of the fetus, the mouth
and oropharynx are suctioned free of mucus and sometimes
meconium.
• The infant is then completely delivered and handed over to the
waiting pediatrician or nurse.
• The pediatrician then takes the Apgar score of the infant.
 The Care of the neonate

• Apgar scoring is done once at 1 minute after birth and once at 5

minutes after birth, and if required, again at 10 minutes after birth.

Apgar scoring is done to assess the

physical state of the fetus.
 The Apgar table

Scoring is done on a 10-point scale. A score of 7 to 10 is considered normal, while 4 t0 7

might require resuscitative measures. A baby with a score of less than 3 requires
immediate resuscitation.
 Care of the neonate

• After the Apgar scoring, the

infant is cleaned and weighed.
• The infant is allowed for
immediate breast feeding if
normal, both in the case of a C-
section or a normal delivery.
• The infant is then under the care
of a trained pediatrician or more
precisely, a neonatologist.
 Congenital defects

• The newborn can have any of the following birth defects:

• Erythroblastosis fetalis
• Patent ductus arteriosis
• Tetralogy of Fallot
• Transposition of aorta
• Hydrocephalus
• Cleft lip and Cleft palate
• Down syndrome, and many more congenital disorders.
 Changes with aging

• Function of ovaries diminish

• Atrophy of external sexual organs.
• End of menstruation referred to as menopause (Normally around 45
to 52 years of age).
• Menopause can be either delayed (after 55 years) or early onset
(before 35 years).
• Perimenopausal period is the 3- to 5-year period during which
estrogen levels begin to drop before menses cease entirely.
 Genetics

• Branch of science concerned with how biological inheritance occurs and

the consequences of this inheritance.
• Each human being has a specific genetic composition called a genome.
• Nucleus is the cell’s controlling structure and contains chromosomes (rod-
like structures) composed of genetic material DNA (deoxyribonucleic acid).
• Each cell in the human body (except ovum and sperm) has 44
chromosomes arranged in pairs. These cells are the autosomes.
• In addition, each cell has 2 sex (gonosomes) chromosomes,
• Females - 2 X chromosomes,
• Males - X and Y chromosomes.
• The sex cells (ovum and sperm) are called the gametes and have 23
chromosomes each.
Chromosomes
 Genetics

• Genes form the functional unit of heredity, occupying specific sites on

chromosomes. They are capable of exact duplication of themselves
during cell division.
• The specific site the gene occupies on a chromosome is known as the
Locus. There are several thousands of genes on a single chromosome.
• Genes are composed of nucleic acids and amino acids.
 Genetics

• Some traits are recessive and some are dominant.

• If the recessive trait is inherited from one parent and not the other, the
trait will not appear in the offspring. However, a dominant trait will always
be expressed. Eg. albinism and hemophilia.
• Some genetic defects -
• Trisomy (Down Syndrome) - Three #21 chromosome.
• Fragile X syndrome.
• Translocation.
• Two classes of genes affect the occurrence of cancer -
• Oncogenes.
• Tumor suppressor genes.
 Examining the Female reproductive system

• Past obstetrical and gynecological history is obtained along

with present problems.
• Sexual maturity – Tanner staging – and regularity and
duration of menses is assessed.
• Present and previous pregnancy details are collected.
• Breasts are examined for any irregularity or discharge.
• External genitalia is examined – bimanual examinations.
• A speculum is used to widen the vagina to conduct internal
pelvic exam
• Cervical cells are collected for the Pap test.
• The gravid uterus is checked for the Hegar sign.
• Fetoscope is used to assess fetal heart sounds.
 Diseases & conditions - infections

• Bacterial vaginosis – Bacterial infection of the vagina causing discharge,

irritation and itching.
• Candidal vaginitis – A vaginal infection due to yeast (candida albicans).
• Toxic shock syndrome – A staphylococcal infection in the vagina of a
menstruating woman characterized by high fever, rashes, vomiting, and
diarrhea. Can lead to death.
 Diseases & conditions - Cancers

• Cervical cancer – Malignancy of the cervix

 Diseases & conditions - Cancers

• Breast cancer – Malignancy in the ducts

and lobes of the breasts, can spread to
surrounding tissues.
 Diseases & conditions - Cancers

• Fibroids – Benign tumor of the smooth Endometrial cancer – Cancer of the

muscles of the uterus. endometrial lining.
 Diseases & conditions - Cancers

• Ovarian cancer – Cancer

of the ovaries.
• Vaginal and vulvar cancer
- Cancer of the vagina and
the vulva.
 Diseases & Conditions – Sexually
transmitted diseases
• Chlamydia – Caused by Chlamydia trachomatis. Causes inflammation of the
genitals, eyes, pharynx, and other organs.
• Gonorrhea – Caused by Neisseria gonorrhoeae. Infects the epithelium of
the cervix, rectum, urethra, eyes, pharynx, and other organs.
• Herpes simplex genital ulcers – Caused by HSV 2. Causes genital lesions.
• Human Papillomavirus genital warts - Caused by HPV.
• Syphilis – Caused by Treponema pallidum. It is a sexually transmitted
disease.
• Trichomonas vaginitis – is a sexually transmitted disease (STD) caused by
Trichomonas vaginalis . It causes inflammation of the vagina, cervix and
urethra in women.
 Diseases & Conditions –
Pregnancy related
• Pre-eclampsia – Development of
hypertension, edema, and proteinuria
during pregnancy. Also called toxemia.
• Eclampsia – Occurrence of convulsions or
coma during labor in a patient with pre-
eclampsia.
• Gestational diabetes – Onset of diabetes
during pregnancy.
• Ectopic pregnancy – Fertilized ovum gets
implanted in some other part other than
the uterus, mostly the fallopian tubes.
 Diseases & Conditions –
Pregnancy related
• Hyperemesis gravidarum – Extreme nausea and vomiting during
pregnancy.
• Infertility – Inability to conceive.
• Miscarriage – Spontaneous expulsion of the embryo or fetus before it
is viable.
• Amenorrhea – Absence of menstruation.
• Cervicitis – Inflammation of the cervix.
• Dysmenorrhea – Pain during menstruation: cramps or constant
aches.
• Dyspareunia – Pain during sexual intercourse.
 Diseases & Conditions –
Pregnancy related
• Placental abruption –
Premature separation of
the placenta from the
uterine wall.
Diseases & Conditions – Others
 Diseases & Conditions - Others

• Prolapse of the uterus –

Descent of the uterus and
the cervix into the vagina due
to weakened muscle.
 Diseases & Conditions – Others

• Mastalgia – Pain in the breasts.

• Menorrhagia – Excessively long periods of menstruation.
• Metrorrhagia – Nonmenstrual bleeding from the uterus.
• Mittelschmerz – Severe pain due to ovulation.
• Oophoritis – Inflammation of the ovaries.
• Salpingitis – Inflammation of the oviducts.
• Vaginitis – Inflammation of the vagina.
• Pyosalpinx – Distension of the oviducts caused by accumulation of
pus.
 Diseases & Conditions - Others

• Endometriosis – A nonmalignant
condition where endometrial
tissue grows outside the uterus,
especially on the ovaries.
 Diseases & Conditions - Others

• Polycystic ovary
syndrome – Symptoms
consisting of enlarged
ovaries, benign ovarian
cysts, hirsutism,
irregular menses.
 Investigations

• Clinical tests:
• Pap smear
• Pregnancy test
• Procedures:
• X-ray
• Hysterosalpingography
• Mammography
• Ultrasound
• Pelvic ultrasonography
• Transvaginal ultrasonography
 Common diagnostic tests & procedures

• Amniocentesis – Amniotic fluid (fetal Colposcopy – The vagina and the cervix
cells) are aspirated and a variety of are endoscopically examined for any
tests conducted. abnormalities.
 Common diagnostic tests & procedures

• Bacterial culture – A culture & sensitivity test is done to assess the

type of infection and the course of treatment.
• Biopsy – Tissue is microscopically examined for presence of
malignancy.
• FSH test – The level of follicle-stimulating hormone is tested to
diagnose ovarian abnormalities and menopause.
• Karyotyping – Graphic display of the cell chromosomes.
• Pelvic CT, radiography, & ultrasonography.
• Pregnancy testing – Blood or urine is tested for presence of hCG.
• Scrapings and KOH solution – Test for fungal infections.
 Common diagnostic tests & procedures

• Pap test – A smear of cervical cells is obtained and tested for

malignancy.
 Common diagnostic tests & procedures

• Hysteroscopy: The uterus is Fetal monitoring:

endoscopically examined. Fetal vital signs are
electronically recorded during
the labor process.
Pregnancy test
Common diagnostic tests & procedures
Hysterosalpingography
Pelvic ultrasonography
 Drugs

• Abortifacient – Used in the termination Antibiotics – Treatment of infections, PIDs,

of pregnancy. and STDs.
• dinoprostone (Cervidil) amoxicillin
• mifepristone (Mifeprex) azithromycin
• Analgesic – Treatment of pain from penicillin
dysmenorrhea. norfloxacin
• ibuprofen (Advil, Motrin) Antifungals – Treatment of Candidiasis.
• naproxen (Aleve) clotrimazole
nystatin
• Androgen – Treatment of Antivirals – Treatment of viral infections.
endometriosis.
famciclovir
• danazol (Danocrine) ribavirin
 Drugs
• Beta-adrenergic agonists – Prevention of Gonadotropin inhibitor – Treatment of
premature labor. endometriosis.
• ritodrine Goserelin
• terbutaline Leuprolide
• Cervical relaxant – To stimulate cervical dilation. Immunosuppressant – Suppression of development
• Dinoprostone of maternal anti-Rh antibodies that would attack
• Estrogen – Used in estrogen replacement therapy the red blood cells of Rh+ fetal blood
after menopause, in oral contraceptives to prevent RhoGAM.
ovulation, treatment of amenorrhea & Smooth muscle relaxant – Used to induce labor.
endometriosis.
Dinoprostone
• Estradiol
Oxytocin
• Estropipate
Vitamin B Supplement – Given to pregnant women
• Gonadotropin – Stimulates follicle formation. to prevent neural tube defects in the baby.
Treatment of infertility and amenorrhea.
• Hcg
• Menotropin
 Therapeutic procedures
• Induced Abortion – Deliberate
expulsion of fetus before it is viable.
Drugs may be used. Other methods are
D&E, D&C, suction curettage, etc.
• Artificial insemination – Attempt to
produce pregnancy by methods other
than sexual intercourse.
• TAH-BSO – Surgical removal of the
uterus, ovaries, and fallopian tubes.
• Episiotomy – Incision of the perineum
Hysterectomy – Excision of the uterus.
Lumpectomy – Excision of a lump in the
breast.
Mastectomy – Excision of a breast.
Oophorectomy – Excision of an ovary.
Salpingectomy – Excision of fallopian
tube.
Vulvectomy – Excision of the vagina.
Tubal ligation – Sterilization by cutting or
blocking the fallopian tubes
 Therapeutic procedures

• Aspiration
• Cauterization
• Colposcopy
• Conization
• Cryosurgery
• Culdocentesis
• Dilation (dilatation) and curettage(D & C)
• Exenteration
• Laparoscopy
• Tubal ligation
Needle biopsy (aspiration) of the breast
Mastectomy - Series
Breast augmentation - Series
Breast Augmentation - Series
Breast augmentation - Series
Breast reduction (mammoplasty) - Series
Cryosurgery
Culdocentesis
D&C
D&C
Uterine & Endometrial cancer
Pelvic laparoscopy
Tubal ligation
Hysterectomy
 Procedures during pregnancy

• Abortion
• Amniocentesis
• Episiotomy
• Cesarean section
• Fetal monitoring
• Pelvimetry
Episiotomy - Series
Cesarean section - Series
Cesarean Section - Series
Cesarean section - Series
Pelvimetry
Abbreviations
Abbreviations
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