Overview: Trends in Maternal and Child Care and
Female Reproductive Anatomy
Trends in Maternal and Child Care:
1. Family Size Shift: Modern families are generally smaller, a
change from the larger families of the past.
2. Emergence of Single Parenthood: Single parents are
increasingly becoming a significant family structure.
3. Maternal Work Dynamics: More mothers are now
managing both work outside the home and family
responsibilities.
4. Geographical Mobility: Contemporary families are more
likely to move residences compared to previous generations.
5. Addressing Abuse Concerns: Unfortunately, instances of
abuse are more prevalent, demanding attention and
intervention.
6. Health-Conscious Approach: Health awareness has taken
center stage, with families making informed health choices.
External Structures of the Female Reproductive
System (Vulva/Pudendum)
A. Mons Pubis or Mons Veneris:
 Located over the symphysis pubis, it's a pad of fatty
tissue.
 Hairless and smooth during childhood, it develops a dark
and curly hair patch called an escutcheon after puberty.
 The hair pattern forms a distinctive triangular shape with
the base pointing upward.
B. Labia Majora:
 These are two lengthwise, thick folds of fatty skin
extending from the mons to the perineum.
 They serve to protect the labia minora, urinary meatus,
and the vaginal mucosa.
C. Labia Minora:
 Thinner folds of hairless skin encircling the clitoris
anteriorly (prepuce) and uniting posteriorly (fourchette).
 The area below the prepuce is called the frenulum.
 Highly sensitive to manipulation and trauma, this is why
it's often torn during childbirth.
D. Vestibule:
 A triangular space located between the labia minora.
 It contains the vaginal introitus, urethral meatus,
Bartholin’s and Skene’s glands.
E. Glans Clitoris:
 A small erectile structure with nerve endings, highly
sensitive to temperature and touch.
 It's associated with sexual arousal and excitement in
females.
 The most sensitive part of a woman’s body, and it's also
used as a guide to the urinary meatus.
F. Urethral Meatus:
 The external opening of the urethra, where urine exits.
 Near this opening are the openings of Skene’s glands
(paraurethral glands).
 These glands secrete fluids that help lubricate the
external genitalia.
 The shorter female urethra contributes to a higher
susceptibility to urinary tract infections (UTIs) compared
to men.
G. Hymen:
 A tough but elastic semicircle of tissue guarding the
vaginal opening.
 It can stretch or tear due to activities like physical
exertion, tampon insertion, or sexual intercourse.
 The remaining tissue of the hymen is known as carunculae
myrtiformis or myrtiform caruncles.
 It forms a boundary separating internal and external
reproductive organs.
Perineum and External Genitalia of Female
Common Variations of Hymen:
1. Annular Hymen: Circular hymen without any gaps.
2. Septate Hymen: Hymen with a band of tissue creating two
separate openings.
3. Cribriform Hymen: Hymen with multiple small
perforations.
4. Parous Introitus: Changes in the vaginal opening after
childbirth.
H. Vaginal Orifice / Introitus:
 The external opening of the vagina.
 In virgins, it's covered by a thin membrane called the
hymen.
 Bartholin's glands (vulvovaginal glands) are located lateral
to the vaginal opening on both sides.
 Bartholin's glands secrete fluids that lubricate the external
vulva during sexual intercourse.
 The alkaline pH of their secretion supports sperm survival
in the vagina.
 The Grafenberg or G-spot, a sensitive area, is located on
the inner anterior aspect of the vagina.
I. Fourchette:
 A thin fold of tissue resulting from the merging of the
labia majora and labia minora below the vaginal orifice.
J. Perineum:
- The perineum is the muscular, skin-covered area between
the vaginal opening and the anus.
Internal Structures of the Female Reproductive System
A. Vagina:
 A hollow, membranous, and muscular canal.
 Typically 3-4 inches long but dilatable.
 Contains rugae, allowing stretching without tearing.
 Located in front of the rectum and behind the bladder.
 Functions:
 Pathway for menstruation.
 Pathway for fetus during normal spontaneous
delivery (NSD).
 Organ of copulation.
 Depository for semen.
 Doderlein's Bacillus: Maintains the vagina's normal flora,
contributing to an acidic pH detrimental to pathogenic
bacteria growth.
 Rugae: Transverse skin folds in the vaginal wall:
 Absent in childhood, they appear after puberty and
disappear at menopause.
 Fornices (Fornixes):The cervix extends into the vagina,
creating four recesses or depressions around its upper
part:
 Anterior fornix.
 Lateral fornices.
 Posterior fornix.
Female Pelvic Organs: Understanding the Uterus and
Its Components
B. Uterus:
 A hollow, muscular, pear-shaped organ situated in the
pelvis.
 Weighs 50-60 g in a non-pregnant woman.
 Supported by broad ligaments and receives an abundant
blood supply from uterine and ovarian arteries.
 During puberty, it grows in size, reaching its maximum at
around 17 years old.
Functions:
 Organ of implantation (nidation) and menstruation.
 Receives the fertilized ovum from the fallopian tube.
 Provides protection for a growing fetus.
Divisions of the Uterus:
1. Cervix:
 Lower portion often referred to as the neck.
 External Cervical Os: Distal opening to the vagina.
 Cervical Canal: The cavity connecting the external and
internal cervical os.
 Internal Cervical Os: Opening to the uterus.
2. Fundus:
 Uppermost convex portion.
 Can be palpated to assess uterine growth during
pregnancy, contractions during labor, and involution
postpartum.
 The most vascular portion and a normal implantation site.
3. Isthmus:
 The constricted portion immediately above the cervix.
 Known as the lower uterine segment.
 Distends during pregnancy and is incised during a
caesarean section.
4. Corpus:
 The body of the uterus, constituting two-thirds of the
organ.
 Accommodates the fetus during pregnancy.
5. Cornua:
 The upper portion where the fallopian tubes are attached.
Uterine Layers and Uterine Malformations: An
Insight
Layers of the Uterus:
1. Perimetrium:
 The outermost layer attached to the broad ligaments.
 Offers additional support to the uterus.
2. Myometrium:
 The middle layer responsible for expelling the fetus during
childbirth.
 Contracts around blood vessels to prevent hemorrhage
(site of oxytocin action).
3. Endometrium:
 The innermost layer that undergoes hormonal changes
throughout the menstrual cycle and pregnancy.
Comprises two layers: Fallopian Tubes and Ovaries: Key Components of the
Female Reproductive System
a. Glandular Layer:
C. Fallopian Tubes (Oviducts/Uterine Tubes):
 Sheds during menstruation.
 Two slender muscular tubes arising from the upper
 Thickens during the proliferative and secretory phases. corners of the uterine body and extending outward.
b. Basal Layer:  Facilitate the fertilization (conception, fecundation,
 Adjacent to the myometrium. impregnation) of ova by sperm.

 Regenerates the endometrium after menstruation and Parts of the Fallopian Tubes:
delivery.
1. Interstitial Portion:
Uterine Malformation Types Classification:  Lies within the uterine wall, with the smallest lumen.
 Class I: Mullerian Agenesis (Absent Uterus). 2. Isthmus:
 Class II: Unicornuate Uterus (One-Sided Uterus).  Approximately 2 cm in length.
 Class III: Uterus Didelphys (Double Uterus).  This portion is cut or sealed during tubal ligation (BTL).
 Class IV: Bicornuate Uterus (Uterus with Two Horns). 3. Ampulla:
 Class V: Septated Uterus (Uterine Septum or Partition).  The longest portion, about 5 cm.
 Class VI: DES Uterus (T-Shaped Uterine Cavity).  Exact site of fertilization (distal 3rd, outer 3rd).
- Resulting from fetal exposure to diethylstilbestrol. 4. Infundibulum:

 The most distal portion.

The rim is covered by fimbriae, which help guide ova into the
fallopian tube.
Uterine Ligaments: Strengthening Structural Support
Function of Fallopian Tubes:
1. Broad Ligament:
 Transport the fertilized ovum from the ovary to the
 Supports the sides of the uterus.
uterus.
 Assists in maintaining the uterus in its normal anteversion
 Site of fertilization.
and anteflexion position.
D. Ovaries:
2. Cardinal Ligament (Transverse Cervical Ligament):
 Almond-shaped organs located on either side of the
 Located in the lower portion of the broad ligament.
uterus.
 Primary support for the uterus.
 Before puberty, ovaries are smooth, flat, and ovoid.
 Damage to this ligament can result in uterine prolapse.
 After ovulation, they take on a nodular and pitted
3. Uterosacral Ligament: appearance.

 Connects the uterus to the sacrum. Functions of Ovaries:

4. Anterior Ligament:  Responsible for producing, maturing, and discharging ova.

 Offers support to the uterus in conjunction with the
bladder.
 Overstretching can lead to bladder herniation into the
vagina (cystocele).
 Secrete estrogen and progesterone.
 Serve as the site of ovulation.
Ovaries: The Seat of Gametogenesis and More

5. Posterior Ligament: Gamete: Sex Cell

 Forms the cul-de-sac of Douglas (rectouterine pouch).  Female gamete: Ovum

 Damage to this ligament may lead to rectal herniation  Male gamete: Sperm
into the vagina (rectocele). Gonad: Organ Producing Sex Cell
 Female gonad: Ovary
 Male gonad: Testes
Oocyte and Spermatocyte: Gamete Formation
 Female: Oocyte - Process: Oogenesis
 Male: Spermatocyte - Process: Spermatogenesis
 Overall process: Gametogenesis
Layers of the Ovary:
1.Tunica Albuginea:
 Outermost protective layer.
 Surrounded by a single layer of cuboidal epithelium.
2. Cortex:
 The functional layer where ovum formation and
maturation occur.
 Contains primordial follicles, Graafian follicles, corpus
luteum, and corpus albicans.
Oocyte count:
 5 months intrauterine: 5 to 7 million
 At birth: 2 million oocytes
 7 years: 500,000
 22 years: 300,000 to 400,000
 36 years old: 30,000 to 40,000
 Menopause: Absent
3. Medulla:
 Layer containing blood vessels, lymphatics, nerves, and
muscle fibers.
Male Reproductive System: Unveiling Andrology
External Structure:
A. Scrotum:
 A rugated, skin-covered pouch located beneath the penis,
housing the testes.
 Its role is to regulate sperm temperature.
 In cold weather, the dartos and cremasteric muscles
contract, pulling the testes closer to the body and
wrinkling the scrotum's outer surface.
 In hot weather or fever, scrotal muscles relax, allowing
the testes to hang away from the body.
 Sebaceous glands secrete directly onto the scrotum,
contributing to its distinct odor.
Degree of Wrinkling:
 Smooth in preterm infants, wrinkled in full-term
newborns.
 Most wrinkled in young men and cold temperatures.
 Least wrinkled in older men and warm temperatures.
Newborn Assessment:
 Palpating the scrotum is crucial to detect testes descent
from the abdominal cavity in newborn males.
 Testes must descend for proper spermatogenesis (sperm
production), as lower scrotal temperature supports this
process.
Enhancing Spermatogenesis:
 Adequate viable sperm production requires favorable
conditions.
 Avoid tight undergarments, pants, and prolonged sitting
to enhance spermatogenesis.
Testes: The Orchestrators of Reproduction
Structure of Testes:
 Two ovoid-shaped bodies situated within the scrotum.
 Protected by a white fibrous capsule, composed of
numerous lobules (250-400).
Composition of Each Lobule:
 Contains interstitial cells (Leydig’s cells) and 1 to 3
seminiferous tubules.
 Seminiferous tubules: Site of spermatozoa production.
 Leydig’s cells: Produce the hormone testosterone.
Functions of the Testes:
1. Spermatogenesis:
 Process transforming spermatocytes into mature
spermatozoa.
2. Hormone Production:
a. Testosterone:
 An androgen or masculinizing hormone.
Responsible for:
 Growth & development of secondary sex characteristics.
 Deepening of voice, muscle & bone growth, genital
growth.
 Hair growth on face, chest, axilla, and pubic areas.
b. FSH (Follicle Stimulating Hormone):
 Collaborates with testosterone to accelerate sperm
production in seminiferous tubules.
 c. LH (Luteinizing Hormone) or ICSH (Interstitial Cell
Stimulating Hormone):
 Stimulates Leydig’s cells for increased testosterone
production.
Sertoli Cells:
 Support the development of sperm cells.
Functions include:
 Maintaining the necessary environment for development
and maturation.
 Secretion of supportive testicular fluid.
Testes Descent, Characteristics, and Self-Care
Testes Formation and Descent:
 Testes form during fetal development.
 Descent begins around 28 weeks and completes late in
intrauterine life (34th to 38th week).
 Late descent leads to undescended testes
(Cryptorchidism) in many preterm infants.
Asymmetry and Protection:
 One testis is often slightly larger and suspended lower in
the scrotum (typically the left).
 This asymmetry aids in testes sliding past each other
during movement, reducing trauma risks.
Temperature and Sperm Survival:
 Sperm survival requires a lower temperature than body
heat.
 Testes' location outside the body, where the temperature
is about 1°F lower, supports sperm survival.
Testicular Self-Exam (TSE):
 Early adolescence is the time to learn TSE for detecting
tenderness or abnormalities.
 Normal testes feel firm, smooth, and egg-shaped.
 Ideally done monthly after a warm shower or bath when
scrotal skin is relaxed.
 Most testicular cancers, common in young men (ages 15-
34), are discovered by men during TSE.
Warning Signs to Watch For:
1. Hard lump in the testicle.
2. Painless swelling or pain in the testicle or scrotum.
3. Feeling of heaviness.
4. Sudden fluid accumulation in the scrotum.
5. Dull ache in the lower abdomen or groin.
Penis: The Male Organ of Copulation and Internal
Structures
Penis: Structure and Composition:
 The male copulatory organ composed of erectile tissue in
the penis shaft.
 Consists of three cylindrical masses of erectile tissue:
a. Corpora Cavernosa: Two lateral columns of erectile tissue.
b. Corpus Spongiosum: Encases the urethra.
Penis Parts:
1. Glans Penis: Cone-shaped expansion of the corpus
spongiosum, highly sensitive.
2. Shaft or Body
3. Prepuce or Foreskin: Retractable skin covering the glans;
often removed during circumcision. Tight foreskin is
phimosis.
Internal Structures:
1. Epididymis:
 Serves as a reservoir for sperm storage and maturation.
 Sperm take approximately 12-20 days to travel the 20 ft.
length of the epididymis.
 Total of 64 days for sperm to mature ("Treatment = 2
months").
 Aspermia: Absence of sperm.
 Oligospermia: Fewer than 20 million sperm/ml.
2. Vas Deferens:
 Duct extending from the epididymis to the ejaculatory
duct and seminal vesicle.
 Provides a passageway for sperm.
 Varicocele: Varicosity of internal spermatic cord.
 Vasectomy: Male birth control method.
3. Seminal Vesicles:
 Convoluted pouches along the lower bladder.
 Empty into the urethra via the ejaculatory ducts.
4. Ejaculatory Duct:
 Formed by the union of the vas deferens and the seminal
vesicle's excretory duct.
 Enters the urethra at the prostate gland.
5. Prostate Gland:
 Located below the urinary bladder.
 Secretes alkaline and most of the seminal fluid.

6. Bulbourethral Glands (Cowper's Glands):

 Adds alkaline fluid to semen.

 Equivalent to Bartholin's glands in females.

7. Urethra:

 Passageway for both urine and semen.

 Extends from the bladder to the urethral meatus

(approximately 8 inches long).

Erection and Ejaculation:

 Stimulation of parasympathetic nerves leads to the
contraction of the ischiocavernous muscle, preventing the
return of venous blood from the cavernous sinuses.

 Blood vessels engorge, causing the penis to elongate,

thicken, and stiffen, resulting in erection.

 Intense stimulation leads to rhythmic contractions of

penile muscles, causing the forceful expulsion of semen,
known as ejaculation.

Seminal Fluid / Semen:

 Grayish-white substance containing spermatozoa and
fructose-rich substances.

 During ejaculation, approximately 3-5 mL of semen is

secreted, containing about 100 million spermatozoa per
mL, or 250-500 million spermatozoa per ejaculation.

 A sperm count less than 20 million per mL of semen or 50

million per ejaculation is considered infertile.