Anatomy & Physiology of Reproductive System PDF

Chapter 1: Anatomy & physiology of reproductive system  Anatomy and Physiology of Female & Male Reproductive System Prepared by Dr. Enas Ebrahim Abbas Learning Objectives: By the end of this lecture the nursing stu...

Chapter 1: Anatomy & physiology of reproductive system  Anatomy and Physiology of Female & Male Reproductive System Prepared by Dr. Enas Ebrahim Abbas Learning Objectives: By the end of this lecture the nursing student will be able to: Describe the parts of external, internal organ of female reproductive system (FRS) and breast. Explain the function of the major external and internal organ of female reproductive system and breast. Outlines: A. External Organs (Vulva( : ▪ Mons Veneries.  ▪ Labia Majora. ▪ Labia Minora. ▪ Clitoris. ▪ Vestibule. o Urethral Orifice. o Two Skene Glands. o Vaginal Orifice. o Bartholoin’s Glands. ▪ Perineum. B. Internal Organs: 1. Vagina. 2. Uterus. 3. Fallopian Tubes. 4. Ovaries. C. Breast. A. External Organs 1. Mons Veneris / Mons Pubis is Characterized by: It is a pad of fat lying over the symphysis pubis covered with pubic hair from the time of puberty. As a women ages, the amount of pubic hair and fatty tissue decreases. The Mons is the anterior fusion of the Labia Majora. External Genitalia 2. Labia Majora (Greater lips): Are two folds of fat it covered with skin and pubic hair on the outer surface. They arise in the Mons pubis and merge into the perineum behind.  3. Labia Minora (Lesser lips): These are two thin folds of skin lying between the labia Majora. Anteriorly, they divided to enclose the clitoris, and posteriorly they fuse, forming the fourchette. The glands in the labia minora serve to lubricate the vulva 4. Clitoris: It is an erectile organ corresponding to male penis. It is rich with blood and nerve supply, so, it is very sensitive and vascular and plays a role in the orgasm of sexual intercourse. The sebaceous gland of the clitoris secrets a cheese like substance called smegma, which has an odor that is sexually exciting to the male. 5. Vestibule: It is extended anteriorly to the clitoris and posteriorly to the perineum. It contains six openings, as follows: a. Urethral Orifice. b. Two skene glands: They are found posteriorly on either sides of the urethra and secrete small amounts of mucous that serve lubrication. c. The Vaginal orifice: It is called the intriotus of the vagina; it is partially closed by the hymen, which is a thin membrane that tears during first sexual intercourse or during the birth of the first child. d. Two Bartholin’s Glands: They are two small glands open on either sides of vaginal orifice, and they secrete mucous which lubricates vaginal opening during sexual intercourse. 6. Perineum: The perineum is the most posterior part of the external female reproductive organs. This external region is located between the vulva and the anus. It is made up of skin and muscle. The perineum can become lacerated or incised during childbirth and may need to be repaired with sutures. Incision of the perineum area to provide more space for the presenting part is called an episiotomy. B. Internal Organs 1. Vagina 2. Uterus 3. Fallopian 4. Ovaries Tube 1.Vagina:  It is the passage, which allows the escape of menstrual blood flow. It receives the penis and the ejected sperm during sexual intercourse. It provides an exit for the fetus during delivery. It is a canal running from the vestibule to the cervix. Vaginal Structure The posterior wall is 10 cm long whereas the anterior wall is only 8 cm. It is composed of fibro-muscular tissue capable of great distension, lined by stratified squamous epithelium that is elevated into folds (rugae). These rugae permit great distension without damage. There are no glands in the vagina, but it is kept moist by a serous transudate from its wall and by cervical discharge. Between puberty and menopause, estrogen helps glycogen deposition in the epithelial cells of the vagina and Doderlein’s bacilli split glycogen into lactic acid giving the vagina its acidic reaction (Ph 4.5) that protect the vagina against infection by pathogenic organisms. 2. Uterus: It is a hollow, muscular and a pear-shaped organ. The lower third is called the cervix and it measures 2.5 cm in each direction. The weight of the uterus is 60- 70 gms. In non-pregnant women. Functions: It shelters the fetus during pregnancy. It expels the uterine contents following pregnancy. Position: It is situated in the cavity of the true pelvis, behind the bladder and in front of the rectum. It leans forward that is known as (ante-version), and it bends forward on itself (ante-flexed). It measures as 7.5 long X 5 wide X 2.5 depths. Relations: Anterior: Bladder. Posterior: Rectum. Lateral: Broad ligaments, fallopian tubes & ovaries. Superior: Intestine. Inferior: Vagina. Uterus Consists of the Following Parts: 1. Fundus: The domed upper wall between the insertions of the fallopian tubes. 2. Cornua: The upper outer angles of the uterus, where the fallopian tubes join.  3. Corpus or body: It makes up the upper 2/3 of the uterus and is the greater part of the uterus. 4. Cavity: It is a potential space between the anterior & posterior walls, it is a triangular shape. 5. Isthmus: It is the narrow area between the cavity and the cervix, it enlarges during pregnancy. 6. Cervix: (Neck of the uterus): ▪ It protrudes into the vagina, the upper half being above the vagina is known as the supra-vaginal portion. While the lower, half is infra- vaginal portion. The uterus has two OS: Internal Os (mouth): Externals Os: It is the narrow opening It is a small round opening at between the isthmus and the the lower end of the cervix cervix. towards the vagina. Ligament of Internal Organs Layers of the Uterus: a. Endometrium: It forms a lining of the epithelium (mucous membrane). It is constantly changing in the thickness throughout menstrual cycle.  It sheds during menstruation. b. Myometrium: It is the muscle coat, thick in the upper part of the uterus and thin in the isthmus and cervix. c. Perimetrium: It is the outer membrane,of the uterus, which extend to the peritoneum. 3. Fallopian Tubes: Functions: Propels the ovum towards the uterus. Receive the spermatozoa, as they travel upwards. Provides a site for fertilization. Supplies fertilized ovum with nutrition. Position: They extend laterally from the Cornua of the uterus toward the wall of the pelvis. They arch over the ovaries. The fringed ends lie near the ovaries in order to pick-up the ova. Structure of Fallopian Tube Structure: It has four parts: 1. Interstitial Portion: It is 2.5 cm long, lies within the wall of the uterus. Its lumen is 1mm (the narrowest part). 2. Isthmus: It is another narrow part with thick muscle wall. It extends for 2.5 cm from the uterus.  3. Ampullary: It is the widest portion where fertilization occurs, 5cm long. 4. Infundibular: It is the funnel-shaped end that is composed of many processes known as fimbrial. One, fimbrial is elongated to form the ovarian fimbriae, which are attached to the ovary. Layers of Fallopian Tubes The lining is a mucous membrane and in this lining are goblet cells, which produce a secretion, containing glycogen to nourish the ovum. Beneath the lining is a layer of vascular connective tissue. The muscle coat consists of smooth muscles that cause peristaltic movement of the fallopian tubes. 4. The Ovaries Functions: Ovaries are responsible for production of ova. Secretion of female sex hormones progesterone and estrogen. Position: Ovaries are attached to the back of the broad ligaments within the peritoneal cavity. Structure: ▪ Medulla:  It is the supporting framework, which is made of fibrous tissue, ovarian blood vessels, lymphatic and nerves transfer through it. ▪ Cortex: It is the functioning part of the ovary contains the ovarian follicles in different stages of development. Breasts: Contain mammary glands, connective tissue. Each breast contains 15-25 clusters called lobes. Each lobule is connected by ducts that open into the nipples. Organs of sexual arousal The nipples are made up of erectile tissue 15. The pigmented around the nipples are called the areola. Breast size is determined primarily by heredity OR by existing fat and glandular tissue. Breasts may exhibit cyclical changes, including increased swelling and tenderness prior to menstruation. Benign breast changes refer to fibrocystic disease Lumps or masses that is noncancerous.  The Male Reproductive System The purpose of the organs of the male reproductive system is to perform the following functions: To produce, maintain, and transport sperm (the male reproductive cells) and protective fluid (semen) To discharge sperm within the female reproductive tract during sex To produce and secrete male sex hormones responsible for maintaining the male reproductive system. Unlike the female reproductive system, most of the male reproductive system is located outside of the body. These external structures include the penis, scrotum, and testicles.  Penis: This is the male organ used in sexual intercourse. It has three parts: the root, which attaches to the wall of the abdomen; the body, or shaft; and the glans, which is the cone-shaped part at the end of the penis. The glans, also called the head of the penis, is covered with a loose layer of skin called foreskin. This skin is sometimes removed in a procedure called circumcision. The opening of the urethra, the tube that transports semen and urine, is at the tip of the penis. The glans of the penis also contains a number of sensitive nerve endings. The body of the penis is cylindrical in shape and consists of three circular shaped chambers. These chambers are made up of special, sponge-like tissue. This tissue contains thousands of large spaces that fill with blood when the man is sexually aroused. As the penis fills with blood, it becomes rigid and erect, which allows for penetration during sexual intercourse. The skin of the penis is loose and elastic to accommodate changes in penis size during an erection. Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm. Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or farther away from the body to cool the temperature.  Testicles (testes): These are oval organs about the size of large olives that lie in the scrotum, secured at either end by a structure called the spermatic cord. Most men have two testes. The testes are responsible for making testosterone, the primary male sex hormone, and for generating sperm. Within the testes are coiled masses of tubes called seminiferous tubules. These tubes are responsible for producing sperm cells. The internal organs of the male reproductive system, also called accessory organs, include the following: Epididymis: The epididymis is a long, coiled tube that rests on the backside of each testicle. It transports and stores sperm cells that are produced in the testes. It also is the job of the epididymis to bring the sperm to maturity, since the sperm that emerge from the testes are immature and incapable of fertilization. During sexual arousal, contractions force the sperm into the vas deferens.  Vas deferens: The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. The vas deferens transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the body, in preparation for ejaculation. Ejaculatory ducts: These are formed by the fusion of the vas deferens and the seminal vesicles (see below). The ejaculatory ducts empty into the urethra. Urethra: The urethra is the tube that carries urine from the bladder to outside of the body. In males, it has the additional function of ejaculating semen when the man reaches orgasm. When the penis is erect during sex, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm. Seminal vesicles: The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder. The seminal  vesicles produce a sugar-rich fluid (fructose) that provides sperm with a source of energy to help them move. The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate. Prostate gland: The prostate gland is a walnut-sized structure that is located below the urinary bladder in front of the rectum. The prostate gland contributes additional fluid to the ejaculate. Prostate fluids also help to nourish the sperm. The urethra, which carries the ejaculate to be expelled during orgasm, runs through the center of the prostate gland. Bulbourethral glands: Also called Cowper's glands, these are pea- sized structures located on the sides of the urethra just below the prostate gland. These glands produce a clear, slippery fluid that empties directly into the urethra. This fluid serves to lubricate the urethra and to neutralize any acidity that may be present due to residual drops of urine in the urethra. Function of Male Reproductive System The entire male reproductive system is dependent on hormones, which are chemicals that regulate the activity of many different types of cells or organs. The primary hormones involved in the male reproductive system are follicle-stimulating hormone, luteinizing hormone, and testosterone. Follicle-stimulating hormone is necessary for sperm production (spermatogenesis), and luteinizing hormone stimulates the production of testosterone, which is also needed to make sperm. Testosterone is responsible for the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, facial hair growth, voice change, and sex drive.  THE BONY PELVIS Prepared by Dr. Enas Ebrahim Abbas General objective: At the end of this lecture every student should be acquired complete knowledge about normal female pelvis Specific objectives: At the end of this lecture every student should be: 1. List the features of normal female pelvis. 2. Identify types of pelvises. 3. Discuss the different parts and measurements of gynecoid pelvis. 4. Identify the pelvic diaphragm and its components. Introduction Knowledge of the shape and dimensions of the normal female pelvis is essential for a proper understanding of the second stage of labor and its abnormalities since the body pelvis is an important component which determines the birth canal structure. The human female pelvis shows adaptations that are of obstetric advantage and relate also to the relatively “big” head of the fetus. The bony pelvis composes of: 2 Innominate bones, each one composed of Illium, Ischium, and Pubis One Sacrum One Coccyx The female bony pelvis is divided into: False pelvis: above the pelvic brim and has no obstetric importance. True pelvis: below the pelvic brim and related to the childbirth. The true Pelvis: It is composed of inlet, cavity, and outlet. The Pelvic inlet (brim) Boundaries Upper border of symphysis pubis anteriorly  Sacral promontory posteriorly Sacroiliac joints, Iliopectineal lines, Pubic crests Diameters of Pelvic inlet 1) Antero-posterior diameter: Anatomical diameter (true conjugate) = 11cm From the tip of the sacral promontory to the upper border of the symphysis pubis. Obstetric conjugate = 10.5 cm From the tip of the sacral promontory to the most bulging point on the back of symphysis pubis which is about 1 cm below its upper border. It is the shortest antero-posterior diameter. Diagonal conjugate = 12.5 cm From the tip of sacral promontory to the lower border of symphysis pubis. i.e., 1.5 cm longer than the true conjugate. Transverse diameter = 13.5cm It is the line between the furthest points on the iliopectineal lines. Oblique diameters: =12 cm From the sacroiliac joint to the opposite iliopectineal eminence. The Pelvic Cavity: It is a segment, the boundaries of which are: o The roof is the plane of pelvic brim. o The floor is the plane of least pelvic dimension. o Anteriorly the shorter symphysis pubis o Posteriorly the longer sacrum. It is rounded with all diameters = 12.5 cm. The Pelvic Outlet ❖ Obstetric outlet: It is a segment, the boundaries of which are: Anteriorly the lower border of symphysis pubis Posteriorly the coccyx. Laterally the ischial spine Diameters of pelvic outlet Antero - posterior diameters: = 13 cm From the tip of the sacrum to the lower border of symphysis pubis in early labor it is 11cm, but during the second stage of labor when the head pushes the mobile coccyx backward 2cm. thus become 13 cm. Transverse diameters: = 11 cm Between the inner aspects of the ischial tuberosities. Bi-spinous diameter = 10.5 cm Between the tips of ischial spines. If this diameter is less than 9.5cm. there is nearly 50% chance for surgical intervention Oblique diameters: =12 cm It is the measurements between the obturator foramen and the sacrospinous ligament. Classification of Pelvic 1- Gynaecoid pelvis (50%): The best type of female pelvis for normal delivery It is the normal female type. Gynaecoid Inlet is slightly transverse oval. Sacrum is wide. Side walls are straight with blunt ischial spines. Sacro-sciatic notch is wide. Subpubic angle is 90-100o.  2- Anthropoid pelvis (25%): It is ape -like type. All anteroposterior diameters are long. Sacrum is long and narrow. Anthropoid Sacro-sciatic notch is wide. Subpubic angle is narrow. 3- Android pelvis (20%): It is a male type. Android Inlet is triangular or heart-shaped with anterior narrow apex. Side walls are converging (funnel pelvis) with projecting ischial spines. Sacro-sciatic notch is narrow. Oval obturator foramen Subpubic angle is narrow