Female Reproductive System PDF

# Female Reproductive System ## Introduction: The reproductive system is different from other body systems that function almost continuously as it is inactive until puberty. The primary sex organs are ovaries in the female. These gonads produce sex cells, or gametes, as well as secreting hormones....

# Female Reproductive System ## Introduction: The reproductive system is different from other body systems that function almost continuously as it is inactive until puberty. The primary sex organs are ovaries in the female. These gonads produce sex cells, or gametes, as well as secreting hormones. The sex hormones estrogen and progesterone in females play vital roles in both the development and function of the reproductive organs and sexual behavior. These hormones also influence the growth and development of many other organs and tissues of the body. ## The Anatomy of Female Reproductive System Consists of: - Soft tissues (internal & external genitalia) - Bone: bony pelvis ## External Genitalia: 1. **Mons Pubis:** - A pad of fat overlying the symphysis pubis and covered by skin and hairs at puberty. - **Function:** protect bones and internal organs 2. **Labia Majora:** - The labia majora are the outer lips of the vulva - The outer two large folds of fatty skin pass from the mons pubis to the perineum. The outer skin is covered by hair at puberty while the inner medial surface is smooth, hairless and contains sebaceous and sweat glands. 3. **Labia Minora:** - The labia minora are the inner lips of the vulva - Two thin folds of modified skin situated inside the labia majora, that contain the main two openings to the urethra and vagina. Protect the structures located inside it (clitoris, urethra, and vagina). 4. **Clitoris:** - The two labia minora meet at the clitoris, a small, sensitive protrusion that is equal to the penis in males. - The clitoris is covered by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Clitoris is very sensitive to stimulation and become erect. - **Function:** sexual pleasure during intercourse 5. **Vestibule:** - The area located between the inner aspects of the labia minora. ## Structures that open in the vestibule are: - Urethra opening and paraurethral gland - The vagina opening - The Bartholin glands 6. **The Hymen:** - A thin membrane situated about 2 cm from the vestibule that encircles or covers part of the vaginal opening and penetrates during the first sexual intercourse. 7. **Bartholin glands:** - (The Greater Vestibular Glands or paravaginal gland): two small bilateral glands secrete mucus during sexual excitement this duct is 2 cm long. 8. **External urethral meatus:** - A triangular slit in the anterior part of the vestibule below the clitoris 2.5 cm in which the urethra opens. ## The Perineum: - Is the short stretch muscle and tissue located between the vaginal opening and anal canal. - The perineum in women often tears during birth to accommodate the passage of the child, and this is natural through a surgical procedure called Episiotomy. ## Internal Genitalia: The internal genitalia consist of: 1. Vagina 2. Cervix 3. Uterus 4. 2 Fallopian tubes 5. 2 Ovaries ## 1- Vagina: - A fibro muscular tube from the vulva to the uterus. - The vagina connects the cervix with the external genitalia; it is located between the bladder and rectum. ## Functions of the Vagina: - As a passageway for the menstrual flow. - As the birth canal during labor. - With the help of two Bartholin glands that lubricated the external genitalia during sexual intercourse. ## Length: - Anterior wall is 8–9 cm, Posterior wall is 10–11 cm ## 2- The Cervix: - The cervix connects the uterus to the vagina. The elongated lower part (1/3) of the uterus measures 2.5–3.0 cm. Divided by the vaginal attachment into - **The cervical canal** is the cavity that communicates above with the uterine cavity at the internal os. - **Below** with the vagina through the external os. - **This** acts as a safety precaution against foreign bodies entering the uterus. - **During childbirth,** the cervix dilates to accommodate the passage of the fetus. ## 3- Uterus: - Commonly referred to as the pear-shaped organ about the size of a clenched fist. It is made up of the perimetrium, myometrium, and endometrium. - The uterus has very powerful muscles that expand to accommodate a growing fetus and push it through the birth canal during delivery. - **Measuring** around 7.5 x 5.0 x 2.5 cm in the longitudinal, transverse, and anteroposterior diameters. - Its normal weight is from 50–60 gm in non-pregnant women. ## Divisions/Parts: 1. **Fundus:** Rounded and broad region superior to the entrance of the uterine tubes. Lies above the insertion of fallopian tubes. - **Cornu:** the area of insertion of the fallopian tubes. 2. **Body:** Major portion of the uterus. 3. **Isthmus:** - Narrowed region between the body and cervix. - An area 4–5 mm in length that lies between the anatomical internal OS above. The isthmus expands during pregnancy forming the lower uterine segment (10 cm) during the last trimester. 4. **The Cervix:** The elongated lower part of the uterus (1/3) - **Measuring** 2.5–3.0 cm. - **Divided** by the vaginal attachment into - Supravaginal portion above (internal OS) - Vaginal portion below (external OS) ## Position: - The uterus is kept in an anteverted-anteflexed position (AVF), with the external os lying at the level of the ischial spines. - **Anteverted:** means the uterus is inclined anteriorly to the axis of the vagina. **Anteflexion:** The body of the uterus is bent forward upon the cervix. - **Relations of the body of the uterus:** - Anteriorly: the bladder - Posteriorly: the rectum - Laterally: the broad ligament on each side ## Histology of the Uterus Consists of: **Three layers:** 1. **Endometrium:** (mucosa) 2. **Myometrium** (muscular) 3. **The peritoneal covering or perimetrium** ## Functions: - Produce and discharge mature ova (ovulation) each month. - Produce estrogen and progesterone in amounts required for normal growth, development, and function to regulate the menstrual cycle. ## Female Reproductive Cycle ## Introduction: - Menstrual cycle is a part of females' body's way of preparing for a possible pregnancy each month. - There are two main components of the menstrual cycle: (the ovarian and uterine cycle. - It is important to remember that both cycles work together simultaneously to produce the menstrual cycle. ## The Menstrual Cycle: - The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg; this process called ovulation. - **Menstruation:** It is periodical shedding of menstrual blood, the most menstrual periods last from 3 to 7 days. ## Or: - **Cyclic changes** in the endometrium caused by estrogen and progesterone. - **These changes** occur in the internal layer of the uterus (endometrium). - **Menarche:** Age at onset of menstruation. Starts at puberty (12-14) years. ## Female Reproductive Cycles: - **Hormonal cycle:** - Hypothalamus pituitary → ovaries → uterus - **Hypothalamus pituitary ovarian axis:** - Toward the end of the normal menstrual cycle, blood levels of estrogen and progesterone decrease - Low blood levels of these ovarian hormones stimulate the hypothalamus to secrete gonadotropin-releasing hormone (GnRH). - In turn, GnRH stimulates anterior pituitary secretion of follicle-stimulating hormone (FSH) - FSH stimulates the development of mature ovarian graafian follicles and their production of estrogen. - Increase Estrogen levels begin to send positive feedback to the hypothalamic through GnRH that triggering the anterior pituitary to release luteinizing hormone (LH). - LH reaches the peaks at about day 13 or 14 of a 28-day cycle ## Functions of luteinizing hormone (LH): - Stimulates release of mature ovum - Stimulates development of corpus luteum that secret progesterone from part of the follicle that remains after the egg is released. - If fertilization and implantation of the ovum have not occurred by this time, regression of the corpus luteum follows. - Levels of progesterone and estrogen decline, menstruation occurs, and the hypothalamus is once again stimulated to secrete GnRH. - This process is called the hypothalamic-pituitary cycle. ## Female Reproductive Cycles **A. Uterine cycle: 4 phases** 1. **Menstrual phase:** - menstruation (1-5) Menstrual flow-endometrial tissue, blood, and mucus 2. **Proliferative phase (6-14):** - This is a phase of repair and proliferation, and follicles become mature. - **FSH:** ovum (egg) matures inside the follicle - **Egg produces estrogen:** which causes endometrium to thicken a little. - **LH:** causes ovulation (release of a mature egg from the follicle. ## 1. Endometrium: - The inner lining of the uterus. Shows cyclic changes with the menstrual cycle under the influence of ovarian hormones. ## 2. Myometrium: - The outer layer of the uterus that offer added strength and support to the structure of the uterus. ## 3. Perimetrium: - The outer layer of the uterus that offer added strength and support to the structure of the uterus. ## 4. Fallopian Tubes: - Two tortuous tubes (10 cm in length) lie in the free upper part of the broad ligament. - Serve as a pathway for the ovum to the uterus. Fertilized egg takes approximately 6 to 10 days to travel through the fallopian tube to implant in the uterine lining. ## Parts of the fallopian tube (4 parts): 1. **Interstitial part (1mm):** pierces the uterine wall, very narrow, with no peritoneal covering and no outer longitudinal muscles. 2. **Isthmus (2mm):** straight, narrow with a thick-walled portion lateral to the uterus. 3. **Ampulla (5 cm):** the widest part in which fertilization takes place. 4. **Infundibulum (2cm):** the outer end opens into the peritoneal cavity by the tubal Ostium. ## 5. Ovaries: - The female gonads or sex glands. **The ovary:** - The ovaries are oval-shaped organs. Almond shaped lying in the fossa ovarica on the lateral pelvic wall. Measuring 3 x 2 x 1 cm. - Ovaries are located on each side of the uterus, below the fallopian tubes. They are grayish-white in color. - A woman is born with approximately 400,000 immature eggs called follicles. - During a lifetime a woman releases about 400 to 500 fully matured eggs for fertilization. ## 3) Secretory phase (15-25): - Corpus luteum develops from follicles & secretes large amounts of progesterone. - Progesterone: responsible for endometrium thickens & engorges blood & nutrients in preparation for implantation of a fertilized egg. - If there is no implantation, corpus luteum degenerates, and estrogen & progesterone levels fall --> triggering menstruation. ## 4) Ischemic phase: - On days 27 and 28, estrogen and progesterone levels fall because the corpus luteum is no longer producing them. - Without these hormones that maintain the blood vessel network, the uterine lining becomes ischemic and marked shrinking of the endometrium. - Spiral arteries become vasoconstriction. - Venous stasis & Ischemic necrosis. - The functional layer of the uterine wall is sloughed off and discarded with the menstrual flow. ## If Fertilization Occurs: - Fertilized ovum implants in the endometrium on about the 6th day of this phase; HCG hormone secreted by trophoblast keeps the corpus luteum secreting estrogen and progesterone. - The luteal phase continues, and menstruation does not occur. ## If Fertilization Doesn't Occur: - No HCG - Corpus luteum degenerates. ## Phases of ovarian cycle: 1. **Follicular phase:** - The follicle becomes enlarge until it gets maturity. - Produces swelling on the surface of the ovary. - Early development of ovarian follicle is induced by FSH. 2. **Ovulatory phase:** - It occurs around mid-cycle about 14 days in a 28-day menstrual cycle. - Ovarian follicle undergoes sudden growth spurt (burst) under the influence of FSH & LH. 3. **Luteal phase:** - It secretes Progesterone and little estrogen. - These hormones prepare the endometrium for implantation of Fertilized ovum (Blastocyst). - If the oocyte is fertilized the Corpus Luteum enlarges & remains active for the first 20 weeks of pregnancy. - If the oocyte is not fertilized the Corpus Luteum degenerates in 10–12 days. ## Corpus Luteum - After ovulation the walls of the ovarian follicle collapse and thrown into folds called Corpus Luteum. - Corpus luteum is responsible for endometrium thickness and embryo nutrient till 20th week of pregnancy before placental formation. ## Nursing Role During the Menstrual Cycle: The nurse must provide health teaching about the following: ## Sanitary pads and tampons: - Wash hands before and after giving self-perineal care. - Washing or wiping the perineum should be always done from front to back. - Reduce the use of tampons by substituting sanitary pads part of the time, especially at night. - Apply the perineal pad snugly enough so it won't slide back and forth with her movements. - Do not touch the side of the perineal pad that will encounter the perineum. - Frequently take warm baths to maintain personal hygiene. ## Diet: - Decrease intake of caffeine (tea, coffee, coals and chocolate) to reduce anxiety. - Decrease intake of salty food to reduce fluid retention. - Eat six small meals a day to prevent hypoglycemia. - Decrease intake of simple sugars & increase fluid intake.