Female Reproductive System PDF

Vulva (Female external genitalia) Mons pubis ○ Elevation of adipose tissue covered by skin and pubic hair which cushions the symphysis pubis Labia major ○ Covered by pubic hair, it contains adipose tissue, sebaceous and apocrine glands Labi...

Vulva (Female external genitalia) Mons pubis ○ Elevation of adipose tissue covered by skin and pubic hair which cushions the symphysis pubis Labia major ○ Covered by pubic hair, it contains adipose tissue, sebaceous and apocrine glands Labia minora ○ Skin fold devoid of pubic hair or fat ○ Has sebaceous glands Clitoris ○ Cylindrical mass of erectile tissue localized in the anterior junction of the labia minora Vestibule ○ Region between labia minora within the hymen (if still present) and contain the opening ducts of several glands Vaginal orifice ○ Occupies the grater portion of the vestibule, is bordered by the hymen Perineum ○ Diamond shape area media to thighs and buttocks in both sexes External urethral orifice ○ Localized posterior to the clitoris and anterior to the vaginal orifice Grater vestibular glands (Bartholin’s) ○ Ducts open between hyphen and labia minora producing mucus during sexual intercourse for lubrication Ovaries Paired intrapelvic organs, supported inside the pelvic cavity (broad and suspensory ligament located here) Ovarian medulla ○ Deep region in the ovarian cortex with loose connective tissue which harbors the blood vessels, lymphatics, and nerves Ovarian follicles ○ Lie within the ovarian cortex and consists of oocytes and the surrounding cells ○ If arranged as a single layer around the oocyte termed follicular cells Mature follicle (Graddian) ○ Large fluid-filled follicle that is prepared for the released of a secondary oocyte (ovulation) Corpus luteum (yellow body) ○ Remnants of ovulated mature follicle which produces progesterone, estrogen, relaxin, and inhibin until its turned into fibrous tissue called corpus albicans Oogenesis ○ Primordial cells arouse from the endoderm of the yolk sac migrating early in fetal life to the ovaries differentiating into the oogonium that will divide mitotically to form the germ cells ○ At birth, 200,000-2,000,000 oogenia remains of which only 400 will mature and ovulate during the reproductive time ○ Posterior pituitary gland- oxytocin hormone Folliculogenesis ○ process by which ovarian follicles develop and mature in the ovaries. It is a crucial aspect of female reproductive biology, as it leads to the formation of eggs (oocytes) that can be fertilized Fallopian tubes ○ Extend laterally on both poles of the uterine fundus ○ Are the channel through which the secondary oocyte travels into the uterus Infundibulum ○ Closest to ovary ○ It possesses the fimbria which is in close relation with the ovary Ampulla: narrow middle segment Isthmus: proximal segment attached to the uterus Uterus Pear shaped organ, uterine body. Contains perimetrium, myometrium, endometrium, cervix- connects uterus with vagina Endometrium ○ Inner epithelial layer, along with its mucous membrane Myometrium ○ Major muscular portion of the uterus ○ Composed of bundles of smooth muscle fibers surrounded by irregular arrays of collagen fibrils and blood vessels Puberty: gonadotropin secretion is high in newborns but decreases abruptly a few weeks after delivery Secretion remains low until the beginning of puberty marked by raising levels of FSH followed by LH Fertilization: the process by which a sperm cell from a male merges with an egg cell (oocyte) from a female to form a new organism. It marks the beginning of pregnancy and occurs in the fallopian tube. Human chorionic gonadotropin (hCG): rescues corpus luteum from degeneration until the 3rd or 4th month of pregnancy Progesterone estrogens: maintain endometrium of uterus during pregnancy, help prepare mammary glands for lactation, prepare mother’s body for birth of baby Relaxin: increases flexibility of pubic symphysis, helps dilate uterine cervix during labor Human chorionic somatomammotropin (hCS): helps prepare mammary glands for lactation, enhances growth by increasing protein synthesis, decreases glucose use, and increases fatty acid use for ATP production Corticotropin-releasing hormone: establishes the timing of birth, increases secretion of cortisol BC methods Abstinence (100% effective) Sterilization: vasectomy, tubal ligation Oral contraceptives, contraceptive injection, hormonal ring: OK effective Intrauterine devices & implants: very effective Spermicides: least effective Barrier methods: male condom, vaginal pouch, pulling out (Coitus interruptus): least effective Tracking cycle: least effective Vulvar diseases Inflammatory disorders ○ All are manifested by pruritus, suppuration, epithelial changes ○ External diseases Etiologic agents STD’s ○ Condyloma (HPV) Latum Flat, moist, and minimally elevated lesion seen in association with secondary syphilis Acuminata Papillary, rugose and elevated lesion in anogenital region HPV Treatment in cervix Condyloma latum ○ Syphilis Benzathine penicillin G - 2.4 million U IM 1 dose Doxycycline 100 mg PO q 12 for 14 d or Tetracycline 500 mg PO QID for 14 d or Azithromycin 2000 mg PO single dose Condyloma acuminata ○ Cryotherapy ○ Surgical excision ○ Carbon dioxide laser ○ Vesicular lesions (Herpes Simplex II) ○ Gonococci infection ○ Syphilis Fungi ○ Candida albicans Preeclampsia and Eclampsia Preeclampsia is a new onset or worsening of existing hypertension with proteinuria after 20 weeks gestation ○ Most cases occur after 34 weeks  ○ May be symptomatic or may cause edema or sudden excessive weight gain (> 5 lb/week) ○ Edema, such as facial or hand swelling (the patient’s ring may no longer fit her finger) ○ Systolic BP > 140 mmHg and/or diastolic > 90 mmHg (at least 2 measurements taken at least 4 hours apart) ○ Systolic BP > 160 mmHg and/or diastolic > 110 mmHg (at least 2 measurements) ○ Proteinuria Defined as > 300 mg/24 hrs or Protein/creatinine ratio > 0.3 or A dipstick reading of 2+ ○ Absence of proteinuria on less accurate tests (eg, urine dipstick testing, routine urinalysis) does not rule out preeclampsia Eclampsia is unexplained generalized seizures in patients with preeclampsia ○ Manifests as generalized (tonic-clonic) seizures Diagnosis is measuring blood pressure and urine protein Complications: end-organ damage (eg, pulmonary edema, impaired liver or kidney function) Treatment: BP control, IV magnesium sulfate and delivery at term, or earlier to prevent maternal or fetal complications Etiology of preeclampsia is unknown ○ High-risk factors include Previous pregnancy w/ preeclampsia Multiple gestation Kidney disorders Autoimmune disorders Type 1 or Type 2 DM Chronic HTN ○ Moderate-risk factors include First pregnancy Maternal age > 35 years Prepregnancy BMI > 30 Family hx of preeclampsia (in a first-degree relative) Non-hispanic Black and American Indian or Alaskan Native women Lower income Signs or symptoms of end-organ damage may include one or more of the following: ○ Thrombocytopenia (platelets < 100 x 109 L) ○ Impaired liver function (aminotransferases > 2 times normal) not accounted for by alternative diagnoses ○ Severe persistent right upper quadrant or epigastric pain unresponsive to medications ○ Renal insufficiency (serum creatinine > 1.1 mg/dL or doubling of serum creatinine in the absence of renal disease) ○ Pulmonary edema, Visual disturbances  ○ New-onset headache unresponsive to medication and not accounted for by alternative diagnoses Complications of preeclampsia and eclampsia ○ HELLP syndrome Hemolysis Elevated liver function tests- ALT, AST Low platelet count Develops in 0.2-0.6% of pregnancies Disorders of the vagina: usually is secondarily affected from lesions of the vulva or cervix Vaginitis: relatively common accompanied by transient problems as vaginal discharge related to infectious organisms ○ Candida sp., Trichomonas Disorders of the cervix: Cervicitis ○ Inflammatory (acute or chronic) ○ chlamydia, ureoplasma, trichomonas, candida and HSV II, Gonorrhea ○ Acute nonspecific is a term limited to post-partum or for staph or strep infections ○ Erosive: secondary to physical agents- coitus, birth trauma, age (menopause) Cervical neoplasms ○ Benign Endocervical polyp Is inflammatory in origin and is lined by mucus-producing endocervical gland cells Complication include Bleeding PAP smear ○ Important test which screens a cervical sample for the identification of pre malignant disorders ○ Cervical Intraepithelial Neoplasia (CIN) describes abnormal changes of the cells that line the cervix is not cancer But if the abnormal cells are not treated, over time they may develop into cancer of the cervix not cause any symptoms ○ Squamous intraepithelial lesion (SIL) ○ ○ Prevention: HPV vaccine  Risk factor for CIN and Invasive Squamous Carcinoma ○ Early age of 1st intercourse (coitus) ○ Multiple sexual partners ○ Male partner with multiple previous sexual partners ○ CIN I (SIL I) regression 60% persistence 3% Only 1-5% progress into CIN III (SIL II) ○ CIN III (SIL II) regression 33% progression into invasive lesion 74% Invasive carcinoma ○ 85 -90% squamous in nature evolving from CIN ○ 10-15 % adenocarcinoma or combination ○ Endometrium Adenomyosis: presence of endometrial tissue within the myometrium ○ Endometriosis: presence of endometrial tissue outside the uterine cavity or myometrium ○ Clinical significance of “ectopic” endometrial tissue undergoes cyclic changes May be associated with infertility, dysmenorrhea, dyspareunia (pelvic pain during sexual intercourse) Etiologies (theories) ○ Regurgitation ○ Metaplastic tissue ○ Vascular or lymphatic spread Tumors of endometrium and myometrium ○ Endometrial polyp Sessile round pedunculated More common at menopause accompanied WITH abnormal uterine bleeding May precede adenocarcinoma Dysfunctional uterine bleeding: abnormal bleeding in absence of an organic cause ○ Leiomyoma ○ Most common benign tumor in females  ○ Found in up to 50% on reproductive years ○ Tumor of smooth muscle (fibroids) Leiomyosarcoma ○ Malignant tumor derived from mesenchymal cells ○ Arises from the smooth muscle of the uterine wall ○ Is an aggressive tumor associated with a high risk of recurrence and death Endometrial carcinoma ○ Adenocarcinomas are the most frequent and treated with anovulatory cycle and/or dysfunctional (irregular) uterine bleeding ○ More commonly develops in “menopausal age” associated with endometrial hyperplasia ○ Risk factors: obesity (increased synthesis of estrogen), diabetes, HTN, infertility (nulliparous) Fallopian tubes Pelvic inflammatory disease (PID) ○ Inflammatory (infectious) disease which may result in abnormal scarring and structure of the lumen ○ Endometriosis ○ Ectopic pregnancy ○ Uterine adenocarcinoma extending into the tubes Ovarian neoplasm Risk factors: nulliparity, family history (5-10% are familial), BRCA 1 and 2 genes are involved Serous tumors Most frequent of the ovarian tumors usually occur between 30-40 y/o Cystic or solid ○ 60% benign ○ 15% low malignant potential ○ 25% malignant Teratomas Germ cell tumor being 15-20% of all ovarian neoplasm Usually arise < 20y/o, the younger the patient the greater the risk of malignancy Benign cystic mature teratomas >90% Mucinous tumors Analogous to serous tumors in all respects but are considered less likely to be malignant Account for 10% of all ovarian neoplasm 80% benign 10% low malignant potential