N-OB-LESSON-1_080929.docx

**Gynecology --** study of the female reproductive organ **Andrology --** study of the male reproductive organ **MALE REPRODUCTIVE SYSTEM** **The Male Reproductive System is consists of:** 1. **Testes** 2. **Ducts** - Epididymis, vas deferens, urethra 3. **Accessory glands** - Seminal...

**Gynecology --** study of the female reproductive organ **Andrology --** study of the male reproductive organ **MALE REPRODUCTIVE SYSTEM** **The Male Reproductive System is consists of:** 1. **Testes** 2. **Ducts** - Epididymis, vas deferens, urethra 3. **Accessory glands** - Seminal vesicles, prostate glands, Cowper's gland 4. **Supporting structures** - Scrotum, penis **Male External Structures** - **Penis:** external male sex organ **EXTERNAL GENITALIA** 1. **PENIS** - Serve as the outlet for both the urinary and reproductive tracts in men (delivers sperm) **Regions of the penis** 1. **The root** - Which attaches to the wall of the abdomen; 2. **The body or shaft;** 3. **The glans** - The cone-shaped part at the end of the penis. (bulging, sensitive ridge of tissue) - 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**. - Penis is composed of 3 cylindrical masses of erectile tissue in the penis shaft. - The **two dorsal columns** are the **corpora cavernosa or corpus cavernosa** - The **single, midline ventral column** is called the **corpus spongiosum.** With sexual excitement ENDOTHELIUM of the blood vessels Released NITRIC OXIDE Result in dilation of blood vessels and increase in blood flow to the arteries of the penis (engorgement) Ischiocavernosus muscle (at the base of the penis) then contracts Trapping both venous and arterial blood into 3 sections of erectile tissue and leading to distention and erection of the penis. 2. **SCROTUM** - Rugated, skin covered, muscular pouch suspended from the perineum. - Divided sac of skin and muscle containing testicles - Maintains testes at **3C lower than normal body temperature** to protect sperm viability. - The scrotum acts as "climate control system" for the testes  - It contains the testes, epididymis and the lower portion of the spermatic cord. - It is divided into left and right internal compartments by a septum. - Beneath the skin is a layer of loose connective tissue and a layer of smooth muscle, called **Dartos muscle.** - During **warm** weather or exercise, the **dartos and cremaster muscles relax,** the skin of the scrotum becomes loose and thin, and the **testes descend away from the body to lower their temperature.** - If the testes become too warm or too cold, normal sperm cell development does not occur. **FUNCTION OF THE SCROTUM** - House testes and maintains their temperature at a level cooler than the body thus promoting normal sperm formation. **INTERNAL STRUCTURES** 1. **TESTES** - Considered the male gonads - Are 2 oval organs or 2 ovoid glands - 2 to 3 cm wide, that lie in the scrotum - Each testis is encased by a protective white fibrous capsule and is composed of a number of lobules, each lobule containing interstitial cells (Leydig's cells) & seminiferous tubule. **Seminiferous Tubule** - produce spermatozoa **Leydig's Cells** - Responsible for production of the male hormone testosterone. **Testes** - First form in utero in the pelvic cavity - Descend late in intrauterine life into the scrotal sac (about 34^th^ to 38^th^ week) - Descent occurs late in pregnancy - Leads to newborn especially preterm born with undescended testes. **Cryptorchidism** - Condition which the testes fail to descent into the scrotum (within abdomen or inguinal area) **Orchiopexy** - Operation that brings the testes into the scrotum must be done before puberty. **Gross Anatomy of Testes** - Tunica Vaginalis - Tunica Albuginea (capsule) - Septa - 250 -- 300 lobules - Seminiferous tubules - **Tunica albuginea** is an anatomy term that literally means "white covering." It is used to refer to three anatomical areas which include: 1. **Tunica albuginea (penis) --** the tough fibrous layer of connective tissue that surrounds the corpora cavernosa of the penis. 2. **Tunica albuginea (testicles) --** a layer of connective tissue covering the testicles 3. **Tunica Vaginalis --** is the serous covering of the testis. It is a pouch of [serous membrane], derives from the [processus vaginalis] of the [peritoneum. ] **FUNCTIONS OF THE TESTES** - Endocrine glands that secrete the primary male hormone, testosterone - The testicle lies inside the scrotum and produces as many as 12 trillion sperms in a male's lifetime, about 40 million of which are ejaculated in one average intercourse. - Each sperm takes about seventy-two hours (3 days) to mature and its maturity is overseen by a complex interaction of hormones. 2. **EPIDIDYMIS** - A tightly coiled tube about 20 feet long responsible for the conduction of sperm from the testes to vas deferens. - During sexual arousal, contractions force the sperm into the vas deferens. - It takes 12 to 20 days for the sperm to travel and a total of 64 days for them to reach maturity. - This is the reason that **aspermia** (absence of sperm) and **oligospermia** (fewer than 20 million sperm per ml) are problems that do not appear to respond immediately to therapy but rather after 2 months of treatment. **FUNCTIONS OF THE EPIDIDYMIS** - Storage for some sperm - Final sperm maturation - Where sperm develops the ability to be motile. 3. **VAS DEFERENS/DUCTUS DEFERENS** - A tube surrounded by arteries and veins and protected by a thick fibrous coating. - Sperm mature as they pass through the vas deferens. - Carries sperm from epididymis into the pelvic cavity. - The [blood vessels and the vas deferens together] are referred to as a **spermatic cord.** **Spermatic Cord** - Contains the proximal ductus deferens testicular artery and veins, lymph vessels, testicular nerve, cremaster muscle and a connective tissue covering. - 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. 4. **EJACULATORY DUCTS** - These are formed by the [fusion of the vas deferens and the seminal vesicles]. The ejaculatory ducts empty into the urethra. - Two ejaculatory ducts pass through the prostate gland and join the seminal vesicles to the urethra. 5. **URETHRA** - The urethra is the tube that carries urine from the bladder to outside of the body. - It is approximately 8 inches (18 -- 20 cm) long - 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. 6. **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 and helps with the sperms' motility (ability to move). - The fluid is viscous and contains fructose, prostaglandins and proteins. - The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate. 7. **PROSTATE GLAND** - The prostate gland is a chestnut or walnut-sized gland 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. - Secretes a thin, alkaline fluid. 8. **BULBOURETHRAL GLANDS/COWPER'S GLAND** - 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. **Seminal Fluid or Semen** - A slightly alkaline mixture of sperm cells and secretions from the accessory glands. - Secretions from the seminal vesicles make up about 60% of the volume of the semen, with most of the remainder coming from the prostate gland. The sperm and secretions from the bulbourethral gland contribute only a small volume. - Prostate gland (60%), seminal vesicles (30%), epididymis (5%), bulbourethral glands (5%) - The volume of semen in a single ejaculation may vary from 1.5 to 6.0 ml. - There are between 50 to 150 million sperm per milliliter of semen. - Sperm counts below 10 to 20 million per milliliter usually present fertility problems. **How does the male reproductive system function?** - Follicle-stimulating hormone is necessary for sperm production (spermatogenesis). - Luteinizing hormone stimulates the production of testosterone, which is also needed to make sperm. - Testosterone is responsible for the development of male characteristic, including muscle mass and strength, fat distribution, bone mass, facial hair growth, voice change, and se drive. **Erection** - Involves increase in length, width & firmness - Changes in blood supply: arterioles dilate, veins constrict - The spongy erectile tissue fills with blood - **Erectile dysfunction (ED)** also known as **impotence** **Spermatogenesis** - The mature sperm cell has a head, midpiece, and tail. - The head, also called the nuclear region, contains the 23 chromosomes surrounded by a nuclear membrane. - The tip of the head is covered by an acrosome, which contains enzymes that help the sperm penetrate the female gamete. - The midpiece, metabolic region, contains mitochondria that provides adenosine triphosphate (ATP). - The tail, locomotor region, uses a typical flagellum for locomotion.  **Performing Testicular Self-Exams** **Step 1:** Draw a warm bath to relax the scrotum **Step 2:** Get familiar with your body **Step 3:** Place one leg on an elevated surface **Step 4:** Use one hand to support testicle **Step 5:** Use the other hand to gently roll testicle between thumb and index finger **Look for:** Hard lumps, tenderness, hardness of testicle or discharge of the penis. **Gynecology --** study of the female reproductive organ **FEMALE REPRODUCTIVE SYSTEM** **Vulva (Pudenda) --** The structure that form the female external genitalia **PURPOSE OF FEMALE REPRODUCTIVE SYSTEM** - Reproduction - Secretes hormones that support secondary sex characteristic changes - Secretes hormones that sustain pregnancy should fertilization occur The vulva refers to those parts that are outwardly visible The vulva/external female genitalia includes: 1. Mons pubis 2. Labia Majora 3. Labia Minora 4. Clitoris 5. Urethral Opening 6. Vaginal Opening 7. Perineum **EXTERNAL GENITALIA** 1. **MONS PUBIS OR MONS VENERIS** - Fatty tissue that covers and cushions symphysis pubis - The triangular mound of fatty tissue that covers the pubic bone - During adolescence sex hormones trigger the growth of pubic hair on the mons pubis - Hair varies in coarseness curlines, amount, color and thickness - It protect the junction of the pubic bone from trauma 2. **LABIA MAJORA** - Referred to as the "outer lips" - Boundary of the vulva - Are two folds of adipose tissue covered by loose connective and epithelium - Anteriorly the folds join in front of the symphysis pubis, and posteriorly or are positioned lateral to the labia minora. - They have a darker pigmentation - **Scrotum in males** 3. **LABIA MINORA** - Referred to as the "inner lips" - Two thin folds of tissue located within the folds of the labia majora - Made up of erectile, connective tissue that darkens and swells during sexual arousal - Located inside the labia majora - The labia minora tightens during intercourse - Contain numerous sebaceous glands - Posteriorly they fuse to form the fourchette - Superiorly, they divide into two to form the prepuce and frenulum of the clitoris - The cleft between the labia minora is called the vestibule - The vagina, urethra and ducts of the greater vestibular glands open into the vestibule - Extends from the clitoris downward toward the perineum - They are not well developed before puberty and atrophy after menopause - Normally the folds are pink 4. **CLITORIS** - Short (1- 2 cm), elongated organ composed of erectile tissue - Covered by a fold skin (prepuce) - Located just behind the upper junction of the labia minora under the prepuce - Homologous to the penis - It is made up of a clitoral **shaft** and a **glans** - **Penile shaft in males** - Highly sensitive organ composed of nerves, blood vessels, and erectile tissue - Becomes engorged with blood during sexual stimulation - Key to sexual pleasure for most women - With 8000 nerve endings (nearly 2x that of the head of the penis), it is the most sensitive portion of the woman's body. - When engorged the clitoris can be anywhere from the size of a chocolate chip to the size of a thumb. - When ISCHIOCAVERNOUS muscle surrounding it contract with sexual arousal, the venous flow outflow for clitoris is blocked, leading to clitoral erection. 5. **URINARY ORIFICE OR OPENING** - **Not true part of female reproductive system,** but part of the vulva - Located directly below clitoris - The external urinary orifice is **1 -- 1.5 cm** below the clitoris. It is often covered by the folds of the labia minora, which must be separated to expose it, for example, for passing a urinary catheter. - The urethra is a membranous tube **3 -- 5 cm** long, for the passage of urine. The proximal two-thirds are lined with stratified transitional epithelium and the distal third by stratified squamous epithelium. **Bartholin's Glands** - Located on either side of the vaginal orifice - **It lubricates the external vulva during coitus** and the [alkaline pH of their secretion helps to improve sperm survival in the vagina ] - **It is the Cowper's Gland in males** **Vestibule** - Contains the external urethral meatus, vaginal introitus, and Bartholins glands (vulvovaginal gland) - The urethra and vagina open into it, as do the paired Bartholin glands (vulvovaginal gland) and Skenes glands (paraurethral glands) - Is oval-shaped area formed between the labia minora, clitoris, and fourchette. **Skene's Glands/Paraurethral Glands** - Located just lateral to the urinary meatus on both sides. **Function of Skene's Glands/Paraurethral Glands** - Secretion helps lubricate the external genital during coitus. - **It is the Prostate Gland in males** 6. **VAGINAL ORIFICE** - Located in lower portion of the vestibule, below the urinary meatus - Also known as the vaginal introitus - Opening may be covered by a thin sheath called the **hymen** - Using the presence of an intact hymen for determining virginity is erroneous - Some women are born without hymens - The hymen can be perforated by many different events 7. **PERINEUM** - Is the most posterior part of the external female reproductive organs - It extends from fourchette anteriorly to the anus posteriorly - Consists of muscular and fibrous tissue and serves as support for pelvic structures - The perineum contains an abundance of nerve endings that make it sensitive to touch. - An episiotomy is an incision of the perineum used during childbirth for widening the vaginal opening - It is easily stretched during childbirth to allow enlargement of vagina and passage of the fetal head. - It contains the muscles (pubococcygeal and levator ani) which support the pelvic organs, the arteries that supply blood and the pudendal nerves which are important during delivery under anesthesia. **Blood Supply** - Vulvar blood supply **Blood supply of external genitalia** - From pudendal artery and a portion of the inferior rectus artery **Venous Return** - Through pudendal vein **Note:** pressure on pudendal vein by fetal head can cause extensive back-pressure and development of varicositiesin in the labia majora. **The rich nerve supply** - Makes the area extremely sensitive to touch, pressure, pain and temperature. - Anesthesia for childbirth is given to block the PUDENDAL NERVE - Normal stretching of the perineum with childbirth causes temporary loss of sensation in the area. **Arterial Supply** - Internal pudendal arteries which arise from the internal iliac arteries - External pudendal arteries from the femoral arteries **Veins** - A large plexus of veins -\> internal iliac veins - **Lymph drainage -\>** superficial inguinal nodes - **Nerve supply -\>** by branches from pudendal nerves **INTERNAL FEMALE STRUCTURES** Consists of: 1. Vagina 2. Uterus \*Cervix 3. Fallopian Tubes 4. Ovaries  **INTERNAL GENITALIA** 1. **VAGINA** - Hollow, musculomembranous canal located posterior to the bladder and anterior to the rectum. - Extends from the cervix of the uterus to the external vulva. - Acts as organ of intercourse and to convey sperm to the cervix. - With childbirth, it expands to serve as the BIRTH CANAL. - It is longer in the posterior wall **around 8 -- 9 cm** than anteriorly approximately **6 -- 7 cm**. the vaginal walls are normally in apposition except at the vault where they are separated by the cervix. - The vault of the vagina is divided into four fornices, (posterior, anterior and two lateral) **Posterior Fornix** - Behind the cervix, serves as a place for the pooling of semen after coitus hence allows a large number of sperm to remain close to the cervix and encourage sperm migration into the cervix. **Anterior Fornix** - At the front **Lateral Fornices (2)** - At the sides - The walls contain may folds or rugae, this rugae makes the vagina very elastic **Bulbocavernosus** - A circular muscle (at external opening of the vagina) - Acts as a voluntary sphincter - Women preparing for childbirth are advised to relax and tense this bulbocavernosus muscle of external vaginal sphincter muscle to make it more supple (flexible & elastic) for birth & help maintain tone after birth. \*\*Kegel's Exercise - Has both sympathetic and parasympathetic nerve innervations originating at the S1 to S3 levels. - Not extremely sensitive organ - The vaginal lining produced mucus that is rich in glycogen - Note: when this glycogen is broken down by lactose fermenting bacteria (doderlein's bacillus) lactic acid is formed making the usual pH of the vagina acidic. **Doderlein's Bacillus** - Is the normal flora of the vagina which makes the pH of vagina acidic, detrimental to the growth of pathologic bacteria. - After menopause, the pH is slightly alkaline 7.5 hence vulvovaginitis infections occur more frequently. **Blood Supply** - Furnish by vaginal artery (branch of the internal iliac artery-rich blood supply) hence vaginal tears at childbirth tend to bleed profusely and vaginal trauma at birth heals rapidly. **Age Changes** - At birth, the vagina s under the influence of maternal estrogens so the epithelium is well developed. - After a couple of weeks the effects of the estrogens disappear and the pH rises to 7 and the epithelium atrophies. (weakening) - At puberty, the reverse occurs and finally at the menopause the vagina tends to shrink and the epithelium atrophies. **Function** - Passageway of menstrual flow - Female organ for coitus; receives male penis - Passageway for the fetus during birth 2. **UTERUS** - Female reproductive organ present in the pelvis. - Pear-shaped, hollow, muscular organ with thick muscular walls. - In nulliparous (women who has not borne child) women uterus is about 50-70 grams, 8cm long, 5cm wide and 2.5cm thick. - Parous women average 80 g or more, 9cm long, 6cm wide and 3cm thick. - Located in the lower pelvis, posterior to the bladder and anterior to the rectum. - During childhood, it is approximately the size of an olive. - 8 year old, an increase of uterus begins - 17 years old reaches an adult size (if pregnant below this age this can lead to low birth weight) - With maturity, uterus is approximately 5-7 cm long, 5cm wide and its widest upper pat 2.5 deep. - Receive the ovum from the fallopian tube, provide place for implantation and nourishment during fetal growth, and furnish protection to a growing fetus. - After pregnancy, the uterus never returns to its non-pregnant size. - Consists of 3 divisions: the **body or corpus, the isthmus, the cervix.** - Cervix is the largest portion of this organ. **The Body or Corpus** - Upper most part - Forms the bulk of the organ - Lining of the cavity is a continuous with that of the fallopian tubes, which enter at its upper aspects (the cornua) - Portion of the structure that expands to contain the growing fetus. **FUNDUS** - Portion of the uterus between the points of attachment of the fallopian tubes. - Is the portion that can be palpated abdominally to determine the amount of uterine growth occurring during pregnancy. - To measure the force of uterine contractions during labor - To assess that the uterus is returning to its non-pregnant state after childbirth. **The Isthmus** - Short segment between the body and the cervix - Non-pregnant 1-2 mm in length - Most commonly cut when fetus is born through cesarean birth. **The Cervix** - Lowest portion of the uterus - Represents approximately 1/3 of the total uterus size and is approximately 2-5cm long. - Approximately half lies above the vagina and half extends into the vagina **Parts of the Cervix** 1. **Internal OS** - Opening of the cancal at the junction of the cervix and isthmus 2. **Cervical Canal** - Central cavity 3. **External OS** - Distal opening of the vagina **NOTE:** The level of the external OS is at the level of ischial spins (an important relationship estimating the level of the fetus in the birth canal. **Nuliparous** - Small and circular **After childbirth** - Orifice is converted into transverse slit that is divided such that there are the so called anterior and posterior lips of the cervix. **After menopause** - Narrow almost to a pin **LAYERS OF THE UTERUS** 1. **Endometrium** - Inner one of mucous membrane 2. **Myometrium** - Middle one of muscle fibers 3. **Perimetrium** - Outer one of connective tissue **The Endometrium** - Important for menstrual function - Formed by 2 layer of cells: 1. **Basal layer** - Closest to the uterine wall not influenced by hormones. 2. **Glandular layer (inner)** - Greatly influenced by estrogen and progesterone. - Grows and becomes so thick and responsive each month under the influence of estrogen and progesterone that is capable of supporting pregnancy. - If pregnancy does not occur, this layer that is shed as the menstrual flow. **Endocervix** - Mucous membrane lining of the cervix **The cells of the cervical lining** - Secrete mucus to provide a lubricated surface so that spermatozoa can readily pass through the cervix. **At the point of menstrual cycle (estrogen at peak)** - 700 ml of mucus per day is produced. **At point when there is low estrogen** - Only few ml is produced. **Mucus** - Alkaline hence it helps decrease the acidity of the upper vagina, aiding in sperm survival **During Pregnancy** - Endocervix becomes plugged with mucus (forming a seal to keep out ascending infections) **The Myometrium** - Muscle layer of the uterus - Composed of 3 interwoven layers of smooth muscles hence the network offers extreme strength to the organ **UTERINE BLOOD SUPPLY** - Large descending abdominal aorta - 2 iliac arteries - Hypogastric arteries (main divisions of arteries) - Uterine arteries - **Supply the uterus** - Copious and adequate to supply the growing needs of a fetus (not far removed from aorta) - Ovarian artery (direct subdivision of the aorta) joins the uterine artery as a fail-safe system to ensure that the uterus will have an adequate blood supply. **Non-pregnant Women** - The blood vessels that supply the cells and lining the uterus are tortuous against the sides of the uterine body. **Pregnant Women** - As uterus enlarges the vessels unwind and so can stretch to maintain an adequate blood supply to the organ. - Uterine veins follow the same twisting course as arteries; they empty through the internal iliac veins. **Association of Uterine Vessels and the Ureters** - Ureters from the kidney pass directly in back of the ovarian vessels, near fallopian tubes, they cross just beneath the uterine vessels before they enter the bladder **Implication:** - Ureter can be injured by a clamp if bleeding is controlled by clamping of the uterine or ovarian vessels. (tubal ligation procedure, CS birth and hysterectomy-removal of the uterus) **Uterine Nerve Supply** 1. **Efferent Nerve (motor)** - Arise from T5 through T10 spinal ganglia 2. **Afferent Nerve (sensory)** - Join the hypogastric plexus and enter the spinal column at T11 and T12. **Note:** - Sensory innervation from the uterus registers in the lower spinal cord column than does motor control hence pain during labor cannot be tolerated. **Implication:** - Anesthetic solution can be injected near the spinal column to stop the pain of uterine contractions at the T11 and T12 levels without stopping motor control or contractions. (principle of epidural anesthesia) **Uterine Supports** - Uterus is suspended in the pelvic cavity by a number of LIGAMENTS and it is also supported by a combination of fascia and muscle. **POSITIONS OF THE UTERUS** Normally, in majority of women, the uterus is anteverted and anteflexed. 1. **Anteversion: (normal)** - Condition in which the fundus is tipped forward 2. **Anteflexion** - Condition in which the body of the uterus is bent sharply forward at the junction with the cervix 3. **Retroversion** - A condition in which the fundus is stripped back 4. **Retroflexion** - A condition in which the body is bent back just above the cervix In the fetus, the uterus first forms with a septum or a fibrous division, longitudinally separating it into two portions. As fetus matures, this septum dissolves hence at birth no remnant of the division remains. **Some Variations of Uterine Formation (Shape and Position)** 1. Normal uterus 2. Bicornuate uterus -- oddly shaped "horns" at the junction of the fallopian tube. 3. Septum dividing uterus -- if septum never atrophies, uterus remains as two seprate compartment 4. Double uterus Note: - Abnormal shapes allow less placenta implantation space. - Variations interfere with fertility or pregnancy  3. **FALLOPIAN TUBES** - Also known as uterine tubes or oviducts - There are **10-14cm** long - Serve as passageway for the ova as they exit the ovary enroute to the uterus - Free end of each tube ends in fingerlike projections called fimbriae - Fimbriated ends draw ovum into tube through wavelike motions when ovum is released from ovary. **PARTS OF THE FALLOPIAN TUBES** 1. **Interstitial** - **1 cm** segment that penetrates the myometrial wall into the uterine cavity. 2. **Isthmus** - Is the narrow proximal end with simple mucosal folds and a thick muscular wall. (2 cm in length) - Portion that is cut or sealed in a tubal ligation. 3. **Ampulla/Ampullary** - Is the relatively dilated lateral half of the tube with a wide lumen and complex mucosal folds. - Widest, longest portion that spreads into fingerlike projections/fimbriae and it is where fertilization usually occurs. (5 cm in length) 4. **Infundibular** - Is the most distal segment that terminates in mobile tentacle-like fimbriae that become turgid at ovulation entrapping the ovum. - 2 cm long and is funnel shaped. Note: - Since Fallopian Tubes are open at their distal ends, a direct pathway exists from external organs, through the vagina to the uterus, and tubes and the peritoneum. - Pathway makes conception possible - It can also lead to infection of the peritoneum (peritonitis) - Careful clean technique must be used during pelvic exam or tx. - Vaginal exam during labor and birth-sterile technique to ensure no organism can enter. 4. **OVARIES (2)/FEMALE GONADS** - Oval, almond sized, dull white or grayish white sex glands on either side of the uterus that measures 4 by 2 cm in diameter and 1.5 cm thick. - Located close to or and on both sides of the uterus in the lower abdomen. In the surface we can observed: 1. Unruptured, glistening, clear fluid graafian follicle - Ovum to be discharge 2. Miniature yellow corpus luteum - Structure left after the ovum has been discharged. - Function: to produce, mature and discharge ova (egg cell), in the process, the ovaries produce estrogen and progesterone and initiate and regulate menstrual cycles. **After Menopause** - Cessation of ovarian function - Uterus, breast and ovaries all undergo atrophy or a reduction in size because of lack of estrogen. **Ovarian Functions:** - Necessary for maturation & maintenance of secondary sex characteristics - Estrogen secreted by ovaries is important to prevent OSTEOPOROSIS. - Responsible for: - Producing mature ova and releasing them at monthly intervals - Producing hormones necessary for normal growth and development of female - Producing hormones necessary for maintaining pregnancy should it occur **Division & Reproductive Cells (Gametes)** **At Birth** - Each ovary contains approximately 2 million immature ova (oocytes), which were formed during the first 5 months of intrauterine life. - Reproductive cells have only half the usual number of chromosomes **Follicle** - A protective sac or thin layer of oocytes **Primordial Follicle** - Underdeveloped state of follicle - Between 5-7 million are first formed in the utero - At birth 2 million, age 7-500,000 (each of the ovary), by age 22-300,00, menopause-non are left) **Menopause** - No functioning oocytes remain in the ovaries