Anatomy of reproductive system by menbit@ymail.com

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  • At the posterior wall of the bladder the tubes expand to form "ampulla of the vas deferens" and join a duct from the seminal vesicles to form the "ejaculatory duct".
  • aroused,  blood into penis, vessels expand, corpora cavernosa & corpus spongiosum fill & expand > penis erect compression of vessels prevents blood flow out of penis; Engorgement;
  • These ligaments work with the Round and Uterosacral ligaments to suspend female reproductive system in the lower abdomen Significantly different from males where all structures hang
  • Anatomy of reproductive system by menbit@ymail.com

    1. 1. 06/26/13 bitewm@gmail.com 1Anatomy of ReproductiveSystemSystemic AnatomyByBitew M(Msc student)Arbaminch UniversityCollege of Medicine and Health Science
    2. 2. 06/26/13 bitewm@gmail.com 2
    3. 3. 06/26/13 bitewm@gmail.com 3Human Life CycleFigure 16.4
    4. 4. OBJECTIVESWhen you have completed this section, youshould be able to• name male RS organs• describe the structure of the testes;• trace the male reproductive tract anddescribe the gross anatomy and histologyof each organ;• describe the blood supply to the malereproductive tract;• Describe accessory glands.06/26/13 bitewm@gmail.com 4
    5. 5. • Reproduction is one of the fundamentalproperties of all living things.06/26/13 bitewm@gmail.com 5
    6. 6. Part-I:Anatomy ofPart-I:Anatomy ofMale ReproductiveMale ReproductiveSystemSystem06/26/13 bitewm@gmail.com 6
    7. 7. 06/26/13 bitewm@gmail.com 7
    8. 8. 06/26/13 bitewm@gmail.com 8Part-I:Male Reproductive SystemIn conjunction with the femalereproductive system, ensures thesurvival and propagation of the species.Consists of organs whose functions areto produce, transfer, and ultimatelyintroduce sperm into the femalereproductive tract.Secretes male sex hormones(androgens).
    9. 9. 06/26/13 bitewm@gmail.com 9Reproductive System• Reproductive system functions ingamete–Production–Storage–Nourishment–Transport• Fertilization–Fusion of male and female gametes toform a zygote
    10. 10. 06/26/13 bitewm@gmail.com 10Male Reproductive System• Pathway of spermatozoa– Epididymis– Ductus deferens (Vas deferens)– Ejaculatory duct• Accessory organs– Seminal vesicles– Prostate gland– Bulbourethral glands– Scrotal sac encloses testes– Penis
    11. 11. 06/26/13 bitewm@gmail.com 11
    12. 12. 06/26/13 bitewm@gmail.com 1228-12Male PelvisMale Pelvis
    13. 13. 06/26/13 bitewm@gmail.com 1328-13What is Perineum?What is Perineum? Diamond-shaped area between the thighs that iscircumscribed anteriorly by the pubic symphysis,laterally by the ischial tuberosities, and posteriorly bythe coccyx. 2 distinct triangle bases formed by an imaginary horizontal line extending betweenthe ischial tuberosities of the ossa coxae.A.Anterior triangle, or urogenital triangle contains the urethral and vaginal orifices in females contains the base of the penis and the scrotum in males.A.Posterior triangle, or anal triangle location of the anus in both sexes.
    14. 14. 06/26/13 bitewm@gmail.com 1414
    15. 15. 06/26/13 bitewm@gmail.com 15
    16. 16. Boundaries of the perineum Pubic symphysis- anteriorlyInferior pubic rami and ischial rami-anterolaterallyIschial tuberosities- laterallySacrotuberous ligaments-posterolaterallyInferiormost sacrum and coccyx-posteriorly06/26/13 bitewm@gmail.com 16
    17. 17. 06/26/13 bitewm@gmail.com 17
    18. 18. 06/26/13 bitewm@gmail.com 18
    19. 19. 06/26/13 bitewm@gmail.com 1928-19Anatomy of Male Reproductive System• Testes-male gonads• Series of ducts– Epididymides– Ductus deferenS– Ejaculatory duct– Urethra• What are Accessoryglands?– Seminal vesicles– Prostate gland– Bulbourethral{cowpers} glands• Supporting structures– Scrotum• 2 chambered sac thatcontains testes• Dartos and cremastermuscles help regulatetemperature.– Penis• Perineum– Diamond-shapedareas between thighs
    20. 20. 06/26/13 bitewm@gmail.com 20 28-20Male Reproductive Structures
    21. 21. • Spermatic cord=Vasdeferens+Bloodvessels(testicular artery and vein)+nerve(testicular verve).06/26/13 bitewm@gmail.com 21
    22. 22. 06/26/13 bitewm@gmail.com 22
    23. 23. 06/26/13 bitewm@gmail.com 23
    24. 24. 06/26/13 bitewm@gmail.com 24Figure 28.1 The MaleReproductive SystemFigure 28.1
    25. 25. 06/26/13 bitewm@gmail.com 25
    26. 26. 06/26/13 bitewm@gmail.com 26Male reproductive organs• Are classifiedas:A.Essential Organs: Gonads, producegametes/sex cells(sperm).A.Accessory Organs:genital ducts,glands, andsupportingstructures
    27. 27. 06/26/13 bitewm@gmail.com 27 28-27Testes• Glands– Exocrine– Endocrine• Compartments dividedby septa.• Seminiferoustubules-producesperm.• Empty into rete testis• Empties into efferentductules• Interstitial or Leydig cells• Descent– Pass fromabdominal cavitythrough inguinalcanal to scrotum• Cryptorchidism– Failure of of one orboth of testes todescend intoscrotum– Prevents normalsperm development
    28. 28. 06/26/13 bitewm@gmail.com 28Male Gonads >> TestesSmall, flattened, oval shapedglands.Size=4-5 cm long, wgtabout10-15 grams,2.5cm indiameter. Left testis hangs about 1cm lowerin scrotal sac than the right this isimportant ………….. Suspended in scrotum. 2 main functions:- spermatogenesis- secretion ofhormones{androgens}
    29. 29. 06/26/13 bitewm@gmail.com 29 Consist of manylobules (250-300 ineach testis) Each lobule contains:SeminiferousTubules forspermatogenesisInterstitial cells ofLeydig that secretetestosterone
    30. 30. 06/26/13 bitewm@gmail.com 30
    31. 31. 06/26/13 bitewm@gmail.com 31
    32. 32. 06/26/13 bitewm@gmail.com 32Male Reproductive System₫ Sperm produced inthe testes leave viathe tubulus rectusthat conveys themto a network oftubules on one sideof each testis calledthe rete testis.₫ From here thesperm are carriedvia efferent ducts tothe epididymis.
    33. 33. 06/26/13 bitewm@gmail.com 33Male Reproductive System The testes are eachsurrounded by twoprotective coats (ortunics):Tunica VaginalisTunica Vaginalis (outerLayer) extension ofperitoneumTunica AlbugineaTunica Albuginea(Inner Layer) extendsbetween each of thelobules
    34. 34. 06/26/13 bitewm@gmail.com 3434
    35. 35. Scrotum• This literally means "pouch" or "sac"• It is a pouch of skin that is incompletelydivided into left and right halves.• Each half houses one testis.• The appearance of the scrotum changes withtemperature.– Eg. Cold (or sexual arousal) it appears shorter andquite wrinkled, because it is pulled closer to thebody for warmth.– Eg. Heat, the skin is flaccid (loose) and the testeshang lower in the scrotum to keep them cool.• Raphe: external midline seam– Continues on inferior surface of the penis, and toContinues on inferior surface of the penis, and toanus.anus.06/26/13 bitewm@gmail.com 35
    36. 36. 06/26/13 bitewm@gmail.com 36The movement of the scrotum andtestes helps to maintain intra scrotaland hence testicular temperatureconstant .Movement of the scrotum isachieved by two groups of muscles:Dartos Muscle which is a smoothmuscle and causes shrinking of thescrotumCremaster Muscle which is skeletalmuscle and it elevates the testes. It isattached to the internal oblique muscleof the trunk.
    37. 37. 06/26/13 bitewm@gmail.com 37Scrotum• Wall comprised of smooth muscle – theDartos• Cremaster m. (skeletal m.) attached todermis• Temperature control of testes• Sperm development occurs at 35°• Sperm will not develop at bodytemperature.
    38. 38. 06/26/13 bitewm@gmail.com 38Male Reproductive System
    39. 39. 06/26/13 bitewm@gmail.com 39
    40. 40. 06/26/13 bitewm@gmail.com 40
    41. 41. 06/26/13 bitewm@gmail.com 41
    42. 42. 06/26/13 bitewm@gmail.com 4242
    43. 43. 06/26/13 bitewm@gmail.com 43
    44. 44. 06/26/13 bitewm@gmail.com 44Sperm
    45. 45. 06/26/13 bitewm@gmail.com 45Structure of Sperm• Sperm cells consist of:1. Head – containing the nucleus (maleDNA)2. Middle piece and neck – containslarge spiral mitochondrion3. Tail – corkscrew motion to propelsperm Acrosome – membrane bound bag ofenzymes covering head.
    46. 46. 06/26/13 bitewm@gmail.com 46
    47. 47. 06/26/13 bitewm@gmail.com 47Structure of a SpermFigure 16.5b
    48. 48. 06/26/13 bitewm@gmail.com 48Structure of Sperm
    49. 49. 06/26/13 bitewm@gmail.com 49Epididymis• Highly folded ductapprox 6m long, for thepassage of sperm fromthe testis to the vasdeferens.• It has 3 divisions:– Head: connected to thetestes receiving immaturesperm– Body– Tail: continuous with thevas deferens, containssmooth muscle andduring ejaculation,contractions of thesmooth muscle expelmature sperm into thevas deferens.Epididymis isshaped like acomma
    50. 50. • Sperm may be stored in the epididymisfrom 18 hrs - 20 days.• During this time the sperm mature,including becoming motile, so they canfertilize an ovum.06/26/13 bitewm@gmail.com 50
    51. 51. 06/26/13 bitewm@gmail.com 51Figure 28.9 The EpididymusFigure 28.9
    52. 52. 06/26/13 bitewm@gmail.com 52Vas deferens• Short, fairly straight tube approx 45cm long.• Ascends from the scrotum into theabdomen and passes over thebladder.– Tube cut in vasectomy• doesn’t effect erection or performance• Vas deferens stores the sperm.– sperm are mature & motile– the local accumulation of CO2 fromthe normal metabolism of the spermcauses the pH to become acidic.• under these conditions sperm losetheir motility– on ejaculation, the alkaline seminalfluid will counteract the low pH andthe sperm will become motile again.
    53. 53. 06/26/13 bitewm@gmail.com 53
    54. 54. 06/26/13 bitewm@gmail.com 54
    55. 55. 06/26/13 bitewm@gmail.com 55Seminal Vesicles• 2 glands behindprostate gland, size& shape of finger,• secretes viscousfluid = 60-70% ofseminal fluid (nourish& energize sperm)• Also secretefructose, citric acid,amino acids andProstaglandins.
    56. 56. 06/26/13 bitewm@gmail.com 56Ejaculatory ducts• Short tubes thatdescend through theprostate gland andterminate in theurethra.• Formed by the unionof the vas deferensand seminal vesicleducts
    57. 57. 06/26/13 bitewm@gmail.com 57Prostate gland– Chestnut-sized gland belowbladder.– Surrounds the ejaculatory ductand part of the urethra.– Secretes a thin liquid that ismilky, alkaline and constitutes30% of the seminal fluid volume– Responsible for raising the pHof the female vagina.– Provides lubrication duringcoitus Cowper’s Glands– below prostate, 2 pea-sizedglands connect to urethra byducts;– secrete thick, clear mucusbefore ejaculation (at tip ofpenis)– alkaline to protect sperm fromacidic vagina.– Fluid has sperm! (Sperm inurethra > PREGNANT!!)
    58. 58. Hypertrophy of the Prostate• The prostate is of considerable medical interestbecause enlargement or benign hypertrophy ofthe prostate (BHP), is common after middle age,affecting virtually every male who lives longenough• An enlarged prostate projects into the urinarybladder and impedes urination by distorting theprostatic urethra• The middle lobe usually enlarges the most andobstructs the internal urethral orifice; the morethe person strains, the more the valve-likeprostatic mass occludes the urethra06/26/13 bitewm@gmail.com 58
    59. 59. Hypertrophy of the Prostate• BHP is a common cause of urethralobstruction,leading to nocturia (need to voidduring the night), dysuria (difficulty and/orpain during urination), and urgency (suddendesire to void)• BHP also increases the risk of bladderinfections (cystitis) as well as kidneydamage06/26/13 bitewm@gmail.com 59
    60. 60. 06/26/13 bitewm@gmail.com 60
    61. 61. 06/26/13 bitewm@gmail.com 61Urethra• Tube 18-20 cm long.• Conveys urine andsperm (at differenttimes).– Three regions of urethra– Contains glands whichsecrete mucus to aidlubrication duringintercourse.
    62. 62. 06/26/13 bitewm@gmail.com 62
    63. 63. Urethral Catheterization• Is done to remove urine from a person whois unable to micturate• It is also performed to irrigate the bladderand to obtain an uncontaminated sample ofurine• When inserting catheters , the curves of themale urethra must be considered06/26/13 bitewm@gmail.com 63
    64. 64. 06/26/13 bitewm@gmail.com 64
    65. 65. PenisPenisThe penis is the male copulatory organ and,by conveying the urethra, provides thecommon outlet for urine and semen.The penis consists of a root, body, andglans.It is composed of three cylindrical bodies oferectile cavernous tissue: the pairedcorpora cavernosa dorsally and singlecorpus spongiosum ventrally.06/26/13 bitewm@gmail.com 65
    66. 66. 06/26/13 bitewm@gmail.com 66
    67. 67. Penis• Note that in the anatomical position, thepenis is erect; when the penis is flaccid,its dorsum is directed anteriorly06/26/13 bitewm@gmail.com 67
    68. 68. 06/26/13 bitewm@gmail.com 68
    69. 69. 06/26/13 bitewm@gmail.com 69Penis• Copulatory organ of the external genitalia.• Contains 3 compartments of erectile tissue which are covered bya loose layer of skin.• Two "corpora cavernosa"• One "corpus spongiosum" which lies ventrally in the penis and houses thespongy urethra. Expands at the end of the penis into the "glans penis".• When aroused, inc. blood into penis, these compartments fill and expand– Leads to erect penis – compression of vessels prevents blood flow out.
    70. 70. 06/26/13 bitewm@gmail.com 70
    71. 71. 06/26/13 bitewm@gmail.com 71Penis• Erectile tissue is sponge-like containing venoussinuses surrounded by arteries and veins.• Upon sexual stimulation, the arteries dilate and thespaces (or caverns) fill with blood. As they fill, theerectile tissue becomes rigid and the penisbecomes erect.• Two main functions of the penis:– Removal of urine via the urethra– Receipt and ejection of sperm and seminal fluid duringcopulation, again via the urethra.
    72. 72. 06/26/13 bitewm@gmail.com 7228-72Penis
    73. 73. 06/26/13 bitewm@gmail.com 73
    74. 74. 06/26/13 bitewm@gmail.com 74A penis, with foreskin retracted
    75. 75. 06/26/13 bitewm@gmail.com 75
    76. 76. 06/26/13 bitewm@gmail.com 76Penis-external portion isabout 8 to 10 cm8 to 10 cm (3–4 in.)long and 3 cm in diameterwhen flaccid (nonerect);the typical dimensions of anerect penis are 13 to 18 cm13 to 18 cm(5–7 in.) long and 4 cm indiameter.
    77. 77. 06/26/13 bitewm@gmail.com 77
    78. 78. 06/26/13 bitewm@gmail.com 78
    79. 79. 06/26/13 bitewm@gmail.com 79
    80. 80. Arterial Supply of the Penis• The deep arteries of the penis are themain vessels supplying the cavernousspaces in the erectile tissue of the corporacavernosa and are, therefore, involved inthe erection of the penis• They give off numerous branches thatopen directly into the cavernous spaces• When the penis is flaccid, these arteriesare coiled, restricting blood flow; they arecalled hel-icinehel-icine arteries of the penis• 13406/26/13 bitewm@gmail.com 80
    81. 81. 06/26/13 bitewm@gmail.com 81
    82. 82. 06/26/13 bitewm@gmail.com 82
    83. 83. Circumcision• The prepuce of the penis is usually sufficientlyelastic for it to be retracted over the glanspenis• In some males, it fits tightly over the glansand cannot be retracted easily• As there are modified sebaceous glands inthe prepuce, the oily secretions from themaccumulate in the preputial sac, locatedbetween the glans and prepuce, causingirritation.06/26/13 bitewm@gmail.com 83
    84. 84. 06/26/13 bitewm@gmail.com 84
    85. 85. Circumcision Circumcision, surgical excision of theCircumcision, surgical excision of theprepuceprepuce,is the most commonly performedminor surgical operation on male infantsAlthough it is a religious practice inJudaism and Islam, it is often doneroutinely for non-religious reasons (apreference usually explained in terms oftradition or hygiene) in North America06/26/13 bitewm@gmail.com 85
    86. 86. 06/26/13 bitewm@gmail.com 86Circumcision• In uncircumcised males there is a structure thatcovers the end of the glans penis called the"prepuce or foreskin".– Its proposed functions include protection, lubricationof glans, part of sexual pleasure system.uncircumcised circumcised
    87. 87. 06/26/13 bitewm@gmail.com 87
    88. 88. 06/26/13 bitewm@gmail.com 88 28-88Ducts• Epididymis– Site of sperm cellmaturation• Ductus deferens orvas deferens– Passes fromepididymis intoabdominal cavity• Ejaculatory duct– Joining of ductusdeferens andseminal vesicle• Urethra– Extends from urinarybladder to distal endof penis– Passageway forurine and malereproductive fluids– 3 parts• Prostatic urethra• Membranous urethra• Spongy or penileurethra
    89. 89. 06/26/13 bitewm@gmail.com 89The Ejaculate• Ejaculate volume is about 3 ml and rangesfrom 2 to 6 ml.• pH is 7.5, slightly basic to neutralize the acidityof the urethra and the vagina• Of the 3 ml of an ejaculate– About 0.2 ml, originates from the Cowpers gland– About 0.5 ml from the prostate gland– about 2 ml is secreted from the seminal vesicles
    90. 90. Tab.1 Reference values for semen analysis
    91. 91. 06/26/13 bitewm@gmail.com 91Review: Journey of the Sperm
    92. 92. 06/26/13 bitewm@gmail.com 92interstitialcells-testosterone
    93. 93. 06/26/13 bitewm@gmail.com 93spermproductionin theseminferoustubules
    94. 94. 06/26/13 bitewm@gmail.com 94spermstoragein theepididymis
    95. 95. 06/26/13 bitewm@gmail.com 95transportin thevasdeferens
    96. 96. 06/26/13 bitewm@gmail.com 96ampulla -storage
    97. 97. 06/26/13 bitewm@gmail.com 97fluid fromtheseminalvessiclesejaculatoryduct
    98. 98. 06/26/13 bitewm@gmail.com 98fluid fromtheprostategland
    99. 99. 06/26/13 bitewm@gmail.com 99cowper’sgland
    100. 100. 06/26/13 bitewm@gmail.com 100ejaculatioSpinal reflextriggers nerveimpulses toducts, glands,muscles ofreproductivesystem.
    101. 101. 06/26/13 bitewm@gmail.com 101Part-II AnatomyOf FemaleReproductiveSystem
    102. 102. 06/26/13 bitewm@gmail.com 102Objectives When you have completed this section, you shouldbe able to• describe the structure of the ovary;• trace the female reproductive tract and describe thegross anatomy and histology of each organ;• identify the ligaments that support the femalereproductive organs;• describe the blood supply to the female reproductivetract;• identify the external genitals of the female; and• describe the structure of the nonlactating breast.
    103. 103. 06/26/13 bitewm@gmail.com 103Female Reproductive System• In conjunction with the male reproductivesystem, ensures the survival andpropagation of the species.• Female reproductive system also providesprotection and nutrition to the developingoffspring.• Secretes female sex hormones (estrogens)
    104. 104. 06/26/13 bitewm@gmail.com 104
    105. 105. 06/26/13 bitewm@gmail.com 105Female Reproductive Organs
    106. 106. 06/26/13 bitewm@gmail.com 10628-106Anatomy of FemaleReproductive System• Female reproductive organs– Ovaries– Uterine tubes– Uterus– Vagina– External genital organs– Mammary glands
    107. 107. Female Internal GenitalFemale Internal GenitalOrgansOrgans•The female internalgenital organs includethe vagina, uterus,uterine tubes, andovaries06/26/13 bitewm@gmail.com 107
    108. 108. 06/26/13 bitewm@gmail.com 108Female reproductive organs…• Are classified as:• Essential Organs:- Gonads, producegametes/sex cells (ova)• (Testes in men, Ovaries inwomen.)• Accessory Organs:- uterine tubes, uterus,vagina, vulva, and mammaryglands
    109. 109. 06/26/13 bitewm@gmail.com 109Female Gonads >> Ovaries. Its capsule, like that of the testis, is called the tunicaalbuginea.• are almond-shaped organ nestled in theovarian fossa, a depression in the dorsalpelvic wall.• Produce the female gametes (ova).• Secrete female hormones estrogen andprogesterone.• Each one located on one side of the uterus(about 3 gms)• measures about 3 cm long, 1.5 cm wide,and 1 cm thick
    110. 110. • The interior of the ovary is indistinctlydivided into;a)Cortex- an outer, where the germ cellsdevelop, andb)medulla -a central; occupied by the majorarteries and veins .The ovary lacks ducts comparable to theseminiferous tubules.each egg develops in its own fluidfilled,bubble like follicle and is released byovulation.06/26/13 bitewm@gmail.com 110
    111. 111. • held in place by several connective tissueligaments . its medial pole is attached to the uterus by theovarian ligament andits lateral pole is attached to the pelvic wall bythe suspensory ligament.A sheet of peritoneum called the broadligament flanks the uterus on each side andencloses the uterine tube in its superior margin.The margin of the ovary is anchored to thebroad ligament by a peritoneal fold called themesovarium.06/26/13 bitewm@gmail.com 111
    112. 112. 06/26/13 bitewm@gmail.com 112FemaleReproductiveSystemOvaries• The female gonads or sex glands• 2 almond sized glands, either sideof uterus• They develop & expel 1 ovum/mth• A woman is born with about400,000 immature eggs calledfollicles• During a lifetime a womanreleases about 400 to 500 fullymatured eggs for fertilization• The follicles in the ovariesproduce the female sexhormones, progesterone andestrogen• These hormones prepare theuterus for implantation of thefertilized egg
    113. 113. 06/26/13 bitewm@gmail.com 113Ovaries• Each ovary is held in place by 3 ligaments:– Broad ligament: suspends ovaries between the uterus & pelvic wall– Ovarian ligament: attaches ovaries to the uterus– Suspensory ligament: attaches ovaries to the pelvic wall
    114. 114. 06/26/13 bitewm@gmail.com 114• These ligaments work with the Round andUterosacral ligaments to suspend femalereproductive system in the lower abdomen• Significantly different from males where allstructures hang
    115. 115. 06/26/13 bitewm@gmail.com 115Ovaries• Each ovary is covered by 3 layers of epithelial cells –each with different functions:– Nurture developing follicles, secrete hormones, bloodvessels and muscles.
    116. 116. supplied with; an ovarian artery,ovarian veins, andovarian nerves,These all travel through thesuspensory ligament.It receives an additional blood supplyfrom the ovarian branches of the uterinearteries.06/26/13 bitewm@gmail.com 116
    117. 117. 06/26/13 bitewm@gmail.com 117
    118. 118. Uterine tubes• At ovulation, a current draws the oocyte intothe fallopian tube.– Finger-like projections called fimbriae• Infundibulum:– funnel-like structure• Narrows into the ampulla• Constricts further into isthmus as it entersuterus06/26/13 bitewm@gmail.com 118
    119. 119. 06/26/13 bitewm@gmail.com 119Uterine Tubes• Also called “Fallopian” tubes or oviducts.• Extensions of the uterus that “loosely” communicate with theovaries.• Ovum carried through Fallopian tubes to uterus via cilia (tinyhair-like projections).• Fertilization occurs here.• is a canal about 10 cm long from the ovary to the uterus.• At the distal (ovarian) end, it flares into a trumpetshapedinfundibulum with feathery projections calledfimbriae(FIM-bree-ee);• the middle part of the tube is the ampulla; and• near the uterus it forms a narrower isthmus.• The uterine tube is enclosed in the mesosalpinx, which isthe superior margin of the broad ligament.
    120. 120. • The wall of the uterine tube is wellendowed with smooth muscle.• Its mucosa is extremely folded andconvoluted and has an epithelium ofciliated cells and a smaller number ofsecretory cells .• The cilia beat toward the uterus and,with the help of muscular contractions ofthe tube, convey the egg in thatdirection.06/26/13 bitewm@gmail.com 120
    121. 121. Ligation of the Uterine Tubes• Ligation of the uterine tubes is a surgicalmethod of birth control• Oocytes discharged from the ovaries thatenter the tubes of these patients degenerateand are soon absorbed• Most surgical sterilizations are done by tuballigation• Abdominal tubal ligation is usually performedthrough a short suprapubic incision made atthe pubic hairline06/26/13 bitewm@gmail.com 121
    122. 122. 06/26/13 bitewm@gmail.com 122Uterine tubes• Tubal ligation, commonly knows as "getting yourtubes tied," is a surgical sterilization technique forwomen.• This procedure closes the fallopian tubes, andstops the egg from traveling to the uterus fromthe ovary.• It also prevents sperm from reaching the fallopiantube to fertilize an egg.• In a tubal ligation, fallopian tubes are cut, burned,or blocked with rings, bands or clips.• The surgery is effective immediately.– Over 98% effective as birth control.– They do not protect against reproductive tractinfections, including HIV/AIDS.
    123. 123. Ectopic Tubal PregnancyIn some women, collections of pus may develop inthe uterine tube and the tube may be partly occludedby adhesions In these cases, the blastocyst may not be able topass along the tube to the uterus, although spermshave obviously done soThe blastocyst may implant in the mucosa of theuterine tube, producing an ectopic tubal pregnancyAlthough implantation may occur in any part of thetube, the common site is in the ampulla06/26/13 bitewm@gmail.com 123
    124. 124. 06/26/13 bitewm@gmail.com 124
    125. 125. Ectopic pregnancyTubal pregnancy is the most common type ofectopic gestation; it occurs in approximately 1 ofevery 250 pregnancies in North AmericaIf not diagnosed early, ectopic tubal pregnanciesmay result in rupture of the uterine tube and severehemorrhage into the abdominopelvic cavity duringthe first 8 weeks of gestationTubal rupture and the associated hemorrhageconstitute a threat to the mothers life and result indeath of the embryo06/26/13 bitewm@gmail.com 125
    126. 126. 06/26/13 bitewm@gmail.com 126The Uterus• The uterus is a thick muscularchamber that opens into the roof of thevagina and usually tilts forward over theurinary bladder.• function is to harbor the fetus, provide asource of nutrition, and expel the fetusat the end of its development.
    127. 127. 06/26/13 bitewm@gmail.com 127
    128. 128. 06/26/13 bitewm@gmail.com 128
    129. 129. 06/26/13 bitewm@gmail.com 129
    130. 130. 06/26/13 bitewm@gmail.com 130
    131. 131. 06/26/13 bitewm@gmail.com 131
    132. 132. 06/26/13 bitewm@gmail.com 132Uterus• Hollow, thick-walled organ – womb• Receives, retains and nourishes thefertilized egg• Before first pregnancy it is the size andshape of a pear– after first child remains a bit larger
    133. 133. 06/26/13 bitewm@gmail.com 133Female Reproductive SystemUterus consists of:Uterus consists of:a)a) IsthmusIsthmus - slightly narrower region between the body and cervix- slightly narrower region between the body and cervixb)b) FundusFundus - rounded region superior to entrance of fallopian tubes- rounded region superior to entrance of fallopian tubesc)c) BodyBody - major hollow part of the uterus- major hollow part of the uterusd)d) CervixCervix - neck or narrow outlet of the uterus: projects into the vagina- neck or narrow outlet of the uterus: projects into the vagina
    134. 134. 06/26/13 bitewm@gmail.com 134Wall of the Uterus• The uterine wall is highly muscular and consists of3 layers:– Perimetrium - outermost layer (think of perimeter)– Myometrium - thick smooth muscle layer, contracts inchildbirth– Endometrium - mucosal lining, site of implantation forembryo• The endometrium receives a rich blood supplyfrom a complex network in the myometrium sothat it can respond to hormonal changes in theblood– Eg. Pregnancy, stages of menstrual cycle
    135. 135. 06/26/13 bitewm@gmail.com 135Female Reproductive Systemd ligament helps keep the uterus and fallopian tubes in place.
    136. 136. 06/26/13 bitewm@gmail.com 136
    137. 137. 06/26/13 bitewm@gmail.com 137Cervix• The cervix connects the uterus to the vagina• The cervical opening to the vagina is small– This acts as a safety precaution against foreignbodies entering the uterus• During childbirth, the cervix dilates toaccommodate the passage of the fetus• This dilation is a sign that labor has begun
    138. 138. 06/26/13 bitewm@gmail.com 138The Uterus• In a woman who hasnever been pregnantis pear-shaped, 3inches long, 2 incheswide and about aninch thick.• main parts: thebody ,cervix,isthmus,fundus.
    139. 139. 06/26/13 bitewm@gmail.com 28-13928-139Reproductive System
    140. 140. 06/26/13 bitewm@gmail.com 28-140
    141. 141. A. Fundus= a broad superior curvature.B. body (corpus)=a midportion.C. Isthmus=constricted portionD. cervixa= cylindrical inferior end. The uterus measures about 7 cm fromcervix to fundus, 4 cm wide at itsbroadest point, and 2.5 cm thick, but it issomewhat larger in women who havebeen pregnant.06/26/13 bitewm@gmail.com 141
    142. 142. lumen of the uterus is roughlytriangular, with its two upper cornersopening into the uterine tubes.It communicates with the vagina byway of a narrow passage through thecervix called the cervical canal.The superior opening of cervicalcanal into the body of the uterus isthe internal os(oss) and its openinginto the vagina is the external os.06/26/13 bitewm@gmail.com 142
    143. 143. The canal contains cervicalglands that secrete mucus,thought to prevent the spread ofmicroorganisms from thevagina into the uterus.Near the time of ovulation, themucus becomes thinner thanusual and allows easierpassage for sperm.06/26/13 bitewm@gmail.com 143
    144. 144. 06/26/13 bitewm@gmail.com 144Uterine Wall• The uterine wall consistsof;a)Perimetrium- an external serosab)Myometrium- a middle muscular layerc)Endometrium- an inner mucosa
    145. 145. 06/26/13 bitewm@gmail.com 145The myometrium• constitutes most of the wall; it is about 1.25 cmthick in the non pregnant uterus.• composed of bundles of smooth muscle running inall directions, but it is less muscular and morefibrous near the cervix; the cervix itself is almostentirely collagenous.• The smooth muscle cells of the myometrium areabout 40um long immediately after menstruation,but they are twice this long at the middle of themenstrual cycle and 10 times as long in pregnancy.• ThThe function of the myometrium is to produce the labore function of the myometrium is to produce the laborcontractions that help to expel the fetus.contractions that help to expel the fetus.
    146. 146. 06/26/13 bitewm@gmail.com 146The endometriumỔ is the mucosa.Ổ has a simple columnar epithelium, compound tubularglands, and a stroma populated by leukocytes,macrophages, and other cells .Ổ site of attachment of the embryoỔ forms the maternal part of the placentaỔ Has layers;a) stratum functionalis superficial half to two-thirds of it shed in each menstrual period.a) stratum basalis - deeper layer stays behind and regenerates a new functionalis in the nextcycle.
    147. 147. 06/26/13 bitewm@gmail.com 147
    148. 148. 06/26/13 bitewm@gmail.com 148Female Reproductive System
    149. 149. 06/26/13 bitewm@gmail.com 14928-149Uterus, Vagina, Uterine Tubes, Ovaries andSupporting Ligaments
    150. 150. 06/26/13 bitewm@gmail.com 150Functions of the UterusPassage for sperm to ascendto the uterine (fallopian)tubes.If no conception orimplantation, menstruation.Site of implantation forszygote.Creates labor “contractions”.
    151. 151. 06/26/13 bitewm@gmail.com 151Normal and abnormalpositions of the uterus.
    152. 152. • Blood Supply= A uterine artery arisesfrom each internal iliac artery.Ligaments• The uterus is supported by; the muscular floor of the pelvic outletandfolds of peritoneum that form supportiveligaments around the organ.as they do for the ovary and uterine tube.06/26/13 bitewm@gmail.com 152
    153. 153. A. The broad ligament has two parts: themesosalpinx and the mesometrium oneach side of the uterus.B. The cervix and superior part of the vaginaare supported by cardinal (lateralcervical) ligaments extending to the pelvicwall.C. A pair of uterosacral ligaments attachthe dorsal side of the uterus to the sacrum.06/26/13 bitewm@gmail.com 153
    154. 154. 06/26/13 bitewm@gmail.com 154
    155. 155.  a pair of round ligaments attach the ventralsurface of the uterus to the abdominal wall.• The round ligaments continue through theinguinal canals and terminate in the labia majora,much like the gubernaculum of the maleterminating in the scrotum.• As the peritoneum folds around the various pelvic organs,it creates several dead-end recesses and pouches. Two major ones are the vesicouterinepouch, which forms the space betweenthe uterus and urinary bladder, andrectouterine pouch between the uterus andrectum.06/26/13 bitewm@gmail.com 155
    156. 156. 06/26/13 bitewm@gmail.com 156
    157. 157. 06/26/13 bitewm@gmail.com 157
    158. 158. Uterine cavityThe uterine cavity (in particular, the cervicalcanal) and the lumen of the vagina togetherconstitute the birth canal through which thefetus passes at the end of gestation. i.e.• birth canal = cervical canal + lumen ofbirth canal = cervical canal + lumen ofvaginavagina06/26/13 bitewm@gmail.com 158
    159. 159. 06/26/13 bitewm@gmail.com 159
    160. 160. The VaginaThe vagina is a muscular tube that extendsupward and backward from the vulva to theuterusIt measures about 8-10 cm long and has anteriorand posterior walls, which are normally inappositionAt its upper end, the anterior wall is pierced bythe cervix, which projects downward andbackward into the vaginaThe upper half of the vagina lies above the pelvicfloor and the lower half lies within the perineum06/26/13 bitewm@gmail.com 160
    161. 161. 06/26/13 bitewm@gmail.com 161Vagina• Thin-walled, fibromuscular tube, 8-10 cm long.• Lies between the bladder and rectum.• Extends from cervix of uterus to exterior of body.• Birth canal (and passage for menses).• Female copulatory organ.• Vaginal mucosa has NO glands.– With the help of two Bartholin’s glands (outsidevagina) becomes lubricated during Sexualintercourse.
    162. 162. 06/26/13 bitewm@gmail.com 162Vagina• Fornix at proximal end (meets cervix of uterus)there is a fold - this is a potential site forinfection in the female reproductive tract.
    163. 163. The VaginaThe area of the vaginal lumen, whichsurrounds the cervix, is divided into fourregions, or fornices: anterior, posterior, rightlateral, and left lateralThe vaginal orifice in a virgin possesses athin mucosal fold called the hymenhymen, which isperforated at its centerAfter childbirth/sexual intercourse the hymenusually consists only of tags.06/26/13 bitewm@gmail.com 163
    164. 164. 06/26/13 bitewm@gmail.com 164The Vagina• Hymen –is found in thosewho didn’t have the firstsex in their life time(virgins) ;at distal end(external opening) theremay be an extension ofthe mucosa partly orcompletely covering thevaginal orifice– highly vascular and oftenbleeds after first sexualintercourse as it is ruptured
    165. 165. 06/26/13 bitewm@gmail.com 165
    166. 166. 06/26/13 bitewm@gmail.com 166Vagina• Tubular organ in front of rectum and behindthe bladder & urethra.• During sexual intercourse, the lininglubricates and stimulates the glans penistriggering ejaculation.• Serves as a receptacle for semen.• Lower portion of birth canal.• Transports blood and tissues duringmenstruation.birth canal, is a tube about 8 to 10 cm long thatallows for the discharge of menstrual fluid, receipt ofthe penis and semen, and birth of a baby.
    167. 167. 06/26/13 bitewm@gmail.com 167The vaginal wall• It is thin but very distensible. The vagina can bemarkedly distended, particularly in the region of theposterior part of the fornix• It consists of an outer adventitia, a middlemuscularis, and an inner mucosa. The vagina tiltsdorsally between the urethra and rectum; theurethra is embedded in its anterior wall.• The vagina has no glands, but it is lubricated by thetransudation (“vaginal sweating”) of serous fluidthrough its walls and by mucus from the cervicalglands above it. The vagina extends slightly beyond thecervix and forms blind-ended spaces calledfornices(singular, fornix).
    168. 168. • At its lower end, the vaginal mucosa foldsinward and forms a membrane, thehymen, which stretches across theorifice.• The hymen has one or more openings toallow menstrual fluid to pass through, but itusually must be ruptured to allow forintercourse.• The lower end of the vagina also hastransverse friction ridges, or vaginalrugae, which stimulate the penis andhelp induce ejaculation.06/26/13 bitewm@gmail.com 168
    169. 169. • The vaginal epithelium is simpleThe vaginal epithelium is simplecuboidalcuboidal in childhood, but theestrogensestrogens of puberty stimulate itto transform into a stratifiedsquamous epithelium. This isan example of metaplasiametaplasia, thetransformation of one tissuetype to another06/26/13 bitewm@gmail.com 169
    170. 170. • The epithelial cells are rich in glycogen.• Bacteria ferment this to lactic acidlactic acid, whichproduces a low vaginal pH (about 3.5–4.0)that inhibits the growth of pathogens.• This acidity is neutralized by the semen soit does not harm the sperm.• The mucosa also has antigen-presentingantigen-presentingcells called dendritic cells, which are aroute by which HIV from infected semeninvades the female body.06/26/13 bitewm@gmail.com 170
    171. 171. The VaginaServes as a canal for menstrual fluidForms the inferior part of the birth canalReceives the penis and ejaculate duringsexual intercourse06/26/13 bitewm@gmail.com 171
    172. 172. 06/26/13 bitewm@gmail.com 172
    173. 173. The Vagina4 muscles compress the vagina and act assphinctersa. pubovaginalis,b. external urethral sphincter,c. urethrovaginal sphincter, andd. bulbospongiosus06/26/13 bitewm@gmail.com 173
    174. 174. 06/26/13 bitewm@gmail.com 174
    175. 175. Digital Examination through theDigital Examination through theVaginaVagina• Because of its relatively thin, distensiblewalls and central location within the pelvis,the cervix, ischial spines, and sacralpromontory can be palpated with the digitsin the vagina and/or rectum (manual pelvicexamination)• Pulsations of the uterine arteries may alsobe felt through the lateral parts of thefornix, as may irregularities of the ovaries,such as cysts06/26/13 bitewm@gmail.com 175
    176. 176. 06/26/13 bitewm@gmail.com 176
    177. 177. Vaginal Fistulae Because of the close relationship of thevagina to adjacent pelvic organs, obstetricaltrauma during long and difficult labor mayresult in weaknesses, ecrosis, or tears inthe vaginal wall and sometimes beyondThese may form or subsequently developinto open communications (fistulas)between the vaginal lumen and that of theadjacent bladder, urethra, rectum, orperineum06/26/13 bitewm@gmail.com 177
    178. 178. Vaginal Fistulae• Urine enters the vagina from bothvesicovaginal and urethrovaginal fistulas;but the flow is continuous from the formerand occurs only during micturition from thelatter• Fecal matter may be discharged from thevagina when there is a rectovaginal fistula06/26/13 bitewm@gmail.com 178
    179. 179. 06/26/13 bitewm@gmail.com 179
    180. 180. 06/26/13 bitewm@gmail.com 181
    181. 181. Female Perineum• The female perineum includes the femaleexternal genitalia, perineal muscles, andanal canal06/26/13 bitewm@gmail.com 182
    182. 182. The Female External Genitalia• Include the mons pubis and labia majora , labiaminora , clitoris, bulbs of the vestibule, andgreater and lesser vestibular glands.• The synonymous terms vulva includes all theseparts.• The vulva serves:As sensory and erectile tissue for sexual arousaland intercourseTo direct the flow of urineTo prevent entry of foreign material into theurogenital tract06/26/13 bitewm@gmail.com183
    183. 183. 06/26/13 bitewm@gmail.com 184The Vulva (Pudendum)The external genitalia of thefemale are collectively called thevulva (pudendum).this includes the mons pubis, labiamajora and minora, clitoris, vaginal orifice,and accessory glands and erectile tissues.It occupies most of the perineum.
    184. 184. 06/26/13 bitewm@gmail.com 185
    185. 185. Mons Pubis Is the rounded, fatty eminence anterior to the pubicsymphysis, pubic tubercles, and superior pubic rami. Themons pubis consists mainly of a mound of adiposetissue overlying the pubic symphysis. The eminence is formed by a mass of fatty subcutaneoustissue The amount of fat increases at puberty and decreases aftermenopause The surface of the mons is continuous with the anteriorabdominal wall After puberty, the mons pubis is covered with coarse pubichairs.06/26/13 bitewm@gmail.com186
    186. 186. 06/26/13 bitewm@gmail.com 187
    187. 187. Labia MajoraThe labia majora are prominent folds of skinthat provide protection for the urethral andvaginal orificesEach labium majus largely filled with a finger-like digital process of loose subcutaneoustissue containing smooth muscle and thetermination of the round ligament of theuterus passes infero-posteriorly from themons pubis toward the anus06/26/13 bitewm@gmail.com 188
    188. 188. 06/26/13 bitewm@gmail.com 189
    189. 189. • The labia majora (singular, labiummajus) are a pair of thick folds of skinand adipose tissue inferior to the mons;the slit between them is the pudendal cleft.• Pubic hair grows on the mons pubis andlateral surfaces of the labia majora atpuberty, but the medial surfaces of thelabia remain hairless.06/26/13 bitewm@gmail.com 190
    190. 190. Labia Majora The labia majora lie on the sides of acentral depression (a narrow slit whenthe thighs are adducted), the pudendalcleft, within which are the labia minoraand vestibule06/26/13 bitewm@gmail.com 191
    191. 191. Labia Majora The external aspects of the labia majora inthe adult are covered with pigmented skincontaining many sebaceous glands and arecovered with crisp pubic hair The internal aspects of the labia aresmooth, pink, and hairlessThe labia are thicker anteriorly where theyjoin to form the anterioranterior commissurecommissure06/26/13 bitewm@gmail.com 192
    192. 192. 06/26/13 bitewm@gmail.com 193
    193. 193. Labia Majora Posteriorly, in nulliparous women(never having borne children) theymerge to form a ridge, the posteriorthe posteriorcommissurecommissure, which overlies theperineal body and is the posterior limitof the vulvaThis commissure usuallyThis commissure usuallydisappears after the first vaginaldisappears after the first vaginalbirthbirth06/26/13 bitewm@gmail.com 194
    194. 194. 06/26/13 bitewm@gmail.com 195
    195. 195. Labia Minora Are rounded folds of fat-free, hairless skinAre enclosed in the pudendal cleft and immediatelysurround the vestibule into which both the externalurethral and the vaginal orifices openHave a core of spongy connective tissuecontaining erectile tissue at their base and manysmall blood vessels Anteriorly, the labia minora form two laminaThe medial laminae of each side unite as thefrenulum of the clitoris06/26/13 bitewm@gmail.com 196
    196. 196. 06/26/13 bitewm@gmail.com 197
    197. 197. Labia Minora The lateral laminae unite anterior to the glans of theclitoris, forming the prepuce (foreskin) of the clitoris In young women, especially virgins, the labiaIn young women, especially virgins, the labiaminora are connected posteriorly by a smallminora are connected posteriorly by a smalltransverse fold, the frenulum of the labia minoratransverse fold, the frenulum of the labia minora(fourchette)(fourchette) Although the internal surface of each labium minusconsists of thin moist skin, it has the pink colortypical of mucous membrane and contains manysebaceous glands and sensory nerve endings06/26/13 bitewm@gmail.com 198
    198. 198. 06/26/13 bitewm@gmail.com 199
    199. 199. Clitoris Is an erectile organ located where thelabia minora meet anteriorlyThe clitoris consists of a root and a body,which are composed of two crura; twocorpora cavernosa; and the glans of theclitoris, which is covered by a prepuceTogether, the body and glans of the clitorisare approximately 2 cm in length and < 1cm in diameter06/26/13 bitewm@gmail.com 200
    200. 200. • The clitoris is highly sensitive andenlarges on tactile stimulationThe glans of the clitoris is the most highlyinnervated part of the clitoris and isdensely supplied with sensory endings06/26/13 bitewm@gmail.com 201
    201. 201. 06/26/13 bitewm@gmail.com 202
    202. 202. • Medial to the labia majora are the muchthinner, entirely hairless labia minora(singular, labium minus).• The area enclosed by them, called thevestibule, contains the urinary andvaginal orifices.• At the anterior margin of the vestibule,the labia minora meet and form ahoodlike prepuce over the clitoris.• The clitoris is structured much like aminiature penis but has no urinaryrole.06/26/13 bitewm@gmail.com 203
    203. 203. • Its function is entirely sensory, serving asthe primary center of erotic stimulation.• Unlike the penis, it is almost entirelyinternal, it has no corpus spongiosum,and it does not enclose the urethra.• Essentially, it is a pair of corporacavernosa enclosed in connective tissue.• Its glans protrudes slightly from theprepuce.• The body (corpus) passes internally,inferior to the pubic symphysis .06/26/13 bitewm@gmail.com 204
    204. 204. • Like the penis, the clitoris is supplied bythe interna pudendal arteries, also calledthe clitoral arteries in the female.• Just deep to the labia majora, a pair ofsubcutaneous erectile tissues called thevestibular bulbs bracket the vagina likeparentheses.• They become congested with bloodduring sexual excitement and cause thevagina to tight somewhat around thepenis, enhancing sexual stimulation.06/26/13 bitewm@gmail.com 205
    205. 205. • On each side of the vagina is a pea-sizedgreater vestibular (Bartholin) gland witha short duct opening into the vestibule orlower vagina .• These glands are homologous to thebulbourethral glands of the male.• They keep the vulva moist, and duringsexual excitement they provide most of thelubrication for intercourse.• The vestibule is also lubricated by anumber of lesser vestibular glands.06/26/13 bitewm@gmail.com 206
    206. 206. • A pair of mucous paraurethral(Skene) glands, homologous to themale prostate, open into the vestibulenear the external urethral orifice.• External Genitalia, collectively called theVulva:• Mons Pubis– fatty, rounded area over the pubic area– During adolescence sex hormones trigger thegrowth of pubic hair on the mons pubis06/26/13 bitewm@gmail.com 207
    207. 207. vestibule• The size and appearance of the vaginalorifice vary with the condition of thehymen, a thin anular fold of mucousmembrane immediately within thevaginal orifice surrounding the lumen• After its rupture, only remnants of thehymen, hymenal caruncles (tags), arevisible• These remnants demarcate the vaginafrom the vestibule06/26/13 bitewm@gmail.com 208
    208. 208. 06/26/13 bitewm@gmail.com 209
    209. 209. • The hymen has no established physiologicalfunction• It is considered primarily a developmentalvestige, but its condition (and that of thefrenulum of the labia minora) often providescritical evidence in cases of child abuse andrape06/26/13 bitewm@gmail.com 210
    210. 210. 06/26/13 bitewm@gmail.com 211
    211. 211. 06/26/13 bitewm@gmail.com 212Female Reproductive System
    212. 212. 06/26/13 bitewm@gmail.com 213Female Reproductive System• Labia Majora• 2 fatty skin folds that arehomologous with the malescrotum• “Outer lips” – darkerpigmentation• Protective covering• Are covered with hair andsebaceous glands• Become flaccid with ageand after childbirth• Swell during intercourse
    213. 213. 06/26/13 bitewm@gmail.com 214Female Reproductive System• Labia Minora• “Inner lips”• smaller folds covered withmucosa and richly suppliedwith sebaceous glands• Made up of erectile,connective tissue thatdarkens and swells duringsexual arousal• Located inside the labiamajora• They are more sensitive andresponsive to touch than thelabia majora• The labia minora tightensduring intercourse
    214. 214. 06/26/13 bitewm@gmail.com 215Female Reproductive System• Clitoris• Contains erectile cavernoustissue like the penis• Richly supplied with nerves,and so is one of the mostsensitive areas for women• Engorges with blood uponsexual arousal• Housed in a hood of tissue(prepuce) formed by thejunction of labia minora• Highly sensitive organcomposed of nerves, bloodvessels, and erectile tissue• Key to sexual pleasure formost women
    215. 215. 06/26/13 bitewm@gmail.com 216Female Reproductive System• Urethra– Opening located directlybelow clitoris– Passage of urine• Vaginal Opening– Opening may be coveredby a thin sheath called thehymen– Using the presence of anintact hymen fordetermining virginity iserroneous– Some women are bornwithout a hymen– The hymen can beperforated by manydifferent events
    216. 216. 06/26/13 bitewm@gmail.com 217Female Reproductive System• Vestibular Glands– Greater vestibular(Bartholins)• 2, posterior, mucoussecreting, can plugand make cysts,reservoir for VD– Lesser vestibular(Skenes)• 2, anterior toopening of thevagina, mucousproducing
    217. 217. 06/26/13 bitewm@gmail.com 218218
    218. 218. 06/26/13 bitewm@gmail.com 219
    219. 219. 06/26/13 bitewm@gmail.com 220
    220. 220. 06/26/13 bitewm@gmail.com 28-22128-221Female External Genitalia Vulva or pudendum orexternal female genitaliaVestibule: SpaceLabia minora: Formborders on sidesClitoris: Erectilestructure-Corpora cavernosa-Corpora spongiosaLabia majora-Unite to form monspubis
    221. 221. 06/26/13 bitewm@gmail.com 22228-222Female Perineum
    222. 222. 06/26/13 bitewm@gmail.com 223VULVA = External Female Genitalia
    223. 223. VaginismusVaginismusAn emotional (psychosomatic)gynecological disorderVaginismus is encountered clinicallywhen pelvic examination is attemptedIn mild forms, it causes dyspareunia(painful intercourse); in severe forms, itprevents vaginal entry and is reportedly acause of unconsummated marriages06/26/13 bitewm@gmail.com 224
    224. 224. Episiotomy• During vaginal surgery and labor, anepisiotomy (surgical incision of the perineumand inferoposterior vaginal wall) is oftenmade to enlarge the vaginal orifice• It was long held that episiotomy decreasesthe prevalence of excessive perineal bodyattenuation and decreases trauma to thepelvic diaphragm,preventing jagged tears ofthe perineal muscles06/26/13 bitewm@gmail.com 225
    225. 225. 06/26/13 bitewm@gmail.com 226
    226. 226. Episiotomy• It is generally agreed that episiotomy isindicated when descent of the fetus isarrested or protracted, when instrumentationis necessary (e.g., use of obstetricalforceps), or to expedite delivery when thereare signs of fetal distress06/26/13 bitewm@gmail.com 227
    227. 227. 06/26/13 bitewm@gmail.com 228
    228. 228. 06/26/13 bitewm@gmail.com 229229
    229. 229. The Female Breast06/26/13 bitewm@gmail.com 230
    230. 230. 06/26/13 bitewm@gmail.com 231
    231. 231. 06/26/13 bitewm@gmail.com 232The Female Breast• Mammary Glands: Internal Structure• Each mammary gland is made up or 15-25 lobesup or 15-25 lobesthat radiate around the nipple• Each lobule is connected by lactiferous ducts thatopen into the nipples (gets milk to nipple)• Lobes contain– Alveolar Glands produce milk during lactation• Lobes are separated by connective tissue and fat• There are suspensory ligaments in theconnective tissue that attach the breasts to thepectoral muscles of the chest
    232. 232. 06/26/13 bitewm@gmail.com 233
    233. 233. 06/26/13 bitewm@gmail.com 234
    234. 234. 06/26/13 bitewm@gmail.com 235
    235. 235. 06/26/13 bitewm@gmail.com 236
    236. 236. 06/26/13 bitewm@gmail.com 237
    237. 237. 06/26/13 bitewm@gmail.com 238The Female Breast
    238. 238. 06/26/13 bitewm@gmail.com 239239
    239. 239. 06/26/13 bitewm@gmail.com 240240
    240. 240. 06/26/13 bitewm@gmail.com 28-24128-241Mammary Glands• Organs of milkproduction locatedwithin mammae orbreasts– Consist ofglandular lobesand adipose tissue– Cooper’sligaments supportthe breasts.
    241. 241. 06/26/13 bitewm@gmail.com 242Female Breasts• Lie over pectoral muscles.• Development controlled byestrogen and progesterone.• Breast size determined byamount of fat surroundingglandular tissue so function isnotnot related to size.• Main function is lactation fornourishment of newborn infants.• Lactation is important for:- nutrients- antibodies- bonding
    242. 242. 06/26/13 bitewm@gmail.com 243
    243. 243. THANK YOU!!

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