Gynecological Anatomy & Physiology


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Gynecological Anatomy & Physiology

  1. 2. REPRODUCTIVE AND SEXUAL HEALTH <ul><li>PUBERTAL DEVELOPMENT: </li></ul><ul><li>Puberty is the stage of life at which the secondary sex changes </li></ul><ul><li>Girls - age 10 to13 years </li></ul><ul><li>Theory: must reach a critical weight of approx. 95lbs (43kgs) </li></ul><ul><li>Boys - age 12 to 14 years </li></ul><ul><ul><li>The role of Androgen- hormones responsible for : </li></ul></ul><ul><ul><ul><li>Muscular development </li></ul></ul></ul><ul><ul><ul><li>Physical growth </li></ul></ul></ul><ul><ul><ul><li>Increase sebaceous gland secretion (acne) </li></ul></ul></ul><ul><ul><li>“ Testosterone -1° androgenic hormone” </li></ul></ul><ul><ul><li>In girls, testosterone influences the development of </li></ul></ul><ul><ul><li>labia majora, clitoris, and axillary & pubic hair latter termed as (adrenarche) </li></ul></ul>
  2. 3. REPRODUCTIVE AND SEXUAL HEALTH <ul><li>Secondary sex characteristic of boys occurs in order: </li></ul><ul><ul><ul><li>increase in weight </li></ul></ul></ul><ul><ul><ul><li>growth of testes </li></ul></ul></ul><ul><ul><ul><li>growth of face, axillary, and pubic hair </li></ul></ul></ul><ul><ul><ul><li>voice changes </li></ul></ul></ul><ul><ul><ul><li>penile growth </li></ul></ul></ul><ul><ul><ul><li>increase in height </li></ul></ul></ul><ul><ul><ul><li>spermatogenesis </li></ul></ul></ul><ul><li>Secondary sex characteristic of girls occurs in order: </li></ul><ul><li>1. growth spurt </li></ul><ul><li>2. increase in the traverse diameter of the pelvis </li></ul><ul><li>3. breast development (thelarche) </li></ul><ul><li>4. growth of pubic hair (adrenarche) </li></ul><ul><li>5. onset of menstruation (menarche 12.5 y/o ave.) </li></ul><ul><li>6. Ovulation occurs 1 – 2 years after menarche </li></ul><ul><li>7. growth of axillary hair (adrenarche) </li></ul><ul><li>8. vaginal secretion </li></ul>
  3. 4. FEMALE REPRODUCTIVE SYSTEM: GYNECOLOGY <ul><li>External Structures </li></ul><ul><ul><li>Mons pubis/ Mons veneris – pad of adipose tissues, which lives over the symphysis pubis, which protects the surrounding delicate tissue from trauma. </li></ul></ul><ul><ul><li>Labia majora – longitudal folds of pigmented skin extending from the mons pubis to the perineum. Contains the Bartholin’s gland that secretes yellowish mucus that acts as a lubricant during sexual activity. </li></ul></ul><ul><ul><li>Labia minora – soft longitudal skin folds between the Labia majora. </li></ul></ul><ul><ul><li>Glans clitoris – erectile tissue located at the upper end of Labia minora; primary site of sexual arousal. </li></ul></ul>
  4. 5. FEMALE REPRODUCTIVE SYSTEM: <ul><li>External Structures continue </li></ul><ul><ul><li>5. Vestibule – a narrow space seen when labia minora are separated that also contains the vaginal introitus, Bartholin’s gland and urethral meatus. </li></ul></ul><ul><ul><li>6. Urethral Meatus – small opening bet, the clitoris and vaginal orifice for the purpose of urination. </li></ul></ul><ul><ul><li>7. Vaginal orifice/introitus/opening – external opening of the vagina that contains the hymen. </li></ul></ul><ul><ul><li>8. Hymen – a membranous tissue ringing the vaginal introitus </li></ul></ul><ul><ul><li>9. Perineum – tissue between the anus and vagina. Site of episiotomy </li></ul></ul><ul><ul><li>The external genitalia’s blood supply: </li></ul></ul><ul><ul><li>Arteries: a. pudental artery b. inferior rectus artery. </li></ul></ul><ul><ul><li>Vein: Pudendal vein </li></ul></ul>
  5. 8. FEMALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures </li></ul><ul><li>Ovaries – female sex glands located on each side of the uterus with two ovaries (4 x 2 x 1.5 cm thick). </li></ul><ul><ul><li>Ovaries are formed with 3 principal divisions: </li></ul></ul><ul><ul><li>a. A protective layer of surface epithelium </li></ul></ul><ul><ul><li>b. The cortex filled with the ovarian and graafian follicle </li></ul></ul><ul><ul><li>c. The central medulla containing nerves, blood vessels, lymphatic tissue and some smooth muscle tissue </li></ul></ul><ul><ul><li>Fxn: - Ovulation (release of ovum) and Secretion of hormones like estrogen and progesterone . </li></ul></ul><ul><ul><li>Estrogen - help to prevents osteoporosis, and atherosclerosis </li></ul></ul><ul><ul><li>and potential risk for breast cancer endometrial cancer </li></ul></ul>
  6. 9. FEMALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures continue </li></ul><ul><li>2. Fallopian Tubes – 4 inches (10 cm) long from each sides of the fundus; </li></ul><ul><li>Divided on four separate part: </li></ul><ul><ul><li>1. Intramural portion- most proximal (1cm in length) </li></ul></ul><ul><ul><li>2. Isthmus portion- extremely narrow (2cm) </li></ul></ul><ul><ul><li>Important: tubal ligation </li></ul></ul><ul><ul><li>3. Ampulla- longest portion (5cm) and widest part </li></ul></ul><ul><ul><li>Function: site of fertilization </li></ul></ul><ul><ul><li>4. Infundibular portion- funnel shape with Fimbrae (2cm) finger like projections. </li></ul></ul><ul><ul><li>Function: responsible for the transport of mature ovum from ovary to uterus. </li></ul></ul>
  7. 12. FEMALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures continue </li></ul><ul><li>3. Uterus – hollow pear-shaped muscular organ. </li></ul><ul><ul><li>Size: 3 inches long (5-7cm), 2 inches wide(5cm) and 1 inch thick (3x2x1) </li></ul></ul><ul><ul><li>Wt: 60 gms. in non pregnant Location: lower pelvis </li></ul></ul><ul><ul><li>Parts: Corpus, Isthmus, and Cervix </li></ul></ul><ul><ul><li>Position: anteverted and anteflexed </li></ul></ul><ul><ul><li>Layers: perimetrium, myometrium and endometrium </li></ul></ul><ul><ul><li>Function: </li></ul></ul><ul><ul><li>1. to receive the ova to fallopian tube place for implantation and nourishment during fetal growth furnish protection to a growing fetus </li></ul></ul><ul><ul><li>2. aids in labor and delivery </li></ul></ul><ul><li>Cervix (2-5cm long) </li></ul><ul><li>Internal cervical os -an impt. relationship in estimating the External cervical os level of dilatation of the fetus in the birth canal before birth. </li></ul>
  8. 19. FEMALE REPRODUCTIVE SYSTEM: <ul><li>Uterus continue </li></ul><ul><li>Nerve Supply: </li></ul><ul><ul><li>Efferent (motor) nerve- spinal ganglia (T5 to T10) </li></ul></ul><ul><ul><li>Afferent (sensory) nerve - hypogastric plexus (T-11 & T-12) </li></ul></ul><ul><ul><li>Impt: Controlling pain in labor ( Epidural anesthesia) </li></ul></ul><ul><li>Uterine Ligaments: </li></ul><ul><ul><li>1. Broad Ligaments – fr. the sides of uterus to pelvic walls </li></ul></ul><ul><ul><li>2. Round Ligaments – fr. sides of uterus to mons pubis. </li></ul></ul><ul><ul><li>3. Cardinal and uterosacral ligaments- provides middle support </li></ul></ul><ul><ul><li>4. Pelvic muscular floor ligaments- provide lower support </li></ul></ul>
  9. 23. FEMALE REPRODUCTIVE SYSTEM: <ul><li>3. Vaginal Canal – 3-4 inch long dilatable canal between the bladder and the rectum; contains rugae that permits stretching without tearing. </li></ul><ul><li>Anterior Vaginal wall- 6-7 cm (anterior fornices) </li></ul><ul><li>Posterior Vaginal wall- 8-9 cm (posterior fornices) </li></ul><ul><ul><li>Function: 1. passageway for menstrual discharges </li></ul></ul><ul><ul><li>2. receives penis during intercourse and </li></ul></ul><ul><ul><li>3. serves as birth canal. </li></ul></ul><ul><ul><li>- lined with stratified squamous epithelium </li></ul></ul><ul><ul><li>- Bulbocavernosus : a circular muscle acts as voluntary sphincter (Kegel exercises) </li></ul></ul><ul><li>Blood supply to the vagina: </li></ul><ul><li>Arteries: vaginal artery branch of internal iliac artery </li></ul><ul><li>Vein: pudental vein </li></ul>
  10. 24. FEMALE REPRODUCTIVE SYSTEM: <ul><li>Vagina continue … </li></ul><ul><li>The external genitalia’s blood supply : mainly from the </li></ul><ul><li>a. pudental artery and </li></ul><ul><li>b. a portion of inferior rectus artery. </li></ul><ul><li>Nerve supply: has both parasympathetic & sympathetic </li></ul><ul><li>(S-1 to S-3 levels) </li></ul><ul><ul><li>Nerve supply of the anterior portion: (L1) </li></ul></ul><ul><ul><li>a. Ilio-inguinal nerves b. Genito-femoral nerves </li></ul></ul><ul><ul><li>Nerve supply of the posterior portion: (S3) </li></ul></ul><ul><ul><li> Pudendal nerves </li></ul></ul><ul><li>“ This is the reason why one type of anesthesia used for childbirth is called Pudendal block.” </li></ul>
  11. 28. MALE REPRODUCTIVE SYSTEM: ANDROLOGY <ul><li>A. External Structures </li></ul><ul><ul><li>1. Penis : the male organ of copulation; a cylindrical shaft consisting of: </li></ul></ul><ul><ul><li>a. corpora cavernosa - t wo lateral columns of erectile tissue </li></ul></ul><ul><ul><li>b. corpus spongiosum - encases the urethra </li></ul></ul><ul><ul><ul><li>-The glans penis , a cone-shaped expansion of the corpus spongiosum that is highly in express males. </li></ul></ul></ul><ul><ul><ul><li>- Erection is stimulated by parasympathetic nerve </li></ul></ul></ul><ul><ul><li>Scrotum : a pouch hanging below the penis that contains the testes . </li></ul></ul><ul><ul><li>3. Testes: two solid ovoid organs 4-5 cm long and 2-3 wide , divided into lobes containing </li></ul></ul><ul><ul><li>Seminiferous tubules - produce spermatozoa. </li></ul></ul><ul><ul><li>Leydig cells - testosterone production . </li></ul></ul>
  13. 32. MALE REPRODUCTIVE SYSTEM: A. External Structures continue SPERMATOZOA are produced by: Hypothalamus Control by GnRH (+/-) feedback Anterior Pituitary gland FSH / LH Testes FSH - release of Androgen Binding Protein (ABP) which promote SPERMATOGENESIS LH - release of Testosterone. “ Spermatozoa does not survive at body temperature. They usually survive 1°F lower than body temperature”.
  14. 33. MALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures </li></ul><ul><ul><li>1. Epididymis: serves as reservoir for sperm storage and maturation. Approximately 20 ft. it takes 12-20 days for the sperm to travel the length of Epididymis. </li></ul></ul><ul><ul><li>A total of 64 days before they reach maturity. </li></ul></ul><ul><ul><li>(“Treatment= 2 months” ). </li></ul></ul><ul><ul><ul><li>Aspermia - (absence of sperm) </li></ul></ul></ul><ul><ul><ul><li>Oligospermia- if < 20 million sperm/ ml </li></ul></ul></ul><ul><ul><li>2. Vas deferens: a duct extending from epididymis to the ejaculatory duct and seminal vesicle, providing a passageway for sperm. (sperm mature). </li></ul></ul><ul><ul><ul><li>Varicocele- varicosity of internal spermatic cord </li></ul></ul></ul><ul><ul><ul><li>Vasectomy (male birth control) </li></ul></ul></ul><ul><ul><li>3. Seminal vesical: are two convoluted pouches that lie along the lower portion of the bladder and empty into the urethra by the way of ejaculatory ducts </li></ul></ul>
  15. 34. MALE REPRODUCTIVE SYSTEM: B. Internal Structures continue 4. Ejaculatory duct: the canal formed by the union of the vas deferens and the excretory duct of the seminal vesicle, which enters the urethra at the prostate gland. 5. Prostate Gland: located just below the urinal bladder. Secretes alkaline and most of the seminal fluid. 6. Bulbourethral glands or Cowper’s Gland: adds alkaline fluid to the semen. 7. Urethra: the passageway for both urine and semen, extending from the bladder to the urethral meatus . (8 inches in long)
  16. 35. MALE REPRODUCTIVE SYSTEM: <ul><li>B. Internal Structures continue </li></ul><ul><li>SEMEN: </li></ul><ul><ul><li>Is a thick whitish fluid ejaculated by the male during orgasm, contains spermatozoa and fructose-rich nutrients. </li></ul></ul><ul><ul><li>During ejaculation, semen receives contributions of fluid from </li></ul></ul><ul><ul><li>Prostate gland (60%) </li></ul></ul><ul><ul><li>Seminal vesicle (30%) </li></ul></ul><ul><ul><li>Epididymis ( 5%) </li></ul></ul><ul><ul><li>Bulbourethral gland (5%) </li></ul></ul><ul><ul><li>Average pH = 7.5 </li></ul></ul><ul><ul><li>The average amount of semen released during ejaculation is 2.5 -5 ml . It can live with in the female genital tract for about 24 to 72 hours . </li></ul></ul><ul><ul><li>(50-200 million/ml of ejaculation ave. of 400 million/ ejaculation ) </li></ul></ul><ul><ul><li>90 seconds- cervix </li></ul></ul><ul><ul><li>5 mins.- end of fallopian tube </li></ul></ul>