The document discusses the female reproductive system. It covers anatomy including the ovaries, uterine tubes, uterus, vagina, external genitalia, breasts, and mammary glands. It describes the menstrual cycle, hormones involved in pregnancy (HCG, estrogen, progesterone, HCS), and adjustments the body makes during pregnancy such as increased blood volume and metabolism.

1. 28-1
Chapter 28
Female
Reproductive
Systems

2. 28-2
Female Reproductive SystemFemale Reproductive System
• Reproductive Anatomy
• Puberty and Menopause
• Oogenesis and the Sexual Cycle
• Female Sexual Response
• Pregnancy and Childbirth
• Lactation

3. 28-3
• Produce and
deliver
gametes
• Provide
nutrition and
room for fetal
development
• Give birth
• Nourish infant
Female Reproductive SystemFemale Reproductive System

4. 28-4
Sex DifferentiationSex Differentiation
• Male and female are indistinguishable for
first 8 to 10 weeks of development
• Female develops
– no testosterone or müllerian-inhibiting factor
• causes degeneration of (male) mesonephric duct
– paramesonephric duct
• develops into uterine tubes, uterus and vagina
– genital tubercle becomes clitoris
– urogenital folds develop into labia minora
– labioscrotal folds into labia majora

5. 28-5
OvaryOvary
Female gonads (1o
sex organs)
Produces eggs and hormones
– almond-shaped, 3 cm x 1.5 cm x 1 cm
– tunica albuginea capsule like on testes
– cortex germ cells develop; medulla holds major A. & V.
Lacks tubes, each egg develops in its own fluid-filled follicle and
is released by ovulation.
Ligaments
– Medially attached to uterus by ovarian ligament
– Laterally attached to pelvic wall by suspensory ligament
• contains ovarian artery, vein and nerves
– Anterior margin anchored by the mesovarium (peritoneal
fold)

6. OvaryOvary
Blood supply:
Two arteries:
1. Ovarian branch of the uterine artery
- approached the medial pole, passing
through the mesovarium;
2. Ovarian Artery
- passes through the suspensory ligament,
approaches lateral pole;
- equivalent to testicular artery.
28-6

7. 28-7
Anatomy of OvaryAnatomy of Ovary

8. Ovary relation to UterusOvary relation to Uterus
28-8

9. 28-9
GenitaliaGenitalia
• Internal genitalia
– duct system of uterine tubes, uterus, vagina
• External genitalia
– clitoris, labia minora, and labia majora
– occupy perineum

10. 28-10
• 10 cm long, muscular tube lined with ciliated cells
• Major portions
– Distal (ovarian) end flares = infundibulum (feathery projections
called fimbriae;
– Middle & longest part = ampulla;
– Near the uterus = isthmus
• Enclosed in superior
margin of broad
ligament (mesosalpinx)
Uterine (Fallopian/Oviduct) TubesUterine (Fallopian/Oviduct) Tubes

11. 28-11
Epithelial Lining of Uterine TubeEpithelial Lining of Uterine Tube
Uterine wall contain smooth
muscle, is extremely folded,
has epithelium of ciliated
cells and secretory cells.
Purpose?
ALL TO MOVE THE EGG!

12. 28-12
UterusUterus
Thick-walled, pear-shaped muscular chamber that opens into
vagina and tilts forward over urinary bladder;
Function: 1. Harbor the fetus
2. Provide nutrition
3. Expel the fetus at the end of development

13. UterusUterus
Superior Portion = fundus
Middle Portion = Body (corpus)
Cylindrical Inferior end = cervix
Communicates with vagina at the cervical end via the
cervical canal.
- internal os = superior portion opening into uterus
- external os = opening into vagina 28-13
Canal contains glands
that produce mucus,
preventing spread of
micro oraganisms.

14. 28-14
Uterine WallUterine Wall
Consists of:
Perimetrium - external serosa layer
Myometrium - middle muscular layer
– 1.25 cm thick in nonpregnant uterus
– smooth muscle
• produces labor contractions, expels fetus
Endometrium
– simple columnar epithelium, compound tubular glands, stroma
populated by leukocytes, macrophages;
• stratum functionalis – superficial – 2/3 , shed each menstrual cycle;
• stratum basalis - deep layer, regenerates a new stratum
functionalis with each cycle
- site of attachment during pregnancy, forms the maternal
part of the placenta.

15. Histology of EndometriumHistology of Endometrium
28-15

16. 28-16
Normal/Abnormal PAP SmearsNormal/Abnormal PAP Smears
•Common age: 30 – 50
•Increase risk in females who: smoke, sexual activity at an early
age, and history of frequent STD or cervical inflammation;
•Often caused by HPV;
•Early detection Pap Smear (looking for dysplasia or carcinoma);
•Cervical intraepithelial neoplasia (CIN) rating system:
•ASCUS, CIN I, CIN II, CIN III

17. Blood SupplyBlood Supply
Important to the menstrual cycle & pregnancy;
Uterine Artery arises from the internal iliac artery
and travels with the broad ligament, penetrating
the myometrium leading to arcuate arteries;
Arcuate arteries give rise to smaller arteries that
penetrate the rest of the way through the
myometrium into the endometrium called spiral
arteries.

18. LigamentsLigaments
Uterus is supported by the muscular floor of pelvic outlet &
portions of the peritoneum;
Broad ligament has two parts:
1. Mesosalpinx
2. mesometrium
Cardinal (lateral cervical) ligaments support the cervix &
superior part of the vagina;
Uterosacral ligaments attach the dorsal side of the uterus to
the sacrum;
Round ligaments (pair) attach the ventral uterus to the
abdominal wall (terminate at the labia majora, like
gubernaculum of male).
Vesicouterine pouch and rectouterine pouch.

19. VaginaVagina
aka birth canal
Functions:
- discharge of menstrual;
- receive semen;
- birth of baby;
Vagina wall consists of:
- outer adventitia
- middle muscularis
- inner mucosa
No glands, lubricated by transudation (vaginal sweating) of
serous fluid and mucus from the cervical glands.

20. VaginaVagina
Lower end of mucosa fold inward and forms the hymen
stretches across the orifice, allows menstrual fluid to
pass but usually must be ruptured to allow for
intercourse;
Lower vagina contains vaginal rugae – stimulates penis;
Epithelial cells are rich in glycogen which is fermented to
lactic acid by bacteria which produces a low pH (3.5-
4.0):
- inhibits growth of pathogens
Mucosa also contains antigen-presenting cells called
dendritic cells – route for HIV from infected semen can
invade the female body.

21. External GenitaliaExternal Genitalia
External genitalia collectively
called vulva;
Includes:
- mons pubis
- labia majora & minora
- clitoris (glans & body)
- vaginal orifice
- accessory glands
- erectile tissues

22. External GenitaliaExternal Genitalia
Clitoris contains corpora
cavernosa, diverge into a pair of
crura – attach it to the pubic
arch;
Supplied by clitoral arteries from
the internal pudendal arteries;
Vestibular bulbs- erectile tissues
(deep to labia majora) on either
side of the vagina – congested
with blood during sexual
excitement;
Greater (Bartholin) Gland –
homologous to the bulbourethral
gland, provide lubrication;
Paraurethral (Skene) Glands –
homologous to the male
prostate, provides lubrication.

23. 28-23
Breasts & Mammary GlandsBreasts & Mammary Glands
• Overlies pectoralis major
– conical body, nipple at apex
– axillary tail contains many lymphatic vessels
• Nipple surrounded by areola
– dermal blood vessels closer to surface
– melanocytes darken during pregnancy
– smooth muscle contracts wrinkling skin and erecting
nipple in response to cold, touch and arousal
• Suspensory ligaments from skin, muscle
• Nonlactating breast has little glandular tissue

24. 28-24
Anatomy of Lactating BreastAnatomy of Lactating Breast

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Anatomy of Lactating BreastAnatomy of Lactating Breast
• Nonlactating breast consists of adipose and
collagenous tissue.
• Breast size has no relationship on the amount of
milk produced.

26. 28-26
Mammary Gland DevelopmentMammary Gland Development
• Lactation
– synthesis and ejection of milk from mammary
glands in breast
• Ducts grow and branch
– due to high estrogen levels in pregnancy
• Followed by budding and development of
acini at the ends of the ducts
– due to progesterone

27. 28-27
Colostrum and Milk SynthesisColostrum and Milk Synthesis
• Colostrum forms in late pregnancy
– similar to breast milk; contains 1/3 less fat,
thinner
– first 1 to 3 days after birth
– contains IgA protection from gastroenteritis
• Synthesis is promoted by prolactin (from
pituitary)
– synthesis of hormone begins 5 weeks into
pregnancy, by full term it is 20x normal level
– steroid hormones from placenta oppose it until
birth

28. 28-28
Colostrum and Milk SynthesisColostrum and Milk Synthesis
• At birth, prolactin secretion drops, but ↑
20 times after nursing
– without nursing, milk production stops in 1
week
• 5-10% of women become pregnant while
nursing
– inhibition of GnRH and reduced ovarian
cycling

29. 28-29
Prolactin and LactationProlactin and Lactation

30. 28-30
Milk EjectionMilk Ejection
• Controlled by a neuroendocrine reflex
– infant’s suckling stimulates sensory
receptors in nipple, signaling hypothalamus
and posterior pituitary to release oxytocin
– oxytocin stimulates myoepithelial cells
• Myoepithelial cells surround secretory
cells in acinus
– contract to squeeze milk into duct
• milk flow within 30-60 seconds after suckling
begins

31. 28-31
Breast CancerBreast Cancer
• 1 out of 8 American women
• Tumors begin with cells from mammary ducts
– may metastasize by lymphatics
• Symptoms may include palpable lump, skin
puckering, skin texture and drainage from nipple
• Most breast cancer is nonhereditary
– some stimulated by estrogen
• Risk factors include
– aging, ionizing radiation, carcinogenic chemicals,
alcohol, smoking and fat intake
– 70% lack risk factors

32. 28-32
Cancer Screening and TreatmentCancer Screening and Treatment

33. 28-33
PubertyPuberty
• Begins at age 9-10 (US)
• Triggered by rising levels of GnRH
– stimulates anterior lobe of pituitary to produce
• follicle-stimulating hormone (FSH)
• luteinizing hormone (LH)
• Follicles develop and begin to secrete
estrogen and progesterone

34. 28-34
Pituitary-Ovarian AxisPituitary-Ovarian Axis

35. 28-35
Sexual CycleSexual Cycle
• Averages 28 days, ranges from 20 to 45
• Hormone cycle: hierarchy of control
– hypothalamus→ pituitary → ovaries → uterus
• Follicular phase (2 weeks)
– menstruation occurs during first 3 to 5 days of cycle
– uterus replaces lost endometrium and follicles grow
• Luteal phase (2 weeks)
– corpus luteum stimulates endometrial thickening
– endometrium lost without pregnancy

36. 28-36
Ovarian Cycle - Follicular PhaseOvarian Cycle - Follicular Phase
• Menstruation (day 1) to ovulation(14) (variable)
• Difficult to predict date of ovulation
• Contains menstrual and preovulatory phases

37. 28-37
Ovarian Cycle - Preantral PhaseOvarian Cycle - Preantral Phase
• Discharge of menstrual fluid (days 1-5)
• Before follicle develops antrum
– primordial and primary follicles

38. 28-38
Ovarian Cycle - Antral PhaseOvarian Cycle - Antral Phase
• Day 6 to 14, one dominant follicle advances to
mature (graafian) follicle; secretes estrogen

39. 28-39
Ovarian Cycle - OvulationOvarian Cycle - Ovulation
• Mature follicle ruptures, releases oocyte
influenced by LH

40. 28-40
Pituitary-Ovarian AxisPituitary-Ovarian Axis

41. 28-41
Ovarian Cycle - Luteal PhaseOvarian Cycle - Luteal Phase
• Corpus luteum - forms from ruptured follicle,
under influence of LH; secretes progesterone

42. 28-42
Ovarian Cycle - Luteal PhaseOvarian Cycle - Luteal Phase
• Transformation from ruptured follicle to
corpus luteum is regulated by LH.
• LH stimulates the corpus luteum to
grow and secrete estradiol and
progesterone.
• Progesterone is crucial for preparing
the uterus for pregnancy.

43. 28-43

44. 28-44
Menstrual Cycle - Proliferative PhaseMenstrual Cycle - Proliferative Phase
• Day 6-14 rebuild endometrial tissue
– mitosis occurs in stratum basalis
– result of estrogen from developing follicles

45. 28-45
• Further thickening of endometrium due to
secretion and fluid accumulation -- not mitosis
• Due to progesterone stimulation of glands
Menstrual Cycle - Secretory PhaseMenstrual Cycle - Secretory Phase

46. 28-46
Menstrual Cycle Premenstrual PhaseMenstrual Cycle Premenstrual Phase
• Involution of corpus luteum, progesterone falls
– spiral arteries constrict causes endometrial ischemia
– stratum functionalis sloughs

47. 28-47
Menstrual Cycle - Menstrual PhaseMenstrual Cycle - Menstrual Phase
• Blood, serous fluid and endometrial tissue are
discharged

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Histology of Ovarian FolliclesHistology of Ovarian Follicles

49. 28-49
Hormones of PregnancyHormones of Pregnancy
• HCG (human chorionic gonadotropin)
– secreted by trophoblast within 9 days of
conception
– prevents involution of corpus luteum
• Estrogens
– increases to 30 times normal before birth
– corpus luteum is source for first 12 weeks until
placenta takes over
– causes uterine, mammary duct and breast
enlargement

50. 28-50
Hormones of PregnancyHormones of Pregnancy
• Progesterone
– secreted by placenta and corpus luteum
– suppresses secretion of FSH and LH
preventing follicular development
– prevents menstruation, thickens endometrium
– stimulates development of acini in breast
• HCS (human chorionic somatomammotropin)
– secreted from placenta in direct proportion to
its size
↓ mother’s glucose usage and ↑ release of
fatty acids

51. 28-51
Hormones of PregnancyHormones of Pregnancy
• Aldosterone secretion rises
– fluid retention ↑ mother’s blood volume
• Endocrine organs
– thyroid gland increases 50% in size
∀↑ BMR of mother
– parathyroid glands enlarge
• stimulate osteoclasts to release additional calcium
from mother’s bones

52. 28-52
Hormone Levels and PregnancyHormone Levels and Pregnancy

53. 28-53
Adjustments to PregnancyAdjustments to Pregnancy

54. 28-54
Adjustments to PregnancyAdjustments to Pregnancy
• Digestive System
– nausea
• first few months
– constipation and heartburn due to
∀↓ intestinal motility
• pressure on stomach
• Metabolism
– BMR ↑ may stimulate appetite
• healthy weight gain - 24 lb.

55. 28-55
Adjustments to PregnancyAdjustments to Pregnancy
• Nutrition
– placenta stores nutrients for 3rd trimester
• protein, iron, calcium, phosphates
– vitamin K
• reduces risk of hemorrhages in neonatal brain
– folic acid
• prevent neurological disorders
– spina bifida, anencephaly
• supplements must be started before pregnancy

56. 28-56
Adjustments to PregnancyAdjustments to Pregnancy
• Circulatory System
– mother’s blood volume and cardiac output -
rises 30%
• due to fluid retention and hemopoiesis
• by full term, placenta requires 625 mL of
blood/minute
– hemorrhoids and varicose veins
• from pressure on large pelvic blood vessels

57. 28-57
Adjustments to PregnancyAdjustments to Pregnancy
• Respiratory System
– minute ventilation ↑ about 50%
• demands of fetus, higher maternal metabolic rate
• ventilation adjusted to keep PCO2 lower than normal
– respiratory rate ↑
• difficult to breathe deeply

58. 28-58
Adjustments to PregnancyAdjustments to Pregnancy
• Urinary System
– salt and water retention
• due to aldosterone and steroids
– GFR ↑ by 50% and output is slightly elevated
• mother disposes additional metabolic wastes
↑ frequency of urination
• due to bladder compression

59. 28-59
Adjustments to PregnancyAdjustments to Pregnancy
• Integumentary Systems
– stretch marks
• due to dermal stretching
– linea alba may become dark (linea nigra)
– temporary chloasma or “mask of pregnancy”
• blotchy darkening of skin over nose and cheeks

60. 28-60
Childbirth - Uterine ContractilityChildbirth - Uterine Contractility
• Parturition
– process of giving birth
• by contraction of uterine and abdominal muscles
• Braxton Hicks contractions
– throughout gestation
– strengthen late in pregnancy - false labor

61. 28-61
Childbirth - Uterine ContractilityChildbirth - Uterine Contractility
• Progesterone inhibits contractions
• Estrogen stimulates contractions
• Near full term - posterior pituitary releases
more oxytocin, uterus produces more
receptors
– directly stimulates myometrial contractions
– stimulates fetal membranes to produce
prostaglandins - synergists of oxytocin
• Stretching
– increases contractility of smooth muscle
– role in initiating labor

62. 28-62
Labor ContractionsLabor Contractions
• Contractions begin 30 minutes apart and
eventually occur every 1-3 minutes
– periodically relax to ↑ blood flow to placenta
and fetus
– contractions strongest in fundus and body of
uterus, pushes fetus into cervix

63. 28-63
Labor ContractionsLabor Contractions
• Self-amplifying cycle of stretch and
contraction
– positive feedback cycles increase contractions
• cervical stretching → oxytocin secretion →
uterine contraction → repeat
• reflex arc from uterus → spinal cord →
abdominal skeletal muscles

64. 28-64
Pain of LaborPain of Labor
• Ischemia of myometrium
• Stretching of cervix, vagina and perineum
– episiotomy prevents tearing
• Large fetal head in a narrow pelvic outlet

65. 28-65
Stages of Labor -- Early DilationStages of Labor -- Early Dilation
• Widening of cervical canal by effacement (thinning) of
cervix to reach 10 cm -- diameter of fetal head
• Rupture of fetal membranes and loss of amniotic fluid

66. 28-66
Stages of Labor -- Late DilationStages of Labor -- Late Dilation
Dilation reaches 10 cm in 24 hours or less in primipara
(first baby) and in as little as few minutes in multipara

67. 28-67
Stages of Labor -- ExpulsionStages of Labor -- Expulsion
• Time baby’s head enters vagina until delivery
– up to 30 minutes
• Valsalva maneuver helps to expel fetus

68. 28-68
Stages of Labor -- PlacentalStages of Labor -- Placental
• Uterine contractions continue causing placental
separation

69. 28-69
Crowning (Expulsion Stage)Crowning (Expulsion Stage)

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Expulsion Stage (cont.)Expulsion Stage (cont.)

71. 28-71
Placental StagePlacental Stage

72. 28-72
PuerperiumPuerperium
• First 6 weeks after delivery
• Anatomy and physiology return to normal
– involution of uterus
• to pre-gravid weight in 4 weeks
• accomplished by autolysis by lysosomal enzymes
– vaginal discharge called lochia
– breastfeeding promotes involution
• suppresses estrogen secretion
• stimulates oxytocin which causes myometrial
contraction

73. 28-73
Mammary Gland DevelopmentMammary Gland Development
• Lactation
– synthesis and ejection of milk from mammary
glands in breast
• Ducts grow and branch
– due to high estrogen levels in pregnancy
• Followed by budding and development of
acini at the ends of the ducts
– due to progesterone

74. 28-74
Colostrum and Milk SynthesisColostrum and Milk Synthesis
• Colostrum forms in late pregnancy
– similar to breast milk; contains 1/3 less fat,
thinner
– first 1 to 3 days after birth
– contains IgA protection from gastroenteritis
• Synthesis is promoted by prolactin (from
pituitary)
– synthesis of hormone begins 5 weeks into
pregnancy, by full term it is 20x normal level
– steroid hormones from placenta oppose it until
birth

75. 28-75
Colostrum and Milk SynthesisColostrum and Milk Synthesis
• At birth, prolactin secretion drops, but ↑
20 times after nursing
– without nursing, milk production stops in 1
week
• 5-10% of women become pregnant while
nursing
– inhibition of GnRH and reduced ovarian
cycling

76. 28-76
Prolactin and LactationProlactin and Lactation

77. 28-77
Milk EjectionMilk Ejection
• Controlled by a neuroendocrine reflex
– infant’s suckling stimulates sensory
receptors in nipple, signaling hypothalamus
and posterior pituitary to release oxytocin
– oxytocin stimulates myoepithelial cells
• Myoepithelial cells surround secretory
cells in acinus
– contract to squeeze milk into duct
• milk flow within 30-60 seconds after suckling
begins

78. 28-78
Breast MilkBreast Milk
• Supplies antibodies and colonizes
intestine with beneficial bacteria
• Colostrum and milk have a laxative effect
that clears intestine of meconium (green,
bile-filled fecal material in newborn)
• Nursing woman can produce 1.5L per day
• Cow’s milk not a good substitute
– 1/3 less lactose but 3 times as much protein
– harder to digest and more nitrogenous waste
(diaper rash)

79. 28-79
Contraceptive DevicesContraceptive Devices