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Female Reproductive System

Histology

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Mons Pubis, Labia Majora and Minora

MP: unusually oblique hair follicles L Maj: same + smooth muscle fibers. Apocrine and sebaceous glands mature at puberty. Eccrine sweat glands: no change since birth L Min: absent hair follicles but sebaceous glands open directly on epidermal surface Epidermis of labia: melanin pigmentation. Outer L min more pigmented than inner. Keratinization also decreases as vagina is approached. Thi extends t h h d This t d to hymen. Vulvar side of hymen: keratinized stratified squamous epithelium. Vaginal side: non- keratinized stratified squamous epithelium rich in glycogen

Clitoris
Female equivalent of penis Two corpora cavernosa of erectile vascular tissue, separated by an incomplete septum surrounded, by a fibrocollagenous sheath. Many nerve endings (Pacini corpuscules) Covered by thin epidermis, devoid of glands, but rich in sensory nerves and receptors.

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Vagina
Fibromuscular tube: vestibule uterus Four layers:
Stratified squamous epithelial mucosa rich in glycogen Lamina propria: rich in elastic fibers and thinwalled blood vessels (veins, venules) Fibromuscular layer: ill-defined inner circular and outer longitudinal smooth mucles. Adventitia: fibrocollagenous tissue with numerous thick elastic fibers, large blood vessels and ganglion cells. Also, deeply some skeletal mucles: around introitus

Rich meshwork of elastic fibers: responsible for elongation during parturition. Vessels: watery vaginal fluids. Shallow longitudinal midline grooves on anterior and posterior vaginal walls, and transverse mucosal folds

Vagina
Changes occur in non-keratinized stratified squamous epithelium Before puberty and after menopause: thin epithelium During reproductive years: under estrogen influence thickening. Basal cells and a distinct parabasal layer mitotic activity. Superficial cells number and size due to glycogen and lipid storage. Glycogen content is maximal at time of ovulation Breakdown of glycogen by lactobacilli lactic acid acid pH Bartholin Glands: acini lined by tall columnar mucussecreting cells with pale cytoplasm and small basal nuclei. Their ducts are lined by a transitional epithelium with a surface mucin-secreting layer

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Cervix
Lower part of uterus part of which protrudes into the vagina Internal os: junction between cervix and body. Here: lining epithelium and urerine wall change External os: opening of cervical canal into vagina. Here also changes in lining epithelium. Cylindrical and symmetrical at birth; becomes barrel-shaped after pregnancy. Os is round in nulliparous women, and a transverse slit in multiparas

Cervical Stroma
Important in parturition. Smooth muscle fibers embedded in collagen whose ratios vary with parity. Normally firm and rubbery, cervical lumen narrow (< 3 mm). During parturition: dilates to 10 cm, and then back to previous state in short time. This capacity depends on radical alterations of cervical stroma softening

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Cervix in Parturition
In the glycosaminoglycan matrix hyaluronic acid concentrations between collagen fibers increases water molecules in cervix separation of collagen fibers in cervical stroma softness of cervix. Dermatan sulfate concentration weakening of dermatan sulfate bridges holding adjacent collagen and elastin fibers together. Changes in collagen and elastin fibers: Type I and II collagen fibers become separated from each other lose other, their strong parallel alignment and become shorter. All this lead to a reduction in tensile strength and a in resistance to the presenting part of the fetus Similar changes occur in elastin fibers

Ectocervix
Covered by epithelium like the one in vagina: non-keratinizing, non keratinizing, stratified, squamous, rich in glycogen. It undergoes cyclical changes during the menstrual cycle: influence of E and P Before and after reproductive age: epithelium much thinner and smaller

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Edocervical Canal
The canal is lined by a single layer of tall columnar mucussecreting epithelium

Endocervical Canal
Deep slit-like invagination of the surface epithelium with blindended tubules arising from the cleft. So large surface area for production of mucin. Role in vaginal lubrification and as a barrier Movement of mucus by ciliated columnar endocervical epithelial cells mostly close to internal os

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Squamo-Columnar Junction
Most likely place of disease Usually located in the region of external os and influenced by os, maternal hormone production inutero At puberty: E extension of columnar epith. onto ectocervix ectropion or cervical erosion transformation zone ( in pregnancy and may bleed) Before puberty pH is alkaline. After puberty due to glycogen breakage pH acidic ( 5-3)

Squamo-Columnar Junction
Exposition of sensitive columnar epith. to acid pH squamous metaplasia and a transformation zone between endocervical columnar epithelium and ectocervical squamous one This TZ could be variable in size. In older women it might retreat into the endocervical canal, with sometimes clinical consequences (e.g. in colposcopy)

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Squamo-Columnar Junction
TZ forms as squamous epith. g p regrows over ectropion: metaplasia. Openings of some glands will be blocked mucin produced will accumulate to form cysts: Nabothian cysts. Also, under (mis)appropriate circumstances (HPV) (HPV), correction may lead to dysplasia that may lead to carcinoma

Cervical mucus
Secreted by endocervical epithelium which shows little microscopical changes thru out the cycle, although ultrastuctural one were noted Physical (rheological) and chemical (ionic composition) properties change during cycles according to hormonal (estrogenic or progestational) milieu

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Cervical mucus
During follicular phase: mucin is thin, watery, abundant and has alkaline pH Composed of network of glycoprotein micelles: inside spaces occupied by plasma rich in Na, K and Cl ions. This is responsible for the ferning pattern seen when dried

Ferning

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Cervical mucus
After ovulation the mucus becomes viscid and scanty, and has an acidic pH. Ultrastucturally diameters of micelles goes from 35 m to 12 m. This forms a barrier for the penetration of sperms and bacteria to protect a possible pregnancy

Cervical Mucus

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Uterine Body
Thick walls of smooth muscles: myometrium Myometrium is hormone-sensitive: hypery yp trophy and hyperplasia (pregnancy) Endometrium: lining of uterine cavity. Also hormone-dependant and cyclical changes Before puberty: simple low cuboidal epith. supported by scanty spindle-celled stroma Reproductive years: 2 layers: deep basal at contact with myometrium (reserve); and superficial functional (cyclical). Around tubal ostia and internal os: less sensitive to E+P After menopause: reversal to prepubertal aspect

Uterine Tubes

10-12 cm, 4 parts: infundibulum, ampulla, isthmus, interstitial Each differ histologically: proportion of muscle/epithelium, and degree of convolution of epithelium Muscular tube lined by specialized epithelium variably folded and plicated

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Uterine Tube
Ampulla

Uterine Tube
Isthmus

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Ovary
Hilum, medulla and cortex Surface layer: cuboidal, continuous with pelvic peritoneum at hilum. Prominent microvilli, occasional cilia; mitochondria abundant and small pinocytotic cells. Fissures lined by epithelium. This may seal and accumulated secretions germinal inclusion cysts t Tunica albuginea separates surface cells from underlying ovarian tissue.

Ovary
Hilum: blood vessels, lymphatics and nerves enter and leave ovary Histologically identical to Leydig cells: round or oval, eosinophilic granular or foamy cytoplasm with lipofuscin pigm. May contain Reinekes cristalloids Medulla: cluster of stromal cells. Hilum and Medulla may also contain vestigial remnants of t i ti i l t f Wolffian ducts Cortex: supporting stroma and gamete-producing structures

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Ovary
Cortical Stroma
Closely packed spindle-shaped fibroblast-like cells spindle shaped fibroblast like Cytoplasm rich in ribosomes and microfilaments Numerous mitochondria around nucleus. Micropinocytotic vesicles and lipid droplets Reticulin and collagen fibers: outer part of cortex g g puberty menopause y p Progressive collagenization: p Cellularity and amount of lipid depends on hormones: in lipid (under P influence) is called luteinization

Ovary
Cortical Stroma Three main functions:
s pports o a supports ova, generates theca interna and externa, secretes steroid hormones: 3 types of stroma cells
Theca cells: interna and externa (around the follicle) ) Scattered lipid-rich luteinized stromal cells EASC (oxidative and enzyme activity): in menopause (might secrete testosterone)

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