Anatomy and Physiology

GENERAL The organs of the reproductive systems are concerned with the general process of reproduction, and each is adapted for specialized tasks. These organs are unique in that their functions are not necessary for the survival of each individual. Instead, their functions are vital to the continuation of the human species. In providing maternity gynecologic health care to women, you will find that it is vital as a nurse and to the patient that you will require a greater depth and breadth of knowledge of the female anatomy and physiology than usual. The female reproductive system consists of internal organs and external organs. The internal organs are located in the pelvic cavity and are supported by the pelvic floor. The external organs are located from the lower margin of the pubis to the perineum. The appearance of the external genitals varies greatly from woman to woman, since age, heredity, race, and the number of children a woman has borne determines the size, shape, and color. Female Reproductive System

The female reproductive system is designed to carry out several functions. It produces the female egg cells necessary for reproduction, called the ova or oocytes. The system is designed to transport the ova to the site of fertilization. The female reproductive anatomy includes the internal structures, external structures, also called the vulva, and accessory reproductive structures. The external structures include the mons pubis, labia majora, labia minora, clitoris, urethra, hymen and perineum. The internal structures consist of the vagina, cervix, uterus, fallopian tube and ovaries. The accessory structures consist of the mammary gland, skenes gland and bartholins gland. External Genitals Mons Pubis Also called mons veneris, this is the fatty rounded area overlying the symphysis pubis and after puberty, thus area is covered with thick coarse hair. The mons veneris is sexually sensitive in some women and protects the pubic bone and vulva from the impact of sexual intercourse. Labia majora

The labia majora enclose and protect the other external reproductive organs. Literally translated as large lips, the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair. Labia minora Literally translated as small lips, the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora, and surround the openings to the vagina and urethra. They are thin stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris. Both the inner and outer labia are quite sensitive to touch and pressure. Clitoris The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation. During sexual excitement, the clitoris erects and extends, the hood retracts, making the clitoral glands more accessible. The size of the clitoris is variable between women. On some, the clitoral glands is very small; on others, it is large and the hood does not completely cover it. Urethra The opening to the urethra is just below the clitoris. Although it is not related to sex or reproduction, it is included in the vulva. The urethra is actually used for the passage of urine. The urethra is connected to the bladder. In females the urethra is 1.5 inches long, compared to males whose urethra is 8 inches long. Because the urethra is so close to the anus, women should always wipe themselves from front to back to avoid infecting the vagina and urethra with bacteria. This location issue is the reason for bladder infections being more common among females. Hymen The hymen is a thin fold of mucous membrane that separates the lumen of the vagina from the urethral sinus. Sometimes it may partially cover the vaginal orifice. The hymen is usually perforated during later fetal development.

Because of the belief that first vaginal penetration would usually tear this membrane and cause bleeding, its intactness has been considered a guarantor of virginity. However, the hymen is a poor indicator of whether a woman has actually engaged in sexual intercourse because a normal hymen does not completely block the vaginal opening. The normal hymen is never actually intact since there is always an opening in it. Furthermore, there is not always bleeding at first vaginal penetration. The blood that is sometimes, but not always, observed after first penetration can be due to tearing of the hymen, but it can also be from injury to nearby tissues. A tear to the hymen, medically referred to as a transection, can be seen in a small percentage of women or girls after first penetration. A transection is caused by penetrating trauma. Masturbation and tampon insertion can, but generally are not forceful enough to cause penetrating trauma to the hymen. Therefore, the appearance of the hymen is not a reliable indicator of virginity or chastity. Perineum The perineum is the short stretch of skin starting at the bottom of the vulva and extending to the anus. It is a diamond shaped area between the symphysis pubis and the coccyx. This area forms the floor of the pelvis and contains the external sex organs and the anal opening. It can be further divided into the urogenital triangle in front and the anal triangle in back.The perineum in some women may tear during the birth of an infant and this is apparently natural. Some physicians however, may cut the perineum preemptively on the grounds that the tearing may be more harmful than a precise cut by a scalpel. If a physician decides the cut is necessary, they will perform it. The cut is called an episiotomy. Vagina The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal. It is about three to five inches long in a grown woman. The muscular wall allows the vagina to expand and contract. The muscular walls are lined with mucous membranes, which keep it protected and moist. A thin sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of the vagina. The vagina receives sperm during sexual intercourse from the penis. The sperm that survive the acidic condition of the vagina continue on through to the fallopian tubes where fertilization may occur.

Female Internal Accessory Organs

Cervix The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior viganal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. It is occasionally called cervix uteri, or neck of the uterus. During menstruation, the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some womens cramps subside or disappear after their first vaginal birth because the cervical opening has widened. The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On average, the ectocervix is three cm long and two and a half cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips. The ectocervixs opening is called the external os. The size and shape of the external os and the ectocervix varies widely with age, hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who have had a vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like and gaping.The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures seven to eight mm at its widest in reproductive-aged women. The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity. During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through. During orgasm, the cervix convulses and the external os dilates. Uterus (womb) The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. . The uterus is only about three inches long and two inches wide, but during pregnancy it changes rapidly and dramatically. The uterus is divided into three parts: the cervix, which is the lower part that opens into the vagina, the main body of the uterus, called the corpus and the fundus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit. The top rim of the uterus is called the fundus and is a landmark for many doctors to track the progress of a pregnancy. The uterine cavity refers to the fundus of the uterus and the body of the uterus. Ovaries

The ovaries are small, oval-shaped glands that are located on either side of the uterus. Each ovary is then attached to the fimbria of the fallopian Tube. Usually each ovary takes turns releasing eggs every month; however, if there was a case where one ovary was absent or dysfunctional then the other ovary would continue providing eggs to be released. Ovaries secrete both estrogen and progesterone. Estrogen is responsible for the appearance of secondary sex characteristics of females at puberty and for the maturation and maintenance of the reproductive organs in their mature functional state. Progesterone functions with estrogen by promoting cyclic changes in the endometrium (it prepares the endometrium for pregnancy), as well as by helping maintain the endometrium in a healthy state during pregnancy. Fallopian tubes

These are narrow tubes about four inches long that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. It is divided into two parts, the infundibulum, where fertilization usually takes place and the ampulla. The ovaries alternately release an egg. When an ovary does ovulate, or release an egg, it is swept into the lumen of the fallopian tube by the frimbriae. Once the egg is in the fallopian tube, tiny hairs in the tubes lining help push it down the narrow passageway toward the uterus. The oocyte, or developing egg cell, takes four to five days to travel down the length of the fallopian tube. Bartholins glands

These are two glands located slightly below and to the left and right of the opening of the vagina in women. They secrete mucus to provide vaginal lubrication. Bartholins glands secrete relatively minute amounts (one or two drops) of fluid just before woman orgasms. The minute droplets of fluid were once believed to be important for lubricating the vagina. Skenes glands

These are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening. These glands are surrounded with tissue, which includes the part of the clitoris that reaches up inside the vagina and swells with blood during sexual arousal. It has been demonstrated that a large amount of lubricating fluid

(filtered blood plasma) can be secreted from this gland when stimulated from inside the vagina. Mammary glands

Mammary glands are the organs that produce milk for the sustenance of a baby. These exocrine glands are enlarged and modified sweat glands. The basic components of the mammary gland are the alveoli (hollow cavities, a few millimetres large) lined with milk-secreting epithelial cells and surrounded by myoepithelial cells. These alveoli join up to form groups known as lobules, and each lobule has a lactiferous duct that drains into openings in the nipple. The myoepithelial cells can contract, similar to muscle cells, and thereby push the milk from the alveoli through the lactiferous ducts towards the nipple, where it collects in widenings (sinuses) of the ducts. A suckling baby essentially squeezes the milk out of these sinuses. The development of mammary glands is controlled by hormones. The mammary glands exist in both sexes, but they are rudimentary until puberty when in response to ovarian hormones they begin to develop in the female. Estrogen promotes formation, while testosterone inhibits it. Colostrum is secreted in late pregnancy and for the first few days after giving birth. True milk secretion (lactation) begins a few days later due to a reduction in circulating progesterone and the presence of the hormone prolactin. The suckling of the baby causes the release of the hormone oxytocin which stimulates contraction of the myoepithelial cells. Puberty Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. This includes the appearance of pubic hairs, obvious body growth, voice tone changes, breast development and many more. Puberty is initiated by hormone signals from the brain to the gonads (the ovaries and testes). In response, the gonads produce a variety of hormones that stimulate the growth, function, or transformation of brain, bones, muscle, skin, breasts, and reproductive organs. Growth accelerates in the first half of puberty and stops at the completion of puberty. Before puberty, body differences between boys and girls are almost entirely restricted to the genitalia. During puberty, major differences of size, shape, composition, and function develop in many body structures and systems. The most obvious of these are referred to as secondary sex characteristics. Although there is a wide range of normal ages, on average, girls begin the process of puberty about 1-2 years earlier than boys (with average ages of 9 to 14 for girls and 10 to 17 for boys), and reach completion in

a shorter time. Girls attain adult height and reproductive maturity about 4 years after the first physical changes of puberty appear. In contrast, boys accelerate more slowly but continue to grow for about 6 years after the first visible pubertal changes. The hormone that dominates female development is estradiol, an estrogen. While estradiol promotes growth of breasts and uterus, it is also the principal hormone driving the pubertal growth spurt and epiphyseal maturation and closure. Estradiol levels rise earlier and reach higher levels in women than in men.Onset is associated with high Gonadotropin-releasing Hormone (GnRH) pulsing, which precedes the rise in sex hormones, luteinizing hormone and Follicle-stimulating hormone. Exogenous GnRH pulses cause the onset of puberty. The cause of this GnRH rise is contentious. Puberty begins consistently at around 47 kg for girls and 55 kg for boys. This dependence on bodyweight makes leptin a good candidate for causing GnRH rise. It is known that leptin has receptors in the hypothalamus which synthesizes GnRH. Furthermore, individuals who are deficient in the leptin pathway fail to initiate puberty. The levels of leptin change in line with the onset of puberty, and then decline to adult levels.