HAS 2024

Reproductive System

Oleh,
En. Mohd Azuraidi Harun
 Sistem reproduktif [reproductive system] –
sekumpulan organ yang terlibat dlm penghasilan
benih (sperma @ ovum), persenyawaan dan
pembentukan zigot dan pembesaran menjadi bayi
dlm kandungan.

 Genital system/genitalia [genital = organ] – juga

merujuk kpd sekumpulan organ2 dlm sistem
pembiakan.

 Sebahagian organ2 dlm genital system adalah

organ2 dlm urinary system [e.g. urethra].

 Oleh itu, 2 sistem ini disebut sbg ‘Genitourinary

system [GUS]’.
 Sistem repoduktif terdiri drpd organ2:
 Internal genital organs – organ2 pembiakan yg

terletak dlm tubuh:

 Wanita: vagina, uterus, Fallopian tube, ovary.

 Lelaki: vas deferens, seminal vesicles,

ejaculatory ducts, prostate gland.

 External genital organs – organ2 pembiakan yg

terletak di luar tubuh:

 Wanita: vaginal orifice.

 Lelaki: scrotum, testis, penis.

Female Genital Organs
 Female internal genital organ:
 Uterus,
 Uterine/Fallopian tube,
 Ovaries,
 Vagina.
 ‘Female external genital organ’ @ vulva @
pudendum:
 Mons pubis, labia majora, labia minora, clitoris,
vestibule.
 Mammary glands
 Female Genital Organs – medial
section
Fallopian tube
Sacrum
Ovary

Uterus Rectum

Urinary
bladder

Mons pubis
Urethra
Labia minora
Labia majora
Anus
 Uterus [anterior view]
Fallopian tube

Ovarian ligament

Ovary

Broad
ligament Uterus
Uterus [superior view]
Urinary bladder

Uterus
Round ligament

Ovarian ligament
Fallopian
tube

Ovary

Uterosacral
ligament
Rectum

Sacrum

Iliac artery
 Ampulla Infundibulum
Isthmus

Fundus

Body of Broad
uterus ligament
Cavity of uterus

Ovary
Cervix Cervical
canal

Vagina
Ovary
 Ovary – a pair of oval organs in female.

 Produce:
 Secondary oocytes that develop into mature ova after

fertilisation,
 Hormones (progesterone, oestrogens, inhibin, relaxin).
 Uterine tube/Fallopian tube
 A pair of tube about 4” long connects
superolaterla border of uterus to
each ovary.

 Provides:
 a route for sperm to reach ovum,

 Transports secondary oocytes and

fertilised ova from ovaries to

uterus.
 Has 3 parts:
 Infundibulum = funnel shaped portion of tube, close to

ovary, but opens to pelvic cavity. Has fingerlike

structure (fimbriae) attached to lateral wall of ovaries.
 Ampulla – widest, longest portion, make up 2/3 of its

length.
 Isthmus – short, narrow, thick-walled portion, joins

uterus.

 Inner epithelium is ciliated columnar epithelium that help

to move fertilised ovum/secondary oocyte along uterine
tube to uterus.
Uterus
 Uterus [rahim] is muscular and hollow organ, about size
and shape of pear.

 Size for nulliparous woman : 3“ long x 2” width x 1” thick.

 Has 3 parts:
 Fundus – dome-shape portion, most superior.

 Body – most part of uterus.

 Cervix – inferior narrow portion, opens into cervi.

 Isthmus – a constricted area, about 1 cm between body
of uterus and cervix.

 Uterine cavity – interior of the body of uterus.

 Cervical canal – interior of the cervix.

 Internal os (os = mouthlike opening) – opening from

cervical canal to uterine cavity.

 External os – opening into vagina.

 Anteflex position of uterus – body of uterus projects

anteriorly and superiorly over urinary bladder.
 Ligaments of uterus:
 Broad ligament – a pair of double fold of peritoneum

attaching uterus to sides of pelvic cavity,

 Uterosacral ligament – connects uterus to sacrum,

 Cardinal/lateral cervical ligament – from cervix and

vagina to lateral pelvic wall,

 Round ligament – from side of uterus to external

genitalia.

 Function of ligaments – maintain the antiflexed position

of uterus.
Ligaments of uterus
 Uterus has 3 layers:
 Perimetrium (peri=around, metrium=uterus) – is part

of peritoneum, composed of squamous epithelium and

serosa.
 Myometrium (myo=muscle) – composed of smooth

muscle,
 Endometrium (endo=in) – innermost layer. It is divided

into 2 layer:
 Stratum functionalis (functional layer) – lining uterine
cavity, slough off during menstruation.
 Stratum basalis (basal layer) – permanent layer, gives
rise to striatum functionalis after each menstruation.
Vagina
 Vagina = tubular, 4” muscular fibrocanal from uterine
cervix to exterior of the body.

 Situated between urinary bladder and rectum.

 Fornix (=arch) surrounds vaginal attachment to the

cervix.

 Hymen (=membrane) is a thin fold of vascularised

mucous membrane closes the inferior end of vaginal
opening into exterior.

 Vaginal orifice – vaginal opening into exterior.

Vulva
 Vulva/pudendum – external genitalia of the female.

 Vulva comprises of
 Mons pubis (mons=mountain) – elevation of adipose

tissue covered by skin and pubic hair. Cushions

symphysis pubis.
 Labia majora (labia=lips, majora=larger) – longitudinal

folds of skin, covered by pubic hair, contains adipose

tissue, sebaceous (oil) glands, sweat glands.
 Labia minora (inner, smaller folds of skin) – has many

sebaceous glands.
 Clitoris – erectile tissue at anterior junction of labia

minora.
Vulva
 Vestibule – area between each labia minora. Within
vestibule, there are vaginal orifice, external urethral
orifice, opening of ducts of several glands.
 Paraurethral (Skene’s) glands – embedded in the

wall of urethra.
 Greater vestibular (Bartholin’s) glands – sides of

vaginal orifice, produces mucus during sexual

intercourse for lubrication.
Vulva shows Skene’s glands and Bartholin’s gland
Perineum
 Perineum – diamond-shaped area medial to thigh and
buttocks of both males and females.

 Boundary:
 Anterior – symphysis pubis,

 Lateral – ischial tuberosity,

 Posterior – coccyx.

 Transverse line drawn between each ischial tuberosities

divides perineum into 2 triangles:
 Urogenital triangle – contains external genitals,
 Anal triangle – contains anus.
Perineum
Mons pubis

Clitoris

Urethra`
Urogenital
triangle Labia minora

Vaginal orifice Labia majora

Anal triangle

Anus
 Boundaries of perineum
Symphysis pubis

UROGENITAL
TRIANGLE

Ischial
tuberosity

ANAL
TRIANGLE

Tips of coccyx
Mammary Glands [breast]
 A pair of hemispheric projection of glands anterior to
pectoralis major muscle.

 Each breast has pigmented projection (nipple) and

series of opening ducts called lactiferous ducts, where
milk emerges.

 Areola – circular pigmented area of skin surrounding

nipple.
 Mammary glands – modified sweat glands that produces
milk, within each breast.

 A mammary gland consists 15 – 20 lobes.

 Each lobes consists of lobules.

 Each lobules has many alveoli [sing. alveolus].

 Alveolus = grapelike clusters of milk-secreting glands.

 Milk is passed through secondary tubules into mammary

ducts.
 Mammary ducts expand to form lactiferous sinuses
[lact=milk]. Then milk drains from lactiferous sinuses into
lactiferous ducts.
Pectoralis major

Lactiferous sinus

Areola

Alveoli

Mammary Nipple
ducts
Mammary gland
Fats
 Clavicle

Suspensory ligaments

2nd rib
Pectoralis major
Lactiferous sinus

Lactiferous duct

Lung Lobules

Fat
Male genitalia – paramedian
section

Ureter

Vas deferens
Seminal
vesicle
Corpus
cavernosum Prostate

Penis

Prepuce
Testis Epididymis
Male genitalia – median section
Urinary bladder

Rectum
Symphysis
pubis

Corpus
cavernosum Prostate
of penis

Corpus Anus
spongiosum
of penis Scrotum
Glans penis
 Urinary bladder and urethra –
median section Urinary bladder
Opening from
ureter

Internal
urethral
orifice
Symphysis
pubis Prostate

Ejaculatory
duct
Penile
urethra
Rectum
Corpus
Bulbourethral
cavernosum
gland
Corpus spongiosum of penis
Urinary bladder – posterior view
Urinary bladder

Ureter

Vas deferens

Seminal
Ampulla of vas
vesicle
deferens

Bulbourethral
(Cowper’s) glands Prostate

Pubic bone Pubic bone

Male urethra – horizontal section
Urinary bladder
Internal urethral orifice

Prostate

Bulbourethral (Cowper’s) Prostatic urethra

gland
Corpus spongiosum
Membranous urethra

Corpora cavernosa
Penile urethra

Glans penis

External urethral meatus

Organs of Male Reproductive
System
 Is composed of:
 Testes [sing: testis]/testicles,
 A system of ducts [epididymis, ductus deferens,
ejaculatory ducts, urethra],
 Accessory sex glands [seminal vesicles, prostate,
bulbourethral glands],
 Supporting structures [scrotum, penis].
Scrotum
 Scrotum – baglike structure that supports testes.

 Normal sperm production requires 2-3°C below core

body temperature.

 That’s why scrotum is outside the body cavity.

 In response to cold temperatures:

 Cremaster muscle contracts, thus move the testes closer to the
body, and absorp body heat.
 Dartos muscle contracts, thus make the scrotum appear
wrinkled.

 Exposure to warmth reverses these actions.

Testis
 Testes [singular: testis], or testicles, are a pair of oval glands
in scrotum.

 Measured about 1” long x 1” diameter.

 Each testis contains 200-300 lobules, that contains

seminiferous tubules.

 Sperm is produced in seminiferous tubules.

 Process of sperm formation is called spermatogenesis.

Testis – midsagittal section
Epididymis Efferent
ductules

Tunica albuginea
Vas deferens

Lobules
Testicular
artery and vein

Septum

Rete testis
Vas/ductus deferens
 Vas deferens [vas=vessel=salur; deferens=defero=carry
down] – a pair of muscular tubes that between
epididymis and ejaculatory ducts.

 Panjang setiap vas deferens ± 45 cm/18”.

 Function of vas deferens – conveys sperm during sexual

arousal from epididymis to urethra by peristaltic
contraction of muscle.
Ejaculatory ducts
 Satu salur sempit hasil dr percantuman antara vas
deferens dan ‘duct of seminal vesicles’.

 Terletak di belakang urinary bladder.

 Ejaculatory ducts memasuki kelenjar prostate dan

bercantum dgn urethra.
Accessory Sex Glands
 Seminal vesicles
 Convoluted pouchlike structure, 2” in length, at

posterior to the urinary bladder.

 Secretes alkaline, viscous fluid.

 Contains:

 Alkaline nature of fluid – neutralise acidic environment in male

urethra and female reproductive tract.
 Fructose – for ATP production by sperm.
 Prostaglandin – for sperm motility and viability.
 Clotting proteins – Helps semen coagulate after ejaculation.
 Contributes about 60% of volume of semen.
 Prostate
 Single, doughnut shaped gland, inferior to urinary bladder.
 Secretes milky, slightly acidic fluid (pH 6.5).
 Contains:
 Citric acid – used by sperm for ATP production.

 Contributes about 25% of volume of semen.

 Bulbourethral (Cowper’s) gland

 Size of peas.
 In deep muscles of perineum, inferior to prostate.
 Secretes alkaline fluid to protects sperm by neutralising acis from uretra
and urine.
Bahagian2 urethra pd lelaki
 Pada lelaki, urethra dibahagikan kpd 3 bahagian:

 Prostatic urethra (berada dalam kelenjar

prostate).
 Membranous urethra (antara kelenjar prostate
dan penis).
 Penile urethra (berada dalam penis).
Seminal vesicles
 Sepasang kelenjar yg berbentuk pear, panjang ± 5
cm.

 Setiap kelenjar seminal vesicle terdiri drpd tubul2 yg

berlingkar2.

 Saluran dari seminal vesicles yg dipanggil ‘ducts of

seminal vesicles’ akan bergabung dgn sepasang
vas deferens menjadi sepasang ejaculatory ducts.
Prostate gland [Kelenjar
prostate]
 Kelenjar paling besar dlm sistem reproduktif lelaki.

 Terletak di bawah urinary bladder.

 Urethra keluar dr pundi kencing dan menembusi

kelenjar prostate menjadi prostatic urethra.

 Dlm kelenjar prostate, vas deferens dan ‘ducts of

seminal vesicles’ bercantum menjadi ‘ejaculatory
ducts’.
Semen
 Semen [=seed] – a mixture of sperm and ‘seminal fluid’.

 Seminal fluid is a mixture of secretions from seminal

vesicles, prostate and bulbourethral glands.

 Semen is alkaline (pH 7.2 – 7.7) due to higher pH and

larger volume of fluid from seminal vesicles.

 Seminal fluid provides sperms with a transportation

medium, nutrients, and protection from acidic
environment of male’s urethra and female’s vagina.
Penis
 Penis (Latin: ekor) ialah organ persenyawaan lelaki
[male copulation organ].
 Terdiri drpd 3 jasad berbentuk silinder dan 1
saluran:
 2 corpus cavernosum [corpus=jasad,

cavernosum=cave=gua]
 1 corpus spongiosum

[spongiosum=sponge=span]
 Urethra [penile part of urethra]

 Hujung distal ada jasad yg dipanggil ‘glans of penis’.

Physiology of Female
Reproductive System

Oogenesis, menstrual cycle, hormonal

regulation of ovaries and uterus,
pregnancy, lactation.
Histology of ovary

Germinal
epithelium

Tunica
albuginea

Ovarian
cortex

Ovarian
medulla

(Graafian)
 Each ovary has:

 Germinal epithelium – a layer of simple epithelium that

surrounds the surface of ovary.

 Tunica albuginea – whitish capsule deep to germinal

epithelium.

 Ovarian cortex – Deep to tunica albuginea, consists of

ovarian follicle surrounded by connective tissue.

 Ovarian medulla – deep to ovarian cortex.

 Ovarian follicles – in ovarian cortex, consists of oocytes in
various stages, surrounded by epithelium.

 Mature (graafian) follicle – large, fluid-filled follicle, ready to

rupture and expel its secondary oocytes [ovulation].

 Corpus luteum – [luteum = yellow] contains the remnants

of mature follicle after ovulation. Corpus luteum will
degenerate to form corpus albicans [albicans = white].
Meiosis –
formation of
ovum
Fertilisation
Implantation
Oogenesis, Fertilisation,
Implantation
 Oogenesis is formations of gametes in ovaries.

 Oogenesis involves meiosis and maturation of germ

cells.

 Primordial follicle – consists of primary oocytes

[oocytes that enter prophase of meiosis 1 but do not
complete that phase until puberty] surrounded by
single layer of follicular cells.

 Primary follicle – consists of primary oocytes

surrounded by several layers of granulosa cells.
 Secondary follicle – primary follicle that its theca
follicular [basement membrane] differentiate into
theca interna and theca externa.

 Mature (graafian) follicle – larger than secondary

follicle. Diploid primary oocytes completes meiosis
1, producing haploid cells of unequal size. The
larger cell is called secondary oocytes. Once
secondary oocytes is formed, it begins meiosis II but
then stops in metaphase. The mature (graafian)
follicle soon ruptures and releases its secondary
oocytes into pelvic cavity, a process known as
ovulation.
 Meiosis II resumes, and secondary oocytes splits
into two haploid (n) cells. The larger cell is called
ovum.

 The nuclei of sperm cell and ovum then unites

forming diploid (2n) zygote [fertilisation].

 Zygote then is moves by ciliary action of Fallopian

tube into endometrium.

 The process of fusion of zygote into endometrium is

called implantation.
Female Reproductive Cycle
 During reproductive years, nonpregnant females show
cyclical changes in ovaries, uterus and hormonal
balances.

 Female reproductive cycle consists of:

 Ovarian cycle – oogenesis and ovarian hormonal production,
 Menstrual/uterine cycle – preparation to receive fertilised ovum.
 Hormonal changes that regulate them – involves hormones
secreted by hypothalamus and pituitary gland,
 Changes in breast and cervix.
Hypothalam
o-pituitary-
ovary
pathway
Hypothalamus and Pituitary
Gland
Hormonal Regulation of the
Female Reproductive Cycle
 GnRH [Gonadotropin-releasing hormone] –
 Secreted by hypothalamus,
 Stimulates the release of FSH and LH from anterior pituitary.

 FSH [Follicle-stimulating hormone]

 Secreted by anterior pituitary,
 Regulated by GnRH,
 Initiates follicular growth,
 Stimulates ovarian follicles to secrete estrogens.
 LH [luteinising hormone]
 Triggers ovulation,
 Promotes formation of corpus luteum,

 Estrogens
 Secreted by ovarian follicles,
 3 of significant estrogens are β-estradiol, estrone, estriol.
 Promotes development and maintenance of:
 female reproductive structures,
 secondary sexual characteristics:
 distribution of adipose tissue in breast, abdomen, mons
pubis, hips,
 voice pitch,
 broad pelvis,
 pattern of hair growth on head and body.
 and breast.
 Progesterone:
 Secreted by corpus luteum,
 Prepare and maintain endometrium for implantation,
 Prepare mammary gland for milk secretion.

 Relaxin:
 Secreted by corpus luteum and placenta,
 Inhibit contraction of uterus,
 Increase flexibility of symphysis pubis at the and of pregnancy,
 Help to dilate cervix during delivery of the baby.
Menstrual cycle
Menstrual cycle
Menstrual cycle
 A concurrent series of changes in the endometrium of
the uterus to prepare it for the arrival of a fertilised ovum
that will develop there until birth.

 Duration of each cycle is about 28 days.

 Can be divided into 4 phases:

 Menstrual phase,
 Follicular phase,
 Ovulation phase,
 Luteal phase,
 Menstrual phase:
 Also called menstruation or menses,
 Lasts for 5 days.
 Events in ovaries:
 Maturity of follicles.
 Events in uterus:
 Menstrual flow consists of 50-150 mL of blood, tissue fluid,
mucus, epithelial cells that shed from endometrium.
 This occurs due to declining level of estrogens and
progesterone that cause uterine arterioles to constrict, and the
tissue starts to die.
 Eventually, entire stratum functionalis sloughs off, leaves
endometrial thickness 2-5 mm.
 Follicular phase:
 Time between end of menstruation and ovulation.
 It lasts from days 6 to day 13 in a 28-day cycle.
 Events in ovary:
 A single follicle in one of two ovaries has outgrown all the
others to become dominant follicle.
 Dominant follicle secretes estrogens and inhibin.
 The dominant follicle becomes mature (graafian) follicle,
which continue to enlarge and ready for ovulation.
 Mature follicle continue to increase its estrogens production.
 Events in uterus:
 Estrogens secreted into bloodstream cause proliferation of
stratum functionalis. Finally, the thickness of endometrium
becomes 4-10 mm.
 Ovulation:
 Rupture of mature (graafian) follicle and release of
secondary oocytes into pelvic cavity.
 Occurs on day 14 in a 28-day cycle.
 A high concentration of estrogens stimulates:
 GnRH release from hypothalamus,
 FSH and LH release from anterior pituitary.
 ‘LH surge’ [sudden peak of the LH level] causes ovulation
[rupture of mature (graafian) follicle and expulsion of
secondary oocyte].
 ‘Mitterschmerz’ [pain in the middle] is caused by leakage of
small amount of blood into pelvic cavity from ruptured
follicle.
 Luteal phase:
 Time between ovulation and onset of next menses.
 It lasts from day 15 to day 28.
 Events in ovary:
 Mature (graafian) follicle becomes corpus luteum, under the
influence of LH.
 Corpus luteum secretes progestrone, estrogens, relaxin and
inhibin.
 If oocyte is not fertilised:
 Corpus luteum survive for 2 weeks,
 It’s secretory activity decreases, degenerates into corpus albicans.
 As the level of estrogens, progesterone, inhibin decrease, release
of GnRH, FSH and LH rise [negative feedback].
  If oocyte is fertilised,
 Corpus luteum persists past 2 week.
 It is rescued by hCG [human chorionic gonadotropin].
 hCG is produced by chorion of embryo beginning 8 days after
fertilisation.
 hCG stimulates secretory activity of corpus luteum.
 Presence of hCG in maternal blood or urine is indicator of
pregnancy [UPT – urine pregnancy test].

 Events in uterus:
 Progestrone and estrogens secreted by corpus luteum:
 Promote growth and coiling of endometrial glands,
 Vascularisation of superficial endometrium,
 Thickening of endometrium to 12-18 mm.
 If there’s no fertilisation, progestrone and estrogen level
decreased due to degeneration of corpus luteum.
 Withdrawal of progesterone and estrogen causes menstruation.
Embryo
Zygote Fetus
Pregnancy
 Embryonic period – from fertilisation to 8th week of
development. The developing human is called embryo.

 Fetal period – begins at week 9 until birth. The

developing human is called fetus.

 Pregnancy – a sequence of events that begins with

fertilisation, proceeds to implantation, embryonic
development, and fetal development, and normally ends
with birth about 38 weeks later [or 40 weeks after the last
menstrual period (LMP)].
 Obstetrics [perbidanan] is the branch of medicine that
deals with the management of pregnancy, labor and
neonatal period [the first 28 days after birth].

 Prenatal development – time from fertilisation to birth. It

is divided into three periods, called trimester.
 First trimester – critical stage of development. All major organs
systems appear. Most vulnerable to the effects of drugs,
radiation, and microbes.
 Second trimester – nearly complete development of organ
systems. Fetus assumes distinctively human features.
 Third trimester – rapid fetal growth. Most of the organ systems
are becoming fully functional.
Lactation
Physiology of Lactation
 Lactation is the secretion and ejection of milk from the
mammary glands.

 Hormone for milk synthesis and secretion is prolactin

(PRL), which is secreted from anterior pituitary gland.

 Lactation blocks ovarian cycles for the first few months

following delivery, if frequency of sucking is about 8-10
times a day.

 This is because during breast-feeding, neural input from

nipples reaches the hypothalamus and supress the
release of GnRH. As a result, FSH and LH decreased
and ovulation is inhibited.
 Factors that cause milk ejection:

 Sudden fall in the level of estrogens and progesterone after

delivery. During pregnancy, high level of estrogens and
progesterone inhibit PRL secretion.

 Sucking action of infant. It’s the primary stimulus. Suckling

initiates sensory nerve impulses from nipples to the
hypothalamus, cause more PRL release by the anterior pituitary.

 Oxytocin secretion. Stimulation of touch receptors in the nipple

initiates sensory nerve impulses that are relayed to the
hypothalamus. So secretion of oxytocin from posterior pituitary
increases and carried through bloodstream to mammary glands,
and stimulates contraction of cells around the glandular tissue
and duct.
 Benefits of breast-feeding:
 Human milk is sterile solution, contains fatty acids, lactose,
amino acids, minerals, vitamins that are ideal for baby’s
digestion, brain development and growth.
 Contains neutrophils and macrophages that ingest microbes in
baby’s GIT.
 Maternal IgA antibodies binds to microbes and prevent their
migration into body’s tissue.
 Reduce risks in children of lymphoma, heart disease, allergies,
respiratory/gastrointestinal infections, ear infections, diarrhoea,
DM, meningitis.
 Protects mother against osteoporosis and breast cancer.
 Supports optimal infant growth, enhance intelectual and
neurological development,
 Foster mother-infant relations by establishing early and
prolonged contact between them.