Chapter 28

Lecture
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28-1

Female Reproductive System

Reproductive Anatomy
Puberty and Menopause
Oogenesis and the Sexual Cycle
Female Sexual Response
Pregnancy and Childbirth
Lactation
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Female Reproductive System

Produce and
deliver
gametes
Provide
nutrition and
room for fetal
development
Give birth
Nourish infant

28-3

Sex Differentiation
Male and female are indistinguishable for
first 8 to 10 weeks of development
Female develops
no testosterone or mllerian-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

28-4

Ovary
Produces eggs and hormones
almond-shaped, 3 cm x 1.5 cm x 1 cm
tunica albuginea capsule like on testes
cortex produces gametes; medulla holds vessels

Each egg develops in its own fluid-filled follicle

and is released by ovulation
Ligaments
attached to uterus by ovarian ligament
attached to pelvic wall by suspensory ligament
contains ovarian artery, vein and nerves

anchored to broad ligament by mesovarium

28-5

Anatomy of Ovary

28-6

Secondary Sex Organs

Internal genitalia
duct system of uterine tubes, uterus,
vagina

External genitalia
clitoris, labia minora, and labia majora
occupy perineum
accessory glands beneath skin provide
lubrication
28-7

Uterine (Fallopian) Tubes

10 cm long, muscular tube
lined with ciliated cells
Major portions

narrow isthmus near uterus

body (ampulla): middle
portion
flares distally into
infundibulum
with fimbriae
Enclosed in superior
margin of broad
ligament (mesosalpinx)

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Epithelial Lining of Uterine Tube

28-9

Uterus

Thick-walled, pear-shaped muscular chamber that opens

into vagina and tilts forward over urinary bladder
internal and external os of cervical canal
openings into uterine tubes in two upper corners

Domed fundus above body of organ

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Reproductive Tract with Ligaments

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Histology of Uterine Wall

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 with thick layer
compound tubular glands
stratum functionalis superficial, shed each period
stratum basalis - deep layer, regenerates a new
28stratum functionalis with each menstrual cycle

Normal/Abnormal PAP Smears

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Vessels of Reproductive Tract

Hormonal changes cause spiral artery

vasoconstriction, necrosis of stratum functionalis and
menstrual flow

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Ligaments of Reproductive Tract

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Vagina
8-10 cm distensible muscular tube
allows for discharge of menstrual fluid, receipt of
penis, semen and birth of baby

Outer adventitia, middle muscularis and inner

mucosa
Epithelium
child - simple cuboidal
puberty - estrogens transform to stratified squamous
bacteria ferment glycogen rich cells producing acidic pH

Tilted posteriorly between rectum and urethra

urethra embedded in its anterior wall
28-

Vulva (Pudendum)
Mons pubis - mound of fat over pubic
symphysis; covered by pubic hair
Labia majora - thick folds of skin
Labia minora - medial, thin hairless folds
form vestibule contains urethral and vaginal openings
form hoodlike prepuce over clitoris

Clitoris - erectile, sensory organ

Vestibular bulbs - erectile tissue around vagina
Greater and lesser vestibular and paraurethral
glands open into vestibule for lubrication
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Female Perineum Showing Vulva

28-

Components of Female Perineum

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Breasts
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
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Anatomy of Lactating Breast

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Anatomy of Lactating Breast

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Sagittal Section of Breast

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Breast 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
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Cancer Screening and Treatment

28-

Puberty
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

28-

Puberty
Thelarche - development of breasts
Pubarche - growth of pubic and axillary hair;
apocrine and sebaceous glands
Menarche - first menstrual period
requires at least 17% body fat in teenager, 22%
in adult
leptin stimulates gonadotropin secretion
improved nutrition ( body fat) has lowered avg.
age of onset to 12

Female hormones secreted cyclically and

in sequence
28-

Climacteric
Midlife change in hormone secretion
due to age related depletion of follicles
occurs with menopause (cessation of
menstruation); average age of 52

Results
atrophy of uterus, vagina and breasts
skin becomes thinner, bone mass declines,
and risks of cardiovascular disease
increase
hot flashes (sudden dilation of cutaneous
arteries) occur several times a day

HRT = hormone replacement therapy

28-

Oogensis and Sexual Cycle

Reproductive cycle - events occurring
between fertilization and birth
Sexual cycle - events recurring every
month when pregnancy does not occur
ovarian cycle = events in ovaries
menstrual cycle = parallel changes in uterus

28-

Oogenesis
Monthly event produces haploid egg by meiosis
Embryonic development of ovary

female germ cells arise from yolk sac

differentiate into oogonia, multiply
transform into primary oocytes - early meiosis I
most degenerate (atresia) by childhood
by puberty 400,000 oocytes remain

FSH stimulates completion of meiosis I,

produces secondary oocyte and 1st polar body
proceeds to meiosis II and ceases until fertilization
after fertilization , releases 2nd polar body

28-

Oogenesis and Follicle Development

28-

Sexual 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

28-

Ovarian Cycle - Follicular Phase

Menstruation (day 1) to ovulation(14) (variable)

Difficult to predict date of ovulation
Contains menstrual and preovulatory phases 28-

Ovarian Cycle - Preantral Phase

Discharge of menstrual fluid (days 1-5)

Before follicle develops antrum
primordial and primary follicles

28-

Ovarian Cycle - Antral Phase

Day 6 to 14, one dominant follicle advances to

mature (graafian) follicle; secretes estrogen

28-

Ovarian Cycle - Ovulation

Mature follicle ruptures, releases oocyte

influenced by LH

28-

Histology of Ovarian Follicles

28-

Pituitary-Ovarian Axis

28-

Ovarian Cycle - Luteal Phase

Corpus luteum - forms from ruptured follicle,

under influence of LH; secretes progesterone
28-

Menstrual Cycle - Proliferative Phase

Day 6-14 rebuild endometrial tissue

mitosis occurs in stratum basalis
result of estrogen from developing follicles

28-

Menstrual Cycle - Secretory Phase

Further thickening of endometrium due to

secretion and fluid accumulation -- not mitosis
Due to progesterone stimulation of glands

28-

Menstrual Cycle Premenstrual Phase

Involution of corpus luteum, progesterone falls

spiral arteries constrict causes endometrial ischemia
stratum functionalis sloughs

28-

Menstrual Cycle - Menstrual Phase

Blood, serous fluid and endometrial tissue are

discharged
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Female Sexual Response

28-

Pregnancy and Childbirth

Gestation (pregnancy)
lasts an average of 266 days from conception
to childbirth
gestational calendar measured from first day
of the womans last menstrual period (LMP)

Birth predicted 280 days from LMP

3 three month intervals called trimesters

28-

Prenatal Development
Age based terminology
blastocyst is less than 2 weeks old
embryo is from 2 to 8 weeks old
fetus is 9 weeks to birth
neonate - newborn to 6 weeks

28-

Hormones 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
28-

Hormones 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
mothers glucose usage and release of
fatty acids

28-

Hormones of Pregnancy
Aldosterone secretion rises
fluid retention mothers blood volume

Endocrine organs
thyroid gland increases 50% in size
BMR of mother

parathyroid glands enlarge

stimulate osteoclasts to release additional calcium
from mothers bones

28-

Hormone Levels and Pregnancy

28-

Adjustments to Pregnancy

28-

Adjustments 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.
28-

Adjustments 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
28-

Adjustments to Pregnancy
Circulatory System
mothers 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

28-

Adjustments 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

28-

Adjustments 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

28-

Adjustments 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

28-

Childbirth - 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

28-

Childbirth - 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

28-

Labor 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

28-

Labor 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

28-

Pain of Labor
Ischemia of myometrium
Stretching of cervix, vagina and perineum
episiotomy prevents tearing

Large fetal head in a narrow pelvic outlet

28-

Stages 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 28-

Stages 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
28-

Stages of Labor -- Expulsion

Time babys head enters vagina until delivery

up to 30 minutes

Valsalva maneuver helps to expel fetus

28-

Stages of Labor -- Placental

Uterine contractions continue causing placental

separation

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Crowning (Expulsion Stage)

28-

Expulsion Stage (cont.)

28-

Placental Stage

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Puerperium
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
28-

Mammary 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
28-

Colostrum 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-

Colostrum 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
28-

Prolactin and Lactation

28-

Milk Ejection
Controlled by a neuroendocrine reflex
infants 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
28-

Breast 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
Cows milk not a good substitute
1/3 less lactose but 3 times as much protein
harder to digest and more nitrogenous waste
(diaper rash)
28-

Contraceptive Devices

28-