1. Chapter 28 Lecture Outline
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2. Female Reproductive System
Reproductive Anatomy
Puberty and Menopause
Oogenesis and the Sexual Cycle
Female Sexual Response
Pregnancy and Childbirth
Lactation

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

4. Sex 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. 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

6. Anatomy of Ovary

7. Secondary Sex Organs Internal genitalia External genitalia
duct system of uterine tubes, uterus, vagina
External genitalia
clitoris, labia minora, and labia majora
occupy perineum
accessory glands beneath skin provide lubrication

8. 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)

9. Epithelial Lining of Uterine Tube

10. 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

11. Reproductive Tract with Ligaments

12. 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 stratum functionalis with each menstrual cycle

13. Normal/Abnormal PAP Smears

14. Vessels of Reproductive Tract
Hormonal changes cause spiral artery vasoconstriction, necrosis of stratum functionalis and menstrual flow

15. Ligaments of Reproductive Tract

16. 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

17. 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

18. Female Perineum Showing Vulva

19. Components of Female Perineum

20. Breasts Overlies pectoralis major Nipple surrounded by areola
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

21. Anatomy of Lactating Breast

22. Anatomy of Lactating Breast

23. Sagittal Section of Breast

24. 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

25. Cancer Screening and Treatment

26. 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

27. 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 Results
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

29. 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

30. 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

31. Oogenesis and Follicle Development

32. 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

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

34. Ovarian Cycle - Preantral Phase
Discharge of menstrual fluid (days 1-5)
Before follicle develops antrum
primordial and primary follicles

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

36. Ovarian Cycle - Ovulation
Mature follicle ruptures, releases oocyte influenced by LH

37. Histology of Ovarian Follicles

38. Pituitary-Ovarian Axis

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

40. Menstrual Cycle - Proliferative Phase
Day 6-14 rebuild endometrial tissue
mitosis occurs in stratum basalis
result of estrogen from developing follicles

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

42. Menstrual Cycle Premenstrual Phase
Involution of corpus luteum, progesterone falls
spiral arteries constrict causes endometrial ischemia
stratum functionalis sloughs

43. Menstrual Cycle - Menstrual Phase
Blood, serous fluid and endometrial tissue are discharged

44. Female Sexual Response

45. Pregnancy and Childbirth
Gestation (pregnancy)
lasts an average of 266 days from conception to childbirth
gestational calendar measured from first day of the woman’s last menstrual period (LMP)
Birth predicted 280 days from LMP
3 three month intervals called trimesters

46. 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

47. Hormones of Pregnancy HCG (human chorionic gonadotropin) Estrogens
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

48. 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
 mother’s glucose usage and  release of fatty acids

49. Hormones of Pregnancy Aldosterone secretion rises Endocrine organs
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

50. Hormone Levels and Pregnancy

51. Adjustments to Pregnancy

52. 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.

53. 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

54. Adjustments 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

55. 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

56. 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

57. 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

58. 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

59. 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

60. 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

61. 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

62. Pain of Labor Ischemia of myometrium
Stretching of cervix, vagina and perineum
episiotomy prevents tearing
Large fetal head in a narrow pelvic outlet

63. 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

64. 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

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

66. Stages of Labor -- Placental
Uterine contractions continue causing placental separation

67. Crowning (Expulsion Stage)

68. Expulsion Stage (cont.)

69. Placental Stage

70. 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

71. 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

72. 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

73. 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

74. Prolactin and Lactation

75. Milk 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 seconds after suckling begins

76. 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
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)

77. Contraceptive Devices