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Introduction to Reproductive Physiology and Female Reproduction, Exams of Physiology

Study notes and review questions on reproductive physiology

Typology: Exams

2023/2024

Available from 10/17/2024

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ANATOMY AND PHYSIOLOGY OF UTERUS
The uterus is a vital organ in female reproductive
anatomy and physiology, primarily responsible for
housing a developing fetus during pregnancy.
Location:
In the female pelvis between the urinary bladder
(anteriorly) and the rectum (posterior).
Region:
Fundus
the top portion of the uterus, which is a dome-
shaped
Body
the central, large part where implantation of the
fertilized egg typically occurs.
Cervix
the lower, narrow part that connects the uterus to
the vagina
Layers:
Structure Function
Endometrium The innermost lining that thickens
in preparation for a possible
pregnancy and sheds during
menstruation If no fertilization
occurs
Myometrium The middle muscular layer
responsible for contractions during
labor
Perimetrium The outermost layer that covers the
uterus
Reproductive Physiology of the uterus
Menstrual Cycle
The uterus plays a key role in the menstrual cycle. The
endometrium thickens in response to estrogen, preparing
for potential implantation of an embryo. If fertilization
does not occur, the lining is shed, resulting in
menstruation.
Fertilization and Implantation
After fertilization in the fallopian tubes, the embryo
travels to the uterus, where it implants in the thickened
endometrium. The uterus then provides a nutrient-rich
environment for the developing embryo, which is crucial for
successful implantation and early embryonic development.
Pregnancy:
The uterus expands significantly during pregnancy to
accommodate the growing fetus. The endometrium forms
part of the placenta, which supplies oxygen and nutrients to
the fetus and removes waste. While, the myometrium’s
muscle fibers stretch and strengthen, preparing for labor.
Labor:
During labor, the myometrium contracts rhythmically
to facilitate the expulsion of the fetus. These contractions are
regulated by the hormone oxytocin, which stimulates the
uterine muscles, helping to dilate the cervix and push the
baby through the birth canal.
THE HUMAN OVARY
the human ovary is a crucial reproductive organ for
producing eggs and hormones. It plays a vital role ion
female fertility and overall health.
Anatomy and Structure of the Ovary
Exterior
the ovary is almond-shaped and located on either side of
the uterus. It is held in place by ligaments and covered by
a thin membrane
Interior
the ovary is composed of two main layers: the outer
cortex, where follicles develop, and the inner medulla,
which contains blood vessels and nerves
Follicles
tiny sacs that contain developing eggs. They are
surrounded by cells that produce hormones and support
the egg’s growth
Ovarian Layers
1. Germinal epithelium – the outermost layer, a single layer
of cells covering the ovary, derived from the peritoneum
2. Tunica albuginea a dense connective tissue layer
beneath the germinal epithelium, providing structural
support
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ANATOMY AND PHYSIOLOGY OF UTERUS

 The uterus is a vital organ in female reproductive anatomy and physiology, primarily responsible for housing a developing fetus during pregnancy. Location: In the female pelvis between the urinary bladder (anteriorly) and the rectum (posterior). Region: Fundus  the top portion of the uterus, which is a dome- shaped Body  the central, large part where implantation of the fertilized egg typically occurs. Cervix  the lower, narrow part that connects the uterus to the vagina Layers: Structure Function Endometrium  The innermost lining that thickens in preparation for a possible pregnancy and sheds during menstruation If no fertilization occurs Myometrium  The middle muscular layer responsible for contractions during labor Perimetrium  The outermost layer that covers the uterus Reproductive Physiology of the uterus Menstrual Cycle  The uterus plays a key role in the menstrual cycle. The endometrium thickens in response to estrogen, preparing for potential implantation of an embryo. If fertilization does not occur, the lining is shed, resulting in menstruation. Fertilization and Implantation After fertilization in the fallopian tubes, the embryo travels to the uterus, where it implants in the thickened endometrium. The uterus then provides a nutrient-rich environment for the developing embryo, which is crucial for successful implantation and early embryonic development. Pregnancy: The uterus expands significantly during pregnancy to accommodate the growing fetus. The endometrium forms part of the placenta, which supplies oxygen and nutrients to the fetus and removes waste. While, the myometrium’s muscle fibers stretch and strengthen, preparing for labor. Labor: During labor, the myometrium contracts rhythmically to facilitate the expulsion of the fetus. These contractions are regulated by the hormone oxytocin, which stimulates the uterine muscles, helping to dilate the cervix and push the baby through the birth canal. THE HUMAN OVARY  the human ovary is a crucial reproductive organ for producing eggs and hormones. It plays a vital role ion female fertility and overall health. Anatomy and Structure of the Ovary Exterior  the ovary is almond-shaped and located on either side of the uterus. It is held in place by ligaments and covered by a thin membrane Interior  the ovary is composed of two main layers: the outer cortex, where follicles develop, and the inner medulla, which contains blood vessels and nerves Follicles  tiny sacs that contain developing eggs. They are surrounded by cells that produce hormones and support the egg’s growth Ovarian Layers

  1. Germinal epithelium – the outermost layer, a single layer of cells covering the ovary, derived from the peritoneum
  2. Tunica albuginea – a dense connective tissue layer beneath the germinal epithelium, providing structural support
  1. Cortex – outer layer of the ovary, containing follicles and developing eggs
  2. Medulla – the inner layer of the ovary, composed of connective tissue, blood vessels, and nerves Primordial Follicles Oocyte  The immature egg cell, surrounded by a single layer of flattened cells called follicular cells. Follicular Cells  These cells provide nourishment and support to the oocyte, promoting its development. Basement Membrane  A thin layer of extracellular matrix that separates the follicular cells from the surrounding stroma. **Ovarian Follicle Development
  3. Primordial follicle**  The development begins with primordial follicles, containing an immature egg surrounded by a single layer of cells. 2. Primary follicle  The egg grows, and the surrounding cells multiply, forming a multilayered structure called a primary follicle. 3. Secondary follicle  The follicle continues to grow, developing a fluid- filled space called the antrum, and becoming a secondary follicle. 4. Graafian follicle  The final stage is the Graafian follicle, containing a mature egg ready for ovulation. It is the largest follicle and has a prominent antrum. **Ovulation and Corpus Luteum
  4. Ovulation**  This process involves the rupture of the Graafian follicle and the release of the mature egg into the fallopian tube. 2. Corpus Luteum  After ovulation, the ruptured follicle transforms into the corpus luteum, a temporary structure that produces progesterone and estrogen. 3. Hormonal Shift and Degeneration  The corpus luteum's hormones prepare the uterus for potential pregnancy, and its decline leads to menstruation if fertilization does not occur. If fertilization does not occur, the corpus luteum degenerates into a scar-like structure called the corpus albicans. **Ovulation
  5. Hormonal surge**  A surge in luteinizing hormone (LH) triggers ovulation. 2. Follicle rupture  The mature Graafian follicle ruptures, releasing the egg into the fallopian tube. 3. Egg transport  The egg is transported through the fallopian tube towards the uterus. Hormonal Regulation of the Ovary

1. Hypothalamus

 The hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland.

2. Pituitary gland

 The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate the ovarian cycle.

3. Ovary

 FSH and LH stimulate follicle growth, ovulation, and the production of estrogen and progesterone by the ovary.

4. Uterus

Causes:

  • Endometrial tissue grows outside the uterus, often on the ovaries, fallopian tubes, or pelvic lining
  • Tissue continues to thicken and break down during menstruation
  • Blood and tissue become trapped due to displacement, leading to complications Symptoms:
  • Severe pain during menstruation, intercourse, urination, or bowel movements
  • Heavy periods
  • Fatigue, nausea, or bloating Complications:
  • Development of cysts on the ovaries (endometriomas)
  • Scar tissue and adhesions forming, causing pelvic structures to stick together
  • Infertility in approximately 40% of women, potentially due to scar tissue affecting fallopian tubes or low progesterone levels impacting uterine lining (luteal phase defect) Treatment Options:
  • Medications
  • Hormone therapy
  • Surgery 2. Endometrial hyperplasia Causes:
  • Hormonal imbalance, specifically excess estrogen and insufficient progesterone
  • Thickening of the endometrial lining in the absence of ovulation
  • Use of medications that mimic estrogen without progestin or progesterone
  • Prolonged high doses of estrogen after menopause Occurrence:
  • Common during perimenopause or after menopause
  • Can also occur in individuals with polycystic ovary syndrome (PCOS), infertility, or obesity Symptoms:
  • Irregular menstrual periods Complications:
  • Risk of abnormal cell growth
  • Potential increased risk of endometrial cancer 3. Cancer
  • The growth of abnormal cells causes endometrial cancer. About 90% of people diagnosed with this condition have abnormal vaginal bleeding. Other possible symptoms of endometrial cancer include:  Non-bloody vaginal discharge.  Pelvic pain.  Feeling a mass in your pelvic area.  Unexplained weight loss. THE HUMAN FALLOPIAN TUBE  Sometimes called “uterine tube” or “oviducts”.  Serves as the “highway” for fertilization.  Connects the ovary and the uterus.  It is where Fertilization occurs.  It transports the fertilized egg into the uterus.  Sometimes medically intervened for permanent contraception’s. Origin of Fallopian Tube  Fallopian tubes are derived from Mullerian duct during early development.  Absence of AMH promotes the development of the fallopian tube.  Well-formed by around 12 to 13 weeks of pregnancy. Anatomy of Fallopian Tubes  Fallopian tube has four major parts:  Isthmus - connects the ampulla and the uterine cavity in the uterus  Ampulla – widest region of the fallopian tube, this is also where the fertilization occurs

Infundibulum – a funnel shape part of the tube where fimbriae attaches. Its primary role is to help guide the oocyte in the tube  Fimbriae – a finger like structure at the end of fallopian tube. It captures the oocyte from ovary Disease and Disorders in Fallopian TubesEctopic Pregnancy – Occurs when the fertilized egg is implanted outside the uterus, often in the fallopian tube. This will cause rupture to the tube and will result internal bleeding.  Pelvic Inflammatory Disease (PID) – Sexually transmitted infection like ghonorea and chlamydia. This infection will cause blockage of the tube  Salpingitis – Infection on the tube that cause infertility  Endometriosis – endometrial tissue growing outside the uterus, may result to tubal scarring and adhesions when growing in the fallopian tube Contraception’s using Fallopian tube Tubal ligation – It is a permanent form of contraception, where the female’s fallopian tube getting tied, cut or blocked to prevent pregnancy  Tubal ligation – It is a permanent form of contraception, where the female’s fallopian tube getting tied, cut or blocked to prevent pregnancy VAGINA Vulva Mons pubis Functions:  The mons pubis is a rounded mass of fatty tissue located over the pubic symphysis, which is the joint that unites the left and right pubic bones.  It provides cushioning and protection to the underlying bones and tissues during activities such as sexual intercourse.  Important Facts:  The mons pubis becomes more pronounced during puberty due to the deposition of fat.  It often has hair growth after puberty, which serves as an additional protective layer.  it is anteriosuperior to the pubic symphysis Anterior labial commissure Functions:  The anterior labial commissure is the area where the labia majora (the outer lips) meet at the front, just below the mons pubis.  It helps to protect the internal genital structures by covering and closing the external genitalia when at rest.  It is the counterpart to the posterior labial commissure, which is located at the back.  It contributes to the overall aesthetics and appearance of the external genitalia. Prepuce of Clitoris  The prepuce (also called the clitoral hood) is a fold of skin that covers and protects the clitoris.  It helps maintain the clitoris's sensitivity by keeping it moist and reducing friction.  The prepuce is analogous to the foreskin in males.  Some cultures practice clitoral hood reduction or removal (hoodectomy), though this is a controversial practice.

 The posterior labial commissure is the area where the labia majora meet at the posterior end of the vulva, near the perineum.  It helps protect and cover the internal genital structures.  It serves as a landmark during gynecological examinations and procedures.  The posterior commissure is located near the perineal body, an important structure for pelvic floor stability. Perineal raphe  The perineal raphe is a line of tissue that runs from the anus, through the perineum, to the scrotum or vulva.  It represents the fusion line of the urogenital folds during embryonic development.  In females, the perineal raphe is less pronounced but still present, running through the perineum to the posterior labial commissure.  In males, it extends from the anus to the underside of the penis. Frenulum of Labia minora  The frenulum of the labia minora is a small fold of tissue that connects the labia minora to the vaginal vestibule.  It helps to anchor the labia minora and provides structural support.  The frenulum is an important structure for the stability and movement of the labia minora.  It is analogous to the frenulum of the clitoris and the frenulum of the penis in males. Deep layer of superficial fascia (Colles’ fascia)  Colles' fascia is a membranous layer of the superficial fascia in the perineum. It extends into the urogenital region and provides structural support to the perineal structures.  It helps to contain and protect the perineal muscles and neurovascular structures by creating a compartment within the superficial perineal pouch.  Colles' fascia is continuous with Scarpa's fascia of the anterior abdominal wall.  It plays a role in limiting the spread of infections or extravasated fluids in the perineal region. Superficial perineal compartment  Contains muscles such as the bulbospongiosus , ischiocavernosus , and superficial transverse perineal muscles , which contribute to the function of the external genitalia.  It houses important structures like the erectile tissues (e.g., the clitoris and the vestibular bulbs) and the superficial perineal nerves and vessels.  Injuries or infections in this compartment can spread to adjacent areas if not contained by fascia. Suspensory ligament of clitoris  The suspensory ligament of the clitoris is a fibrous band that connects the clitoris to the pubic symphysis, providing structural support.  It helps maintain the position of the clitoris and contributes to the clitoral erection by anchoring it during sexual arousal.  This ligament is analogous to the suspensory ligament of the penis in males.  Its function is crucial for the proper orientation and responsiveness of the clitoris during sexual activities. Vestibular bulb  The vestibular bulbs are paired erectile tissues located on either side of the vaginal opening.  During sexual arousal, they fill with blood, contributing to the tightening of the vaginal orifice and enhancing sexual pleasure.  The vestibular bulbs are homologous to the bulb of the penis in males.  They play a role in sexual response and are part of the larger clitoral complex, contributing to clitoral and vaginal sensitivity. Central tendon of perineum (perineal body)  The perineal body is crucial for maintaining the integrity of the pelvic floor, and damage to it (e.g., during childbirth) can lead to pelvic organ prolapse.  It plays a significant role in the stability and function of the perineum. External adventitia  The adventitia is the outermost layer of the vaginal wall. It consists of connective tissue that provides structural support and anchors the vagina to surrounding organs such as the urethra and bladder. It also contains blood vessels, lymphatics, and nerves.

External longitudinal muscle  This layer of smooth muscle helps in the contraction and relaxation of the vagina. It plays a crucial role during childbirth by allowing the vagina to stretch and accommodate the passage of the baby. It also assists in the expulsion of menstrual blood and other vaginal secretions. Circular smooth muscle  The circular smooth muscle layer, located beneath the longitudinal muscle, provides further support for the vagina's structural integrity. It works in conjunction with the longitudinal muscle to facilitate the contractions necessary during sexual intercourse, childbirth, and the expulsion of menstrual fluids. Lamina propia of the mucous membrane  The lamina propria is a layer of loose connective tissue located just beneath the epithelium. It contains blood vessels, nerves, and immune cells. This layer supports the epithelium and provides the necessary nutrients and oxygen for its maintenance. It also plays a role in the immune defense of the vagina. Surface rugae  Rugae are the folds or ridges present on the inner surface of the vaginal wall. They allow the vagina to expand and stretch during sexual intercourse and childbirth. These folds also increase surface area, facilitating the accommodation of vaginal secretions and maintaining the health of the vaginal environment. Stratified squamous epithelium lining  The stratified squamous epithelium is the innermost layer of the vaginal wall. It provides a protective barrier against mechanical stress, infections, and other potential damage. The cells of this layer are rich in glycogen, which is metabolized by vaginal bacteria to produce lactic acid. This helps maintain an acidic pH in the vagina, protecting against harmful pathogens.

DISEASES

Vaginal Agenesis Causes :  Vaginal agenesis, also known as Mayer-Rokitansky-Küster- Hauser (MRKH) syndrome, is a congenital condition where the vagina is underdeveloped or absent. It occurs due to abnormal development of the Müllerian ducts during embryogenesis. Symptoms :  Absence of menstruation (primary amenorrhea) in teenage years.  Absent or very short vagina.  Normal external genitalia and secondary sexual characteristics.  Possible associated kidney or skeletal abnormalities. Treatment :  Non-surgical treatments include dilation therapy to create or lengthen the vaginal canal.  Surgical treatments, such as vaginoplasty, to construct a functional vagina.  Psychological support and counseling to address emotional and psychological impacts.  Vaginal agenesis is complete absence of the vagina. This congenital defect is typically part of the Mayer- Rokitansky-Kuster-Hauser syndrome, characterized by an absence of the vagina and uterus (46,XX karyotype). This syndrome is thought to be a developmental accident rather than an inherited condition. Vaginal septum Causes :  A vaginal septum is a congenital condition where a wall of tissue (septum) divides the vagina either vertically (longitudinal septum) or horizontally (transverse septum). It results from incomplete fusion or reabsorption of the Müllerian ducts during development. Symptoms :

 Probiotics may help restore the balance of bacteria in the vagina. Trichomoniasis Causes :  Sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis.  Transmitted through unprotected sexual contact.  Trichomoniasis is a sexually transmitted vaginal infection caused by the parasitic organism Trichomonas vaginalis Symptoms :

  • Frothy, yellow-green vaginal discharge with a strong odor.
  • Vaginal itching, redness, and irritation.
  • Pain during intercourse and urination. Treatment :  Antibiotics, specifically metronidazole or tinidazole, usually administered as a single dose.  Treatment of sexual partners to prevent reinfection.  Abstaining from sexual activity until the infection is fully cleared. Imperforate hymen Causes :  Occurs during fetal development. While the exact cause is not fully understood, it is believed to result from the failure of the hymenal tissue to properly peforate during fetal development. Symptoms : Newborns : Often asymptomatic at birth but may present with a bulging hymen due to fluid accumulation (mucocolpos) Adolescents (After puberty):
  • Primary amenorrhea: absence of menstrual period despite reaching puberty.
  • Cyclic pelvic pain: occurs monthly as menstrual blood accumulates in the vagina (hematocolpos) or even in the uterus (hematometra) without an outlet.
  • Abdominal swelling: due to the build-up of menstrual blood.
  • Difficulty with urination
  • Back pain Treatment :  Minor surgical procedure called Hymenotomy or Hymenectomy, where an incision is made in the hymen to create an opening for menstrual blood to pass, done under anesthesia.

Trichomoniasis is a sexually transmitted vaginal

infection caused by the parasitic organism Trichomonas

vaginalis. Symptoms include increased vaginal discharge

(thin, watery, yellow/green) and malodor.

Diagnosis is made by microscopic identification

of the motile organisms, trichomonads, on a saline slide

preparation. Treatment is with oral metronidazole,

available by prescription only.

SEVERAL HORMONES THAT TARE CRUCIAL IN THE FUNCTION

AND HEALTH OF THE VAGINA

Testosterone Role : Though typically associated with male physiology, testosterone also plays a role in female sexual health. It contributes to libido and may affect the sensitivity of vaginal tissues. Impact : Lower levels of testosterone, particularly in postmenopausal women, can contribute to decreased sexual desire and vaginal dryness. Oxytocin Role : Oxytocin is known as the "love hormone" and is released during sexual activity, childbirth, and breastfeeding. It promotes bonding and also stimulates contractions of the uterus and vaginal muscles. Impact : Oxytocin enhances vaginal sensitivity and lubrication during sexual activity. Relaxin Role : This hormone is particularly important during pregnancy. It helps to relax the ligaments in the pelvis and soften the cervix in preparation for childbirth.

Impact : Relaxin allows the vagina to stretch more easily during delivery. Prolactin Role : Prolactin primarily stimulates milk production in breastfeeding women, but it can also influence vaginal dryness. High levels of prolactin can reduce estrogen production. Impact : Women who are breastfeeding may experience vaginal dryness due to elevated prolactin levels.