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Anatomy and Physiology

The Female Reproductive System

The female reproductive system consists of external and internal structures. Other

anatomic structures that affect the female reproductive system include the

hypothalamus and pituitary gland of the endocrine system.

External Genitalia

The external genitalia (the vulva) include two thick folds of tissue called the labia

majora and two smaller lips of delicate tissue called the labia minora, which lie

within the labia majora. The upper portions of the labia minora unite, forming a

partial covering for the clitoris, a highly sensitive organ composed of erectile tissue.

Between the labia minora, below and posterior to the clitoris, is the urinary meatus.

This is the external opening of the female urethra and is about 3 cm (1.5 inches)

long. Below this orice is a larger opening, the vaginal orice or introitus. On each

side of the vaginal orice is a vestibular (Bartholins) gland, a bean-sized structure

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that empties its mucous secretion through a small duct. The opening of the duct lies

within the labia minora, external to the hymen. The area between the vagina and

rectum is called the perineum.

Internal Reproductive Structures

The internal structures consist of the vagina, uterus, ovaries, and fallopian or uterine

tubes.

Vagina

The vagina, a canal lined with mucous membrane, is 7.5 to 10 cm (3 to 4 inches)

long and extends upward and backward from the vulva to the cervix. Anterior to it

are the bladder and the urethra, and posterior to it lies the rectum. The anterior and

posterior walls of the vagina normally touch each other. The upper part of the

vagina, the fornix, surrounds the cervix (the inferior part of the uterus).

Uterus

The uterus, a pear-shaped muscular organ, is about 7.5 cm (3 inches) long and 5 cm

(2 inches) wide at its upper part. Its walls are about 1.25 cm (0.5 inch) thick. The

size of the uterus varies, depending on parity (number of viable births) and uterine

abnormalities (eg, broids, which are a type of tumor that may distort the uterus).

A nulliparous woman (one who has not completed a pregnancy to the stage of fetal

viability) usually has a smaller uterus than a multiparous woman (one who has

completed two or more pregnancies to the stage of fetal viability). The uterus lies

posterior to the bladder and is held in position by several ligaments. The round

ligaments extend anteriorly and laterally to the internal inguinal ring and down the

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inguinal canal, where they blend with the tissues of the labia majora. The broad

ligaments are folds of peritoneum extending from the lateral pelvic walls and

enveloping the fallopian tubes. The uterosacral ligaments extend posteriorly to the

sacrum. The uterus has two parts: the cervix, which projects into the vagina, and a

larger upper part, the fundusor body, which is covered posteriorly and partly

anteriorly by peritoneum. The triangular inner portion of the fundus narrows to a

small canal in the cervix that has constrictions at each end, referred to as the external

os and internal os. The upper lateral parts of the uterus are called the cornua. From

here, the oviducts or fallopian (or uterine) tubes extend outward, and their lumina

are internally continuous with the uterine cavity.

Ovaries

The ovaries lie behind the broad ligaments, behind and below the fallopian tubes.

They are oval bodies about 3 cm (1.2 inches) long. At birth, they contain thousands

of tiny egg cells, or ova. The ovaries and the fallopian tubes together are referred to

as the adnexa.

Function of the female reproductive system

Ovulation

At puberty (usually between ages 12 and 14, but earlier for some; 10 or 11 years

of age is not uncommon), the ova begin to mature. During a period known as the

follicular phase, an ovum enlarges as a type of cyst called a graaan follicle until

it reaches the surface of the ovary, where transport occurs. The ovum (or oocyte)

is discharged into the peritoneal cavity. This periodic discharge of matured ovum

is referred to as ovulation. The ovum usually nds its way into the fallopian tube,

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where it is carried to the uterus. If it meets a spermatozoon, the male reproductive

cell, a union occurs and conception takes place. After the discharge of the ovum,

the cells of the graaan follicle undergo a rapid change. Gradually, they become

yellow (corpus luteum) and produce progesterone, a hormone that prepares the

uterus for receiving the fertilized ovum. Ovulation usually occurs 2 weeks prior to

the next menstrual period.

The Menstrual Cycle

The menstrual cycle is a complex process involving the reproductive and endocrine

systems. The ovaries produce steroid hormones, predominantly estrogens and

progesterone. Several different estrogens are produced by the ovarian follicle,

which consists of the developing ovum and its surrounding cells. The most potent

of the ovarian estrogens is estradiol. Estrogens are responsible for developing and

maintaining the female reproductive organs and the secondary sex characteristics

associated with the adult female. Estrogens play an important role in breast

development and in monthly cyclic changes in the uterus. Progesterone is also

important in regulating the changes that occur in the uterus during the menstrual

cycle. It is secreted by the corpus luteum, which is the ovarian follicle after the

ovum has been released. Progesterone is the most important hormone for

conditioning the endometrium (the mucous membrane lining the uterus) in

preparation for implantation of a fertilized ovum. If pregnancy occurs, the

progesterone secretion becomes largely a function of the placenta and is essential

for maintaining a normal pregnancy. In addition, progesterone, working with

estrogen, prepares the breast for producing and secreting milk. Androgens are also

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produced by the ovaries, but only in small amounts. These hormones are involved

in the early development of the follicle and also affect the female libido. Two

gonadotropic hormones are released by the pituitary gland: FSH and LH. Follicle-

stimulating hormone (FSH) is primarily responsible for stimulating the ovaries to

secrete estrogen. Luteinizing hormone (LH) is primarily responsible for stimulating

progesterone production. Feedback mechanisms, in part, regulate FSH and LH

secretion. For example, elevated estrogen levels in the blood inhibit FSH secretion

but promote LH secretion, whereas elevated progesterone levels inhibit LH

secretion. In addition, gonadotropin-releasing hormone (GnRH) from the

hypothalamus affects the rate of FSH and LH release. The secretion of ovarian

hormones follows a cyclic pattern that results in changes in the uterine endometrium

and in menstruation. This cycle is typically 28 days in length, but there are many

normal variations (21 to 42 days). In the proliferative phase at the beginning of the

cycle (just after menstruation), FSH output increases, stimulating estrogen

secretion. This causes the endometrium to thicken and become more vascular. In

the secretory phase near the middle portion of the cycle (day 14 in a 28-day cycle),

LH output increases, stimulating ovulation. Under the combined stimulus of

estrogen and progesterone, the endometrium reaches the peak of its thickening and

vascularization. The luteal phase begins after ovulation and is characterized by the

secretion of progesterone from the corpus luteum. If the ovum is fertilized, estrogen

and progesterone levels remain high and the complex hormonal changes of

pregnancy follow. If the ovum has not been fertilized, FSH and LH output

diminishes, estrogen and progesterone secretion falls, the ovum disintegrates, and

the endometrium, which has become thick and congested, becomes hemorrhagic.

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The product consisting of old blood, mucus, and endometrial tissue is discharged

through the cervix and into the vagina. After the menstrual ow stops, the cycle

begins again; the endometrium proliferates and thickens from estrogenic

stimulation, and ovulation recurs.

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