FEMALE REPRODUCTIVE SYSTEM

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• FEMALE REPRODUCTIVE SYSTEM
• By
• Dr. Jay Shahed

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External Genitalia

• Mons Pubis
• Top space of external genitalia
• Clitoris
• Most innervated part of E.G.
• Replaces the Penis in males.
• Hymen
• Sheet that covers entrance of vagina
• Perineum
• Space between genitalia and anus.
• Episiotomy location during delivery.

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• Labia Majora
• Large lips
• Outer boarders
• Labia Minora
• small lips

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Internal Genitalia

• Essential Organs
• A. Ovaries
• Female oval gonads
• Has follicles
• 1 million at birth
• 400 at puberty
• Few around Menopause

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Ovarian Cycle

• Primary follicles
• secondary follicle
• Granulosa cells, Antrum,Corpus Luteum Corpus
  Albicans.
• Granulosa cells
• Produces Estrogen
• Corpus Luteum
• Produces progesterone

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Ovulation

• The expulsion of the ovum from the Ovary.
• Occurs 14 days before the start of the next
  expected Menstrual cycle.

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Oogenesis

• The meiotic cell division.
• Ovum
• 1 Ovum 1 polar body
• (functional ) (unfunctional)
• (23 chromosomes)
  (23 chromosomes)

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Fallopian Tubes

• 10 cm long both sides
• Fimbrae
• Finger like projections
• Infundibulem
• Funnel part
• Tube
• Opens into uterus one side and other to abdominal
  cavity

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Uterus

• Parts
• Fundus
• Top part
• Body
• Center part
• Cervix
• The mouth
• Cervical canal
• Cervix

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Muscular layers

• Epimetrium
• The most outer layer
• Myometrium
• Middle layer (Thickest )
• Endometrium
• Internal layer

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Vagina

• 10 cm long
• Located between the rectum and the bladder
• Hymen
• covers the outside opening

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Vestibule

• The oval space that includes
• Labia minora
• Clitoris
• Urethral opening
• Bartholin glands
• Secretes lubricating fluid

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Menstrual Cycle ( See Chart)

• Is the normal body physiological changes that a
  woman goes through on a monthly basis.
• Normal range 21-34 days
• Changes occurs in
• Uterus
• Ovaries
• Vagina
• Breast

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Menstrual Phases

• Menses( Menstrual period) 1-5 days
• Uterine tissue shreds leaving torn blood vessels
  that causes bleeding.
• Hormonal changes
• LH level Low
• FSH level Low
• Estrogen level Low
• Progesterone level Low

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• Proliferative phase 6-13 days
• Epithelial cells reproduce, repairing uterine
  lining
• Hormonal changes
• LH level Low
• FSH level Low
• Estrogen level Low
• Progesterone level Low

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• Ovulation Day 14
• the expulsion of the ovum from the follicle and
  ovary into the pelvic cavity and then moving to
  the Fallopian tube for possible fertilization.
• Hormonal changes
• LH level High
• FSH level High
• Estrogen level High
• Progesterone level Low

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• Secretory phase Day 15-28
• Uterine lining prepares for pregnancy
• Thickening of the Endometrium
• Secreting and development of greater blood
  vessels
• Last day Blood supply decreases greatly causing
  some lining cells to die.
• Implantation of fertilized ovum
• Hormonal changes
• LH level Low
• FSH level Low
• Estrogen level Moderate
• Progesterone level High

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• OBSTATRICS
• GYNECOLGICAL
• Disorders

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Premenstrual syndrome ( PMS )

• Occurs 1-2 weeks before menstruation
• SS
• Bloating / irritability
• Nervousness
• Numbness
• Fatigue
• Depression
• Rhinitis
• Change in appetite
• Tx. Salt restrictions

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Spontaneous Abortion?

• Miscarriage
• If less than 20 weeks
• Still birth
• If after 20 weeks
• Symptoms
• Bleeding, cramps, rupture of membrane
• Management
• If Incomplete abortion Do DC (dilation
  curettage)

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Causes

• Congenital defect development
• Abnormal Placenta Previa
• Abrupta Placenta
• Endocrine problems
• Malnutrition
• Infections
• Drugs
• Blood disorder (Erythro Blastosis Fetalis)
  mother ( Rh-) , father ( Rh) child ( Rh)

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Amenorrhea

• Absence of menstruation
• Primary
• the failure of menstruating
• Stress, hormonal imbalance, genetic, brain tumors
• Secondary
• Loss of 3 or more cycles
• Weight loss, pregnancy, lactation, menopause,
  pathological.

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Dysfunctional Uterine bleeding (DUB)

• Irregular or excessive uterine bleeding
• Cause
• Hormonal imbalance
• Hyperplasia of the uterus

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Toxic Shock syndrome

• Allergic reaction to the tampon fibers
• Staphylococcus infection
• Super infection, septic shock

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Vaginitis

• Inflammation or infection of the vagina
• STD, Yeast infection

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Cervicitis

• Abnormal Thick, purulent white discharges.
• Dysuria pain on urination.
• Most frequent after vaginal erosion during
  delivery.

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Cystocele

• Protrusion of bladder into vagina
• Causes
• injury during birth
• obesity
• heavy lifting
• chronic coughing
• Aging (decrease muscular tone).

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Dysmenorrhea

• Spasmodic pelvic pain during menstruation
• M/F young females (12-14 hrs) start before
  menstrual cycle and last for 24-48hrs.
• Decrease in elderliness
• Headaches
• Dizziness.
• Nausea / Vomiting diarrhea
• Fatigue.
• Low back pain
• Could also follow an organic Disease.
• . TX. Surgery

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• Cancers
• Tumors

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Ovarian cancer

• Affect 1/70 woman in the USA
• Usually caused by adenocaricenoma
• Difficult to detect early
• Risk factors
• Age 40 and over
• Infertility
• Nullipara
• Hx of miscarriages
• Endometriosis

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Cervical cancer

• Ages 30-50
• Often Dx. Early
• Pap smear
• Risk factors
• Multiple partners
• Sexually active
• Early age sex
• Orientals

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Breast cancer

• Most common type of cancer in women
• Common age 40
• Early detection
• Self Examination
• Mammogram annually after age 40 if there is a
  family Hx.

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Endometriosis

• Presence of endometrial tissues outside uterus.
  (Menstrual fragments)
• Causes
• possible after uterus surgery
• poor nutrition
• hormonal influence
• intercourse during menstruation
• use of tampons

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• SS
• Lower abdominal pelvic pain.
• Profuse menses.
• Rectal bleeding
• N/V
• Abdominal cramps.
• Treatment
• Hormones therapy
• Surgery Hysterectomy.

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Fibrocystic Disease

• Multiple palpable lumps
• - breast pain, sacs filled with fluid
• High Risk of Cancer

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Fibroid Tumors

• Benign tumors of smooth muscles or connective
  tissue
• M/F pelvic tumor in females.
• Cause unknown
• Menorrhagia increase menstruation volume.
• Bladder or rectal pregnancy
• Pain
• abdominal symptoms
• Tx. - surgery

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Ovarian Cysts

• Sacs (follicles) filled with blood pus or fluid.
• Occurs before menopause.
• Tx Surgery

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Signs Symptoms

• Bleeding
• Nausea
• Vomiting
• Pelvo-abdominal pain
• Dx Ultra Sound.

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Polyps

• Second Most Frequent abnormality during
  reproductive years (13-40)
• SS
• Bleeding after intercourse, douching or tampon
  insertion
• Tx. Surgery

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Pelvic inflammatory disease( PID).

• Multiple pelvic organs are involved.
• Acute or chronic
• cervix- Cervicitis
• Uterus- endometritis.
• tube - salpangitis
• Ovaries- oophoritis.

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• Most Frequent causes
• Gonorrhea
• After the insertion of an IUD
• Post - operative.
• Abortion.
• S S
• discharge, fever, pain, Dysuria, bleeding, N/V

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Rectocele

• Protrusion of the rectum into vagina
• Post menopausal
• After pregnancy due to (instruments)

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• Sexually Transmitted Disease
• ( STD )

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• Acquired Immunodeficiency Syndrome
• ( AIDS)

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Causative agent

• HIV virus

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Transmission

• Direct contact of body fluid
• (Serum, CSF, Sperms )
• Break in the skin or mucosa
• Sexual contact with infected partner
• Sharing needles for IV drug use.
• Contact with contaminated blood or body fluids
• Blood transfusion ( if not properly screened).
• Mother -fetus transmission.
• HIV is not transmitted through
• Casual contact
• Insect bite

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Mechanism

• HIV attacking the T-Helper cell (CD4, CD8)
  which assist the bodys antibodies fight
  infections.

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Phases Of AIDS

• Incubation period (Replication period)
• 1-3 months
• Reaches the seroconversion to the antibody
  positive state.
• Usually Asymptomatic
• If Symptomatic
• Malaise, sore throat, cold symptoms, pyrexia
• If severe
• Meningitis, Encephalopathy

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• Latent stage
• 8-14 years
• Infectious period
• Asymptomatic

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• Persistent generalized lymphadenopathy stage (
  PGL )
• Painless lymphadenopathy
• Tonsillar enlargement
• Mild fever
• General malaise
• Sweating
• Weight loss

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• AIDS- related complex stage
• CD4CD8 ratio drops to below 1.0
• Marked malaise
• Significant weight loss
• Adenitis
• Blood disorders
• Anemia
• Thrombocytopenia
• Leukopenia

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• Skin lesions
• Seborrhoec dermatitis
• Oral Candidiasis ( Thrush)
• Hairy leukoplakia
• Herpes simplex
• Herpes Zoster ( Shingles)
• Impetigo
• Vasculitis
• Psoriasis

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• Other Opportunistic infections stage ( OI )
• Pneumocystis carinii pneumonia ( PCP )
• Parasite
• Aspergillosis
• Fungal infection of many organs ( Lung).
• Nocardiosis
• Bacterial pneumonia
• Abscesses of brain and skin
• Cytomegalavirus
• Virus

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• Atypical mycobacterium
• Bacteria
• Toxoplasma gondii
• Protozoan parasite
• Brain, eyes.

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• Malignancies
• Kaposis sarcoma
• vascular skin and mucous membrane tumor
• Non- Hodgkins Lymphoma
• Tumors of the lymph nodes

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• Slim disease
• severe weight loss
• Chronic diarrhea
• Dementia
• Enlarged lateral ventricles

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• HIV detection
• Seropositive test
• Positive antibody titer
• Seronegative test
• Negative antibody titer
• Possibly did not reach the titer level to test
  positive ( 1-3 months)
• ELISA
• Enzyme-linked immunosorbent assay
• Blood test ( HIV antibodies)
• Western blot
• Blood test to confirm ELISA

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.Herpes Simplex II (Genital Herpes)

• Cause
• Varecella virus
• SS
• Labial vesicles.
• Tx.
• Zovirax

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Gonorrhea

• MF. Neisseria Gonorrhea.
• Greenish, yellowish discharge
• Tx.
• Ceftriaxone Doxycycline IM
• Dx.
• Microscopic.

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Syphilis (spirochetes).

• Chancre painless, non-itching lesion
• Lymph nodes, skin, mucous is involved
• Goes to brain and other systems
• Test
• FTA-ABS (Fluorescent Treponemal Antibody with
  Absorbed Serum)
• VDRL (Venereal Disease Research Lab). Dark Field
  Microscope
• Tx. Benzathine ( Penicillin)

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Trichomoniasis Vaginalis

• Parasite.
• Yellow foul discharge
• Dx.
• Microscopic
• Tx.
• Metronidazole
• Tx both sexes

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Canadidiasis ( Candida albican )

• Yeast like fungus
• Normally in mouth, skin, GI, vagina
• Overgrowth can be caused by
• Long-term antibiotics.
• Estrogen levels.
• Diabetes
• Tight clothes.
• SS
• itching, dry white thick discharge
• Tx.
• Miconazole (Nystatin).

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Chlamydia Trachomatis ( Lymphogranuloma-venereum)

• Specialized bacteria.
• Affects the lymph nodes
• Causes infection
• Associated disorders
• Conjunctivitis
• Vaginitis
• Infertility
• Proctitis.
• Endometritis
• Pneumonitis
• Can transmit to newborn through vagina.

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• SS -
• vaginal discharge
• Dysuria
• Frequency in urination.
• Tx
• Tetracycline

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Chancroid

• Bacteria
• Starts with a small papule on the skin
• Changes to a painful coin shape ulcer
• More frequent in men.
• Tx.
• Ceftriaxone

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Genital warts

• HPV-6 HPV-7
• Caused by Papillomavirus
• Nipple like genital lesions
• Tx.
• Surgery
• Interferon

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Giardiasis

• Protozoan ( Giardia lamblia )
• Sexual transmission causes intestinal infection
• Could be Asymptomatic
• If symptomatic
• Diarrhea
• Malabsorbtion
• Tx Quinacrine

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Hepatitis

• HBV
• Causes liver disease
• Fever
• Jaundice
• Tx
• Symptomatic
• Prevention
• Vaccination.

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Scabies

• Mites, lice
• Pubic skin rash
• Secondary bacterial infection
• Transmitted through touch
• TX
• Special shampoo and comb for 7-10 days ( Sulfur )
• Steroids
• Oral antibiotics if another infection occurs
• Treat all other family members involved
• Wash all clothes, furniture, carpet

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Pregnancy

• 1st trimester -
• Last menstrual period to 14 week.
• 2nd trimester -
• 15th week to 28th week.
• 3rd trimester -
• 28th week to delivery.

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Labor

• 1st stage
• onset F labor (complete dilation)
• 2nd stage
• complete dilation to birth.
• 3rd stage
• birth to expulsion of placenta membrane.

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Abnormalities

• Placenta Previa
• Misimplantation of the placenta
• Abrupta Placenta
• Detachment of the Placenta.

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• Male
• REPRODUCTIVE
• SYSTEM

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External Genitalia

• Penis
• 2 Corpora Cavernosa ducts
• Filled with blood
• Scrotum
• Sac like structure contains testes
• Prepuce
• Foreskin

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Internal Structures

• Essential organs
• Gonads (testicles)
• Tunica Albuginea
• Lines outside of testes
• Seminefrous tubules
• Production of sperm
• Interstitial cells
• Production of testosterone

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Accessory Organs

• Ducts
• Epididymis
• coiled tube 6m in length
• Lies on top of testes
• Sperm maturity
• Vas Deferens (Ductus)
• Receives sperm from the Epididymis through pelvic
  cavity
• Passes through the Inguinal Canal

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• Ejaculating Duct
• Connected to seminal vesicle gland and Urethra
• Passes fluid from the seminal vesicle
• Prostatic duct
• Duct going through prostate from bladder to
  urethra
• Transport prostrate fluid
• Bulbourethral duct
• Duct from Cowper gland to urethra

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Sex Glands

• 3-5 ml of fluid with 100 million sperms
• 1.Seminal Vesicles
• Produces 60 of seminal fluid
• Yellow, thick, rich in fructose
• Provides energy for sperm mobility

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• 2.Prostate gland
• Doughnut shape
• Seminal fluid
• Milk colored secretion
• Produces white-fluid that consist of 30 of
  seminal fluid

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• 3.Bulbounethral gland (Cowpers)
• Pea shape and size
• Mucus like fluid

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Meiosis

• Spermatogenesis
• Production of sperm (Spermatozoa)
• Spermatogonium
• primary Spermatocyte

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• Male Reproductive Disorders

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Prostate

• Prostate hypertrophy
• Enlarged prostate
• Prostate Cancer
• Affects older people over 50
• Prostatitis
• Inflammation of the Prostate.
• Causes
• viral infection
• Urethral Catheter.

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Penis

• Phimosis
• Tight foreskin

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Scrotum

• Hydrocele
• Accumulation of fluid in scrotum
• Varcocele
• Ruptured veins in scrotum
• Inguinal hernia
• Loosening of muscular wall and bulging

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Testes

• Cryptorchidism
• Undescended testes
• Testicular Cancer
• M/F of male cancer
• Black twice frequent white
• Genetic diet.
• MF form adenoma sarcoma
• Tx.
• Surgery
• Chemotherapy

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Epididymis

• Epididymitis
• Sperm mature develop the ability to swim
• Causes
• Bacterial infection
• SS
• Pain inguinal canal
• Swelling in groin scrotum
• Decrease Spermatozoa (infertility).
• Tx.
• Antibiotics Pillow under scrotum

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Sterility

• Absence of sperm production

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• Congenital Disorders

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Impotency

• Unable to reach or maintain an erection
• Causes
• Metabolic disorder
• 50 psychological 50 physical.
• Nerve damage
• Decrease testosterone
• Decrease sperm count.
• Decrease normal Temp.( 1C, 3F cooler than body).

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• The inability
• to
• reproduce

Infertility
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• Affects one in six couples
• The causes are often known and many can be
  corrected.
• Rates are rising in the USA.

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MALE INFERTILITY

• Causes
• Abnormal sperm structure ( shape )
• Low sperm count ( less than 400 million )
• Hormonal imbalance ( Decrease testosterone).
• Increase scrotum temperature ( inflammation).
• Diseases ( diabetes, Immune disorders,
  Cryptorchidism ( Undescended testes)
• Psychological

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Treatment

• Surgical repair of abnormal structures
• Balance hormones.
• Treat underline disease
• Undesended testes
• diabetes

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Female infertility

• Abnormality in the reproductive tract structures.
• Older woman increase risk of producing abnormal
  chromosomes.
• Abnormal menstrual cycle
• ( basal body temperature changes).
• Pathological disorders
• Ovarian tumors
• Gland imbalance ( Pituitary, Thyroid, Increase
  prolactin ).

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• Vaginal and cervical secretion problems
• Thick, sticky Low sperm
• PH imbalance inactive sperms
• Female antibodies Kills sperms
• Oocyte fails to produce sperm attraction.
• Psychological

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Treatment in females

• Fertility drugs
• stimulates ovulation( watch for multiple births)
• Oocyte donation or ovarian transplant.
• Surgical repair of abnormal structures.
• Surgical removal of fibroids,endometriosis