Mons Pubis

Clitoris

Urethra

Vestibule
Labia Majora

Labia
Minora

Vagina Introitus
Mons Pubis
rounded, skin-covered fat pad
protects pelvic bones during coitus
located anterior to the symphisis
pubis
Clitoris Located below the clitoral hood
Erectile organ, rich in vascular & nervous supply

Analogous to male penis

A highly sensitive organ
Distends during sexual
stimulation
 Urethra
Located posterior to the clitoris and
usually closer to the vaginal opening

Urethral meatus
external opening of the
urethra
Labia Majora
Two longitudinal folds of adipose & connective tissue.

Protects vulva components that it surrounds

Protects the urethra & vagina from infection

Extend from clitoris anteriorly & gradually narrow

to merge & from posterior commissure of perineum
Labia Minora
•Smaller than labia majora
•Composed of skin, fat, & some erectile
tissue
•Consists of two skin folds of skin extend
to from prepuce of clitoris anteriorly & a
transverse fold of skin forming fourchette
posteriorly
•Secretions are bactericidal & aid in
lubricating vulval skin & protecting it from
urine
•Protects urethra & vagina from infection
Vaginal introitus
opening bet. External & internal genitalia

site of coitus
 Vestibule the area between the labia minora
Contains:
Urethral meatus – external opening of the urethra
al introitus – site of coitus; opening bet. External & internal geni

men – elastic membrane that partially covers the vaginal orifice

Bartholin’s Gland – paravaginal glands; site of vagina;
- Small, pea-shaped glands deep in
perineal structures
- Secrete clear, viscid, odorless, alkaline
mucous that improves viability & motility
of sperm along reproductive tract
Skene’s Gland – paraurethral gland; site of urethra
1. Fallopian Tubes4. Uterus

Cervix
2. Ovary
3. Vagina 5. 3 walls of uterus
Fallopian Tubes
– Slender cylindrical structures attached
bilaterally to the uterus & supported by the
upperfolds of the broad ligament

– Main function: transportation of sperm toward

the ovary / the eggs toward the uterus
Interstitial –
part of the tube
that lies within
the uterine wall
Infundibulum
– most distal
part that
contains
FIMBRAE
(fingerlike
projections
that pick up
ovum after its
release into
Isthmus – part
that is cut or
sealed during
tubal ligation
Ampulla –
outer
third of
the
fallopian
tube
 Ovaries
Major functions:
producing ova for
fertilization by
sperm & producing
estrogen &
progesterone
 Ovaries
Size: 3 – 5 cm long;
1.5 – 3cm wide;
1-1.5cm thick
Located beside
fallopian tubes
 Ovaries
Pinkish-white to gray in appearance

Almond shaped glandular

structures that produces ova
 1. GnRH

2. Leutinizing
hormone
5. Progesterone
4. Estrogen 3.Follicle
s timulating
hormone
Ovarian Hormones
Leutinizing Hormone (LH)
» Responsible for ovulation
» Forms the corpus luteum
» Secretion of LH is increased by GnRH
» LH converts the empty follicle into a
corpus luteum after ovulation
Follicle Stimulating Hormone
(FSH)
Initiates the maturation

Secretion of FSH is increased by GnRH

Promotes proliferation & differentiation of ovarian

follicle during the first half of ovarian cycle

Fosters development of the ovum within the follicle

in the preparation for ovulation
Leutinizing Hormone (LH)

Secretion of LH is increased by GnRH

Forms the corpus luteum

Responsible for ovulation

LH converts the empty follicle into a corpus

luteum after ovulation
 Estrogen
Assist in maturation of ovarian follicle & being secreted
from ovarian follicular cells

Stimulates the thickening of endometrium

Promote proliferation of uterine endometrial cells

Responsible for secondary sex characteristics

Stimulates contraction of smooth muscles

Promotes calcium & phosphate retention

(strengthening bones)
 Progesterone
Relaxation of smooth muscle

Works together with estrogen; coordinating

during menstrual cycle
Produced exclusively by the corpus luteum
Preparing the endometrium to receive &
maintain an implanted embryo
 A fibromascular
tube tat connects the
external and internal
genitalia
Essentially free of
sensory nerve fibers Vagina
Location: behind the
urinary bladder &
urethra & interior to
the rectum
Function: route for
discharges of menses
and other secretions
Also serves as an
organ of sexual
fulfillment and
reproduction
 Endomet mucous membrane lining

rium
of the uterine cavity;

Divided into 2
layers:
(1) Stratum
functionalis
(superficial layer
that sloughs off
with each
menstruation and
after delivery)
Purpose:
(2) Stratum basalis location for the
(deeper layer that implantation of
is retained during
menses &
a fertilized
proliferates the ovum;
stratum if pregnancy not
functionalis) realized,
Myometri (middle layer;thick

um and muscular; its

function is to
contract)
Contraction
of this
muscle helps
to expel
menstrual
flow and the
products of
conception
during
miscarriage
of childbirth.
Perimetri thin, serous, external

um
peritoneal membrane that
covers and protects the
outside of the uterus

Anterior:
reflected over the
bladder wall,
forming the
vesicouterine
pouch

Posterior:
extends from the
rectouterine
pouch
Uteru Thick-walled muscular organ
s
Fundus Pear-shaped, hollow structure is
located between the
bladder(posterior) and the rectum Tub
Fallopian
(anterior)
Size: 7.5 cm (3in) long; 5cm 2(in)
wide; 2.5 cm (1 in) in depth Ovary

Body of the UterusFunction: menstruation, gestation,

and parturition
Endometrium
Cervix Myometrium

Vagina Cervcal Canal

Breast
 Breas are complex accessory organ

t
-responds to hormonal changes
of puberty, menstrual cycle,
pregnancy, & lactation
- during puberty, breast development
is controlled by multiple hormones,
estrogen playing the central role
- under the influence of prolactin, the
mammary glands of the breast
secrete milk necessary to nourish the
newborn infant
- location: over the pectoral muscles
between the 2nd & 6th ribs
- breast tail/tail of Spence: extends
upward& laterally toward the axilla
- consist of nipple, areola, ducts,
lobes, fibrous & fatty tissue
 Cylindrical projection near
the center of the breast Nipple
Located approx. 4th
intercostal space

sexual stimulation results

in engorgement & muscle
contraction, which causes
the nipple to erect

surrounded by pigmented,
circular area, the areola, & is
perforated by several duct
openings
Lobu Lie within peripheral breast
tissue
les Alveoli which contain
both ancinar &
myoepithelial cells
- theancinar cells manufacture
& secrete milk, and the
myoepithelial cells contract to
forcemilk into the ducts

each lobule is drained by an

intraobular duct that empties into
a lactiferous ducts.
- these ducts dilates, forming a
reservoir called Lactiferous
sinus(ampulla)
 Menstrual Cycle
oogenesis & uterine preparation are periodic events recur
repeatedly; approximately once a month
Menstrual Cycle
Oogenesis
Creation of Gametes
Follicular Phase (Day 1 -14)
Ovarian follicle mature under the
influence of FSH and Estrogen
LH surge causes ovulation
OVULATION
Ovum is discharged from mature follicle
Corpus luteum develops under the influence of LH
ENDOMETRIAL
CYCLE
Refers to the cyclic
changes in the cells
lining the uterus
(endometrium)
Menstrual (1-5)
 E, P

Sloughing of
Endometrial Lining

Menstruation
E,P
Sloughing of
Endometrial
Lining
Menstruation
Menstrual Proliferative Secretory Ischemic
(1-5) (6-14) (15-21) (16-28)

 E, P  E Formulation of Pregeneratio

H: FSH – RF Corpus Luteum n of Corpus
 (Yellow body) Luteum
Sloughing APG: FSH  
O: E a. Fertilization Corpus
of
 E (+) sex; (+) Albicans
Endometrial Maturation sperm (10 days)
Lining P = Pregnancy
of Ovarian
 Follicle b. No
Menstruati (“Graafian Fertilization
on Follicle”) (+) sex; (-)
sperm
 P
No pregnancy
H: LH-RF
(Ovulation)
 P = LH
APG: LH
O: P
 DISORDERS OF THE
FEMALE REPRODUCTIVE
1. Menstrual cycle Disorders
SYSTEM
4. Fallopian Tubes & Ovaries
a. Amenorrhea a. Pelvic Inflammatory Disease
b. PMS b. Ectopic Pregnancy
c. Dysmenorrhea
d. Menopause 5. Pelvic Support
2. External Genitalia a. Cystocele
a. Barholin’s Gland Abscess b. Rectocele
b. Vulvodynia c. Uterine Prolapse
3. Vagina
a. Vaginitis 5. Breast
4. Uterine Cervix a. Mastitis
a. Cervicitis b. Galactorrhea
5. Uterus c. Breast Cancer
a. Endometritis
b. Endometriosis
c.Adenomyosis
 Amenorrhea
Primary: Failure to begin menstrual cycle/any sexual
characteristics by age

Secondary: occurs only in women who have previously

menstruation, is the cessation of menstruation for 3
month (regular cycle/ 6-12 months (irregular cycles)

Etiology:
PHYSIOLOGIC; GENETIC; ANATOMIC;
ENDOCRINOLOGIC ; CONSTITUTIONAL; PSYCHOGENIC

Treatment: Correcting the underlying cause;

Management: Clomid; oral pills
 PMS(Pre-Menstrual
Etiology:
Syndrome)
Excess of Estrogen
Progesterone deficiency
Vitamin. Mineral deficiency (B6, C, Selenium, Mg)
Nutritional Factors (excess consumption of caffeine/refined sugar)

S/S: (symptomatic)
Edema Breast Tenderness
Wt gain Depression
Abdominal Pain
Headache
Crying spells and irritability
Food craving
emotional and Behavioral s/s:)

Mood changes Change in exercise

Irritability Decrease ability to concentrate
Crying spells Insomnia
 DYSMENORRHEA
2 types:
a.) Primary – painful menses
unrelated to a physical cause

b.) Secondary – associated with

uterine / pelvic pathology

factors: Endometriosis; PID, IUD use

 Excessive Uterine
amount of Vasoconstricti
Prostaglan on, ischemia,
smooth
din
muscle pains

Increase Increase
Uterine
Prostagland
Endometriu
Activity m (sloughs)
(Uterine in
Contraction)
S/S:
- Sharp, cramping in lower abdomen
that may radiate to lower back/inner thigh
- Accompanied by increase menstrual
flow
- Severe in first 2 days
 MENOPAUSE
Physiology:
- reduced number of ovarian follicles
- reduced sensitivity of the few
remaining follicles to gonadotropin
- without the follicle development , the
ovaries continue to produce androgen but
production of all types of estrogen ceases
Bartholin’s Gland Cyst
and Abscess
CYST (infected)
 purulent
content 
untreated: Result
is abscess
common cause: bacterial, chlamydial or
gonoccocal infection.

Cyst size: orange

Frequently recur

Abscess:
Abscess tender & painful

TX: Administration of appropriate

antibiotics, local application of moist heat,
and I & D
 Vulvodynia
Forms:
Cyclic vulvodynia –episodic flares that occur only
before menses or after coitus
s/s: pruritis, pain develops; thick and scaly lesions

Vulvar vestibulitis syndrome (VVS)

– pain at onset of intercourse
Leading cause of dyspareaunia in women younger than 50’s

s/s: localized point tenderness near the vaginal opening & sensitive
to tampon placement, tight fitting pants, bicycling or prolonged
sitting
Nerve fibers to the
vestibular
epithelium become
highly sensitized 
causing neurons in
the dorsal horn to
respond abnormally
 which transforms
the sensation of
touch in the
vestibule into pain
Vulvar dysesthesia

– (idiopathic/essential vulvodynia)

-widespread, severe, constant burning that

interferes with daily activities

- no abnormalities found upon examination

 Vaginitis
Causes:
Post menopausal
Atrophic vaginitis
(occurs after
menopause)
decrease of
estrogen levels
Chemical irritation
Allergy
Trauma
Prevention/Treatment:
1. daily hygiene habits that keep the genital
area dry & clean
2. maintenance of normal vagina flora & healthy
vaginal mucosa
3. avoidance of contact w/ organisms known to
cause vaginal infections ( douches, bath
powders)
4. tight clothing (prevents the dissipation of
body heat & evaporation of skin moisture &
promotes favorable conditions for irritation &
growth of pathogen)
 Cervicitis
Acute Cervicitis
occurs with sexually transmitted infection
due to E. Coli; Staphylococcus; Streptococcus
may follow child birth/trauma/surgery
S/s: Dyspareunia, backache, dull pain, urinary
frequency and urgency
Dx:
Dx Vaginal Microscopy (Cervix appeared
congested with white purulent discharge with a
fowl odor; reddened, eroded and tender)
WBC increase
Chronic Cervicitis – low grade inflammatory process
occurs after acute infection, childbirth, trauma ,
obstruction
s/s: vaginal discharge (less coprous); irritating vulva;
metorrhagia
Dx: Speculum examination (redness and swelling with
grandular appearance); vaginal examination;
colposcopy; pap smear (inflammation)
Tx: cryosurgery/cauterization
untreated cervicitis may extend to include the
development of pelvic cellulites, low back pain, painful
intercourse, cervical stenosis, dysmenorhea &further
infection of the uterus or fallopian tube
 Endometritis
Acute – uncommon; occurs
after cervical barrier
compromised by abortion,
- instrumentation and delivery
curettage both diagnostic and
currative

Chronic – associated with IUD,

PID
s/s: vaginal bleeding, milt to
severe uterine tenderness,
fever, malaise, foul smelling
discharge
tx: Oral or IV antibiotics
therapy; depending on the
severity
 Endometriosis
Etiology:
genetic factors; cell ; biology ; inflammation;
immune mechanism

Pathophysiology:
Implant respond to normal stimulation 
Tissues grows & thickens under cyclic
hormonal influences  Bleeding occurs in
visceral structures (it cannot flow away from
the tissue)  Forms abdominal lesions 
Debri accumulates  Dark (brown/black/blue)
cystic lesions
s/s:
Dysmennorhea – backache “cramps”
- increase throughout menstruation and
subsides after
Dyschezia – related to implants and adhesion in
colorectal areas
Dyspareunia – involves cul-de sac, uterine
ligaments, upper vagina
Dysuria – bladder involvement
Infertility – excessive scarring of ovaries and
oviducts; toxic to sperm thus preventing
fertilization
Diagnostics:

Pelvic examination: small nodular

masses on pelvic organs that is
painful with palpitation ; uterus may
be retroverted and fixed due to
adhesion

Laparoscopy – (=) lesions and

adhesions
 Adenomyosis
– condition in which endometrial glands & stoma are
found within the myometrium
- found in multiparous women in their late fourth/fifth
decade
- it is thought that events associated with repeated
pregnancies, deliveries, and uterine involution may
cause the endometrium to be displaced throughout the
myometrium.
-Coexist with myomas or endometrial hyperplasia.

Diagnosis: incidental finding in a uterus suggestive for

myomas or hyperplasia
Tx: Conservative therapy using oral contraceptives or
GnRH agonist / hysterectomy
0
 Pelvic Inflammatory
Disease (PID)
general term used to refer any infection of upper reproductive
tract (uterus, fallopian tubes& ovaries)

Pathophysiology:
Orgaisms ascend through the endocervical
canal to the endometrial cavity and then to the tubes &
ovaries  Endocervical canal slightly dilated during
menstruation (allowing bacteria to gain entrance to the
uterus & other pelvic structures)  (after entering) the
bacteria multiplies rapidly in the favorable environment
of the sloughing endometrium  ascend to fallopian
tube
s/s:
sudden onset of severe pelvic pain; chills;
fever;
n/v; heavy, purulent vaginal discharge;
vagina: itching and bleeding; hydorsal pinx
(distention of tube with fluid)
and increase WBC

Dx: Pelvic Examination ( pelvic

renderness/cervical motion pain);
Ultrasonography (inflammatory mass)
Complications: Abdominal peritonitis; paralytic
ileus;; pelvic abscess; thrombophlebitis

Tx: IV antibiotics
Ectopic Pregnancy
occurs when a fertilized ovum implants
outside the uterine cavity

most common site: fallopian tube

cause: delayed ovum transport which may

result from decreased motlity or distorted
tubal anatomy

factors: PID, therapeutic abortion, tubal

ligation or tubal reversal
the site of implantation in the tube
may determine the onset of symptoms
& the timing diagnosis

as the tubal pregnancy eventually

outgrows its blood supply, at which
point the pregnancy terminates or he
tube itself ruptures because it can no
longer contain the growing pregnancy
s/s:
lower abdominal discomfort
adnexal tenderness
hCG lower than normal
Pelvic ultrasound after 5 wks
gestation may reveal empty
uterine cavity

Dx: laparoscopy

Tx: surgery
Cyctocele herniation of bladder into
the vagina
Pathophysiology
Occurs when the normal
muscle support for the
bladder is weakened, & the
bladder sags below the
uterus
Vaginal wall stretches &
bulges downward because of
the force of gravity & the
pressure from coughing,
lifting, straining at stool
The bladder herniates
through the anterior vaginal
wall and Cystocele forms
S/s:
Annoying bearing down
sensation

Difficulty in emptying
the bladder, frequency,
urgency of urination and
cystitis
Rectocele herniation of rectum into
the vagina
Cause: disruption of
rectovaginal fascia
during childbirth; or
chronic fecal
constipation & straining

A woman may state that

she has to press
between the vagina &
rectum ( to reduce the
rectocele) or press in
the vagina to help with
defacation
 Pathophysiology
occurs when posterior vaginal wall & underlying
rectum bulge forward, ultimately protruding
through the introitus as the pelvic floor and
perineal muscles are weakened

S/s:
feeling of rectal or
pelvic pressure

difficulty emptying the

rectum
Uterine Prolapse
 Pathophysiology

The ligaments that

normally support the
uterus stretch, failing
to hold the body of the
uterus in position
Increase in intra-
abdominal pressure
will cause the uterus
to descend down the
vaginal canal
S/s:
Dragging
sensation(occurs at
groin , sacral & lumbar
area)

Discomforts improves
when lies flat, relieving
the downward pressure
Mass protruding in
vagina
Mastitis
occurs in women
in postpartum
period
3 types:
Mastitis
Congestive Mastitis
– (breast engorgement) Normal

Not infection but comes due to accumulation of

fluid(milk, blood,lypmp) as breast shifts from
producing colostrums to true milk at 3rd/4th
postpartum day

s/s: Breast heavy/hard/warm/tender; slight

increase of temperature
3 types:
Chronic Mastitis - non infectious breast
inflammation

Usually appears in perimenopausal women when

lactiferous ducts becomes obstructed by secretions and
cellular debris

Obstruction results dilation of ducts (Ductal Ectasia)

Small ducts may rupture into tissues, causing
inflammatory
Induration of fibrous that can result in nipple secretion

s/s: breast pain (burning/itching sensation)

Infective Mastitis
- acute infection of breast (S. Aureus)

Organism enter the ducts to infect mammary

gland from newborn’s mouth via cracks in nipple

s/s: abscess formation; breast:

red/hot/swollen/tender; fever & malaise
 Galactorrhea
secretion of breast milk in a nonlactating
breast.
may result from vigourous nipple
stimulation (lovemaking, exogenous
hormones, internal hormonal imbalance or
local chest infection or trauma)

pituitary tumor may produce large amounts

of prolactin cause galactorrhea
 Breast Cancer
most common female cancer

risk factors:
sex
increasing age
personal or family hx
hormonal influences that promote breast
maturation & may increase chance of cell
mutation
 Breast Cancer
Detection: mass,
puckering, nipple
retraction, or
unusual discharge;
BSE
 Breast Cancer
BSE – done routinely
by older women older
that 20 years of age

Premonopausal
women should
conduct right after
menses
Important is to
devise a regular,
systematic,
convenient &
 Breast Cancer
Mammography
effective screening
technique

Tx: surgery,
chemotheraphy,
radiation &
hormonal
manipulation
 NEUROENDOCRINE FEEDBACK MECHANISMS

BRAIN
Sensory
Input
Hypothalamus

Short GnRH Long

Feedback Feedback
(-)
General
Pituitary General
Circulation Circulation
(bloodstream)
LH
FSH

Fallopian tubes Ovary Estrogen

Vagina
Breast
Uterus Target Organs