MATERNAL AND CHILD HEALTH NURSING

ANATOMY AND PHYSIOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM

Lecturer: Mark Fredderick R. Abejo RN,MAN
__________________________________________________________________________
FEMALE REPRODUCTIVE SYSTEM

I. External Genitalia (Vulva/Pudendum)

MONS PUBIS
-Soft fatty tissue, lies directly over symphysis pubis & becomes covered w/ hair just before puberty
It is where the pubic hair grows.

LABIA MINORA

LABIA MAJORA
-W/ hair outside but smooth inside
fatty skin folds from MONS PUBIS to
PERINEUM and protects the labia minora
, urinary meatus & vagina

-Thin, pink, smooth, hairless, extremely

sensitive to pressure, touch and
temperature. The glands of labia minora
lubricate the vulva. It is formed by the
frenulum and the prepuce of the clitoris
which is also very sensitive because it has
rich nerve supply.

Covers and protects VESTIBULE

VAGINAL INTROITUS

CLITORIS
URETHRAL MEATUS

TWO GLANDS THAT LUBRICATE DURING SEX

-Entrance of urethra,
opens approximately
1cm below clitoris

1. SKENES GLANDS (Paraurethral Glands): lubricates the

external genitalia
2. Bartholins Gland (Vulvovaginal Glands): alkaline in ph,
helps improve sperm survival
Doderleins Bacillus: causes the vaginal ph to be acidic, which
forms lactic acid
Hymen: the elastic tissue, symbolizes virginity. Thorn &
bloody during forced sexual act
RUGAE: thick folds of membranous stratified epitheliums on
the internal wall of the vagina, capable of stretching during
the birth process, to accommodate the delivery of the fetus.

MCHN

-Composed of glans &

shaft that is partially
covered by prepuce
-GLANS is small and
round and is filled w/
many nerve endings and
rich blood supply
-SHAFT is a cord
connecting the glans to
the pubic bone; w/in it is
the major blood supply
of clitoris

Mark Abejo

II. Internal Genitalia

ORGAN

Uterus

FUNCTIONS

Pear shape muscular

organ
which
has
three(3)
main
functions
1. receive the ova
from the fallopian
tube
2. provide a place for
implantation of the
ova
3. Nourishment for
fetal growth.

STRUCTURE

NOTES

Divisions of the Uterus

Layers of the Uterus:

I. Cervix : lowest portion , 1/3 of the

total uterus

1. Endometrium:
inner layer, most
vascular,
SHED DURING
MENSTRUATION.THE
NON-PREGNANT
UTERUS

External Os: where the nurse obtain

the
Pap
Smear
to
the
SQUAMOCOLUMNAR
JUNCTION
cells. This is where the cerclage is
done for incompetent cervix.
Namely:
A. Shirodkar Barter Suture- permanent
closure of the internal cervical os,
until the 38th week after which is
separated TREATMENT FOR
INCOMPETENT
CERVIX
and
PREVIOUS ABORTION.
B. Mc Donalds or Purse String
Cerclage of the external os: usually
Normal spontaneous delivery will be
done for the patient.

2. Myometrium:
LARGEST PORTION
EXPELS THE FETUS
DURING THE BIRTH
PROCESS. The part
that contracts during
hemorrhage. Prevents
hemorrhage.

3. Perimetrium:
Outer most layer. Aids
for support & added
strength.

II. Isthmus: shortest portion of the

uterus, the portion that is cut when the
fetus is delivered during cesarean
birth.
III. Fundus: Upper segment, this is the
most vascular, the portion also where
palpation is done. Also touching it by
the tip of the fingers during contraction
is the best method to determine the
intensity of contractions during labor.
Bandls Ring ( Pathological Retraction
Ring): seen in Prolonged Labor or
Dystocia

MCHN

Mark Abejo

Fallopian
tubes

Site of fertilization of
the ovum with perm

4 Parts of the Fallopian tubes

1. Interstitial : lies within the uterine
wall
2. Isthmus: the portion that is cut or
sealed in TUBAL LIGATION
( site for sterilization)
3. Ampulla: where fertilization occurs ,
this is also the LONGEST portion,
frequent site for ectopic pregnancy.
4. Infundibular: covered by the
Fimbriae cells that help guide the ova
to the Fallopian Tube.

Fallopian
tubes
transport the ova from
the ovaries to the
uterus.

Ovaries

Ovulation (the release

of an ovum); Steroid
hormone production

Pair of follicle containing organs on

the other side of the uterus
Ovaries: 4 by 2 cm in diameter, 1.5
cm thick. Responsible for
the
production,
Maturation,
and
discharge of ova
Secretion of estrogen
and progesterone
Cortex of the Ovaries; developing
and graafian follicles are found here.

The ovaries lie in the

upper pelvic cavity.

Vagina

Organ for coitus;

Birth canal; Conduit
for menstrual flow.

Tube extending from the introitus to

cervix

Fibromuscular
lined
with
membrane

organ
mucus

III. THE PELVIS

A. Structures
1. Two Os Coxae or Innominate Bones- it is made up of:
a. Ilium- is the upper, extended part which has a curved upper border called Iliac Crest.
b. Ischium- is the under part which when sitting, the body rests on the ischial tuberosities and an
important landmark is the ischial spines.
c. Pubis- is the front part that joins to form an articulation of the pelvis called the Symphysis Pubis.
2. Sacrum- a wedge-shaped that forms the back part of the pelvis that consists of 5 fused vertebrae, the first
having a prominent upper margin called the Sacral Promontory; it articulates with the ilium and sacroiliac
joint.
3. Coccyx- is the lowest part of the spine with a degree of movement between the sacrum and coccyx which is
made possible by the third articulation of the pelvis called Sacrococcygeal joint which allows room for
delivery of the fetal head
B. Divisions
1. False Pelvis- the superior half formed by the ilia offers landmarks for pelvic measurements; it supports the
growing uterus during pregnancy and directs the fetus into the true pelvis near the end of gestation.
2. True Pelvis- the inferior half formed by the pubes in front, the ilia and the ischia on the sides and the
sacrum and coccyx behind; it is made up of three parts:
a. Inlet- the entrance way to the true pelvis wherein its transverse diameter is wider than its
anteroposterior diameter, thus
Transverse diameter
= 13.5 cm
Antero-posterior diameter
= 11
cm
Right and left oblique diameter = 12.75 cm
b. Cavity- the space between the inlet and outlet
c. Outlet- the inferior portion of the pelvis bounded in the back by the coccyx, on the sides by the ischial
tuberosities and in front by the inferior aspect of the symphysis pubis and the pubic arch; its
anteroposterior diameter is wider than its transverse diameter

C. Types
1. Gynecoid- normal female pelvis where inlet is well rounded forward and back; it is most ideal for
childbirth.
2. Anthropoid- transverse diameter is narrow, AP diameter is larger than normal.
3. Platypelloid- inlet is oval, AP diameter is shallow.
4. Android- male pelvis where inlet has a narrow, shallow posterior portion and pointed anterior portion

MCHN

Mark Abejo

D.

Types of Pelvic Ligaments

1. Round: remain lax during non-pregnancy & become HYPERTROPHIED & elongated during pregnancy.
2. Cardinal: chief uterine supports
3. Broad ligaments: drapes over the fallopian tubes, uterus & ovaries

D. Measurements
1. External- suggestive only of pelvic size
a. Intercristal- distance between the middle points of the iliac crests with an average= 28 cm.
b. Interspinous- distance between the anterosuperior iliac spines with an average= 25 cm.
c. Intertrochanteric- distance between the trochanters of the femur with an average= 31 cm.
d. External Conjugate or Baudelocques- the distance between the anterior aspect of the symphysis
pubis and depression below L5 with an
average= 18-20 cm.

2.

Internal- gives the actual diameter of the inlet and outlet

a. Diagonal Conjugate- distance between the sacral promontory and inferior margin of the symphysis
pubis with an average= 12.5 cm.
b. True Conjugate or Conjugata Vera- distance between the anterior surface of the sacral promontory
and the superior margin of the symphysis pubis; it is very important measurement because it is the
diameter of the pelvic inlet with an average=10.5-11 cm.
c. Bi-ischial diameter or Tuberischii- transverse diameter of the pelvic outlet and measured at the level
of the anus with an average= 11 cm.

MALE REPRODUCTIVE SYSTEM

External Features:
2 Erectile Tissues in the penis:
a. Corpus cavernosa
b. corpus spongiosum
Internal Features:
Epididymis: totals 20 ft. WHERE SPERMS ARE STORED
Vas / Ductus Deferens: carries the sperm to the inguinal canal
Seminal Gland / Vesicle: Secretes SEMEN
Prostrate Gland: secretes SEMEN also.
Cowpers Gland/ Bulbo-urethral: secretes also semen
SEMEN sources: 1. Prostrate gland
:
60%
2. Seminal vesicles
:
30%
3. Epididymis
:
5%
4. Cowpers
:
5%

MCHN

Mark Abejo

Accessory Structures

Mammary Gland
III. Mammary Glands

MAMMARY GLANDS
-2 mammary glands located on each side of chest wall
-Each breast 15-20 lobes containing clusters of ALVEOLI

ACINI

DUCTULES

NIPPLES

-Saclike end of
the glandular
system
-Lined both w/
epithelial cells
that secrete
colostrum(
which is rich in
IgA) & milk &
w/ muscles that
expel milk

-Exit alveoli & join

to form larger canals
LACTIFEROUS
DUCTS
-During lactation,
milk flows to the
alveoli and then thru
the duct system
further going to the
balloon like storage
sacs called
LACTIFEROUS
SINUSES

-Sinuses merge into

openings on nipple

MCHN

Mark Abejo

Female Reproductive Hormones

HORMONES

Follicle Stimulating
Hormone
*Stimulates
Graafian follicle to
mature and resulting
in increase levels of
estrogen

Lutenizing
Hormone
-When follicle is
ripe and mature,
triggers follicular
rupture and release
of ovum
-Peaks at 16-18
hours before
ovulation.
-stimulates
ovulation &
development of
corpus luteum

Estrogen
-Produce from ovaries,
adrenal cortex, and
placenta
-Assists in maturation of
Graafian follicle
-Stimulates thickening of
endometrium.
Other functions
a. Contracts
smooth
muscles Inhibits the
secretion of FSH
b. Responsible for the
increase
vaginal
secretion in the vagina
(LEUKORRHEA)
c. Thickens
the
endometrium
d. SUPPRESSES
THE
FSH & Prolactin
e. Responsible for the
devt of 2ndary sex
characteristics
in
females
f. Stimulates
uterine
contractions
&
smuscular peristalsis
of the fallopian tubes
for the passage of the
ovum to the uterus.
g. Mildly increases Na &
water reabsorption
h. Stimulates
LH
secretion
&
responsible for the
production of cervical
mucus associated in
ferning & spinnbarkeit

Progesterone
*Produce from corpus
luteum, placenta
-Secretes thick/viscous
cervical secretions.
A. Preparation of the
uterus to receive a
fertilized ovum
B. Decrease uterine
motility/
contractility during
pregnancy
C. Increases basal
metabolism
D. Enhances
placental growth
E. Stimulates the
devt of acini cells
in
the
breast(major cells
for breast milk)

Increase
the
endometriums
supply
of
glycogen, oxygen
& amino acids for
maintaining
pregnancy

LUTENIZING HORMONE AND ESTROGEN peak immediately before ovulation

Most women ovulate two weeks before the beginning of the next period.
Other Reproductive Hormones
1. Lactogenic Hormone (Prolactin)
-Stimulates lactation
2. Melanocyte Stimulating Hormone
-Responsible for the linea nigra & chloasma in pregnancy
-Secreted by the anterior pituitary hormone MELANOTROPIN
-Will end on the 2nd month of pregnancy
3. Human Chorionic Gonadotropin
-Increases in nausea and vomiting
Responsible for Hyperemesis Gravidarum

MCHN

Mark Abejo

MENSTRUATION
Menarche: 1st menstrual period, usually age 12, but may begin as early as 9.
Menopause: cessation of menstrual cycle that occurs normally from 40 & 55 y.o.
Menstrual Cycle:
1. Menstrual Phase ( 1 14 days)
-Corpus luteum dies.
-Progesterone & Estrogen vanishes- triggers/stimulate the production of FSH.
-Endometrium degenerated/ sheds- menstruation occurs.
Sexual intercourse during menstruation is not harmful.
2. Proliferative Phase- Estrogen Phase ( 6 14 days) Graafian Follicle: Estrogen
Anterior Pituitary Gland
secretes FSH
stimulates the development of
the Graafian follicle
(secretes Estrogen)
suppresses FSH &
stimulates LH
LH stimulates ovulation
Increase Estrogen
kills/decreases FSH
3. Secretory Phase (15 to 21 days) Progesterone Phase (Corpus Luteum: Progesterone)
Other Books it is called: Luteal Phase
After Ovulation-----release of mature ovum from the Graafian follicle----Graafian Follicles die and replaced by Corpus Luteum-----secretes
progesterone Functions of Progesterone:
4. Pre-Menstrual Phase (22 days to 28 days)
-If fertilization does not occur, corpus luteum begins to die
-Progesterone & Estrogen decreases
-Endometrium degenerates
-Menstruation stops during pregnancy because there is decrease secretion of
hormones by the ovary.

OVARIAN CYCLE
(ACORDING TO HORMONAL ACTIVITY)
0

14

DEVELOPING FOLLICLES

OVULATION

FOLLICULAR PHASE
Ovarian follicles mature under influence
of FSH and estrogen
LH surge causes ovulation

21
CORPUS LUTEUM

28
LUTEAL
REGRESSION

LUTEAL PHASE
-mittelshmerz
-cervical changes
-increase BBT

ENDOMETRIAL/UTERINE CYCLE
(Described by varying thickness of the endometrium)
MENSTRUAL
PHASE
-Menstruation
-Decrease estrogen
-Decrease
progesterone

MCHN

PROLEFERATIVE
PHASE
-Hypothalamus
secretes FSH
-APG (anterior
pituitary gland)
secretes FSH
-Maturation of
Graafian follicle
-Increased estrogen
-Hypothalamus stops
FSH & starts LH
-APG stops FSH &
starts LH secretion

SECRETORY PHASE
-Formation of corpus luteum
-Increase progesterone
-NO FERTILIZATION; corpus
luteum degenerates 10 days after
ovulation
-WITH
FERTILIZATION;
concepts produces HCG that
sustains life corpus luteum;
progesterone level is maintained at
high level
-Progesterone level decreases
-Corpus albicans
Sloughing off of endometrial
lining

PREMENSTRUAL
PHASE
-endometrium
degenerates

Mark Abejo

Menstrual Cycle

Menstrual Disorders
Dysmenorrhea
- PrimaryNo known cause
- SecondaryMay be caused by
tumor/inflammatory
conditions

MCHN

Premenstrual
Syndrome

Amenorrhea

Menorrhagia

-Edema of
Primary-Excessive or
lower
Never
prolonged
extremities
menstruated;
bleeding
- Abdominal
structural/congenit
bloating
al abnormality
- Weight gain Secondary
- Headache
Cessation of
-Breast
menstruation
tenderness
- Depression
- Crying
- Loss of
concentrati
on

Metrorrhagia
- Irregular
bleeding in
between
periods

Mark Abejo