Mons Pubis Clitoris Urethra Labia Majora Labia Minora Vagina Introitus Vestibule

Mons Pubis
rounded, skin-covered fat pad protects pelvic bones during coitus located anterior to the symphisis pubis


Located below the clitoral hood

Erectile organ, rich in vascular & nervous supply Analogous to male penis A highly sensitive organ Distends during sexual stimulation

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

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


4. Fallopian Tubes Uterus






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

Major functions: producing ova for fertilization by sperm & producing estrogen & progesterone


Located beside fallopian tubes
Size: 3 – 5 cm long; 1.5 – 3cm wide; 1-1.5cm thick

Pinkish-white to gray in appearance

Almond shaped glandular structures that produces ova

1. GnRH

5. Progesterone 4. Estrogen

2. Leutinizing hormone
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

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)


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 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


Divided into 2 layers: (1) Stratum functionalis (superficial layer that sloughs off with each menstruation and after delivery)

Endomet rium

mucous membrane lining of the uterine cavity;

(2) Stratum basalis (deeper layer that is retained during menses & proliferates the stratum functionalis)

Purpose: location for the implantation of a fertilized ovum; if pregnancy not realized,

Myometri um
Contraction of this muscle helps to expel menstrual flow and the products of conception during miscarriage of childbirth.

(middle layer;

thick and muscular; its function is to contract)

Perimetri um
Anterior: reflected over the bladder wall, forming the vesicouterine pouch Posterior: extends from the rectouterine pouch

thin, serous, external peritoneal membrane that covers and protects the outside of the uterus

Thick-walled muscular organ Fundus Pear-shaped, hollow structure is located between the Fallopian bladder(posterior) and the rectum Tub (anterior) Size: 7.5 cm (3in) long; 5cm 2(in) Ovary wide; 2.5 cm (1 in) in depth Body of the UterusFunction: menstruation, gestation, and parturition
Cervix Vagina Myometrium

Uteru s


Cervcal Canal


-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

Breas t

are complex accessory organ

Cylindrical projection near the center of the breast 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 les

Lie within peripheral breast tissue

Alveoli which contain
both ancinar & myoepithelial cells
- the

ancinar 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)

oogenesis & uterine preparation are periodic events recur repeatedly; approximately once a month

Menstrual Cycle

Menstrual Cycle


Creation of Gametes

Follicular Phase (Day 1 -14)
Ovarian follicle mature under the influence of FSH and Estrogen LH surge causes ovulation

Ovum is discharged from mature follicle Corpus luteum develops under the influence of LH

Refers to the cyclic changes in the cells lining the uterus (endometrium)

Menstrual (1-5)
 E, P  Sloughing of Endometrial Lining  Menstruation


Sloughing of Endometrial Lining


Menstrual Proliferative (1-5) (6-14)  E  E, P H: FSH – RF  Sloughing APG: FSH O: E of

Secretory (15-21)

Ischemic (16-28)

 E Endometrial Maturation Lining of Ovarian  Follicle Menstruati (“Graafian Follicle”) on  P H: LH-RF (Ovulation) APG: LH O: P

Formulation of Pregeneratio Corpus Luteum n of Corpus Luteum (Yellow body)   Corpus a. Fertilization Albicans (+) sex; (+) (10 days) sperm P = Pregnancy b. No Fertilization (+) sex; (-) sperm No pregnancy  P = LH

DISORDERS OF THE FEMALE REPRODUCTIVE SYSTEM Tubes & Ovaries 4. Fallopian 1. Menstrual cycle Disorders
a. Amenorrhea b. PMS c. Dysmenorrhea d. Menopause 2. External Genitalia a. Barholin’s Gland Abscess b. Vulvodynia 3. Vagina a. Vaginitis 4. Uterine Cervix a. Cervicitis 5. Uterus a. Endometritis b. Endometriosis c.Adenomyosis
a. Pelvic Inflammatory Disease b. Ectopic Pregnancy 5. Pelvic Support a. Cystocele b. Rectocele c. Uterine Prolapse 5. Breast a. Mastitis b. Galactorrhea c. Breast Cancer

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 Syndrome) Etiology:
Excess of Estrogen Progesterone deficiency Vitamin. Mineral deficiency (B6, C, Selenium, Mg) Nutritional Factors (excess consumption of caffeine/refined sugar)
S/S: (symptomatic) Edema Wt gain Abdominal Pain Headache

Breast Tenderness Depression Crying spells and irritability Food craving

emotional and Behavioral s/s:) Mood changes Irritability Crying spells Change in exercise Decrease ability to concentrate Insomnia

2 types: a.) Primary – painful menses unrelated to a physical cause b.) Secondary – associated with uterine / pelvic pathology factors: Endometriosis; PID, IUD use

Excessive amount of Prostaglan din

Uterine Vasoconstricti on, ischemia, smooth muscle pains

Increase Uterine Activity (Uterine Contraction)

Increase Prostagland in

Endometriu m (sloughs)

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

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: tender & painful Abscess TX: Administration of appropriate antibiotics, local application of moist heat, and I & D



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

Causes: Post menopausal Atrophic vaginitis (occurs after menopause) decrease of estrogen levels Chemical irritation Allergy Trauma

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)

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: Vaginal Microscopy (Cervix appeared Dx 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

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

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

– 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


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


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

the vagina

herniation of rectum into

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 intraabdominal 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

occurs in women in postpartum period

3 types:


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 inflammation

non infectious breast

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

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

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Fallopian tubes Vagina Breast Uterus

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