Female Reproductive System Flashcards
sexual dimorphism
differences in male vs female traits, morphologically and behaviourally
name 4 general primary sex characteristics of female reproductive system
ovaries
vagina
uterus
vulva (external genitalia)
name 4 general primary sex characteristics of the male reproductive system
testes
penis
scrotum
prostate gland
primary sex characteristics
traits that are necessary for reproduction
secondary sex characteristics
traits that are unique to each sex but not necessary for reproduction
name 3 secondary sex characteristics in females
breasts
distribution of hair
fat deposits
name 3 secondary sex characteristics in males
muscular development
broadening of shoulders
changes in voice
what did the human breast evolve from?
the sweat glands
what muscles do the breasts rest on?
the mammary glands (breasts) rest on the upper chest wall on a muscle called the pectoralis major. beneath this is the pectoralis minor, which lies on the chest wall made up of the ribs and intercostal muscles
what surrounds and supports breast tissue?
the pectoral fat pad. it is covered in skin with the nipple sticking out from the middle for milk to come from
describe the nipple
surrounded by brown pigmented area called the areola which contains smooth muscle, and may be surrounded by hair.
what are fibrous and connective tissues and what’s the difference?
they’re both connective tissue.
fibrous tissue provides strength and support to the body. it is composed of fibroblasts (cells that produce collagen and other fibres). collagen provides strength and elastin. Found in tendons, ligaments, cartilage, and fibrous capsules around organs
connective tissue is a more general term, refers to cells and extracellular matrix that fills space between tissues and organs in body. subtypes include adipose, blood, bone, cartilage. structural support, insulation, and communication between cells.
name the 3 key features of the breast
lobules
ducts
connective tissue
describe the lobules
the glands that produce milk
describe the ducts
small tubes that transport milk from the lobules to the nipple
what does connective tissue do in the breast
connective tissue supports and protects the breast tissue (lobules, ducts)
how do mammary glands change before and during pregnancy
picture on slide 14 shows deeply stained epithelial elements (cells that line the ducts and lobules). these are the intralobular ducts.
intralobular ducts are surrounded by fine intralobular tissue. between them, lies interlobular connective tissue that contains dense collagen and adipose cells.
lobular epithelial cells line the lobules of the breast, and are responsible for milk production. organized in small groups called alveoli, which are small sacs that produce and store milk.
during pregnancy the lobules grow significantly, and the lobular epithelial cells are mostly responsible for this. they also play a role in the structural integrity of the lobules and production of milk.
which two hormones are most important for breast development during pregnancy
estrogen and progesterone
describe estrogen in pregnancy
a steroid hormone produced mainly in the ovaries. plays a key role in growth and development of ductual and lobular tissue of the breast.
estrogen levels rise during pregnancy and stimulate growth of ductal system, formation of new lobules, and the development of milk producing cells within lobules. estrogen also increases blood flow to breasts, which helps wth lactation
describe progesterone in pregnancy
steroid hormone produced by ovaries and placenta
key role in preparing the breast for lactation by stimulating growth of alveolar cells within the lobules, which produce milk.
progesterone causes ducts to enlarge and swell, which is why breasts feel fuller and heavier during pregnancy
progesterone inhibits contraction of myoepithelial cells that surround alveoli and ducts, which maintain the milk inside the ducts and alveoli
describe the placenta’s role in pregnancy
fetus needs it to grow and develop, supply nutrients and oxygen
waste exchange between fetus and placenta
fetus is connected to placenta which is connected to umbilical cord (tube with 2 arteries and a vein)
blood from fetus enters placenta through umbilical arteries, exchanges gasses and other substances with parent’s blood, then travels back to fetus via umbilical vein
placenta also produces hormones like human chorionic gonadotropin (hCG) and estriol. it functions as an endocrine gland and produces hormones that are necessary to maintain a healthy pregnancy. can also help protect the fetus from certain infections, by producing placental protein that can neutralize microorganisms and toxins
what are the main constituents of human milk
water
lactose (sugar)
fat
proteins
amino acids
vitamins
energy content is 19cal/ounce
how does the breast change during pregnancy
result of progesterone
areolas begin to swell, then breasts rapidly swell. most people feel soreness down sides of breasts and nipple tingling
describe cancer
can start anywhere in body
cells usually grow and divide, and die when they get old or damaged. Cancer breaks this process down, and as cells become more abnormal or damaged they don’t die, meaning new cells form where they are not needed. cancer of blood (leukaemia) dont form solid tumours
what is a malignant cancer tumour? a benign tumour?
a malignant tumour that can spread to/invade nearby tissues. sometimes tumours can break off and travel to distant places in the body through the blood or lymph system to form new tumours
a benign tumour do not invade nearby tissues, but they can be quite large. when removed they usually dont grow back. can be life threatening in the brain.
what causes cancer genetically?
genes that control how cells grow and divide are altered, or they can be inherited.
can arise as result of errors that occur during cell division or damage to DNA from exposures. (ex. smoke, radiation, UV rays from the sun)
what is the leading cause of death in ontario?
cancer.
1in 2 expect to be diagnosed, 1 in 4 expect to die.
mortality rate decreased since the 80s, stable since 2000s
what are most common cancers in men?
prostate
lung
colorectal
what are most common cancers in women?
breast
lung
colorectal
which cancer is most dangerous, prostate or breast?
breast, has higher death % and is more common
what is the difference between a diagnostic and screening procedure?
diagnostic: if a symptom needs to be investigated, such as a lump in the breast
screening: this type of mammogram looks for signs that breast cancer may be developing
describe how a mammogram works
screening: breast is placed between compression plates, squeezed while x rays are taken. X ray is taken with low dose of radiation. picture made is called a mammogram. can help find tumours
diagnostic: spot compression done on suspicious area with spot compression plate. gives closer view of one area of breast.
when should you have a mammogram?
every 2 years for women/afab 50-74 years old. this has reduced deaths by 1/3 in this age range
whether mammograms are beneficial to those outside this age range is inconclusive
when should you have an early mammogram?
women/afab aged 30-69 can be screened through the high risk ontario breast screening program if they have a referral, no acute breast symptoms and fall into one of these categories:
- have a mutation in a known BC causing gene
- are first degree relatives with someone who has a gene mutation
- have been assessed by genetics clinic as having 25% or more lifetime risk of getting BC
- have had radiation therapy to chest to treat another cancer or condition before age 30 and at least 8 years ago
- personal history of breast or ovarian cancer
describe a mammogram
x ray imaging test to detect abnormalities in the breast tissue. detects changes in density and structure, lumps or masses, which can indicate presence of cancer
microcalcifications are tiny mineral deposits, can appear as white spots in the mammogram. can be early sign of BC. mammogram does not directly detect cancer cells, but abnormalities in the breast tissue can be indicative of BC. biopsy needed to confirm
what are dense breasts?
some ppl have more fibrous tissue in their breasts than fatty tissue. may be diagnosed with dense breasts.
dense breasts mean higher BC risk, higher than a family history of BC. mammograms miss about 50% of BC in dense breasts, since there is low contrast.
what is a biopsy?
a test that removes some tissue or fluid from a sus area. the removed cells are examined under a microscope and further tested to check for the presence of BC. only diagnostic procedure to definitively determine what the sus area is
explain the hormone receptor status test
BC cells taken out during biopsy to check for estrogen and progesterone receptors. cancer is hormone receptor positive or negative depending on if they have these receptors. important in deciding on treatment options
what is an ER+ breast cancer? PR+?
ER+: have estrogen receptors
PR+: have progesterone receptors
what is a hormone receptor positive cancer?
a cancer with either ER or PR receptors
tends to grow slower than hormone receptor negative cancers
tend to have better outlook short term, but these cancers can sometimes come back many years after treatment
what is a hormone receptor negative cancer?
hormone receptor negative breast cancers have neither estrogen or progesterone receptors
hormone therapy drugs are not helpful with these
these cancers tend to grow faster than hormone receptor positive cancers. if they come back after treatment, it’s often in the first few years
are more common in those who have not yet gone through menopause
what is HER2 and what does it mean to be HER2+?
HER2: human epidermal growth factor 2
this receptor is part of a family of receptors that play a role in controlling cell growth and division
HER2 is a protein that helps breast cancer cells grow fast
if BC has higher than normal levels of HER2, it is HER2+
these cancers spread faster than HER2- , but are more likely to respond to treatment
what is a triple negative breast cancer?
don’t have estrogen receptors or progesterone receptors
more common in women under 40, black women, or women with mutated BRCA1
triple - spread and grow faster than other types of BC
hormone therapy is not helpful in treating these cancers.
they dont have much HER2, so drugs that target HER2 don’t help either
surgery for cancer
surgical removal of the tumour or affected tissues
often the first line treatment of solid tumors that are localized and haven’t spread
chemotherapy for cancer
use of drugs to kill or inhibit the growth of cancer cells
may be used as main treatment or in combination with other therapies. effective for cancers that have spread or are difficult to treat with surgery alone
radiation therapy for cancer
use of high dose of radiation to kill cancer cells
often used after surgery to eliminate any remaining cancer cells, or as a primary treatment if surgery is not possible
hormone therapy for cancer
interferes with the activity of hormones that promote the growth of hormone sensitive cancers
common for breast and prostate cancers that are hormone receptor positive
what are main risk factors for breast cancer?
age
race
family history
personal health history
early menstruation
late menopause (After 55)
what is invasive cancer?
a type of cancer that has spread beyond the original site where it began and has invaded nearby tissue
which background has the highest rate of breast cancer diagnosis?
white/caucasian women
what hormonal factors (menstruation, birth) can add breast cancer risk
early menstruation (before 12) and late menopause (after 55)
having a first child at an older age
never having given birth
what are the genes that are scrutinized for breast cancer risk
BRCA1
BRCA2
which lifestyle factors put people at risk for breast cancer?
sedentary lifestyle
alcohol consumption
combined hormone replacement therapy
explain how alcohol consumption and cancer are linked
alcohol is a carcinogen that causes at least 7 types of cancer. mainly breast and colon, along with rectum, mouth and throat cancer.
many carcinogenic contaminants are introduced during fermentation and production. like phenols and hydrocarbons
ethanol metabolizes into acetaldehyde, which is a toxic chemical and a probable human carcinogen.
acetaldehyde can damage DNA and proteins, generated reactive oxygen species that can also damage DNA, proteins, and lipids via oxidation
what is the BRCA gene test
a blood test to detect mutations in the two breast cancer genes: BRCA1 and BRCA2.
if +, physician works with patient to determine risk level
if there is no mutation the result is - .
there could be gene variants doctors dont know about. these are called variants of uncertain significance (VUS)
what are BRCA1 and BRCA2?
BReast CAncer genes 1 and 2
everyone has a copy, they have been found to impact a person’s chances of developing breast cancer.
these genes produce proteins that help repair damaged DNA. when functioning properly they repair DNA, keep other genes healthy and prevent cancerous changes.
If someone has a harmful variant, they tend to develop cancer at younger ages than people who do not have such a variant.
0.25% of the population carries mutated BRCA genes.
55-65% of women with the BRCA1 mutation will develop BC before 70
45% of women with BRCA2 mutation will develop BC by 70
what is a VUS?
variant of uncertain significance is when an abnormal form of a BRCA gene is found, but it is unknown if it is harmful or not.
its significance to the development or progression of disease is unknown. it is hard to predict clinical relevance of such variants
what cancers are BRCA gene mutations responsible for?
5-10% of breast cancers
15% of ovarian cancers
both men and women are prone to cancers if their BRCA is mutated
true or false: you need a physician referral and sign off to get genetic testing for BRCA
true. a physician or NP needs to refer you
what is an invasive ductal carcinoma?
of men who develop breast cancer, they are mostly IDCs.
cells in/around the ducts begin to invade surrounding tissue. most common type of BC, making up 70-80% of all diagnoses.
less than 1% of BC are in males, and of this 1%, 80% are IDC.
describe the female external genital area
the vulva
vulva is a collective term to describe the external genitalia, including the mons veneris, labia majora/minora, clitoris and vaginal opening.
structures allow for sexual reproduction by providing means for sperm to enter the body and fertilize an egg
the mons veneris
aka. mons
fatty tissue covered with skin and pubic hair. acts as a cushion during sex, while pubic hair helps to vaporize odours
labia majora
aka. outer lips
two folds of skin that extend down from the mons on either side of the vulva. like the mons, they are padded with fatty tissue and hair
labia minora
aka, inner lips
thin folds of hairless skin between the two labia majora. they meet at the front to form the clitoral hood and enclose the vestibule space.
amply supplied with glands, blood vessels and nerve endings and are erotically sensitive
what are the 3 main components of the vestibule
clitoris
urethral opening
vaginal opening
introitus
refers to the opening of a body canal or passage
in the female reproductive system, the vaginal introitus refers to the opening of the vagina, which connects the vaginal canal to the outside of the body
draw some anatomy out! the muscles and the structures of the external female genitalia
ok bestie
pubic symphysis
the line of fusion between the left and right pubic bones
glans of clitoris
a small highly sensitive knob of tissue positioned at the front of the vestibule
the clit
clitoris
the clit, esp the glans is richly innervated with sensory nerve fibres whose function is to produce sexual arousal.
the only function of the clit is sexual pleasure
its stimulation is the most reliable way for afab ppl to get orgasm
erection of clit is physiological sign of sexual arousal. during erection, the shaft of the clit becomes firmer but the glans remains soft. the reason for this is that the shaft is surrounded by a layer of tough connective tissue that restricts its expansion whereas the glans is free to expand
what are the two internal extensions of the clitoris
crura
vestibular bulbs
the crura
diverge backward and down clitoral shaft. partially enwrap the urethra
vestibular bulbs
are closely associated with the clitoris. they are curved masses of erectile tissue that surround the vestibule and underlie the labia minora.
erection of vestibular bulbs during sexual arousal helps stiffen and lengthen the vagina
what are the 2 muscles associated with the clitoris
the ischiocavernosus muscle
the bulbospongiosus muscle
the ischiocavernosis muscle
surrounds each crus of the clitoris. contract during sexual arousal
the bulbospongiosus muscle
runs down and surrounds the vaginal opening. contractions of this muscle tighten the vaginal opening, increases clitoral erection and may help increase erotic sensations of vaginal penetration by transferring mechanical stim to the clit
the pubococcygeus muscles
muscles of the pelvic floor, one of the muscles targeted by kegel exercises
the steady contraction of these muscles stiffens the walls of the vagina during sex. that actually increases the sexual sensations for both individuals during penetrative sex
these muscles will contract more strongly during orgasm, increase pleasure, prevent urinary and fecal leakage. and possibly help keep sperm in the vagina
what is female circumcision
aka female genital cutting or female genital mutilation
involves partial or complete removal of external female genitalia for non medical reasons
typically done to girls in infancy to 15, common in Africa, Middle East and SE asia
considered a human rights violation and is illegal in many countries.
serious health consequences, like infections, complications during childbirth, and death
clitoridectomy
90% of female genital mutilation
removal of entire external portion of the clitoris
infibulation
10% of all female genital mutilation
clitoridectomy + sewing together labia majora over vestibule
describe the hymen
the hymen is a thin membrane located at the entrance of the vagina. not a necessary organ and has no known function
not a solid barrier, a ring of tissue that can vary in shape, size, thickness
some hymens are barely visible, while others are more prominent
not a reliable indicator of virginity, as it can be stretched or torn for various reasons, or left unscathed
why is the hymen not a good indicator of virginity?
some people are born without a hymen, or it is not visible
the hymen can be stretched or torn without causing pain or bleeding
annular hymen
forms in a ring around vaginal opening
septate hymen
forms two holes in vaginal opening, sort of a pig’s snout appearance
cribiform hymen
the membrane has many holes, very tryptophobia-triggering
the wonder down under book
virginity fraud
sexual education about the hymen and debunks myths around female virginity and the hymen
advocate against virginity testing
look at the reproductive tract diagram for anatomy!!
ok!!!
Bartholin’s glands
greater vestibular glands, located on either side of vaginal opening
produce small amount of mucus to help lubricate vagina during sexual activity
what is the G spot? does it exist?
the Graenberg-spot (G spot) is thought to be an area of increased sexual sensitivity
if it exists, the best candidate is the paraurethral glands, located in root of the anterior wall of the vagina and next to urethra
in 2008 Italian researchers reported that the region containing paraurethral glands are larger in those who get orgasm from vaginal stimulation than those who do not
maybe the orgasm is just from stimulation of nerve fibres in wall of vagina? or urethra? or erectile tissue?
3 layers of vaginal wall
thin cellular lining/mucosa
intermediate muscle layer
outermost fibro-elastic layer
outer third of the vagina near the opening has a different developmental origin. it is tighter and richly innervated. most sensation during sex derives from outer portion of vagina
describe vaginal bacteria and fungi
vagina is inhabited by many microorganisms
lactobacilli are type of bacteria that are naturally present. considered probiotics, and are beneficial bacteria for overall health
they maintain vaginal pH, which helps prevent growth of harmful bacteria and yeast
healthy bacteria produce lactic acid, lowering the pH and creating an acidic environment
also produce hydrogen peroxide that protects vagina from infection. helps to keep balance of good bacteria.
main vaginal microorganisms
lactobacilli (95%)
candida albicans (fungal yeast)
what is candidiasis
a yeast infection
overgrowth of fungi
inflammation of vaginal walls, itching and white discharge
treatment: antifungal medication
what is normal pH of a healthy vagina?
slightly acidic, at 3.8-4.5
this protects vagina from infection by creating environment that is inhospitable to harmful bacteria and other pathogens. the acidity is maintained by healthy bacteria like lactobacilli which makes lactic acid
pH can fluctuate throughout menstrual cycle, during sexual activity or pregnancy, or with use of certain medications. as long as the pH isn’t consistently higher, there will not be a condition like bacterial vaginosis or a yeast infection
what can disrupt vaginal pH>
antibiotics: not only target harmful bacteria but also beneficial vaginal bacteria, leading to imbalance
douching: disturb natural pH and wash away good bacteria
hormonal changes: fluctuations in hormone levels like those in menstruation/pregnancy or menopause can affect balance of vaginal bacteria
sexual activity: can influence vaginal microbiome by disrupting it
certain hygiene products: harsh soaps or perfumed products can disrupt natural balance
tight clothing: creates warm and moist environment which promotes growth of harmful bacteria
stress: high levels of stress can impact immune system and potentially contribute to imbalance in vaginal microbiome
immunosuppression: conditions or medications that weaken the immune system can make vagina susceptible to infection
cervix
narrow part of uterus
the os
the external os connects the vagina to a short canal through the cervix
describe the uterus’s functions and layers
functions:
- pregnancy
- menstrual cycle
layers:
- endometrium (inner lining)
- myometrium (muscular wall)
- perimetrium (outer covering)
TNM staging system for cancer
T: tumour
describes main tumor, and if it has grown to other parts or tissues.
T ranges from 1-4, with higher number meaning larger tumor, or that it has grown deeper into tissues
N: lymph nodes
whether cancer has spread to lymph nodes around organ
N0- no spread
N1,N2,N3 means cancer has spread to lymph nodes, higher number means more lymph nodes and their size/location
M:metastasis
if the cancer has spread to other parts of the body via blood or lymphatic system
M0- no spread
M1- spread
what demographic sees the most cancer deaths?
black/african american
