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Anatomy and Physiology > Female reproductive system > Flashcards

Female reproductive system Flashcards

1
Q

The Y chromosome contains which gene that codes for the production of Testis-Determining Factor (TDF)?

A

SRY (Sex-Determining Region of the Y)
permits differentiation into male sex organs
lack of gene permits differentiation into female sex organs

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2
Q

What happens in female (XX) gender differentiation?

A

ovaries develop
no testosterone from Leydig cells
Wolffian ducts degenerate
no Müllerian inhibiting factor from Sertoli cells
upper Müllerian ducts develop into fallopian tubes
lower Müllerian ducts develop into uterus and upper parts of vagina

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3
Q

What are the female reproductive organs?

A

gonads - ovaries
internal genitalia - fallopian tubes, uterus, cervix, vagina
external genitalia - mons pubis, pudendal cleft, labia majora, labia minora, Bartholin’s glands, clitoris

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4
Q

What are the functions of the female reproductive system?

A

produce the female gametes (ova)
transport the ovum along the Fallopian tube where it is fertilised
protect and nurture the developing embryo and foetus until ready for birth
deliver the baby safely

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5
Q

What is the structure of the ovaries?

A

paired structures - one on either side of the uterus
about 3 cm long in peritoneal cavity
interior is divided into the cortex (contains the ova) and the medulla (contains blood vessels, nerves, and lymphatic tissue surrounded by loose connective tissue)

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6
Q

What is the structure of the Fallopian tubes?

A

the passageway for the ovum to get to the uterus
begin as a large funnel, surrounded by ciliated projections (fimbriae)
this leads to a widened area (ampulla) followed by a longer, narrower portion (isthmus)
connected to the superior portion of the uterus

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7
Q

What is oogenesis?

A

the process of ovum production

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8
Q

What is the first stage of oogenesis?

A

production of embryonic stem cells in the ovary

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9
Q

What is the second stage of oogenesis?

A

embryonic stem cells undergo mitosis, producing millions of primary oocytes
women have all the eggs they will ever have five months before they are born

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10
Q

What is the third stage of oogenesis?

A

primary oocytes still have 46 chromosomes and they must undergo meiosis to become gametes, with only 23 chromosomes
they are eventually surrounded by helper cells
at this point, they are called primordial follicles and stay dormant until puberty

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11
Q

What is the fourth stage of oogenesis?

A

hormonal signals during puberty cause some primordial follicles to enlarge
these enlarged cells are called primary follicles

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12
Q

What is the fifth stage of oogenesis?

A

once a girl reaches puberty, one primary follicle will become a secondary follicle each month
the secondary follicle will not complete its development unless it is ovulated and fertilised
just before ovulation, the secondary follicle fills with fluid and moves toward the surface of the ovary, where it becomes a visible lump

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13
Q

What happens in ovulation?

A

fimbriae brush the surface of the ovary
this causes the follicle to rupture and the ovum is released into the peritoneal cavity
fimbriae pull it towards the funnel and into the Fallopian tube
ovum moves along it to the uterus by the action of ciliated epithelium

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14
Q

What happens in fertilisation?

A

if sperm is present, it will penetrate the ovum, fertilizing it and triggering the rest of the ovum development.
the successfully fertilized egg has 46 chromosomes and is called a zygote
the zygote enters the uterus and implants into the proliferated endometrium, stopping the woman from experiencing menses

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15
Q

What happens to the ruptured follicle?

A

becomes the corpus luteum

secretes hormones to help maintain the thickened endometrium to nourish the embyro

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16
Q

Where is the uterus located?

A

in the pelvic cavity, posterior and superior to the urinary bladder and anterior to the rectum

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17
Q

What are the four major regions of the uterus?

A

fundus, body, isthmus, cervix

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18
Q

What is the fundus?

A

the rounded superior portion between the uterine tubes

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19
Q

What is the body?

A

starts directly below the level of the fallopian tubes and continues downward until uterine walls and cavity start to narrow

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20
Q

What is the isthmus?

A

the narrow inferior portion

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21
Q

What is the cervix?

A

a valve-like portion of the uterus which protrudes into the vagina

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22
Q

What are the three layers of the uterus?

A

perimetrium, myometrium, endometrium

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23
Q

What is the perimetrium?

A

outermost, visceral layer

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24
Q

What is the myometrium?

A

composed of smooth muscle

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25
Q

What is the endometrium

A

the inner lining

a mucosa layer of columnar epithelium and secretory cells with two divisions

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26
Q

What are the two divisions of the endometrium?

A

basal layer and functional layer

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27
Q

What is the basal layer?

A

responsible for regenerating the uterine lining each month

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28
Q

What is the functional layer?

A

sheds about every 28 days when a woman has her period

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29
Q

What is the structure of the vagina?

A

fibromuscular tube
runs from the cervix to the opening to the external genitalia
self-cleaning organ with healthy microbiota which flow towards the exit minimising the risk of infection

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30
Q

What is the structure of the vulva (external female genitalia)?

A

consists of the labia majora and labia minora, mons pubis, clitoris, vulval vestibule and associated glands, external urethral orifice and vaginal opening
important role in sexual activity due to extensive nervous supply enabling pleasure when stimulated

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31
Q

What is the structure of the labia majora?

A

lip-like structures either side of the vulva composed of skin and adipose tissue
start from the pudendal cleft through the base of the mons pubis, and join behind the vaginal opening anterior to the perineum
during puberty, the outer surface of the labia majora grows pubic hair, while the inner surface is smooth, hairless, and resembles a mucous membrane
both surfaces contain many oil and sweat glands
nerve supply is less extensive than in rest of vulva

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32
Q

What is the structure of the labia minora?

A

two hairless folds of skin between the labia majora

the surfaces are similar to a mucous membrane

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33
Q

What is the function of the labia minora?

A

protect the vestibule, urethra and vagina with the upper anterior part protecting the clitoris

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34
Q

What is the structure of the clitoris?

A

the female equivalent of the penis
contains some erectile tissue and responds to sexual arousal by enlarging and becoming firm
surrounded and protected by the clitoral hood formed by an extension of the labia minora
glans contains around 8000 sensory nerve endings

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35
Q

What is an episiotomy?

A

a surgical incision under local anaesthetic of the perineum carried out to increase the size of the vaginal opening to facilitate the birth of the baby
reduces damage to the perineum and is readily repaired by suturing after delivery

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36
Q

What can women undertake during the last five weeks of pregnancy to stretch the perineum?

A

digital perineal massage

37
Q

What is the first degree of perineal trauma?

A

damage to the skin only

38
Q

What is the second degree of perineal trauma?

A

damage to the perineal muscles but not the anus

39
Q

What is the third degree of perineal trauma?

A

perineal injury including damage to the anal sphincter
3a - damage to external anal sphincter <50% thickness
3b - damage to external anal sphincter >50% thickness
3c - internal anal sphincter also torn

40
Q

What is the fourth degree of perineal trauma?

A

perineal injury including both external and internal anal sphincters and anal epithelium

41
Q

What is the structure of the vulval vestibule and associated organs?

A

the vestibule is delineated by labia minora on either side with the clitoris anterior and joining of two labia minora posterior
urethra and vagina open into vestibule
urinary meatus is about 2.5 cm behind the clitoris anterior to the vagina
vaginal opening (introitus) is partially covered by hymen (membrane usually broken with intercourse)
glands open into the vestibule around the lower end of the urethra and the anterior wall of the vagina
the tissue surrounding these glands are stimulated with sexual activity and swell with blood

42
Q

What are Bartholin’s glands?

A

located to the right and left and slightly posterior to the introitus
lubricate introitus with mucous secretions
the gland can become infected and blocking of this duct causes a Bartholin’s cyst

43
Q

What changes occur in the pituitary hormone secretion through the menstrual cycle?

A

FSH and LH reach a peak at about the mid-point of the cycle

after ovulation, inhibin provide negative feedback on gonadotropin hormones which reduces FSH secretion

44
Q

What changes occur in oestrogen secretion through the menstrual cycle?

A

as the ovarian follicle develops it begins to secrete oestrogen, reaching its peak just before ovulation
oestrogen stimulates growth of endometrium in preparation for a fertilised ovum

45
Q

What changes occur in progesterone secretion through the menstrual cycle?

A

after ovulation, corpus luteum secretes fairly high levels of progesterone and medium levels of oestrogen and inhibin

46
Q

What is sexuality?

A

the interrelationship between the biological, sociocultural and psychological factors that influence the ways in which we experience and express ourselves as sexual beings and which need to be taken into account in providing sensitive person-centred care

47
Q

What are the six components of sexuality?

A

sexual orientation, reproductive health, body image, relationship, love and affection, gender role and identity

48
Q

What is gender role?

A

how people behave as men or women (as society perceives them)
moderated by the environment in terms of what is socially and culturally acceptable

49
Q

What is gender identity?

A

the sense of being male or female
considered to be biological, determined prenatally and largely consistent with gender anatomy
in males, gender identity is influenced by testosterone levels

50
Q

What is sexual orientation?

A

the romantic or sexual attraction to another

considered to be determined prenatally by endocrine conditions

51
Q

What happens during the arousal stage in females?

A

vasodilation causes: fluid secretion from vaginal walls to provide lubrication, external genitalia (clitoris, vaginal opening, labia) become swollen, flushing (particularly on chest and neck)
top of vagina expands
pulse and respiration rates increase, blood pressure rises

52
Q

What happens during the plateau stage in females?

A

increased blood flow causes swelling and firmness of bottom third of vagina
breasts may increase in size by <25%
blood flow round nipple increases - looks less erect
nearing orgasm, clitoris pulls back against pubic bone and seems to disappear - continuous stimulation needed

53
Q

What happens during the orgasm stage in females?

A

rhythmic contractions of genital muscles during orgasm with intense and pleasurable release of tension
most do not have recovery period, may have another orgasm if stimulated again
not all women have orgasm on every occasion, foreplay is important in reaching orgasm

54
Q

What happens during the resolution stage in females?

A

body slowly returns to normal state
swelling goes down
pulse, blood pressure, respiration return to normal levels

55
Q

What is the duration of pregnancy?

A

38 weeks from date of conception

40 weeks after the first day of a woman’s last menstrual period

56
Q

What is a cephalic presentation birth?

A

the most common position for delivery

foetus positioned head down into the pelvis with the back towards the side and front of the woman’s body

57
Q

Why do progesterone and oestrogen levels rise throughout pregnancy?

A

to suppress the hypothalamic and menstrual cycles
placenta takes over secretion of oestrogen
progesterone relaxes smooth muscle

58
Q

What is human chorionic gonadotropin (hCG)?

A

secreted by placenta
maintains the corpus luteum in producing progesterone, a function later taken over by the placenta
hCG excretion levels in urine are measured to confirm pregnancy

59
Q

What is prolactin secreted from the pituitary gland during pregnancy?

A

to prepare the breasts for breast-feeding

60
Q

Why does parathyroid hormone increase during pregnancy?

A

to raise calcium levels in the body by acting on the gut (increased absorption) and kidneys (increased reabsorption)

61
Q

How do levels of adrenal hormones (cortisol and aldosterone) change during pregnancy?

A

increase

62
Q

What is human placental lactogen (hPL)?

A

secreted by placenta
stimulates fat metabolism by the woman so that glucose is converted for use by the foetus
it can decrease the sensitivity of maternal tissue to insulin, sometimes causing gestational diabetes

63
Q

How does the placenta prevent an attack by the mother’s immune system against the foetus and placenta?

A

it acts as a barrier between the foetus and the mother’s immune system
some IgG molecules pass the placenta from the mother giving the foetus some immunity against disease which lasts for some time after delivery

64
Q

What cardiovascular changes occur during pregnancy?

A

plasma and blood volume increase
cardiac output rises due to increased heart rate and stroke volume
blood pressure initially falls (weeks 12-26) due to action of relaxin which causes smooth muscle relaxation and vasodilation
blood pressure returns to pre-pregnancy levels by week 36
increased erythropoietin secretion increases erythrocyte numbers and white cell count increases

65
Q

Why is blood more likely to coagulate during pregnancy?

A

increased production of coagulation factors by liver
this leads to increased risk of venous thromboembolism (VTE), particularly after labour
the enlarging uterus restricts venous return and lymphatic drainage from the legs and fluid can accumulate in the feet causing oedema

66
Q

What other physical changes occur during pregnancy?

A

increase in weight due to growth of foetus and placenta, amniotic fluid surrounding foetus, increased breast size, and increase in water and fat retention
increasing size of uterus causes changes in shape and posture of the woman’s body - change in centre of mass causes alterations in posture, gait, balance and an increased risk of falls
oestrogen and relaxin involved in remodelling of soft tissues, ligaments and cartilage
sacroiliac and symphysis pubis joints stretch and become wider to facilitate birth of baby

67
Q

Why is additional protein in the diet important during pregnancy?

A

development of the muscular tissue of the uterus to facilitate delivery
breast development for lactation and breast-feeding

68
Q

Why is folic acid recommended before conception and in early pregnancy?

A

to reduce the incidence of neural tube defects (conditions in which the spinal cord and spine do not develop normally and result in severe disabilities)

69
Q

What health problems can occur during pregnancy that cause nutritional issues?

A

insulin resistance - causes gestational diabetes
morning sickness (nausea and vomiting)
hyperemesis gravidarum - persistent severe vomiting that can lead to weight loss and dehydration
acid reflux - due to prolonged gastric emptying and constipation due to decreased colonic activity

70
Q

What is a vertex presentation of the foetus?

A

most common form of cephalic presentation

the crown of the head, which has the smallest diameter in the foetus, comes first

71
Q

What happens during the first stage of labour?

A

lasts from the beginning of proper contractions until the cervix is fully dilated
length is variable - average of 8 hrs in a first pregnancy, short in subsequent labours
usually the ‘waters break’ during this stage when the membranes around the baby lining break and the amniotic fluid gushes out

72
Q

What happens during the second stage of labour?

A

lasts from full dilation of the cervix until delivery of the baby
the woman feels the need to push the baby out
an episiotomy may be performed if the woman is having difficulty in expelling the baby

73
Q

What happens during the third stage of labour?

A

lasts from delivery of the baby to delivery of the placenta and membranes
these must be checked to ensure that they are complete as any left in the uterus can cause post-partum haemorrhage
oxytocin often administered to facilitate completion of this stage

74
Q

What is oxytocin?

A

hormone produced by the paraventricular and supraoptic nuclei of the hypothalamus
passes down nerve fibres and stored in posterior pituitary gland before being released into the bloodstream

75
Q

How is oxytocin involved in labour and delivery?

A

towards the end of pregnancy, the raised oestrogen levels increase the numbers of oxytocin receptors in the uterus
once labour starts, contractions cause cervical dilation which stimulates prostaglandin secretion and sends nerve impulses back to the brain
positive feedback increases oxytocin, and causes yet more contractions
after delivery of the baby, the presence of oxytocin stimulates uterine contractions and facilitates delivery of the placenta
it also promotes bonding by the mother with the baby

76
Q

What are the two main issues that are relevant postpartum?

A

returning to the non-pregnant state

infant feeding and nurturing

77
Q

What happens during the postpartum period?

A 
the mother's body returns to its usual state, including hormone levels and size and condition of the uterus
lasts for six weeks following delivery
cervical os returns to non-pregnant tight opening 
vaginal discharge (lochia) lasts up to about 60 days (more commonly 33 days) 
lochia contains blood, mucus and uterine tissue
78
Q

Lochia moves through which three stages?

A 
lochia rubra (red) - three to five days  
lochia serosa (brownish/pink) - up to ten days
lochia alba (white/yellow) - second through third to sixth week
79
Q

When does milk ‘come in’ to the breast?

A

about the second or third day after delivery

80
Q

Where is milk stored in the female breast prior to feeding?

A

lactiferous sinuses

81
Q

What is colostrum?

A

the first secretion available for the baby
contains more leucocytes and antibodies (particularly IgA) than in mature milk
this provides protection against infection for the baby
colostrum gives way to mature breast milk over about two weeks

82
Q

Why is exclusive breastfeeding recommended for the first six months of life?

A

reduces the incidence of GI and respiratory infections (in certain countries)
inhibits restoration of menstruation
enhances weight loss in breastfeeding mothers

83
Q

How is body fat distribution different in men and women?

A

women have more gluteofemoral fat and less abdominal and visceral fat
this means women have a lower waist-hip ratio (WHR)

84
Q

What relationship has been identified between the WHR and the breastfed baby’s cognitive development?

A

it appears that the fat in these areas contains the long-chain polyunsaturated fatty acids (LCPUFAs), especially DHA (omega-3 docosahexaenoic acid), that are essential for neurodevelopment
about 60-80% of LCPUFAs needed for brain development come from this area of fat storage which is not used until late pregnancy and during lactation when brain development is at its maximum
loss of fat from the gluteofemoral region occurs with each pregnancy and with breast-feeding

85
Q

Milk production is initiated by a decrease in which hormone?

A

oestrogen

86
Q

What are the two main hormones involved in lactation and breast-feeding?

A

prolactin and oxytocin

87
Q

How is prolactin involved in the regulation of lactation?

A

it stimulates growth of mammary glands during pregnancy in preparation for lactation
levels falls following delivery, but then prolactin secretion is stimulated by the baby suckling on the nipple and promoting milk production

88
Q

How is oxytocin involved in the regulation of lactation?

A

it stimulates contraction of smooth muscle that lines the lactiferous ducts of the breast and squeezes milk out of the nipple for the baby
it stimulates expression of milk into the lactiferous sinuses and the baby’s mouth

89
Q

How is positive feedback involved in lactation?

A

positive feedback from the baby’s suckling occurs via nerve impulses sent to the hypothalamus
this stimulates prolactin release from the anterior pituitary gland and oxytocin release from the posterior pituitary gland
these hormones maintain lactation and increase milk volume to ensure adequate nutrition for the baby

Anatomy and Physiology (13 decks)

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