Female Reproductive System Flashcards
What is the function of mammary glands?
Synthesize, secrete and eject milk to nourish the new born
What is the function of the vagina?
Receives the penis during sexual intercourse and is a passageway for childbirth
What are the functions of the uterus?
- site of Implantation of fertilized ovum
- site for development of the fetus during pregnancy and labor
- inner lining sheds during menstruation
What are the function of the ovaries?
Produce secondary oocytes and hormones including progesterone, estrogen, inhibin and relaxin
What is the function of the uterine tubes?
Transports a secondary oocyte to the uterus and is usually the site of fertilllization
What ligaments hold the ovaries to the peritoneal cavity?
Broad ligament - part of the parietal peritoneum
Ovarian ligament- anchors ovaries to uterus
Suspensory ligament- attaches ovaries to pelvic wall
What are produced by ovaries?
Hormones- progesterone, estrogen, inhibin and relaxin
Secondary oocytes which develop into a mature ova(eggs)
Ovaries are paired female glands ___________. To the testes
Homologous
What is the surface of the ovary covered by?
Germinal epithelium
What does the medulla of the ovaries contain?
Blood vessels, lymphatic and nerves
What is the ovarian cortex made of?
Connective tissue and ovarian follicle at different stages
What is the tunica albugenia?
A thick connective tissue layer between germinal epithelium and ovarian cortex
Where do the ovarian arteries branched from?
Abdominal aorta
Where do the ovarian veins end?
Left ovarian vein ends in the left renal vein
Right ovarian vein ends in inferior vena cava
Ovarian vessels travel in ___________ _________
Suspensory ligament
Where does ovarian lymphatic drainage end?
In the lateral aortic lymph nodes
What are risk factors for ovarian cancer?
Age(usually over 50)
Race(highest in whites)
Family history of ovarian cancer
More grant 40 years of ovulation
Nulliparty or first pregnancy after age 30
High fat, low fiber, vitamin A deficient diet
Prolonged exposure to talc or asbestos
What is ovarian cancer?
Sixth most common cancer in females but the leading cause of deaths from gynecological cancers except for breast cancer
Why is ovarian cancer a leading cause of cancer in females?
Because it is difficult to detect before metastases(spread to different sites)
Describe the asymptomatic stages/early stages of ovarian cancer
Usually in the early stages or patient may have mild symptoms like abdominal discomfort, heartburn, nausea, loss of appetite, bloating and flatulence
What are the symptoms of ovarian cancer when it is symptomatic/later stages?
Enlarged abdomen, abdominal and pelvic pain, persistent gastrointestinal disturbances, urinary complications, menstrual irregularities and heavy menstrual bleeding
What is the Fallopian tube?
Pair of fibromuscular tubes- no direct connection to ovary
What is the purpose of the Fallopian tube?
Conducts ova expelled from ovary to the uterus
What is an ectopic pregnancy?
When egg implants outside of the uterus. This can be intra-abdominal, tubal
What are the parts of the Fallopian tube?
Ampulla, infundibulum and isthmus
What is the uterus?
A muscular organ that provides a protective and nutritive environment for developing fetus
Where is the uterus located?
Behind the bladder and in front of the rectum
Where is the rectouterine pouch (of Douglas)?
Between uterus and rectum
Describe the 3 parts of the uterus
Fundus- dome-shaped and superior to the termination of the uterine tubes
Body- tapering central portion
Cervix is the inferior narrow portion
What are the 3 layers of the uterine wall?
- Outer peritoneum- lined by serosa or adventitia
- Middle thick layer- myometrium
- Innneer endometrium
Name the 2 parts of the endometrium
- Stratum functionalis
2. Stratum basalis
What is the function of the stratum functionalis?
It changes drastically during each cycle, being lost monthly if pregnancy does not occur
What is the function of the stratum basalis?
Close to Myometrium, maintained during menstruation and provides stem cells for stratum functionalis
What is the normal anatomical position of the uterus?
Anteverted and anteflexed
The body of the uterus is bent forwards over the cervix- anteflexion
Long axis of the cervix is bent forward over the long axis of the vagina- anteverted
What structures provide support for the uterus?
Pelvic floor muscles
Perineal body
Transverse cervical ligaments
Uterosacral ligaments
Round ligaments of the uterus
What is a uterine prolapse?
The loss of support by the cardinal and/or uterosacral ligaments and by the pelvic floor muscles (lavatory ani and coccygeus)
What are treatments for a uterine prolapse?
Exercises
Lifestyle changes
Surgery
What is the consequence of a uterine prolapse?
Support structures can no longer counteract typical intra-abdominal pressures
Various degrees of prolapse May occur
What is an episiotomy?
A cut/incision in the Perineum between the vagina and the anus made with surgical sciccors to widen the birth canal for the baby to pass through.
What are the complications due to an episiotomy?
Pain
Increased risk of fecal incontinence
What are some indications that an episiotomy?
Very large fetus
Breech presentation(buttocks or lower limbs coming first)
Abnormal fetal heart rate(fetal distress)
Forceps delivery
What is the arterial supply of the uterus?
Uterine arteries-branches of the internal iliac arteries
Describe veinous drainage of the uterus
Uterine and vaginal veins which drain to the ovarian and internal iliac veins
What is a hysterectomy?
The surgical removal of the uterus and is the most common gynecological operation
Surgical incision is made through the abdominnal wall or the vagina
Can be complete, partial, radical or subtotal
What are some indications a hysterectomy maybe needed?
Uterine fibroids(abnormal growths)
Pelvic inflammatory disease( remember public health)
Endometriosis
Excessive uterine bleeding
Cancer of the cervix, uterus or ovaries
In most cases, cervical cancer can be detected in its earliest stages by a _______ ________
Pap smear
How are most cases of cervical cancer caused?
By several types of HPV( human papilloma virus), most commonly implicated are 16 and 18
Is HPV sexually transmitted?
Yes
What are risk factors for cervical cancer?
HPV
Smoking
Immunosuppression
Long term oral contraceptive use
Being overweight
What are the main symptoms of cervical cancer?
Abnormal vaginal bleeding
Describe the development of cervical cancer
Begins as a precancerous stage called cervical dysplasia where there is a change in number, shape and growth of cervical cells
Abnormal cells can either revert back to normal or progress slowly to cancer
Describe the impact of carvical cancer
Affects about 12,000 females a year in the US with a mortality of 4,000 annually
How can cervical cancer be prevented?
Two vaccines are available to protect against cervical cancer
Gardasil and Cervarix
How can cervical cancer be treated?
Radiation therapy
Cryotherapy
Surgery
Laser therapy
Chemotherapy
Describe the 3 layers of the vagina
(Outer most layer)Mucousa- comprised of non-keratinized stratified epithelium and lamina propia
Middle layer- muscularis- 2 layers of smooth muscle= inner circular and outer longitudinal layer
Inner layer, adventitia- loose connective tissue that anchors the vagina to the surroundings
Histology of mammary glands varies with _________ and the __________ ________ of the individual
Age
Physiological state
Hormones that affect mammary glands come from,,,,
The ovary, placenta and pituitary
Describe the mammary glands
Modified sweat glands, 15-25 lobes tuboalveolar glands
Describe the glandular elements/ arrangement of mammary glands
Arranged in radical fashion around the nipple into which ducts from secretory units empty
Who does fibrocystic change of ducts affect? Why?
Affects women between 30-50 years and usually due to hormonal stimulation of the breast tissue(glands and fibrous stroma)
What are the consequences and symptoms of fibrocystic change of the breast?
Dilated fluid filled acini and stroma abundance
Small cyst and nodules are formed leading to painful and lumpy breast
This is not a cancer
Symptoms- follow a periodic trend tied closely related to the menstrual cycle
What is the second leading cause of cancer death in women?
Breast cancer
What are treatments for breast cancer?
Breast conservation surgery
Radiation therapy
Modified radical mastectomy
Chemotherapy
What is the most common type of breast cancer?
Ductal carcinoma
What are the risk factors of breast cancer?
Female sex(it’s rare in men)
Advancing age
Positive family history
Increased exposure to endogenous estrogen (Early menarche and late menopause)
Delayed childbirth
Prolonged use of hormone replacement therapy
Alcohol consumption
Nulliparty
What is the screening recommendations for testing for breast cancer by the American Cancer society in women over 20?
Monthly breast self examination
What is the screening recommendation for breast cancer by the American Cancer society for women between 20-40 years?
Clinical breast examination every 3 years
What is the screening recommendation for breast cancer in women over 40 years or older?
Annual mammography and annual clinical breast examination
What is the typical duration of the menstrual cycle?
24-35 ( average 28 days)
Name the 4 phases of the menstrual cycle and the days in which they occur
Menstrual phase = 1-5 days
Preovulatory phase= 6-13 days
Ovulation= day 14
Postovulatory phase= days 15-28
What is the purpose of Gonadotropin in female reproductive cycles?
Secreted by hypothalamus controls ovarian and uterine cycle
Stimulates release of follicle-stimulating hormone(FSH) and lutenizing hormone (LH) from anterior pituitary
How does GnRH lead to follicular development?
Stimulates release of LH and FSH
Each month from puberty to menopause LH and FSH stimulate many primordial follicles to develop until one reaches ovulation
This is caused by a surge of LH as well as formation of the corpus luteum
FSH and LH Stimulate follicles to secrete estrogen
Corpus Luteum secretes progesterone, estrogen, relaxin and inhibin until it degenerate into corpus albicans
Explain the development of the follicle
Primordial follicles develop into primary follicles in the cortex of the ovaries
With about 200,000 to 2,000,000 primordial follicles at birth 40,000 remain at puberty and 400 will mature during a lifetime
Primary follicle completes first meiosis division to form a secondary follicle and first polar body
Secondary follicle enters second meiosis division and becomes a mature (Graafian) follicle
During ovulation, the Graafian follicle ruptures and releases a secondary oocyte and surrounding granulosa cells
Corpus luteum- remnant of mature follicle after ovulation
What is the purpose of estrogens secreted by ovarian follicles in hormonal regulation?
- Promote development and maintenance of female reproductive structures and secondary sex characteristics
- increases protein anabolism including building strong bones
- lowers blood cholesterol
- inhibit release of GnRH, LH and FSH via negative feedback
What is the purpose of progesterone in hormonal regulation?
- Secreted mainly by corpus luteum
- works with estrogens to prepare and maintain endometrium for implantation and mammary glands for milk production
- inhibits secretion of GnRH and LH( negative feedback)
What is the purpose of relaxin in hormonal regulation?
Produced by the corpus luteum
Relaxes uterus by inhibiting contraction of the myometrium
At the end of pregnancy, increases flexibility of pubic symphysis and dilates the uterine cervix
What is the purpose of inhibin in hormonal regulation?
- Secreted by granulosa cells of growing follicles and by corpus luteum
- inhibits secretion of FSH and LH
Describe the menstrual phase of the uterine cycle
First 5 days of a new cycle
FSH stimulates several primordial follicles to primary follicles and then secondary follicles- this takes several months and a follicle that begins developing in one cycle may not mature until several cycles later
Declining levels estrogens and progesterone stimulate release of prostaglandins causing uterine spiral arterioles in stratum functionalis to constrict
This deprived cells in stratum functionalis to become oxygen deprived and die, discharging as menstruak discharge
Only stratum basalis remains
Describe the preovulatory phase in the uterine cycle
Days 6-13
Some of the secondary follicles begin to secrete estrogens and inhibin
The dominant follicle secretes estrogens and inhibin to inhibit FSH to prevent other follicles from growing
Estrogens stimulate repair of the endometrium
Cells of stratum basalis undergo mitosis to form new stratum functionalis
Thickness of endometrium doubles
In the uterine cycle, preovulatory phase is the proliferative because the endometrium is proliferating
How are fraternal/non identical twins produced ?
Normally one dominant follicle becomes the mature follicle
But 2 or 3 secondary follicles can become codominant and are ovulated and fertilized at the same time
What are the preovulatory and menstrual phases called in the ovarian cycle?
The follicular phase because follicles are growing
Describe ovulation
-Rupture of Graafian/mature follicle and release of secondary oocyte
Day 14 of 28 day cycle
-a high levels of estrogens exert a positive feedback effect on cells secreting LH and GnRH
Describe the postovulatory phase
Duration most constant of phases
Last 14 days of 28 days
After ovulation, mature follicle collapses to form Corpus luteum under the influence of LH
- Secretes progesterone, estrogen, relaxin and inhibin
- in the ovarian cycle, this is the literal ohase
Describe the fate of the Corpus Luteum if oocyte is not fertilized.
Corpus lasts 2 weeks and degenerates into the Corpus albicans
-As levels of estrogen, progesterone and inhibin decrease, release of GnRH, FSH and LH increase due to loss of negative feedback
Follicular growth begins as a new cycle begins
Describe the fate of the corpus luteum if the oocyte is fertilized
Corpus luteum lasts more than 2 weeks
Human chorionic gonadotropin(hCG) produced by chorion of embryo about 8 days after fertilization stimulates corpus luteum
Describe the secretory phase of the uterine cycle
Progesterone and estrogens produced by corpus let emu stimulate growth of endometrium with changes peaking about 1 week after ovulation when a fertilized ovum might arrive in the uterus
Differentiate the uterine and ovarian supply
Uterine arterial supply- branches of the internal iliac arteries
Ovarian arterial supply- from aorta
From what cells are inhibin secreted?
Granulosa cells on growing follicles
Corpus luteum
What is chlamydia?
A commonly transmitted STD caused by infection with Chlamydia Trachomatis
What are the symptoms of chlamydia?
Usually asymptomatic
Can cause cervix is in women as well as other serious complications:
- Pelvic inflammatory Disease(PID)
- Tubal factor infertility
- Ectopic pregnancy
- Chronic pelvic pain
What is the treatment for Chlamydia?
Antibiotics
Drug of choice is Azithromycin or Doxycycline
What is gonorrhea?
STD caused by infection by bacterium Neisseria gonorrhoeae within the:
- Cervix and uterus and uterine tubes in women
- Urethra in men and women
- an also infect mucous me,brands of mouth, throat, eyes and anus
What are the symptoms and complications of Gonorrhea?
Women infected with gonorrhea are usually asymptomatic
Women are at risk of developing serious complications from infection, even in the absence of symptoms.
Complications are similar to those of chlamydia
What are the treatments for gonorrhea?
Antibiotic
Drug of choice is ceftriaxone(intramuscular)
What causes genital herpes?
Caused by 2 types of viruses:
Herpes simplex type. 1 and herpes simplex type 2
Describe the symptoms of herpes
Most people who have genital herpes have no or very mild symptoms
When symptomatic the typical manifestation is a cluster of blisters appearing on or around genitalia, rectum or mouth resembling cold sores
Blisters break and leave painful sores that may take weeks to heal
What is treatment for Genital herpes?
Cannot be cured
Antiviral(acyclovir) help reduce pain and number of lesions
What is Syphilis?
An STD caused by the bacterium Treponema pallidum
May also be transferred from mother to fetus resulting in Congenital syphilis
What are 4 stages of syphilis?
Primary syphilis, secondary syphilis, latent syphilis and late stage
What are the symptoms of primary syphilis?
Classicallly presents with a single firm, painless and non-itchy ulcer on the genitalia known as chancre
What are the symptoms of Secondary Syphilis?
Presents with diffuse rash which frequently involves palms and soles
What are the symptoms for latent syphilis?
Shows no symptoms
What are the symptoms of the late stages of syphilis?
- May damage the internal organs and patients may show symptoms difficulty coordinating muscle movements
- paralysis
- numbness
- gradual blindness
- dementia
How can Syphilis be treated?
- Drug of choice is Benzathine penicillin G (intramuscular)
- if allergic to penicillin: Doxycycline or Tetracyclin
What are Genital warts?
Highly contagious warts or condylomata acuminata
What causes Genital Warts?
HPV types 6 and 11
How can Genital warts be prevented?
Gardasil HPV vaccine
What is the use of Gardasil?
Protects against HPV types 16, 18, 6 and 11
Cervical cancer and genital warts
What are the treatments for Genital Warts?
There is no cure for genital warts through topical gels like trichloroacetic acid or podophyllotoxin are often useful
What is an abortion?
The premature expulsion of the products from the uterus usually before the twentieth week of pregnancy
Can be spontaneous(naturally occurring/miscarriage) or induced(intentional)
What are the types of induced abortion?
Mifepristone
Vacuum aspiration
Dilation and evacuation
Late-stage abortion
What are the methods of sterilization of each sex?
Male- vasectomy
Female- tubal ligation
What is coitus interruptus? Why is it ineffective?
Withdrawal of penis before ejaculation
Problem: pre-ejaculatory fluid
List 2 methods of periodic abstinence
Rhythm method
Symptoms-thermal method
What birth control method is 10p% effective?
Abstinence
