The Female Reproductive System the Female Reproductive System
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Chapter 28 *Lecture Powepoint
Chapter 28 *Lecture PowePoint The Female Reproductive System *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The female reproductive system is more complex than the male system because it serves more purposes – Produces and delivers gametes – Provides nutrition and safe harbor for fetal development – Gives birth – Nourishes infant • Female system is more cyclic, and the hormones are secreted in a more complex sequence than the relatively steady secretion in the male 28-2 Sexual Differentiation • The two sexes indistinguishable for first 8 to 10 weeks of development • Female reproductive tract develops from the paramesonephric ducts – Not because of the positive action of any hormone – Because of the absence of testosterone and müllerian-inhibiting factor (MIF) 28-3 Reproductive Anatomy • Expected Learning Outcomes – Describe the structure of the ovary – Trace the female reproductive tract and describe the gross anatomy and histology of each organ – Identify the ligaments that support the female reproductive organs – Describe the blood supply to the female reproductive tract – Identify the external genitalia of the female – Describe the structure of the nonlactating breast 28-4 Sexual Differentiation • Without testosterone: – Causes mesonephric ducts to degenerate – Genital tubercle becomes the glans clitoris – Urogenital folds become the labia minora – Labioscrotal folds -
The Cyclist's Vulva
The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al. -
Female Perineum Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
Color Code Important Female Perineum Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of the lecture, the student should be able to describe the: ✓ Boundaries of the perineum. ✓ Division of perineum into two triangles. ✓ Boundaries & Contents of anal & urogenital triangles. ✓ Lower part of Anal canal. ✓ Boundaries & contents of Ischiorectal fossa. ✓ Innervation, Blood supply and lymphatic drainage of perineum. Lecture Outline ‰ Introduction: • The trunk is divided into 4 main cavities: thoracic, abdominal, pelvic, and perineal. (see image 1) • The pelvis has an inlet and an outlet. (see image 2) The lowest part of the pelvic outlet is the perineum. • The perineum is separated from the pelvic cavity superiorly by the pelvic floor. • The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue. (see image 3) We will talk about them more in the next lecture. Image (1) Image (2) Image (3) Note: this image is seen from ABOVE Perineum (In this lecture the boundaries and relations are important) o Perineum is the region of the body below the pelvic diaphragm (The outlet of the pelvis) o It is a diamond shaped area between the thighs. Boundaries: (these are the external or surface boundaries) Anteriorly Laterally Posteriorly Medial surfaces of Intergluteal folds Mons pubis the thighs or cleft Contents: 1. Lower ends of urethra, vagina & anal canal 2. External genitalia 3. Perineal body & Anococcygeal body Extra (we will now talk about these in the next slides) Perineum Extra explanation: The perineal body is an irregular Perineal body fibromuscular mass. -
MR Imaging of Vaginal Morphology, Paravaginal Attachments and Ligaments
MR imaging of vaginal morph:ingynious 05/06/15 10:09 Pagina 53 Original article MR imaging of vaginal morphology, paravaginal attachments and ligaments. Normal features VITTORIO PILONI Iniziativa Medica, Diagnostic Imaging Centre, Monselice (Padova), Italy Abstract: Aim: To define the MR appearance of the intact vaginal and paravaginal anatomy. Method: the pelvic MR examinations achieved with external coil of 25 nulliparous women (group A), mean age 31.3 range 28-35 years without pelvic floor dysfunctions, were compared with those of 8 women who had cesarean delivery (group B), mean age 34.1 range 31-40 years, for evidence of (a) vaginal morphology, length and axis inclination; (b) perineal body’s position with respect to the hymen plane; and (c) visibility of paravaginal attachments and lig- aments. Results: in both groups, axial MR images showed that the upper vagina had an horizontal, linear shape in over 91%; the middle vagi- na an H-shape or W-shape in 74% and 26%, respectively; and the lower vagina a U-shape in 82% of cases. Vaginal length, axis inclination and distance of perineal body to the hymen were not significantly different between the two groups (mean ± SD 77.3 ± 3.2 mm vs 74.3 ± 5.2 mm; 70.1 ± 4.8 degrees vs 74.04 ± 1.6 degrees; and +3.2 ± 2.4 mm vs + 2.4 ± 1.8 mm, in group A and B, respectively, P > 0.05). Overall, the lower third vaginal morphology was the less easily identifiable structure (visibility score, 2); the uterosacral ligaments and the parau- rethral ligaments were the most frequently depicted attachments (visibility score, 3 and 4, respectively); the distance of the perineal body to the hymen was the most consistent reference landmark (mean +3 mm, range -2 to + 5 mm, visibility score 4). -
Understanding Cancer of the Vulva
Understanding Cancer of the Vulva An information sheet for women with cancer, their families and friends. This information has been prepared to help you If something goes wrong with the genes that understand more about cancer of the vulva control a cell, that cell may start behaving (vulvar cancer). It is an introduction to the strangely. Instead of growing normally, it may diagnosis, treatment and effects of this cancer. grow and divide in an uncontrolled way, forming a mass of cells. The mass of cells looks We cannot advise you about the best treatment and feels like a lump, and is called a tumour. for you. You need to discuss this with your doctors. However, we hope this information A tumour can be benign (not cancer) or it can will answer some of your questions and help be malignant (cancer). The difference is that you think about the questions you want to ask benign tumours do not spread to other parts of your doctors. the body, while malignant tumours can. For more detailed information on cancer of the A malignant tumour is made up of cancer cells. vulva, you may wish to contact the Cancer When it first develops, the tumour stays in one Council Helpline on 13 11 20 or refer to the place. This is called the primary tumour. list of recommended websites under the heading Information on the Internet on the If the cancer cells that make up the primary back page of this booklet. tumour are not treated, they may start to spread to other areas of the body and form new tumours. -
Clinical Pelvic Anatomy
SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig. -
Skin Damage from Chronic Irritation Or Scratching
Skin Damage from Chronic Irritation or Scratching Chronic irritation and scratching can cause skin damage to the vulva. Confusingly, this may be called many different things like Eczema, Lichen Simplex Chronicus (LSC), Chronic Dermatitis or Squamous Cell Hyperplasia. Some of these diagnoses require that a biopsy of the vulva has been performed; others are based just on clinical opinion after history and physical examination. Many things can trigger irritation of the vulva. For instance, scratching alone can lead to changes on the vulva that can be seen on physical exam or self-inspection. Often the original event that precipitated irritation and itching is unknown. Sometimes it is a vaginal infection, sometimes it is a contact irritant and sometimes it is a nervous itch. Regardless, the skin becomes irritated and inflamed, therefore beginning the “Scratch-Itch” cycle. Once this cycle is perpetuated, it is difficult for the vulvar skin to heal and the changes persist. When a biopsy is performed, it can greatly assist your practitioner in finding a diagnosis that can lead to successful treatment. Lichen simplex chronicus (LSC) and Squmous Cell Hyperplasia are 2 diagnoses that can be rendered after a skin biopsy. These are essentially similar entities and are defined as abnormal thickening of the skin of the vulva. Two thirds of patients who develop this condition are premenopausal. Moisture, chronic scratching, scrubbing, allergens, and medications may cause variations in the appearance of the lesions. The size of the lesions ranges from small to large, red to white, excoriated to eroded, and most frequently involve certain areas of the vulva like the hood of the clitoris, the labia majora, the interlabial sulcus (space between major and minor lips) outer aspect of the labia minora, and the perineal body (space between anus and vaginal opening). -
Genital Variation
Genital Variation People’s genitals are as unique as snowflakes! No two are alike... Our bodies, including our genitals, come in a variety of shapes, colors, and sizes. No two are exactly alike. Same bits & pieces, composed differently Did you know all human fetuses start out “female” unless hormones direct them differently? That’s why a fully-formed penis shares many characteristics with a clitoris, including a darker “underskin” and a thin “ridge” or seam” which runs from scrotum to anus. Basically, everyone’s sexual anatomy is arranged to accomplish the same few tasks: to produce steroid hormones for growth and development, to support reproduction, and to create pleasure during sex. Variations in anatomy simply reflect our unique abilities to accomplish these same tasks. Media paints an inaccurate picture The images of genitals shown in ads and in porn are commonly altered—subjected to airbrushing, makeup, fancy camera angles, photo editing and size-distorting techniques. The end result is a socially-constructed aesthetic, one which creates a false perception of conformity and reinforces a sex/gender binary. Real bodies are more interesting, varied, and nuanced. Vulvas, vaginas, & labia AA wide wide range r ofang variablese of existvariables in the look eofxis a vulvat in (the the external look genitalia). of a vulv Thesea include(the theex lengthternal and gwidthenit ofalia). a clitoris These or vagina, include as well as thethe color, leng length,th and rigidityand ofwidth labia. Typically, of a clit thereoris are twoor setsvagina, of labia, asthe labiawell majora as the (outer c labia)olor , andleng labiath, minora and (inner rigidity labia). -
Labial Hypertrophy and Asymmetry
Labial Hypertrophy and Asymmetry What are labial hypertrophy and labial asymmetry? Labial hypertrophy is an increase in the size of one or both of the “lips” of the vagina, called the labia. Labial hypertrophy can affect the inner labia, known as the labia minora, or the outer labia, called the labia majora. When only one side of the labia is enlarged, the condition is referred to as labial asymmetry. There is no definition of “normal” labia size, but sometimes the labia minora or majora are larger than another persons How is labial hypertrophy or asymmetry or larger on one side. treated? It is important to remember that your body is What causes labial hypertrophy? healthy and normal no matter the size of your Labia come in all different shapes and sizes and all labia. Everyone should practice good hygiene, are completely normal. The reason why some washing their genitalia once per day with mild, people have larger labia than others is unknown. scent-free, color-free, chemical-free soap. If you Sometimes labia have been enlarged since birth, have labial hypertrophy, you may consider but many times a person may first notice an avoiding wearing tight underwear and clothing, increase in size of their labia during puberty. and during your period, you might use chemical- free sanitary pads to prevent irritation or try tampons, menstrual underwear or the menstrual What are the symptoms of labial cup. Over the counter topical mild ointments can hypertrophy? be used to prevent irritation. Usually labial hypertrophy causes no problems or If you have pain that continues, irritation or symptoms. -
Depigmented Plaques on Vulva University of Hawaii, Honolulu (Dr
PHOTO ROUNDS Somya Abubucker, MD; Bernard Cohen, MD Depigmented plaques on vulva University of Hawaii, Honolulu (Dr. Abubucker); Johns Hopkins University School of Medicine, The distinctive pattern of our young patient’s skin Baltimore, Md (Dr. Cohen) changes made the diagnosis clear. [email protected] DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health a mother brought her 8-year-old besides herself. Her mother was concerned at San Antonio daughter to our office for evaluation of vit- that the white spots might spread to the rest The authors reported no potential iligo “down there” (FIGURE). The skin erup- of her daughter’s body, which could affect her conflict of interest relevant to this tion first appeared on her vulva a year earlier socially. article. and was intermittently pruritic. The lesions were initially smaller and red, but had since lightened in color, coalesced, and had begun ● WHAT IS YOUR DIAGNOSIS? to spread to the perianal area. The patient’s mother had received a call from her daugh- ● HOW WOULD YOU TREAT THIS ter’s teacher who observed that her daughter PATIENT? was scratching the area and might be mastur- bating in class. FIGURE The mother reported that 6 months Depigmented plaques earlier, her daughter had experienced bloody spots in her underwear accompanied by dys- in a figure-8 pattern uria. The mother brought her to the emer- gency department, where she was treated with antibiotics for a urinary tract infection. Our physical examination revealed well- circumscribed, symmetric, depigmented, confluent, crinkled, parchment-like plaques with small hemorrhagic erosions on the me- dial labia majora and minora. -
Female Reproductive System
Female Reproductive System Professor Barry O'Reilly's Website Patients' Leaflets Female Reproductive System 1. The vulva's functions and structures Situated in a woman's pubic region, the vulva is part of the female external genitalia. It is actually a name for a collection of structures, that work as a team to support both urination and sexual reproduction. Veneris/mon publis: The veneris or mon pubis covers the female pubic bone, acting in the role of cushion during intercourse. It is formed like a soft small hill made up of fatty tissue. Labia: The female reproductive system contains two labia: the labia majora and labia minora (major and minor). The minora is contained within the majora which protects it. The function of both labia are to protect the vulva's vestibule. Clitoris: Made up of clitoral glans, the clitoris contains numerous nerve endings, making it extremely sensitive. The clitoral hood, which can be likened to the male foreskin, covers the clitoris. Vestibule: The vestibule is home to the vaginal opening and the urinary meatus, which contains the urethral opening. Introitus: The introitus is the vaginal opening. Mostly this is covered by the hymen, which is a membrane that most females are born with, which ruptures during the woman's first act of sexual intercourse. There are a small number of cases when baby girls are born, who don't have hymens. Bartholin's glands: The greater vestibular glands, also known as the Bartholin's glands are located on the vaginal opening, at the back. On the back part of the vaginal opening is the Bartholin´s glands (greater vestibular glands). -
Ta2, Part Iii
TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART III Contents: Systemata visceralia Visceral systems Caput V: Systema digestorium Chapter 5: Digestive system Caput VI: Systema respiratorium Chapter 6: Respiratory system Caput VII: Cavitas thoracis Chapter 7: Thoracic cavity Caput VIII: Systema urinarium Chapter 8: Urinary system Caput IX: Systemata genitalia Chapter 9: Genital systems Caput X: Cavitas abdominopelvica Chapter 10: Abdominopelvic cavity Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: SYSTEMA DIGESTORIUM Chapter 5: DIGESTIVE SYSTEM Latin term Latin synonym UK English US English English synonym Other 2772 Systemata visceralia Visceral systems Visceral systems Splanchnologia 2773 Systema digestorium Systema alimentarium Digestive system Digestive system Alimentary system Apparatus digestorius; Gastrointestinal system 2774 Stoma Ostium orale; Os Mouth Mouth 2775 Labia oris Lips Lips See Anatomia generalis (Ch.