THE REPRODUCTIVE SYSTEM | ANATOMICAL, PHYSIOLOGICAL AND CLINICAL EXPLANATION|, Study notes of Anatomy

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The reproductive system

The reproductive

system

Fig 246

The female external genitalia

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Fig 247

Lateral view of the intrapelvic female genitalia and related structures

The reproductive system

Comments Anatomical: a muscular coat and a stratified squamous epithelium with ridges and folds. It The vagina is a tube made up of three tissue layers—areolar tissue, lies between the bladder and the anus, and it opens into the vestibule and the uterine cervix. The uterus is a hollow muscular organ that lies between the bladder and the rectum. The uterine cervix opens into the vagina at the external os. The hymen is a thin fold of mucous membrane that partially obstructs the vaginal orifice. Physiological: passage for the fetus during labour. The hymen, which does not entirely close the The vagina acts as a receptacle during intercourse and provides a vaginal orifice, allows the egress of menstrual blood. Clinical: obliquely at an angle of about 45 degrees. It can be anteverted, leaning forward The axis of the uterus, running in an anterosuperior direction, is set and oriented anterosuperiorly as a whole, or anteflexed, tilting forward along its long axis. It is more often in the anteverted position. The hymen is stretched during sexual intercourse.

1. 2. SacrumPouch of Douglas (rectouterine
2. cul-de-sac)Posterior vaginal fornix
3. 5. CervixRectum
4. 7. VaginaLabium majus
5. Labium minus 10.^ 9.^ ClitorisPubic bone
   11. 12. BladderAnterior vaginal fornix
   12. 14. Vesicouterine pouchUterus
   13. 16. OvaryFallopian tube
   14. Peritoneum

The reproductive system

Comments Anatomical: fallopian tubes and the two ovaries—lie inside the pelvic cavity. The vagina is The female reproductive organs—the vagina, the uterus, the two made up of three tissue layers, with the inner layer consisting of a squamous epithelium with transverse folds. The uterus has a body, a cervix and a fundus. The fallopian tubes, lying on either side of the uterus, are fimbriated at their distal extremities. Physiological: and release the ova. The fallopian tubes transport the ovum from the ovary towards The ovaries are the female gonads, which secrete the sex hormones the uterus by peristaltic and ciliary activity. They are the sites of fertilisation of the ovum, which becomes the zygote, ready for migration into the uterus and for implantation. Clinical: in a previously normally menstruating woman. It can also be primary when it Secondary amenorrhoea is the absence of menstruation for over 3 months occurs in young females who fail to menstruate. The duration of pregnancy is 40 weeks from the first day of the last menstrual period or 38 weeks from the last ovulation. An extrauterine pregnancy must be considered if menstruation is delayed and is associated with the passage of scanty, dark brown blood and pelvic pain.

1. 2. Broad ligamentOvarian ligament
2. 4. IsthmusUterine fundus
3. 6. Intramural part of fallopian tubeFallopian tube
4. Ampulla
   8. 9. Infundibulum with its fimbriaeRound ligament
5. 11. Body of uterusCervix uteri
6. 13. Vagina with foldsExternal os of cervix
7. Ovary

Fig 249 The green line shows the boundary between the functional and the basal

layers of the endometrium.

The layers of the uterine wall

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Fig 250

The main suspensory ligaments of the uterus

The reproductive system

1. 2. UterusOvarian ligament
2. 4. Fallopian tubePeritoneum (broad ligament)
3. 6. Fimbriated end of the fallopian tubeSuspensory ligament of the ovary
4. 8. Cut border of the broad ligamentRound ligament 10.^ 9.^ Uterine cervixVagina

Comments Anatomical: organs and the muscles of the pelvic floor. The broad, round, uterosacral, transverse The uterus is kept in place by its ligaments, the adjacent intrapelvic cervical and pubocervical ligaments hold the uterus in place inside the pelvic cavity. The broad ligament is a double-layered fold of the peritoneum on either side of the uterus. The fibrous round ligament runs inside the broad ligament and is inserted into the labium majus. Physiological: tube, with the help of the ovarian ligament. On both sides, the broad ligament attaches the ovary to the fallopian Clinical: infection, can, if recurrent, cause progressive fibrosis of the tube, with tubal occlusion Infections of the tube (e.g., salpingitis), secondary to a sexually transmitted and infertility.

The reproductive system

Comments Anatomical: The cortex surrounds the medulla and consists of connective tissue covered by The ovary is made up of two tissue layers, the cortex and the medulla. the germinal epithelium. It contains the ovarian follicles, each of which harbours an ovum in various stages of maturation. Physiological: fertile period, with one mature follicle releasing an ovum into the fallopian tube. Ovulation occurs once during the menstrual cycle in a woman’s After ovulation, this follicle develops into a corpus luteum, which is replaced by fibrous tissue and becomes the scar-like corpus albicans on the ovarian surface. Clinical: ovum becomes the zygote, which will be implanted into the uterine wall to become From birth, the connective tissue contains immature follicles. The fertilised first an embryo and then a fetus. The ovary can be the seat of benign tumours or cysts, especially in women between 20 and 25 years of age, as well as malignant tumours, which tend to be asymptomatic initially. Thus, they are diagnosed in their late stages, after they have spread into the pelvis and produced ascites.

1. 2. MesovariumBlood vessels
2. 4. Germinal epitheliumPrimordial follicle
3. 6. MedullaMaturing ovarian follicle
4. 8. Mature ovarian follicleOvum 10.^ 9.^ Follicular fluidRuptured follicle
5. 12. OvumOvulation
6. 14. Formation of the corpus luteumFully formed corpus luteum
7. Corpus albicans

Fig 252

The structure of the breast

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Fig 253

The male reproductive organs and adjacent structures

The reproductive system

Comments Anatomical: seminal vesicles, the ejaculatory ducts, the prostate, the urethra and the penis. The male reproductive organs include the scrotum, the testes, the The scrotum is a sac of pigmented skin overlying fibrous tissue and smooth muscle and is located below the pubic symphysis. The seminal vesicles are two fibromuscular reservoirs lying behind the prostate, close to the posterior wall of the bladder. The prostate is an accessory gland located behind the pubic symphysis, in front of the rectum and below the bladder, and flanked laterally by the levator ani muscles. It is traversed by the urethra and the ejaculatory ducts. Physiological: secrete prostatic fluid, which acts as a diluting fluid for the spermatozoa. The The prostate is made up of a collection of small blind follicles that scrotum protects the testes, which are mixed glands with two functions: endocrine function, (androgen secretion) and exocrine function (spermatogenesis). Clinical: quality, quantity and movements of spermatozoa in the genital tract can be Age, consumption of alcohol, smoking, and abnormalities in the formation, responsible for male subfertility. Aspermia is the complete absence of or presence of less than 0.5 mL of semen on ejaculation; azoospermia is the complete absence of spermatozoa in the ejaculate.

1. 2. SacrumRetrovesical pouch
2. 4. Seminal vesicleProstate
3. 6. RectumAnal canal and anal sphincter
4. 8. Scrotum containing the testesGlans penis 10.^ 9.^ UrethraCorpus spongiosum
5. 12. Corpus cavernosumBladder
6. Peritoneum

The reproductive system

Comments Anatomical: cord. Each testis is made up of 200 to 300 lobules filled with seminiferous tubules The scrotum holds two testes, each of which is attached to a spermatic separated by interstitial Leydig cells. Each testis is invested with three coats—the tunica vaginalis, which is an external membrane derived from the abdominal and pelvic peritoneum; the tunica albuginea, which lies deep to the tunica vaginalis and contributes to the lobulation of the testis, and the tunica vasculosa, which contains the blood vessels embedded in connective tissue. Physiological: organs responsible for spermatogenesis (the production of spermatozoa) from The testes have two functions. They are the male reproductive puberty onwards. The interstitial Leydig cells secrete testosterone, the primary male hormone responsible for the development of the genital organs. The luteinising hormone from the pituitary gland stimulates the Leydig cells to produce testosterone, which at puberty brings about the development of the secondary male sexual characteristics that transform boys into men. Clinical: of the kidneys and, by the 8th month of fetal life, they have descended into the In embryos, the testes develop in the abdominal cavity, below the level scrotum and lost all contact with the abdominal cavity. During their descent into the scrotum, they carry some peritoneum, blood vessels, lymphatics, nerves and the vasa deferentia. Male puberty occurs at 10 to 14 years of age, with the following typical changes: increases in height and body weight; in hair growth on the face, in the axillae and on the thorax, the abdomen and the pubic region; in the size of the penis, scrotum and prostate; and in the size of the larynx, accompanied by a lowering of the voice, and in the thickness of the skin.

1. 2. Spermatic cordEpididymis
2. 4. Smooth muscleSeminiferous tubules
3. 6. Septum of scrotumLobules
4. 8. Tunica albugineaTunica vasculosa 10.^ 9.^ SkinTunica vaginalis

Fig 255

The testis: longitudinal section of the testis and the vas deferens