M.M.R

Anatomy And Physiology Of The Female Genital System

Dr. Miada Mahmoud Rady

M.M.R

• Gynecology : is the branch of medicine that deals with

the diseases and care of the reproductive system of

women.

• Obstetrics : is the branch of medicine that deals with

birth.

Introduction

M.M.R

Female genital tract

Internal genitalia (Genital tract):

1. Ovaries

2. Oviducts

3. Uterus

4. Cervix

5. Vagina

External genitals (vulva):

1. Labia major

2. Labia minor

3. Mons pubis

4. Clitoris

5. Perineum

6. Vestibule.

M.M.R

M.M.R

External Genital Tract• Collectively known as vulva or pudendum.• Called external as it seen from outside of the body .

perineum

M.M.R

M.M.R

Rounded pad of fatty tissue that overlies and protects

the symphysis pubis.

Located anterior to the urethral and vaginal openings

Covered by course, dark hair which normally appears

in early puberty and become sparse after menopause

Mons pubis

M.M.R

The labia majora and labia minora :

1. Surround and protect the vaginal opening .

2. The labia majora are darkly pigmented and covered with

pubic hair, but the labia minora are not.

The clitoris :

1. Cylindrical mass of erectile tissue and nerves .

2. Located at the anterior junction of the labia minora.

3. Has an important role in the sexual excitement of the female.

M.M.R

The area of muscle and tissue located between the

vaginal opening and anal canal.

Contains an abundance of nerve endings that make it

sensitive to touch.

An episiotomy is an incision of the perineum used

during childbirth for widening the vaginal opening.

The perineum

M.M.R

• Is oval-shaped area formed between the labia minora,

clitoris, and fourchette.

• Structure located within the vestibule are :

A. Urethral opening .

B. Vaginal opening ( covered by the hymen) .

C. Bartholin glands .

The vestibule

M.M.R

Bartholin Gland

Two small pea - sized

glands , located in the

posterior part of the

vestibule .

They secrete mucus that

acts as a lubricant during

sexual intercourse.

M.M.R

Vagina

Fibromuscular tube that extends from the perineum through

the pelvic floor and into the pelvic cavity.

About 8-12 cm long .

Lying between the bladder anteriorly and the rectum

posteriorly.

The vagina connects the uterus above with the vestibule

below.

Function : passage of menstrual flow , passage of fetus ,the

female organs of coitus.

M.M.R

Anatomical Relations

Of the Vagina

M.M.R

• The lowermost part of the uterus and it is about 2.5 to 3 cm.

• The os is the opening in the cervical canal that runs between the

uterus and vagina , there are two :

A. The internal os : is the opening between the cervix and

uterus( in the upper part of the cervix).

B. The external os : is the opening between the cervix and vagina (

in the lower part of the cervix).

The cervix

M.M.R

During childbirth, the cervix dilates and shortens to

accommodate the passage of the fetus , dilation is a sign

imminent labour.

M.M.R

The uterus is a hollow, pear shaped, thick-walled

muscular organ and weights about 50- 60 gm.

The uterus lies in the midline between the bladder and

rectum.

The uterus is divided into three parts : body , isthmus

and the cervix.

The uterine wall is made up of three layers:

Perimetrium , Myometrium and Endometrium.

The uterus

M.M.R

Anatomical parts of the uterus

A. Body : fundus is part of

the body above insertion

of the uterine tubes.

B. Isthmus.

C. Cervix or the neck of

the uterus.

M.M.R

Perimetrium : outer peritoneal layer covering most

Myometrium : middle muscular layer of the uterus .

Endometrium : is the inner layer of the uterus , it is

responsive to the cyclic variations of estrogen and

progesterone during the female reproductive cycle

every month.

Layers of the uterus

M.M.R

M.M.R

Structural anatomy

of the

uterus

M.M.R

The function of the uterus :

1. Menstruation : monthly shedding of the

endometrial lining of the uterus .

2. Pregnancy : the uterus support s, protects and

allows the fetus to grow

3. Labour and birth : the uterine muscle contracts to

expel the fetus outside the uterus.

M.M.R

Fallopian tubes

Also known as oviducts or uterine tube .

The two long slender tubes (passageways) that

connect uterus to ovary.

Normally there is one fallopian tube associated with

each ovary.

Length : (8 to 14) cm , average (10) cm.

M.M.R

Function :

A. The site of fertilization of the ovum by the male

sperm (outer third).

B. Serve as a pathway for the fertilized ovum to the

uterus , ( fertilized egg takes approximately 6 to 10

days to travel through the fallopian tube to implant in

the uterine lining).

Function of the fallopian tubes

M.M.R

Anatomical Parts

Of

The

Fallopian

Tubes

M.M.R

Fertilization of the ovum in the

fallopian tubes

M.M.R

The female gonads or sex glands.

Two almond-sized , located on each side of uterus behind &

below fallopian tubes.

Function of the ovaries:

A. Production of estrogen & progesterone in response to follicle

stimulation hormone (FSH) & luteinizing hormone (LH)

secreted from pituitary gland

B. Production of the ova

The Ovaries

M.M.R

Physiology Of Female Reproduction

M.M.R

Ovulation

A woman is born with approximately 400,000 immature eggs

called follicles.

During a lifetime a woman release around 400 to 500 fully

matured eggs for fertilization.

The follicles in the ovaries produce the female sex hormones,

progesterone and estrogen.

These hormones prepare the uterus for implantation of the

fertilized egg.

M.M.R

Menstrual cycle

Definition : cyclical changes occurring from one

menstruation to the next and is composed of the

ovarian cycle and the uterine cycle.

Duration of the cycle : varies from 21-35 days ,

average 28 days (28+/-7days).

M.M.R

Menstrual cycle

Menstrual

ovarian

Follicular Luteal

uterine

Proliferative

Secretory

M.M.R

1. Follicular phase :

The first phase of the ovarian cycle.

Starts from days 1 to day 13 , First day of menstruation until

ovulation.

FSH ( follicle stimulating hormone) promotes the

development of a follicle that secretes estrogen.

An estrogen spike leads to a surge in LH and ovulation

around day 14 in the 28-day cycle.

Ovarian cycle

M.M.R

2. The luteal phase:

The second phase of the ovarian cycle

Starts from day 14 to day 28 , when the oocyte is released

from the ovary (ovulation) and ends on the first day of

menstruation,

LH promotes the develop of the corpus luteum that functions

to secrete progesterone .

If pregnancy does not occur menstruation begins.

Ovarian cycle

M.M.R

M.M.R

M.M.R

1. The proliferative phase:

The first phase of the uterine cycle is.

Starts from Day 5 to day14 , time after the end menstruation

and just before the next ovulation occurs

The uterine lining (endometrium) increases in thickness under

the effect of estrogen secreted by growing follicle to be

prepared to receive a fertilized oocyte.

Uterine cycle

M.M.R

2. The secretory phase

The second phase of the uterine cycle

Starts from day 14 to day 28 , time after ovulation until the onset

of the menstruation

Occurs when the oocyte is not fertilized leading

a. Estrogen and progesterone levels decrease.

b. The thick lining of the uterus is shed from the woman's body.

Uterine cycle

M.M.R

M.M.R

M.M.R

M.M.R

ANY QUESTIONS ?

THANK YOU .

M.M.R

Gynecological emergencies

Dr. Miada Mahmoud Rady

M.M.R

• Definition : the cyclic and periodic discharge

of 25 to 65 mL of blood, epithelial cells,

mucus, and tissue.

• Duration of the menstrual flow: 2-7 days

Menstruation

M.M.R

Systemic changes during menstrual cycle1. Weight gain due to salt and water retention.

2. Increase susceptibility to bruising

3. Breast pain and tenderness resulting from swelling

4. Headache including menstrual migraine ( vascular headache

resulting from the hormonal changes.

5. Severe cramping.

6. Emotional changes e.g. Irritability and depression

M.M.R

Terminology

Menarche : onset of first menstruation , typically occur between

11- 14 years of age.

Amenorrhea : is the absence of menses, and may occur due to:

1. Pregnancy (most common cause).

2. Exercise.

3. Excessive weight loss .

4. Emotional problems or extreme stress

5. Anorexia nervosa .

M.M.R

Premenstrual tension syndrome

Definition : Cluster of the symptoms that occur during the

menstrual cycle.

Occurs 7 to 14 days before the onset of the menstrual flow

Affects about one third of all premenopausal women

Generally subsides once the flow begins .

Symptoms are divided into physical and emotional symptoms.

M.M.R

Presentation of PMS

Emotional symptoms :

1. Tension or anxiety.

2. Crying spells.

3. Mood swings.

4. Appetite changes.

5. Trouble falling asleep .

6. Social withdrawal.

7. Poor concentration.

Physical signs and symptoms :

1. Joint or muscle pain.

2. Headache and Fatigue.

3. Weight gain.

4. Abdominal bloating.

5. Breast tenderness.

6. Acne flare-ups.

7. Constipation or diarrhea.

M.M.R

• Women may experience reactive

hypoglycemia, resulting in

increased fatigue .

• Symptoms are exacerbated by :

1. Stress.

2. Diet.

3. Drug use.

Premenstrual tension syndrome

M.M.R

Premenstrual tension syndrome

Prehospital treatment :

Mainly supportive including :

1. Administration of oral or IV

glucose if glucose levels

support.

2. Administration of a small dose

of analgesics or anxiolytics to

reduce patient anxiety .

M.M.R

Mittelschmerz Abdominal pain and cramping in the two weeks before the

beginning of menses.

May last only a few minutes or as long as 48 hours.

Signs and symptoms : Mid cyclic

1. sharp, cramping pain in the lower abdomen.

2. Localized to one side.

3. history of similar pain episodes during previous periods.

4. Nausea , vomiting and inter menstrual spotting .

5. Pain can often be relieved by over-the-counter analgesics.

M.M.R

Menopause

Definition : last menses when a woman has reached the end of

childbearing age.

Typically begins between the ages of 40 and 50.

The menstrual cycles become less frequent .

M.M.R

Symptoms of menopause 3D

• Dyspnea • Digestive

problem• diaphoresis

3 H

• Hot flushes• Headache• Hair loss

M.M.R

Symptoms of menopause

1. Diaphoresis ( excessive sweating )

2. Hair loss

3. Hot flashes (sometimes accompanied by tachycardia)

4. Severe muscle aches and pains

5. Headache

6. Dyspnea

7. Vertigo

8. Digestive problems

9. Emotional instability

M.M.R

Complication

1. Atherosclerosis

2. Osteoporosis

3. Coronary heart disease

4. Atrophy of genitourinary organs which result in

Vaginal dryness and discomfort.

Urinary frequency.

Nocturia.

Incontinence.

M.M.R

SYMPTOMS OF MENPAUSE

M.M.R

MANGEMENT

• Hormone replacement therapy.• Multivitamins .

M.M.R

Emergency Medical Care of gynecological case

Management is directed at:

I. Mitigating life threats

II. Being compassionate

III. Protecting the patient’s modesty

M.M.R

Specific Emergencies

Life-threatening gynecologic emergencies

include:

1. Ectopic pregnancy

2. Ruptured ovarian cyst

3. Tubo-ovarian abscess

M.M.R

Vaginal bleeding

Vaginal bleeding or dysfunctional uterine bleeding is one of the

most frequent reasons that women consult a gynecologist.

1. Hypermenorrhea : Flow of blood lasts several days longer than

normal or is excessive.

2. Polymenorrhea: Blood flow occurs more often than a 24-day

interval.

3. Metrorrhagia: Blood flow or intermittent spotting occurring

irregularly but frequently

M.M.R

Causes of vaginal bleeding

1. Trauma : rape , accident or during sexual intercourse.

2. Infection : vaginitis , cervicitis and endometritis.

3. Tumor : vaginal , cervical or uterine cancer .

4. Ovarian cyst and polycystic ovarian disease.

5. Endometriosis.

6. Systemic disease e.g. thyroid disease , bleeding disorders.

7. obstetric causes of vaginal bleeding e.g. abortion , ectopic

pregnancy , abruptioplacenta and placenta praevia.

M.M.R

Assessment

1. Include questions about any incidents or events that led up to

the patient requesting EMS.

2. Determine the amount of blood loss.

3. If significant, assess for signs and symptoms of hypovolemic

shock.

4. Determine if the patient has any pain or discharge associated

with the bleeding

M.M.R

Management

Prehospital treatment is largely supportive:

1. Manage any signs and symptoms of shock with high-flow

oxygen.

2. Keep the patient warm.

3. Provide IV fluid therapy.

4. If the bleeding is severe, apply dressings to the vaginal area.

5. Maintain professionalism and empathy

M.M.R

Dysmenorrhea

Definition : painful menstruation .

Two types :

1. Primary dysmenorrhoea :

Occurs at the beginning of menstrual blood flow and lasts for the

first 2 days .

No underlying pathology ( functional ).

Severe cramping may precede the period.

Nausea, vomiting, and diarrhea may accompany the pain.

M.M.R

2. Secondary dysmenorrhoea

Present before, during, and after the menstrual flow.

May signal an underlying pathology.

M.M.R

Causes of secondary dysmenorrhoea:

1. Uterine fibroid.

2. Endometriosis.

3. Pelvic inflammatory disease.

4. Adenomyosis.

5. Chronic pelvic congestion.

6. Intra uterine device.

M.M.R

Management

• Assurance • Bed rest • Usually respond to simple analgesics .• If not transport to the hospital for further assessment.

M.M.R

Endometritis Definition : inflammation or irritation of the uterine lining.

More likely after labour or after a miscarriage.

Most likely caused by infection, such as gonorrhea and

chlamydia .

M.M.R

Clinical presentation

Symptoms :

1. Fever (high or low grade) and malaise .

2. Lower abdominal or pelvic pain.

3. Constipation and abdominal distention.

4. Vaginal bleeding and / or purulent discharge .

Signs :

5. Abdominal auscultation : decreased bowel sounds.

6. Tenderness on abdominal palpation.

M.M.R

Management

1. Provide reassurance to your patient.

2. Address ABCS and watch for signs of septic shock

3. An IV may be necessary and fluid can be given according

to patient vital signs .

4. Transport in a comfortable position.

5. Treatment is antibiotics .

M.M.R

Endometriosis

Definition : painful condition caused by growth of endometrial

tissue outside the uterus.

Organs of the pelvic cavity are the most common locations for

the ectopic growths.

Complication : one of the leading causes of infertility in women.

M.M.R

Clinical presentation

Pain

Pelvic

Low back pain

painful sexual intercourse

Dysuria and painful defecation

Painful menstrual cramps

bleeding

Heavy menstruation

Intermenstural spotting

Gastrointestinal bleeding

Fatigue Mistaken for

chronic fatigue

syndrome

M.M.R

Management Prehospital care is based on the patient's complaint :

1. If the patient reports severe pain → provide pain relief with

analgesics if allowed in your protocol.

2. Let the patient position herself so she is comfortable.

3. Use dressing or towels as needed to absorb any significant

bleeding.

4. Transport to hospital.

M.M.R

ANY QUESTIONS ?

THANK YOU .