2. Contents
• E x t e r n a l G e n i t a l i a
• I n t e r n a l G e n i t a l i a
• A c c e s s o r y s t r u c t u r e s
• D y n a m i c s o f P u b e r t y
3. W h y d o y o u n e e d t o k n o w
a b o u t t h e a n a t o m y a n d
p h y s i o l o g y o f t h e f e m a l e
r e p r o d u c t i v e s y s t e m ?
5. The female external genitalia = vulva
Include the:
• mons pubis
• labia majora, labia minora
• fourchette
• clitoris
• vaginal vestibule
• perineum.
6.
7. • Anatomy:
The mons pubis (mons veneris) is a pad of fatty tissue
covered by coarse skin and hair.
• Physiology:
It protects the symphysis pubis and contributes to the
rounded contour of the female body.
Mons pubis
Folliculitits
8.
9. • Anatomy:
The labia majora are two folds of fatty tissue on each side of
the vaginal vestibule
• Physiology:
Many small glands are located on the moist interior surface.
Labia majora
Piercings
10.
11. • Anatomy:
The labia minora are two thin, soft folds of tissue that are
seen when the labia majora are separated
• Physiology:
Secretions from sebaceous glands in the labia are
bactericidal to reduce infection and lubricate and protect the
skin of the vulva
Labia minora
Lichen
sclerosus/
planus
12.
13. • Anatomy:
The fourchette is a fold of tissue just below the vagina,
where the labia majora and the labia minora meet
It is also known as the obstetrical perineum.
• Physiology:
It is designed to stretch during penetration and child birth
Fourchette
Posterior
fourchette
fissuring
14.
15. • Anatomy:
The clitoris is a small, erectile body in the most anterior
portion of the labia minora. It is similar in structure to the
penis.
• Physiology:
Functionally, it is the most erotic, sensitive part of the female
genitalia.
Clitoris
Clitorodynia
16.
17. • The vaginal vestibule is the area seen when the labia
minora are separated and includes five structures:
• Urethral meatus
• Skene ducts (paraurethral ducts)
• Vaginal introitus
• Hymen
• Ducts of the Bartholin glands (vulvovaginal glands)
Vestibule
19. ❑ Urethral meatus:
• lies approximately 2 cm below the clitoris
• has a fold like appearance with a slit type of opening,
and it serves as the exit for urine
❑ Skene ducts (paraurethral ducts):
• located on each side of the urethra and provide
lubrication for the urethra and the vaginal orifice
Vestibule
UTI
Glandular
inflammation
20.
21. ❑ Vaginal introitus:
• It is the division between the external and internal
female genitalia
❑ Hymen:
• A thin elastic membrane that closes the vagina from
the vestibule to various degrees
❑ Ducts of the Bartholin glands (vulvovaginal glands:
• provide lubrication for the vaginal introitus during
sexual arousal and are normally not visible
Vestibule
Bartholins cyst
23. • The perineum is a strong, muscular area between the
vaginal opening and the anus.
• The elastic fibers and connective tissue of the perineum
allow stretching to permit the birth of the fetus.
Perineum
Perineal tears
27. • It is a tubular structure made of muscle and membranous
tissue that connects the external genitalia to the uterus
• An average adult vagina is slightly curved and can range
between 7 to 12 cm in length, but it is variable
• It is self-cleansing and during the reproductive years
maintains a normal acidic pH of 4 to 5
Vagina
Vaginal
infections
28.
29. • The uterus (womb) is a hollow muscular organ in
which a fertilized ovum is implanted, an embryo
forms, and a fetus develops
• Shaped like an upside-down pear or light bulb
Uterus
30. • In a mature, nonpregnant woman, it weighs
approximately 60 g and is 7.5 cm long, 5 cm wide, and 1
to 2.5 cm thick
• The uterus lies between the bladder and the rectum
above the vagina.
Uterus
31. ❑ Fundus:
• Upper part of the uterus, it is broad and flat
• The fallopian tubes enter the uterus on each side of
the fundus
❑ Corpus (body):
• The middle portion, plays an active role in
menstruation and pregnancy.
Parts of the uterus
33. The fundus and the corpus have three distinct layers
• Perimetrium: is the outermost or serosal layer that envelops the
uterus
• Myometrium: is the middle muscular layer that functions during
pregnancy and birth
• Endometrium: is the inner or mucosal layer that is functional
during menstruation and implantation of the fertilized ovum. It is
governed by cyclical hormonal changes
Parts of the uterus- fundus and corpus
Fibroids
Endometriosis
34.
35. ❑ Cervix:
• Lower part of the uterus
• It is narrow and tubular, opens into the upper vagina
• Consists of a cervical canal with
• an internal opening near the uterine corpus
(internal os) and
• an opening into the vagina (the external os)
Parts of the uterus: Cervix (Cx)
Cervical
cancer/ HPV
Cervicitis
36.
37. The mucosal lining of the cervix has four functions:
1. Lubricates the vagina.
2. Acts as a bacteriostatic agent.
3. Provides an alkaline environment to shelter deposited
sperm from the acidic pH of the vagina.
4. Produces a mucous plug in the cervical canal during
pregnancy.
Parts of the uterus: Cervix (Cx): Physiology
38.
39.
40.
41. • Uterine tubes/ Oviducts/ Fallopian tubes
• Fallopian tubes extend laterally from the uterus
• 8 to 13.5cm in length
• Each tube has four sections
o Interstitial portion
o Isthmus
o Ampulla
o Infundibulum
• Fimbriae
Fallopian Tubes- anatomy
43. • Interstitial portion extends into the uterine cavity and
lies within the wall of the uterus
• Isthmus is a narrow area near the uterus
• Ampulla is the wider area of the tube and is the usual
site of fertilization
Fallopian Tubes- anatomy
44. • Infundibulum is the funnel-like enlarged distal end of
the tube
• Fingerlike projections from the infundibulum, called
fimbriae, hover over each ovary and “capture” the
ovum (egg) as it is released by the ovary at ovulation
Fallopian Tubes- anatomy
45. Fallopian Tubes- physiology
Four functions of the fallopian tubes are to provide the following:
1. A passageway in which sperm meet the ovum
2. The site of fertilization (usually the outer one-third of the tube)
3. A safe, nourishing environment for the ovum or zygote
(fertilized ovum)
4. The means of transporting the ovum or zygote to the corpus of
the uterus
Tubal ligation
Ectopic
pregnancy
47. • They are two almond-shaped glands, each about the size of
a walnut
• Location:
• lower abdominal cavity, one on each side of the uterus
• held in place by ovarian and uterine ligaments
Ovaries- anatomy
48. The ovaries have two functions:
1. Production of hormones, chiefly estrogen and
progesterone
2. Stimulation of an ovum’s maturation during each
menstrual cycle
Ovaries- physiology
PCOS
Ovarian CA
52. PUBERTY The age where we learn what
embarrassment and awkwardness is.
Don’t worry, it gets better.
53. W h a t i s p u b e r t y ?
W h a t a r e t h e c h a n g e s i n
t h i s p h a s e o f l i f e ?
54. ❑ Puberty is the process of physical maturation where an
adolescent reaches sexual maturity and becomes
capable of reproduction
❑ On average, puberty begins between
• Females: 8 and 13 yrs
• Males: 9 to 14 yrs
Puberty: Definition
56. Psychological, emotional, and social changes
▪ More sensitive to peer acceptance and rejection
▪ Developing functional and adaptive skills and competencies
▪ Risk for depression
▪ Discovering self identity
▪ Demonstrating expanding cognitive abilities
Puberty: Emotional Changes
57. •Mood swings including irritability, tearfulness, anger,
overwhelming happiness or confusion
•Intense emotions of love, low self-esteem, frustration and apathy
•They may become argumentative and challenge authority or
rules
Puberty: Emotional Changes
58. •May be physically attracted to others
•Begin to want more independence and freedom
•Moving to Secondary school and changing peers
•Being expected to pick subjects and plan for the future
Puberty: Emotional Changes
59. •May want to spend more time alone and crave privacy
•Peers become more important
•Increased experimentation and risk-taking behaviour
•Different expectations from family/school/peers
•Experimentation with different identities
•Expressing individuality
Puberty: Emotional Changes
61. Puberty: Hormonal Changes
• Initiation of puberty: controlled by GnRH neurons
• Pulsatile secretion of GnRH from these neurons causes:
physiologic changes associated with puberty
• GnRH → Release of LH & FSH from the gonadotropic cells of
the anterior pituitary gland
• FSH and LH affect the Leydig and Sertoli cells in the testes and
the theca and granulosa cells of the ovary
65. Puberty: Hormonal Changes
• Adrenal cortex produces hormones responsible for adrenarche
• Adrenal gland is responsible for making hormones including
androgens contributing to:
• Growth of pubic hair
• Oily skin, oily hair, body odor
• Functions separately from the hypothalamic-pituitary-
gonadal axis
66. Puberty: Physical Changes- Female
Thelarche
• Refers to breast growth
• First sign of puberty in girls
• Occurring around 9 or 10 years of age
• Increase in estrogen→ development of lactiferous duct system
• Increase in progesterone→ increasing number of the lobular
alveoli at the ends of lactiferous ducts
67. Puberty: Physical Changes- Female
Pubarche
• Growth of pubic hair
• Approximately six months after thelarche begins
• Initially appears light, sparse and straight
• Later becomes coarse, thick, and dark throughout the course of
puberty
• Approximately two years after pubarche
• Axillary hair will begin to grow, a secondary sexual
characteristic mediated by testosterone
68. Puberty: Physical Changes- Female
Menarche
• A female's first menstrual period
• Caused by increase in FSH and LH
• 1.5 to 3 years after thelarche
• Uterine endometrium undergoes cycles of proliferation and regression
due to fluctuating plasma estradiol levels
69. Puberty: Physical Changes- Female
Menarche
• This occurs until a point is reached when substantial growth of
endometrium occurs
• Then, withdrawal of estrogen results in the first menstruation (menarche)
• Plasma progesterone levels remain low until a rise occurs after menarche
(occurrence of ovulation)
• First ovulation takes place approximately 6 to 9 months after menarche
due to an immature positive feedback mechanism of estrogen
70. Puberty: Physical Changes- Female
Ovarian Development
• Gonadotropins stimulate ovary to produce estradiol
• Responsible for developing secondary sexual characteristics
• Thelarche, growth of reproductive organs
• Fat redistribution to the hips and breasts
• Bone maturation
• Ovarian size increases from prepubertal volume (~ 0.5 cm3) to a
postpubertal volume (~ 4.0 cm3)
71. Puberty: Physical Changes- Female
Uterus Size
• The uterus of a prepubertal female is tear-drop shaped
• The neck and isthmus accounting for up to two-thirds of the uterine
volume
• Increased estrogen production causes:
• pear-shaped uterus
• Increase in length and thickness of uterine body
72. Puberty: Physical Changes- Female
•Vaginal Changes
• Enlargement of labia majora and labia minora
• Clear to white vaginal discharge before menarche
76. Puberty: Physical Changes- Males
Testicular Size
• First sign of puberty in boys
• Increase is due to the development of the seminiferous tubules
• LH → synthesis of testosterone by Leydig cells
• FSH → production of sperm by Sertoli cells
• Testicular size increases throughout puberty up to Tanner stage 4
77. Puberty: Physical Changes- Males
Testicular Size
• Increase in testicular size causes the scrotal skin to become thinner and
darker in color
• Boys typically experience their first ejaculation approx. one year after
the testicles begin to grow
• Fertility is achieved approx. one year after the first ejaculation
78. Puberty: Physical Changes- Males
Pubarche
• Growth of pubic hair at the penile base
• Occurs alongside testicular development
• Pubic hairs initially appear light, straight and thin; then become darker,
curlier, and thicker
• 2 years from pubarche, axillary, chest, and facial hair begin to grow
79. Puberty: Physical Changes- Males
Penis Size
• The growth of the penis occurs after testicular enlargement
• The penis grows in length, width
• The glans penis and corpus cavernosum also enlarge
81. Precocious puberty
The appearance of secondary sexual characteristics prior to the age of
<8 in girls
<9 in boys
Precocious
puberty (PP)
Central PP
Peripheral
PP
82. Pathologies of Puberty: Central PP
• Involves activation of the hypothalamic-pituitary-gonadal (HPG) axis,
which leads to early but normal pubertal development
• More common in girls
• Causes:
• Idiopathic
• Neoplasm, radiation, head trauma
• Genetic conditions
83. Pathologies of Puberty: Peripheral PP
• Results from an increase in sex steroids that does not come from
activation of the HPG axis
• Findings: a rapid and atypically sequenced pubertal progression
• Causes:
• McCune-Albright syndrome
• Testotoxicosis
84. Pathologies of Puberty: Delayed Puberty
Lack of physical evidence of puberty by 2 to 2.5 standard deviations
above the mean age for the initiation of puberty
➢ Boys:
• Longer than four years between the first signs of testicular
enlargement and the end of puberty or
• Absence of testicular growth by 14 years old
➢ Girls:
• Absence of breast growth by 13 years of age or
• More than four years between thelarche and menarche
85. Pathologies of Puberty: Delayed Puberty
Causes:
• Hypogonadotropic hypogonadism
• Hypergonadotropic hypogonadism
• Hypopituitarism
• Chromosomal abnormalities [Turner 45XO, Klinefelter 47XXY]
• Hypothalamic dysfunction due to secondary causes
86. Pathologies of Puberty:
Contrasexual Developement
• Occurs when male or female children develop physical features of the
opposite gender
• More common in girls (common cause: PCOS and increased responses
by the adrenal gland
• Girls may develop male-like distribution of hair, hirsutism
• Clitoromegaly and loss of the the contour of breast mass
87. Pathologies of Puberty:
Contrasexual Developement
Causes:
• Cushing syndrome
• Acromegaly
• Exogenous androgens
• Adrenal tumors
• Ovarian tumors
• Hyperprolactinemia
Although contra-sexual
development is less common
in boys, the cause is typically
estrogen-secreting tumors
89. 1.
Prepared by Dr. Mitali Srivastava
Reference:
Breehl L, Caban O. Physiology, Puberty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2024 [cited 2024 Feb 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534827/
