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Reproduuction System image (Meosis image (Needed for perpetuation…

- - - - Genitalia divided into:
        
        Primary genitalia: gonads that produce gametes
        
        Secondary genitalia: other structures that aid in reproductive process
  - - - Is divided into 4 stages, usually over 28 days.
        
        During the follicle stage- lasts 10 days, the hormone, FSH, is released by the pituitary. At the ovary FSH stimulates the follicle and ovum to mature, which results in a release in estrogen and preparing the uterus
        
        Ovulation stage- the pituitary stops producing FSH, and starts producing LH.
        
        At day 14, the follicle ruptures and ovum is relased
        
        Corpus luteum stage- the corpus luteum secretes progesterone and will continue to do so if egg gets fertilized (stage lasts 14 days)
        
        Final stage is menstruation stage- egg not fertilized so the corpus luteum slows the progesterone production and the uterine lining begins to break down and then discharged over 3-6 days
      - The menstrual cycle begins with first day of menses
      - Menstruation is term referring to actual shedding of endometrium, “period” itself
      - Menses refers to time during which woman is menstruating, time when woman is having her “period”
      - Menses usually lasts 4–5 days, but can be longer or shorter in different women, can vary month to month in same woman
    - - Once menses is over, endometrium begins to proliferate, readying itself for egg about to be released from ovary (ovulation)
      - From day 1–14 oocyte, or egg cell, is undergoing a number of developmental changes getting ready for ovulation on day 14
      - Ovulation is release of mature egg from ovary
      - Egg travels from ovary to uterus, which has been preparing for it
      - If oocyte is fertilized by sperm, it will implant in thickened endometrium
      - If it doesn’t implant within few days, endometrium will begin to decay and menstruation will occur within 2 weeks after
      - Time between end of menses and ovulation is known as follicular, or proliferative, phase
        
        During this time endometrium is proliferating and follicles (eggs and associated helper cells) are maturing in ovary
      - Time between ovulation and menses known as luteal, or secretory phase
        
        because of development of structure called corpus luteum in ovary and beginning of secretion in uterus
      - Oogenesis
        
        Process of egg production called oogenesis
        
        Oogenesis begins with birth of oogonia, or egg stem cells, in ovary
        
        Oogonia undergo mitosis, producing millions of primary oocytes; happens very early in woman’s life, with millions of primary oocytes produced as fetus
        
        Women have all eggs they will ever have five months before they are born
        
        Primary oocytes, since they are born via mitosis, still have 46 chromosomes
        
        They must undergo meiosis to become gametes, with only 23 chromosomes, allowing them to combine with another gamete and ending with total of 46 chromosomes
        
        Primary oocytes stay in kind of suspended animation until puberty, when they finish developing
        
        Primary oocytes eventually are surrounded by helper cells, called granulosa cells; at this point they are called primordial follicles, and stay dormant until puberty
        
        Hormonal signals during puberty cause some primordial follicles to enlarge and increase number of granulosa cells
        
        Enlarged cells called primary follicles
        
        Once a girl reaches puberty, one primary follicle will become secondary follicle
        
        Secondary follicle will not complete development unless it is ovulated and fertilized
        
        Just before ovulation, secondary follicle fills with fluid and moves toward surface of ovary, where it becomes a visible lump
        
        Fimbria of uterine tubes brush surface of ovary, causing follicle to rupture
        
        When follicle ruptures, egg (actually an oocyte) is released into peritoneal cavity and fimbria pull it toward funnel, drawing it into uterine tube
        
        As egg travels down uterine tube it will either be fertilized or not
        
        If sperm present in uterine tube and all conditions are right, sperm will penetrate egg, fertilizing it and triggering rest of egg development
        
        Successfully fertilized egg has 46 chromosomes and now called zygote
        
        Zygote enters uterus and implants into proliferated endometrium, stopping woman from experiencing menses
        
        Ruptured follicle left behind in ovary will become corpus luteum and secrete hormones to help maintain thickened endometrium to nourish embryo
        
        If there no sperm in uterine tube, conditions are not right, or something goes wrong after fertilization, zygote will not implant in uterus
        
        If there is no implantation within few days, uterine lining will begin to degenerate and woman will have her period, with egg swept out in menstrual flow
        
        Corpus luteum will become corpus albicans and eventually disappear
- - - - Uterine tubes, also called oviducts or fallopian tubes, are passageways for eggs to get to uterus
      - Each tube begins as large funnel, infundibulum, surrounded by ciliated projections called fimbria
      - Infundibulum leads to widened area, ampulla, followed by a longer, narrower portion known as isthmus
      - Uterine tubes are connected to superior portion of uterus
      - Constructed of sheets of smooth muscle lined with highly folded, ciliated, simple columnar epithelium
      - Outside is covered by visceral peritoneum and suspended by mesentery known as mesosalpinx
    - - Found in pelvic cavity posterior and superior to urinary bladder and anterior to rectum
      - Major portion called body; rounded superior portion between uterine tubes is fundus and narrow inferior portion is isthmus
      - Cervix is valve-like portion of uterus that protrudes into vagina, while cervical canal communicates with vagina
      - Like ovaries, the uterus is suspended and anchored by series of ligaments
      - Mesometrium attaches uterus to lateral pelvic walls
      - Combination of mesometrium and mesovarium called broad ligament
      - Lateral cervical ligaments attach cervix and vagina to lateral pelvic walls
      - Uterus anchored to anterior wall of pelvic cavity by round ligaments
      - Consists of 3 layers:
        
        Perimetrium: outermost layer, also called the visceral peritoneum
        
        Myometrium: consists of smooth muscle
        
        Endometrium: inner lining is mucosa layer of columnar epithelium and secretory cells with two divisions
        
        Basal layer: responsible for regenerating uterine lining each month
        
        Functional layer: sheds about every 28 days when woman has her period
      - Endometrium is highly vascular
      - Blood supplied by uterine artery, which branches from internal iliac arteries on each side
      - Uterine arteries split into arctuate arteries, supplying myometrium, and radial arteries, which supply blood to endometrium
      - Straight radial arteries supply basal layer
      - Spiral radial arteries supply functional layer, decaying and regenerating every month as part of menstrual cycle, and undergoing spasms which contribute to shedding of endometrium each month
      - Blood returns to circulation via network of venus sinuses
    - - Tube, approximately 10 cm long, running from uterus to outside of body
      - Purpose is to receive penis during intercourse and allow for passage of menstrual fluid out of uterus
        
        Also called birth canal, since another function is to allow movement of baby out of uterus during childbirth
      - External opening may be covered a perforated membrane, the hymen
        
        Torn hymen once thought to prove that woman had intercourse, but many hymens are highly perforated and easily ruptured by day to day activities such as riding a bike or jogging; intact hymen not valid test for virginity (some cultures still hold this to be true)
    - - Collectively known as vulva and is complex and important part of reproduction
      - The vulva is surrounded by two prominences called labia majora, rounded fat deposits that meet and protect rest of external genitalia
      - Labia majora meet anteriorly to form mons pubis, covered by pubic hair
      - The perineum is the area between the vagina and the rectum.
      - Between the labia majora is opening known as pudendal cleft, with vestibule located within that contains urethra and vagina
      - Several glands surround vestibule to keep it moist such as the Bartholin’s glands.
      - Lateral border of vestibule formed by thin labia minora, which meet anteriorly to form prepuce
      - Posterior to prepuce is the clitoris, small erectile structure, 2 cm in diameter
      - Like penis, clitoris engorges with blood during sexual arousal; however, clitoris increases in diameter, not length
      - Clitoris has shaft, body, and glans (tip)
- - - - Eventually scarring and damage to the organs
      - 6 million in US have
      - Some experience no symptoms others do
    - - Abdominal and back pain during menstruation
      - Painful intercourse
      - Chronic pelvic pain
      - Painful urination and bowel movements, especially during menstruation
      - Some woman will have the symptoms that mimic a bladder infection
      - Untreated, endometriosis can cause adhesions on the intestine and bladder, scar tissue can cause reproductive problems, most common cause of infertility
    - - Detailed history and physical exam
      - Ultrasound, which can detect large implants of endometrial tissue outside uterus
      - Laparoscopic examination of pelvic cavity
      - Only way to diagnose endometriosis with certainty
      - Suspected endometrial implants biopsied to confirm they are endometrial tissue
    - - Pain can be treated with NSAIDs
      - To prevent progression of implants, you can
        
        Remove implants (and associated scar tissue) surgically
        
        Suppress implants using hormones
      - Severe cases may require hysterectomy with removal of ovaries
      - Hormonal treatments can include
        
        Contraceptives (combined estrogen and progesterone)
        
        GnRH agonists (gonadatropic releasing hormone)
        
        Synthetic male hormones (androgens)