GYNE Anatomy and Physiology

External Female Reproductive Organs collectively called the vulva or pudendum. These structures
include the mons pubis, labia majora and minora, clitoris, structures of the vestibule, and perineum.

Mons Pubis rounded, fleshy prominence over the symphysis pubis that forms the anterior border of
the external reproductive organs. It is covered with varying amounts of pubic hair.
Labia Majora two rounded, fleshy folds of tissue that extend from the mons pubis to the perineum
that have slightly deeper pigmentation than surrounding skin and are covered with pubic hair;
protects the more fragile tissues of the external genitalia.
Pudendal cleft space between the labia majora.
Labia Minora - runs parallel to and within the labia majora. It extends from the clitoris anteriorly and
merges posteriorly to form the fourchette, which is the posterior rim of the vaginal introitus. It does
not have pubic hair and is highly vascular and respond to stimulation by becoming engorged with
blood. Anteriorly unite over the clitoris to form a fold of skin called the prepuce.
Clitoris small projection at the anterior junction of the two labia minora, usually less than 2 cm in
length and consists of a shaft and a distal glans.
Corpora cavernosa two erectile structures in the clitoris that expands at the base end of the
clitoris to form the crus of the clitoris and attaches the clitoris to the pelvic bones.
Vestibule structures enclosed by the labia minora. The urinary meatus, vaginal introitus, and ducts
of Skene and Bartholin glands lie within the vestibule.
Skene, or periurethral provide lubrication for the urethra.
Bartholin provide lubrication for the vaginal introitus, particularly during sexual arousal.
Hymen thin fold of mucosa that partially separates the vagina and the vestibule.
Perineum most posterior part of the external female reproductive organs. It extends from the
fourchette anteriorly to the anus posteriorly. It is composed of fibrous and muscular tissues that
provide support for pelvic structures.
Internal Female Reproductive Organs include the vagina, uterus, fallopian tubes, and ovaries that are
supported and contained within the bony pelvis.

Vagina the female organ of copulation, receiving the penis during intercourse. It also allows
menstrual flow and childbirth. It consists of an outer muscular layer and an inner mucous membrane.
Columns longitudinal ridges that extend the length of the anterior and posterior vaginal walls.
Rugae transverse ridges or folds that extend between the anterior and posterior columns.
Fornix superior, domed part of the vagina attached to the sides of the cervix.
Uterus hollow, thick-walled, muscular organ, which is shaped like a flat, upside-down pear. It
houses and nourishes the fetus until birth. It measures about 7.5 5 2.5 cm and is larger in women
who have borne children. It is suspended above the bladder and is anterior to the rectum. Its normal
position is anteverted and slightly anteflexed.
Divisions of the Uterus:
Corpus or body upper division of the uterus. The uppermost part of the uterine corpus, above
the area where the fallopian tubes enter the uterus, is the fundus of the uterus.
Isthmus narrower transition zone located between the corpus of the uterus and the cervix.
During late pregnancy the isthmus elongates and is known as the lower uterine segment.
Cervix tubular neck of the lower uterus about 2 to 3 cm in length. It effaces (thins) and dilates
(opens) to allow passage of the fetus during labor. The os is the opening in the cervix between
the uterus and vagina. The upper cervix and lower cervix are marked by the internal os and
external os, respectively. The external os of a childless woman is round and smooth. After vaginal
birth the external os has an irregular, slitlike shape and may have tags of scar tissue.
Layers of the Uterus:
Perimetrium outer layer of serous membrane
that covers most of the uterus; is laterally continuous
with the broad ligaments on both sides of the uterus.
Myometrium middle layer of thick muscle that
contains three types of smooth muscle fiber, each suited
to specific functions in childbearing:
1. Longitudinal fibers mostly in the fundus,
expels fetus toward the pelvic outlet.
2. Interlacing fibers constitute middle layer,
contract after birth to compress blood vessels that pass
between them to limit blood loss.
 3. Circular fibers form constrictions where fallopian tubes enter the uterus and
surround the internal cervical os; prevent reflux of menstrual blood and tissue
into fallopian tubes, promote normal implantation of the fertilized ovum by
controlling its entry into the uterus, and retains it.
Endometrium inner layer; responds to the cyclic variations of estrogen and progesterone
during the female reproductive cycle. It has two layers:
1. Basal layer nearest the myometrium; regenerates the functional layer of the
endometrium after each menstrual period and after childbirth.
2. Functional layer above basal layer; endometrial arteries, veins, and glands extend
into it and are shed during menstrual periods and after childbirth in the lochia.
Fallopian tubes or oviducts 8 to 14 cm long and quite narrow (2 to 3 mm at their narrowest and 5 to
8 mm at their widest); passageway for ovum as it travels from ovary to uterus and is the site of
fertilization. It enters the upper uterus at the cornu, or horn, of the uterus.
Cilia hair-like processes that line the fallopian tubes, which beat rhythmically toward the
uterine cavity to propel the ovum through the tube.
Four divisions:
1. The interstitial portion runs into the uterine cavity and lies within the uterine wall.
2. The isthmus is the narrow part adjacent to the uterus.
3. The ampulla is the wider area lateral to the isthmus where fertilization occurs.
4. The infundibulum is the wide, funnel-shaped terminal end of the tube.
Fimbriae fingerlike processes that surround the infundibulum.
Ovaries female gonads, or sex glands. They have two functions: (1) sex hormone production and (2)
maturation of an ovum during each reproductive cycle. It secretes estrogen and progesterone in
varying amounts during a womans reproductive cycle to prepare the uterine lining for pregnancy.

Support Structures the bony pelvis supports and protects the lower abdominal and internal
reproductive organs while muscles and ligaments provide added support for the internal organs of the
pelvis against the downward force of gravity and increases in intra-abdominal pressure.

Pelvis basin-shaped structure at the lower end of the spine. Its posterior wall is formed by the
sacrum. The side and anterior pelvic walls are composed of three fused bones: the ilium, the ischium,
and the pubis.
Linea terminalis or pelvic brim or ileopectineal line imaginary line that divides the upper, or
false, pelvis from the lower, or true, pelvis.
 Muscles paired muscles enclose the lower pelvis and provide support for internal reproductive,
urinary, and bowel structures.
Pelvic fascia provide support for pelvic organs where vaginal and urethral openings are located.
Levator ani collection of three pairs of muscles: the pubococcygeus, also called the pubovaginal
muscle in the female; the puborectal; and the iliococcygeus.
Ischiocavernosus muscle extends from the clitoris to the ischial tuberosities on each side of the
lower bony pelvis. Two transverse perineal muscles extend from fibrous tissue of the perineum
to the two ischial tuberosities, stabilizing the center of the perineum.
Ligaments seven pairs of ligaments maintain the internal reproductive organs and their nerve and
blood supplies in their proper positions within the pelvis.
Lateral Support.
Paired ligaments stabilize the uterus and ovaries laterally and keep them in the midline of the
pelvis. The broad ligament is a sheet of tissue extending from each side of the uterus to the
lateral pelvic wall. The round ligament and fallopian tube mark the upper border of the broad
ligament. Within the two broad ligaments are the ovarian ligaments, blood vessels, and
lymphatics.
Right and left cardinal ligaments provide support to the lower uterus and vagina.
Two ovarian ligaments connect the ovaries to the lateral uterine walls. The infundibulopelvic
(suspensory) ligaments connect the lateral ovary and distal fallopian tubes to the pelvic side walls
and also carries the blood vessel and nerve supply for the ovary.
Anterior Support.
Round ligaments connect the upper uterus to the connective tissue of the labia majora and
maintain the uterus in anteflexed position and help direct the fetal presenting part against the
cervix during labor.
Pubocervical ligaments connect the cervix and interior surface of the symphysis pubis.
Posterior Support.
Uterosacral ligaments extend from the lower posterior uterus to the sacrum containing the
sympathetic and parasympathetic nerves of the autonomic nervous system.

The Female Breasts or mammary glands are not directly functional in repro- duction, but they secrete
milk after childbirth to nourish the infant.

Nipple composed of sensitive erectile tissue surrounded by areola.

Montgomerys tubercles sebaceous glands in the areola.
Alveoli small sacs that contain acinar cells to secrete milk.
Lactiferous ducts and sinuses collect milk from alveoli and conduct it to outside.
Cooper ligaments group of suspensory ligaments that support and hold the breasts in place
ligaments extending from the fascia over the pectoralis major muscles to the skin over the mammary
glands and prevent the breasts from excessive sagging.
The Female Reproductive Cycle regular and recurrent changes in the anterior pituitary secretions,
ovaries, and uterine endometrium that are designed to prepare the body for pregnancy.
Called the menstrual cycle because menstruation provides a marker for each cycles beginning and
end if pregnancy does not occur.
Menses is a period of mild hemorrhage that occurs approximately once each month, during which the
uterine epithelium is sloughed and expelled from the uterus. Menstruation is the discharge of the
blood and other elements of the uterine mucous membrane.
Driven by a feedback loop between the anterior pituitary and ovaries.
Duration is about 28 days butmay range from 20 to 45 days. Significant deviations from the 28-day
cycle are associated with reduced fertility.
Two cycles that reflect changes in the ovaries and uterine endometrium.

Ovarian Cycle
Anterior pituitary secretes FSH and LH in response to GnRH from hypothalamus to stimulate
release of mature ovum from the ovaries along with hormones that will prepare the
endometrium for implantation of a fertilized ovum.
Consists of three phases: follicular, ovulatory, and luteal.
1. Follicular Phase
Period where ovum matures.
Begins with first day of menstruation and ends 14 days later in a 28-day cycle.
Fall in estrogen and progesterone secretion by the ovary before menstruation stimulates
secretion of FSH and LH by the anterior pituitary, subsequently, 6 to 12 graafian follicles
begin to grow. Each follicle secretes fluid containing high levels of estrogen, which
accelerates maturation by making the follicle more sensitive to the effects of FSH.
Eventually, one follicle outgrows the others to reach maturity. The mature follicle secretes
large amounts of estrogen, which depresses FSH secretion. The dip in FSH secretion just
before ovulation blocks further maturation of the less-developed follicles.
2. Ovulatory Phase
Near the middle of a 28-day cycle and about 2 days before ovulation, LH secretion rises
markedly; secretion of FSH also rises. These surges in LH and FSH levels cause a slight fall in
follicular estrogen production and a rise in progesterone secretion, stimulating final
maturation of a single follicle and release of its ovum. At ovulation a blisterlike projection
called stigma forms on the wall of the follicle that ruptures, and the ovum with its
surrounding cells is released from the surface of the ovary, where it is picked up by the
fimbriated end of the fallopian tube for transport to the uterus.
3. Luteal Phase
Its beginning is marked by ovulation and occurs 14 days before the next menstrual period.
After ovulation and under the influence of LH, the remaining cells of the old follicle persist
for about 12 days as a corpus luteum secreting estrogen and large amounts of progesterone
to prepare the endometrium for a fertilized ovum. FSH and LH decrease in response to
higher levels of estrogen and progesterone.
If the ovum is fertilized, it secretes chorionic gonadotropin hormone that causes persistence
of the corpus luteum to maintain an early pregnancy. If the ovum is not fertilized, FSH and LH
fall to low levels, and the corpus luteum regresses. Decline of estrogen and progesterone
levels along with corpus luteum regression results in menstruation.
The loss of estrogen and progesterone from the corpus luteum at the end of one cycle
stimulates the anterior pituitary to again secrete more FSH and LH, initiating a new female
reproductive cycle. The old corpus luteum is replaced by fibrous tissue called the corpus
albicans.
Endometrial Cycle uterine endometrium responds to ovarian hormone stimulation with cyclic changes.
Three phases mark the changes in the endometrium: proliferative, secretory, and menstrual.
1. Proliferative Phase
 Occurs as ovum matures
and is released during first
half of the ovarian cycle.
After completion of a
menstrual period the
endometrium is very thin
and a basal layer of
endometrial cells remain.
These cells multiply to form
new endometrial epithelium
and endometrial glands
under the stimulation of
estrogen. Endometrial spiral
arteries and endometrial
veins elongate to
accompany thickening of the
functional endometrial layer
and nourish the proliferating
cells. As ovulation
approaches, the
endometrial glands secrete
thin, stringy mucus that aids
entry of sperm into the
uterus.
2. Secretory Phase
Occurs during the last half of
the ovarian cycle as the uterus is prepared to receive a fertilized ovum.
The endometrium continues to thicken under the influence of estrogen and progesterone
from the corpus luteum, reaching its maximum thickness of 5 to 6 mm. Progesterone from
the corpus luteum causes the thick endometrium to secrete substances to nourish a
fertilized ovum.
3. Menstrual Phase
Fertilization does not occur, corpus luteum regresses, and its production of estrogen and
progesterone falls. About 2 days before the onset of menstruation, vasospasm of the
endometrial blood vessels causes the endometrium to become ischemic and necrotic. The
necrotic areas of endometrium separate from the basal layers, resulting in the menstrual
flow where women lose about 40 mL of blood.

Hormonse Involved in Regulating Menstruation

1. Follicle-Stimulating Hormone (FSH) stimulates the development of new follicles as well as the
production of the hormone estrogen. During the follicular phase of the menstrual cycle, an
increase in FSH occurs. This increase stimulates the growth and development of new follicles,
one of which will develop into the ovulated egg.
2. Estrogen responsible for the continuing development of follicles within the ovaries. In the
uterus, the rising levels of this hormone play an important role in thickening the endometrium --
a layer of the uterus. It also causes the mucus within the cervix to become thicker. Finally,
estrogen release acts as a suppressor of its own release -- called a negative feedback loop. It also
acts to suppress the production of LH, until just before ovulation. Afterward, estrogen actually
stimulates the release of large amounts of LH in what is called the mid-cycle LH surge.
3. Luteinizing Hormone (LH) peaks in the middle of the 28-day cycle; typically called the LH surge
and serves as a signal that ovulation is about to occur. During this peak of LH release,
concentration of this hormone becomes ten times higher than usual. Ovulation generally occurs
 within 9 hours of the LH surge. The egg releases from the ovary, able to be fertilized for about 1-
2 days after it releases. If it does not become fertilized, it begins to disintegrate or releases along
with the inner lining of the uterus as part of the monthly menstruation cycle.
4. Progesterone release from corpus luteum once ovulation has occured. It makes the mucus
around the entrance of the uterus thick and sticky, preparing for a potential pregnancy. If the
released egg becomes fertilized, it will become implanted in the wall of the uterus and the fetus
will begin to grow.

Changes in Cervical Mucus

During most of the female reproductive cycle, the mucus of the cervix is scant, thick, and sticky. Just
before ovulation, cervical mucus becomes thin, clear, and elastic to promote passage of sperm into the
uterus and fallopian tube, where they can fertilize the ovum. Spinnbarkeit refers to the elasticity of
cervical mucus.