FEMALE PRODUCTIVE SYSTEM 1.

Pelvic organ in pelvic cavity

a. Fimbriae finger-like projection sweeping up ovary b. Uterine (Fallopian) tube aka ovarian duct 17cm-long tube continuous with lumen of oviduct, connect to either side of ovary, continuous with uterine tube pick up oocyte to transport to uterus may get infection from bacteria entering through vagina c. Uterus where fertilized ovarian mature i. Cervix neck of uterus into vagina d. Vagina has fold passage for menstrual fluid, intercourse & delivering baby e. Ovary a pair of pear/ovoid shape, like an unshelled almond in shape & size, lie in upper part of pelvic cavity, 1 on each side of uterus, attached to uterus by ovarian ligament & to pelvic wall by suspensory ligament i. Ovarian artery came from abdominal aorta provide rich blood supply to ovary

ii. Histology 1. Surface epithelium simple cuboidal epithelium 2. Tunica albuginea white capsule surrounding ovary protect ovary

3. Cortex outer region where oocyte mature 4. Medulla - inner region where blood supply comes in 5. Follicles egg in development iii. Ligaments 1. Ovarian ligament hold ovary in place, connect with uterus 2. Broad ligament support ovary, connect to uterus side to lateral wall of pelvic 3. Suspensory ligament hold ovary in place the only one has CT & arterial supply (ovarian artery, a branch of aorta) bring blood to ovary iv. Growth & development of ovarian follicle 1. Gametogenesis process of gamete production (spermatocytes in male = undifferetiated stem cell >< oocyte in female = differentiated stem cell oogenesis = production process of mature ova with oocyte grow bigger as it matures) 2. At birth, human has 700k-1mil follicles/ovary adult = 400k follicles/ ovary ~450 ovary /life time only 1 ovary ovulate/ month, the majority of follicle degenerated through atresia process 3. At puberty & onward, each month, 20-50 follicle are selected for growth & development during which follicle in size 25 to 50 times >< only one has oocyte that will ovulate, remaining follicles undergo atresia (degeneration & reabsorption of follicle & oocyte through apoptosis, may happen in any stage of follicle development) 4. Follicle process of development - primordial preantral early antral antral preovulated ovulation = ruptured follicle with oocyte released early corpus luteum mature corpus luteum corpus albicans (degenerated corpus luteum) a. Primordial follicle non-growing follicle, has 46 chromosomes & all organelles like normal cells, growth is stimulated by FSH i. Granulosa cell aka follicular cell, squamous epithelium surrounding oocyte, has FSH , join together by gap junction & desmosome b. Preantral follicle growing follicle, before formation of antrum i. Developing theca simple squamous epithelium surrounding granulosa cell layer, with a basement MB in between ii. Granulosa cell cuboidal epithelium forming a thick layer surrounding oocyte iii. Zona pellucida gel-like substances lining between granulosa & oocyte, made up of GAG & other glycoprotein immediately cover oocyte leave with oocyte during ovulation c. Early antral follicle i. Theca interna cuboidal steroid producing cell, abundant with SER (cristae) & tubular mitochondria, lipid droplet (precursor for steroid) 1. Androstenedione synthesized in theca interna pass into granulosa cell ii. Theca externa flatten epithelium iii. Blood vessel between theca interna & externa provide nutrient via diffusion iv. Early antral space filled with fluid containing transdudate of plasma from theca interna with inorgnanic ion, GAG, several protein including steroid-binding protein, steroid (estrogen, progesterone, androgen) v. Granulosa cell increase in # through mitosis, convert androstenedione into estradiol (high during 1st half of menstrual cycle) d. Preovulatory follicle aka mature/graafian follicle i. Corona radiate ring of granulosa cells around oocyte, leave follicle with oocyte during ovulation

ii. Cumulus oophorus mound of granulosa contirnue around oocyte iii. Oocyte undergoes miotic changes - once released transported into ovarian duct degenerated if not fertilized 1. Microvilis for macromolecule uptake through diffusion for nutrient & communication (indicated by coated vesicle) 2. Desmosome attach oocyte to zona pellucida 3. Ovulation - Oocyte, zona pellucida & corona radiata

2. Ovarian 3. Menstrual cycle a. Follicular phase day 1 to 14, hypothalamus release GnRH pituitary release of FSH follicular growth & follicular release of estrogen (+) feedback on LH & (-) feedback on FSH follicular mature into graafian pre-ovulatory follicle b. Ovulation LH on day 14 main action = ovulation, some action on follicular growth & corpus luteum formation i. Antrum - fluid pressure thinning of follicle ii. LH effect break open MB possibly by protease action (current hypothesis) assist ovulation c. Luteal phase day15 to 28, after ovulation, corpus luteum release progesterone & estrogen (-) feedback on LH i. Corpus luteum yellow body 1. has luteal cell (theca lutein & granulosa lutein cells) with lots of blood vessel blood leakage clot replace by CT tissue = fibrin 2. Granulosa lutein cell a. came from granulosa cells, has blood vessel growth blood leakage b. live 14 days, release estrogen & progesterone prepare endometrium, uterine lining of uterus for potential fertilization & implantation i. no fertilization corpur luteum degenerate into white scar = corpus albicans ii. if fertilized, corpus luteum stay alive & continue to release P & E to maintain pregnancy

4. Uterine (fallopian) tubes- aka oviduct, in diameter (uterus to ovary)

a. Mucosa line both uterine tube & uterus, i. Epithelial layer - ciliated columnar (50%) & secretory columnar (50%) epithelium respond to estrogen ii. Lamia propria has lots CT with rather large veins iii. Muscularis not well defined iv. Serosa outer layer consist of squamous mesothelial cells covering a thing loose CT layer b. Intramural portion lead straight to wall of uterus c. Isthmus narrow & short, has less cilia & more SM layer & smaller fold than ampulla, where oocyte degenerate if not fertilized d. Ampulla longest portion of uterine tube, has many fold extending into lumen, has cilia that move oocyte along e. Infundibulum widest portion, muscaoca is made of elaborated branched longitunidal folds with 2 type of epitheliual cells (ciliated cells f. Fimbriae finger-like projection beating in 1 direction to help taking oocyte to fallopian tube g. Functions i. Receive ovulated oocyte & transport it (fertilized or not) toward uterus by ciliary action & SM contraction (peristalsis) ii. Sperm transport iii. Secretion are nutritive for oocyte during its transport iv. Estrogen (estradiol) is responsible for function of uterine tube action v. Fertilization normally occur in ampulla region vi. Both cell types (secretory & ciliated) in higher during follicular phase of ovarian cycle due to E stimulation reach maximum higher at ovulation vii. At time of ovulation, oviduct undergo active motion as its infundibulum come close to ovarian surface vein in lamina propria enlarge rigidity & distention facilitate its approximation to ovary 5. Ectopic pregnancy abnormal location of implantation of fertilized oocyte, most common in uterine tube, can also happen in ovary, abdominal / intestinal wall, cervix of uterus dont proceed beyond 8-10wks after implantation, must removed surgically or bleed to death (leading cause of maternal mortality) 6. Uterus pear shape, lie in the pelvic cavity between urinary bladder & rectum, a. Component fundus, uterus cavity, body, cervical canal, cervix b. Wall of uterus i. Endometrium uterine mucosa, mucus MB with lots of blood vessel in lamina propria, has simple columnar epitheliums 1. Basalis stay behind during menstruation to generate new functionalis 2. Functionalis thickest layer, break off during menstruation 3. Uterine gland start from basalis to surface of functionalis, secrete nutrition for implanted embryo ii. Myometrium SM layer, thickest layer has intensive contraction during delivery iii. Blood supply has 2 major blood vessel supply blood to uterus 1. L & R tortuous artery can stretch when uterus enlarge during pregnancy 2. Straight arterioles branch of uterine artery, most go to functionalis, some to basalis 3. Spiral arteriole goes through mucus MB of functionalis a. Intermittent constriction close off blood supply to functional b/f menstrual flow ischemia in functionalis functionalis dies & break off menstrual flow consist of blood & functionalis tissue

7. Menstrual cycle a. Menstrual phase day 1- 4 i. Basalis stay behind during menstruation ii. Functionalis degenerated & removed with menstrual fluid only endometrium layer present, no myometrium b. Proliferation/ follicular phase day 5 14 regeneration i. Basalis under proliferation form new functionalis (coiled arteries & uterine glands, lamia propria) in response to estrogen (from ovary) form new surface by columnar cells c. Secretory (luteal) phase day 15 28, corpus luteum release estrogen and progesterone i. Uterine gland - tortuousness & release glycogen & glycoprotein as nutrient for implanted oocyte ii. Functionalis highest during this phase in response to estrogen (main hormone in 1st half) & progesterone (main hormone in this phase) iii. fluid lamina propria & fibroblast-like cells expand iv. Ischemic phase day 27 to 18 if oocyte not fertilized return to menstrual phase

8. Vagina dilatable organ, fibrous muscular organ b/c of muscle surrounding, 10cm length on average, lead into perineum a. Location in pelvic cavity b. Function passage of menstruation, baby & intercourse c. Epithelial cells stratified squamous protection during intercourse & delivering baby d. Lamina propria lots of SM, & blood vessels e. Mucosa has folds f. Perineum divide into anal & urogenital triangles, has external genitalia i. Mon pubis - mount of tissue called mons ii. Lip labia minora & majora g. Clitoris equivalent to male penis, mainly erectile tissue (engorged during sexual stimulation), has head (external portion) & crus (extension of clitoris, connected to bone) h. Vestibule space between labia minor & vagina, where urinary urethra opening & vagina locates i. Vestibular bulb engorge with blood during sexual stimulation