Reproductive Anatomy and Physiology

Reproductive physical maturity and the capacity for human reproduction begin
during puberty, a period of rapid growth and change experienced by both males and females.
Puberty is not an isolated event, but a process which takes place over several years.

1. Internal Organs
a) Uterus

The uterus is a hollow organ about the size and shape of a pear. It serves two important
functions: it is the organ of menstruation and during pregnancy it receives the fertilized ovum,
retains and nourishes it until it expels the fetus during labor.

Divisions of the uterus,the uterus consist:

 Body Or Corpus -the major portion of the uterus is called the body or corpus
 Fundus- is the superior, rounded region above the entrance of the fallopian tubes.
 Cervix- inferior outlet that protrudes into the vagina.
 Isthmus- is the slightly constricted portion that joins the corpus to the cervix.
Walls of the uterus. The walls are thick and are composed of three layers:
 endometrium
 myometrium
 Perimetrium
b) Vagina
 is the thin in walled muscular tube about 6 inches long leading from the uterus to the external
genitalia. It is located between the bladder and the rectum.
 Provides the passageway for childbirth and menstrual flow; it receives the penis and semen
during sexual intercourse.

c) Fallopian Tubes (Two)

 Each tube is about 4 inches long and extends medially from each ovary to empty into the superior
region of the uterus.
 It transport ovum from the ovaries to the uterus. There is no contact of fallopian tubes with the
ovaries.

d) Ovaries

The ovaries are for oogenesis-the production of eggs (female sex cells) and for hormone production
(estrogen and progesterone).
2. External Female Organs.
a) Mons Pubis
 This is the fatty rounded area overlying the symphysis pubis and covered with thick coarse hair.
b) Labia Majora
 The labia majora run posteriorly from the mons pubis. They are the 2 elongated hair covered skin
folds. They enclose and protect other external reproductive organs.
c) Labia Minora
 The labia minora are 2 smaller folds enclosed by the labia majora. They protect the opening of the
vagina and urethra.
d) Vestibule
 The vestibule consists of the clitoris, urethral meatus, and the vaginal introitus.
The clitoris is a short erectile organ at the top of the vaginal vestibule whose function is sexual excitation.
e) Perineum
 This is the skin covered muscular area between the vaginal opening (introitus) and the anus. It
aids in constricting the urinary, vaginal, and anal opening. It also helps support the pelvic
contents.
f) Bartholin’s Glands (Vulvovaginal or Vestibular Glands)
 The Bartholin’s glands lie on either side of the vaginal opening. They produce a mucoid
substance, which provides lubrication for intercourse.

PROCESS OF MENSTRUAL CYCLE

The Menstrual cycle is a term used to describe monthly events that occur within a
woman's body in preparation for the possibility of pregnancy. Each month, an egg is released
from an ovary in a process called ovulation. At the same time, the lining of the uterus thickens,
ready for pregnancy. If fertilization does not take place, the lining of the uterus is shed in
menstrual bleeding and the cycle starts over.

An ovary contains hundreds of thousands of primary oocytes - immature eggs, or ova.

Each of these is enclosed in a structure called a follicle, and at this stage -- a primordial follicle.
The menstrual cycle is under control of hormones secreted by the pituitary gland and the ovaries.
The pituitary itself is under control of the hypothalamus. The hypothalamus produces a hormone
called the gonadotropin-releasing hormone or GnRH. GnRH stimulates the anterior lobe of the
pituitary to secrete follicle-stimulating hormone (FSH).
FSH travels in the bloodstream to the ovaries and stimulates a group of follicles to grow. These
primordial follicles develop into primary follicles and then secondary follicles. These produce a
hormone named estrogen which acts to stimulate the growth of the endometrium -- the inner
lining of the uterus. The secondary follicles compete with each other and only one of them will
survive and become a mature follicle, the rest atrophy and die.
The increasing level of estrogen also acts on the hypothalamus and the anterior pituitary to
increase the level of GnRH and induce the production of another hormone -- luteinizing hormone
(LH). A surge in LH secretion triggers ovulation - the release of the egg from the follicle and the
ovary. The egg is then swept up by the fimbriae and taken into the uterine tube.
Fertilization by a spermatozoon, when it occurs, usually takes place in the ampulla, the widest
section of the fallopian tube.

Meanwhile, the left-over of the ruptured follicle has become a corpus luteum which
secretes progesterone. Progesterone further stimulates uterine development making it a
nutritious bed for the embryo in the event of pregnancy. In the absence of pregnancy, the corpus
luteum atrophies and progesterone level falls. This leads to the breakdown of the endometrium,
menstruation begins and the cycle starts over.
PHASES OF MENSTRUAL CYCLE

Menstrual phase (day 1-5)

Menstrual phase begins on the first day of menstruation and lasts till the 5th day of the menstrual
cycle. The following events occur during this phase:

 The uterus sheds its inner lining of soft tissue and blood vessels which exits the body from
the vagina in the form of menstrual fluid.
 Blood loss of 10 ml to 80 ml is considered normal.
 You may experience abdominal cramps. These cramps are caused by the contraction of the
uterine and the abdominal muscles to expel the menstrual fluid.

Follicular phase (day 1-13)

This phase also begins on the first day of menstruation, but it lasts till the 13th day of the
menstrual cycle. The following events occur during this phase:

 The pituitary gland secretes a hormone that stimulates the egg cells in the ovaries to grow.
 One of these egg cells begins to mature in a sac-like-structure called follicle. It takes 13 days
for the egg cell to reach maturity.
 While the egg cell matures, its follicle secretes a hormone that stimulates the uterus to
develop a lining of blood vessels and soft tissue called endometrium.

Ovulation phase (day 14)

On the 14th day of the cycle, the pituitary gland secretes a hormone that causes the ovary to
release the matured egg cell. The released egg cell is swept into the fallopian tube by the cilia of
the fimbriae. Fimbriae are finger like projections located at the end of the fallopian tube close to
the ovaries and cilia are slender hair like projections on each Fimbria.
Luteal phase (day 15-28)
The following events occur during this phase:

 The egg cell released during the ovulation phase stays in the fallopian tube for 24 hours.
 If a sperm cell does not impregnate the egg cell within that time, the egg cell disintegrates.
 The hormone that causes the uterus to retain its endometrium gets used up by the end of the
menstrual cycle. This causes the menstrual phase of the next cycle to begins.

(https://www.menstrupedia.com/articles/physiology/cycle-phases)
LABOR AND BIRTH PROCESS

Stages of Labor
Labor is traditionally divided into three stages:

Stage 1. The first stage of labor is divided into three phases: latent, active, and transition
phase.

 Latent Phase

The latent or early phase begins at the onset of regularly perceived uterine contractions
and ends when rapid cervical dilatation begins. Contractions during this phase is mild and
short,lasting 20-40 seconds. Cervical effacement occurs and the cervix dilates from 0-3 cm. The
phase averages 6 hours in a nullipara and 4.5 hours in a multipara.a woman who enters labor
with a “nonripe” cervix will
probably have a longer than average
latent phase.

Three phases of the 1st stage of

labor.

 Active phase

During the active phase of labor,

cervical dilatation occurs more
rapidly, increasing from 4-7 cm. at a rate of about 1 cm. per hour in nulliparas and 2 cm per hour
in multiparas. Contractions grow stronger ,lasting 40-60 seconds , and occur approximately
every 3-5 minutes.Show (increased vaginal secretions) and perhaps spontaneous rupture of the
membranes may occur during this time.

 Transition phase

During the transition phase, contractions reach their peak of intensity, occurring every 2-3
minutes with a duration of 60-70 seconds ,and a maximum cervical dilatation of 8-10 cm
occurs.If it has not previously occurred, show will occur as the last of the mucus plug from the
cervix is released. If the membranes have not previously ruptured ,they will usually rupture at
full dilatation (10cm). By the end of this phase, both full dilatation (10 cm) and complete
cervical effacement (obliteration of the cervix) have occurred.

Stage 2. The second stage of labor is the time span from full dilatation and cervical
effacement to birth of the infant. With uncompleted birth and without epidural anesthesia this
stage takes about 1 hour. Your pushing, along with the force of your contractions, will propel
your baby through the birth canal. The fontanels (soft spots) on your baby's head allow it to fit
through the narrow canal.

The fetus begins descent and, as the fetal head touches the internal perineum to begin
internal rotation, her perineum begins to bulge and appear tense. The anus may become everted ,
and stool maybe expelled. As the fetal head pushes against the vaginal introitus, this opens and
the fetal scalp appears at the opening of the vagina and enlarges from the sizes of a dime , to a
quarter , then a half-dollar. This is termed as crowning. As the fetal head is pushed out of the
birth canal , it extends , then rotates to bring the shoulders into the best line with the pelvis. The
body of the baby is then born.

Stage 3. The third stage of labor , the placental stage, begins with the birth of the infant and
ends with the delivery of the placenta. After the birthof the infant , the uterus can be palpated as
a firm, round mass just below the level of the umbilicus. After a few minutes of rest , uterine
contractions begin again, and the organ assumes a discoid shape. It retains this new shape until
the placenta has separated, approximately 5 minutes after the birth of the infant usually

Placental separation: the placenta has loosened and is ready to deliver when:

 There is lengthening of the umbilical cord.

 A sudden gush of vaginal blood occurs.
 The placenta is visible at the vaginal opening.
 The uterus contracts and the feels firm again.

Placental Expulsion- once separation has occurred , the placenta delivers either by the natural
bearing-down effort of the mother or by gentle pressure on the contracted uterine fundus by the
primary health care maneuver ( a Crede Maneuver). If placenta does not deliver spontaneously it
can be removed manually.

(Pillitteri A. “Maternal and Child Health Nursing” Volume I ,2016).