Anatomy and Physiology : Female reproductive system In the reproductive process, two kinds of sex cells or gametes are

involved. The male sperm, and the female egg or ovum. These two cells meet in the female's reproductive system to create a new individual. The egg is fertilized in the uterine tube and implanted in the uterus. Both the male and female reproductive systems are essential for reproduction. The female needs a male to fertilize her egg, even though she is the one who carries the offspring through pregnancy and childbirth.

A. Internal Genitals Vagina The vagina is a muscular, hollow tube that extends from the vaginal opening to the cervix of the uterus. It is situated between the urinary bladder and the rectum. It is about three to five inches long in a grown woman. The muscular wall allows the vagina to expand and contract. The muscular walls are lined with mucous membranes, which keep it protected and moist. A thin sheet of tissue with one or more holes in it, called the hymen, partially covers the opening of the vagina.

The vagina receives sperm during sexual intercourse from the penis. The sperm that survive the acidic condition of the vagina continue on through to the fallopian tubes where fertilization may occur. The vagina is made up of three layers. The perimetrium (outermost layer), myometrium (middle layer), endometrium (innermost layer). The endometrium is made of vaginal rugae that stretch and allow penetration to occur. These also help with stimulation of the penis. The myometrium layer has glands that secrete an acidic mucus (pH of around 4.0.) that keeps bacterial growth down. The perimetrium layer is especially important with delivery of a fetus and placenta because of it's muscular walls. Receives a male's erect penis and semen during sexual intercourse. Pathway through a woman's body for the baby to take during childbirth. Provides the route for the menstrual blood (menses) from the uterus, to leave the body. May hold forms of birth control, such as a diaphragm, Fem Cap, Nuva Ring, IUD, or female condom.

Cervix The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. The location where they meet forms an almost 90 degree angle. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus". During menstruation, the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some women's cramps subside or disappear after their first vaginal birth because the cervical opening has widened. The portion projecting into the vagina is referred to as the portio vaginalis or exocervix. On average, the exocervix is three cm long and two and a half cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips. The exocervix's opening is called the external os. The size and shape of the external os and the exocervix varies widely with age,

hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who have had a vaginal birth, the exocervix appears bulkier and the external os appears wider, more slit-like and gaping. The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures seven to eight mm at its widest in reproductive-aged women. The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity. During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through. During orgasm, the cervix convulses and the external os dilates.

Uterus The uterus is shaped like an upside-down pear, with a thick lining and muscular walls. Located near the floor of the pelvic cavity, it is hollow to allow a blastocyte, or fertilized egg, to implant and grow. It also allows for the inner lining of the uterus to build up until a fertilized egg is implanted, or it is sloughed off during menses. The uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. These muscles also contract rhythmically during an orgasm in a wave like action. It is thought that this is to help push or guide the sperm up the uterus to the fallopian tubes where fertilization may be possible. The uterus is only about three inches long and two inches wide, but during pregnancy it changes rapidly and dramatically. The top rim of the uterus is called the fundus and is a landmark for many doctors to track the progress of a pregnancy and massaged by nurses after the baby is born to help return the uterus to normal size. Massaging helps to stimulate contractions. The uterine cavity refers to the fundus of the uterus and the body of the uterus.

Helping support the uterus are ligaments that attach from the body of the uterus to the pelvic wall and abdominal wall. During pregnancy the ligaments prolapse due to the growing uterus, but retract after childbirth. In some cases after menopause, they may lose elasticity and uterine prolapse may occur. This can be fixed with surgery. Some problems of the uterus include uterine fibroids, pelvic pain (including endometriosis, adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and cancer. It is only after all alternative options have been considered that surgery is recommended in these cases. This surgery is called hysterectomy. Hysterectomy is the removal of the uterus, and may include the removal of one or both of the ovaries and the cervix may or may not be removed. Once performed it is irreversible. After a hysterectomy, many women begin a form of alternate hormone therapy due to the lack of ovaries and hormone production. This is not always necessary and can be monitored with blood analysis.

Fallopian Tubes or uterine tubes At the upper corners of the uterus are the fallopian tubes (uterine tubes). There are a total of two uterine tubes. One on each side of the uterus. Each uterine attaches to a side of the uterus and connects to an ovary on the same side of attachment. They are positioned between the ligaments that support the uterus. The uterine tubes are about four inches long and about as wide as a piece of spaghetti. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each uterine tube is a fringed area that looks like a funnel. This fringed area, called the infundibulum, lies close to the ovary, but is not attached. The ovaries generally alternately release an egg every month. When an ovary does ovulate, or release an egg, it is swept into the lumen of the uterine tube by the frimbriae. Once the egg is in the uterine tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the uterus. The oocyte, or developing egg cell, takes four to five days to travel down the length of the uterine tube.

If enough sperm are ejaculated during sexual intercourse and there is an oocyte in the uterine tube, fertilization will occur. Fertilization most often occurs in the fallopian tube. After fertilization occurs, the zygote, or fertilized egg, will continue down to the uterus and implant itself in the uterine wall where it will grow and develop until birth. If a zygote doesn't move down to the uterus and implants itself in the uterine tube, it is called a ectopic or tubal pregnancy. If this occurs, the pregnancy will need to be terminated and the tube generally removed to prevent permanent damage to the fallopian tube, possible hemorrhage and possible death of the mother. The picture below shows the uterus on the left side of the picture, the vagina just inferior to the uterus, the ovary which is lateral to the uterus. The broad ligament connects the uterus to the ovary. The uterine tube is located superior to the ovary. Ovaries The ovaries are paired, oval organs located within the pelvic cavity lateral to the uterus. In an adult, ovaries are slightly larger than an almond about 2 to 3 centimeters long, 2 cm wide, and 1 to 1.5 cm thick. Their size usually varies during each menstrual cycle as well as during pregnancy. The ovaries are anchored within the pelvic cavity by special "cords" and sheets of connection tissue. A double fold of peritonuem called the mesovarium, attaches to each ovary at its hilum. The hilum is the anterior surface of the ovary where blood vessels and nerves enter the ovary. The mesovarium secures each ovary to a broad ligament, which is a drape of peritonuem that hangs over the uterus. Each ovary is anchored to the posterior aspect of the broad ligament by an ovarian ligament, which is the superior portion of the round ligament of the uterus. A suspensory ligament attaches to the lateral edge of each ovary and projects superolaterally to the pelvic wall. The ovarian blood vessels and nerves are housed within each suspensory ligament, and they join the ovary at its hilum.

Smooth muscle fibers within both the mesovarium and the suspensory ligament contract at the time of ovulation to bring the ovaries into close proximity with the uterine tube openings. Each ovary is supplied by an ovarian vein and artery. The ovarian arteries are branches that come directly off the aorta immediately inferior to the renal vessel. The ovarian veins exit the ovary and drain into either the inferior cava or one of the renal veins. Traveling with the ovarian artery and vein are autonomic nerves. Sympathetic axons come from the T10 segments of the spinal cord whereas parasympathetic axons come from CN X.

B. External genitalia The female external genitalia are collectively known as the vulva or pudendum. They consist of paired folds called the labia majora, which are thickly padded with subcutaneous fat, covered by skin and pubic hair, and have a moist internal lining. The labia majora join and continue over the symphysis pubis as the mons pubis, a small mound raised by a thick underlying pad of fat. The labia minora are freshly folds within the labia majora that lie on either side of the vestibule containing the vaginal and urinary opening and the opening of the greater vestibular glands. The clitoris is erectile tissue, like the penis. The upper ends of the labia minora join around the clitoris to form a prepuce (foreskin).

Lymphatic System The lymphatic system works in close cooperation with other body systems to perform these important functions: The lymphatic system aids the immune system in destroying pathogens and filtering waste so that the lymph can be safely returned to the circulatory system. To remove excess fluid, waste, debris, dead blood cells, pathogens, cancer cells, and toxins from these cells and the tissue spaces between them. The lymphatic system also works with the circulatory system to deliver nutrients, oxygen, and hormones from the blood to the cells that make up the tissues of the body.

Lymph Lymph originates as plasma, which is the fluid portion of blood. The arterial blood that flows out of the heart slows as it moves through a capillary bed (see figure above). This slowing allows some plasma to leave the arterioles and flow into the tissues where it becomes tissue fluid. Also known as intercellular fluid, or interstitial fluid, this tissue fluid delivers nutrients, oxygen, and hormones to the cells. As this fluid leaves the cells, it takes with it cellular waste products and protein cells.

Approximately 90 percent of this tissue fluid flows into the venules. Here it enters the venous circulation as plasma and continues in the circulatory system. The remaining 10 percent of the fluid that is left behind is now known as lymph. Blood Flow Compared with Lymphatic Flow The bloodstream is pumped by the heart. It circulates throughout the body and is cleansed by being filtered by the kidneys. The lymphatic system does not have a pump to aid in its flow, instead this system is designed so that lymph only flows upward through the body traveling from the extremities (feet and hands) and upward through the body toward the neck. As it travels through the body, lymph passes through lymph nodes where it is filtered. At the base of the neck, the lymph enters the subclavian veins and once again becomes plasma in the bloodstream.
Lymph returning to the subclavian veins. Lymph Notes

Lymphatic Capillaries In order to leave the tissues, the lymph must enter the lymphatic system through specialized lymphatic capillaries. Approximately 70 percent of these are superficial capillaries that are located near, or just under, the skin. The remaining 30 percent, which are known as deep lymphatic capillaries, surround most of the bodys organs.

Lymphatic capillaries begin as blind-ended tubes that are only a single cell in thickness. These cells are arranged in a slightly overlapping pattern, much like the shingles on a roof. Each of these individual cells is fastened to nearby tissues by an anchoring filament. As shown in the animation below, pressure from the fluid surrounding the capillary forces these cells to separate for a moment to allow lymph to enter the capillary. Then the cells

of the wall close together. This does not allow the lymph to leave the capillary. Instead it is forced to move forward.

Lymphatic Vessels The lymphatic capillaries gradually join together to form a meshlike network of tubes that are located deeper in the body. As they become larger, these structures are known as lymphatic vessels. Deeper within the body the lymphatic vessels become progressively larger and are located near major veins. Like veins, lymphatic vessels, which are known as lymphangions have one-way valves to prevent any backward flow. Each angions is a segment created by the space between two sets of valves. Smooth muscles in the walls of the lymphatic vessels cause the angions to contract sequentially to aid the flow of lymph toward the thoracic region. Because of their shape, these vessels are previously referred to as a string of pearls.
A functioning lymphangion (Courtesy of Laura Niklason)

Lymph Nodes There are between 600-700 lymph nodes present in the average human body. It is the role of these nodes to filter the lymph before it can be returned to the circulatory system. Although these nodes can increase or decrease in size throughout life, any nodes that has been damaged or destroyed, does not regenerate.

Lymph nodes kill pathogens and cancer cells. They also remove debris and excess fluid.. Lymph Notes

Afferent lymphatic vessels carry unfiltered lymph into the node. Here waste products, and some of the fluid, are filtered out. In another section of the node, lymphocytes, which are specialized white blood cells, kill pathogens that may be present. This causes the swelling commonly swelling known as swollen glands. Lymph nodes also trap cancer cells and slow the spread of the cancer until they are overwhelmed by it. Efferent lymphatic vessels carry the filtered lymph out of the node to continue its return to the circulatory system.

Lymph Organs Lymph organs include the bone marrow, lymph nodes, spleen, and thymus. Bone marrow contains tissue that produces lymphocytes. B-lymphocytes (B-cells) mature in the bone marrow. T-lymphocytes (T-cells) mature in the thymus gland. Other blood cells such as monocytes and leukocytes are produced in the bone marrow. Lymph nodes are areas of concentrated lymphocytes and macrophages along the lymphatic veins. The spleen is similar to

the lymph node except that it is larger and filled with blood. The spleen serves as a reservoir for blood, and filters or purifies the blood and lymph fluid that flows through it. If the spleen is damaged or removed, the individual is more susceptible to infections. The thymus secretes a hormone, thymosin, that causes pre-T-cells to mature (in the thymus) into T-cells.

Immune System The immune system is composed of many interdependent cell types that collectively protect the body from bacterial, parasitic, fungal, viral infections and from the growth of tumor cells. Many of these cell types have specialized functions. The cells of the immune system can engulf bacteria, kill parasites or tumor cells, or kill viral-infected cells. The organs of the immune system, positioned throughout the body, are called lymphoid organs. The Organs of the Immune System Bone Marrow -- All the cells of the immune system are initially derived from the bone marrow. They form through a process called hematopoiesis. During hematopoiesis, bone marrow-derived stem cells differentiate into either mature cells of the immune system or into precursors of cells that migrate out of the bone marrow to continue their maturation elsewhere. The bone marrow produces B cells, natural killer cells, granulocytes and immature thymocytes, in addition to red blood cells and platelets. Thymus -- The function of the thymus is to produce mature T cells. Immature thymocytes, also known as prothymocytes, leave the bone marrow and migrate into the thymus. Through a remarkable maturation process sometimes referred to as thymic education, T cells that are beneficial to the immune system are spared, while those T cells that might evoke a detrimental autoimmune response are eliminated. The mature T cells are then released into the bloodstream. Spleen -- The spleen is an immunologic filter of the blood. It is made up of B cells, T cells, macrophages, dendritic cells, natural killer cells and red blood cells. In addition to capturing foreign materials (antigens) from the blood that passes through the spleen, migratory macrophages and dendritic cells bring antigens to the spleen via the bloodstream. An immune response is initiated when the macrophage or dendritic cells present the antigen to the

appropriate B or T cells. This organ can be thought of as an immunological conference center. In the spleen, B cells become activated and produce large amounts of antibody. Also, old red blood cells are destroyed in the spleen. Lymph Nodes -- The lymph nodes function as an immunologic filter for the bodily fluid known as lymph. Lymph nodes are found throughout the body. Composed mostly of T cells, B cells, dendritic cells and macrophages, the nodes drain fluid from most of our tissues. Antigens are filtered out of the lymph in the lymph node before returning the lymph to the circulation. In a similar fashion as the spleen, the macrophages and dendritic cells that capture antigens present these foreign materials to T and B cells, consequently initiating an immune response. The Cells of the Immune System T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a pertinent coordinator of immune regulation. The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Another important type of T cell is called the T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites. The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body. They often depend on the secondary lymphoid organs (the lymph nodes and spleen) as sites where activation occurs, but they are also found in other tissues of the body, most conspicuously the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- Natural killer cells, often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirusinfected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference" in the lymphoid organs. However, NK cells that have been activated by secretions

from CD4+ T cells will kill their tumor or viral-infected targets more effectively. B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to one particular protein that specifically recognize and bind to one particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Another group of white blood cells is collectively referred to as granulocytes or polymorphonuclear leukocytes (PMNs). Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. They engulf these foreign bodies and degrade them using their powerful enzymes. Macrophages -- Macrophages are important in the regulation of immune responses. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other cells of the immune system such as T cells and B cells. This is one of the important first steps in the initiation of an immune response. Stimulated macrophages exhibit increased levels of phagocytosis and are also secretory. Dendritic Cells -- Another cell type, addressed only recently, is the dendritic cell. Dendritic cells, which also originate in the bone marrow, function as antigen presenting cells (APC). In fact, the dendritic cells are more efficient apcs than macrophages. These cells are usually found in the structural compartment of the lymphoid organs such as the thymus, lymph nodes and spleen. However, they are also found in the bloodstream and other tissues of the body. It is believed that they capture antigen or bring it to the lymphoid organs where an immune response is initiated. Unfortunately, one reason we know so little about

dendritic cells is that they are extremely hard to isolate, which is often a prerequisite for the study of the functional qualities of specific cell types. `Of particular issue here is the recent finding that dendritic cells bind high amount of HIV, and may be a reservoir of virus that is transmitted to CD4+ T cells during an activation event. The Immune Response An immune response to foreign antigen requires the presence of an antigen-presenting cell (APC), (usually either a macrophage or dendritic cell) in combination with a B cell or T cell. When an APC presents an antigen on its cell surface to a B cell, the B cell is signalled to proliferate and produce antibodies that specifically bind to that antigen. If the antibodies bind to antigens on bacteria or parasites it acts as a signal for pmns or macrophages to engulf (phagocytose) and kill them. Another important function of antibodies is to initiate the "complement destruction cascade." When antibodies bind to cells or bacteria, serum proteins called complement bind to the immobilized antibodies and destroy the bacteria by creating holes in them. Antibodies can also signal natural killer cells and macrophages to kill viral or bacterialinfected cells. If the APC presents the antigen to T cells, the T cells become activated. Activated T cells proliferate and become secretory in the case of CD4+ T cells, or, if they are CD8+ T cells, they become activated to kill target cells that specifically express the antigen presented by the APC. The production of antibodies and the activity of CD8+ killer T cells are highly regulated by the CD4+ helper T cell subset. The CD4+ T cells provide growth factors or signals to these cells that signal them to proliferate and function more efficiently. This multitude of interleukins or cytokines that are produced and secreted by CD4+ T cells are often crucial to ensure the activation of natural killer cells, macrophages, CD8+ T cells, and PMNs is listed in the chart below.