杨冬梓 Dongzi Yang

Memorial Hospital of Sun Yat-Sen University

中山大学 附属孙逸仙纪念医院妇产科

Welcome to the course ofWelcome to the course of Obstetrics & GynecologyObstetrics & Gynecology

Welcome to the course ofWelcome to the course of Obstetrics & GynecologyObstetrics & Gynecology

Chapter 1-2

Female reproductive system

女性生殖系统

Chapter 1-2

Female reproductive system

女性生殖系统

Obstetrics & GynecologyObstetrics & Gynecology

Female reproductive systemFemale reproductive system Female reproductive systemFemale reproductive system

Organization (Anatomy) Functions （ Physiology ）

Visualize the anatomical structure of the female reproductive system. Describe the hormones that regulate the female reproductive system. Explain the sequence of events during the menstrual cycle.

Contents

After learning these two chapters, you should be able to :

Chapter 1: Anatomy of the female reproductive system

Chapter 1: Anatomy of the female reproductive system

Adjacent organs

The blood ,nerve, and lymphatic supplies to the pelvic structures (self-study)

The pelvic structures External and internal genitalia

Be familiar with

Comprehend

Female reproductive system Female reproductive system

The PelvisThe Pelvis

Structures Dividing line Types

External genital organsExternal genital organs

Internal genital organsInternal genital organs

Vagina Uterus Fallopian tubes (oviducts) Ovaries

Anterior view Posterior view

Bony pelvisBony pelvis Bony pelvisBony pelvis

《 supper mom’s body 》

Bony pelvis: Structures Structures Bony pelvis: Structures Structures

骶骨Os sacrum

5 or 6 sacral vertebrae

尾骨Os coccyx

4 or 5 caudal or coccygeal vertebrae

左右髋骨Os coxae(Innominate bone)

左右髂骨Os ilium

左右坐骨Os ischium

左右耻骨Os pubis

ilium

sacrum

pubiscoccyx

ischium

Bony pelvis: JointsJoints Bony pelvis: JointsJoints

Jointscartilaginous symphyseal

Sacro-coccygeal joint

Symphysis pubica

synovial joint

Sacro-iliac jointSacro-iliac joint

Sacro-coccygeal joint

Symphysis pubica

Bony pelvis: The LigamentsThe Ligaments Bony pelvis: The LigamentsThe Ligaments

骶结节韧带 Lig. sacrotuberaleattached to the ilium,sacral vertebrae and the ischial tuberosity

骶棘韧带 Lig. sacrospinaleextending from the sacrum and coccyx to the spine of the ischium

Bony pelvis: Bony pelvis:

The greater pelvis (false pelvis)

The lesser pelvis(true pelvis)

subpubic angle (pubic arch)

Outline ： connet the promontory of the sacrum with the superior margin of the pubis （耻骨联合上 缘、 髂耻缘及骶岬上缘的连线） Inlet Outlet Female pelvic cavity: broader and shallower

Bony pelvis: PlanesPlanes Bony pelvis: PlanesPlanes

The pelvic inletThe pelvic inlet The pelvic inletThe pelvic inlet

13-14cm 12.5cm

11.5cm

Diameters of the pelvic inlet

Transverse diameter

Oblique diameter

The anteroposterior diameter

The pelvic outletThe pelvic outlet The pelvic outletThe pelvic outlet

10-12cm

9cm

The diameters of the pelvic outlet

The anteroposterior diameter

The transverse diameter of the outlet

Types of pelvisTypes of pelvis Types of pelvisTypes of pelvis

Gynecoid Android Anthropoid platypelloid

The female pelvic inlet is oval;

The pelvic cavity is broader and shallower,

The bony wall of the pelvic canal are more vertical

Subpubic angle is broader in the female pelvis.

Female external genital organsFemale external genital organs Female external genital organsFemale external genital organs

• anatomy• Physiology

External genital organsExternal genital organs External genital organsExternal genital organs

Mons pubis

clitoris

Urethral orifice

Vaginal orifice

vestibuleLabia majora

Labia minora

Vulva (The female urogenital triangle)

External genitalia

anus

Hymen 处女膜

阴道 (vagina)

子宫 (uterus)

输卵管 (fallopian tubes)

卵巢 (ovaries)

Female internalFemale internal genital organsgenital organs Female internalFemale internal genital organsgenital organs

InternalInternal genital organs:genital organs: VaginaVagina InternalInternal genital organs:genital organs: VaginaVagina

fornix

fornix

InternalInternal genital organs:genital organs: UterusUterus InternalInternal genital organs:genital organs: UterusUterusFundus uteri

Cavitas uteri

Canalis cervicisuteri

Corpus uteri

cervix

Internal os

External os

Transition zone

Lateral view of the pelvic viscera

LigamentsLigaments LigamentsLigaments

Round ligament

Broad ligament

Cardinal ligament

Uterosacral ligament

Lateral view of the pelvic viscera

输卵管 ureter

卵巢 ovaties

子宫圆韧带 round lig.

Laparoscopic view

InternalInternal genital organs:genital organs: Fallopian tube or Fallopian tube or Oviduct OvaryOviduct Ovary InternalInternal genital organs:genital organs: Fallopian tube or Fallopian tube or Oviduct OvaryOviduct Ovary

ampulla

isthmus

ovaryinfundibulum

InternalInternal genital organs:genital organs: OvaryOvary InternalInternal genital organs:genital organs: OvaryOvary

OvaryOvary

尿道 Urethra

膀胱 bladder

输尿管 ureters

直肠 rectum

阑尾 appendix

Adjacent organsAdjacent organs Adjacent organsAdjacent organs

Lateral view of the pelvic viscera

Superior view of the abdominal cavity

Self - StudySelf - Study Self - StudySelf - Study

Blood vessels, lymphatic drainage, and nerves

Pelvic floor

Neuropathways in ParturitionPelvic Area Enlarged

Why do obstetricians care about the diameters of the inlet of pelvis when a woman delivers ？

Why do obstetricians care about the diameters of the inlet of pelvis when a woman delivers ？

Problem- base learning (PBL)Problem- base learning (PBL)

In IVF-ET, the pathway of oocyte retrieval is by the way of the pouch of the Douglas, why ？

In IVF-ET, the pathway of oocyte retrieval is by the way of the pouch of the Douglas, why ？

Chapter 2

Female reproductive physiology

女性生殖生理

Chapter 2

Female reproductive physiology

女性生殖生理

Obstetrics & GynecologyObstetrics & Gynecology

Adrenarche, growth spurt

Thelarche, secondary sexual charateristics Menarche

PubertyPuberty

The cessation of menstruation and ovulation Age 45-55 years

MenopauseMenopause

1 10 20 30 40 50 60 70age(year)

infant

The reproductive life of women

menarche

reproductionmenopause

Puberty and MenopausePuberty and Menopause Puberty and MenopausePuberty and Menopause

The number of oocytes in the ovary The number of oocytes in the ovary from birth to menopause from birth to menopause The number of oocytes in the ovary The number of oocytes in the ovary from birth to menopause from birth to menopause

Puberty : from the onset of active gonads to the final maturationReproduction ： menstrual cycle ； ovarian cycle and uterine cycleMenopause: the cessation of gonads function

From puberty to menopauseFrom puberty to menopause From puberty to menopauseFrom puberty to menopause

Ovarian cycle Follicular phase ovulation Luteal phase Uterine cycle (endometrial cycle) Proliferative phase Secretory phase Menses

Menstrual cycle physiologyMenstrual cycle physiology Menstrual cycle physiologyMenstrual cycle physiology

Normal menstrual cycle

Menstrual cycle physiologyMenstrual cycle physiology Menstrual cycle physiologyMenstrual cycle physiology

Menstrual cycle regulationMenstrual cycle regulation Menstrual cycle regulationMenstrual cycle regulation

Oogenesis

Fertility

menstuation

Hypothalamus- pituitary- ovary (HPO) axisHypothalamus- pituitary- ovary (HPO) axis Hypothalamus- pituitary- ovary (HPO) axisHypothalamus- pituitary- ovary (HPO) axis

ovaryovary

LHLH FSHFSH

PituitaryPituitary

E2

、P

(-)

E2

、P

(-)

I

Inh

ibin

(-)

Inh

ibin

(-)

Hypothalamus

GnRHGnRH

Thecal cellsGranulosa cells

the basement membrane

The two-cell two gonadotrophin theoryThe two-cell two gonadotrophin theory The two-cell two gonadotrophin theoryThe two-cell two gonadotrophin theory

The two-cell two gonadotrophin theoryThe two-cell two gonadotrophin theory The two-cell two gonadotrophin theoryThe two-cell two gonadotrophin theory

Ovarian sex steroids ( Hormones )Ovarian sex steroids ( Hormones ) Ovarian sex steroids ( Hormones )Ovarian sex steroids ( Hormones )

Oestrogens, e.g. oestradiol

1. Development of the reproductive organs and secondary sexual characteristics.2. Proliferation of the functional layer of uterus endometrium.

Progestogens, e.g. progesterone

1. Maintenance of the uterine endometrium.2. Stimulation of the uterine secretions

Androgens, e.g. endrostenedione

act with adrenal angrogen to promote pubic and axillary hair growth during puberty

Problem- base learning (PBL)Problem- base learning (PBL)Problem- base learning (PBL)Problem- base learning (PBL)

Base on the two-cell two gonadotrophin theory, if LH elevated continually, which hormone will be increased ？

Base on the two-cell two gonadotrophin theory, if LH elevated continually, which hormone will be increased ？

In a woman with irregular menstrual cycle, what do you firstly suspect?

In a woman with irregular menstrual cycle, what do you firstly suspect?

NOVAK Gynecology （ the14rd edition ） ,Jonathan

S. Berek ， Lippincott Williams & Wilkins ,2007

Anatomy.2nd edition, Dykes, Ameerally, Mosby. 200

3

Sanders, Debuse: Endocrine & Reproductive syste

ms. Mosby. 2002

ReferencesReferences ReferencesReferences