CCMA Training Notes: Reproductive System Review
Reproductive system
Anatomy
The Male Reproductive System
Scrotum: This is a sack-like structure surrounding the testicles that protects and supports the testicles. It is suspended from the pubic arch behind the penis.
Testicles (testes): These are two small, egg-shaped glands that produce sperm.
Seminiferous Tubules: Sperm are formed within the seminiferous tubules of each testicle.
Epididymis: This is the coiled tube at the upper part of each testicle and then turns upward toward the body where it forms the vas deferens.
Spermatic Cord: Attached to each testicle are the spermatic rods extending upward from the epididymis.
Penis: Is the male sex organ that transports the sperm into the female vagina. It is made of three columns of erectile tissue.
Glans Penis: Is the head of the penis located at the tip of the penis.
Foreskin or Prepuce: Is the retractable double-layered fold of skin that covers and protects the glans penis.
Vas Deferens: This is also called the ductus deferens. It is a long, narrow continuation of each epididymis. They joined the urethra.
Seminal Vesicles: These are glands that secrete a thick, yellow substance that nourishes the sperm cells. They are loacted at the base of the urinary bladder.
Ejaculatory Duct: This tube begins at the Vas Deferens and passes through the prostate gland. It then empties into the urethra. During a reflex action caused by the ejaculatory ducts, semen passes into the urethra. The semen then exits the body through the penis.
Prostate Gland: This gland lies under the bladder and surrounds the end of the urethra where the vas deferens enters the urethra. It secretes a very thick
Bulbourethral Glands: There are two of them which are also known as Cowper’s glands. These are found below the prostate gland, one on each side of the urethra. The glands secrete pre-ejaculate during sexual arousal that helps flush out residual urine and foreign matter in the urethra. It also lubricates the urethra, so the sperm passes through unencumbered.
Urethra: This organ is also part of the urinary tract, and it passes through the penis to the outside of the body serving both systems.
The Female Reproductive System
External Female Genitalia:
Mons Pubis: This is the rounded, fleshy prominence located over the pubic symphysis.
Vulva: It consists of the labia, clitoris, Bartholin’s glands, and vaginal orifice.
Bartholin's Glands: These two small, round glands produce a mucus secretion to lubricate the vagina.
Labia Majora and Labia Minora: These are lip-type structures that protect the external genitalia and urethral meatus in the vagina.
Vaginal Orifice: This is the exterior opening of the vagina.
Breasts: Are fatty tissue that include the mammary glands suspended by ligaments between the skin and pectoral muscles.
Mammary Glands: These glands produce milk for nourishing the newborn infant. They include lactiferous ducts that carry milk from the mammary glands to the nipple.
Internal Female Genitalia:
Ovaries: These are a pair of smell, almond-shaped organs in the lower abdomen, on either side of the uterus. They produce and store eggs (ova) and makes hormones that control the menstrual cycle and pregnancy.
Ova: This is the medical term for the egg, or female gametes. They are present at birth. After puberty, one egg (normally) matures and is released each month for potential fertilization by the sperm from the mate.
Fallopian Tubes: There are two fallopian tubes that extend from the upper end of the uterus to a point near the ovary.
Infundibulum: This is the funnel-shaped opening into the fallopian tube near the ovary.
Fimbriae: This is the fringed, finger-like extensions of the infundibulum.
Uterus: This is a pear-shaped organ with muscular walls. Inside is a mucous membrane lining that has a rich supply of blood vessels and there are 3 layers of the uterus called...
Perimetrium: It is on the outside.
Myometrium: It is in the middle.
Endometrium: It is on the inside.
Vagina: This is the muscular tube lined with mucosa extending from the cervix to the outside of the body.
Cervix: This is the lower, narrow porition that extends into the vagina.
Internal and External Structures
Physiology
Male Physiology
Sperm is produced in the seminiferous tubules of the testes and released by th testes into the epididymis where they mature and are stored. When the penis fills with blood and becomes erect ejaculation occurs.
Mature sperm being their journey from the epididymis to the vas deferens, which propels sperm forward with smooth muscle contractions.
The sperm arrives at the ampulla just above the prostate gland.
The seminal vehicles release their secretions.
The seminal fluid and sperm are propelled forward through the ejaculatory ducts toward the urethra.
The prostate gland secretes a milky fluid to make sperm.
Finally, the semen is ejaculated from the penis through the urethra.
Female Physiology
The ovaries produce the eggs (gametes) and related sex hormones.
After menarche (the female’s first menstrual cycle), puberty occurs, and the monthly menstrual cycle begins.
Each month, one egg follicle becomes dominant into a Graafian Follicle.
At ovulation, the Graafian follicle expels the ovum from its surrounding tissue.
If no fertilization takes place, the egg is expelled from the uterus along with the secretory endometrial lining which is menstrual bleeding, BUT if it does take place, the fertilized egg implants in the endometrial wall so that the egg can develop into a fetus.
At perimenopause, the female transitions between regular menstrual periods and no periods at all. Menopause is the normal termination of the menstruation in a woman during middle age.
Pregnancy
Ovulation: Specifically refers to the release of a mature egg from a follicle on the surface of one of the ovaries which happens on the 14th day of the female’s menstrual cycle. When the ovum is released, it is caught up in the fimbriae of the fallopian tube and moved along toward the uterus. This takes about 5 days and if sperm is present, one can fertilize the ovum. After the ovum was released, the ruptured. Follicle enlarges and becomes the corpus luteum which secretes progesterone during the second half of the menstrual cycle. This helps the uterine lining grow to support the fertilized egg. If the ovum is not fertilized, the corpus luteum dies and is eliminated as menstrual flow.
Fertilization: During sexual intercourse (also called copulation or coitus), the male ejaculates about 100 million sperm into the female’s vagina. The sperm travels upward through the vagina, into the uterus, and into the fallopian tubes.
Conception: When sperm penetrates and fertilizes the descending ovum. The union is the beginning of new life forms a single cell – a zygote. After fertilization, the zygote travels to the uterus and embeds in the uterus lining. At the 8th week of pregnancy, the zygote is referred to as an embryo. From the 9th week, the baby in utero is called a fetus.
Chorion: Is the thin outer membrane that encloses the embryo.
Placenta: Is a temporary organ that forms in the uterus to allow the exchange of nutrients, oxygen, and waste products between the mother and growing fetus. The placenta also secretes hormones to maintain pregnancy.
Amniotic sac: Is the innermost membrane surrounding the embryo in the uterus.
Amniotic fluid: Is the liquid that protects the fetus inside the uterus.
Afterbirth: This is the placenta and fetal membranes expelled after birth of the baby.
Umbilical Cord: Refers to the tube that carries blood, oxygen, and nutrients from the placenta to the growing fetus and transports waste from the fetus to be disposed of through the mother’s excretory system. The umbilical cord is attached to the fetus at the naval.
Gestation: Refers to the period of development of the baby in the uterus. It lasts for about 280 days, or 40 weeks.
Pregnancy: Refers to the condition of having a developing baby in the uterus. It's divided into three trimesters, and each is about 13 weeks.
Due date: estimated date of confinement (EDC) and it is calculated from tghe 1st day of the last menstrual period.
The Female Sexual Cycle
Follicular phase:
Menstruation
Growing Follicle
Proliferative phase
Ovulation where the endometrium helps release an egg is released at 14 days from start of menstruation
Luteal phase:
Entering the secretory phase the endometrium diminishes slowly into the corpus luteum with the egg growing inside uterus.
Then after 28 days the corpus luteum finally diminishes into the corpus Albicans with egg inside uterus still growing.
Pregnancy Terms
Nulligravida: Refers to a woman who has never been pregnant.
Nullipara: Refers to a woman who has never been borne a viable child. Viable means that the fetus can live outside the body independently, even if it has not reached the full 40 weeks.
Primigravida: The refers to a woman during her 1st pregnancy.
Primipara: This refers to a woman who has borne one viable child.
Multiparous: This refers to a woman who has given birth two or more times.
Labor and Delivery
1st Stage: During this stage of labor, there is gradual dilation and effacement of the cervix and rupture of amniotic sac.
Effacement: Refers to the process by which the cervix prepares for delivery by softening, shortening, and thinning.
2nd Stage: This stage begins when the cervix is dilated to 10 centimeters. The contractions of the uterus become stronger and more frequent. The mother can begin pushing to help expel the child through the birth canal (vagina). The baby’s head presents first in a normal birth; however, the baby can be turned around. Cephalic presentation or crowning is when the baby is coming out headfirst.
3rd Stage: In this stage, the placenta is expelled from the mother as the childbirth.
Common Diseases and Disorders
Disorders of the Penis
Balanitis: Refers to an inflammation of the glans penis typically caused by poor hygiene in men who have not had the foreskin removed by circumcision.
Phimosis: Refers to narrowing of the opening of the foreskin so that it cannot be pulled back to expose the glans penis.
Erectile dysfunction (ED): Impotence or the inability of male to achieve or maintain a penile erection.
Peyronie’s disease: Also known as penile curvature and refers to a penis that is bent or curved during erection.
Priapism: Refers to painful erection that lasts for four hours or more but is not accompanied by sexual excitement and does not go away after sexual excitement has ended. It can be caused by blood-related diseases or medications.
Premature ejaculation: In this condition, the male reaches climax too soon, either before or shortly after penetration of the female.
Disorders of the Testicles
Andropause: Refers to Androgen Decline in the Aging Male (ADAM) which is the decrease of the male hormone testosterone beginning typically in the late 40s and progressing gradually over the next decades.
Cryptorchidism: Is the medical term for an undescended testicle and refers to defect in which one or both testicles fall to descend into their normal position in the scrotum.
Anorchism: Is a congenital absence of one or both testicles.
Epididymitis: Inflammation of the epididymis caused by an infection from the urethra or bladder.
Spermatocele: Cyst that develops in the epididymis and is filled with a milky fluid having sperm.
Testicular cancer: Type of cancer that begins in the testicles and is the most common cancer in American males between the age of 15 and 34.
Testicular torsion: Sharp pain in the scrotum caused by twisting of the vas deferens and blood vessels leading into the testicles.
Testitis: Inflammation of one or both testicles.
Varicocele: A knot of widening varicose veins on one side of the scrotum.
Hydrocele: A fluid filled with sac in the scrotum.
Azoospermia: The absence of sperm in the semen.
Oligospermia: a sperm count of below 20 million/mL.
Hematospermia: the presence of blood in the seminal fluid.
Sexually Transmitted Diseases (STDs)
Chlamydia: An infection is caused by the bacterium Chlamydia trachoma-tis.
Bacterial Vaginosis (BV): This is a condition in females in which there is an abnormal overgrowth of bacteria in the vagina.
Genital Herpes: This STD is caused by the herpes simplex virus type 1 or type 2.
Genital Wards: These are caused by human papillomaviruses (HPV). The infection affects the male urethra and the female external genitalia, cervix, and vagina. This virus also increases risk of cervical cancer.
Gonorrehea: This STD is caused by the bacterium Neisseria.
Human Immunodeficiency Virus (HIV): This STD is transmitted through exposure to infected body fluids, especially through sexual intercourse with an infected partner.
Syphilis: This STD is caused by the bacterium Treponema pallidum.
Trichomoniasis: This STD is an infection caused by the parasite Trichomonas vaginalis.
Disorders of the Ovaries and Fallopian Tubes
Anovulation: The absence of ovulation when it would be normally expected.
Can be caused by poor nutrition, stress, or hormone imbalances.
There may or may not be menstruation.
Oophoritis: The inflammation of an ovary that can occur with pelvic inflammatory disease.
Pelvic Inflammatory Disease (PID): This is any inflammation of the female reproductive organs not associated with pregnancy or surgery and is often a complication of an STD.
Polycystic Ovary Syndrome: This condition is caused by a hormonal imbalance.
The ovaries develop cysts because of incompletely developed follicles.
Pyosalpinx: An an accumulation of pus in one of the fallopian tubes.
Salpingitis: An inflammation of a fallopian tube.
Ovarian Cancer: Type of cancer that begins in the cells of the ovaries but can metastasize or spread to other body tissues and organs.
Disorders of the Uterus
Endometriosis: This refers to a painful condition in which tissue that is similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes, and the tissue lining the pelvis.
Endometrial Cancer: This type of cancer begins in the lining of the uterus.
Uterine Fibroids: These are benign tumors composed of muscle and fibrous tissue developing in the wall of the uterus.
Uterine Prolapse: A pelvic floor hernia where the uterus slides too low in the pelvic cavity and sags into the vagina.
Disorders of the Cervix
Cervicitis: An inflammation of the cervix typically caused by an infection.
Endocervicitis: An inflammation of the mucous membrane lining of the cervix.
Cervical Dysplasia: The presence of precancerous changes in cells of the inner lining of the cervix. Early detection and treatment can prevent these cells from becoming malignant, or cancerous.
Cervical Cancer: Squamous cell cancer caused by human papillomaviruses (HPV) that can often be prevented with vaccination and can be detected early via a Pap smear.
Disorders of the Vagina and External Genitalia
Vaginitis: An inflammation of the lining of the vagina caused by bacteria, viruses, or fungi.
Vagina Atrophy: A decrease in the lubrication and elasticity of the vagina typically caused by changes in hormones with aging and menopause.
Vaginal Candidiasis: The medical term for a yeast infection and it is caused by the fungus Candida albicans.
Vaginismus: Involuntary spasms of the pelvic floor muscles closing off the vagina.
Colporrhexis: Tearing or laceration of the vaginal wall.
Dyspareunia: Pain during intercourse.
Leukorrhea: Profuse, whiteish mucus discharge from the vagina and sometimes uterus.
Pruritus Vulvae: Severe itching of the external female genitalia.
Vulvitis: An inflammation of the vulva.
Breast Diseases
Mastitis: A breast infection caused by bacteria that most frequently occurs during breastfeeding.
Mastalgia: Pain in the breast.
Galactorrhea: A production of breast milk by a woman who is not breastfeeding.
Fibrocystic Breast Disease: Is where there are one or more benign cysts in the breast typically in older women.
Fibroadenoma: The presence of a round, firm mass caused by excess growth of glandular and connective tissue in the breast.
Breast Cancer: The formation of cancerous cells in breast tissue.
Menstrual Disorders
Amenorrhea: The absence of a menstrual period for 90 days or more and can be cause by stress, hormone problems, poor nutrition, or excessive exercise.
Dysmenorrhea: Pain caused lay uterine tramps during the menstrual period.
Hypermenorrhea: An excessive amount of menstrual flow over a period of more than seven days.
Hypomenorrhea: An abnormally small amount of menstrual flow during a shortened menstrual period.
Menometrorrhagia: Excessive uterine bleeding both during the menstrual cycle and at other times.
Metrorrhagia: Uterine bleeding between menstrual cycles.
Oligomenorrhea: Infrequent or noticeably light menstruation.
Polymenorrhea: A menstrual cycle that is more frequent than normal.
Premenstrual Syndrome: The symptoms experienced by many women within the 2-week period before menstruation.
Symptoms include swelling and bloating, headache, mood swings, breast pain, and cramps.
Premenstrual Dysphoric Disorder (PMDD): Severe emotional and physical symptoms linked to the menstrual cycle.
Premature Syndrome: When the ovaries cease functioning before the age of 40 and can be cause by disease, hormonal problems, or surgical removal of the ovaries.
Pathology of Pregnancy and Child Brith
Ectopic pregnancy: Is where the fertilized egg is implanted and begins to develop outside of the uterus.
Abortion: The interruption or termination of pregnancy before fetus is viable.
Induced abortion is caused by human intervention.
Gestational Diabetes Mellitus: A form of diabetes that occurs during pregnancy.
Infertility: The inability of a couple to become pregnant after 1 year of regular, unprotected intercourse and can also refer to the inability of the woman to carry a pregnancy to a live birth.
Preeclampsia: A pregnancy complication where the mother develops hypertension, or high blood temperature.
Eclampsia: A serious form of preeclampsia where the blood pressure is severely high causing convulsions and coma.
HELLP Syndrome: The hemolysis, elevated liver enzymes, and low platelet count related to preeclampsia or eclampsia.
It is life-threatening and can occur toward the end of the pregnancy or after childbirth.
Abruptio Placentae: When the placenta separates from the uterine wall before childbirth.
It is the leading cause of death of the fetus.
Breech Presentation: Presentation of the fetus with the buttocks or feet of the fetus positioned to enter the birth canal first instead of the head.
Placenta Previa: The abnormal implantation of the placenta in the lower portion of the uterus,
Premature Infant: A preemie is a fetus borne before the 37th week of gestation.
Stillbirth: Birth of a fetus that died before or during delivery.
Postpartum Depression: Mothers with this mood disorder feel sadness and loss of pleasure in normal activities shortly after giving birth and it is cause by hormonal imbalance.
Types of abnormal pregnancies and their likelihood:
Interstitial: Development of the embryo in the interstitial department and around 2-3%.
Isthmic: Development of the embryo in the isthmic department and around 12%.
Ampullary: Development of the embryo in the ampullar department and around 77%.
Abdominal: Development of the embryo in the abdomen and around 1%.
Cervical: Development of the embryo in the cervix and around 1%.
Ovarian: Development of the embryo in the ovary and around 3%.
Fimbrial: Development of fetus in the fibroids and around 11%.