THE FEMALE REPRODUCTIVE SYSTEM

Transcription

1 Hello and welcome back to InterpreterPrep.com THE FEMALE REPRODUCTIVE SYSTEM We are going to be covering the FEMALE REPRODUCTIVE SYSTEM and all its mysteries in this presentation. SEXUALLY TRANSMITTED DISEASES (STD's) will also be included. The female reproductive system is located in the pelvis, below the small intestines as we see here in this image that shows a turquoise colored uterus and two blue ovaries. The female reproductive system: consists of: 1) The OVARIES 2) The FALLOPIAN TUBES 3) The UTERUS and its CERVIX 4) The VAGINA 5) The EXTERNAL GENITALIA (LABIA MAJORA AND MINORA) Now, let s talk about each part a little bit. 1) The OVARIES: the ovaries are two almond shaped organs, located in the upper and outer part of the pelvis like we see in the image. Just like their male counterparts, the testicles, the ovaries have a DOUBLE ROLE : A) ENDOCRINE ROLE: which they carry out by secreting the female hormones (ESTROGEN, PROGESTERONE) into the bloodstream. I'll come back and explain what these hormones do a little later. B) REPRODUCTIVE ROLE: because the ovaries produce the OVA (human eggs). We will explore that more in the Obstetrics presentation. 2) The FALLOPIAN TUBES: are two tubes that extend from the ovaries to the body of the uterus which are lined with mucous membrane (just like the membrane inside of your mouth). They possess finger-like projections called fimbriae that catch the ovum. Once inside the tube, the ovum is shuffled along by waves of contractions (peristalsis) down into the body of the uterus. We see here a cross section of the tube and ovary showing a progression of the ovum down the tube. This is about a 5 day journey and it's generally where the egg meets the sperm-boy meets girl! 3) The UTERUS: imagine the uterus like a hollow upside-down pear (fruit). Its function is to receive the fertilized egg and harbor it during the course of pregnancy. It is made of smooth muscle and also has an inner lining of mucous membrane. If pregnancy doesn't occur it sheds its inner lining called the ENDOMETRIUM and menstruation occurs.

2 The uterus is divided from top to bottom in 3 parts: -FUNDUS: area where the fallopian tubes are located. -BODY: the central portion. -CERVIX: the lowest part of the uterus; where it narrows as seen here which opens into the vagina through the EXTERNAL OS. 4) The VAGINA: is a muscular tube, about 3 inches long, that connects the uterus with the vulva. As we see in this image, the VAGINA sits between the BLADDER and the RECTUM. Right behind the upper back wall of the vagina lies the lowest part of the abdominal cavity (seen in gray) which explains why a sample of fluids from the abdominal cavity can be obtained by piercing this upper back wall of the vagina with a needle. A procedure called a: CULDOCENTESIS. The vagina contains folds of tissue called rugae which allow the vagina to stretch during intercourse and childbirth. The vagina is: the female organ of copulation part of the birth canal and serves as a passageway for the menstrual flow All this we have talked about: the ovaries, fallopian tubes, uterus and vagina are known as the INTERNAL GENITALIA. 5) The EXTERNAL GENITALIA aka VULVA: consist of: - MONS PUBIS: name given to the fatty tissue that covers the pubic region - LABIA MAJORA and MINORA: The labia majora are 2 folds of skin containing fatty tissue, containing hair that cover the entry to the vagina. The labia minora are two thin folds of tissue located within the labia majora (shaded in red in the sketch). - CLITORIS: is erectile tissue located up where both labia minora meet similar to the male penis (like a mini penis). - VESTIBULE: oval-shaped area seen when we separate the labia minora (shaded in yellow in sketch). It's the area which contains: A) URINARY MEATUS: which is the opening of the urethra, where urine flows out. B) VAGINAL ORIFICE aka INTROITUS: is the entry to the vagina. At birth the introitus is covered by a thin membrane called hymen which forms a border around the outer opening of the vagina. Its absence doesn't necessarily equate to lost virginity (since it can be torn during sports for example). C) BARTHOLIN'S GLANDS: these glands function is to lubricate the vagina. They are located on each side of the introitus and although you can see them in the sketch as yellow-red circles they are below the skin and not visible. - PERINEUM: diamond shaped area that extends from the vagina to the anus (area within the green lines seen in the sketch). I like to describe it as the in between the legs area! Composed of muscular and fibrous tissues that serve as a support for the vagina and other pelvic structures. Sometimes an incision is done at delivery time to avoid the tearing of the perineum during childbirth. That incision is called an EPISIOTOMY.

3 Let s give a brief summary of the actions of the female sex hormones: ESTROGEN is responsible for: - The MATURATION OF the OVARIAN FOLLICLES - The THICKENING OF THE ENDOMETRIUM in preparation to receive the fertilized egg every month. - The ONSET OF MENSTRUATION - and the appearance of the SECONDARY SEXUAL CHARACTERISTICS in puberty such as growth of the breasts, deposit of fat to give the rounded female look, the growth of pubic and axillary hair and the growth spurt. PROGESTERONE: As its name implies: PRO = FOR and GEST = PREGNANCY. - This hormone helps prepare for pregnancy. It provides SUPPORT FOR THE ENDOMETRIUM and THE PLACENTA. SOME SIGNS OF DISEASE: 1) PAIN or DISCOMFORT: in the lower quadrants of the abdomen, pelvis or vagina 2) VAGINAL DISCHARGE: clear or whitish fluid that comes out of the vagina 3) BLEEDING: that occurs in between periods or when heavier or more prolonged than usual. 4) VAGINAL ITCH and REDNESS 5) BAD ODOR 6) INFERTILITY: inability to get pregnant. 7) FEVER: body's temperature over 98.6 Fahrenheit SOME DISEASES: 1) OVARIAN CANCER: malignant tumor of the ovaries. Usually diagnosed in advanced stages due to non-specific symptoms like bloating, abdominal pain. 2) OVARIAN CYSTS: as we can see in the image there on the right side is a normal ovary which a normal amount of follicles inside it but on the left side we see a POLYCYSTIC OVARY where there is an excess of mature follicles. Associated with infertility and menstrual irregularities. 3) SALPINGITIS aka PELVIC INFLAMMATORY DISEASE (PID): is the inflammation of the Fallopian Tubes usually due to an infection in the tube. Leaves scars in tubes which can cause infertility or a tubal pregnancy if the ovum gets stuck when traveling down the scarred tube! 4) CONGENITAL DEFECT: better known as a birth defect. Not actually a disease. Some women may be born with a defect in their uterus where instead of the uterus angled forwardswhich is normal- it is bent back (retroversion) or where its top part is split in two-as we see here, a bicornuate uterus. These birth defects are rare but can make pregnancy difficult.

4 5) CERVICAL CANCER: a malignant tumor of the cervix. One of the most common cancers of the female reproductive system. Considered an STD because of its association with infection by the HPV. Seen in younger women. 6) CERVICITIS: inflammation of the cervix, can cause discharge and bleeding and is generally caused by gonorrhea, trichomoniasis or chlamydial infections. 7) ENDOMETRIAL CANCER: malignant tumor of the inner lining of the uterus. Seen in older women. 8) ENDOMETRIOSIS: means there are areas of endometrium outside of their normal location inside the uterus like in the ovary or in the small bowel. Main symptom is painful menses which doctors call: dysmenorrhea. 9) FIBROIDS: term commonly used to refer to benign growths of smooth muscle in the uterus. Their principal symptom is heavy bleeding during periods which can cause anemia. 10) CYSTOCELE: appears when bladder protrudes into vagina. 11) RECTOCELE: appears when rectum protrudes into the vagina 12) VAGINITIS aka VULVOVAGINITIS: is the inflammation of the vagina with symptoms like: discharge, itching, redness and pain. Can be caused by : a fungal infection of the vagina ( CANDIDIASIS) ( fungus = yeast same thing) a parasitic infection ( TRICHOMONIASIS) bacterial infection: (GARDNERELLA). FOREIGN BODY: retained in the vagina like a condom or tampon can also cause vaginitis or other IRRITANTS such as soaps, perfumes, semen, DOUCHES. 13) MENOPAUSE: not a disease. Just the shutting down of the ovaries which make less estrogen and stop producing ovum. Occurs between years of age the hormonal changes that occur during menopause give way to symptoms like: HOT FLASHES. SOME DIAGNOSTIC PROCEDURES: 1) GYNECOLOGICAL EXAM: SPECULUM: as we see here in this image there are different types of specula. A speculum introduced into the vagina opens the vaginal cavity so the cervix can be observed. 2) PAP SMEAR: screening test used to diagnose early stage cervical cancer. A speculum is inserted to permit access to the cervix which is then swabbed to obtain samples which are sent out to be analyzed under microscope by a pathologist. 3) COLPOSCOPY: as we see in this next image a gynecologist is having a peek at the vagina and cervix through the use of a colposcope. 4) CULDOCENTESIS: procedure we mentioned earlier, where a needle is passed through the back wall of the vagina in order to get a sample of fluid from the abdominal cavity for

5 testing. Used to help diagnose ectopic pregnancy or infection. 5) ENDOMETRIAL BIOPSY: another invasive procedure used to obtain a sample of the inner lining of the uterus. Used to diagnose endometrial hyperplasia and uterine cancer. Uterine hyperplasia means a thickening of the endometrium and is a risk factor for uterine cancer. 6) TRANSVAGINAL ULTRASOUND: is a particular form of ultrasound used in gynecology which is done using a special transducer that is introduced into the vagina. It is very useful to check the ovaries. SOME TREATMENTS: 1) LAPAROSCOPY: is a surgical procedure done under general anesthesia. A small incision is made at the navel creating an opening called an umbilical port through which a gas (CO 2) is pumped into the abdomen, sort of like inflating the abdomen so as to separate the abdominal wall from the organs to make room for the surgeon to operate. The laparoscope (which is like a rod with a light and a camera on its tip) is also inserted through the umbilical port and then 2 or 3 trocars which are thin hollow tubes are put in at different parts of the abdomen so as to create other ports through which the surgeon can operate. In this photo you can see trocars sticking out of an abdomen and a scissor-like surgical instrument being introduced through one of the trocars. This type of procedure produces a short post-op. The patient can go home quickly and get back to his normal activities in a couple of weeks. 2) LAPAROTOMY: means regular, non-laparoscopic surgery (large incision is made). 3) HORMONES : given in the form of pills known as: oral contraceptives, for example, are useful in reducing pain in endometriosis 4) CANCER TREATMENTS : include -CHEMOTHERAPY -RADIATION -HORMONES 5) CONIZATION: Please look at the image in the upper left hand corner. It shows a LESION in the cervix. In the next image in the upper right hand corner an imaginary dotted line signals where the gynecologist will be cutting to remove the lesion. Then in the bottom left hand corner we see the doctor starting to remove the lesion. In the bottom right hand corner the procedure is finished. In between the 2 bottom images is the actual CONE shaped wedge of cervix which was removed and explains why this procedure is called a conization. This procedure is used to diagnose and treat precancerous lesions called dysplasia and noninvasive cervical cancer. The conization can be done : by burning the lesion ( through a loop excision) as seen in this image, by LASER or by cutting it out with a SCALPEL (cold knife conization). 6) CRYOSURGERY: surgical treatment where abnormal tissue is destroyed by freezing it.

6 7) HYSTERECTOMY: surgical removal of the uterus which may be total or partial. May include removal of the ovaries too. 8) ANTIBIOTICS: an example: METRONIDAZOLE 9) ANTIFUNGALS: an example : MICONAZOLE 10) Some patients opt for HORMONE REPLACEMENT THERAPY to alleviate menopause symptoms (hot flashes, etc.). Now we'll begin the second part of this presentation where we'll briefly go over: SEXUALLY TRANSMITTED DISEASES (STDs) When we talk about STDs, we are talking about a group of diseases that are predominantly spread during sex (vaginal, anal or oral). The disease is spread from one person to another by contact with body fluids like blood, semen or vaginal secretions. The use of barriers (like a condom) to prevent contact with infectious sores or fluids helps reduce the risk of getting them. 1) AIDS: caused by a retrovirus called HIV (HUMAN IMMUNODEFICIENCY VIRUS) which I like to refer to as the microscopic giant, so tiny yet so immensely powerful! AIDS stands for: ACQUIRED IMMOUNODEFICIENCY SYNDROME. Untreated AIDS is a fatal illness. Roughly 2 million people die of AIDS every year. The virus infects the cells of the immune system, destroying the lymphocytes, cells that are in charge of protecting us from infections. Without their protection a patient falls prey to a wide range of OPPORTUNISTIC INFECTIONS which is a medical term for infections that occur in patients with weak defenses, like for example : ORAL CANDIDIASIS aka THRUSH TOXOPLASMOSIS PNEUMOCYSTIS PNEUMONIA SHINGLES TUBERCULOSIS Other complications in patients with AIDS are cancers like LYMPHOMA and KAPOSI's SARCOMA AIDS can be CONTRACTED by: -UNPROTECTED SEX -SHARING NEEDLES -BREASTFEEDING -BLOOD TRANSFUSION Patients with no symptoms are known as HIV positive. HIV (+) = INFECTED BUT NOT SICK

7 HIV infection is diagnosed by: -DIAGNOSIS: lab tests: either an oral swab or blood tests. These tests detect the presence of HIV antibodies. -TREATMENT: today thanks to the arsenal of ANTIRETROVIRAL DRUGS like AZT, SAQUINAVIR, DDI and others, doctors are better able to manage the disease and patients stay alive longer; what's known as an increased life expectancy. The antiretroviral drugs are given together combined in what's called a drug cocktail to avoid the virus getting resistant to the drugs. Treatments are monitored by blood tests like: VIRAL LOAD, CD4 CELL COUNT. If a patient's viral load is low and CD4 counts high then the treatment is going well. 2) GONORRHEA: gonorrhea is an infection caused by a bacteria named GONOCOCCUS. Symptoms include painful urination and discharge. Infection can be asymptomatic in women and cause scarring of the Fallopian tubes leading to fertility problems, ectopic pregnancy. The presence of gonococcus in the birth canal can cause serious eye infections in the newborn reason why silver nitrate eye drops are placed in the newborn's eyes to prevent this. -TREATMENT: Antibiotics: CEFTRIAXONE 3) SYPHILIS: is a bacterial infection. In its initial stage, a painless sore called a chancre appears on genitals, anus or mouth (period known as primary syphilis), the chancre disappears on its own after a few weeks. About 2 months later a diffuse (all-over-the body) skin rash appears. This stage is known as secondary syphilis. Untreated it, too, will go away after a few weeks and after a long period of years passes, internal lesions called gummas develop in bones, liver, testicles and the central nervous system can be affected. This is the last period called tertiary syphilis. Syphilis can also be transmitted to the fetus causing serious birth defects (heart, bones, teeth). -DIAGNOSIS is generally done with blood tests like a: VDRL. -TREATMENT: antibiotics, for example: PENICILLIN. 4) GENITAL HERPES: is an infection caused by the HERPES SIMPLEX VIRUS (HSV). Causes blisters on the genitals or anus. This virus also causes blisters on the lips called cold sores. Can be transmitted to the newborn during birth. Baby can develop encephalitis and other conditions. -TREATMENT: drugs that end in cyclovir are used to shorten outbreaks. Example: ACYCLOVIR. The virus can't be cured with current treatments. 5) HUMAN PAPILLOMAVIRUS: there are many types of this virus. Some of these cause common skin warts like the one we see there on that pinky finger, when the warts appear on the genitals they're called CONDYLOMAS. The high-risk types such as types 16 and 18 can cause cervical cancer. There is now a vaccine (GARDASIL) available to prevent infection with these high risk types.

8 6) TRICHOMONIASIS: is caused by a parasite. Produces mild vaginal itching. At other times there may be pain with intercourse and foul smelling discharge (vaginitis). -TREATMENT: an antibiotic called METRONIDAZOLE is effective. 7) CHLAMYDIA: a bacterial infection. Possible symptoms are discharge (CERVICITIS) and painful intercourse in women and painful urination in men. Untreated it can cause PID in women and epididymitis in men. Can affect the newborn causing miscarriage, blindness, premature birth or pneumonia. -TREATMENT: antibiotics, for example AZITHROMYCIN. 8) OTHER STDs. I will only mention the following diseases which are also considered STDs : -HEPATITIS B -SCABIES -PUBIC LICE -CHANCROID -LYMPHOGRANULOMA VENEREUM The doctors who specialize in treating diseases of the Female Reproductive System are called GYNECOLOGISTS. The specialty is called GYNECOLOGY. In this presentation we have gone over many terms related to GYNECOLOGY while we discussed the anatomy of the FEMALE REPRODUCTIVE SYSTEM. Signs and symptoms of sickness, diseases, diagnostic procedures and some treatments were also discussed. I hope you've enjoyed this lesson and come away with a better understanding of the field of GYNECOLOGY and the terms related to this field of medicine. Thank you for choosing InterpreterPrep.com