Female Reproductive System
Suspensory
ligament of
ovary
Peritoneum
Uterosacral
ligament
Perimetrium
Rectouterine
pouch
Rectum
Posterior fornix
Cervix
Anterior fornix
Vagina
Anus
Urogenital diaphragm
Greater vestibular
(Bartholin’s) gland
Infundibulum
Uterine tube
Ovary
Fimbriae
Uterus
Round ligament
Vesicouterine
pouch
Urinary bladder
Pubic symphysis
Mons pubis
Urethra
Clitoris
External urethral
orifice
Hymen
Labium minus
Labium majus
Figure 27.10
Ovaries
Held in place by several ligaments
Ovarian ligament: anchors ovary medially to the uterus
Suspensory ligament: anchors ovary laterally to the
pelvic wall
Mesovarium: suspends the ovary
Broad ligament: supports the uterine tubes, uterus, and
vagina; also contains the suspensory ligament and the
mesovarium
Suspensory
ligament of ovary
Ovarian blood
vessels
Uterine (fallopian) tube
Mesosalpinx
Mesovarium
Broad
ligament
Mesometrium
Ovarian ligament
Body of uterus
Ureter
Uterine blood vessels
Isthmus
Uterosacral ligament
Lateral cervical
(cardinal) ligament
Lateral fornix
Cervix
(a)
Fundus
of uterus
Ovary
Lumen (cavity)
of uterus
Uterine
tube
Ampulla
Isthmus
Infundibulum
Fimbriae
Round ligament of uterus
Endometrium
Wall of uterus
Myometrium
Perimetrium
Internal os
Cervical canal
External os
Vagina
Figure 27.12a
Ovaries
Blood supply: ovarian arteries and the ovarian branch of
the uterine artery
Follicle
Immature egg (oocyte) surrounded by
Follicle cells (one cell layer thick)
Several stages of development
Primordial follicle: squamouslike follicle cells + oocyte
Primary follicle: cuboidal or columnar follicle cells + oocyte
Secondary follicle: two or more layers of granulosa cells +
oocyte
Late secondary follicle: contains fluid-filled space between
granulosa cells; coalesces to form a central antrum
Ovaries
Vesicular (Graafian) follicle
Fluid-filled antrum forms; follicle bulges from ovary
surface
Ovulation
Ejection of the oocyte from the ripening follicle
Corpus luteum develops from ruptured follicle after
ovulation
Tunica
albuginea
Degenerating corpus
luteum (corpus
albicans)
Germinal
epithelium
Primary
follicles
Ovarian
ligament
Cortex
Oocyte
Granulosa cells
Late secondary follicle
Mesovarium and
blood vessels
Vesicular
(Graafian)
follicle
Antrum
Oocyte
Zona
pellucida
Theca
folliculi
Ovulated
oocyte
Corpus luteum
Corona
Developing
radiata
corpus luteum
(a) Diagrammatic view of an ovary sectioned to reveal the follicles in its interior
Medulla
Figure 27.11a
Female Duct System
Uterine (fallopian) tubes or oviducts
Uterus
Vagina
Uterine Tubes
Ampulla
Distal expansion with infundibulum near ovary
Usual site of fertilization
Ciliated fibriae of infundibulum create currents to move
oocyte into uterine tube
Isthmus: constricted region where tube joins uterus
Oocyte is carried along by peristalsis and ciliary action
Suspensory
ligament of ovary
Ovarian blood
vessels
Uterine (fallopian) tube
Mesosalpinx
Mesovarium
Broad
ligament
Mesometrium
Ovarian ligament
Body of uterus
Ureter
Uterine blood vessels
Isthmus
Uterosacral ligament
Lateral cervical
(cardinal) ligament
Lateral fornix
Cervix
(a)
Fundus
of uterus
Ovary
Lumen (cavity)
of uterus
Uterine
tube
Ampulla
Isthmus
Infundibulum
Fimbriae
Round ligament of uterus
Endometrium
Wall of uterus
Myometrium
Perimetrium
Internal os
Cervical canal
External os
Vagina
Figure 27.12a
Uterus
Body: major portion
Fundus: rounded superior region
Isthmus: narrowed inferior region
Cervix: narrow neck, or outlet; projects into the vagina
Cervical canal communicates with the
Vagina via the external os
Uterine body via the internal os
Cervical glands secrete mucus that blocks sperm entry
except during midcycle
Uterine Wall
Three layers
1. Perimetrium: serous layer (visceral peritoneum)
2. Myometrium: interlacing layers of smooth muscle
3. Endometrium: mucosal lining
Endometrium
Stratum functionalis (functional layer)
Changes in response to ovarian hormone cycles
Is shed during menstruation
Spasms of spiral arteries leads to shedding of stratum
functionalis
Stratum basalis (basal layer)
Forms new functionalis after menstruation
Unresponsive to ovarian hormones
Vagina
Birth canal and organ of copulation
Extends between the bladder and the rectum from the
cervix to the exterior
Urethra embedded in the anterior wall
Vagina
Layers of wall
1. Fibroelastic adventitia
2. Smooth muscle muscularis
3. Stratified squamous mucosa with rugae
Mucosa near the vaginal orifice/opening forms an
incomplete partition called the hymen
Vaginal fornix: upper end of the vagina surrounding
the cervix
External Genitalia
Mons pubis: fatty area overlying pubic symphysis
Labia majora: hair-covered, fatty skin folds
Labia minora: skin folds lying within labia majora
Vestibule: recess between labia minora
Greater vestibular glands
Release mucus into the vestibule for lubrication
Homologous to the bulbourethral glands
External Genitalia
Clitoris
Erectile tissue hooded by a prepuce
Glans clitoris: exposed portion
Perineum
Diamond-shaped region between the pubic arch and
coccyx
Bordered by the ischial tuberosities laterally
Clitoris
Labia minora
Labia majora
Inferior ramus of pubis
Pubic symphysis
Anus
Body of clitoris,
containing corpora
cavernosa
Clitoris (glans)
Crus of clitoris
Urethral orifice
Vaginal orifice
(b)
Bulb of
vestibule
Fourchette
Greater
vestibular
gland
Figure 27.14b
Mammary Glands
Modified sweat glands consisting of 15–25 lobes
Areola: pigmented skin surrounding the nipple
Suspensory ligaments: attach the breast to underlying
muscle
Lobules within lobes contain glandular alveoli that
produce milk
Milk  lactiferous ducts  lactiferous sinuses  open
to the outside at the nipple
First rib
Skin (cut)
Pectoralis major muscle
Suspensory ligament
Adipose tissue
Lobe
Areola
Nipple
Opening of
lactiferous duct
Lactiferous sinus
(a)
Lactiferous duct
Lobule containing
alveoli
Hypodermis
(superficial fascia)
Intercostal muscles
(b)
Figure 27.15
Breast Cancer
Usually arises from the epithelial cells of small ducts
Risk factors include:
Early onset of menstruation and late menopause
No pregnancies or first pregnancy late in life
Family history of breast cancer
10% are due to hereditary defects, including mutations to the
genes BRCA1 and BRCA2
Breast Cancer: Detection and
Treatment
70% of women with breast cancer have no known risk
factors
Early detection via self-examination and mammography
Treatment depends upon the characteristics of the
lesion:
Radiation, chemotherapy, and surgery followed by
irradiation and chemotherapy
(a) Mammogram procedure
Malignancy
(b) Film of normal breast
(c) Film of breast with tumor
Figure 27.16
Oogenesis
Production of female gametes
Begins in the fetal period
Oogonia (2n ovarian stem cells) multiply by mitosis and
store nutrients
Primary oocytes develop in primordial follicles
Primary oocytes begin meiosis but stall in prophase I
Oogenesis
Each month after puberty, a few primary oocytes are activated
One is selected each month to resume meiosis I
Result is two haploid cells
Secondary oocyte
First polar body (benign…reabsorbed)
The secondary oocyte arrests/stops in metaphase II and is
ovulated
If penetrated by sperm the second oocyte completes meiosis II,
yielding
Ovum (the functional gamete)
Second polar body
Follicle development
in ovary
Meiotic events
Before birth
Oogonium (stem cell)
Follicle cells
Oocyte
Mitosis
Primary oocyte
Primordial follicle
Primary oocyte
(arrested in prophase I;
present at birth)
Primordial follicle
Growth
Infancy and
childhood
(ovary inactive)
Each month from
puberty to
menopause
Primary follicle
Primary oocyte (still
arrested in prophase I)
Secondary follicle
Spindle
Meiosis I (completed
by one primary oocyte
each month in response
to LH surge)
First polar body
Meiosis II of polar
body (may or may
not occur)
Polar bodies
(all polar bodies
degenerate)
Vesicular (Graafian)
follicle
Secondary oocyte
(arrested in
metaphase II)
Ovulation
Sperm
Second
Ovum
polar body
Meiosis II
completed
(only if
sperm
penetration
occurs)
Degenating
Ovulated secondary
oocyte
In absence of
fertilization, ruptured
follicle becomes a
corpus luteum and
ultimately degenerates.
corpus luteum
Figure 27.17
Ovarian Cycle
Monthly series of events associated with the
maturation of an egg
Two consecutive phases (in a 28-day cycle)
Follicular phase: period of follicle growth (days 1–14)
Ovulation occurs midcycle
Luteal phase: period of corpus luteum activity (days 14–
28)
Theca folliculi
3
2
4
1
5
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
oocyte
Secondary oocyte
Corona radiata
1
Primordial
follicles
Figure 27.18 (1 of 7)
Theca folliculi
3
2
4
1
5
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
oocyte
Secondary oocyte
Corona radiata
2
Primary
follicle
Figure 27.18 (2 of 7)
Theca folliculi
3
2
4
1
5
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
oocyte
Secondary oocyte
Corona radiata
3
Secondary
follicle
Figure 27.18 (3 of 7)
Theca folliculi
3
2
4
1
5
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
oocyte
Secondary oocyte
Corona radiata
4
Late secondary
follicle
Figure 27.18 (4 of 7)
Theca folliculi
3
2
4
1
5
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
oocyte
Secondary oocyte
Corona radiata
5
Mature vesicular
follicle carries out
meiosis I; ready to
be ovulated
Figure 27.18 (5 of 7)
Theca folliculi
3
2
4
1
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
5
oocyte
6 Follicle ruptures;
secondary oocyte
Secondary oocyte
Corona radiata
ovulated
Figure 27.18 (6 of 7)
Luteal Phase
Ruptured follicle collapses
Granulosa cells and internal thecal cells form corpus
luteum
Corpus luteum secretes progesterone and estrogen
Luteal Phase
If no pregnancy, the corpus luteum degenerates into a
corpus albicans in 10 days
If pregnancy occurs, corpus luteum produces
hormones until the placenta takes over at about
3 months
Theca folliculi
3
2
4
1
6
8
7
Primary oocyte
Zona pellucida
Antrum
Secondary
5
oocyte
7 Corpus luteum
(forms from
Secondary oocyte
ruptured follicle)
Corona radiata
Figure 27.18 (7 of 7)
Establishing the Ovarian Cycle
During childhood, ovaries grow and secrete small
amounts of estrogens that inhibit the hypothalamic
release of GnRH
As puberty nears, GnRH is released; FSH and LH are
released by the pituitary, and act on the ovaries
These events continue until an adult cyclic pattern is
achieved and menarche occurs
During childhood, until puberty
Ovaries secrete small amounts of estrogens
Estrogen inhibits release of GnRH
Establishing the Ovarian Cycle
At puberty
Leptin from adipose tissue decreases the estrogen
inhibition
GnRH, FSH, and LH are released
In about four years, an adult cyclic pattern is achieved
and menarche occurs
Hormonal Interactions
During a 28-Day Ovarian
Cycle
Day 1: GnRH  release of FSH and LH
FSH and LH  growth of several follicles, and estrogen
release
 estrogen levels
Inhibit the release of FSH and LH
Stimulate synthesis and storage of FSH and LH
Enhance further estrogen output
Hormonal Interactions
During a 28-Day Ovarian
Cycle
Estrogen output by the vesicular follicle increases
High estrogen levels have a positive feedback effect on
the pituitary at midcycle
Sudden LH surge at day 14
Hormonal Interactions
During a 28-Day Ovarian
Cycle
Effects of LH surge
Completion of meiosis I (secondary oocyte continues on
to metaphase II)
Triggers ovulation
Transforms ruptured follicle into corpus luteum
Hormonal Interactions
During a 28-Day Ovarian
Cycle
Functions of corpus luteum
Produces inhibin, progesterone, and estrogen
These hormones inhibit FSH and LH release
Declining LH and FSH ends luteal activity and inhibits
follicle development
Hormonal Interactions
During a 28-Day Ovarian
Cycle
Days 26–28: corpus luteum degenerates and ovarian
hormone levels drop sharply
Ends the blockade of FSH and LH
The cycle starts anew
LH
FSH
(a) Fluctuation of gonadotropin levels: Fluctuating
levels of pituitary gonadotropins (follicle-stimulating
hormone and luteinizing hormone) in the blood
regulate the events of the ovarian cycle.
Figure 27.20a
Primary
Vesicular
Corpus
follicle
follicle
luteum Degenerating
Secondary
Ovulation
corpus luteum
follicle
Follicular
phase
Ovulation
(Day 14)
Luteal
phase
(b) Ovarian cycle: Structural changes in the ovarian
follicles during the ovarian cycle are correlated with
(d) changes in the endometrium of the uterus during
the uterine cycle.
Figure 27.20b
Uterine (Menstrual) Cycle
Cyclic changes in endometrium in response to ovarian
hormones
Three phases
1. Days 1–5: menstrual phase
2. Days 6–14: proliferative (preovulatory) phase
3. Days 15–28: secretory (postovulatory) phase (constant 14-
day length)
Uterine Cycle
Menstrual phase
Ovarian hormones are at their lowest levels
Gonadotropins are beginning to rise
Stratum functionalis is shed and the menstrual flow
occurs
Uterine Cycle
Proliferative phase
Estrogen levels prompt generation of new functional
layer and increased synthesis of progesterone receptors
in endometrium
Glands enlarge and spiral arteries increase in number
Uterine Cycle
Secretory phase
Progesterone levels prompt
Further development of endometrium
Glandular secretion of glycogen
Formation of the cervical mucus plug
Estrogens
Progesterone
(c) Fluctuation of ovarian hormone levels:
Fluctuating levels of ovarian hormones (estrogens
and progesterone) cause the endometrial changes
of the uterine cycle. The high estrogen levels are
also responsible for the LH/FSH surge in (a).
Figure 27.20c
Endometrial
glands
Blood vessels
Menstrual
flow
Functional layer
Basal layer
Days
Menstrual
phase
Proliferative
phase
Secretory
phase
(d) The three phases of the uterine cycle:
• Menstrual: Shedding of the functional layer of the
endometrium.
• Proliferative: Rebuilding of the functional layer of
the endometrium.
• Secretory: Begins immediately after ovulation.
Enrichment of the blood supply and glandular secretion of
nutrients prepare the endometrium to receive an embryo.
Both the menstrual and proliferative phases occur before ovulation, and
together they correspond to the follicular phase of the ovarian cycle. The
secretory phase corresponds in time to the luteal phase of the ovarian cycle.
Figure 27.20d
Uterine Cycle
If fertilization does not occur
Corpus luteum degenerates
Progesterone levels fall
Spiral arteries kink and spasm
Endometrial cells begin to die
Spiral arteries constrict again, then relax and open wide
Rush of blood fragments weakened capillary beds and the
functional layer sloughs
Menopause
Has occurred when menses have ceased for an entire
year
There is no equivalent to menopause in males
Menopause
Declining estrogen levels 
Atrophy of reproductive organs and breasts
Irritability and depression in some
Hot flashes as skin blood vessels undergo intense
vasodilation
Gradual thinning of the skin and bone loss
Increased total blood cholesterol levels and falling HDL
Effects of Estrogens
Promote oogenesis and follicle growth in the ovary
Exert anabolic effects on the female reproductive tract
Support the rapid but short-lived growth spurt at
puberty
Effects of Estrogens
Induce secondary sex characteristics
Growth of the breasts
Increased deposit of subcutaneous fat (hips and breasts)
Widening and lightening of the pelvis
Effects of Estrogens
Metabolic effects
Maintain low total blood cholesterol and high HDL
levels
Facilitates calcium uptake
Effects of Progesterone
Progesterone works with estrogen to establish and
regulate the uterine cycle
Effects of placental progesterone during pregnancy
Inhibits uterine motility
Helps prepare the breasts for lactation
Female Sexual Response
Initiated by touch and psychological stimuli
The clitoris, vaginal mucosa, and breasts engorge with
blood
Vestibular gland secretions lubricate the vestibule
Orgasm is accompanied by muscle tension, increase in
pulse rate and blood pressure, and rhythmic
contractions of the uterus
Female Sexual Response
Females do not have a refractory period after orgasm
and can experience multiple orgasms in a single sexual
experience
Orgasm is not essential for conception
Sexually Transmitted
Infections (STIs)
Also called sexually transmitted diseases (STDs) or
venereal diseases (VDs)
The single most important cause of reproductive
disorders
Gonorrhea
Bacterial infection of mucosae of reproductive and
urinary tracts
Spread by contact with genital, anal, and pharyngeal
mucosae
Gonorrhea
Signs and symptoms
Males
Urethritis, painful urination, discharge of pus
Females
20% display no signs or symptoms
Abdominal discomfort, vaginal discharge, or abnormal
uterine bleeding
Can result in pelvic inflammatory disease and sterility
Treatment: antibiotics, but resistant strains are becoming
prevalent
Syphilis
Bacterial infection transmitted sexually or contracted
congenitally
Infected fetuses are stillborn or die shortly after birth
Infection is asymptomatic for 2–3 weeks
A painless chancre appears at the site of infection and
disappears in a few weeks
Syphilis
If untreated, secondary signs appear several weeks later
for 3–12 weeks, and then disappear: pink skin rash,
fever, and joint pain
The latent period may or may not progress to tertiary
syphilis, characterized by gummas (lesions of the CNS,
blood vessels, bones, and skin)
Treatment: penicillin
Chlamydia
Most common bacterial STI in the United States
Responsible for 25–50% of all diagnosed cases of
pelvic inflammatory disease
Symptoms: urethritis; penile and vaginal
discharges; abdominal, rectal, or testicular pain;
painful intercourse; irregular menses
Can cause arthritis and urinary tract infections in
men, and sterility in women
Treatment: tetracycline
Viral Infections
Genital warts
Caused by human papillomavirus (HPV)
Second most common STI in the United States
Increase the risk of cancers in infected body regions
Viral Infections
Genital herpes
Caused by human herpes virus type 2
Characterized by latent periods and flare-ups
Congenital herpes can cause malformations of a fetus
Treatment: acyclovir and other antiviral drugs