MODULE

Anatomy of Human Reproductive System

REPRODUCTIVE SYSTEM BLOCK 6TH SEMESTER

dr. Rita Rosita, M.Kes

DEPARTMENT OF ANATOMY OF HISTOLOGY FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY

Module Anatomy of Human Reproductive System

What this module is about This module is about the human reproductive system. It will familiarize you with the parts, functions, growth and development of genetalia organ. This topic will be of interest to you as it deals with the beginning of human life. There are four lessons prepared for you in this module and they are as follows: 1. 2. 3. 4. 5. Lesson 1 - Pelvis and perineum Lesson 2 - The Female Reproductive System Lesson 3 - The Male Reproductive System Lesson 4 - Human Genetalia Development Lesson 5 Histological feature of Reproductive System What you are expected to learn As you go over the lesson, you are expected to: 1. Describe and compare the general organization of male and female reproductive systems. 2. Explain the stages of genetalia development 3. Identify and describe the location, gross anatomy of the principal structures of pelvis and perineum 4. Describe the histological features of gonad, ducts and accessory glands of the reproductive system 5. Compare age-related changes in the male and female reproductive system

How to learn from this module In order to achieve the objectives of this module successfully, you have to remember the following: 1. Read and follow the instructions carefully. 2. Answer the pretest. 3. Take down notes and record points for clarification. 4. Take the posttest 5. Try to obtain at least a 70% level of proficiency in the tests. What to do before (Pretest) Test I. Match each numbered item with the most closely related lettered item. Use letters for answer in the spaces provided.

Column A __________ 1. endometrium __________ 2. labia majora __________ 3. menopause __________ 4. Leydig cell __________ 5. Vas defferens __________ 6. Uterine tube __________ 7. Secretory __________ 8. Seminal fluid __________ 9. Testis _________10. Isthmus

Column B A. Organs that produce spermatozoa B. Responsible for the production of testosterone C. The part of the female reproductive system where the egg is fertilized D. The part of the male reproductive organ that is cut during vasectomy E. The thick, whitish fluid consisting of sperms and secretions from several glands of the male reproductive tract F. Inner layer of the uterine wall G. Organs which homologues to the scrotum of males H. A short and narrow segment of uterine tube adjacent into the uterine cavity I. Phase of uterine cycle which the endometrial glands enlarge, and the arteries elongate and spiraling. J. The time when ovulation and menstruation cease

Test II. Find the figure of these organ and provide the function of the different parts of the male and female reproductive system. Organ Testes Uterus Clitoris Vagina Scrotum Vas deferens Function

Seminal vesicle Prostate gland Urethra Penis

Lesson 1. Pelvis and Perineum

Pelvis The bony pelvis is made up of 4 bones:
1. 2 os coxae or innominate bones: These are formed from 3 separate bones which fuse around the 16th year of life: the ilium, the ischium. and the pubis. These are names which are used to designate particular parts of the fused os coxae in the adult. (See Fig. 1 below.) 2. 1 sacrum: Formed from 5 sacral vertebrae which fuse. On its ventral surface are 4 pairs of foramina through which the ventral primary rams of sacral nerves exit. On its dorsal surface are 4 pairs of foramina through which the dorsal rami of sacral nerves exit. 3. 1 coccyx: Formed from 4 fused vertebrae.

Fig. 1

Self test : 1. Pelvic inlet extends from

2. Differentiate between the male and female pelvic bones

3. True pelvis, what is it? 4. Pelvic outlet, can you mention the border? 5. Name the muscles of pelvic walls !

MUSCLES OF PELVIC WALLS Lateral wall

Posteror wall

Floor

Perineum The perineum is the diamond-shaped area between the thighs. The anterior, posterior, and lateral boundaries of the perineum are the same as those of the bony pelvic outlet: the pubic symphysis anteriorly, ischiopubic rami and ischial tuberosities anterolaterally, sacrotuberous ligaments posterolaterally, and coccyx posteriorly. Anterior Triangle An arbitrary line joining the ischial tuberosities divides the perineum into an anterior triangle, also called the urogenital triangle, and a posterior triangle, termed the anal triangle (Fig. 2). The anterior triangle is bounded by the pubic rami superiorly, the ischial tuberosities laterally, and the superficial transverse perineal muscle posteriorly. The anterior triangle is further divided into superficial and deep spaces by the perineal membrane. This is a sheet of dense fibrous tissue and was previously known as the inferior fascia of the urogenital diaphragm. The perineal membrane attaches laterally to the ischiopubic rami, medially to the distal third of the urethra and vagina, and posteriorly to the perineal body. Anteriorly, it attaches to the arcuate ligament of the pubis. Superficial Space of the Anterior Triangle This space is bounded deeply by the perineal membrane and superficially by Colles fascia. It is a closed compartment, and infection or bleeding within it remains contained. The anterior triangle contains several important structures that include the ischiocavernosus, bulbocavernosus, and superficial transverse perineal muscles; Bartholin glands; vestibular bulbs; clitoral body and crura; and branches of the pudendal vessels and nerve Deep Space of the Anterior Triangle This space lies deep to the perineal membrane and extends up into the pelvis. In contrast to the superficial perineal space, which is a closed compartment, the deep space is continuous superiorly with the pelvic cavity . It contains the compressor urethrae and urethrovaginal sphincter muscles, external urethral sphincter, parts of urethra and vagina, branches of the internal pudendal artery, and the dorsal nerve and vein of the clitoris (Fig. 3).

Posterior Triangle This triangle contains the ischiorectal fossa, anal canal, anal sphincter complex, and branches of the internal pudendal vessels and pudendal nerve Ischiorectal Fossae These are two fat-filled wedge-shaped spaces found on either side of the anal canal and comprise the bulk of the posterior triangle Their structure reflects their function. They provide support to surrounding organs, yet allow distension of the rectum during defecation and stretching of the vagina during delivery. The anal canal and sphincter complex lie in the center of these fossae. Deeply, there is no fascial boundary between the fossa and the tissues above the perineal membrane. Thus, the two fossae communicate posteriorly, behind the anal canal. This continuity of the ischioanal fossa across perineal compartments allows fluid, infection, and malignancy to spread from one side of the anal canal to the other as well as into the areas deep to the perineal membrane. This can be clinically important if episiotomy infection extends to involve either fossa. Pudendal Nerve and Vessels The pudendal nerve is formed from the anterior rami of the second through fourth sacral nerves. It courses between the piriformis and coccygeus muscles and exits through the greater sciatic foramen in a location posteromedial to the ischial spine.This anatomy is important when injecting local anesthetic for a pudendal nerve block. The ischial spine serves an easily identifiable landmark for anesthetic infiltration around this nerve The pudendal nerve then courses along the obturator internus muscle. Along this muscle, the nerve lies within the pudendal canal, also known as Alcock canal, which is formed by splitting of the obturator fascia. The pudendal nerve leaves this canal to enter the perineum and divides into three terminal branches.The dorsal nerve of the clitoris supplies the skin of the clitoris. The perineal nerve serves the muscles of the anterior triangle and labial skin. The inferior rectal branch supplies the external anal sphincter, the mucous membrane of the anal canal, and the perianal skin. The major blood supply to the perineum is via the internal pudendal artery and its branches. These include the inferior rectal artery and posterior labial artery. Perineal Body The median raphe of the levator ani, between the anus and the vagina, is reinforced by the central tendon of the perineum. The bulbocavernosus, superficial transverse perineal, and external anal sphincter muscles also converge on the central tendon. Thus, these structures contribute to the perineal body, which provides significant perineal support. The perineal body is incised by an episiotomy incision and is torn with second-, third-, and fourth-degree lacerations.

Figure 2:

Did you know? Perineal massage can cut episiotomy rates. There was a 15 percent reduction in the number of episiotomies
performed among the women who practiced perineal massage, compared with those who did not. And whether or not they had an episiotomy, women who practiced the massage technique were also less likely to report perineal pain 3 months after the birth than those who did not massage. Selftest 1. 2. 3. 4. 5. :Match

each

numbered

item

with

the

most
A. B. C. D.

closely

related

lettered

item.

Posterior part of perineum Fat-filled space support stretching vagina during delivery Space between perineal membrane and Colles fascia

Perineal body Ischial spine Ishiorectal fossae Anal triangle

Landmark for anesthetic infiltration of pudendal nerve

Central tendon of muscles supporting perineum

E. Superficial Triangle

Space

of

the

Anterior

Lesson 2. The Female Reproductive System Humans have many body systems but the system involved in the production of offspring is called the reproductive system. Most organ systems of the body show little difference between male and female except in the case of the reproductive system. There is a striking difference between the male and the female reproductive systems, although they also share a number of similarities. For example, the reproductive organs of male and female are developed from the same embryological structures, and some hormones are the same for the male and female although they produce different responses.

The female reproductive system has the following functions: 1. Production of female sex cells 2. Reception of sperm cells from the male 3. Nurturing the development of and providing nourishment for, the new individual Try to examine the diagram on Figure 1a. The figure shows a cut away view the front of the female reproductive organ. Now, study the job of each part. Part Job Ovary Oviduct/ uterine tube Uterus Vagina

Figure 3.

The Ovaries The female reproductive organ consists of ovaries, uterine tubes (fallopian tubes), uterus, vagina, external genitalia, and mammary glands. The internal reproductive organs of female are located within pelvis, between the urinary bladder and rectum. The uterus and the vagina are in the middle line, with an ovary on each side of the uterus. There are two ovaries each comparable to the size of an almond nut. It is suspended in the pelvic cavity by a ligament. The ligament extends from each ovary to the lateral body wall, and the ovarian ligament. The mesovarium is the mesentery that suspends the ovary to the body wall. The ovary contains ovarian follicle, which contains an oocyte, the female germ cell.

Ovulation When follicles mature, they expand and rupture to release the egg and the process is called ovulation. After ovulation, the remaining cells of the ruptured follicle become transformed into a glandular structure called the corpus luteum. Fallopian Tubes This part extends from the area of the ovaries to the uterus. Long, thin processes called fimbriae surround the opening of each uterine tube. Fertilization usually occurs in the part of the uterine tube near the ovary. Uterus This is as big as a medium-sized pear. The larger rounded part is directed superiorly. The part of the uterus superior to the entrance of the uterine tubes is called the fundus. The main part is called the body, and the narrower part is the cervix, directed inferiorly. Internally, the uterine cavity continues through the cervix as the cervical canal, which opens into the vagina. Vagina This is the female organ for copulation and functions to receive the penis during intercourse. It also allows menstrual flow and childbirth. The vagina extends from the uterus to the outside of the body. In young females, the vaginal opening is covered by a thin mucous membrane called the hymen. This can completely close the vaginal opening (hymen imperforata), in which case it must be removed to allow menstrual flow. The hymen can be perforated or torn at some earlier time in a young females life during a variety of activities including strenuous exercise External Genitalia The female external genitalia consists of the vestibule and its surrounding structures. The vestibule is the space into which the vagina and urethra open. A pair of thin, longitudinal skin folds called the labia minora borders the vestibule. A small erectile structure called the clitoris is located in the anterior margin of the vestibule. The two labia minora unite over the clitoris to form a fold of skin called prepuce skin. Mammary Glands These are the organs of milk production and are located in the breasts. The mammary glands are modified sweat glands. Externally, each breast of both males and females has a raised nipple surrounded by a circular, pigmented, areola. Each breast consists of around 15-20 glandular lobes covered by a considerable amount of fat tissue. It is this fat that gives the breast its form. Figure 4.

Did you know? Menstrual cramps are the results of the strong contractions of the uterine wall that occur before and during menstruation. The cramps can result from excessive secretion of prostaglandins. Sloughing of the endometrium of the uterus results in the inflammation in the endometrial layer of the uterus and prostaglandins are produced as part of the inflammation. In some women, menstrual cramps are extremely uncomfortable. Some women take aspirin-like drugs to avoid prostaglandin secretion just before menstruation. These drugs can reduce the pain. Selftest : Match each number item with the most closely related lettered item. 1. Protects and supports developing embryo 2. Passageway for elimination of menstrual fluids 3. Contain introitus vaginae and OUE 4. Secret fluid for lubrication of vaginae 5. Layer/ligament between ovarium and fallopian tube

A. B. C. D. E.

Bartolins gland Vaginae Uterus Mesovarium Vestibulum

Lesson 3. The Male Reproductive System Examine diagram below on next page which show parts of male reproductive system. Figure 6 shows the main parts of the male reproductive system. Notice that this figure is a cut-away view from the side. Also notice that certain parts of male reproductive system are also part of urinary system. Be familiar with the specific functions of the parts using the table below:

Part Testis Scrotum Penis Tube (vas deferens) Urethra Glands a. seminal vesicle b. prostate gland c. Bulbourethral gland

Job

Did you know? that some males do not have descended testes? Ideally, during the seventh and the eighth month of fetal development or in some cases shortly after birth the testes descends. However, in some cases the testes fails to descend into the scrotal sac in a condition called cryptorchidism. It results to sterility because of the inhibiting effect of normal body temperature on spermatogenesis. Scrotum Externally, the scrotum consists of skin. Beneath the skin are a loose connective tissue and a layer of smooth muscle called dartos. In cold temperatures, the dartos muscles contract, causing the skin of the scrotum to become firm and wrinkled, reducing the overall size of the scrotum. Testes The testes are oval organs within the scrotum each about 4-5 cm long. Each testes is composed of cone-shaped lobules that contain seminiferous tubules, in which sperm cells develop. Epididymis This is a tightly coiled series of thread-like tubules that form a comma-shaped structure on the posterior side of the testes. The sperm cells continue to mature along this tube. Vas deferens

The vas deferens emerges from the epididymis and ascends along the posterior side of the testis to become associated with the blood vessels and nerves that supply the testes. From the epididymis, sperms move to this tube up to the ampulla of the ductus deferens. The wall of this tube is composed of smooth muscles. Ejaculatory Duct The ejaculatory duct extends into the prostate gland and ends by joining the urethra within the prostate gland. Urethra The male urethra extends from the urinary bladder to the distal end of the penis. The urethra is a passageway for both urine and male reproductive fluids. The two, however, do not exit the urethra at the same time. So, there is no mixing. While seminal fluid passes through the urethra, a reflex causes the urinary sphincter muscles to contract tightly to keep urine from passing the urinary bladder through the urethra. Penis The penis is the male organ of copulation and functions in the transfer of sperm cells from the male to the vagina of the female. It is only an accessory organ of reproduction and not the reproductive organ as most people think of. It is composed of erectile tissues and the engorgement of this erectile tissue with blood causes the penis to enlarge and become firm in a process called erection.

Where Are Sperms Formed? Each testis is partitioned into as many as 300 wedge-shaped lobes. Each contains two to three highly coiled tubes, the seminiferous tubules, and this is where sperms develop. Although a testis is only about 5 cm long, 125 meters of tubes are packed in it! When sperms move out of the testis, they enter a long, coiled duct, the epididymis.The sperms are not fully developed at this time, but secretions from the duct walls help them mature. When they are about to leave the body, they pass through a thick-walled tube the vas deferens, the ejaculatory ducts, and finally, the urethra, where they are ejected.

Figure 6.

Cross-section of the testis Did you know? ..that prostate cancer is the second most common cause of male deaths from cancer in the United States? Self-Test Answer the following questions: 1. Why are so many sperms released if only one is needed to fertilize the egg? 2. List the pathway of sperm in a male human being. (Be specific!) 3. How is the location of the testes (outside the peritoneal cavity) important to the production of viable sperm 4. What is the function of blood-testes barrier?

Posttest Test I. Identify the word/phrase being described or defined in each item. __________ 1. Merger of ampula ductus deferens and ductus vesica seminalis __________ 2. varicose vein in the scrotum __________ 3. The part of the male reproductive organ that is cut during vasectomy __________ 4. In cold temperatures, itscontract, wrinkled, reducing the overall size of the scrotum __________ 5. become enlarge and firm in a process called erection __________ 6. The part of the female reproductive system where the egg is fertilized

__________ 7. The technology where doctor places donated sperm in womans reproductive tract __________ 8. The female sex hormone __________ 9. The periodic shedding of tissues and blood from inner lining of uterus __________10. The thick, whitish fluid consisting of sperms and secretions from several glands of male reproductive tract __________11. Plays important role in maturation of sperm

________12. produce testosterone required for spermatogenesis

Test II. Identify the structures indicated by the arrow and the star

1 11

2 12 10 0

9 13 4

8 7 6

14 6

No 1 2 3 4 5 6 7

Name

No Name 8 9 10 11 12 13 14

1 2 3 4 5 6 7 8 9 10

11
12 13 14 15 16

Test III. Provide the function of different parts of male and female reproductive system. Organ Testes Uterus Clitoris Vagina Scrotum Seminal vesicle Prostate gland Urethra Penis Function

Case study :
1. A 24-year-old woman is undergoing a vaginal delivery. A midline episiotomy is

performed that incises into the perineal body. What structures are likely to be cut during this process?
2. A 27-year-old female notes a tender lump in her groin area that appeared

approximately 3 weeks ago. She relates that she had a similar mass about 1year ago that required minor surgery. On physical examination, she is afebrile, and the inspection of perineum shows a 3 2-cm fluctuant mass at the 5-oclock position of vestibule. It is mildly tender, red, and slightly warm on touch. What is the most likely diagnosis? What structures are causing the groin enlargement?
3. A 20-year-old male reports that he has had a non tender, heavy sensation in his scrotal

area for 2 months. He jogs several miles every day but denies lifting heavy objects. He has trauma to the area, but has no urinary complaints, does not smoke; otherwise, he appears healthy. His blood pressure is 110/70 mm Hg, heart rate is 80 beats/min, and no fever. Heart and lungs examinations are normal. His back and abdomen are nontender, and no abdominal masses are detected. External genitalia examination reveals an enlargement of scrotum and shows light penetration with transillumination. The rectal examination is unremarkable. What is the most likely diagnosis?

Lesson 4 : Genetalia Development Although chromosomal or genetic sex of an embryo is determined at fertilization in regard to different kind of sperm that fertilizes the secondary oocyte, male and female morphologic characteristics do not begin to develop until the seventh week. The early genital systems in two sexes are similar; therefore, the initial period of genital development is referred to as the indifferent stage of sexual development. Module task 1. Chromosomal and genetic sex depends on whether an X-bearing sperm or a Y-bearing sperm fertilizes the X-bearing oocyte. Before the seventh week, the gonads of the two sexes are identical in appearance and are called indifferent gonads. What is the sex determining factor? Explain how could it determine the type of sexual differentiation Answer :

2. Describe the development of ovary Answer : 3. During the fifth and sixth weeks, the genital system is in an indifferent state, and two pairs of genital ducts are present. The mesonephric ducts (Wolffian ducts) play an important part in the development of the male reproductive system and the paramesonephric ducts (Mullerian ducts) have a leading role in the development of the female reproductive system. Describe the molecular regulation of genital duct development Answer : 4. Masculinization of the indifferent external genitalia is induced by testosterone which is produced by interstitial cells of fetal testes. Could you explain about the development of male external genetalia ? Answer : 5. Errors in sex determination and differentiation result in various degrees of intermediate sex intersexuality or hermaphroditism. Intersex implies a discrepancy between the morphology of the gonads (testes/ovaries) and the appearance of the external genitalia. What is male pseudohermaphroditism? Answer :

Lesson 5. Histological feature of Reproductive System Module task 1. Describe the histological feature of ovary at puberty Answer :

2. The body of uterus consists of a firm outer coat of muscle (myometrium) and an inner lining of vascular, glandular material (endometrium). The endometrium thickens during the menstrual cycle to allow implantation of a fertilized egg. Pregnancy occurs when the fertilized egg implants successfully into the endometrial lining. If fertilization does not occur, the endometrium sloughs off and is expelled as menstrual flow. This cyclic process the menstrual cycle results from the interaction between the female reproductive organs and the endocrine system. Describe differences of endometrium lining uterine cavity according menstrual cycle phase Answer :

3. Mammary glands are an accessory reproductive gland within breasts tissue to produce milk. Fifteen to twenty-five lobes of glandular tissue containing mammary alveoli synthesize and secrete the milk in the mammary glands, a process known as lactation. Are there any differences of histological appearance of mammary gland between active phase and lactation? Describe it, please ! Answer :

4. Each testis is composed of an exocrine part and an endocrine part. What is the meaning of that statement? The seminiferous tubules are the exocrine portion of the testis. These tubules are lined by a stratified epithelium that consists of Could you draw the histological appearance of seminiferous tubule? Answer :

5. Prostate is the largest accessory sex gland of men (about 2 3 4 cm). What are prostate gland consist of? Do you know the characteristic feature of prostate? In good histological sections it is possible to distinguish three concentric zones. Identify it! Answer :