FEMININE REPRODUCTION

SYSTEM

Oleh :

Dr. Ibnu Pranoto, Sp.An, Sp.OG(K)

Feminine
Reproductive System

Anatomy of Female
Reproductive System
Female

reproductive organs

Ovaries
Uterine tubes
Uterus
Vagina
External genital organs
Mammary glands

Female Pelvis

Uterus, Vagina, Uterine

Tubes, Ovaries and
Supporting Ligaments

Ovarian function
Oogenesis
Maturation

of oocyte.
Expulsion of the mature oocyte
(ovulation).
Secretion of the female sex hormone
(estrogen and progestogen), as well as
the peptide hormone inhibin.

FOLLICLE DEVELOPMENT CHANGES IN OVARY

AGE

FOLLICLES

20 WEEKS GESTATION

6.O00.000 7.000.000

AT BIRTH

1.000.000 - 2.000.000

PUBERTY

300.000 400.000

READY TO DEVELOP

400 - 500

37 YEARS

10.000

Ovary Histology

Maturation of Follicle and

Oocyte

Folliculogenesis

Maturation and
Fertilization
of Oocyte

Ovulation and Follicle Fate

Ovulation

Follicle swells and

ruptures, secondary
oocyte is released
from ovary
Second meiotic
division completed
when secondary
oocyte unites with
sperm cell to form
zygote

Fate

of the follicle

Graafian follicle
become corpus
luteum
If fertilization occurs,
corpus luteum
persists
If no fertilization,
becomes corpus
albicans

Follicular Selection
Primordial Follicles
Recruitment

Continuous but
asynchronous growth
of follicles

Preantral Follicles
Selected dominant follicle

Follicles not
selected undergo
atresia

Anthral follicle
Maturation ( 2 weeks growth)
Preovulatory (Graafian) follicle
FSH is responsible for:
1. Recruitment of the pool of the precursor follicles
2. Initiating selection and maturation of the dominant follicle

Follicle and Oocyte

Development

Oogenesis is the
production of a
secondary oocyte in
ovaries
Oogonia are cells from
which oocytes develop
Primary oocytes are
surround by granulosa
cells and called a
primordial follicle
Primordial follicle
becomes a primary
follicle when oocyte
enlarges and cells
change

Primary follicle becomes

secondary follicle and
enlarges to form mature
or graafian follicle
Usually only one is
ovulated, others
degenerate

Primary oocyte completes

first meiotic division to
produce secondary
oocyte and a polar body
Secondary oocyte begins
second meiotic division,
which stops in metaphase
II

Uterine Tubes and Uterus

Uterine

or fallopian
tubes or oviducts
Open directly into
peritoneal cavity to
receive oocyte from
ovary
Transport oocyte or
zygote from ovary to
uterus

Uterus

Parts: Body, isthmus,

cervix
Composed of 3
layers
Perimetrium:

Serous

membrane
Myometrium: Smooth
muscle
Endometrium:
Mucous membrane

Vagina and Perineum

Vagina

Female organ of
copulation
Allows menstrual
flow and childbirth
Hymen covers the
vaginal opening or
orifice

Perineum

Divided into two

triangles
Urogenital:

Contains
the external
genitalia
Anal triangle

Clinical

perineum

Region between
vagina and anus
Episiotomy: Incision
to prevent tearing
during childbirth

Female External Genitalia

Vulva or pudendum or
external female
genitalia
Vestibule: Space
Labia

minora: Form
borders on sides
Clitoris: Erectile
structure
Corpora cavernosa
Corpora spongiosa

Labia majora
Unite

pubis

to form mons

Female Perineum

Mammary Glands
Organs

of milk
production located
within mammae or
breasts
Consist of glandular
lobes and adipose
tissue
Coopers ligaments
support the breasts

Puberty and Menstrual

Cycle
Puberty

Begins with
menarche or first
episode of menstrual
bleeding
Begins when GnRH
levels increase

Menstrual

Cycle

About 28 days long

Phases
Menses
Proliferative

phase
Secretory phase
Menses

Amenorrhea:
Absence of a
menstrual cycle
Menopause:
Cessation of
menstrual cycles

Menstrual Cycle

Hormone Regulation
during Menstrual Cycle

Female Sexual Behavior

and Sex Act
Female

sexual
behavior

sex act

Parasympathetic
stimulation
Blood

Depends on
hormones
Androgens

Female

and

steroids

Depends on
psychological
factors

engorgement in
clitoris and around
vaginal opening
Erect nipples
Mucouslike fluid
extruded into vagina
and through wall

Orgasm not
necessary for
fertilization to occur

ANATOMI DASAR PANGGUL

Kumpulan jaringan yang menutupi
rongga panggul.
Terdiri atas :otot,ligamentum, organ
visera, fascia yang menahan tekanan
intraabdomen
-menjaga kontinensia dan faeses
-koitus,persalinan,pengeluaran produk
ekskresi

TIGA LAPISAN PENUNJANG

1.

Fascia endopelvis
2. M. levator ani
3. membran perineum&
dd.pelvis/sfingter ani ekterna

M.LEVATOR ANI
M.pubokoksigeus/puboviseral
M.ileokoksigeus

DIAFRAGMA UROGENITAL
M.burbokavernosus
M.perineus

transversalis dalam dan

luar.
Fungsi: mencegah prolapsus tidak
lebih parah (bila fascia endopelvis
melemah)

PERINEAL BODY
Masa

jaringan fibrosa yang tebal,

tanpa batas yang jelas diantara vagina
dan anus.
M.sfingter ani eksternus
Robekan pd ruptur perinei totalis

STRES INKONTINENSIA

Definisi:keluarnya urin yg tidak dapat

dikontrol/dikendalikan secara objektif dapat
diperlihatkan dan merupakan masalah sosial atau
higienis.
Tekanan intravesika>intrauretra
Faktor penyokong kontinensia urin:uretra, vu,UVJ,
sfingter uretra interna dan eksterna.
Paritas,menopause, usia, operasi panggul dan
obesitas.
Aktifitas tubuh:batuk, bersin,meloncat,naik tangga
dll.

MACAM INKONTINENSIA URIN

STRES

INKONTINENSIA
OVERAKTIVE BLADDER/urge
MIXED INCONTINENCE
OVERFLOW INCONTINENCE
KELAINAN ANATOMIS
INKONTINENS. FUNGSIONAL
INKONTINENSIA TRANSIEN

INKONTINENSIA TRANSIEN
(DIAPPERS)
Delirium
Infection
Atrophic

vaginitis
Pharmacologic
Psychological
Endocrine
Restricted mobility
Stool impaction

DIAGNOSIS
STRES INKONTINENSIA
Terdapat

sindroma saluran kemih

bawah dan rasa malu
Karena operasi perbaikan vagina

PEMERIKSAAN TAMBAHAN
Inkontinensia
Urine

urine & aktifitas seksual

sisa
Tes provokasi :batuk.
Pemeriksaan : spekulum,Q test,
urodinamik dan tekanan uretra.

PENATALAKSANAAN
Pemberian

estrogen
Pemakaian pesarium
Operasi

ANATOMI ALAT GENITAL

Perubahan

anatomi o.k.
kehamilan,partus, umur, menopause.
Anatomi :kadaver, teranetesi berbeda
dng waktu berdiri.

TUJUAN BEDAH
REKONTRUKSI
Untuk

mengembalikan organ abnormal

kekeadaan biasa.

ANATOMI
PROLAPSUS UTERI
DIFINISI
TURUNNYA

ALAT GENITAL KARENA

HILANGNYA PENUNJANG ANATOMI
DIAFRAGMA PELVIS/VAGINA

KAUSA
USIA

LANJUT
DEFISIENSI ESTROGEN
TRAUMA PERSALINAN
GENETIK
TEKANAN INTRAABDOMINAL

RIWAYAT
Peningkatan

insidensi
Peningkatan usia wanita/umur panjang
Aktivitas seksual
Rekontruksi vagina, fungsi kandung
kemih dan rektum

PROLAPS GENITAL
1.

SISTOKEL
2. REKTOKEL
3. ENTEROKEL
4.PROLAPSUS UTERI
5. PROLAPSUS VAGINA

Vesikokel/Kistokel

Rektokel

Prolapsus Uteri Total

(Procidensia)

Procidensia

KLASIFIKASI PROLAPSUS
TINGKAT

I : didalam vagina
TINGKAT II : di introitus vagina
TINGKAT III : di luar introitus
PROSIDENSIA

THANK YOU