Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Scrotum
Testes
Spermatic Cord
Penis
Duct System
Accessory glands
Semen
Gross Anatomy
Pathway for Sperm
Blood Supply
Nervous Innervation
Sperm produced in the seminiferous tubules is conveyed through the tubulus rectus to
the rete testis on the posterior side of the testis
From the rete testis sperm travels through the efferent ductules to enter the epididymis
- Epididymis is outside testis itself
- Epididymis is soft, testis are hard
2nd way to regulate temp the plexus acts as a heat sink (blood
entering from testis is cool, as it travels up the body and comes in
cotact the testicular artery its taking the heat out of that artery)
External Anatomy
Internal Anatomy
Root
Shaft or body
Glans penis enlargement at the end
Prepuce of foreskin around the glans
Spongy urethra
Corpus spongiosum surrounds the urethra
Corpora cavernosa paired erectile bodies bounded by the fibrous albuginea and forms
the crura of the penis proximally
Spongy urethra it is also known as the penile urethra (it takes
through corpus spongiosum) corpus = body
Corpora cavernous the erectile bodies, two of those on either side
Notice the central artery in top picture erection is the copora filling
up with blood basically
Epididymis
Ductus Deferens
Ejaculatory Duct
Urethra
Duct enters the prostate gland and empties into the urethra know!?
o Vasectomy incision in scrotum pull out spermatic cord locate
ductis deferens, you do this by feel. The testicular artery will be
very compressible, while vas deferens will be life half-cooked
spaghetti
Seminal Vesicles
Prostate Gland
Bulbourethral Gland
Sperm being released is released as semen provided by top 2
Size of a chestnut
Encircles the urethra
Just inferior to the bladder
Enclosed in a thick connective tissue capsule
Made up of 20 30 compound tubular-alveolar glands embedded in smooth muscle and
connective tissue DONT have to know!!
Produces a milky, slightly acidic fluid
If those sperm are motile too early it will use up all the energy it has, so it activates the sperm at
this time
Prostatitis inflammation of prostate
- elevated, but once treated the BPA drops back down
- To make dx the prostate gets boggy and is tender to palpation instead of firm
- You massage the prostate, get second urinalysis, if WBCs are in the urinalysis then it is
prostatitis
- Usually treats with antibiotics
Prostatic cancer
-BPA is VERY high
-Significant thing is the prostate is hard like a rock
BPH slight enlargement with out cancer
-Slight elevated in BPA
-See on of two things. May or may not enlarge and engorge the urethra, if it does it will make
them get up multiple times to go to backroom at night, weak stream, problems stopping the
stream,
-prostate will feel normal, just bigger!
-Meds and TERP can be used to fix it
BPA blood test. It is elevated in ALL 3 conditions
Erection
Ejaculation
When not sexually aroused arterioles to the erectile tissue are constricted, limiting the
blood flow
During sexual excitement, smooth muscles of the arterioles relaxes and allow erectile
tissue to fill with blood
Controlled by the parasympathetic system
Initiating event
- Touching genital skin
- Mechanical stimulation of the penis
- Erotic sights, sounds, or smells
Semen Contents:
Sperm
Fructose from the seminal vesicles
If you consider the opening of the cervix, the fallopian tube is not
attached to the ovary it is sitting open.
Dont see lots of ab infections because cervix is plugged with mucus
Reverse peristalsis moves the sperm up into the fallopian tubes
Clotting factor causes fibrinolysis that allow sperm to swim out of the ejaculate
Mitosis of Spermatogonia
Meiosis of Spermatocytes
Spermiogenesis
Role of Sustentacular Cells
Spermatogenesis Spermiogenesis:
Spermatids are nonmotile
During spermiogenesis, spermatids loose cytoplasm and form a tail
Spermatogenesis Role of Sustentacular Cells:
Supporting cells
Have tight junctions that form a blood-testis barrier that prevents antibodies from
attacking sperm (sperm is not recognized as self)
o Prevents sperm from being attacked by antibodies
Ovaries
Duct System
Uterus
External Genitalia or Vulva
Mammary Gland
General Description
Blood Supply
Capsule
Follicles
About twice the size of an almond and shaped like and almond
Contained in the peritoneal cavity NOT RETEROPERITONEAL
The fallopian tube (which is ultimately is in contact with the exterior)
opens up over the ovary, which is why you need mucus plug
Ovaries Capsules:
Ovaries Follicles:
Mature vesicular follicles or Graafian follicles bulges at the surface of the ovary
Ovulation the release of the mature oocyte
Ruptured follicle becomes a corpus luteum
Follicle produces estrogen while the ruptured follicle (corpus luteum)
produces progesterone
8 10 cm
Lies between the bladder and rectum
The urethra is embedded in its anterior wall
Female organ of copulation
3 coats
- Adventitia fibroelastic outer layer connective tissue on the outside
- Muscularis smooth muscle
- Mucosa has transverse ridges or rugae that stimulate the penis
Mucosa is stratified squamous epithelium
Dendritic cells act as antigen presenting cells (provide route for HIV transmission)
Vaginal secretions
- Acidic in adults helps prevent infections
- Alkaline in adolescents predisposes teenagers to STDs
Female Anatomy Uterus:
General Description
Supports
Uterine Wall
Blood Supply
Uterus Supports:
Round ligament goes through the inguinal canal and anchors the uterus to the labia
Uterus Endometrium:
Prepuce of the clitoris skin fold covering the clitoris formed by the junction of the
labia minora folds
Lobules - smaller units in the lobes that contain alveoli that produce milk
Oogenesis
Ovarian Cycle
Hormonal Regulation
Menstrual Cycle
Extra Uterine Effects of Hormones
Primary oocytes begin the first meiotic division but are stalled in
prophase I
At puberty select oocytes continue meiosis I producing a large
secondary oocyte and a first polar body
o Meiosis stops twice.
o First part is stalled out in Prophase I. Second is at
meiosis I.
o Only have one ovum eventually and 3 polar bodies
(gives you 4 after two divisions) All of the contents of
the cell is put into one ovum and it will start dividing on
its own.
o Remember prophase I and know it restarts at puberty!
The first polar body undergoes meiosis II and produces two smaller polar bodies END
RESULT IS 3 polar bodies total!
Follicular Phase
Ovulation
Luteal Phase
Ovarian cycle production of ovum and the production of appropriate
hormones
The hormones (estrogen and progesterone) affect the uterus, and is
responsible for the changes in the uterus
Squamous like cells surrounding the primary oocyte grow becoming cuboidal cells
The oocyte enlarges becoming a primary follicle
There are always several follicles at different stages of maturation however one is
dominant
Dominance is probably due to FSH sensitivity
The ballooning ovary wall ruptures and expels the secondary oocyte
FSH sensitivity is the hormone that causes the production of gametes (same FSH that
causes the production of sperm)
The ruptured follicle collapses and fills with blood corpus hemorrhagicum is
eventually absorbed
28 day cycle
There is always some estrogen, at some point there will be virtually no
progesterone
Waxing and waning of FSH and LH
Positive and negative feedback loops
Day 1 rising levels of GnRH stimulate production of FSH and LH
FSH and LH stimulate follicle growth and maturation and estrogen secretions
o Day 1 of menstrual cycle is when menses begins
o Why levels of GnRH? Because prior to this when we had elevated
estrogen levels we were inhibiting GnRH (and therefore FSH and
LH), once the estrogen levels start to drop off you loose the
inhibiting stuff
o GnRH is being PRODCUED BEING OF DROPPING LEVELS OF
ESTROGEN AND PROGESTERONE!!
FSH affects the follicle
LH affects the thecal cells and granulosa cells to cause them to produce androgens
FSH is important in determining which follicle matures as said
previously
Rising levels of estrogen inhibit production of FSH and LH
Estrogen increases the output of estrogen by intensifying the effect of FSH on the follicle
Inhibin released by the granulosa cells exerts negative feed back on FSH release
Initially a small rise in estrogen inhibits the hypothalamic-pituitary axis
Blood stops flowing to the protruding part of the follicle wall and within 5 minutes the
follicle wall bulges, thins out, and ruptures
o Drop in blood flow around follicle and then 5 minutes after that
ovulation will take place
o Why does estrogen drop off? D/t damage to the follicle or you
can say progesterone will start being produced d/t the damage
and estrogen stops being produced
The LH surge causes the formation of the corpus luteum that produces progesterone
Rising progesterone and estrogen levels have an inhibitory effect on the release of LH
and FSH
As LH falls, the corpus luteum degenerates and levels of serum ovarian hormones drop
Declining ovarian hormones ends the blockade of LH and FSH about day 26 28
If implantation doesnt take place then the luteum degenerates
Drop in both estrogen and progesterone is what causes menses
Menstrual phase
Proliferative (Preovulatory) Phase
Secretory (Postovulatory) Phase
Secretory phase where you are accepting the fertilized ovum for
implantation
First phase of pregnancy the fertilized ovum has to be implanted in the
endometrium
Days 6 - 14
Endometrium rebuilds itself under the influence of estrogen
Glands enlarge, spiral arteries increase in number
How much endometrium is produced is based on the amount of
estrogen
A lot of estrogen = a lot of endometrium
2 extremely important points
1- for the endometrium to stay in place you HAVE to have estrogen.
2-The endometrium can only get so big and then it cannot maintain
itself
If you have too much estrogen you can start slughing off some of the
endometrium important in birth control pills, if you keep LH levels
down they wont spike = no ovulation
Birth control pill with too much estrogen then what you see is middle of
cycle is some spotting (top layer of endometrium being sloughed off)
Endometrium becomes thick and well vascularized
Estrogen induces synthesis of progesterone receptors
Cervical mucus becomes thin and crystalline
Ovulation takes place at the end of the proliferative phase because of a surge in LH
Days 15 28
Blood gushes into weakened capillaries causing rupture and sloughing of the
endometrium
-used to say estrogen was cardioprotective, but not now. But then that means testosterone is
detrimental to the arteries (it raises their cholesterol)
-And calcium deposits in bone:
In menopause usually starts in 50s
Once you have a hysterectomy you cant judge when they will go through menopause
Besides irregularity periods, what are the other big symptom that is had to tolerate? Hot flashes!!
After menopause whats the big concern? Osteoporosis!! If a woman fractures a hip their life
expectancy is about 6 months
Clinical pearl:
Woman with fractured leg will look shorter and is rotated outward, thats how you need an x-ray
for an older persons possible hip fracture
ERT: (estrogen replacement therapy)
Aimed at 1) stopping hot flashes and 2) preventing osteoporosis
First just gave estrogen (without progesterone) and that is called giving estrogen unopposed but
there is a problem, unopposed estrogen is a MAJOR risk factor for uterine cancer
-Then they decided to give progesterone with the estrogen (estrogen first 3 weeks, progesterone
one 1) but that gave them periods again
-Now if you give estrogen and progesterone at the same time you dont have cycles or uterine
cancer
-Estrogen takes care of hot flashes, estrogen WILL PREVENT osteoporosis, if they develop
osteoporosis and they are NOT on osteoporosis putting them on estrogen will NOT reverse
the osteoporosis
-But with the ADDITION of progesterone WITH estrogen WILL reverse osteoporosis
If a woman has a hysterectomy you generally dont put them on estrogen replacement, and if you
do theres no compelling reason to also put them on progesterone, just put them on low-dose
estrogen
----------Pregnancy:
Lasts 40 weeks - 10 months
-look for the uterus will stay in pelvis to about week 12 after that you can feel it popping out of
the pelvis
-at week 20 it is at the level of the umbilicus
-then by 40 weeks it almost up to the xiphoid process
-once it hits the umbilicus at 20 weeks it will be about 20 cm - so each week the uterus grows
about 1 cm
-up until about 24-28 weeks you see them once a month, then see then every 2 weeks until 36
weeks, from 36 on you see them every week and you measure the uterus every time!! An
indication of how the baby is growing!! If it is high or low then you do the ultrasound
-If not where you should be, it is usually do to amniotic fluid (too low, not enough fluid, etc.). It
being too high can ALSO be d/t twins
-At 36 weeks you used to say you could go ahead and deliver, now you need to go the full 40
weeks
Delivery:
-prior to going into labor, the cervix is thick and closed
-during labor 1) the cervix has to thin out (effacement) and 2) the cervix has to dilate
-It is extremely important to not push until 10 cm!! But if the cervix isnt 100% effaced, the
cervix will swell and the baby will not come out
-Shoulder dyostia when the shoulders get stuck in the pelvis during delivery. Once you get the
head out you have to get the rest of the body out, there isnt time for a C-section
-cervix is completely dilated, when head is visible = crowning which helps thin out perineum
-babies head comes out nose/face down, then you turn so that the shoulders go from anterior to
posterior, you then deliver the top shoulder by taking the head and pulling down until the front
shoulder pops, once the top shoulder comes out the rest is easy
-you clamp the cord, but it is filled with the babies blood and the placenta has a lot of it so you
cant clamp it too quickly the baby will be anemic. If you wait too long, the baby will be very red
d/t high RBC
-The placenta should come of spontaneously so it will just pop out
-after delivery the uterus has to contract very hard and stay contracted usual cause of prolonged
bleeding is all of the placenta did NOT come out (retained placenta) and you have to go get the
rest taken out
-After delivery you have to make sure the uterus and cervix is back to normal usually takes 6
weeks for everything to go back to normal