Female Reproductive System

The female reproductive system is designed to carry out several functions. It produces

the female egg cells necessary for reproduction, called the ova or oocytes. The system
is designed to transport the ova to the site of fertilization. Conception, the fertilization of
an egg by a sperm, normally occurs in the fallopian tubes. The next step for the
fertilized egg is to implant into the walls of the uterus, beginning the initial stages of
pregnancy. If fertilization and/or implantation does not take place, the system is
designed to menstruate (the monthly shedding of the uterine lining). In addition, the
female reproductive system produces female sex hormones that maintain the
reproductive cycle. (Johnson, 2018)

Internal Genitalia

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Vagina

The vagina is a muscular canal (approximately 10 cm long) that serves as the entrance
to the reproductive tract. It also serves as the exit from the uterus during menses and
childbirth. The outer walls of the anterior and posterior vagina are formed into
longitudinal columns, or ridges, and the superior portion of the vagina—called the fornix
—meets the protruding uterine cervix. (“Anatomy and Physiology of the Female”, 2013)
According to “Female Reproductive Organ Anatomy” (2019), the vagina is held in place
by endopelvic fascia and ligaments and is lined by rugae, which are situated in folds
throughout. The function of these rugae is for easy distention, especially during child
bearing. The structure of the vagina is a network of connective, membranous, and
erectile tissues.

Uterus and Cervix

“Anatomy and Physiology of the Female Reproductive System” (2013) provides a

comprehensive explanation of the uterus relative to the cervix. The uterus is the
muscular organ that nourishes and supports the growing embryo. Its average size is
approximately 5 cm wide by 7 cm long when a female is not pregnant. It has three
sections. The portion of the uterus superior to the opening of the uterine tubes is called
the fundus. The middle section of the uterus is called the body of uterus (or corpus).
The cervix is the narrow inferior portion of the uterus that projects into the vagina. The
cervix produces mucus secretions that become thin and stringy under the influence of
high systemic plasma estrogen concentrations, and these secretions can facilitate
sperm movement through the reproductive tract.

The wall of the uterus is made up of three layers. The most superficial layer is the
serous membrane, or perimetrium, which consists of epithelial tissue that covers the
exterior portion of the uterus. The middle layer, or myometrium, is a thick layer of
smooth muscle responsible for uterine contractions. Most of the uterus is myometrial
tissue, and the muscle fibers run horizontally, vertically, and diagonally, allowing the
powerful contractions that occur during labor and the less powerful contractions (or
cramps) that help to expel menstrual blood during a woman’s period.

The innermost layer of the uterus is called the endometrium. The endometrium contains
a connective tissue lining, the lamina propria, which is covered by epithelial tissue that
lines the lumen. Structurally, the endometrium consists of two layers: the stratum
basalis and the stratum functionalis (the basal and functional layers). The stratum
basalis layer is adjacent to the myometrium; this layer does not shed during menses. In
contrast, the thicker stratum functionalis layer contains the the endothelial tissue that
lines the uterine lumen. It is the stratum functionalis that grows and thickens in response
to increased levels of estrogen and progesterone.

Fallopian Tubes

“Female Reproductive Organ Anatomy” (2019) offers a description for the fallopian
tubes. Fallopian tubes (uterine tubes or oviducts) are uterine appendages located
bilaterally at the superior portion of the cavity. Their primary function is to transport
sperm toward the egg, which is released by the ovary, and then to allow passage of the
fertilized egg back to the uterus for implantation.

The uterine tube has 3 parts. The first segment, closest to the uterus, is called the
isthmus. The second segment is the ampulla, which becomes more dilated in diameter
and is the typical place of fertilization. The final segment, furthest from the uterus, is the
infundibulum. The infundibulum gives rise to the fimbriae, fingerlike projections that are
responsible for catching the egg that is released by the ovary.

Ovaries

The ovaries are paired organs located on either side of the uterus. The ovaries are
responsible for housing and releasing the ova, or eggs, necessary for reproduction. At
birth, a female has approximately 1-2 million eggs, but only 300 of these eggs ever
mature and are released for the purpose of fertilization. A cross-section of the ovary
reveals many cystic structures that vary in size. These structures represent ovarian
follicles at different stages of development and degeneration. (“Female Reproductive
Organ Anatomy”, 2019)

Menstrual Cycle

A menstrual cycle (a female reproductive cycle) is episodic uterine bleeding in response

to cyclic hormonal changes. The purpose of a menstrual cycle is to bring an ovum to
maturity and renew a uterine tissue bed that will be responsible for the ova’s growth
should it be fertilized. It is the process that allows for conception and implantation of a
new life.

The length of menstrual cycles differs from woman to woman, but the average length is
28 days (from the beginning of one menstrual flow to the beginning of the next).
(Pillitteri, 2009)

Physiology of Menstruation

According to Pillitteri (2009), four body structures are involved in the physiology of the
menstrual cycle: the hypothalamus, the pituitary gland, the ovaries, and the uterus. For
a menstrual cycle to be complete, all four structures must contribute their part.

Hypothalamus

The release of GnRH (also called luteinizing hormone– releasing hormone, or LHRH) by
the hypothalamus initiates the menstrual cycle. When the level of estrogen (produced
by the ovaries) rises, release of the hormone is repressed, and menstrual cycles do not
occur (the principle that birth control pills use to eliminate menstrual flow).

GnRH is transmitted from the hypothalamus to the anterior pituitary gland and signals
the gland to begin producing the gonadotropic hormones FSH and LH. Because
production of GnRH is cyclic, menstrual periods also cycle.
Pituitary Gland

Under the influence of GnRH, the anterior lobe of the pituitary gland (the
adenohypophysis) produces two hormones that act on the ovaries to further influence
the menstrual cycle: (a) FSH, a hormone that is active early in the cycle and is
responsible for maturation of the ovum, and (b) LH, a hormone that becomes most
active at the midpoint of the cycle and is responsible for ovulation, or release of the
mature egg cell from the ovary, and growth of the uterine lining during the second half of
the menstrual cycle.

FSH and LH are called gonadotropic hormones because they cause growth (trophy) in
the gonads (ovaries). Every month during the fertile period of a woman’s life, one of the
ovary’s primordial follicles is activated by FSH to begin to grow and mature. As it grows,
its cells produce a clear fluid (follicular fluid) that contains a high degree of estrogen
(mainly estradiol) and some progesterone. As the follicle reaches its maximum size, it is
propelled toward the surface of the ovary. At full maturity, it is visible on the surface of
the ovary as a clear water blister. At this stage of maturation, the small ovum (barely
visible to the naked eye), with its surrounding follicle membrane and fluid, is termed a
graafian follicle. By day 14 before the end of a menstrual cycle (the midpoint of a typical
28-day cycle), the ovum has divided by mitotic division into two separate bodies: a
primary oocyte, which contains the bulk of the cytoplasm, and a secondary oocyte,
which contains so little cytoplasm that it is not functional. The structure also has
accomplished its meiotic division, reducing its number of chromosomes to the haploid
(having only one member of a pair) number of 23.

After an upsurge of LH from the pituitary, prostaglandins are released and the graafian
follicle ruptures. The ovum is set free from the surface of the ovary, a process termed
ovulation. It is swept into the open end of a fallopian tube.

After the ovum and the follicular fluid have been discharged from the ovary, the cells of
the follicle remain in the form of a hollow, empty pit. The FSH has done its work at this
point and now decreases in amount. The second pituitary hormone, LH, continues to
rise in amount and acts on the follicle cells of the ovary. It influences the follicle cells to
produce lutein, a bright-yellow fluid. Lutein is high in progesterone and contains some
estrogen, whereas the follicular fluid was high in estrogen with some progesterone. This
yellow fluid fills the empty follicle, which is then termed a corpus luteum (yellow body).

If conception (fertilization by a spermatozoon) occurs as the ovum proceeds down a

fallopian tube and the fertilized ovum implants on the endometrium of the uterus, the
corpus luteum remains throughout the major portion of the pregnancy (approximately 16
to 20 weeks). If conception does not occur, the unfertilized ovum atrophies after 4 or 5
days, and the corpus luteum (called a “false” corpus luteum) remains for only 8 to 10
days. As the corpus luteum regresses, it is gradually replaced by white fibrous tissue,
and the resulting structure is termed a corpus albicans (white body).

Uterus

According to Pillitteri (2009), there are fourth phases of the menstrual cycle as
manifested in the uterus:

Proliferative - Immediately after a menstrual flow (which occurs during the first 4
or 5 days of a cycle), the endometrium, or lining of the uterus, is very thin,
approximately one cell layer in depth. As the ovary begins to produce estrogen
(in the follicular fluid, under the direction of the pituitary FSH), the endometrium
begins to proliferate. This growth is very rapid and increases the thickness of the
endometrium approximately eightfold. This increase continues for the first half of
the menstrual cycle (from approximately day 5 to day 14). This half of a
menstrual cycle is termed interchangeably the proliferative, estrogenic, follicular,
or postmenstrual phase.

Secretory - After ovulation, the formation of progesterone in the corpus luteum

(under the direction of LH) causes the glands of the uterine endometrium to
become corkscrew or twisted in appearance and dilated with quantities of
glycogen (an elementary sugar) and mucin (a protein). The capillaries of the
endometrium increase in amount until the lining takes on the appearance of rich,
 spongy velvet. This second phase of the menstrual cycle is termed the
progestational, luteal, premenstrual, or secretory phase.

Ischemic - If fertilization does not occur, the corpus luteum in the ovary begins to
regress after 8 to 10 days. As it regresses, the production of progesterone and
estrogen decreases. With the withdrawal of progesterone stimulation, the
endometrium of the uterus begins to degenerate (at approximately day 24 or day
25 of the cycle). The capillaries rupture, with minute hemorrhages, and the
endometrium sloughs off.

Menses - This is the end of an arbitrarily defined menstrual cycle. Because it is

the only external marker of the cycle, however, the first day of menstrual flow is
used to mark the beginning day of a new menstrual cycle. (p. 100-102)

Female Reproductive Organ Anatomy. (2019, November 9). Retrieved from

https://emedicine.medscape.com/article/1898919-overview]

Johnson, T. C. (2018, December 12). Female Reproductive System: Organs, Function,

and More. Retrieved from https://www.webmd.com/sex-relationships/guide/your-guide-
female-reproductive-system#1

OpenStax. (2013, March 6). 27.2 Anatomy and Physiology of the Female Reproductive
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anatomy-and-physiology-of-the-female-reproductive-system/
Pillitteri, A. (2009). Maternal & child health nursing: care of the childbearing &
childrearing family, 6th ed. Lippincott.