LEARNING TARGETS At the completion of this chapter the student will be able to:

◆ Describe gender differentiation and differences in male and female embryos including timing

of anatomical sexual differences.

◆ Identify anatomy of the female and male reproductive systems.

◆ Explain physiological functions of the reproductive organs.

◆ Analyze the actions and interactions of hormones from the hypothalamus, pituitary, gonads,

and other hormones that affect the reproductive system.

◆ Describe the process of sexual maturation.

◆ Discuss various physiological events that accompany the menstrual cycle.

◆ Develop an understanding of physiological changes that occur during the menopause years.

◆ Identify several age-related issues for men.

moving toward evidence-based practice Menstrual Cycle Variability

Fehring, R.J., Schneider, M., & Raviele, K. (2006). Variability in the phases of the menstrual cycle. JOGNN,
35(3), 376–384.

The purpose of this study was to determine the variability in the phases of the menstrual cycle among
165 healthy, regularly menstruating women. The sample consisted of 21- to 44-yearold women from four
major U.S. cities. All participants reported having regular menstrual cycles that occurred every 21–42
days. None of the women had used depot medroxyprogesterone acetate (Depo-Provera) for the previous
12 months or oral or subdermal contraceptives for 3 months before the study. None of the women had
known fertility problems. To be included in the study, breastfeeding mothers must have experienced at
least

three menstrual cycles after infant weaning.

The participants were taught how to monitor fertility by the

use of the Clearblue Easy Fertility Monitor, a handheld electronic

device designed to read wick-type urine test strips. The monitor

notes “low,” “high,” or “peak” fertility status based on urine

hormone levels. According to the manufacturer, the Clearblue

Easy Fertility Monitor is accurate in detecting a hormone surge

98.8% of the time. The participants were also taught how to

record monitor readings and the days of menstruation on a fertility chart. The fertility charts were
reviewed with each participant

at 1, 2, 6, and 12 months.

This prospective descriptive study utilized a data set with

biological markers to estimate menstrual cycle parameters:

• Length of the follicular, fertile, luteal, and menstrual phases

• The estimated day of ovulation based on the “peak fertility” monitor reading (determined by the
urinary luteinizing hormone surge)

• The cycle length, determined by counting the number of

days beginning with the 1st day of menses to the beginning of the next menses

• The fertile phase, defi ned as a 6-day interval beginning

with the 5 days preceding and including the second “peak

fertility” day (the estimated day of ovulation)

(continued) moving toward evidence-based practice (continued)

• The follicular phase, defi ned as the interval from the fi rst

day of menses up to and including the estimated day of

ovulation

• The luteal phase, defi ned as the interval from the fi rst day
after the estimated day of ovulation up to and including the

day before the next menstrual cycle

• The menses phase, defi ned as the interval beginning with

the fi rst day of bleeding through the last day of bleeding

Data analysis revealed the following:

• Mean age 29.0 years; average number of children 1.3

• Average number of menstrual cycles per 12 months 5.2

(range 3–13)

• Mean frequency of menstrual cycles 28.9 days; (range

22–36 days)

• Mean frequency of menstrual cycles in women over

35 years of age 27.2 days

• On average, the fertile phase began on cycle day 13 and

lasted for 6 days

• On average, the menstrual phase lasted for 5.8 days

(range 3–8 days)

• On average, the follicular phase lasted 16.5 days (range

10–22 days)

• On average, the luteal phase lasted 12.4 days (range

9–16 days)

The study fi ndings confi rmed and expanded known information about the norms of menstrual cycle
variability. There is

considerable normal variability in the phases of the menstrual

cycle among regularly menstruating women; the greatest

amount of variability occurs in the follicular phase.

1. What might be considered as limitations to this study?

2. How is this information useful to clinical nursing practice?

See Suggested Responses for Moving Toward Evidence-Based

Practice on the Electronic Study Guide or DavisPlus.

Introduction

This chapter provides an overview of the anatomy and

physiology of the male and female reproductive systems.

Growth and development over the lifespan is explored

with a primary focus on females, and special issues related

to male development. The menstrual cycle and events that

occur in the absence of fertilization as well as those that

take place soon after conception are explored. A discussion of key hormones that impact the menstrual
cycle

enhances understanding of the symphony of cyclic events

during the reproductive years.

Sexual Differentiation in the Embryo

In humans, the course of gender maturation is quite

lengthy, extending from embryonic development to full

maturation in later adolescence. Although the gender of

an individual is determined at the moment of conception, it takes about 8 weeks of development before
the

reproductive system becomes differentiated as male or

female. Before 8 weeks’ gestation, the embryo displays

no distinguishing sexual characteristics. At 5 weeks after

conception, the fi rst reproductive tissue arises from the

mesoderm, the embryo’s middle layer. The fi rst structure formed is a gonad (sex gland), which is
composed

of an internal portion called a medulla and an external

portion known as the cortex. During the next few weeks,

the gonad undergoes various developmental changes.

Primitive reproductive ducts form during this undifferentiated period, and include a pair of mesonephric
ducts

and a pair of paramesonephric ducts. The mesonephric

ducts are dominant in males and the paramesonephric

ducts are dominant in females (Blackburn, 2003).

Depending on the gender of the embryo, one ductal pair

becomes dominant in genital development while the

other genital pair regresses. Differing male/female developmental changes in the embryonic
mesonephric/

paramesonephric duct structure are the fi rst gender

changes that occur.

Male Gender
In a male embryo, the cortex of the gonad regresses and

the medulla develops into a testis at around the 7th to 8th

week of gestation. The mesonephric ducts evolve into the

efferent ductule, vas deferens, epididymis, seminal vesicle,

and ejaculatory duct. Collectively, these structures become

the male genital tract. This process is stimulated by the

production of testosterone in the testes. The testes also

secrete Müllerian regression factor, which suppresses the

paramesonephric ducts. The testes do not produce spermatozoa (sperm) until puberty. Beginning in the
12th

developmental week, androgens begin to stimulate the

growth of the external genitalia (Blackburn, 2003).

Female Gender

In a female embryo, the medulla of the fi rst primitive

gonad regresses while the cortex develops into an ovary at

approximately 10 weeks. During fetal life, underdeveloped egg cells, oogonia, develop to become
oocytes,

(primitive eggs). At the time of birth, There are 2 to 4 million oocytes present in the ovary. The process of
oocyte

development that results in maturation of human ova is

called oogenesis. External female genitalia develop in

the absence of androgens. At approximately 12 weeks, the

clitoris is formed and the labia majora and minora develop

from the surrounding connective tissue. By 16 weeks, the

paramesonephric ducts have evolved into the fallopian

tubes, uterus, and vagina.

Ch05_111-136-14864.indd 114 12/12/

Female Reproductive System

EXTERNAL STRUCTURES (PUDENDUM

MULIEBRE)

The external genital structures include the mons pubis, labia

majora, labia minora, clitoris, vestibule of the vagina, urethral (urinary) meatus, Skene’s glands, Bartholin’s glands,

vaginal introitus (opening), hymen, and the perineum

(Fig. 5-1).

The vulva (pudendum femininum) is the portion of

the female external genitalia that lies posterior to the

mons pubis. It consists of the labia majora, labia minora,

clitoris, vestibule of the vagina, vaginal opening, and Bartholin’s glands (Venes, 2009).

Mons Pubis

The mons pubis, or mons veneris, is a layer of subcutaneous tissue anterior to the genitalia in front of the
symphysis pubis. It is located in the lowest portion of the abdomen and typically is covered with pubic hair that
grows in

a transverse pattern. The texture and amount of pubic hair

vary ethnically. In Asian women, the hair is fi ne and

sparse. In women of African descent, the hair is thick and

curly. The mons pubis is essentially a fatty pad that cushions and protects the pelvic bones, especially during

intercourse.

Labia

The labia majora are the two folds of tissue that lie lateral

to the genitalia and serve to protect the delicate tissues

between them. The external labia are covered with pubic

hair while the medial surfaces, which are moist and pink,

are without pubic hair. During pregnancy, the labia

majora are highly vascular due to hormonal infl uences.

The labia majora share an extensive lymphatic network

with other vulvar structures, leading to an enhanced

capacity to spread diseases such as malignant carcinomas.

The labia majora become less prominent after each

pregnancy.

The labia minora are two folds of tissue that lie within

the labia majora and converge near the anus to form the

fourchette (a tense fold of mucous membrane at the posterior opening of the vagina). Similar to but smaller than

the labia majora, these structures are moist and absent of

hair follicles and resemble mucous membrane. The labia

minora contain a number of sebaceous glands that provide lubrication and protective bacteriocidal secretions.

During puberty the labia minora enlarge. After menopause they become smaller due to declining hormonal

levels. The mons, labia majora, and labia minora all function to protect the clitoris and vestibule.

Clitoris

The clitoris is located at the upper junction of the labia

minora. The prepuce, or clitoral hood, is a small fold of

skin that partially covers the glans (head) of the clitoris.

Composed of erectile tissue, the clitoris is primarily the

organ of sexual pleasure and orgasm in women. The clitoris contains a rich blood and nerve supply, and is
extremely

sensitive. Sensory receptors located in the clitoris send

information to the sexual response area in the brain. This

message prompts the clitoris to secrete a cheese-like fatty

substance with a distinctive odor called smegma. It is

believed that smegma is a pheromone (chemical signal

sent between individuals). Anatomically, the clitoral shape

is similar to that of the urinary meatus, and the structural

similarity of the two organs sometimes results in misguided and painful catheterization attempts. Some cultures
remove the clitoris and other external genitalia in a

ritualistic process called female circumcision.

Vestibule
The vestibule is essentially an oval-shaped space enclosed

by the labia minora. It contains openings to the urethra

and vagina, the Skene’s glands, and the Bartholin’s glands.

This area of a woman’s anatomy is extremely sensitive to

chemical irritants. Nurses should be prepared to educate

women about the potential discomforts associated with

the use of dyes and perfumes found in soaps, detergents,

and feminine hygiene products, and encourage their discontinuation if symptoms develop.

Urethral (Urinary) Meatus

The urethral or urinary meatus (opening) is located in the

midline of the vestibule, approximately 0.4 to 1 inch (1 to

2.5 cm) below the clitoris. The small opening is often

shaped like an inverted “V.” The vaginal orifi ce or introitus

lies in the lower portion of the vestibule posterior to the

urethral meatus. It is essentially a boundary between

the internal and external genitals. The hymen, a connective tissue membrane, encircles the vaginal introitus.

Skene’s Glands and Bartholin’s Glands

The Skene’s glands (paraurethral glands), located on each

side of the urethra, produce mucus that helps to lubricate

the vagina. The Skene’s glands are not readily visible. To

facilitate examination, the margins of the urethra are

drawn apart and the mucous membrane gently everted to

reveal the small glandular opening on each side of the

fl oor of the urethra (Venes, 2009).

The Bartholin’s glands, also known as the greater vestibular or vulvovaginal glands, are located deep within the

posterior portion of the vestibule near the posterior vaginal introitus. These glands secrete a clear mucus that

moistens and lubricates the vagina during sexual arousal.

Hymen
Surrounding the opening of the vagina is a small portion

of tissue called the hymen. The hymen typically forms a

border around the entrance of the vagina in premenstrual

girls. Hymenal tissue does not completely cover or occlude

the vagina. Ultimately the hymen becomes widened,

sometimes by tearing, which may be accompanied by

bleeding. Widening of the hymen may also occur following a vulvar injury, tampon insertion, or at the time of the

fi rst sexual intercourse. It is a societal myth that the

hymen must be intact for a female to be considered

a virgin.

Perineum

The perineum, an anatomical landmark, is the skincovered region between the vagina and the anus. The perineal
body consists of fi bromuscular tissue located between

the lower part of the vagina and the anus. During the labor
process, as the fetus descends through the vagina, the

perineum stretches and becomes very thin, sometimes

tearing as the baby is born. An episiotomy (incision made

to enlarge the perineal opening to allow delivery of a

fetus) may be performed to widen the external passage

(see Chapter 12 for further discussion).

Now Can You— Discuss aspects of development of

the reproductive system and identify

components of the female reproductive

tract?

1. Identify the developmental week when differentiation of the

embryo’s reproductive system occurs?

2. Name three structures that arise from the mesonephric ducts?

3. Describe the anatomical locations and functions of the labia,

Skene’s glands, and Bartholin’s glands?

PELVIC FLOOR

The bony pelvis contains a pelvic fl oor of soft tissues that

provides support and stability for surrounding structures.

Most of the perineal support comes from the pelvic diaphragm (musculofascial layer forming the lower boundary

of the abdominopelvic cavity) and the urogenital diaphragm

(musculofascial sheath lying between the ischiopubic rami

surrounding the female vagina). The pelvic diaphragm

includes fascia and the levator ani and coccygeus muscles

(Cunningham et al., 2005).

Above the pelvic diaphragm lies the pelvic cavity;

below and behind is the perineum. The urogenital diaphragm includes fascia, deep transverse perineal muscles,

and the urethral constrictor (Cunningham et al, 2005).

The muscles of the pelvic fl oor include the levator ani

(consists of the iliococcygeal, pubococcygeal [pubovaginal], puborectal muscles) and the coccygeus. These
structures create a “sling” that provides support for internal

pelvic structures and the pelvic fl oor. The ischiocavernosus muscle extends from the clitoris to the ischial

tuberosities on each side of the lower bony pelvis. Two

transverse perineal muscles extend from fi brous tissue of

the perineum to the ischial tuberosities to stabilize the

perineum (Fig. 5-2).

INTERNAL STRUCTURES

The internal female reproductive structures consist of the

ovaries, fallopian tubes (oviducts, or uterine tubes), uterus,

adjacent structures (adnexa), and vagina (Figs. 5-3 and

5-4). The ureters, bladder, and urethra are structures of the

internal urinary system.

Ovaries

The ovaries are sometimes referred to as the essential

female organ because they produce ova (female gametes

or eggs) that are required for reproduction. They are a pair

of oval structures, each measuring approximately 1.5

inches (4 cm) long, located on each side of the uterus

below and behind the fallopian tubes. The ovarian ligament extends from the medial side of each ovary to the

uterine wall; the broad ligament is a fold of the peritoneum that provides a covering for the ovaries. These two

ligaments help to keep the ovaries in place.

The ovaries are responsible for the production of ova and

the secretion of female sex hormones. Both of these functions become activated at the time of puberty. Oogenesis

(the process of meiosis for egg cell formation) results in the

formation of mature eggs within the ovary. Oogenesis is a

process that occurs at regular (usually monthly) intervals.

The ovaries also secrete the female sex hormones estrogen

Hormonal influences on reproduction:

Hypothalamus: releasing factors

gonadotropin releasing hormone;

corticotropin releasing hormone;

growth hormone releasing factor/

inhibiting factor;

thyrotropin releasing hormone;

prolactin inhibiting factor

Pituitary: ACTH; prolactin; growth hormone;

gonadotropins; oxytocin

Gonadal: estrogen; progesterone; testosterone

In addition: hCG, prostaglandins; relaxin

Physical, psychological

& emotional changes

Internal:

• Ovaries=oogenesis

• Fallopian tubes

• Uterus

- Corpus

- Isthmus

- Cervix

• Vagina

• Ligaments/muscles

supporting uterus

External:
• Vulva

- Labia majora/minora

- Clitoris

- Vaginal vestibule

- Vaginal opening

- Bartholin’s glands

• Mons pubis

• Skene’s glands

• Hymen

• Perineum

• Thelarche

• Menarche

• Hypothalamus/pituitary/

ovarian axis
development of

secondary sex

characteristics

Menstrual cycle:

• Begins in puberty

• Changes occur in uterus,

cervix and vagina

• Controlled by hormones via

positive and negative

feedback

Uterine cycle:

• Proliferative phase

• Secretory phase
• Ischemic phase

Hypothalamic-pituitaryovarian cycle:

• Interaction of GnRH, LH, FSH,

estrogen and progesterone

that promote:

- Ovarian follicle growth,

ovulation, luteinization

- Onset of menstruation

Bony pelvis:

• Supports/protects

pelvic contents

• Fixed axis for

birth passage

Breasts:
• Nipples/areola

• Montgomery

tubercles

• Alveoli/lactiferous

ducts

Types:

• Gynecoid

• Android

• Anthropoid

• Platypelloid

Measurements/

Pelvimetry:

• Pelvic inlet
• Midpelvis

• Pelvic outlet

Internal:

• Testes

• Epididymis

• Vas deferens

• Ductus deferens

• Ejaculatory ducts

• Urethra

• Spermatic cords

• Accessory glands

• Reproductive

function of

testes begins
• Enlargement of

testes

• Development of

secondary sex

characteristics

• Growth spurt

• Sperm production

External:

• Perineum

• Pelvis

• Scrotum

Structures of the female

reproductive system
Other

Puberty

At 5 weeks:

Begin male/female

differentiation in embryo

Reproductive

Anatomy & Physiology

Structures of the male

reproductive system

Now Can You:

• Discuss various aspects of the female and male reproductive systems

• Identify aspects of the bony pelvis and female breast

• Discuss key hormones involved in reproduction