Female reproductive organs. External female genital organs: vulva

The structure of the female reproductive system

The female reproductive system consists of the genital organs, mammary glands, some parts of the brain and endocrine glands that regulate the functioning of the genital organs.

The female reproductive organs are divided into internal and external. External organs: labia, vagina, perineum. Internal organs: uterus, cervix, fallopian tubes, ovaries.

Vagina- This is a muscular organ that starts from the entrance to the vagina and ends at the cervix. The cells of the vaginal mucosa contain a special substance - glycogen, which is used by the vaginal microflora. This is how lactic acid is formed, which gives protective properties to the vaginal secretion and prevents pathogenic microorganisms from entering the woman's reproductive system.

Uterus is a hollow muscular organ that serves as a site for the development of the fetus. Consists of the cervix and body. The cervix is ​​a canal about 4 cm long. It consists of the vaginal part of the cervix, "facing" into the vagina and having an opening - the internal pharynx. During colposcopy and examination in the mirrors by a gynecologist, it is the vaginal part of the cervix that is evaluated. The supravaginal or uterine part of the cervix opens into the uterine cavity with the internal uterine os. The cells of the mucous membrane of the cervical canal secrete mucus, which has protective properties and prevents the penetration of various microorganisms into the uterine cavity. Before ovulation, these cells produce more liquid mucus, which facilitates the penetration of spermatozoa into the uterine cavity (). During childbirth, the “birth canal” is formed by the vagina and cervical canal, through which the fetus moves.

In the body of the uterus, a cavity is isolated that has the appearance of a triangle in the frontal plane. The wall of the uterus contains three layers of muscle cells. The inside of the uterus is lined with a mucous membrane called the endometrium. Under the influence of hormones secreted by the ovaries, the endometrium changes monthly (menstrual cycle). The main function of the uterus is to carry a pregnancy. In the uterine cavity, the fetal egg is attached and the fetus develops further ().

The fallopian tubes start from the corners of the uterine cavity and have a length of about 10 cm. There are two openings in the tube: a wider one opens into the abdominal cavity and forms a funnel of the fallopian tube; narrower - the mouth of the tube, opens into the uterine cavity.

The funnel of the fallopian tube ends with fimbriae, necessary for the “capture” of the egg that has entered the abdominal cavity after ovulation. On the inner surface of the fallopian tubes there are cells with cilia, which in wave-like movements contribute to the advancement of the embryo to the uterine cavity (). Thus, the transport function is the main function of the fallopian tubes.

ovaries- female gonads. They are located on the sides of the uterus and "contact" with the funnel of the fallopian tube, or rather with the fimbriae. The ovaries contain follicles, which are rounded formations filled with fluid. It is there, in the follicle, that the egg is located, which, after fertilization, gives rise to a new organism (). In addition, the ovaries produce female sex hormones that regulate the work of not only the reproductive system, but the entire body of a woman.

Function of the female reproductive system

The main function of the female reproductive system is reproductive function. This means that the conception of a new organism and its bearing takes place in the body of a woman. This function is performed by the interaction of several organs related to the female reproductive system. This interaction provides hormonal regulation. It is this regulation that is the main link in the implementation of the reproductive function of the female body.

The pituitary gland, located in the brain, is one of the highest departments of hormonal regulation in all internal organs and systems in the human body. The pituitary gland secretes hormones that regulate the work of other endocrine glands - the sex glands (LH and FSH), the thyroid gland (TSH - thyroid-stimulating hormone), the adrenal glands (ACTH - adrenocorticotropic hormone). Also, the pituitary gland secretes a number of hormones that regulate the work of the genital organs (oxytocin), the urinary system (vasopressin or antidiuretic hormone), the mammary gland (prolactin, oxytocin), the skeletal system (GH or growth hormone).

The work of the reproductive system is regulated by several "basic" hormones secreted by the pituitary gland: FSH, LH, prolactin. FSH - follicle-stimulating hormone - acts on the process of maturation of follicles. Thus, with an insufficient / excessive concentration of this hormone, the process of maturation of the follicles is disrupted, which can lead to infertility (). LH - luteinizing hormone - is involved in ovulation and the formation of the corpus luteum. Prolactin (milk hormone) affects the secretion of milk during lactation. Prolactin refers to hormones antagonists (rivals) of FSH and LH, i.e. an increase in the concentration of prolactin in a woman's body causes disruption of the ovaries, which can lead to infertility ().

In addition, the work of the female reproductive system is regulated by hormones secreted by other endocrine glands: thyroid hormones - T4 (thyroxine), T3 (triiodothyronine); adrenal hormones - DEA and DEA-S. Violation of the function of these endocrine glands leads to disruption of the reproductive system and, accordingly, to infertility ().

Cyclic changes in a woman's body or the menstrual-ovarian cycle

In a woman's body, every month there is a change in the lining of the uterus (menstrual cycle) and a change in the ovaries (ovarian cycle). Thus, it is correct to speak of the menstrual-ovarian cycle. The menstrual-ovarian cycle lasts from the first day of menstruation to the first day of the next menstruation (from 21 to 35 days).

The ovarian (ovarian) cycle consists of the maturation of the follicle (folliculogenesis), ovulation, and the formation of the corpus luteum.

Under the influence of the hormone FSH at the beginning of the menstrual cycle, the maturation of follicles in the ovary begins - the so-called follicular phase of the menstrual cycle. FSH acts on primary follicles, which leads to their growth. Usually, several primary follicles come into growth, but closer to the middle of the cycle, one of the follicles becomes the "leader". In the process of growth of the leading follicle, its cells begin to produce the hormone estradiol, which causes thickening of the uterine mucosa.

In the middle of the menstrual cycle, when the follicle reaches 18-22 mm, the pituitary gland secretes luteinizing hormone - LH (ovulatory peak), leading to ovulation (rupture of the follicle and release of the egg from it into the abdominal cavity). Then, under the influence of LH again, a corpus luteum is formed - an endocrine gland that secretes progesterone - the “pregnancy hormone”. Under the influence of progesterone, the lining of the uterus changes (the luteal phase of the cycle), which prepares it for pregnancy. Thus, infertility can also occur due to insufficient function of the corpus luteum.

The menstrual cycle is a change in the lining of the uterus (endometrium) that occurs along with the ovarian cycle. In the follicular phase of the cycle, the endometrium thickens (under the influence of the hormone estradiol). After ovulation, the corpus luteum hormone (progesterone) causes the endometrial cells to accumulate a large amount of nutrients for the embryo - the luteal phase of the cycle.

In the absence of fertilization, rejection of the uterine mucosa occurs - menstruation. Together with menstruation, the maturation of primary follicles occurs - a new menstrual cycle.

Changes in other organs and systems

Along with changes in the genital organs as a result of the action of hormones, cyclic changes also occur throughout the woman's body.

This can be especially noticed in the second phase of the menstrual cycle, when the body is “preparing” for a possible pregnancy. Progesterone causes fluid and salt retention in the body, increased appetite. The consequences of this process are weight gain, engorgement of the mammary glands, bloating. In addition, due to a small swelling of the brain tissue, a headache, inertia of thinking, drowsiness or insomnia are possible. Sometimes there are mood swings - tearfulness, irritability, fatigue, lethargy and apathy. With the onset of menstruation, such changes in the body of a woman disappear.

The female reproductive organs are divided into external and internal.

external genitalia

The external female genital organs include the large and small labia, the clitoris, the vestibule (entrance) of the vagina, as well as some glands.

Large labia

They are two skin folds with a rich subcutaneous fat layer, venous plexuses. Large labia limit the slit-like space - genital gap. Contains large vestibular glands ( bartholin glands), located on the border of the anterior and middle thirds of the lips. In front, the large labia are connected by adhesions - anterior lip commissure, behind, merging, they form posterior commissure of lips. The labia majora on both sides cover the labia minora, their outer surface is covered with hair.

Small labia

They are thin skin folds located under the labia majora, between them. The anterior edge of each labia minora splits into two legs in front, forming at the confluence above the clitoris foreskin of the clitoris, the posterior legs of the labia minora, when merged under the clitoris, form clitoral frenulum.

Clitoris

It is a rudimentary analogue of the penis. During sexual arousal, an erection occurs, it becomes elastic, filled with blood, increases in size. The clitoris, like the penis, is from the cavernous bodies, foreskin, head, but all of these are much smaller than those of men.

Vestibule (entrance) of the vagina

The vestibule (entrance) of the vagina is a space bounded from above by the clitoris, from below and behind - by the posterior commissure of the labia majora, from the sides - by the labia minora, the bottom of the vestibule is hymen, which is a membrane of connective tissue and separates the internal female genital organs from the external ones. Sometimes the hymen may not have a hole - atresia of the hymen. With this anomaly during puberty, menstrual blood accumulates over the hymen. This requires surgery.

Crotch

The perineum is not directly related to the external genitalia. However, it plays an important role in supporting the internal genital organs and is involved in the birth act. The perineum is located between the posterior commissure of the labia majora and the coccyx, it is a plate consisting of skin, muscles and fascia.

Pubis

The pubis is located in the lower part of the anterior abdominal wall and is a triangular area with a well-developed subcutaneous fat layer and hairiness. Pubic hair in women looks like a triangle, pointing down - this is the female type of hair, due to the action of female sex hormones. With an increased content of male sex hormones, there is a tendency to the male type of hair growth - the hair grows up to the navel, becomes stiffer and thicker.

Rice. one. External female genital organs

Internal sex organs

The internal genital organs are vagina, uterus, fallopian tubes, ovaries.

Vagina

The vagina is an organ in the form of a tube 8-10 cm long. Its lower end is located under the hymen, and its upper end covers the cervix. During sexual intercourse, seminal fluid is poured into the vagina. From the vagina, spermatozoa move through the cervical canal into the uterine cavity, and from it into the fallopian tubes. The walls of the vagina consist of mucous and muscular layers capable of stretching and contracting, which is important during childbirth and sexual intercourse.

Uterus

The uterus is a pear-shaped muscular organ that serves to develop and carry the fetus during pregnancy and expel it outside during childbirth.

The uterus is located in the pelvic cavity between the bladder in front and the rectum in the back.

Outside of pregnancy, the uterus has a length of 7-9 cm, a width of 4.5-5 cm, the thickness of its walls is 1-2 cm, the mass of the uterus is on average 50-100 g. During pregnancy, the uterine cavity can increase 20 times!

In the uterus are distinguished bottom, body, cervix.

Cervix has 2 parts: vaginal (goes into the vaginal cavity) and supravaginal (located above the vagina).

The body of the uterus in relation to the cervix is ​​located at an angle, usually facing forward. In the body of the uterus there is a slit-like space - uterine cavity, and in the neck - cervical canal.

Rice. 2. Internal female reproductive organs

The shape of the uterine cavity on the frontal section is triangular, in the upper corners of it there are uterine openings of the tubes, and in the lower corner the uterine cavity passes into the canal (in obstetrics, the transition point is called the internal pharynx). The cervical canal opens into the vagina through an opening called opening of the uterus (external uterine os). The opening of the uterus is limited by two thickenings of the cervix - the anterior and posterior lips of the cervix. This hole in a nulliparous woman has a rounded shape, in a woman who has given birth, it looks like a transverse slit. The cervical canal contains a mucous plug, which is the secret of its glands. The mucous plug prevents the penetration of microorganisms from the vagina into the uterus.

The wall of the uterus consists of three layers:

• the inner layer is the mucous membrane (endometrium), in which 2 sublayers are distinguished: basal (germ layer, the functional layer is restored from it after menstruation) and functional (which undergoes cyclic changes during the menstrual cycle and is rejected during menstruation);
• middle layer - muscular (myometrium) - the most powerful layer of the uterus, consists of smooth muscle tissue;
• the outer layer - serous (perimetry) - consists of connective tissue.

The uterus also has ligaments (ligamentous apparatus), which perform a suspension, fixing and supporting function in relation to the uterus. The uterine ligaments, fallopian tubes, and ovaries are appendages of the uterus.

In violation of intrauterine development, the uterus can be bicornuate, saddle-shaped. An underdeveloped uterus (small size) is called infantile.

On both sides of the uterus, the fallopian tubes depart, opening into the peritoneal cavity at the surface of the ovary.

The fallopian tubes

The fallopian tubes (right and left) are in the form of a tubular organ 10-12 cm long and 0.5 cm thick and serve to carry eggs into the uterus (one of the names of the tube is the oviduct). The fallopian tubes are located on the sides of the uterus and communicate with it through the fallopian tubes.

The fallopian tube has the following parts:

• interstitial part (passes in the wall of the uterus);
• isthmus (isthmic department) - the most narrowed middle part;
• ampoule (expanded part of the tube)
• funnel, the edges of which look like fringes - fimbriae.

Fertilization occurs in the ampulla of the fallopian tube, after which it moves to the uterus due to undulating contractions of the tube and flickering of the cilia of the epithelium, which lines the inside of the tube.

Ovary

The ovary is a paired organ, the female gonad. The ovaries are almond-shaped and whitish-pink in color. The average length of an ovary in an adult woman is 3.5-4 cm, width 2-2.5 cm, thickness 1-1.5 cm, weight 6-8 g. reproductive function). Oocyte maturation occurs from the time of puberty to menopause. The ovaries also produce sex hormones (endocrine function).

Large and important changes occur in the human body during puberty and they manifest themselves in changes in appearance, well-being and mood, as well as in the intensity of development and formation of the organs of the reproductive system.

Studying the anatomical structure and functions of your body will help you better understand and appreciate this important period in the life of every person.

Male genital organs include the following anatomical elements: internal - testicles (male sex glands), their ducts, accessory sex glands and external - scrotum and penis (penis).

The testes (testes, or testos) are two round-shaped glands in which spermatozoa are produced and male sex hormones (androgen and testosterone) are synthesized.

The testicles are located in the scrotum, which performs a protective function. The male reproductive organ (penis) is located at the bottom of the pubic lobe. It is formed by spongy tissue, which is supplied with blood from two large arteries and has the ability, when excited, to fill with blood, increase the penis in size, changing the angle of inclination (erection). The penis has a body and head covered with a fold of skin and a mucous membrane called the "foreskin".

The urethra, or urethra, is a thin tube that connects to the bladder and the vas deferens of the testis. Urine and semen are expelled through it.

The vas deferens are two thin tubes that carry sperm from the testicle to the seminal vesicles, where they accumulate and mature.

The prostate, or prostate gland, is a muscular organ in which a white liquid is produced, which, mixing with spermatozoa, forms sperm. When the prostate muscles contract, the semen is pushed out through the urethra. This is called ejaculation.

The female genital organs include the following anatomical elements: internal - ovaries, uterine or fallopian tubes, uterus, vagina - and external - small and large labia, clitoris, hymen (maiden's hymen).

The ovaries are two glands, resembling large beans in shape and size. They are located on both sides of the uterus in the lower abdomen of a woman. In the ovaries, female sex cells develop - eggs - and female sex hormones - estrogens are synthesized. The egg matures in a small ovarian vesicle for 24-30 days, after which the vesicle ruptures and the egg is released into the fallopian tubes. This is called ovulation.

The uterine (fallopian) tubes connect the uterine cavity to the ovaries. In the fallopian tubes, the egg is fertilized by the sperm.

The uterus is a cavity muscular organ resembling a pear, lined from the inside with a mucous membrane.

The uterus has three openings: two lateral ones, connecting it to the fallopian tubes, and a lower one, connecting it through the cervix to the vagina. When a fertilized egg enters the uterus, it sinks into the mucous membrane, attaching itself to the wall of the uterus. Here the embryo develops, and later the fetus. The unfertilized egg leaves the woman's body along with parts of the uterine lining and a small amount of blood. This is called menstruation.

The lower thin part of the uterus is called the cervix. In pregnant women, the cervix and vagina form the birth canal through which the fetus exits the uterine cavity at birth.

The labia minora (vulva) are folds of skin that cover the external entrance of the vagina and urethra. The clitoris is located here, in which there are many nerve receptors, which is important for erection (sexual arousal). On the sides of the small lips are the large labia.

In girls who have not had sexual intercourse (coitus), the external entrance to the vagina is closed by a thin connective tissue membrane called hymen, or maiden's hymen.

maturation of germ cells

The process of formation of male and female germ cells is called gametogenesis, which occurs in the sex glands and consists of four periods: reproduction, growth, maturation and formation.

During reproduction, the primary germ cells - gametogonia (spermatozoa or eggs) divide several times by mitosis.

During the growth period, they increase in size, preparing for the next period. During the period of maturation, in the process of meiosis, a decrease in the number of chromosomes occurs, female and male germ cells with a haploid set of chromosomes are formed. The latter, without dividing, enter a period of formation and are transformed into mature male reproductive cells - spermatozoa and female - eggs.

Chapter:
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you want to have a baby
In the life of every family, sooner or later there comes a moment when the spouses have to decide whether to have a child or not. It is better if you think about it in advance, before the onset of pregnancy, that is, the conception of a child will be planned.
Sexual desire is not always subordinated to the desire to have a child, and often due to insufficient medical literacy, and sometimes due to the lack of available contraceptives, unwanted pregnancies occur.
In our country, the number of abortions exceeds the number of births, and many children are born after much thought of parents - to leave the pregnancy or terminate it. Such a psychological state of the future mother interferes not only with the emergence of her natural feeling of love and tenderness for the unborn child, but also with the normal course of pregnancy.
Of course, yours may be different. You have carefully weighed the upcoming difficulties and are aware that with the advent of a new, small and most important person in the family, you will have significantly more worries, you will have to largely abandon the established way of life and rhythm of life, give up some attachments and habits. But you think that all the difficulties will more than pay off with the happiness of motherhood and fatherhood, and you are right. We can assume that psychologically you are really ready to give life to a child. He will be desired, and this is one of the most important factors in his normal development and upbringing.
However, there are, but sometimes completely ignored, medical aspects of family planning.
Expecting the appearance of a child, you are sure in advance that he will be the most beautiful, the smartest, the happiest. This is how your child, most likely, will turn out to be for you, especially if he is healthy. But the health of a child depends on many reasons, most of which can be predicted and targeted. Let's talk about it.
But in order to have a clear idea of ​​the processes that occur in the organisms of women and men and ensure the continuation of the family, let's get acquainted at least in general terms with the anatomy and physiology of the female and male reproductive systems.

In the genitals of women, there are outdoor and domestic.

These are the pubis, large and small labia, the clitoris, the vestibule of the vagina, the glands of the vestibule, the hymen (separating the external genitalia from the internal) and the anterior perineum.

The pubis is located in the lowest part of the anterior abdominal wall. With the onset of puberty, its surface is covered with hair.

The labia majora are formed by two folds of skin extending from the pubis, where their anterior commissure occurs. At the perineum, they converge into the posterior commissure. The skin of the labia majora is covered with hair.

The labia minora are located between the large ones. In front they form the small flesh of the clitoris, and then behind they become narrower, thinner, merging with the labia majora in their posterior third.

The clitoris is similar in structure to the male penis, but much smaller in size. It is formed by two cavernous bodies, and on top is covered with delicate skin rich in sebaceous glands. During sexual arousal, the cavernous bodies are filled with blood, which causes an erection of the clitoris - it tenses and increases in size.

The vestibule of the vagina is a space bounded in front and above by the clitoris, behind and below by the posterior commissure of the labia majora, and from the sides by the labia minora. The bottom of the vestibule is formed by the hymen or its remnants surrounding the entrance to the vagina.

In the vestibule are the external opening of the urethra, located somewhat back and down from the clitoris, the excretory ducts of the small and large glands of the vestibules. In the lateral sections of the vestibule, under the base of the labia majora, there are cavernous bodies of the vestibule bulbs, the structure of which is similar to the structure of the cavernous bodies of the clitoris.

The large glands of the vestibule (Bartholin's glands) are complex tubular formations with a diameter of about 1 cm. Their excretory ducts open at the confluence of the labia majora with the small ones. The glands secrete a liquid secret that moistens the vestibule of the vagina.

The large glands of the vestibule are located in the thickness of the posterior third of the labia majora, one on each side.

The hymen is a thin connective tissue plate with one (rarely several) opening through which the secret of the internal genital organs and menstrual blood are released. At the first sexual intercourse, the hymen is usually torn, its edges in sexually active women who have not given birth look like fringes - the so-called hymenal papillae. After childbirth, these papillae are strongly smoothed out.

Between the posterior commissure of the labia majora and the anus is the anterior perineum, and between the anus and the tip of the coccyx is the posterior perineum. When an obstetrician-gynecologist speaks of the perineum, he usually means the anterior perineum, since its back part is not significant for obstetrics.

The internal female genital organs include the vagina, uterus and its appendages - the uterine (fallopian) tubes and ovaries, as well as their ligaments (round and wide ligaments of the uterus, own and hanging ligaments of the ovaries).

The vagina is a tube 10-12 cm long, running in the direction from the bottom up and somewhat back from the vestibule of the vagina to the uterus. The upper part of the vagina is connected to the cervix, forming four vaults - anterior, posterior and two lateral.

The vaginal wall has a thickness of 0.3-0.4 cm, it is elastic and consists of three layers of inner (mucous), middle (smooth muscle) and outer (connective tissue). During puberty, the mucous membrane forms folds, mostly located transversely. Folding of the mucosa decreases after childbirth, and in many women who have given birth, it is practically absent.

The mucous membrane of the vagina has a pale pink color, which becomes bluish during pregnancy.

The middle, smooth muscle layer is well extensible, which is especially important during childbirth. External, connective tissue, connects the vagina with neighboring organs - the bladder and rectum.

The uterus is shaped like a pear, squeezed in the anteroposterior direction. This is a hollow organ. The mass of the uterus in a nulliparous sexually mature woman reaches 50-100 g, length - 7-8 cm, maximum width (at the bottom) - 5 cm, wall thickness - 1-2 cm.

The uterus is divided into three sections, the neck, body and the line between them - the so-called isthmus.

The cervix accounts for about a third of the length of this organ. Part of the cervix is ​​located in the vagina, and therefore is called the vaginal part of the cervix. In a nulliparous woman, this part resembles a truncated cone (subconical neck), in a woman who has given birth, it is a cylinder.

Through the entire cervix passes the cervical canal, which looks like a spindle. This form best contributes to the retention in its lumen of the mucous plug - the secret of the glands of the cervical canal. This mucus has bactericidal properties, that is, it kills bacteria and thereby prevents the infection from entering the uterine cavity.

The cervical canal opens into the uterine cavity with an internal os, and into the vagina with an external os. The external pharynx of the cervical canal in a nulliparous woman looks like a dot, and in a woman who has given birth, it looks like a transverse slit due to small gaps during childbirth.

From the isthmus of the uterus at the end of pregnancy, the lower uterine segment is formed - the thinnest part of the uterus in childbirth.

The body of the uterus is located above the isthmus, its top is called the bottom.

The wall of the uterus consists of three layers of the inner - the mucous membrane (endometrium), the middle - the muscular layer and the outer - the serous layer, or peritoneum. The mucous membrane, in turn, is divided into two more layers - basal and functional.

As we have said, the uterine appendages are the fallopian tubes, ovaries and ligaments. The fallopian tubes depart from the bottom of the uterus (its corners) towards the side walls of the pelvis.

The fallopian tubes, in essence, are the oviducts through which the egg enters the uterine cavity. The average length of the fallopian tube is 10-12 cm. Its lumen in the wall of the uterus is only 0.5 mm, but gradually increases, reaching 5 mm at the end (in the funnel).

From the funnel are numerous fringes - fimbriae. The fallopian tubes contract in waves, the cilia lining them from the inside fluctuate, due to which the egg moves into the uterine cavity.

The ovary is a paired organ, which is a female gonad with an average size of 3x2x1 cm. The eggs grow and develop in the ovary. It also produces female sex hormones - estrogen and progesterone.

Hormones (Greek hormao - I excite, induce) are biologically active substances that are produced by the endocrine glands (Greek endon - inside, krino - I secrete) and enter directly into the blood. One of these glands is the ovary. Sex hormones regulate the activity of the reproductive system.

A more or less permanent position of the internal genital organs is possible due to the action of the suspension, fixation and support apparatus. These are pair links. The peculiarity of their functions is such that, while holding the uterus and appendages in a certain position, they at the same time allow them to maintain a fairly significant mobility, which is necessary for the normal development of pregnancy and the course of childbirth.

The internal genital organs of a woman are located in the cavity of the small pelvis (that is, in the lower part of the pelvis) - the space between the sacrum and tailbone at the back, the pubic joint in front and the ischial bones from the sides. In the small pelvis, in addition to the female genital organs, the rectum and bladder are also located when it is not filled with urine or is almost empty. The pelvis of an adult woman, compared to a man's, is more voluminous and wide, but at the same time less deep.

The body of a woman, and primarily her reproductive system, prepares every month for the onset of pregnancy. These complex, rhythmically repeating changes that occur in the body are called the menstrual cycle.

Its duration is different for different women, most often - 28 days, less often - 21 days, very rarely - 30-35 days.

What exactly happens in a woman's body during the menstrual cycle?

Under the influence of the hormones of the hypothalamus and pituitary gland (brain regions), an egg grows and develops in one of the ovaries (Fig. 3). It matures in the follicle, a vesicle filled with liquid.

As the follicle grows, the cells lining its inner surface produce an increasing amount of estrogenic hormones. Under the influence of these hormones, the thickness of the endometrium gradually increases.

When the follicle reaches 2-2.5 cm in diameter - and this happens in the middle of the menstrual cycle (on the 10-14th day, depending on its duration), - it breaks. This phenomenon is called ovulation, the egg is released from the follicle into the abdominal cavity.

After ovulation, the so-called corpus luteum forms at the site of the follicle, which secretes progesterone, the hormone that maintains pregnancy. Under its influence, changes occur in the endometrium, due to which the mucous membrane of the uterus becomes able to accept the embryo.

The egg, as a result of complex biological chemical processes, enters the fallopian tube, where fertilization can occur. If this does not happen, the corpus luteum undergoes a reverse development, the concentration of hormones (progesterone and estrogens) decreases significantly.

Maturation of the egg in the ovary.
1 - primary follicles, 2 - growing follicle, 3 - mature follicles, 4 - egg after ovulation, 5 - collapsed mature follicle, 6 - corpus luteum, 7 - regressed follicle

Basal temperature curve
a - a two-phase cycle (there is a rise in temperature after ovulation),
b - anovulatory cycle (no rise in temperature).

This process is called the ovarian cycle. It is not visible, and its course can be judged only by using special research methods (determining the concentration of hormones in the blood, ultrasound examination of the ovaries, functional diagnostic tests, etc.). But under the influence of those changes that occur in the ovary, changes occur in other parts of the female reproductive system, the results of which can be detected.

So, if the reproductive system functions correctly, then a woman in the absence of pregnancy regularly has menstruation. As you can see, the onset of menstruation does not mean the beginning, but the end of the menstrual cycle. It signals the death of an unfertilized egg, the attenuation of those functional changes that were associated with the preparation of the body for pregnancy. Therefore, it is possible to become pregnant during the first menstrual cycle, when there has not been a single menstruation yet.

If the egg is fertilized, menstruation stops.

The processes that occur in the ovary and uterus during the menstrual cycle affect the entire body. Changes in the activity of the nervous and cardiovascular systems, thermoregulation, metabolism. Many women notice this by increased irritability, drowsiness and fatigue before menstruation, which are replaced by cheerfulness and a burst of energy after it.

If during the entire menstrual cycle the temperature in the rectum (basal or rectal temperature) is measured every day at the same time, for example, in the morning immediately after waking up, and the results are plotted on a graph (Figure 4), then you can get a kind of curve. In a healthy woman, it has a two-phase character until the 12th-14th day it goes lower, and in the next 7-10 days - above 37°C (37.1-37.5°C). An increase in temperature indicates the beginning of ovulation and its continuation. It must be said that the measurement of rectal temperature is used to determine the days when pregnancy cannot occur.

Although in childhood (from birth to 8-9 years) the genitals of the girl gradually increase, this is a period of physiological rest. There is no menstrual function, the eggs in the ovaries do not grow and do not mature. Few female sex hormones are produced, and their effect on the body is minimal. Therefore, there are no secondary sexual characteristics (hair growth, development of the mammary glands).

During puberty (from 8-9 to 18 years old), the girl gradually turns into a woman, at 8-9 years old the bone pelvis becomes wider and adipose tissue is deposited on the hips, at 9-10 years old nipples grow, at 10-11 years old mammary glands, at 11 years old pubic hair appears, at 12-13 years old nipples are pigmented, and the mammary glands continue to grow, at 12-14 years old menstruation appears, at 13-14 years old hair in the armpits is shown.

The period of puberty in women lasts until about 45 years. From 20 to 35 years - the time most favorable for pregnancy, the body is best prepared for this.

In the next five years - from 45 to 50 years - the functioning of the reproductive system gradually fades away. Sometimes the menstrual cycle is disturbed due to changes in the timing of the maturation of the follicle and the onset of ovulation. At this time, due to the restructuring of the endocrine system, menopausal disorders often occur (increased nervousness, a feeling of a rush of blood to the head, severe sweating, etc.).

During the period of aging, the menstrual function stops completely, and the uterus and ovaries decrease in size - their reverse development occurs.

In the reproductive age, which lasts an average of 25-30 years for a woman, various gynecological diseases often occur. Many of them can cause infertility.

To prevent, timely detection and treatment of them, it is necessary to visit a gynecologist regularly, even if you feel completely healthy.

The first visit to the antenatal clinic, at a minimum, should take place soon after the onset of sexual activity. The doctor will give you the necessary advice on sexual hygiene, answer questions that have arisen in connection with the new condition of the girl who has become a woman, and recommend a method of contraception.

Already at the first visit to the antenatal clinic, asymptomatic diseases and deviations from the norm are sometimes found, which can then cause infertility.

Let's consider some of them.

During the period of the formation of the menstrual function, menstruation is quite often irregular. After the first menstruation, it may take 2-3 months or more before the next one.

If this gap is not too long, you should not worry, certain relationships are established in the body between the higher and lower stages of the menstrual cycle mechanism - the brain regions (hypothalamus and pituitary gland) that regulate hormone production, and the genital organs (ovaries and uterus).

But if the menstrual cycle does not stabilize by the age of 15-16, menstruation is painful, profuse, does not stop for a long time, so that the hemoglobin content in the blood decreases and anemia develops (these are cyclic uterine bleeding if their onset coincides with the onset of menstruation, and acyclic if they occur at any time and it is impossible to establish the rhythm of the cycle), or, on the contrary, scanty, rare and short (oligomenorrhea in Greek oligos - few, insignificant), or absent at all (amenorrhea), you must definitely consult a doctor. Similar menstrual irregularities can be observed in women and other age groups.

What are the causes of menstrual irregularities?

There are many of them: these are malformations and anomalies in the position of the female genital organs, inflammatory diseases, primarily of the uterus and its appendages, abortions with complications, an abnormal course of childbirth and the postpartum period, obesity, tumors of the genital organs, impaired functioning of the endocrine glands (ovaries, adrenal cortex, thyroid gland) or centers of the brain, chronic diseases of other organs and systems, stress, severe nervous shocks, adverse environmental conditions, in particular harmful production factors, stay in other climatic zones.

In case of violations of the menstrual cycle, you need to consult a doctor without delay - it is easier to cope with any disease if you start treatment on time.

In addition, diseases, one of the symptoms of which is a violation of the menstrual cycle, if left untreated, can further lead to infertility.

A healthy woman before the onset of sexual activity has quite strong biological barriers that prevent infection of the genital tract and organs. These are the acid reaction of the contents of the vagina, which is deadly for many pathogenic bacteria, the specific microflora of the vagina, which also kills them, and, finally, the mucous plug of the cervix, which has bactericidal properties.

However, with the onset of sexual activity, the protective functions of the vaginal contents decrease, which creates conditions for the infection to penetrate through the vagina into the cervix, and from it into the uterus and further into the tubes and ovaries.

Neighboring organs, such as an inflamed appendix, can also become a source of infection.

Some microorganisms enter the genital tract of a woman during sexual intercourse, for example, Trichomonas - a protozoan that has an organelle of movement - a flagellum, thanks to which it can penetrate into the uterus, and into its tubes, and even into abdominal laziness.

In men, trichomoniasis is most often asymptomatic, and they can infect women without even knowing that they are sick. But you can get trichomoniasis by using a towel that a sick person wiped himself with.

Trichomonas are also dangerous because they can "transport" other pathogens. The same "carriers" are spermatozoa. Moreover, they can become infected both in the body of a man and in the vagina of a woman.

When infected with Trichomonas appear whitish or purulent foamy discharge from the genital tract, itching and burning of the external genitalia, a feeling of heaviness in the lower abdomen, pain during sexual intercourse.

Infection with gonococcus, which is often carried by trichomonas, and more often by spermatozoa, leads to gonorrhea - purulent inflammation of the urethra, cervical mucosa and fallopian tubes. As a rule, as a result of inflammation, the patency of the latter is disturbed and infertility develops.

The disease begins with the appearance of pain and burning during urination, yellow-green discharge from the urethra and vagina. Then the temperature rises, there are pains in the lower abdomen, which usually indicates the spread of the pathological process to the fallopian tubes.

The mucous membrane of the vagina can be infected with yeast. In this case, white plaques appear on it, under which sores are located. Thick leucorrhoea of ​​a cheesy appearance is released, itching and burning of the external genital organs occur. If the disease began during pregnancy and the woman was not treated, the child may become infected during passage through the birth canal, he will develop thrush - a fungal infection of the oral mucosa.

Often, various parts of the female reproductive system are affected by the herpes virus. In this case, the temperature may rise, on the mucous membrane of the external genital organs (if they are affected), painful sores appear, causing itching and burning sensation.

If you experience these symptoms, contact your doctor immediately. The disease must be cured in its acute stage. Otherwise, it will take a chronic course, and then it will be much more difficult to cope with it.

The danger of chronic inflammation of the genital organs, and especially the uterine appendages - tubes and ovaries, lies in the fact that this very often leads to infertility.

In addition, chronic inflammatory processes in the genital organs are not indifferent to the course of pregnancy.

First, the risk of its spontaneous interruption increases.

Secondly, intrauterine infection of the fetus is possible, which can lead to severe consequences for the child.

Prevention of inflammatory diseases of the genital organs consists in observing hygiene requirements, eliminating hypothermia, eliminating foci of chronic infection (sick teeth, chronic tonsillitis, etc.).

You also need to know that inflammation of the uterine appendages contributes to an inferior sex life - for example, when preventing pregnancy through interrupted sexual intercourse or when the husband is impotence.

Lack of sexual arousal causes stagnation of blood in the genitals, facilitating the development of infection.

One of the frequent malformations is a continuous hymen, in the presence of which menstrual blood and the secret of the glands of the cervical canal are not released to the outside.

Pathology is usually detected after the onset of menstrual function, when once a month the girl feels pain in the lower abdomen and a feeling of discomfort in the vagina. There is no menstrual flow.

Treatment of this anomaly is carried out surgically, dissect and sheathe the edges of the hymen.

With the complete absence of the vagina or part of it, as well as the infection of the vagina as a result of inflammation transferred in the prenatal period or early childhood, pregnancy is impossible due to the lack of its connection with the uterus.

If at the same time there are no other anomalies in the development of the genital organs, the surgical restoration of the vagina makes possible not only sexual life, but also pregnancy.

Such malformations as doubling, or bicornuity, of the uterus usually do not prevent the onset of pregnancy, and it can occur alternately in one or the other uterus (horn).

A rudimentary (undeveloped) uterus, as well as the complete absence of it or the ovaries, naturally excludes the possibility of pregnancy.

With anomalies in the development of the fallopian tubes, underdevelopment or the absence of one of them is more often observed. At the same time, a single tube may be quite enough for the onset of pregnancy.

Interestingly, in the absence of a tube and an ovary from opposite sides (for example, during their surgical removal), pregnancy is also possible. In this case, the egg enters the tube, having traveled a long way in the abdominal cavity.

Of the anomalies in the position of the genital organs in young women, the most common retroreflexion of the uterus (its deviation back), which is congenital or may occur as a result of inflammatory diseases of the pelvic organs. Infantilism also contributes to the backward deviation of the uterus, in which, as in the case of an asthenic constitution, the ligamentous apparatus that holds the uterus in a normal position is weakened.

Retroreflexia can cause infertility due to the displacement of the cervix and its removal from the posterior fornix of the vagina, where sperm is mainly collected after ejaculation.

If the uterus remains mobile (there is no fixed retroreflexion), gynecological massage is used, which helps to restore the normal position of the organ.

Fixed retroreflexia is usually the result of an inflammatory process in the small pelvis and requires anti-inflammatory treatment, and in the presence of severe pain (especially during menstruation), surgical correction of the incorrect position of the uterus.

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The external female genital organs are vulva. It includes anatomical structures that are placed outside from the pubis in front to the posterior opening in the back. They are presented:

Pubis- a rounded increase formed by adipose connective tissue, which is located above the pubic symphysis. The amount of adipose tissue in the pubic area increases during puberty and gradually decreases after menopause. The skin of the pubis during puberty is covered with curly pubic hair, which thins after menopause. The upper border of the hairline in women usually forms a horizontal line, but may vary; down, the hair grows along the outer surface of the labia majora, and forms a triangle with a base at the upper edge - a shield. The pubic skin contains sweat and sebaceous glands.

Largelabia- These are two rounded folds of skin that extend from the pubis to the perineum on both sides of the pudendal fissure. Embryologically, the labia majora are homologous to the male scrotum. In front, they form the anterior commissure of the labia, behind - a transverse bridge slightly elevated above the surface of the skin - the posterior commissure of the labia. The labia majora are 7-8 cm long, 2-3 cm wide and 1-1.5 cm thick; contain adipose and fibrous tissue, sweat and sebaceous glands.

Venous plexuses in the thickness of the labia majora, when they rupture during trauma, contribute to the development of a hematoma. In the upper part of the labia majora, the round ligament of the uterus ends and the obliterated vaginal process of the peritoneum, the Nuka canal, is located. Vulvar cysts can form in this canal.

By the period, the outer surface of the labia majora does not differ from the surrounding skin. During puberty, the outer labia are covered with hair. In children and women who have not given birth, the labia majora are usually in a closed position and completely cover the pudendal fissure; their inner surface is smooth, thinned and resembles a mucous membrane. After childbirth, the labia majora do not close completely, their inner surface becomes more skin-like (although not covered with hair), which is more noticeable in women who have had many births. After menopause, the labia majora are subject to atrophy, the secretion of the glands decreases.

Smalllabia- two small, thin, reddish folds of skin that are located medially from the large labia and obscure the entrance to the vagina and the external opening of the urethra. The labia minora is very variable in shape and size. In women who have not given birth, they are usually covered by large shameful lips, and in those who have had many births, they protrude beyond the large labia.

The labia minora is covered with stratified squamous epithelium, does not contain hair follicles, but has numerous sebaceous glands and several sweat glands. The sebaceous glands enlarge during puberty and atrophy after menopause. The thickness of the labia minora contains connective tissue with numerous vessels and some muscle fibers, as in typical erectile structures. The presence of numerous nerve endings in small shameful lips contributes to their extreme sensitivity. From above, the labia minora converge (the anterior frenulum of the labia) and each of them is divided into two smaller folds, the lateral part of which forms the foreskin, and the medial part forms the frenulum of the clitoris.

In the lower part, the labia minora gradually become thinner and form the posterior frenulum of the labia, which is noticeable in nulliparous women. In women who have given birth, the labia minora below gradually merge with the inner surface of the labia majora.

Clitoris- This is a small, cylindrical organ, usually no more than 2 cm long, which is located in the upper part of the vaginal vestibule between the upper ends of the labia minora. The clitoris consists of a head, body and two legs and is homologous to the male penis. The long, narrow clitoral peduncles originate from the inferior surface of the ischio-pubic rami and join under the middle of the pubic arch to form the body of the clitoris. The latter contains two cavernous bodies, in the wall of which smooth muscle fibers pass.

The head of the clitoris usually does not exceed 0.5 cm in diameter or 1/3 of the length of the clitoris. It is formed by spindle cells and is covered with a stratified squamous cell, which contains numerous sensory nerve endings. When the clitoris is erect, its vessels are combined with the bulbs of the vestibule - cavernous tissue, which is localized on both sides of the vagina, between the skin and the bulbospongius muscle. The clitoris is the main erogenous zone of a woman.

thresholdvagina- an almond-shaped space between the clitoris from above and the posterior frenulum of the labia minora below, laterally limited by the shameful lips. The vestibule of the vagina is a structure similar to the embryonic urogenital sinus. On the eve of the vagina, 6 openings open: the urethra, the vagina, the Bartholin ducts (large vestibular) and, often, the Skene (small vestibular, paraurethral) glands. The back of the vaginal vestibule between the entrance to the vagina and the posterior frenulum of the labia forms a navicular fossa, or fossa of the vestibule of the vagina, usually noticeable in women who have not given birth.

Bartholin'sglands, or greater vestibules of the gland, - paired small complex structures with a diameter of 0.5 to 1 cm, which are located at the bottom of the vestibule on both sides of the entrance to the vagina and are analogues of the Cooper glands in men. They are located under the muscles surrounding the entrance to the vagina and are sometimes partially covered by the bulbs of the vestibule.

The ducts of the Bartholin glands are 1.5-2 cm long and open on the eve of the vagina from the outside of the lateral edge of the entrance to the vagina, between the maiden membrane and the small shameful lips. During sexual arousal, the Bartholin glands secrete a mucous secretion. Closure of the gland duct infection in the case (by gonococci or other bacteria) can lead to the development of an abscess of the Bartholin's gland.

outer holeurethra located in the middle of the vaginal vestibule, 2 cm below the clitoris on a slightly raised surface (papillary elevation), usually has the form of an inverted letter B and can stretch up to 4-5 mm in diameter. The length of the urethra in women is 3.5-5 cm. The lower 2/3 of the urethra are located directly above the anterior wall of the vagina and are covered with transitional epithelium, the distal 1/3 - with stratified squamous epithelium. Under the external opening of the urethra are the openings of the small vestibular (skene, paraurethral) glands, which are analogues of the male prostate gland. Sometimes their duct (about 0.5 mm in diameter) opens in the posterior wall, inside its opening.

bulbs of vestibule

Under the mucous membrane of the vestibule of the vagina, on each side, bulbs of the vestibule are placed, having an almond-shaped shape 3-4 cm long, 1-2 cm wide, and 0.5-1 cm thick and contain numerous venous plexuses. These structures are in close proximity to the ischiopubic rami and are partly covered by the ischiocavernosus muscles, as well as muscles that compress the vaginal opening.

The lower edge of the bulbs of the vestibule is usually located in the middle of the entrance to the vagina, and the upper edge reaches the clitoris. Embryologically, the bulbs of the vestibule are referred to as analogues of the spongy bodies of the penis. In children, these structures usually extend beyond the pubic arch, with only their posterior end partially surrounding the vagina. But in the event of an injury, rupture of these venous structures can lead to severe external bleeding or the formation of a vulvar hematoma.

The entrance to the vagina is very variable in size and shape. In women who have not had sexual intercourse, the entrance to the vagina is surrounded by small pudendal lips and is almost completely covered by the hymen.

Maidenhymen(KUTEP) - a thin, vascularized membrane that separates the vagina from its vestibule. There are significant variations in the shape, thickness of the hymen, as well as the shape of its opening:

• annular,
• membranous,
• lattice, etc.

Usually, the hole in women who have not had sexual intercourse can pass 1, or, less often, 2 fingers. The imperforated hymen is a rare anomaly and leads to a delay in menstrual blood, the formation of hematocolpos, hematometers, cryptomenorrhea. The girl's membrane is formed by elastic and collagenous connective tissue with a small amount of nerve fibers, does not contain glandular and muscle elements and is covered with stratified squamous epithelium.

In newborns, the hymen is highly vascularized; in pregnant women, its epithelium thickens and contains a lot of glycogen; after menopause, her epithelium becomes thin. During the first intercourse, the hymen usually ruptures at the back, which is not always accompanied by bloody discharge, although profuse bleeding may sometimes occur. Sometimes the hymen is rigid and in case of impossibility of sexual intercourse requires its opening (surgical defloration). After childbirth, only its remnants remain - the papillae of the hymen.

Changes in the maiden's hymen can have not only medical, but also legal significance in solving some problems of forensic medicine (sexual violence, childbirth, etc.).

The blood supply to the vulva is carried out by numerous branches of the internal (from the internal iliac artery) and external (from the femoral artery) pudendal arteries, the lower rectal arteries. The veins accompany the arteries of the same name. The innervation of the vulva is carried out by the iliac-axillary, pudendal, femoral cutaneous and rectal nerves.

The area between the posterior frenulum of the labia and the external opening of the anus is called the gynecological (anterior) perineum.

Clinical correlations

The skin of the vulva can be affected by local and general skin diseases. In the moist area of ​​the vulva, diaper rash often occurs, in obese women this area is especially susceptible to chronic infection. The skin of the vulva in postmenopausal women is sensitive to topical administration of corticosteroids and testosterone and insensitive to estrogens. A common cystic structure of the vulva is the Bartholin gland cyst, which becomes painful as it develops. Chronic infections of the paraurethral glands can lead to the formation of urethral diverticula, which have clinical symptoms similar to other lower urinary tract infections: frequent, uncontrolled and painful urination (dysuria).

Trauma to the vulva may result in significant hematoma or profuse external bleeding due to the rich vascularity and lack of valves in the veins of this area. On the other hand, increased vascularization of the vulva promotes rapid wound healing. Therefore, wound infection in the area of ​​episiotomy or in obstetric injuries of the vulva rarely develops.