The Physiology Of The Female Genital Organs

The various hormones produced by the Hypothalamus of the brain stem, pituitary gland and ovaries control the menstrual and ovarian cycles. The hypothalamus produces 2 major hormones which play vital roles in the female reproductive system. These are the Gonardotrophin releasing hormone (GnRH) and the pituitary inhibitory hormones (PIH). The pituitary gland however produces various hormones, 3 of which are directly related to the functionality of the female reproductive system. These are :

• Follicle stimulating hormones (FSH) 
• Luteinizing Hormone (LH) 
• Prolactin

The FSH and LH are called gonadotrophic hormones because they act directly on the gonads (i e. Ovaries and tested). Prolactin plays a vital role in breast milk production. 

Functions Of Female Sex Hormones 

Estrogen : estrogen is responsible for most of the changes which occur during puberty. These include :

• The growth of the duct systems of the breasts leading to breast enlargement. 
• Estrous / feminine behaviours in the females. 
• Increase in libido. 
• Secondary sexual characteristics which includes enlargement of the breasts, uterus and vagina, female fat distribution around the hips, buttocks and breasts. 

Progesterone : This hormone is produced in the ovaries. Its functions include:

• Thickening of cervical mucus. 
• Preparation of the uterus for menstruation. 
• Maintenance of pregnancy. 
• Stimulates the development of the breasts lobules and alveoli.
• It is responsible for the increase in basal body temperature during ovulation. 

The ovarian cycle 

This comprises the morphological and functional changes which occurred in the ovaries during the menstrual cycle. The ovarian cycle is divided into 3 phases namely:

• Follicular phase
• Ovulatory phase
• Luteal phase. 

Follicular phase:

Here the ovarian follicles progressively mature in preparation for ovulation. 

Ovulatory phase:

Here, the dominant follicle (egg) Herzegovina released at about the middle of the menstrual cycle. For example, on day in a woman with cycle length of 28 days. 

Luteal phase:

This is the phase following ovulation. Here a structure called corpus luteum is formed. This produces predominantly progesterone and then estrogen to a lesser extent. 

Endometrial cycle 

The uterus is made up of 3 distinct layers namely, the endometrium, myometrium and serosal layer. Under the influence of the ovarian hormones, the endometrium which is the innermost layer undergoes cyclical changes. These cyclical changes are divided into 3 phases which are, proliferatory phase, secretory phase and the menstrual phase. 

The proliferatory and secretory phases features the gradual thickening of the endometrium. However, the menstrual phase involves sloughing off or shedding of the thickened endometrium leading to menstrual bleeding. 

Puberty

This is defined as a period of human development during which secondary sexual characteristics appear. These characteristics include rapid growth in height, changes in the attitude, development of breasts, appearance the public and axillary hairs, menarchy (first menstrual flow), widening of the hips assoc with fat deposition around the hips and buttocks. These and other changes observed during puberty are mediated by estrogen majorly and to a lesser extent, progesterone. They average age at puberty is usually between 8-14 years. 

Menopause 

Menopause is the permanent cessation of menstruation. It is said to have occurred if a woman between the ages of 43 and 53 ceases to observe her normal menstrual flow for a period of 1 year. This usually occurs about the age of 50 years. It marks the end of the female reproductive. 

Gynecological Abnormalities 

A. Urogenital Prolapse :

A prolapse is defined as an abnormal protrusion of an organ or its part beyond its normal anatomical confines. Urogenital prolapse therefore is the protrusion of urogenital organs beyond their natural anatomical confines. 

Types Of Urogenital Prolapse :

• Uterine Prolapse 
• Vaginal Prolapse 

Causes Of Prolapse :

• Congenital 
• Childbirth 
• Menopause 
• Increase intra abdominal pressure which may occur in chronic cough, ascites heavy loads. 

Symptoms And Signs Of Prolapse; 

• Feeling of swelling or fullness in the vagina.
• Feeling of something coming down through the vagina. 
• Constipation. 
• Dragging discomfort in the lower abdomen. 
• Back pain. 
• Vaginal discharge. 
• Frequent urination. 

Treatment Of Urogenital Prolapse :

Palliative measures : this involves the use of pessaries especially during pregnancy and in elderly women who cannot undergoes surgical care. 

Surgical Therapy : This involves surgical repairs of prolapse.

Complications Of Urogenital Prolapse :

• Decubitus ulceration which is due to frequent frictions between the prolapsed organ and the thighs and clothing. 
• Elongation of the cervix. 
• Urinary tract infections.
• Cancer of the cervix. 

Vesicovaginal Fistula (VVF) 

A fistula is defined as an abnormal communication between 2 epithelial surfaces. VVF occurs when such abnormal connection is between the urinary bladder and the vagina. 

Causes Of Vesicovaginal Fistula :

• Prolonged obstructed labour usually due to cephalopelvic disproportion. 
• Rupture of uterus. 
• Surgical procedures such as myomectomy, destructive operation, hysterectomy, Caesarean section, etc. 
• Female genital mutilation. 
• Coital injuries. 
• Congenital causes. 
• Penetrating vaginal injuries. 
• Road traffic accidents. 
• Pelvic fractured. 

Symptoms And Signs Of VVF

The commonest symptom is urinary dribbling or incontinence usually with a history of prolonged obstructed labour. 

Complications Associated With Genital Fistulae

• Stress incontinence. 
• Urinary tract infection. 
• Dyparuenia. 
• Depression. 
• Stigma and social injury. 

Pelvic Infections

Pelvic infections rank among the gynecological  conditions affecting mostly women between 20-40. Some of these infections are responsible for the recurrent vaginal discharge and vulval itching. 

However, most of the infections apart from a few do not have serious far reaching consequences. A few may therefore affect the reproductive capacity of the persons involved causing serious complications. These complications may include chronic pelvic pain and infertility. Infertility is usually due to tubal blockage arising from infection and scaring. 

Classes Of Pelvic Infections

Depending on the site involved in the infection, pelvic infection are classified in the following :

• Upper genital tract infections. 
• Lower genital tract infection. 

Lower genital tract infections are those infections involving mainly the vulva and cervix. On the other hand, Upper genital tract infections are those involving the uterus, Fallopian tubes and pelvic peritoneum. 

Most pelvic infections are acquired through sexual intercourse or other related habits hence they are referred to as sexually transmitted infection (STIs).