FEMININE REPRODUCTION SYSTEMOleh :

Dr. Ibnu Pranoto, Sp.An, Sp.OG(K)

FeminineReproductive System

Anatomy of Female Reproductive SystemFemale reproductive organsOvariesUterine tubesUterusVaginaExternal genital organsMammary glands

Female Pelvis

Uterus, Vagina, Uterine Tubes, Ovaries and Supporting Ligaments

Ovarian functionOogenesisMaturation of oocyte.Expulsion of the mature oocyte (ovulation).Secretion of the female sex hormone (estrogen and progestogen), as well as the peptide hormone inhibin.

FOLLICLE DEVELOPMENT CHANGES IN OVARY

AGE FOLLICLES20 WEEKS GESTATIONAT BIRTH6.O00.000 7.000.0001.000.000 - 2.000.000PUBERTY300.000 400.000READY TO DEVELOP400 - 50037 YEARS 10.000

Ovary Histology

Maturation of Follicle and Oocyte

Folliculogenesis

Maturation and Fertilization of Oocyte

Ovulation and Follicle FateOvulationFollicle swells and ruptures, secondary oocyte is released from ovarySecond meiotic division completed when secondary oocyte unites with sperm cell to form zygoteFate of the follicleGraafian follicle become corpus luteumIf fertilization occurs, corpus luteum persistsIf no fertilization, becomes corpus albicans

Follicular Selection

Primordial Follicles

Recruitment

Preantral Follicles

Selected dominant follicle

Anthral follicle Maturation ( 2 weeks growth)

Preovulatory (Graafian) follicle

Follicles not selected undergo atresiaContinuous but asynchronous growthof folliclesFSH is responsible for:Recruitment of the pool of the precursor folliclesInitiating selection and maturation of the dominant follicle

Follicle and Oocyte DevelopmentOogenesis is the production of a secondary oocyte in ovariesOogonia are cells from which oocytes developPrimary oocytes are surround by granulosa cells and called a primordial folliclePrimordial follicle becomes a primary follicle when oocyte enlarges and cells changePrimary follicle becomes secondary follicle and enlarges to form mature or graafian follicleUsually only one is ovulated, others degeneratePrimary oocyte completes first meiotic division to produce secondary oocyte and a polar bodySecondary oocyte begins second meiotic division, which stops in metaphase II

Uterine Tubes and UterusUterine or fallopian tubes or oviductsOpen directly into peritoneal cavity to receive oocyte from ovaryTransport oocyte or zygote from ovary to uterusUterusParts: Body, isthmus, cervixComposed of 3 layersPerimetrium: Serous membrane Myometrium: Smooth muscleEndometrium: Mucous membrane

Vagina and PerineumVaginaFemale organ of copulationAllows menstrual flow and childbirthHymen covers the vaginal opening or orificePerineumDivided into two trianglesUrogenital: Contains the external genitaliaAnal triangleClinical perineum Region between vagina and anusEpisiotomy: Incision to prevent tearing during childbirth

Female External GenitaliaVulva or pudendum or external female genitaliaVestibule: SpaceLabia minora: Form borders on sidesClitoris: Erectile structureCorpora cavernosaCorpora spongiosaLabia majoraUnite to form mons pubis

Female Perineum

Mammary GlandsOrgans of milk production located within mammae or breastsConsist of glandular lobes and adipose tissueCoopers ligaments support the breasts

Puberty and Menstrual CyclePubertyBegins with menarche or first episode of menstrual bleedingBegins when GnRH levels increase

Menstrual CycleAbout 28 days longPhasesMensesProliferative phaseSecretory phaseMensesAmenorrhea: Absence of a menstrual cycleMenopause: Cessation of menstrual cycles

Menstrual Cycle

Hormone Regulation during Menstrual Cycle

Female Sexual Behaviorand Sex ActFemale sexual behaviorDepends on hormonesAndrogens and steroidsDepends on psychological factorsFemale sex actParasympathetic stimulationBlood engorgement in clitoris and around vaginal openingErect nipplesMucouslike fluid extruded into vagina and through wallOrgasm not necessary for fertilization to occur

ANATOMI DASAR PANGGULKumpulan jaringan yang menutupi rongga panggul.Terdiri atas :otot,ligamentum, organ visera, fascia yang menahan tekanan intraabdomen-menjaga kontinensia dan faeses-koitus,persalinan,pengeluaran produk ekskresi

TIGA LAPISAN PENUNJANG1. Fascia endopelvis2. M. levator ani3. membran perineum& dd.pelvis/sfingter ani ekterna

M.LEVATOR ANIM.pubokoksigeus/puboviseralM.ileokoksigeus

DIAFRAGMA UROGENITALM.burbokavernosusM.perineus transversalis dalam dan luar.Fungsi: mencegah prolapsus tidak lebih parah (bila fascia endopelvis melemah)

PERINEAL BODYMasa jaringan fibrosa yang tebal, tanpa batas yang jelas diantara vagina dan anus.M.sfingter ani eksternusRobekan pd ruptur perinei totalis

STRES INKONTINENSIA Definisi:keluarnya urin yg tidak dapat dikontrol/dikendalikan secara objektif dapat diperlihatkan dan merupakan masalah sosial atau higienis.Tekanan intravesika>intrauretraFaktor penyokong kontinensia urin:uretra, vu,UVJ, sfingter uretra interna dan eksterna.Paritas,menopause, usia, operasi panggul dan obesitas.Aktifitas tubuh:batuk, bersin,meloncat,naik tangga dll.

MACAM INKONTINENSIA URIN

STRES INKONTINENSIAOVERAKTIVE BLADDER/urgeMIXED INCONTINENCEOVERFLOW INCONTINENCEKELAINAN ANATOMISINKONTINENS. FUNGSIONALINKONTINENSIA TRANSIEN

INKONTINENSIA TRANSIEN(DIAPPERS)DeliriumInfectionAtrophic vaginitisPharmacologicPsychologicalEndocrineRestricted mobilityStool impaction

DIAGNOSISSTRES INKONTINENSIATerdapat sindroma saluran kemih bawah dan rasa maluKarena operasi perbaikan vagina

PEMERIKSAAN TAMBAHANInkontinensia urine & aktifitas seksualUrine sisaTes provokasi :batuk.Pemeriksaan : spekulum,Q test, urodinamik dan tekanan uretra.

PENATALAKSANAANPemberian estrogenPemakaian pesariumOperasi

ANATOMI ALAT GENITALPerubahan anatomi o.k. kehamilan,partus, umur, menopause.Anatomi :kadaver, teranetesi berbeda dng waktu berdiri.

TUJUAN BEDAH REKONTRUKSIUntuk mengembalikan organ abnormal kekeadaan biasa.

ANATOMI PROLAPSUS UTERIDIFINISI TURUNNYA ALAT GENITAL KARENA HILANGNYA PENUNJANG ANATOMI DIAFRAGMA PELVIS/VAGINA

KAUSAUSIA LANJUTDEFISIENSI ESTROGENTRAUMA PERSALINANGENETIKTEKANAN INTRAABDOMINAL

RIWAYATPeningkatan insidensiPeningkatan usia wanita/umur panjangAktivitas seksualRekontruksi vagina, fungsi kandung kemih dan rektum

PROLAPS GENITAL 1. SISTOKEL2. REKTOKEL3. ENTEROKEL4.PROLAPSUS UTERI5. PROLAPSUS VAGINA

Vesikokel/Kistokel

Rektokel

Prolapsus Uteri Total (Procidensia)

Procidensia

KLASIFIKASI PROLAPSUSTINGKAT I : didalam vaginaTINGKAT II : di introitus vagina TINGKAT III : di luar introitus PROSIDENSIA

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