Unit V: Systems Responsible for Reproduction

The objectives for Unit V include explaining the structure and function of the Male
Reproductive system, explaining the structure and function of the Female Reproductive
system, applying knowledge of both systems in a clinical setting, and identifying
abnormalities based on knowledge of normal structure and function.

The unit outline covers I. Introduction, II. Female Reproductive System, III. Male
Reproductive System, and IV. Reproduction.

I. Introduction to Reproduction

The main responsibility of the reproductive system is reproduction, continuing the human
species by producing offspring. A new individual develops from the fusion of two different
sex cells, called gametes. Male gametes are spermatozoa (singular: spermatozoon), and
female gametes are ova (singular: ovum). The union of these gametes is called fertilization.
The product of fertilization is the zygote, which develops into a fetus within the female
reproductive organs. Although male and female reproductive organs differ anatomically, both
systems are regulated by the hypothalamus via hormonal activity.

II. Female Reproductive System

Functions: The female reproductive system is responsible for the formation of ova, hormone
production by the ovaries, reception of spermatozoa, provision of an environment for
fertilization and fetal development, parturition (childbirth), and the production of breast
milk (lactation).

Organs: The system consists of external genitalia (Vulva) and internal genitalia.
External Genitalia (Vulva)

The external genitalia are collectively known as the vulva, consisting of the Labia majora,
Labia minora, Clitoris, Vaginal orifice, and Vestibule.

1. Labia majora (singular: labium majus): These are two large folds forming the
boundary of the vulva, composed of fibrous tissue, fat, and covered in skin. They
contain large numbers of sebaceous and exocrine sweat glands. They extend
backward from the mons pubis (a pad of fat over the symphysis pubis). Hair grows
on the mons pubis and lateral surfaces of the labia majora at puberty.
2. Labia minora (singular: labium minus): Two smaller, highly vascular folds of skin
located between the labia majora. They contain numerous sebaceous and exocrine
glands. They enclose the vestibule, into which the vagina, urethra, and ducts of the
greater vestibular glands open. Posteriorly, they unite to form the fourchette, and
anteriorly, they surround the clitoris, forming the prepuce above and the frenulum
below.
3. Clitoris: A small structure that corresponds to the penis in males. It is composed of
erectile tissue and is richly supplied with sensory nerve endings. It is the most
sensitive part of the vulva.
4. Greater Vestibular Glands (Bartholin’s glands): Located one on either side of the
vaginal orifice. They produce a colorless mucoid secretion that lubricates the vulva,
particularly large amounts during sexual excitement.
5. Lesser Vestibular Glands (Skene’s glands): Groups of mucous glands that open via
two small ducts on the posterior wall of the urethral meatus.
6. Perineum: The triangular area extending from the base of the labia minora to the anal
canal. It consists of connective tissue, muscles, and fat, and provides attachment to the
muscles of the pelvic floor. It stretches remarkably during labor. An incision made in
the perineum during childbirth is called Perineum (Episiotomy is listed as a clinical
application).
Blood Supply, Lymph Drainage, Nerve Supply to External Genitalia: Arterial supply
comes from the Internal pudendal artery (a branch of the internal iliac artery) and the
External pudendal artery (a branch of a femoral artery). Venous drainage forms a large
plexus draining into the internal iliac veins. Lymph drains through the superficial
inguinal nodes. Nerve supply is from pudendal nerves.

Disorders & Clinical Application (External Genitalia): Disorders include inflammation,

Gonorrhea or other bacterial infections (like Staphylococcus aureus), congenital
abnormalities, genital swelling, itching, cysts (e.g., Bartholian cyst), and genital warts.
Clinical applications include Episiotomy in normal vaginal delivery and perineal care and
catheterization.

Internal Genitalia

Internal reproductive organs lie in the pelvic cavity and consist of the Vagina, Hymen,
Uterus, two uterine tubes, and two ovaries.
1. Vagina: A fibromuscular tube lined with Stratified squamous epithelium located in
the pelvic cavity. It connects the internal and external reproductive organs, opening
into the vestibule distally and connecting with the uterine cervix proximally. It runs
obliquely upwards and backwards at about a 45-degree angle. The posterior wall is
about 9cm long, while the anterior wall is shorter (7.5cm).
o Relations: Anteriorly, it relates to the base of the bladder and urethra.
Posteriorly, it relates to the rectum, anus, and the peritoneum of the
rectovaginal pouch (pouch of douglas).
o Structure: The inner layer is Thick Stratified squamous epithelium forming
ridges or rugae. The middle layer consists of smooth muscle (circular and
longitudinal bundles), and the outer layer is areolar tissue. The epithelium
lacks secretory glands, but the surface is kept moist by cervical secretions.
o Vault: The upper blind end of the vagina. The protrusion of the cervix divides
the vault into three parts: Anterior fornix, Posterior fornix, and Lateral
fornix.
o Functions: Receptacle for the penis during sexual intercourse (coitus),
conduit for menstrual flow, elastic passageway for the baby during childbirth,
and maintenance of a pH level between 4.9–3.5 to prevent microorganism
entry.
o Disorders: Vaginitis, Vaginismus, Genital warts, Herpes simplex virus
(HSV), Gonorrhea, Vaginal cancer, Vaginal prolapse, and Vaginal candiditis.
o Clinical Applications: Vaginal examination, identification of abnormal
anatomical structures, insertion of prostaglandin and vaginal tablets, and use
for normal vaginal delivery.
2. Hymen: A thin membranous diaphragm guarding the vaginal entrance. It is normally
perforated to allow menstrual blood exit; an imperforate hymen is rare but may be
discovered after puberty when menstrual flow cannot escape. The hymen is stretched
or torn by sexual intercourse or childbirth.
3. Blood supply, Nerve supply, lymph drainage to Vagina
o Arterial supply - Arterial supply is from the internal iliac artery
o Venous drainage - A venous plexus drains in to the internal iliac veins
o Lymph drainage - This is through the deep and superficial iliac glands
o Nerve supply - Parasympathetic fibers from the sacral outflow
- Sympathetic fibers from the lumbar outflow
- Somatic sensory fibers from the pudendal nerves

4. Uterus: A hollow, muscular, pear-shaped organ. It is flattened anteroposteriorly and

lies in the pelvic cavity between the urinary bladder and the rectum. Normally, it is
tilted forwards over the top of the bladder. It is typically about 7.5 cm long and 5cm
wide, with walls about 2.5cm thick, but it grows considerably (20 inch) during
pregnancy.
o Parts: The three parts are the Fundus (dome-shaped part above the uterine
tubes), the Body (main, pear-shaped part, upper two-thirds), and the Cervix
(lower, narrow part, about 2.5cm long). The cervix extends into the vagina,
opening at the External OS.

Fundus

Body
o Wall Structure (Three Layers):
 1. Perimetrium: Outer coat, equivalent to peritoneum. Posteriorly, it
covers the fundus, body, and cervix. then it folds back on to the rectum to
form the Rectouterine pouch (Pouch of Douglas) Anteriorly, it folds onto
the urinary bladder, forming the Vesicouterine pouch.
 2. Myometrium: Thick middle coat of smooth muscle arranged in
three layers, interlaced with areolar tissue, blood vessels, and nerves.
 3. Endometrium: Specialized mucous membrane. Thickness varies
with the menstrual cycle. It is covered by partially ciliated columnar
epithelium, changing to Stratified squamous epithelium in the lower
part. It has a rich blood supply via spiral arteries. It consists of two
layers: The Basal layer (next to the myometrium) and the Functional
layer (upper layer). The Functional layer becomes thick in the first half
of the cycle and is shed during menstruation.
o Supportive Ligaments: Broad ligaments, Round ligaments, Uterosacral
ligaments, Transverse cervical (cardinal) ligaments, and Pubocervical
ligament.
o Blood supply, lymph drainage and Nerve supply to Uterus
 Blood supply - By uterine arteries, branches of the internal iliac
arteries. Veins drain in to internal iliac veins
 Lymph drainage - Drain in to the aortic lymph nodes and group of
nodes associated with iliac blood vessels
 Nerve supply - Parasympathetic fibers from the sacral outflow.
Sympathetic fibers from the lumbar outflow
o Functions: Maintain the menstrual cycle after puberty, retain and nourish the
developing fetus during pregnancy, and facilitate the expulsion of the fetus
and conceptual products during delivery.
o Disorders: Cervical Carcinoma, Endometritis, Endometriosis, Adenomyosis,
and Leiomyoma (fibroid, myoma).
o Clinical Applications: Identify normal position and deviation, Vaginal
examination, Pap smear, insertion of a folly catheter in pregnancy, and
Management of PPH (Postpartum Hemorrhage).
o Uterus Blood Supply/Drainage/Nerve Supply: Blood supply is by uterine
arteries (branches of the internal iliac arteries). Veins drain into internal iliac
veins. Lymph drains into aortic lymph nodes and groups of nodes associated
with iliac blood vessels. Nerve supply includes Parasympathetic fibers from
the sacral outflow and Sympathetic fibers from the lumbar outflow.
I. Male Reproductive System The male system is divided into Internal Organs (Spermatic
cords, Testes, System of ducts - Epididymis, Deferent ducts (vas deferens), Ejaculatory
ducts Urethra, Accessory glands - Seminal vesicles, Prostate gland Bulbourethral glands)
and External Organs (Scrotum, Penis).

 Spermatic cords
o Suspend testes in the scrotum.
o Covered in a sheath of smooth muscle and connective and fibrous tissues,
o Extends through the inguinal canal
o Attached to the testis on the posterior wall.
o Cord contains:
 Testicular artery.
 Testicular vein
 Lymphatics
 Testicular nerves (Branches from 10th and 11 th thoracic nerves).
 Deferent duct

 Testes: Reproductive glands that are oval-shaped and suspended in the scrotum by the
spermatic cord. Seminiferous tubules Tightly coiled structures in testes. Their
function includes Leydig cells producing the hormone Testosterone, and
Seminiferous tubules producing Sperm. Spermatogenesis takes 65–75 days, begins
at puberty, and continues throughout life.
 Layers of Testes
o Tunica vaginalis: Outer covering (double membrane). Down growth of
abdominal and pelvic peritoneum
o Tunica albuginea: Middle, fibrous layer with ingrowths (septa) dividing the
testis into lobules.
o Tunica vasculosa: Inner layer Consists network of capillaries. Supported by
delicate connective
  Blood supply, Nerve supply & Lymphatic drainage
o Arterial Blood Supply - Testicular arteries
o Nerve Supply - Spermatic plexus
o Venous Drainage - Testicular veins
o Lymphatic Drainage - Lumbar lymph nodes
 Functions of Testes
o Leydig cells- Produce hormones – Testosterone
o Seminiferous tubules- Produce Sperm
o Sertoli cells- Help to process spermatogenesis
 Seminiferous tubule Epididymis Maturation, Storage

Structure of sperm (Sperm -Male gamete)

Head
 Flattenedandpointed.
 Nucleus–23chromosomes
 Acrosome-Lysozyme enzyme helps to penetrate the ovum wall.
Body
 Packed with mitochondria.
 To fuel the propelling action of the tail.

Tail–Helps to motility

 Mitochondria - Provide energy to move along female reproductive system.

Hormones:
 GnRH: Stimulates FSH and LH secretion.
 FSH: Promotes sperm production.
 LH: Stimulates the production of Testosterone.
 Testosterone: Develops secondary sexual characteristics.
Disorders in Testes
 Cryptorchidism (Undescending testes) -Testes not descend into scrotum
 Orchitis - Inflammation of the testis. Commonly caused by mumps virus
 Kinfelter’s Syndrome – Genetic disease 2 or more X chromosomes in males.
 Testicular Cancer

 System of Ducts: Includes the Epididymis (site of sperm maturation—about 14

days—and storage), Deferent ducts (convey sperm during sexual arousal),
Ejaculatory ducts (formed by the union of the duct from the seminal vesicle and the
deferent duct), and the Urethra (common pathway for urine and semen).

Deferent Duct
 Epididymis
o Comma-shaped organ. Lies along posterior border of each testis
o Consists - Tightly coiled ductus epididymis.
o From the testis, defferent ductules join to ductus epididymis.
o From the epididymis, immature spermatozoa transport via deferent duct
o Functions of the Epididymis
 Site of sperm maturation - About 14 days.
 Storage of sperm
 Helps propel sperm into the deferent duct (vas deferens)
 During sexual arousal by peristaltic contraction of smooth
muscle.
 Deferent Duct
o Length - about 45 cm (18 in.)
o Ascends along the posterior border of the epididymis through the spermatic
cord and then enters the pelvic cavity.
o Function
 Conveys sperm during sexual arousal from the epididymis
 Ejaculatory Duct
o Length - 2 cm
o Formed by union of duct from seminal vesicle and deferent duct.
o Pass through prostate gland and join to prostatic urethra.
o Function
 Carrying seminal fluid and spermatozoa to urethra.
 Urethra
o Male urethra provides common pathway for flow of urine and semen.
Disorders of Ductus
 Epididymis
o Epididymitis
 Ejaculatory duct
o Ejaculatory duct obstruction
 Urethra
o Hypospadia
o Epispadia
o Urethritis
o Urethral stricture
 Vas deferens
o Congenital absence of vas deferens

Accessory Glands
o Seminal vesicles
o Prostate gland
o Bulbourethral Glands (Cowper’s Glands)
 Seminal vesicles
o Two small fibro muscular pouches -lined with columnar epithelium
o Lying on posterior aspect of bladder.
o Function
 Contract and expel their stored contents, seminal fluid, during
ejaculation

 The Prostate Gland

o Lies in the pelvic cavity
 In front of rectum
 Behind symphysis pubis
 Surrounding first part of urethra.
o Consists of
 Outer fibrous covering
 Layer of smooth muscle
 Glandular substance composed of columnar epithelial cells.
o Blood supply
 Internal pudenal, Inferior vesical and middle rectal arteries
 Venous drainage - Internal iliac vein
 Lymph drainage - Internal iliac and sacral lymph nodes
 Nerve supply - Parasympathetic fibers from pelvic splanchnic nerves,
Sympathetic fibers from inferior hypogastric plexuses
 o Functions of Prostate Gland
 Secretes a milky, slightly acidic fluid (pH about 6.5) - Provides
protective local environment for sperm arriving in acidic vagina.
 Content substances:
 Citric acid - Used by sperm for ATP production (via Krebs
cycle)
 Clotting enzyme – (Thickens the semen in vagina). Increasing
retain in the cervix.
 Seminal plasmin - (An antibiotic) Can destroy bacteria.
o Disorders in Prostate Gland
 Benign prostatic enlargement
 Hyperplastic nodules form around urethra
 Cause constriction or obstruction of urine flow
 Causing urine retention
 Prostatic carcinoma Common cause of death in men over 50.
 Acute prostatitis – Infection

Bulbourethral Glands
(Cowper’s Glands)

 Bulbourethral Glands (Cowper’s Glands)

o Two small glands - Pea-size
o Located on sides of urethra, just below prostate gland.
o Clear, slippery fluid empties directly in to urethra, during erection.
o Function of fluid:
 Neutralizes traces of acidic urine in the urethra.
 Lubricates the urethra to facilitate the ejaculation of semen.
  Ejaculation
o Spermatozoa are expelled from epididymis and pass through deferent duct,
ejaculatory duct and urethra.
o Semen is propelled by powerful rhythmical contraction of smooth muscle in
walls of deferent duct.
o Between 2 and 5 ml of semen produce in a normal ejaculate, and contain
between 40 and 100 million spermatozoa per ml.
 Semen
o Mixture of sperm and seminal fluid
o Slightly alkaline pH of 7.2 – 7.7
o Function:
 Provides
 Transportation medium
 Nutrients
 Protection from hostile acidic environment of male’s urethra
and female’s vagina

II. Reproduction (Female Cycle, Puberty, Menopause)

 Puberty (Menarche): Occurs between 10–14 years, marking the beginning of the
childbearing period and leading to the maturation of the uterus, uterine tubes, and
ovaries, as well as the start of the menstrual cycle and ovulation.
 Menstrual Cycle: Occurs cyclically (approximately 26–30 days) in females from
menarche to menopause.
o The Menstrual Phase (around 4 days) involves the breakdown of the
endometrium due to reduced levels of Progesterone and Oestrogen.
o The Proliferative Phase (around 10 days) is stimulated by Oestrogen, which
causes rapid cell multiplication, thickening the endometrium.
o Ovulation occurs when Oestrogen is at its peak and an increase in LH triggers
the rupture of mature follicles, releasing the ovum.
o The Secretory/Luteal Phase (around 14 days) involves the formation of the
Corpus Luteum, which secretes Progesterone to prepare the endometrium
with nourishing substances for a potentially fertilized ovum.
 Menopause: Usually occurs between age 45–55, marking the end of the childbearing
period as the ovaries become less responsive to FSH and LH. Risks after menopause
include loss of bone mass (osteoporosis) and increased cardiovascular disease risk.

III. The Breast and Mammary Gland The mammary glands are accessory glands of the
female reproductive system.

 Structure: They are composed of lobes containing lobules (where milk is produced),
which open into lactiferous ducts draining toward the nipple. The areola surrounds the
nipple and contains sebaceous glands (Montgomery’s tubercles) for lubrication.
 Function (Lactation): Milk production is stimulated by Prolactin (Anterior
pituitary) after childbirth. Milk secretion (ejection) is caused by Oxytocin (Posterior
pituitary) release, which is triggered by the nerve impulses generated from infant
sucking.
 Breast Milk is more than 80% water; Colostrum is a high-protein, yellowish fluid
secreted early in pregnancy.
 Disorders include Mastitis, Cysts, Benign lump, and Breast cancer.
Puberty in Males
 Age range: 10–14 years
 Stimulated by:
o Anterior pituitary gland - Luteinizing Hormone (LH)
o Testes:
 Interstitial cells increase testosterone production
 Development of secondary sexual characteristics
Secondary Sexual Characteristics in Males
 Growth of muscle and bone → increased height and weight
 Enlargement of larynx → deepening of voice
 Growth of facial, axillary, chest, abdominal, and pubic hair
 Enlargement of penis, scrotum, and prostate gland
 Maturation of seminiferous tubules → sperm production
 Skin thickens and becomes oilier
Aging in Males
 No male equivalent to female menopause
 Begins around age 50
 Gradual decline in fertility, sexual ability, and testosterone secretion

Disorders in Male Reproductive System

 Gynaecomastia: Breast tissue proliferation in men
 Erectile dysfunction (Impotence)
 Male infertility due to:
o Endocrine disorders
o Obstruction of deferent duct
o Failure of erection/ejaculation
o SurgicalVasectomy
 Suppression of spermatogenesis (e.g., Ionizing radiation, chemotherapy, other drugs)
Sexually Transmitted Diseases (STDs)
 Infection of the reproductive system Caused by specific sexually transmitted
microbes.
 Syphilis (Treponema pallidum)
 HIV
 Hepatitis B
 Herpes simplex virus
 Chlamydia (Chlamydia trachomatis)
 Gonorrhea (Neisseria gonorrhoeae)
 Genital warts
Clinical Applications in Males
 Male catheterization
 Surgical procedures (tumor excision, vasectomy, prostate surgery, Subfertility
treatment)
 Subfertility treatments
 Circumcision
 Identification of congenital abnormalities

Puberty in Females (Menarche)

 Occurs between 10–14 years
 Marks the start of the childbearing period
 Physical and psychological changes
Secondary Sexual Characteristics in Females
 Maturation of uterus, uterine tubes, and ovaries
 Start of menstrual cycle and ovulation (menarche)
 Breast development and enlargement
 Pubic and axillary hair growth
 Increased height and widening of pelvis
 Increased fat deposition (hips and breasts)

Female Reproductive Cycle

Menstrual Cycle
 In females from menarche to menopause (throughout the child bearing period),
ovaries & endometrium undergoes cyclic changes approximately 26 - 30 days (28
days) on a regular cycle. It is called menstrual cycle.
 Cyclic changes in ovaries and endometrium
 Regulated by hormonal negative feedback mechanisms

Hormonal Regulation
 GnRH (GonadotropinReleasing Hormone) → from hypothalamus
 FSH (FollicleStimulating Hormone) → from anterior pituitary
 LH (Luteinizing Hormone) → from anterior pituitary
 Oestrogen → from ovarian follicles
 Progesterone → from corpus luteum
Phases of the Menstrual Cycle
Menstrual Phase (4 days)
 If ovum is not fertilized, the high Progesterone concentration in blood
 Inhibit GnRH and LH
 Corpus Luteum degenerate
 Reduce levels of Progesterone and Oestrogen
 Progesterone levels decline,
 Endometrium degenerate and breakdown uterine lining
 Happen 14 days after ovulation.
 When progesterone and estrogen levels drop, massage go to the hypothalamus and
next menstrual cycle starts.
 Menstrual flow includes:
o Endometrial cells
o Glandular secretions
o Unfertilized ovum
o Blood from capillaries

Proliferative Phase (10 days)

 Begins at the end of menstrual phase.
 Lasts about 10 days.
 Starts when blood progesterone levels reduced.
 Message going to the Hypothalamus and release GnRH
 GnRH stimulate the Anterior Pituitary
 Anterior Pituitary release FSH and LH
 The levels of FSH increases stimulating the maturation of ovarian follicle.
 Ovarian follicles produce oestrogen.
 Oestrogen stimulates the proliferation of the functional layer of endometrium
 Several changes occur in the endometrium.
 Becomes thicker by rapid cell multiplication (Thickness is 2-3mm)
 Increases mucus secreting glands
 Increases blood capillaries.
 Ends with Ovulation and Oestrogen production decline.
Ovulation (Usually Occurs on 14 in 28 days)
 Oestrogen in peak level.
 Pituitary gland slows the secretion of FSH.
 Begins to secrete the LH
 By increasing LH, Mature follicles ruptured Release ovum (Secondary oocyte)
Secretory (Luteal) Phase (14 days)
 Remaining part of ovarian follicle (lining cells) stimulated by LH.
 It becomes “Corpus Luteum”.
o Corpus Luteum - Secrete Progesterone
o Progesterone - Stimulates glands of the endometrium to start secreting the
nourishing substances.
o Progesterone make several changes in endometrium.
 Endometrium become edematous
 Increase secretary glands
 Produce watery mucus
 Changes help to passage of spermatozoa through uterus to uterine tubes.
 Ready to nourish the fertilized ovum.
 Corpus luteum continues to produce estrogen and progesterone about 10-12 days.
 If fertilized no breakdown of endometrium and no menstrual flow

Reproductive Functions of Progesterone

 Stimulate and supports thickening and increased glandular development of uterine
lining during secretary phase
 With oestrogen, Inhibit secretion of FSH and LH from the anterior pituitary in second
half of cycle
Reproductive functions of Oestrogen
 Development of secondary sexual characteristics in Puberty
 Stimulate and support thickening of uterine lining during proliferative phase
 Triggers LH surge mid-cycle, stimulating ovulation
 Stimulate anterior pituitary secretion of FSH and LH in first half of cycle
Importance of learning Menstrual cycle
 Help clients to have better relationship with the sexuality and the fertility.
 To make aware of birth controlling methods.
 Help women to deal with Menstrual pain.
 To identify abnormal conditions in Menstrual cycle and help clients.
 To refer women to medical advice who need treatments.
Menopause
 Menopause usually occurs between age 45 - 55.
 Marking the end of childbearing period.
 May occur suddenly or over a period of years (Sometimes as long as 10 years)
 Caused by changes in sex hormone levels.
 Ovaries gradually become less responsive to FSH and LH
 Ovulation and the menstrual cycle become irregular, eventually ceasing
Body Changes During Menopause
 Short-term unpredictable vasodilatation, Flushing, sweating and palpitations
 Sleep pattern disturbances.
 Shrinkage of the breasts.
 Axillary and pubic hair become sparse.
 Atrophy of the sex organs.
 Uncharacteristic behavior E.g.: Irritability, Mood changes
 Gradual thinning of the skin
Stages of Menopause
 Perimenopause: Before menopause; menstruation becomes irregular, can be long
period
 Menopause: Terminate menstruation and ovulation
 Post menopause: It start full year has passed after the last period

Risks After Menopause

 Loss of bone mass → osteoporosis
 Increased blood cholesterol → cardiovascular disease risk
 Increased cancer risk
Common Postmenopausal Conditions
 Diabetes
 Hypertension
 Heart disease
 Autoimmune disorders
 Joint/back pain
 UTIs (Urinary Tract Infection)
 Psychological disorders
Health Education for Menopausal Women
 Maintain nutrition and exercise
 Psychological support
 Hormone replacement therapy (HRT)
 Regular screening tests
 Self-care and self-esteem building
The Breast and Mammary Glands
 Accessory glands of female reproductive system.
 Structurally- Related to skin
 Functionally - Related to reproductive system
 Small and immature until puberty.
 Grow and mature - Influence of Oestrogen and Progesterone.
 Each breast lies over the pectoralis major muscle and serratus anterior muscle.
 Extending from the second rib downwards to sixth rib
 Horizontally from the margin of sternum to the mid axillary line
  The subcutaneous tissue of the anterior thorax within the breasts.
 Composed of lobes that contain glands and ducts.
 Dense connective and adipose tissues separate the lobes.
 Ducts connect the mammary glands to the nipple.
 Hormones stimulate breast development
 The breasts or mammary glands are accessory glands of the female reproductive
system
 Each breast contains about 20 lobes,
 Each contains a number of glandular structures called lobules, (milk produced)
 Lobules open into tiny lactiferous ducts, drain milk towards the nipple.
The nipple.
 Small conical eminence, center of the breast surrounded by a pigmented area, the
areola
 Surface of the areola are numerous sebaceous glands. (Montgomery’s tubercles),
lubricate the nipple during lactation.
 Somatic sensory nerve endings around the nipple, touch receptors are stimulated by
sucking,
 Impulses pass to the hypothalamus and secretion of the hormone Oxytocin is
increased, promoting the release of milk. (positive feedback)
 Hormone Prolactin (anterior pituitary) stimulates the production of milk
 Arterial supply
 Thoracic branches of the axillary arteries
 Internal mammary arteries
 Intercostal arteries.
 Venous drainage
 Axillary veins
 Mammary veins
 Lymph Drainage
 Axillary lymph vessels and nodes.
 Nerve supply
 Branches from 4th, 5th, 6th thoracic nerves Sympathetic fibers.
 Numerous somatic sensory nerve endings Specially around the nipple.
 Function
o Synthesize, secrete, and eject milk (lactation)
o Active during late pregnancy and postpartum
Mechanism of Milk Production
 During pregnancy,
o High levels of Oestrogen and Progesterone Prepare the glands for milk
production.
 After child birth,
o Formation of milk is under hormonal control.
o Anterior pituitary gland – Prolactin
o Causes actual synthesis of milk

 Sucking of the infant  Nipple stimulates  Nerve impulses Hypothalamus

Posterior pituitary gland  Oxytocin Release of milk.
 Prolactin (anterior pituitary) → milk synthesis
 Oxytocin (posterior pituitary) → milk ejection (letdown reflex)
 Stimulated by infant suckling → positive feedback loop

Composition of Breast Milk

 Mostly water (>80%)
 Lactose, protein, fats
 Colostrum: Yellowish, high in protein, less sugar/fat

Breast Changes During Pregnancy

 Enlargement due to estrogen and progesterone
 Secondary areola appears
 Increased Montgomery glands
 Breast get enlarged and ready for lactation.

Disorders of the Breast

 Mastitis (inflammation)
 Cysts
 Benign lumps
 Breast cancer
 Congenital abnormalities
Clinical Applications
 Breast engorgement
 Cracked/sore nipples
 Mastectomy
 Breast self-examination (SBE)
 Breastfeeding assistance
 Mammogram
 Surgeries - Mastectomy