Anatomy and Physiology of the

reproductive system

Dr Joseph Somuah Akuamoah

KAAF UNIVERSITY COLLEGE
Public Health Consultant, CEO St Joe’s specialist Clinic
0243-988130

1
 Reproduction
• Male internal genital organs
• Female internal genital organs
• Male reproductive and hormonal
functions
• Female physiology before pregnancy
and female hormones

2
 Male genital organs
1. The male internal genital organs include the:
• Testes
• Epididymides (singular = epididymis)
• Ductus deferentes (singular = deferens)
• Seminal glands
• Ejaculatory ducts
• Prostate
• Bulbo-urethral glands
2. External genital organs include the:
• Scrotum
• penis 3
 Spermatic cord, scrotum and testes
Spermatic cord
• It contains structures running to and from
the testis and suspends the testis in the
scrotum
• It begins at the deep inguinal ring lateral to
the inferior epigastric vessels, passes
through the inguinal canal, exits at the
superficial inguinal ring and ends in the
scrotum at the posterior border of the
testis.
4
 Spermatic cord, scrotum and testes
Spermatic cord
• Its coverings include the following;
 Internal spermatic fascia
 Cremasteric fascia
 External spermatic fascia
• The cremasteric fascia contains loops of
cremaster muscle.

5
 Spermatic cord, scrotum and testes
Cremasteric muscle
• The cremaster muscle (striated) reflexively draws
the testes superiorly in the scrotum, particularly in
response to cold. In a hot day or hot bath, the
muscle relaxes and the testis descends deeply in
the scrotum.
• This responses occur in attempt to regulate the
temperature of the testis for spermatogenesis (1C
less than core temperature) or protect the testes
during sexual intercourse.
• It is innervated by the genitofemoral nerve.
6
 Spermatic cord, scrotum and testes
Constituents of the spermatic cord
• Ductus (vas) deferens which is approximately 45
cm long and conveys sperms from the epididymis
to the ejaculatory duct.
• Testicular artery to the testis and epididymis
• Artery of the ductus deferens
• Cremasteric artery
• Pampiniform venous plexus-a network formed by
about 12 veins
• Sympathetic nerve fibers and genitofemoral nerve
• Lymphatic vessels
7
 Scrotum
• Is a cutaneous sac consisting of two layers
 The heavily pigmented skin and the
 Dartos fascia (fat free layer) including
smooth muscle fibers (dartos muscle)
responsible for the rugose (wrinkled)
appearance of the scrotum.
• Because the dartos muscle attaches to the
skin, its contraction causes the scrotum to
wrinkle when cold, to reduce the surface
area and assist the cremaster muscle to
hold the testes closer to the body to reduce8
heat loss.
 Scrotum
vasculature
• Arterial supply to the scrotum inclure
 The internal pudendal,
 external pudendal and
 cremasteric arteries supply blood to the scrotum
• The scrotal veins accompany the arteries
• The lymphatic vessels of the scrotum drain into
the superficial inguinal lymph nodes
Innervation
• The genitofemoral nerve, scrotal nerves and the
posterior cutaneous nerve of thigh supply the
scrotum 9
 Testes
• The testes (testicles) are the male gonads-paired
oval reproductive glands that produce
spermatozoa and male hormone-testosterone
• The testis are suspended in the scrotum by the
spermatic cords, with the testis usually suspended
(hanging) more inferiorly than the right testis.
• The surface of each testis is covered by the
visceral layer of the tunica vaginalis
• Arterial blood supply is the testicular arteries
• The pampiniform venous plexus drain into the
testicular veins
• Innervation is by the testicular plexus of nerves.
10
 Penis
• The penis is the male copulatory organ and
provides the common outlet for urine and sperm.
• The penis consists of the root, body and glans
• The penis is composed of 3 cylindrical cavernous
bodies of erectile tissue, which are;
 The paired corpora cavernosa dorsally and the
 Single corpus spongiosum ventrally
• It consists of the skin, connective tissue, blood
and lymph vessels, fascia, the corpora cavernosa
and corpus spongiosum, with the spongy urethra.
• Arteries of the penis and its veins drain the penis
• S2-S4 spinal cord segments innervate the penis
11
 Epididymis

• The epididymis is an elongated structure on the

posterior surface of the testis.
• Efferent ductules of the testis transport newly
developed sperms to the epididymis.
• The epididymis is formed by minute convolutions
of the duct of the epididymis

12
 Ductus deferens

• The ductus deferens is the continuation of the duct

of the epididymis.
• It has a relatively thick muscular wall and a minute
lumen, giving it a cord- like firmness.
• The tiny artery of the ductus deferens arises from
the vesical artery.
• Veins from the ductus deferens drain into the
testicular vein

13
 Seminal glands
• Each seminal gland (vesicle) is an elongated
structure (aproximately 5 cm long that lies
between the fundus of the bladder and the rectum.
• They are obliquely placed superior to the prostate
and do not store sperms.
• They secrete a thick alkaline fluid with fructose
(energy source for sperms), and a coagulating
agent that mixes with the sperms as they pass into
the ejaculatory ducts and urethra.
• The duct of the seminal gland joins the ductus
deferens to form the ejaculatory duct.
• Blood supply is the inferior vesical and middle
14
rectal arteries and its accompanying veins
 Ejaculatory ducts
• The ejaculatory ducts (approximately 2.5 cm) are
slender tubes that arise by the union of the ducts
of the seminal glands with the ductus deferentes.
• They arise near the neck of the bladder, and run
close together as they pass antero-inferiorly
through the posterior part of the prostate.
• Although the ejaculatory ducts traverse the
glandular prostate, prostatic secretions do not join
the seminal fluid until the ejaculatory ducts have
terminated in the prostatic urethra.
• The arteries to the ductus deferens supply blood
to the ejaculatory ducts and the veins join the
prostatic and vesical cavenous plexuses. 15
 Prostate Gland
• The firm, walnut-size prostate surrounds the prostatic
urethra. It is the largest accessory gland of the male
reproductive system.
• The thin, milky Prostatic fluid provides approximately
20% of the volume of semen (a mixture of secretions
produced by the testes, seminal glands, prostate and
bulbo-urethral glands) that provides the vehicle by
which spermatozoa are transported.
• The prostatic arteries supply blood to the gland and
the veins join to form the prostatic venous plexus.
• The ductus deferens, seminal glands, ejaculatory
ducts and prostate are innervated by sympathetic
fibers from T12-L2 (or L3) 16
Male genitalia

17
 Bulbo-urethral glands
• The two pea-size bulbo-urethral glands (cowper
glands) lie poterolateral to the intermediate part of
the urethra, largely embedded within the external
urethral sphincter.
• The ducts of the bulbo-urethral glands pass
through the perineal membrane with the
intermediate urethra, and open through minute
apertures into the proximal part of the spongy
urethra in the bulb of the penis.
• Their mucus-like secretion enters the urethra
during sexual arousal.

18
 Medical importance
1. Male sterilization
• The most common method of sterilizing males is
deferentectomy (vasectomy)
• In this procedure, part of the ductus deferens is
ligated and/or excised through an incision in the
superior part of the scrotum. The ejaculated fluid
from the seminal glands, prostate and bulbo-
urethral glands therefore contain no sperms.
• The unexpelled sperms degenerate in the
epididymis and the proximal part of the ductus
deferens.
• Reversal of deferentectomy can be successful in
19
patients less than 30 years and <7 years post op.
 Medical importance
2. Hypertrophy of Prostate
• Enlargement or benign hypertrophy of the prostate
(BPH) is common after middle age, affecting
virtually every male who lives long enough.
• An enlarged prostate impedes urination by
distorting the prostatic urethra.
• Examination of the prostate is by digital rectal
examination. A full bladder, offers resistance
holding the gland in place and making it more
palpable.
• Treatment is by medication or surgery

20
 Female genital organs
The female internal genital organs include the:
• Ovaries
• Uterine tubes
• Uterus
• Vagina
The female external genitalia include: (READ)
• Mons pubis
• Labia majora(big lips)
• Labia minora (inner pinkish lips)
• Clitoris (erectile organ)
• Bulbs of the vestibule
• Greater and lesser vestibular glands (Bartholin) 21
Internal and external female genitalia

22
 Ovaries
• The ovaries are almond shaped female gonads
in which the oocytes (female gametes) develop.
• They are also endocrine glands that produce
reproductive hormones
• Each ovary is suspended by a mesentery, the
mesovarium; which is a subdivision of the
mesentery of the uterus-the broad ligament.
• The ovarian vessels, lymphatics and nerves lie
within the suspensory ligament of the ovary.
• The oocyte expelled at ovulation passes into the
peritoneal cavity but is trapped by the fimbriae of
the infundibulum of the uterine tube. 23
 Uterine tubes
• The uterine tubes( formerly called oviducts or
fallopian tubes) conduct the oocyte, discharged
monthly from an ovary during child bearing age.
• They also provide the usual site for fertilization.
They extend laterally from the uterine horns and
open into the peritoneal cavity near the ovaries.
• The tubes are approximately 10 cm long and lie
in a narrow mesentery-the mesosalpinx.
• Ovarian and uterine arteries supply blood and
are drained by the pampiniform plexus of veins.
• Sympathetic and parasympathetic fibers of T11-
L1 innervate the ovaries and tubes. 24
 Uterus
• The uterus (womb) is a thick-walled, pear
shaped, hollow muscular organ lying in the
lesser pelvis in the non gravid (non
pregnant).
• The adult uterus is usually anteverted and
is divided into 2 parts-the body and the
cervix.
• The body of the uterus includes the fundus
of the uterus and the isthmus of the uterus.
The cervix (approx 2.5 cm) is the inferior
third of the uterus. 25
 Uterus
• The walls of the body of the uterus consists of 3
coats or layers:
 Perimetrium:- outer serous coat
 Myometrium:-the middle coat of smooth muscle
 Endometrium:- the inner mucous coat which is
actively involved in the menstrual cycle.
• The ligaments of the uterus are-the ligament of
the ovary and the round ligament of the uterus.
• Blood supply is from the uterine arteries and the
uterine veins drain the uterus

26
 Vagina
• Vagina is a distensible Musculo-membranous
tube (7-9 cm long) extending from the middle
cervix of the uterus to the vaginal orifice.
• The vaginal orifice, external urethral orifice, and
ducts of the greater and lesser vestibular glands
open into the vestibule of the vagina (the cleft
between the labia minora)
• The functions of the vagina are:
 Serves as a canal for menstrual fluid
 Form the inferior part of the birth canal
 Receives the penis and ejaculate during sex
27
 Vagina
• The uterine, vaginal and internal pudendal
arteries supply blood to the vagina. The vaginal
veins form the vaginal venous plexus.
• Innervation is mainly from the S2-S4 spinal cord
segments.
• The opening of the ducts of the greater
vestibular glands (Bartholins) are located at the 5
and 7’ o’clock positions in the lithotomy position.

28
 Medical importance
• Hysterosalpingography:- for tubal patency
• Ligation of uterine tubes:- for birth control
• Ectopic tubal pregnancy:-usually from adhesions
as a result of infection
• Bicornate uterus:-developmental abnormalities
• Uterine prolapse:- due to increased intra-
abdominal pressure
• Manual examination of uterus:-bimanual
• Distension of vagina:- particularly in the posterior
part of the fornix for child - birth and sexual
intercourse
• Vaginal fistulae-vesicovaginal and rectovaginal 29
 Questions
• Name and describe the process during which a
spermatid is converted to a motile sperm, and
describe the major structural (and functional)
regions of a sperm.
• Trace the pathway of a sperm from the male
testes to the uterine tube of a female.
• Some students were saying that the
bulbourethral glands of males act like city
workers who come around and clear parked cars
from the street before a parade. What did they
mean by this analogy?

30
Male reproductive and hormonal functions
• The reproductive functions of the male are
divided into 3 major divisions:-
1. Spermatogenesis
2. Performance of the male sexual act
3. Regulation of male reproductive functions by the
various hormones.

31
 1. Spermatogenesis
• Spermatogenesis occurs in the seminiferous
tubules during active sexual life as the result of
stimulation by anterior pituitary gonadotrophic
hormones; beginning around the age 13 years.
• Large primary spermatocytes undergo meiotic
division to form two secondary spermatocytes.
After a few days, these also divide to form
spermatids that are eventually modified to
become spermatozoa (sperm).
• During this division, the 46 chromosomes (23
pairs of chromosomes) of the spermatocyte are
divided, so 23 chromosomes go to one spermatid
and the other 23 to the second spermatid. 32
 Spermatogenesis….
• This also divides the chromosomal genes so that
only one half of the genetic characteristics of the
eventual fetus are provided by the father, whereas
the other half are derived from the oocyte
provided by the mother.
• The spermatids differentiate and elongate into
spermatozoa- composed of a head and a tail.
• The head comprises the condensed nucleus of
the cell. The tail of the sperm, called the flagellum,
provides motility of the sperm.
• Normal sperm move in a fluid medium at a
velocity of 1-4 mm/min
33
 Spermatogenesis……
Maturation of sperm
• After the sperm is formed in the seminiferous
tubules, the sperm require several days to pass
through the 6-meter long tubule of the epididymis.
Storage of sperms
• The two testes of the human adult form up to 120
million sperms each day. A small quantity of these
can be stored in the epididymis but most are
stored in the vas deferens.
• They can remain stored, maintaining their fertility
for at least a month. With a high level of sexual
activity and ejaculations, storage may be no
longer than for a few days. 34
 Spermatogenesis….
The mature sperm
• The activity of sperm increases markedly with
increasing temperature.
• Although sperm can live for many weeks in the
suppressed state in the testes, life expectancy of
ejaculated sperm in the female genital tract is only
1-2 days.
Semen
• Semen is ejaculated during the male sexual act.
• It is composed of the fluid and sperm from the vas
deferens (10%), seminal vesicles (60%), prostate
gland (30%) and small amounts from the
bulbourethral glands 35
 Male sexual act
• The most important source of sensory nerve
signals for initiating the male sexual act is the
glans penis. E.g. Direct stimulation of the genitalia
• Impulses may also enter the spinal cord from
areas adjacent to the penis (scrotum, perineum,
anal area) to aid in stimulating the sexual act.
• Appropriate psychic stimuli like fantasy can
greatly enhance the ability of a person to perform
the sexual act.
• Thinking sexual thoughts or dreaming can initiate
the male act culminating in ejaculation-nocturnal
emissions
36
 Stages of the Male sexual act
Penile erection
• This is caused by parasympathetic impulses that pass
from the sacral portion of the spinal cord through the
pelvic nerves to the penis. The stimulation makes the
nerves release nitric oxide.
• Nitric oxide released leads to rapid arterial blood flow
into the erectile tissue of the penis whiles the venous
outflow is partially occluded causing ballooning of the
erectile tissue for the penis to become hard and
elongated.
• The parasympathetic impulses cause the urethral and
bulbourethral glands to secrete mucus which aids in
lubrication during coitus. However the female sexual
organs provide most of the lubrication during coitus . 37
 Stages of the Male sexual act
Emission and ejaculation
• When the sexual stimulus becomes extremely
intense, the reflex centers of the spinal cord begin
to emit sympathetic impulses that leave the cord
at T-12 to L-2 to the genitals to initiate emission,
the forerunner of ejaculation.
• The entire period between emission and
ejaculation is called the male orgasm.
• At its termination, the male sexual excitement
disappears almost entirely within 1-2 minutes and
erection ceases, a process called resolution

38
 Medical importance
Erectile dysfunction
• This is the inability of the man to develop or maintain
an erection of sufficient rigidity for satisfactory sexual
intercourse
• Can be due to 1. performance nervousness, anxiety,
fear, social pressure; 2. drugs (alcohol, nicotine); 3.
vascular disease (diabetes, hypertension) or 4.
neurological (trauma to the parasympathetic nerves)
Baldness
• This could be hereditary. This is the most common
cause. Or could be due to…..
• Increased levels of testosterone leads to baldness –
a man without a testes cannot be bald. 39
 Female hormonal system
Three hormones are important in females
• A hypothalamic releasing hormone-gonadotropin
releasing hormone (GnRH)
• The anterior pituitary sex hormones-follicle
stimulating hormone (FSH) and luteinizing
hormone (LH) both of which are secreted in
response to the release of GnRH from the
hypothalamus
• The ovarian hormones-oestrogen and
progesterone which are secreted by the ovaries in
response to FSH and LH from the anterior
pituitary.
40
 Monthly ovarian cycle
• The rates of secretion of the female hormones
and corresponding physical changes in the
ovaries and other sexual organs gives a
rhythmical pattern in reproductive females.
• This rhythmical pattern is called the female
monthly sexual cycle which averages 28 days.
(can be as short as 20 days and long as 45 days)
• Only a single ovum is normally released from the
ovaries each month, so normally only a single
fetus will begin to grow at a time
• The uterine endometrium is prepared in advance
for implantation of the fertilized ovum.
• Ovulation in a 28 day female occurs on day 14 41
 Puberty, menarche and menopause
• Puberty means the onset of adult sexual life and
menarche means the beginning of the cycle of
menstruation.
• Puberty is caused by a gradual increase in
gonadotrophic hormone secretion by the pituitary
around age 8 years of life leading to onset of
puberty and menstruation at ages 11 to 16 years.
• At age 40-50 years the sexual cycle becomes
irregular and ovulation often fails to occur.
• Menopause is the period during which the cycle
ceases and the female sex hormone diminish to
almost to none
42
 Female sexual act
1. Stimulation
• Thinking sexual thoughts can lead to female
sexual desire, and this aids greatly in the
performance of the female sexual act.
• Desire for sex also changes during the monthly
sexual cycle, reaching a peak near the time of
ovulation, probably due to the high levels of
oestrogen secretion during the preovulatory
period.
• Local sexual stimulation occur around the vulva,
vagina and other perineal regions.
• The clitoris is especially sensitive for initiating
sexual sensations 43
 Female sexual act
2. Female erection and lubrication
• Located around the introitus and extending into
the clitoris is erectile tissue (penis) controlled by
the parasympathetic nerves which sends signals
for dilatation of the arteries of the erectile tissue.
• Parasympathetic fibers also cause the Bartholin
glands to secrete mucus inside the introitus for
good lubrication during sexual intercourse
• Dilatation of the arteries causes the introitus to
tighten around the penis which aids the male to
ejaculate fast

44
 Female sexual act
3. Female orgasm
• When local sexual stimulation reaches maximum
intensity, and especially when this is supported by
appropriate psychic conditioning signals from the
cerebrum, reflexes are initiated that cause the
female orgasm, also called the female climax.
• Female orgasm is analogous to emission and
ejaculation in the male and may help promote
fertilization of the ovum. (increased perineal
contractions and dilation of the cervical canal for
up to 30 minutes allows easy transport of sperm)
• After orgasm, there is a sense of satisfaction -
resolution 45
 Medical importance
1. Fertile period of each sexual cycle
• The ovum remains viable and capable of being
fertilized after it is expelled from the ovary
probably no longer than 24 hours. Therefore
sperm must be available soon after ovulation if
fertilization is to take place
• A few sperm can remain fertile in the female
reproductive tract for up to 5 days. Hence for
fertilization to take place, intercourse must
sometime between 4 and 5 days before
ovulation up to a few hours after ovulation
• The period of female fertility during each month
is short about 4 to 5 days. 46
 Medical importance
2. Abnormal conditions that cause female sterility
• About 5-10% of women are infertile.
Occasionally no abnormality can be discovered
in the female genital organs.
• The most common cause of female sterility is
failure to ovulate due to:-
 hyposecretion of gonadotrophic hormones
 Abnormal ovaries that do not allow ovulation
• Simple tests for ovulation include:
 the daily temperature chart;
 urine test during the latter half of the sexual cycle
for a surge in pregnanediol etc.
47
 Questions
1. List three secondary sex characteristics of
females.
2. Describe the events and possible consequences
of menopause.
3. A man swam in a cold lake for an hour and then
noticed that his scrotum was shrunken and
wrinkled. His first thought was that he had lost
his testicles. What had really happened?

48
 Questions
4.
a.What types of sexual dysfunction might arise in men
taking drugs that inhibit sympathetic nervous activity as
part of their treatment for high blood pressure?
b.Explain the physiologic basis for administering
posterior pituitary extract to induce or facilitate labor
c.Akosua Mensah who is in in her second month of
gestation, has been experiencing severe abdominal
cramping. Her Physician has diagnosed her condition as
an Ectopic pregnancy.
(i)What is an ectopic pregnancy?
(ii) Why must this pregnancy be surgically removed? 49