Sports activities from infancy to adolescence

sport e ciclo mestruale
  1. Is it important to exercise since infancy?
  2. Exercise in young adolescents
  3. Exercise and menstrual cycle
  4. Why do sports activities influence the menstrual cycle?

Is it important to exercise since infancy?

When the habit of engaging in physical activity is acquired during infancy, it tends to become an integral part of a person’s lifestyle. Among the factors that characterise a person’s lifestyle, exercise plays a crucial role for overall health. In fact, several scientific studies show that regular exercise promotes growth and development not only during infancy but also during adolescence. To maintain a good state of health and normal weight, adolescents in particular should exercise daily. However, unfortunately, recent data shows that adolescents do not exercise as much and are therefore exposed to an increased risk of chronic and metabolic diseases like diabetes and obesity.

Exercise in young adolescents

In young adolescents exercise can influence the menstrual cycle. The menstrual cycle, that has an average duration of 28 days, can be divided into 3 phases: a pre-menstrual phase that includes the days before menstruation, a menstrual phase characterised by bleeding, and a post-menstrual phase.

Exercise and menstrual cycle are two intersecting elements in the life of women that exercise regularly. Women tend to avoid exercising during menstruation but female cycle and training can be performed simultaneously. Many women that suffer during the first phase of the menstrual cycle prefer not to train during that time but it should be noted that exercising instead could have positive effects because of the production of endorphins that relieve pain.

Exercise and menstrual cycle

During the first phase of the cycle, the menstrual one, light training is advisable; during the second phase of the cycle, the follicular one, higher levels of FSH cause an increase in strength and concentration and therefore more intense exercise is possible. The same is true for the final phase of the cycle, the ovulatory phase, which is characterised by peaks of FSH and LH. Intense exercise and training can cause disorders of the menstrual cycle such as: menorrhagia (intense menstrual flow), polymenorrhea (abnormal uterine bleeding as an anticipation of menstruation), oligomenorrhea which causes a delay in menstruation often associated to eating disorders, and, last but not least, amenorrhea (absence of menstruation for at least three months).

Why do sports activities influence the menstrual cycle?

Excessive exercise can influence the menstrual cycle because the physical effort has an impact on the hypothalamus and on the hypophysis, the two glands that regulate the ovarian function with the secretion of gonadotropins FSH and LH. As a consequence, physical effort influences the secretion of sex hormones involved in the menstrual and ovarian cycles with a reduction of oestrogen levels that causes menstrual cycle disorders.

Recent studies on women that practice sports at a professional level have shown that 30-40% of them is affected by amenorrhea during the training period. One of the main reasons for this is the low percentage of body fat which causes the body to stop menstruation as a form of protection.

The correlation between irregular cycle and physical activity is very frequent especially during adolescence when the hormonal system is not completely formed. The most common physical activity in adolescence is ballet. Those adolescents that practice this sport at a professional level undergo hard and intense training, which, together with low body weight and a low calorie diet, influences the production of sex hormones and therefore affects the menstrual cycle.

Insulin resistance and PCOS

insulino resistenza e ovaio policistico
  1. What is insulin resistance?
  2. Insulin resistance and PCOS
  3. How can it be resolved?
  4. Are there any specific medications?

What is insulin resistance?

Insulin resistance is the reduction of the capacity of body cells, in particular of muscular and adipose cells, to respond to insulin and therefore to use it. Insulin is a hormone produced by beta cells in the pancreas; small quantities are released after each meal to allow the entry of glucose enabling its use as an energy source. Insulin resistance causes a minor entry of glucose in the cells, an increase in insulin levels and therefore insulinemia, and in particular a hyper stimulation of those tissues that are sensible to the action of this hormone.

Insulin resistance and PCOS

The organs that are more affected by this syndrome are: skeletal muscle, liver, adipose tissue, ovaries, uterus; for this reason, insulin resistance is one of the metabolic causes of PCOS.

Insulin resistance causes an increased production of androgens by the ovary theca cells, leading to a dysregulation of LH activity (ovulation hormone) and to a simultaneous abnormal growth of the endometrium.

In the majority of cases, insulin resistance treatment leads to the resolution of PCOS with consequent improvement of symptoms and increased fertility. The appearance of dark spots, known as acanthosis nigricans, is a common sign of insulin resistance and PCOS.

How can it be resolved?

One of the ways to resolve insulin resistance is to follow a diet with low glycemic index. The glycemic index of food is the speed at which the concentration of glucose in the blood occurs after the intake of such food. After the intake of carbohydrates with high glycemic index, glycaemia undergoes a sudden increase; great quantities of insulin are secreted with the consequent hyper stimulation of tissues. Foods with low glycemic index are fruit and vegetables, dairy products, cereals like oats and barley, al dente pasta, while those with high glycemic index are all those foods that are easily assimilated: sugar, refined cereals, rice, potatoes, wafers, biscuits, sweets and cakes, sugary drinks, fizzy drinks, foods that contain sugar, dextrose and glucose syrup in their ingredients.

Are there any specific medications?

In addition to a change in lifestyle through a low-calorie diet, weight loss and exercise to improve symptoms, the treatment includes the use of medications that control high blood sugar like metformin. These drugs make the body more sensible to insulin and help cells to better use glucose in the blood, thus regulating the menstrual cycle.

If used appropriately, these drugs can regulate the menstrual cycle and ovulation, reduce infertility, and minimise hirsutism and acne. A better use of insulin in the body also reduces the risk of cardiovascular diseases and diabetes that is more common in women affected by PCOS.

Polycystic Ovary Syndrome

sindrome ovaio policistico
  1. What is the Polycystic Ovary Syndrome or PCOS?
  2. Which are the symptoms?
  3. Which are the complications?
  4. Diagnosis and Treatment
  5. Is a healthy lifestyle important?

What is the Polycystic Ovary Syndrome or PCOS?

Polycystic Ovary Syndrome (PCOS) affects women’s health in terms of metabolism and reproductive system. It is characterised by a thickening of the ovaries due to the appearance of multiple ovarian cysts and to hormonal and metabolic alterations (hyperandrogenemia, insulin resistance with consequent hyperinsulinemia).

PCOS, which affects 5-10% of women, starts in puberty and is the most common endocrine alteration in women of childbearing potential.

PCOS is the expression of a complex functional alteration of the reproductive system given by the increase in androgens (male hormones), which causes the typical symptoms of this pathology.

Which are the symptoms?

Typical symptoms include irregular menstruation or amenorrhea, minor hirsutism with growth of hair in atypical areas such as chin, upper lip, back, thus with signs of virilisation.

Other symptoms can include weight gain together with fatigue, lack of energy, sleep problems, mood swings; in some women it can affect fertility and pregnant women affected by PCOS have a higher risk of complications during pregnancy like gestational diabetes, pre-term labour and pre-eclampsia.

Which are the complications?

Polycystic Ovary Syndrome can cause serious complications. The presence of high levels of oestrogens amplifies the risk of endometrial hyperplasia and endometrial cancer. The presence of high levels of androgens instead increases the risk of metabolic syndrome and hirsutism. In the long term, the excess of these hormones can cause a greater risk of cardiovascular disorders like hypertension and hyperlipidaemia. PCOS is closely correlated to obesity, which causes insulin resistance that contributes to the increase in the ovaries’ production of androgens.

Diagnosis and Treatment

PCOS diagnosis is obtained by the gynaecologist through specific exams such as serum hormone dosage exams, pelvic scans, glycaemic control, insulinemia control, and hormone dosage including total testosterone, FSH, prolactin and TSH. When testosterone levels are slightly increased and FSH levels slightly decreased, this suggests a PCOS diagnosis. The two elements that are necessary in order to come up with an accurate diagnosis are an ovulatory dysfunction as clinical and/or bio-chemical evidence of hyperandrogenism and the presence of more than 10 follicles/cysts per ovary observed through pelvic scan. PCOS treatment includes the administration of progesterone or oral contraceptives to correct hormonal abnormalities, relieve symptoms and improve fertility in particular for those women who desire to become pregnant. Hormonal contraceptives are the primary therapy as they reduce circulating androgens making menstrual cycles more regular.

Is a healthy lifestyle important?

PCOS is not a synonym of sterility and in this case, ovulation is induced through the use of contraceptives. Exercise and weight loss are also very important as they reduce insulin resistance: the reduction of insulin and oestrogens levels causes the recovery of ovulation or at least favours the effect of contraceptives used to induce ovulation.

For this reason, a healthy lifestyle is very important to prevent such pathology.

Obesity and fertility

obesità e fertilità
  1. What is obesity?
  2. Does obesity influence the menstrual cycle and fertility?
  3. Obesity and Polycystic Ovary Syndrome

What is obesity?

Obesity is a syndrome characterised by an excessive and abnormal increase in body weight, with an excessive formation of body fat in the tissues. There are two types of obesity:

  • Android obesity: characterised by the distribution of the body’s extra fat primarily around the neck, shoulders and over the upper abdominal region of the body.
  • Gynoid obesity: characterised by the distribution of the body’s extra fat in the lower parts of the body (thighs, glutes, lower abdominal region) and by a poor development of muscles, frequent in women.

Does obesity influence the menstrual cycle and fertility?

The physiological mechanisms related to gender, in particular the effects of hormones, play a significant role in feminine obesity. The impact of being overweight and especially of obesity has alarmingly increased in female population of childbearing potential. Recent studies have shown that overweight women are affected by disorders of the menstrual cycle. This confirms the fact that excess weight has plays an important role in those mechanisms involved with infertility. In fact, obese women can be affected by those complications related to obesity like diabetes, arterial hypertension, stroke and arteriosclerosis but can also be affected by problems of the reproductive system. Much more than women of healthy weight, obese women are frequently affected by amenorrhea that is the absence of menstrual cycle. The analysis of the hormonal profile of obese women has shown that obesity and excessive weight in general are often associated to infertility because women are in a state of hypogonadotrophic hypogonadism, which means that there is an alteration of the hypothalamus-hypophysis-ovary axis that regulates the menstrual cycle through the synthesis of gonadotropins like FSH and LH.

In addition, obesity also modifies the levels of insulin produced by the pancreas, causing an overproduction of androgens, which, correlated to an increase in the production of oestrogens, impacts on the menstrual cycle causing disorders, reduction of ovulation and therefore low levels of fertility. Last but not least, fat deposits in the ovaries can interfere with follicular and embryonic development in case of pregnancy.

Obesity and Polycystic Ovary Syndrome

The most widespread problem of obese women is the Polycystic Ovary Syndrome (PCOS), which is characterised by hyperandrogenemia, ovulation absence, hirsutism, acne and altered morphology of the ovaries. Obesity amplifies the hyperandrogenemia of PCOS, thus impacting on the fertility rate and on anovulatory cycles.

Pregnancy rate for obese women treated for infertility is lower than for women of healthy weight and even after fertility treatments, the risk of miscarriage is very high.

Obesity is an important risk factor related to a series of gynaecological diseases. It is therefore important, especially for young adolescents, to set prevention strategies that allow the normalization of body weight for obese or overweight adolescents because this can increase the chances of recovery of the menstrual cycle and of ovulation.

Genital hygiene

igiene intima
  1. How important is intimate hygiene?
  2. Which is the right intimate detergent?
  3. The use of vaginal washes
  4. Intimate hygiene and menstrual cycle

How important is intimate hygiene?

Intimate hygiene is very important for the health and well being of every woman. Female genitalia are a very sensitive area and specific cleaning is necessary to avoid the proliferation of germs and is essential to prevent disorders of the genital system such as cystitis and/or simple irritations. During the menstrual cycle, intimate hygiene is essential because irritations caused by the contact of the genital area with pads can occur.

An appropriate intimate hygiene is required to cleanse the outside part of the vagina using a specific detergent. The internal part is instead autonomously maintained clean. During cleansing, it is important to cleanse the vulva and the anus avoiding the movement to the vulvar area of those bacteria of the intestines that come from the anus and can cause infections.

It is also important that the genital area does not remain too humid; therefore the drying stage also requires particular attention.

To avoid the proliferation of microbes in the vagina, it is appropriate to wash it at least once a day and after every sexual intercourse. It is also necessary not to exaggerate with intimate hygiene because, being a delicate area, too much can cause irritation to the skin.

Which is the right intimate detergent?

The vagina hosts the bacteria that constitute the vaginal bacterial flora, whose balance should always be respected. It is therefore very important to maintain the appropriate vaginal pH using delicate intimate detergents at neutral pH, that respect the natural acidity of the vagina, and not to use irritating products that are too aggressive.

During the course of life, vaginal pH changes. During the period before puberty and during menopause, pH values range between 4.5 and 5; in these stages, the risk of infection is higher. During fertile age instead, pH is slightly acid and the ideal detergent should have a pH with values not over 7. The detergent must be enriched with hydrating and soothing active ingredients. In case of vaginal infections, the gynaecologist can recommend antimicrobial detergents.

The use of vaginal washes

The use of vaginal washes is also included in intimate hygiene as these are a method to cleanse the vagina through the use of a cannula connected to a bottle that contains a liquid to cleanse the internal parts.

The use of vaginal washes should not be excessive as these impact on the balance of the vaginal flora. The gynaecologist should recommend vaginal washes for specific treatment.

Intimate hygiene and menstrual cycle

During periods, intimate hygiene is crucial so forget what grandmothers used to say about “no washing during ‘those’ days”! Today, a better understanding of the female body and of its needs, together with a different lifestyle, allows us to understand and value the importance of intimate hygiene during our monthly period, most importantly for our health and well being.

Trichomoniasis and adolescence

vaginite tricomoniasi
  1. What is trichomoniasis?
  2. How is trichomoniasis transmitted?
  3. Symptoms and complications
  4. Diagnosis and treatment

What is Trichomoniasis?

The pathogenic protozoan Trichomonas vaginalis causes an infection of the genital apparatus, called Trichomoniasis. The flagellate protozoan multiplies itself in the genital mucosa and is transmitted through unprotected oral, vaginal or anal sexual contact. Trichomoniasis is one of the most common causes of vaginitis after bacterial vaginosis such as candida.

How is Trichomoniasis transmitted?

Trichomoniasis is transmitted through direct contact of genitalia during unprotected sexual intercourse. In pregnant women, the infection may be transmitted to the baby during delivery. The chance of being infected is reduced with proper genital hygiene and the use of male and female condoms during sexual intercourse.

Symptoms and complications

Trichomoniasis is more common in women than men and can range from being asymptomatic to causing an itching inflammation in the vagina, accompanied by yellow-green, foamy and malodorous vaginal discharge associated to vulvar pain during sexual intercourse and micturition. Oedema of the vaginal lips can also appear together with red spots on the vaginal walls and cervix surfaces. Urethritis and cystitis are also possible. In men instead, Trichomoniasis is less common and generally asymptomatic. However, the infection affects the urethra and the prostate, with festering discharge and a moderate pain of the penis, particularly during micturition.

The infection generally clears spontaneously but an adequate therapy helps in avoiding that the infection extends to uterus and cervix in women and causes prostatitis and epididymitis in men, ultimately causing, for both, an increased risk of infertility. The vaginal and urethral inflammation can facilitate the risk of HIV infection and other sexually transmitted diseases. The onset of symptoms of Trichomoniasis is variable and ranges between 5 and 20 days.

Diagnosis and Treatment

In women, diagnosis can be obtained through:

  1. Exams of vaginal secretion, which is the simplest method to discern between bacterial vaginosis and Trichomoniasis. Secretion is placed on a petri dish with physiologic solution and examined under a microscope to detect Trichonomas, which are flagellated pear-shaped bacteria. Trichomoniasis is also frequently diagnosed by observing the microorganism after a smear test.
  2. Immunochromatographic dipstick flow test or Nucleic-acid amplification tests (NAATs) that are more sensitive than exams or microscope cultures and also simultaneously detect other sexually transmitted diseases such as chlamydia and gonorrhoea.

In men, diagnosis is obtained through urine sample or urethral swab. The treatment of Trichomoniasis includes oral intake of nitromidazole drugs such as metronidazole or tinidazole. Partners should also undergo the same sort of treatment.

Sexually transmitted diseases during adolescence

malattie sessualmente trasmissibili
  1. What to we need to know about sexually transmitted diseases (STDs)?
  2. What are the complications related to STDs?

What to we need to know about sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) have a high impact on sexually active adolescents’ health and also have an increasing incidence around the world, without any socio-economic distinction. The reason for this should be traced back both to a low knowledge of the most common pathologies and to promiscuity that is highly evident especially in adolescents. It is crucial to follow screening guidelines and to use diagnostic tests for immediate treatment to avoid complications. A STD diagnosis is substantial for everyone and in particular for adolescents. All STDs can be caused by:

  • Bacteria
  • Virus
  • Protozoa
  • Parasites or fungi

The most diffused virus is the Papilloma virus while for the sexually transmitted diseases the most common is Chlamydia. Other common infections in adolescents include gonorrhoea, syphilis, trichomonas, and herpes simplex (HSV). Such infections can be contracted also after a single and isolated sexual intercourse with an infected partner. The risk is higher for those that have several occasional intercourses but is also extended to those who have stable relationships considering that the microorganism can remain silent for long periods of time and thus the subject may discover being infected after a long time.

What are the complications related to STDs?

The complications of STDs can include:

  • Serious infections
  • Chronic pain
  • Infertility
  • Cancer
  • Detrimental effects on the uterus

Every year, about half of the new sexually transmitted infections occur in adolescents aged 15-24. In fact, the highest rates of sexually transmitted diseases are in young people, adults and adolescents. The identification of these infections depends on different types of screening for every STD. It is therefore important to divulge information on their sexual health to make sure they understand and know about the risks and the appropriate diagnostic practices for each sexually transmitted disease.

Hormonal contraception: pill and ring

pillola contraccettiva e anello vaginale
  1. Hormonal contraception: more information about the contraceptive pill
  2. Hormonal contraception: contraceptive ring, what do we need to know?

Hormonal contraception: more information about the contraceptive pill

According to the World Health Organisation guidelines, hormonal contraception can be used in complete safety from the age of menarche onwards. Still today, contraceptive pills are the most effective contraceptive method used by the majority of women to protect themselves from unwanted pregnancies. The new pill is a combined oral contraceptive (COC) and acts by inhibiting ovulation through the intake of the first seven pills, while the remaining pills maintain ovulation absence. The contraceptive pill is considered 100% effective and for this reason it is considered the most safe among the different contraceptive methods. In fact, unwanted pregnancies that occur during the use of contraceptive pills are most likely related to mistakes in the pill’s intake. The contraindications related to the pill are the same for both adults and adolescents that use the COC pill, which reveals to be very useful during a stable relationship. However, the use of condoms is still necessary to prevent sexually transmitted diseases. The pill is also indicated for those adolescents that experience irregular cycles because with its use periods become more regular, flow decreases and a significant reduction of pain related to menstruation is observable. Also acne, that is a quite common condition that can affect adolescents, improves with the use of the pill. Pills with “high” and “low” oestrogen dosage exist on the market. Before modern days, pills contained very high oestrogen levels, which caused many side effects. For this reason, research has focused on the production of pills with lower ethinyl estradiol quantity, changing from 50 micrograms to only 15/20 micrograms contained in modern pills. To make sure to take the right decision and avoid any discomfort or side effect, before taking any type of pill it is crucial to undergo all the examinations prescribed by the gynaecologist.

Hormonal contraception: contraceptive ring, what do we need to know?

In Italy, the only existing type of contraceptive ring is sold in pharmacies with medical prescription. It is a device with a 4 mm thickness and 54 mm diameter containing two different feminine hormones, progesterone and oestrogen. Such hormones are slowly released at low quantities and enter general circulation impeding fertilization by blocking the ovary’s release of the follicle. It has several advantages because of the synergy between the two hormones: oestrogen increases the effectiveness of progesterone giving a greater ovulation-inhibiting effect, and mainly maintains the development of the endometrium and provides a good control of the menstrual cycle. To make sure it works correctly, it is necessary to follow instructions: it must be inserted inside the vagina on the first day of menstruation and must be removed after exactly three weeks. During the week in which the ring is removed, vaginal bleeding similar to menstruation is observable usually after 2 or 3 days from the ring’s removal. It is advisable to remove the ring at approximately the same time it has been inserted. The new ring will have to be positioned exactly one week after the removal of the previous one, on the same day and at the same time also in case of continued bleeding. The ring has a contraceptive effectiveness of over 99% but like other hormonal contraceptives it does not protect from sexually transmitted diseases.

Physiology of the Menstrual Cycle

menopausa donne consigli
  1. What is the menstrual cycle?
  2. Which are the phases of the menstrual cycle?
  3. Which are the principal hormones involved?
  4. What happens during the menstrual cycle?

What is the menstrual cycle?

The menstrual cycle is a sequence of physiological and periodical changes of the feminine reproductive system. It is regulated by hormones produced by the ovaries and the hypophysis. All women have their first menstrual cycle during puberty and will cyclically have it until menopause, with interruptions only during pregnancy. The ovarian cycle, and likewise the menstrual cycle, lasts on average 28 days and consists of three phases which follow one another and that are strictly correlated to the hormones that are secreted during the cycle.

Which are the phases of the menstrual cycle?

  • Menstrual phase: during which the endometrium tends to flake off and is expelled through the vagina with menstruation
  • Proliferative phase: during which the endometrium is restored
  • Secretory phase: during which the endometrium becomes thicker to accommodate the fertilized egg

Which are the principal hormones involved?

Sometimes the menstrual cycle causes abdominal pain during the pre-menstrual phase with a series of disorders that affect women during the days immediately before menstruation. Menstrual cycles, also known as periods, last 25-35 days, with an average of 28 days for women aged in their 20s and 26 days for women in their 40s. In a normal menstrual cycle, cyclical changes of the following four principal hormones take place:

  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Oestrogen
  • Progesterone

The process involving changes in these hormones is usually associated to a change in body temperature. Through the central nervous system, the hypothalamus releases the gonadotrophin-releasing hormone (GnRH), which regulates the release of LH and FSH, which then subsequently regulate the secretion of oestrogen. After this, the levels of FSH and oestrogens increase, ovarian folliclesdevelop and mature. About seven days after ovulation, if no fertilization has occurred, the production of hormones starts to slow down. It is during the last days of the cycle, with the decline in hormonal levels and the first days of menstruation, during which such hormonal levels are low, that women are affected by the most annoying disorders. Cycles are counted from the first day of the menstrual flow when the levels of all four hormones are low.

What happens during the menstrual cycle?

Menstrual bleeding is the external symptom of the above-mentioned cycle in women, which occurs at the end of the luteal and at the beginning of the follicular phases of the ovarian cycle. In 80% of women during ovulation, menstrual bleeding occurs for 3-6 days with heavier flow on the second day with a loss of about 33 ml of blood (10-84). In women aged 35-50, a reduction of bleeding can be observed, while older women usually lose 6 ml more than younger ones. The menstrual cycle is closely linked and controlled by endocrine, autocrine and paracrine factors that regulate follicular development, ovulation and endometrial remodelling.

Female sexual anatomy: from infancy to adolescence

apparato genitale femminile
  1. The genital tract: how does it change?
  2. The vulva: what does it include?

The genital tract: how does it change?

The genital tract undergoes a series of changes throughout life, the majority of which occurs during puberty. In the first stages of development, female and male genitalia are indistinguishable and even though gender is determined during fecundation, it becomes clinically apparent at the 12th week of embryonic life, during which, in the absence of androgens, the differentiation of tissues leads to the external feminine phenotype. In females, ovarian differentiation begins at about 8 weeks gestation, stem cells differentiate themselves in oogonium and then in oocytes with the first meiotic cell division until puberty. Under the influence of oestrogens, Muller’s ducts differentiate themselves in internal genitalia, and Wolff’s ducts form the female external genitalia, of which the lower vagina, the labia and the clitoris. The genital system can be divided into two triangles, the anterior urogenital triangle and the posterior anal triangle. The anterior triangle includes the external genitalia and the urethral opening, commonly referred to as vulva.

The vulva: what does it include?

The vulva includes:

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  • Labia majora: two fibroadipose folds, after puberty they are covered in hair and rich in sebaceous, apocrine and eccrine glands
  • Labia minora: two folds with no hair that are constituted by neurovascular structures, sebaceous follicles, sweat glands and muscles
  • Batholin’s glands: secrete mucus to maintain an adequate lubrication
  • Clitoris: the feminine erectile organ is 5 mm long in children and in pre-pubertal age and 1-2 cm in mature females
  • Vaginal orifice: surrounded by the hymen, incomplete mucous membrane that matures during puberty under the influence of oestrogens, becoming thicker and more elastic.

The internal feminine genitalia are:

  • Vagina: limited by bladder, urethra and rectum
  • Uterus: fibro-muscular organ divided into the lower cervix and upper uterine body. It is composed of three layers: endometrium, myometrium, and perimetrium. At birth the cervix is twice the length of the uterine body. During puberty, this ratio is inverted and in adult women the uterine body is two or three times the size of the cervix

The uterine annexes consist of the ovaries and of the fallopian tubes.

  • The Fallopian tubes: their function includes the transportation of ovules and spermatozoa and the creation of an environment adequate for conception
  • Ovaries: vary on the basis of age, menstrual cycle and under hormonal influence.

A correct understanding of the feminine reproductive system is crucial for an accurate evaluation and treatment of developmental anomalies.