CHAPTER XXIV 

 EFFECTS ON THE FEMALE REPRODUCTIVE TRACT 



The female reproductive tract is especially susceptible to the effects of 

 inanition and malnutrition. The general effects on the body during pregnancy 

 were noted in Chapters IV and V. The direct effects on the female tract are of 

 special interest to the gynecologist in relation to the production of amenorrhea 

 and sterility, which have recently been widespread in Europe because of the 

 malnutrition resulting from war and famine. The repression of sexual develop- 

 ment in the undernourished children likewise presents a problem of interest 

 and importance in social medicine. 



This chapter will include the effects of inanition upon the ovary and uterus. 

 A few observations are available also for the uterine tubes (oviducts) in 

 amphibia and birds. After a brief summary of the effects on the entire female 

 reproductive tract, the data will be considered in detail separately for the 

 ovary and the uterus. 



Summary of Effects on the Female Reproductive Tract 



In human females beyond the age of puberty, the reproductive system is 

 especially susceptible to the effects of malnutrition, amenorrhea and consequent 

 sterility being the characteristic result of severe inanition, either total or partial. 

 Similar results appear during inanition among the lower animals. 



The incapacity of the female reproductive tract through inanition is due 

 primarily to the effect on the ovary. The atrophic and degenerative changes 

 in the ovary concern especially the Graafian follicles, which undergo regression 

 and atresia. In man and mammals, this prevents not only normal ovulation, 

 but also the formation of corpora lutea, and therefore inhibits the endocrine 

 activity of the ovary and the associated process of menstruation or related 

 phenomena of the estrous cycle. 



The more nearly mature follicles and ova are the most susceptible, and 

 undergo prompt involution, with degenerative (occasionally cystic) changes 

 and ultimately complete resorption. Yolk-rich ova in birds and amphibia are 

 absorbed through phagocytic activity of the granulosa cells. The simpler 

 and smaller follicles with the primordial ova appear more resistant, and mitoses 

 continue in the follicle cells. If the inanition is not extremely severe or pro- 

 longed, the normal process of ovogenesis is promptly resumed upon adequate 

 refeeding. In extreme cases, however, relative or complete sterility may result 

 from the ovarian injury. It appears possible that in some cases the lesions of 

 the ovum during inanition may affect sex-determination, or cause abnormalities 

 in the offspring. 



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