WEEK 2_ REPRODUCTIVE AND SEXUAL HEALTH.pdf

WEEK 2: REPRODUCTIVE AND SEXUAL HEALTH NCMA 217 - Maternal and Child Health Nursing (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) OUTLINE 1.2 Components of Sexuality 1. Human Sexuality...

WEEK 2: REPRODUCTIVE AND SEXUAL HEALTH NCMA 217 - Maternal and Child Health Nursing (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) OUTLINE 1.2 Components of Sexuality 1. Human Sexuality 1. Reproductive Sexuality - involves the biological 1.1. Sexuality and Sexual Identity aspects of conception & procreation. It also 1.2. Components of Sexuality includes the sexual response 1.2.1. Types of Sexual Orientation 2. Gender Sexuality - deals w/ the social & 1.2.2. Types of Sexual Expression emotional aspects of being a man or a woman. 1.3. Human Sexual Response 3. Erotic Sexuality - refers to sexual love and 1.4. Disorders of Sexual Functioning arousing sexual desires 2. The Reproductive System 2.1. Reproductive Development 2.2. Physiology of Onset 1.2.1 Types of Sexual Orientation 2.2.1. Puberty Sexual gratification is experienced in several 2.2.2. Female and Male Reproductive ways. What is considered normal varies greatly System Homologues among cultures, although general components of 2.2.3. Secondary Sex Characteristics accepted sexual activity are that it is an activity of 2.3. Anatomy of the Male and Female adults and privacy, consent, and lack of force are Reproductive System included. 2.3.1. Anatomy and Physiology of the 1. Heterosexual is a person who finds sexual Reproductive System fulfillment with a member of the opposite gender. 2.3.2. Male Reproductive System 2. Homosexual is a person who finds sexual 2.3.3. Functions of the Male fulfillment with a member of his or her own sex. Reproductive System Many homosexual men prefer to use the term 2.3.3.1. External Structures “gay.” “Lesbian” refers to a homosexual woman. 2.3.3.2. Internal Structures More recent terms are “men who have sex with men” (abbreviated as “MWM”) and “women who 2.3.4. Female Reproductive System have sex with women” (WWW). Many young 2.3.5. Functions of the Female adults are worried about the stigma of being Reproductive System labeled homosexual and therefore keep their 2.3.5.1. External Structures identity secret from heterosexual acquaintances. 2.3.5.2. Internal Structures 3. Bisexuality - people are said to be bisexual if 2.3.5.3. Breasts they achieve sexual satisfaction from both 3. Menstruation homosexual and heterosexual relationships. Like 3.1. Physiology of Menstruation men who have sex with men, bisexual men may 3.2. Organs involved in Menstruation be at greater risk for HIV and STIs than are 3.3. The Menstrual Cycle others. Female partners of bisexual men need to 3.4. Fertilization: The Beginning of Pregnancy be aware that they are also at increased risk for HIV and other STIs. 4. Informations 4. Transsexual or transgender person is an 4.1. Terminologies individual who, although of one biologic gender, 4.2. References feels as if he or she is of the opposite gender (Jain & Bradbeer, 2007). Such people may have sex change operations so that they appear 1. HUMAN SEXUALITY cosmetically as the gender they feel that they are. 1.1 Sexuality and Sexual Identity ➔ Sexuality is a multidimensional phenomenon 1.2.2 Types of Sexual Expression that includes feelings, attitudes, and actions. It has both biological and cultural components. It 1. Sexual abstinence (celibacy) is separation from encompasses and gives direction to a person’s sexual activity (Ott, Labbett, & Gold, 2007). It is physical, emotional, social, and intellectual the avowed state of certain religious orders. It is responses throughout life. also a way of life for many adults and one that is ➔ Biologic gender is the term used to denote a becoming fashionable among a growing number person’s chromosomal sex: male (XY) or female of young adults. It is the main point of many high (XX). school sex education classes. ➔ Gender identity or sexual identity is the inner 2. Masturbation is self-stimulation for erotic sense a person has of being male or female, pleasure; it can also be a mutually enjoyable which may be the same as or different from activity for sexual partners. It offers sexual biologic gender. release, which may be interpreted by the person ➔ Gender role is the male or female behavior a as overall tension or anxiety relief. Masters person exhibits, which, again, may or may not be (1998) reported that women may find the same as biological gender or gender identity. masturbation to orgasm the most satisfying sexual expression and use it more commonly  than men. Children between 2 and 6 years of 2. Plateau age discover masturbation as an enjoyable The plateau stage is reached just before activity as they explore their bodies. orgasm. In the woman, the clitoris is 3. Erotic stimulation is the use of visual materials drawn forward and retracts under the such as magazines or photographs for sexual clitoral prepuce; the lower part of the arousal. Although this is thought to be mostly a vagina becomes extremely congested male phenomenon, there is increasing interest in (formation of the orgasmic platform), and centerfold photographs in magazines marketed there is increased nipple elevation. primarily to women. Some parents of In men, the vasocongestion leads to adolescents may need to be assured that an distention of the penis. Heart rate interest in this type of material is developmental increases to 100 to 175 beats per and normal. minute and respiratory rate to 4. Fetishism is sexual arousal resulting from the approximately 40 respirations per use of certain objects or situations. Leather, minute. rubber, shoes, and feet are frequently perceived 3. Orgasm to have erotic qualities. The object of stimulation Orgasm occurs when stimulation does not just enhance the experience; rather, it proceeds through the plateau stage to a becomes a focus of arousal and a person may point at which the body suddenly come to require the object or situation for discharges accumulated sexual tension. stimulation. A vigorous contraction of muscles in the 5. Transvestite is an individual who dresses in the pelvic area expels or dissipates blood clothes of the opposite sex. Transvestites can be and fluid from the area of congestion. heterosexual, homosexual, or bisexual. Many are The average number of contractions for married. Some transvestites, particularly married a woman is 8 to 15 contractions at heterosexuals, may be under a great deal of intervals of 1 every 0.8 seconds. strain to keep their lifestyle a secret from friends In men, muscle contractions surrounding and neighbors. the seminal vessels and prostate project 6. Sadomasochism involves inflicting pain semen into the proximal urethra. These (sadism) or receiving pain (masochism) to contractions are followed immediately by achieve sexual satisfaction. It is a practice three to seven propulsive ejaculatory generally considered to be within the limits of contractions, occurring at the same time normal sexual expression as long as the pain interval as in the woman, which force involved is minimal and the experience is semen from the penis. satisfying to both sexual partners. 4. Resolution Resolution is a 30-minute period during which the external and internal genital 1.3 Human Sexual Response organs return to an unaroused state. ➔ Sexuality has always been a part of human life, For the male, a refractory period occurs but it is only in the past few decades that it has during which further orgasm is been studied scientifically. One common finding impossible. of researchers has been that feelings and Women do not go through this refractory attitudes about sex vary widely: the sexual period, so it is possible for women who experience is unique to each individual, but are interested and properly stimulated to sexual physiology (i.e., how the body responds to have additional orgasms immediately sexual arousal) has common features. after the first. 1. Excitement occurs with physical and psychological 1.4 Disorders of Sexual Functioning stimulation (i.e., sight, sound, emotion, or thought) that causes parasympathetic 1. Inhibited Sexual Desire nerve stimulation. This leads to arterial Lessened interest in sexual relations is dilation and venous constriction in the normal in some circumstances, such as genital area. The resulting increased after the death of a family member, a blood supply leads to vasocongestion divorce, or a stressful job change. The and increasing muscular tension. support of a caring sexual partner or In women, this vasocongestion causes relief of the tension causing the stress the clitoris to increase in size and allows a return to sexual interest. mucoid fluid to appear on vaginal walls Decreased sexual desire can also be a as lubrication. The vagina widens in side effect of many medicines. Chronic diameter and increases in length. The diseases, such as peptic ulcers or nipples become erect. chronic pulmonary disorders, that cause In men, penile erection occurs, as well frequent pain or discomfort may interfere as scrotal thickening and elevation of the with a man’s or a woman’s overall testes. In both sexes, there is an well-being and interest in sexual activity. increase in heart and respiratory rates Some women experience a decrease in and blood pressure. sexual desire during perimenopause. Administration of androgen (testosterone) to women may be helpful BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 2  at that time, because it can improve 6. Vaginismus interest in sexual activity. is involuntary contraction of the muscles 2. Failure to Achieve Orgasm at the outlet of the vagina when coitus is The failure of a woman to achieve attempted that prohibits penile orgasm can be a result of poor sexual penetration (Engman, Wijma, & Wijma, technique, concentrating too hard on 2007). achievement, or negative attitudes Vaginismus may occur in women who toward sexual relationships. Treatment have been raped. Other causes are is aimed at relieving the underlying unknown, but it could also be the result cause. It may include instruction and of early learning patterns in which sexual counseling for the couple about sexual relations were viewed as bad or sinful. feelings and needs. As with other sexual problems, sexual or 3. Erectile Dysfunction psychological counseling to reduce this Erectile dysfunction (ED), formerly response may be necessary. referred to as impotence, is the inability 7. Dyspareunia and Vestibulitis of a man to produce or maintain an Dyspareunia is pain during coitus. This erection long enough for vaginal can occur because of endometriosis penetration or partner satisfaction (abnormal placement of endometrial (Wessells et al., 2007). Most causes of tissue), vestibulitis (inflammation of the ED are physical, such as aging, vestibule), vaginal infection, or hormonal atherosclerosis, or diabetes, which limit changes such as those that occur with blood supply. It may also occur as a side menopause and cause vaginal drying. A effect of certain drugs. psychological component may be Examples of drugs prescribed today for present. ED are sildenafil (Viagra), tadalafil Treatment is aimed at the underlying (Cialis), and vardenafil (Levitra), which cause. Encouraging open are taken up to once a day to stimulate communication between sexual partners penile erection. can be instrumental in resolving the A surgical implant to aid erection by the problem. use of vacuum pressure is a possible alternative (Hossein, 2007). 2. THE REPRODUCTIVE SYSTEM Testosterone injections may be helpful in some men. ➔ The major function of the reproductive system is 4. Premature Ejaculation to ensure survival of the species. An individual Premature ejaculation is ejaculation may live a long, healthy, and happy life without before penile–vaginal contact (Docherty, producing offspring, but if the species is to 2007). The term also is often used to continue, at least some individuals must produce mean ejaculation before the sexual offspring. partner’s satisfaction has been ➔ Within the context of producing offspring, the achieved. Premature ejaculation can be reproductive system has four functions: unsatisfactory and frustrating for both ◆ To produce egg and sperm cells partners. ◆ To transport and sustain these cells The cause, like that of ED, can be ◆ To nurture the developing offspring psychological. Masturbating to orgasm ◆ To produce hormones (in which orgasm is achieved quickly because of lack of time) may play a role. Other reasons suggested are doubt 2.1 Reproductive Development about masculinity and fear of ➔ Gonad is a body organ that produces sex cells impregnating a partner, which prevent (the ovary in females and the testis in males) the man from sustaining an erection. ➔ Before 5 weeks upon conception the baby’s sex Sexual counseling for both partners to is cannot be differentiated but after 7 to 8 weeks reduce stress, as well as serotonergic the sex of the baby will be known (for antidepressants such as Mirtazapine, chromosomal males will produce testosterone may be helpful in alleviating the the mesonepheric ducts will become the male problem. reproductive organ and for chromosomal female 5. Persistent Sexual Arousal Syndrome (PSAS) there will be no testosterone hence the is excessive and unrelenting sexual paramesonephric ducts will become the female arousal in the absence of desire reproductive organ). (Mahoney & Zarate, 2007). It may be ➔ The first 8 weeks upon conception is called triggered by medications or organogenesis, in which the vital organs (e.g, psychological factors. When assessing brain, heart) of the body are being developed. someone with the disorder, be certain to ➔ Within 18-20 weeks is the time wherein the sex ask if the person is taking any herbal of the baby was fully developed. remedies such as Ginkgo biloba ➔ Mesonephric ducts develops in males because some of these can have ➔ Paramesonephric ducts develops in females arousal effects. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 3  1. Intrauterine Development - The sex of an GIRLS (estrogen) BOYS (testosterone) individual is determined at the moment of conception by the chromosome information supplied by the particular ovum and sperm that Growth spurt Increase in weight joined to create the new life. A gonad is a body organ that produces the cells Increase in the transverse Growth of testes necessary for reproduction (the ovary in females, diameter of the pelvis the testis in males). At approximately week 5 of intrauterine life, primitive gonadal tissue is Breast development Growth of face, axillary & already formed. (thelarche) pubic hair In both sexes, two undifferentiated ducts, the mesonephric (wolffian) and paramesonephric Growth of pubic hair Voice changes (müllerian) ducts, are present. (pubarche) By week 7 or 8, in chromosomal males, this early gonadal tissue differentiates into primitive testes Onset of menstruation Penile growth and begins formation of testosterone. Under the (menarche) influence of testosterone, the mesonephric duct begins to develop into the male reproductive Growth of axillary hair Increase in height organs, and the paramesonephric duct (adrenarche) regresses. If testosterone is not present by week 10, the gonadal tissue differentiates into ovaries, Vaginal Secretions Spermatogenesis and the paramesonephric duct develops into (spermarche) female reproductive organs 2. Pubertal Development - Puberty is the stage of life at which secondary sex changes begin. 2.2.2 Female and Male Reproductive System These changes are stimulated when the Homologues hypothalamus synthesizes and releases gonadotropin-releasing hormone (GnRH), which Female Male in turn triggers the anterior pituitary to begin the release of follicle-stimulating hormone (FSH) and Clitoral glans Penile glans luteinizing hormone (LH). FSH and LH initiate the production of androgen and estrogen, which in Clitoral shaft Penile shaft turn initiate secondary sex characteristics, the visible signs of maturity. Labia majora Scrotum 3. Role of Androgen - Androgenic hormones are the hormones responsible for muscular Ovaries Testes development, physical growth, and the increase in sebaceous gland secretions that Skene’s glands Prostate causes typical acne in both boys and girls. In males, androgenic hormones are produced by Bartholin’s glands Cowper’s glands the adrenal cortex and the testes; in females, by the adrenal cortex and the ovaries. 4. Role of Estrogen – When triggered at puberty 2.2.3 Secondary Sex Characteristics by FSH, ovarian follicles in females begin to excrete a high level of the hormone ➔ Adolescent sexual development is categorized estrogen.This hormone is actually not one into stages (Tanner, 1990). There is wide substance but three compounds (estrone [E1], variation in the time required for adolescents to estradiol [E2], and estriol [E3]) move through these developmental stages; however, the sequential order is fairly constant. In girls, pubertal changes typically are manifest 2.2 Physiology of Onset as: ➔ Puberty is initiated by hypothalamic-pituitary – 1. Growth spurt gonad complex. 2. Increase in the transverse diameter of the pelvis ➔ Puberty usually starts in Girls at 10-13 years old 3. Breast development and Boys starts at 12-14 years old. 4. Growth of pubic hair 5. Onset of menstruation 6. Growth of axillary hair 2.2.1 Puberty 7. Vaginal secretions ➔ Secondary sex characteristics of boys usually ➔ Is the stage of life at which secondary sex occur in the order of: changes begin. 1. Increase in weight 2. Growth of testes 3. Growth of face, axillary, and pubic hair 4. Voice changes 5. Penile growth 6. Increase in height 7. Spermatogenesis (production of sperm) BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 4  ○ In very cold weather, the scrotal muscle 2.3 Anatomy of the Male and Female Reproductive contracts to bring the testes closer to the System body for warmth. ○ In very hot weather, or in the presence 2.3.1 Anatomy and Physiology of the Reproductive of fever, the muscle relaxes, allowing System the testes to fall away from the body. 2. Testes 2.3.2 Male Reproductive System are two ovoid glands, 2 to 3 cm wide, that lie in the scrotum(walnut size). Each testis is encased by a protective white fibrous capsule and is composed of several lobules, with each lobule containing interstitial cells (Leydig’s cells) and a seminiferous tubule. Surrounded by 2 tunics: ○ Tunica Vaginalis - derived from the parietal peritoneum ○ Tunica Albuginea Seminiferous tubules produce spermatozoa. Leydig’s cells are responsible for the production of testosterone. Testes in a fetus first form in the pelvic cavity. They descend, late in intrauterine life (about the 34th to 38th week), into the scrotal sac. Because The main reproductive organs of the male body are the this descent occurs so late in pregnancy, many testes, which produce sperm and also hormones, in the male preterm infants are born with undescended form of testosterone. testes. They feel round and smooth, and freely movable within the scrotum. 2.3.3 Functions of the Male Reproductive System In most males, one testis is slightly larger than ➔ Production of gametes the other and is suspended slightly lower in the ◆ Male sex cells, i.e., sperm scrotum than the other (usually the left one). ➔ Synthesis of androgens Because of this, testes tend to slide past each ◆ Male sex hormones, e.g. testosterone other more readily on sitting or muscular activity, ➔ Delivery of sperm into the female reproductive and there is less possibility of trauma to them. tract. Spermatozoa do not survive at a temperature as high as that of the body, however, so the location of the testes outside the body, where the 2.2.3.1 Male External Structures temperature is approximately 1° F lower than 1. Scrotum body temperature, provides protection for sperm Loose, pouch-like sac of skin that hangs behind survival. (McCance & Huether, 2007). the penis 3. Penis. is a rugated, skin-covered, muscular pouch The penis is composed of three cylindrical suspended from the perineum. masses of erectile tissue in the penis shaft: Contains testes, epididymis, and the lower two termed the corpus cavernosa, and a third portion of the spermatic cord termed the corpus spongiosum. The urethra Its functions are to support the testes and to help passes through these layers of erectile tissue, regulate the temperature of sperm through making the penis serve as the outlet for both the contraction and relaxation and moving closer to urinary and the reproductive tracts in men. and further away from the perineum At the distal end of the organ is a bulging, The looseness of the scrotum is intentional to sensitive ridge of tissue, the glans. A retractable provide expansion and contraction casing of skin, the prepuce, protects the Lowers T° by 3°C nerve-sensitive glans at birth. Glans The distal end of the organ is a bulging sensitive ridge of tissue which has the external urinary meatus at its tip. Corona The proximal margin of the glans. Prepuce - Also called the foreskin. - Loose skin attached to the BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 5  Sperm are immobile and incapable of shaft, allowing for fertilization as they pass or are stored at expansion during the epididymis level. erection. It takes at least 12 to 20 days for them - Retractable to travel the length of the epididymis and casing of skin a total of 64 days for them to reach that protects the maturity. nerve sensitive This is one reason that aspermia glans at birth (absence of sperm) and oligospermia 4. Frenulum (20 million sperm/mL) are problems that Ventral fold of tissue attaches the skin to do not appear to respond immediately to the glans. therapy but rather only 2 months. Contains the urethra as well as 3 erectile Example scenario, for a male patient bodies: who has oligospermia and has taken a ○ 2 dorsal erectile tissues known medicine for it, the drug will take effect as the corpora cavernosa quickly but it does not mean that he ○ 1 midventral tissue known as already has the normal sperm counts. the corpus spongiosum So as a nurse we have to tell to the Surrounds penile patient that he need to go back for urethra re-assessment for about 2 months Expands distally to before we can conclude that he already form the glans penis have the normal sperm count Sexual excitement → Nitric acid is released from the endothelium of blood vessels → Result in 2. Vas Deferens (Ductus Deferens) engorgement or an increase in the blood flow to is an additional hollow tube surrounded by the arteries of the penis →The Ischiocavernosus arteries and veins and protected by a thick muscle at the penis base then contracts → fibrous coating. Trapping both venous and arterial blood in the 3 It carries sperm from the epididymis through the sections of erectile tissue→ Leading to distention inguinal canal into the abdominal cavity, where it and erection of the penis. ends at the seminal vesicles and the ejaculatory ducts. It is about 40 cm long. The vas deferens serves as a transport function 2.2.3.2 Male Internal Structures and the area of the ampulla serves as storage 1. Epididymis - the seminiferous tubule of each reservoir of sperm for release at ejaculation. testis leads to a tightly coiled tube, the Sperm mature as they pass through the vas epididymis, which is responsible for deferens. conducting sperm from the tubule to the vas Vasectomy (severing of the vas deferens to deferens, the next step in the passage to the prevent passage of sperm) is a popular means of outside. male birth control (Cook et al., 2009). It is also Because each epididymis is so tightly irreversible. coiled, its length is extremely deceptive: If a male patient done a vasectomy, as a nurse it is actually over 20 ft long. we have to tell him that he still needs to use Some sperm are stored in the condom if he will have a sexual intercourse for epididymis, and a portion of the alkaline about 1 month to be sure. fluid that will surround sperm at maturity It is believed that the vas deferens acts as a (semen, or seminal fluid that contains a reservoir for sperm between ejaculations. basic sugar and mucin, a form of 3. Seminal Vesicles protein) is produced by the cells lining are two convoluted pouches that lie along the the epididymis. lower portion of the posterior surface of the bladder and empty into the urethra by way of the ejaculatory ducts. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 6  Secrete seminal fluid (or semen, 60% of it comes The sperm collectively make up the semen. from prostate gland, 30% comes from seminal vesicle, 30% come from epididymis and 5% from Semen / seminal fluid bulbourethral glands) Thick, creamy white fluid with the consistency of Sperm become increasingly motile mucus or egg whites These glands secrete a viscous alkaline liquid Normal amount is 2 mL – 6 mL per ejeculation that has a high sugar, protein, and prostaglandin Fertile man will dispel 20-160 million sperm per content. Sperm become increasingly motile with ejaculate. this added fluid, because it surrounds them with nutrients and a more favorable pH. Spermatozoon 4. Ejaculatory Ducts is made up of a head and a tail The two ejaculatory ducts pass through the ○ The head carries the male’s haploid prostate gland and join the seminal vesicles to number of chromosomes (23). For the urethra. males, they have 23 chromosomes in These are formed by the fusion of the vas which 22 for autosomes and 1 for the deferens and the seminal vesicles. sex chromosomes either X or Y The ejaculatory ducts are part of the human male chromosomes while for females, they anatomy, which cause the reflex action of have 23 chromosomes, 22 for ejaculation. Each male has two of them. autosomes and 1 for sex chromosomes They begin at the vas deferens, pass through the which is X chromosome only. Therefore prostate, and empty into the urethra at the the sex of the fetus is determined by the Colliculus seminalis. During ejaculation, semen male parents. passes through the ducts and exits the body via ○ the part that enters the ovum at the penis. fertilization 5. Prostate Gland ○ the tail specialize in motility is a chestnut-sized gland that lies just below the sperm may be stored in the male genital system bladder. The urethra passes through the center for 42 days of it, like the whole in a doughnut. sperm can live only 2-3 days in the female The prostate gland secretes a thin, alkaline genital tract once ejaculated. fluid. When added to the secretion from the seminal vesicles and the accompanying sperm 2.3.4 Female Reproductive System from the epididymis, this alkaline fluid further protects sperm from being immobilized by the naturally low pH level of the urethra. 6. Bulbourethral Glands two bulbourethral or Cowper’s glands lie beside the prostate gland and empty via short ducts into the urethra. Like the prostate gland and seminal vesicles, they secrete an alkaline fluid that helps counteract the acid secretion of the urethra and ensure the safe passage of spermatozoa. Produce small droplets of fluid during sexual activity that neutralizes the acidity of the male urethra and aid in the transport of sperm 5% semen 7. Urethra is a hollow tube leading from the base of the 2.3.5 Functions of the Female Reproductive bladder, which, after passing through the System prostate gland, continues to the outside through the shaft and glans of the penis. ➔ It produces the female egg cells necessary for It is approximately 8 in (18 to 20 cm) long. reproduction, called the ova or oocytes. 3 sections: ➔ It is designed to transport the ova to the site of ○ Prostatic fertilization. Within the prostate ➔ If fertilization does not take place, the system is ○ Membranous designed to menstruate. Within the urogenital diaphragm ➔ It produces female sex hormone that maintain ○ Penile (spongy) the reproductive cycle. Within the penis 2.3.5.1 Female External Structures The seminal vesicles, prostate gland and Cowper’s gland produce a liquid called a seminal plasma. 1. Mons Veneris/Pubis is a pad of adipose tissue located over Seminal Plasma the symphysis pubis, the pubic bone Aids in the transport of sperm joint. Provides energizing nutrients for the sperm It is covered by a triangle of coarse, Contains form of sugar – fructose, mucous, salts, curly hairs. water, base buffers and coagulators to aid the sperm in their journey. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 7  The purpose of the mons veneris is to The clitoris is sensitive to touch and protect the junction of the pubic bone temperature and is the center of sexual from trauma. arousal and orgasm in a woman. It contains many nerve endings that It contains erectile tissue, blood vessels makes the mons pubis sensitive to touch and nerves. and pressure. It is made up of erectile tissue with many 2. Labia Minora. large and small venous channels Located posterior to the mons veneris surrounded by large amounts of spread two hairless folds of connective involuntary muscle tissue, the tissue, the labia minora. Before ischiocavernosus facilitating erection menarche, these folds are fairly small; of the organ. by childbearing age, they are firm and The clitoris measures 5 – 6 mm. long full; after menopause, they atrophy and and 6 – 8 mm.across. again become much smaller. It has very rich blood and nerve It has 2 smaller lips located within the supplies. labia majora. Functions : It appears thin pale pink in color. ➔ Stimulate and elevate levels of When stimulated, it turns to dark red or sexual tension. dark pink due to the presence of blood ➔ Serve as a landmark in locating vessels, no hair; smooth in texture. urethral opening during The internal structure is covered with catheterization mucous membrane, and the external 6. Skene’s glands (paraurethral glands) portion with skin are located just lateral to the urinary 3. Labia Majora. meatus, one on each side. Their ducts The labia majora are two rounded folds open into the urethra. of adipose(fatty) tissue covered by loose a pair of small glands lying on each side connective tissue and epithelium that of the urethra they produce a small are positioned lateral to the labia minora. amount of mucus and are especially Covered by pubic hair, the labia majora susceptible to serve as protection for the external gonorrheal infection genitalia and the distal urethra and it is homologous to male prostate vagina. 7. Bartholin’s glands (vulvovaginal glands) The outer lips separate downward from are located just lateral to the vaginal themons and meet again below the opening on both sides. Their ducts open vaginaintroitus. into the distal vagina. It contains a multitude of sebaceous and air of small, pea –sized glands located sweat glands. within the substances of the labia majora It also serves as protection for the they correspond to the bulbourethral or external genitalia and the distal urethra Cowper’s gland in male and vagina. the gland secretes a small amount of 4. Vestibule clear, viscid mucus during sexual is the flattened, smooth surface inside excitement the labia. Secretions from both of these glands The openings to the bladder (the help to lubricate the external genitalia urethra) and the uterus (the vagina) both during coitus. arise from the vestibule The alkaline pH of their secretions helps to improve sperm survival in the vagina. 8. Vaginal Orifice/Introitus occupies the lower portion of the vestibule and varies considerably in size and shape the vagina has an abundantly vascular supply 9. Urethral Meatus/Urethral Orifice although not a true part, it is considered as part of the reproductive system because of its closeness and relationship to the vulva 5. Clitoris is a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora. It is covered by a fold of skin, called the prepuce. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 8  Each ovary contains approximately 200,000 to 400,000 follicles during a female's childbirth. Ovarian function, therefore, is necessary for maturation and maintenance of secondary sex characteristics in females. At birth, each ovary contains approximately 2 million immature ova (oocytes), which were formed during the first 5 months of intrauterine life. By age 7 years, only approximately 500,000 are present in each ovary; by 22 years, there are approximately 300,000; and by menopause, none are left (all have either matured or 10. Fourchette atrophied). is the ridge of tissue formed by the Ovaries have three principal divisions: posterior joining of the two labia minora ➔ Protective layer of surface and the labia majora. epithelium This is the structure that is sometimes ➔ Cortex, where the immature cut (episiotomy) during childbirth to (primordial) oocytes mature into enlarge the vaginal opening. ova and large amounts of estrogen and progesterone are 11. Perineum produced located just posterior to the fourchette ➔ Central medulla, which contains This is a muscular area that's easily the nerves, blood vessels, stretched during childbirth to allow lymphatic tissue, and some enlargement of the vagina and passage smooth muscle tissue of the fetal head. Many exercises (Kegel’s,squatting & tailor-sitting) are aimed at making the perineal muscle more flexible to allow easier expansion during birth without tearing of this tissue. 12. Hymen is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood. It is often torn during the time of first sexual intercourse. However, because of the use of tampons and active sports participation, many girls who have not had sexual relations do LAYERS OF OVARIES not have intact hymens at the time of their first pelvic examination. Tunica Albuginea Dense and dull white and It is composed mainly of connective serves as protective layer tissue both elastic and collagen. Both surfaces are covered by stratified Cortex Main functional part squamous epithelium. because it contains ova, Can be broken through strenuous graafian follicles, corpora physical activities or masturbation. lutea, degenerated corpora lutea (corpora 2.3.5.2 Female Internal Structures albicantia) 1. Ovaries. The ovaries are approximately 4 cm Medulla Or central portion of the long by 2 cm in diameter and approximately 1.5 ovary is composed of cm thick, or the size and shape of almonds. They loose connective tissue are grayish white and appear pitted, or with minute indentations on the surface. 2. Fallopian Tubes. The function of the two ovaries (the The fallopian tubes arise from each upper corner female gonads) is to produce, mature, of the uterine body and extend outward and and discharge ova (the egg cells). In backward until each opens at its distal end, next the process, the ovaries produce to an ovary. estrogen and progesterone and Fallopian tubes are approximately 10 cm long in initiate and regulate menstrual a mature woman. cycles. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 9  Their function is to convey the mature ovum from in the fallopian tube that may cause rupture of the ovaries to the uterus and to provide a place the fallopian tube. for fertilization of the ovum by sperm. Its primary purpose is to house and It takes about 3 days for an egg to travel the nurture a pregnancy. length, but an unfertilized egg lives only 24 The function of the uterus is to receive hours. the ovum from the fallopian tube; If unfertilized it will die before it arrives in the provide a place for implantation and uterus. nourishment; furnish protection to a Functions: growing fetus; and, at maturity of the ○ Site of fertilization fetus, expel it from a woman’s body. ○ Provide transportation for the ovum from Anatomically, the uterus consists of the ovary to the uterus three divisions: ○ Serves as a warm, moist, nourishing ➔ The body of the uterus is the environment for the ovum or zygote uppermost part and forms the Parts of the Fallopian Tube: bulk of the organ. During ○ The most proximal division, the pregnancy, the body of the interstitial portion, is that part of the uterus is the portion of the tube that lies within the uterine wall. structure that expands to This portion is only about 1 cm in contain the growing fetus. The length; the lumen of the tube is only 1 portion of the uterus between mm in diameter at this point. the points of attachment of the ○ The isthmus is the next distal portion. It fallopian tubes is termed the is approximately 2 cm in length and like fundus. the interstitial tube, is extremely narrow. ◆ Fundus is the top This is the portion of the tube that is cut portion that can be or sealed in a tubal ligation, or tubal palpated to measure sterilization procedure. uterine growth and the ○ The ampulla is the third and also the force of uterine longest portion of the tube. It is contraction during approximately 5 cm in length. It is in this labor. portion that fertilization of an ovum ➔ The isthmus of the uterus is a usually occurs. short segment between the ○ The infundibular portion is the most body and the cervix. In the distal segment of the tube. It is nonpregnant uterus, it is only 1 approximately 2 cm long and is funnel to 2 mm in length. It is the shaped. The rim of the funnel is covered portion of the uterus that is most by fimbria (small hairs) that help to commonly cut when a fetus is guide the ovum into the fallopian tube. born by a cesarean birth. ➔ The cervix is the lowest portion of the uterus. It represents The wall of the fallopian tube is made up of 4 approximately one third of the layers: total uterus size and is approximately 2 to 5 cm long. Peritoneal (serous) Covers the tubes The opening of the canal at the junction of the cervix and Subserous (adventitial) Contains the blood and isthmus is the internal cervical nerve supply os; the distal opening to the vagina is the external cervical Muscular Responsible for the os. The level of the external os peristaltic is at the level of the ischial spines (an important Mucosal Composed of ciliated and relationship in estimating the nonciliated cells with the level of the fetus in the birth number of ciliated cells canal). more abundant at the ◆ Cervical Canal - fimbria. central cavity 3. Uterus. The uterus is a hollow, muscular, ◆ Internal Cervical OS pear-shaped organ located in the lower pelvis, (opening) - junction of posterior to the bladder and anterior to the the canal at the rectum. During childhood, it is approximately the isthmus size of an olive. An adolescent is closer to 17 ◆ External Cervical OS - years old before the uterus reaches its adult size. distal opening to the With maturity, a uterus is approximately 5 to 7 cm vagina long, 5 cm wide, and, in its widest upper part, 2.5 ➔ TAHBSO cm deep. In a nonpregnant state, it weighs - Total abdominal approximately 60 g. Ectopic pregnancy is an hysterectomy bilateral implantation that happens outside the uterus but salpingo-oophorectomy is the removal of the BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 10  entire reproductive Stratum functionalis – shed during menstruation organ. Stratum basalis – deeper, permanent layer, gives rise - Abdominal to new stratum functionalis hysterectomy is removal of the uterus. 4. Vagina - Bilateral salpingo is Passageway for sperm and menstrual flow the removal of the Receptacle for penis during intercourse fallopian tube. Inferior portion of birth canal - Oophorectomy is Capable of considerable distention (stretching) removal of the ovary. Mucosa is continuous with that of the uterus and ➔ The cervical mucosa has 3 consists of nonkeratinized stratified squamous functions: epithelium. ◆ provide lubrication for Contains large stores of glycogen which the vaginal canal decomposes to organic acids – lower pH = less ◆ act as a bacteriostatic susceptible to infection & less hospitable to agent sperm. ◆ provide an alkaline environment to shelter deposited sperm from 2.3.5.3 Breasts the acidic vagina. The mammary glands, or breasts, form from ◆ Secretory cells of the ectodermic tissue early in utero. They then cervix produce about remain in a halted stage of development until a 20 – 60 ml of mucus / rise in estrogen at puberty produces a marked day. increase in their size. The size increase occurs ◆ At time of ovulation, mainly because of an increase of connective this mucus becomes tissue plus deposition of fat. The glandular tissue ◆ thinner and more of the breasts, necessary for successful alkaline. breastfeeding, remains undeveloped until a first ◆ provide an alkaline pregnancy begins. environment to shelter Accessory organs of the female reproductive deposited sperm from system the acidic vagina. Modified sweat glands ◆ Secretory cells of the Function is to synthesize, secrete and eject milk cervix produce about (lactation) 20 – 60 ml of mucus / Lie over the pectoralis major muscles day. Are attached to fascia by the suspensory ◆ At time of ovulation, ligaments (of Cooper) this mucus becomes Breast size is determined more by fat than by thinner and more glandular tissue. alkaline. Milk glands of the breasts are divided by ◆ Mucus provides for the connective tissue partitions into approximately 20 energy needs of the lobes. All of the glands in each lobe produce milk sperm, protects sperm by acinar cells and deliver it to the nipple via a from the environment lactiferous duct. The nipple has approximately of the vagina, and 20 small openings through which milk is protects them from secreted. An ampulla portion of the duct, located phagocytes. just posterior to the nipple, serves as a reservoir ◆ At other times, mucus for milk before breastfeeding. becomes thick and can A nipple is composed of smooth muscle that is form a cervical plug capable of erection on manual or sucking which impedes stimulation. On stimulation, it transmits passages of sensations to the posterior pituitary gland to pathogens. release oxytocin. Oxytocin acts to constrict milk gland cells and push milk forward into the ducts LAYERS OF UTERUS that lead to the nipple. The skin surrounding the nipples is darkly pigmented out to approximately Peritoneum A part of visceral 4 cm and is termed the areola. The area appears peritoneum rough on the surface because it contains many sebaceous glands, called Montgomery’s Myometrium Bulk of uterus - three tubercles that secrete lubricating substances for layers of muscle that the nipple. contract under influence Ampulla - portion of the duct just posterior to the of oxytocin during labor nipples serves as a reservoir for milk before breastfeeding. Breasts are located anterior to the pectoral Endometrium Highly vascular mucosa muscle. In many women,breast tissue extends well into the axilla. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 11  ○ Each breast has 15-20 lobes made up of hypothalamus, the pituitary gland, the ovaries, several lobes. Lobules are made of and the uterus. milk-secreting cells arranged in alveoli. All the glands in each lobe produce milk by acini 3.2 Organs involved in Menstruation cells & deliver it to the nipple by lactiferous duct Milk production is stimulated mostly by prolactin 1. Hypothalamus with some help from estrogen & progesterone. The release of GnRH (also called luteinizing hormone–releasing hormone, or LHRH) by the Gynecomastia hypothalamus initiates the menstrual cycle. Increase in male breast size GnRH is transmitted from the hypothalamus to Most evident in obese boys the anterior pituitary gland and signals the gland Normal change of puberty to begin producing the gonadotropic hormones FSH and LH. Because production of GnRH is cyclic, menstrual periods also cycle. 3. MENSTRUATION stimulates anterior pituitary gland to begin ➔ monthly discharge of blood from the uterus production of gonadotropic hormones. occurring form puberty to menopause wherein 2. Pituitary gland about 30-60 cc of blood, epithelial cells and Under the influence of GnRH, the anterior lobe of mucus are being discharged. the pituitary gland (the adenohypophysis) The purpose of a menstrual cycle is to produces two hormones that act on the ovaries bring an ovum to maturity and renew a to further influence the menstrual cycle: uterine tissue bed that will be a. FSH, a hormone that is active early in responsible for the ova’s growth should the cycle and is responsible for it be fertilized. It is the process that maturation of the ovum allows for conception and implantation of b. LH, a hormone that becomes most a new life. active at the midpoint of the cycle and is The length of menstrual cycles differs responsible for ovulation, or release of from woman to woman, but the average the mature egg cell from the ovary, and length is 28 days growth of the uterine lining during the (from the beginning of one menstrual second half of the menstrual cycle. flow to the beginning of the next). It is 3. Ovary not unusual for cycles to be as short as As it grows, its cells produce a clear fluid 23 days or as long as 35 days. The (follicular fluid) that contains a high degree of length of the average menstrual flow estrogen (mainly estradiol) and some (termed menses) is 4 to 6 days, progesterone. At this stage of maturation, the although women may have periods as small ovum (barely visible to the naked eye, short as 2 days or as long as 7 days approximately the size of a printed period), with This is the monthly menstrual bleeding its surrounding follicle membrane and fluid, is (also called menstruation or menstrual termed a graafian follicle. period) that you have from your early One ovum matures in one or the other ovary & is teen years until your menstrual periods discharged from it each month. end around age 50 (menopause) After an upsurge of LH from the pituitary, About once a month, the uterus grows a prostaglandins are released and the graafian new, thickened lining (endometrium) that follicle ruptures. The ovum is set free from the can hold a fertilized egg. surface of the ovary, a process termed ovulation. When there is no fertilized egg to start a It is swept into the open end of a fallopian tube pregnancy, the uterus then sheds its lining. Ovarian Cycle The menstrual cycle is measured from The Follicular Phase: Days 1 through 13 the first day of menstrual bleeding, Day ○ In response to follicle stimulating 1, up to Day 1 of your next menstrual hormone (FSH) released from the bleeding. pituitary gland in the brain, ultimately A teen's cycles tend to be long (up to 42 one egg matures. days), growing shorter over several Ovulation: Day 14 years. ○ At about day 14, in response to a surge The average menstrual period is 5 days. of luteinizing hormone, the egg is The amount of blood loss every released from the ovary. menstrual period is 30 to 80 ml. The ○ The egg travels through the fallopian normal color of the menses is dark red tube toward the uterus. that contains mucus and endometrial The Luteal Phase: Days 14 through 28 cells. ○ The remains of the follicle become the corpus luteum which releases 3.1 Physiology of Menstruation progesterone Four body structures are involved in the Time of ovulation physiology of the menstrual cycle: the An easy way to approximate the time of ovulation for women with regular cycles is to subtract 16 BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 12  from the number of days in the cycle and then combination of peristaltic action of the tube and add 4. This will calculate the span of days in movements of the tube cilia help propel the ovum which ovulation is most likely to occur. along the length of the tube. At the time of ovulation, there is a reduction in Signs and symptoms of ovulation the viscosity (thickness) of the cervical mucus, Mittelschmerz which makes it easy for spermatozoa to ○ abdominal tenderness on left/right iliac penetrate it. Sperm transport is so efficient close regions,brought about by peritoneal to ovulation that spermatozoa deposited in the irritation due to blood coming out from vagina generally reach the cervix within 90 the graafian follicle. seconds and the outer end of a fallopian tube Spinnbarkeit within 5 minutes after deposition. ○ vaginal secretion is clear & transparent Spermatozoa move through the cervix and the Change in vaginal mucus body of the uterus and into the fallopian tubes, Goodel’s sign toward the waiting ovum by the combination of Mood changes movement by their flagella (tails) and uterine Breast tenderness contractions. Increased levels of Capacitation is a final process that sperm must Progesterone undergo to be ready for fertilization. This Change in basal body process, which happens as the sperm move temperature toward the ovum, consists of changes in the plasma membrane of the sperm head, which Antepartal Period reveal the sperm-binding receptor sites. Hyaluronidase (a proteolytic enzyme) is Ovum released by the spermatozoa and dissolves the ○ from ovulation to fertilization layer of cells protecting the ovum. Under ordinary Zygote circumstances, only one spermatozoon is able to ○ from fertilization to implantation penetrate the cell membrane of the ovum. Once Embryo it penetrates the cell, the cell membrane changes ○ from implantation to 5-8 weeks composition to become impervious to other Fetus spermatozoa. ○ from 5-8 weeks until term Conceptus Implantation ○ Developing embryo or fetus And Large cells tend to collect at the periphery of the placental structure throughout ball, leaving a fluid space surrounding an inner pregnancy cell mass. At this stage, the structure becomes a blastocyst. It is this structure that attaches to the Process of fertilization uterine endometrium. The cells in the outer ring Fertilization ( Conception, Fecundation) are trophoblast cells. ○ is the union of an ovum and a Implantation, or contact between the growing spermatozoon. This usually occurs in structure and the uterine endometrium, occurs the outer third of the fallopian tube. approximately 8 to 10 days after fertilization. The structure brushes against the rich uterine Fertilization endometrium (in the second [secretory] phase of Usually only one of a woman’s ova will reach the menstrual cycle), a process termed maturity each month. Once the mature ovum is apposition. It attaches to the surface of the released, fertilization must occur fairly quickly endometrium (adhesion) and settles down into its because an ovum is capable of fertilization for soft folds (invasion). only 24 hours (48 hours at the most). The blastocyst is able to invade the endometrium After that time, it atrophies and becomes because, as the trophoblast cells on the outside nonfunctional. Because the functional life of a of the structure touch the endometrium, they spermatozoon is also about 48 hours, possibly produce proteolytic enzymes that dissolve any as long as 72 hours, the total critical time span tissue they touch. This action allows the during which sexual relations must occur for blastocyst to burrow deeply into the endometrium fertilization to be successful is about 72 hours and receive some basic nourishment of glycogen (48 hours before ovulation plus 24 hours and mucoprotein from the endometrial glands. As afterward). invasion continues, the structure establishes an As the ovum is extruded from the graafian follicle effective communication network with the blood of an ovary with ovulation, it is surrounded by a system of the endometrium. ring of mucopolysaccharide fluid (the zona Implantation or contact between the growing pellucida) and a circle of cells (the corona structure and the uterine endometrium occurs radiata). approximately 8 to 10 days after fertilization. The ovum and these surrounding cells (which Apposition increase the bulk of the ovum and serve as ○ the blastocyst brushes against the rich protective buffers against injury) are propelled uterine endometrium into a nearby fallopian tube by currents initiated Adhesion by the fimbriae—the fine, hairlike structures that ○ it attaches to the surface of the line the openings of the fallopian tubes. A endometrium BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 13  Invasion hypothalamus to produce follicle stimulating ○ the blastocyst settles down into its soft hormone releasing factor (FSHRF). folds. 2. FSHRF is responsible for stimulating the anterior pituitary gland (APG) to produce the FSH which 4. Uterus will act on one immature oocyte inside. a also illustrates uterine changes that occur primordial follicle, stimulating its growth. monthly as a result of stimulation from the 3. In view of the FSH, estrogen is now going to be hormones produced by the ovaries. produced in an increasing amount inside the stimulation from the hormones produced by the follicle, which is found in the ovary. Once ovaries causes specific monthly effects on the estrogen is present, the primordial follicle is now uterus termed Graafian follicle. The GF is the structure Uterine Cycle therefore that contains high amounts of estrogen Proliferative Phase: Days 5 -14 4. Estrogen in the GF will cause the cells in the ○ The uterine lining increases rapidly in uterus to proliferate (grow rapidly); increasing its thickness, and the uterine glands thickness to about eight fold. This is called proliferate and grow. Proliferative/follicular phase. Secretory Phase: Days 14 through 28 5. On the 13th day of my menstrual cycle, there is ○ When an egg is not fertilized, the corpus now a very low level of progesterone in the luteum gradually disappears, estrogen blood. This stimulates the hypothalamus to and progesterone levels drop, and the produce Luteinizing Hormone releasing factor thickened uterine lining is shed. This is (LHRF). menses (your period). 6. LHRF is responsible for stimulating the APG to produce LH. Effects of Estrogen to the body: 7. The LH in turn, is responsible for stimulating the ovary to produce progesterone. The increased Inhibits production of FHS. amounts of both estrogen and progesterone Causes hypertrophy and hyperplasia of push the new mature ovum to the surface of the myometrium ovary until the following day (14th) the GF Stimulates the growth of ductile structures of the ruptures and releases the mature ovum. breast 8. Once ovulation has taken place, the GF which Increases quantity and pH of cervical mucus contains an increased amount of progesterone causing it to become watery and can be to a