anatomy-and-physiology-of-human-reproductive-organ-.she.pdf

Anatomy and Physiology of the Reproductive Organ Sheila S. Zate RM,RN Clinical Instructor Female Reproductive Organ EXTERNAL PARTS  Female External Structures The structures that form the female external genitalia are termed the vulva (from the Latin word for “cover...

Anatomy and Physiology of the Reproductive Organ Sheila S. Zate RM,RN Clinical Instructor Female Reproductive Organ EXTERNAL PARTS  Female External Structures The structures that form the female external genitalia are termed the vulva (from the Latin word for “covering”). The term VULVA or PUDENDA refers to the entire female external genitalia. 1. Mons Pubis The mons pubis is a tissue mound made up of fat located directly anterior to the pubic bones. This mound of tissue is prominent in females and is usually covered in pubic hair. The mons pubis functions as a source of cushioning during sexual intercourse. The mons pubis also contains sebaceous glands that secrete pheromones to induce sexual attraction. 2. Labia Majora The word "labia majora" is defined as the larger lips. The labia majora are a prominent pair of cutaneous skin folds that will form the lateral longitudinal borders of the vulval clefts. The labia majora forms the folds that cover the labia minora, clitoris, vulva vestibule, vestibular bulbs, Bartholin's glands, Skene's glands, urethra, and the vaginal opening. The labia majora engorges with blood and appears edematous during sexual arousal. 3. Labia Minora The "labia minora" is defined as the smaller lips. The labia minor are a pair of small cutaneous folds that begins at the clitoris and extends downward. The anterior folds of the labia minora encircle the clitoris forming the clitoral hood and the frenulum of the clitoris. 4. Clitoris The clitoris is a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora. It’s covered by a fold of skin, the prepuce; is sensitive to touch and temperature; and is the center of sexual arousal and orgasm in a woman. composed of two erectile tissues called corposa cavernosa that are connected to the pubic bone. 5. Hymen is a tough but elastic semicircle of tissue that covers the opening to the vagina during childhood. - is often torn during the time of first sexual intercourse. - hematocolpometra a female has an imperforate hymen, or a hymen so complete that it does not allow for the passage of menstrual blood from the vagina or for sexual relations until it is surgically incised 6. Urethral Meatus – the external opening of the female urethra is located just below the clitoris. The purpose of the urethra is for the excretion of urine. The urethra in females opens within the vulva vestibule located inferior to the clitoris, but superior to the vagina opening. the shortness of the female urethra makes a woman more susceptible to urinary tract infection (UTI) than men. The urethra in females opens within the vulva vestibule located inferior to the clitoris, but superior to the vagina opening. 7. Vaginal Orifice or introitus is the external opening of the vagina located just below the urethral meatus. - the Grafenberg or G-spot is a very sensitive area located at the inner anterior surface of the vagina. 8. fourchette -is the ridge of tissue formed by the posterior joining of the labia minora and the labia majora. the structure that sometimes tears (laceration) or is cut (episiotomy) during childbirth to enlarge the vaginal opening. 9. Perineal muscle (often called the perineal body)- posterior to the fourchette. is a muscular area, it stretches during childbirth to allow enlargement of the vagina and passage of the fetal head.  Internal parts Vagina: Your vagina is a muscular canal that joins the cervix (the lower part of uterus) to the outside of the body. It can widen to accommodate a baby during delivery and then shrink back to hold something narrow like a tampon. It’s lined with mucous membranes that help keep it moist. Cervix: Your cervix is the lowest part of your uterus. A hole in the middle allows sperm to enter and menstrual blood to exit. Your cervix opens (dilates) to allow a baby to come out during a vaginal childbirth. Your cervix is what prevents things like tampons from getting lost inside your body. Uterus: Your uterus is a hollow, pear-shaped organ that holds a fetus during pregnancy. Your uterus is divided into two parts: the cervix and the corpus. Your corpus is the larger part of your uterus that expands during pregnancy. Ovaries: Ovaries are small, oval-shaped glands that are located on either side of your uterus. Your ovaries produce eggs and hormones. Fallopian tubes: These are narrow tubes that are attached to the upper part of your uterus and serve as pathways for your egg (ovum) to travel from your ovaries to your uterus. Fertilization of an egg by sperm normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into your uterine lining.  Parts of the Penis: An uncircumcised 1. Shaft or body and a circumcised 2. Glans is a bulging, penis. sensitive ridge of tissue at the distal end of the organ 3. Prepuce or the Foreskin - a retractable casing of skin; protects the nerve-sensitive glans at birth. In some cases the prepuce is too tight and cannot be retracted over the glans, this condition is called phimosis 4. Urethral Meatus – is the 1. Scrotum - is a rugated, skin-covered, muscular pouch suspended from the perineum containing the testes; covered by sparse hair after puberty. - is supplied abundantly by sweat and sebaceous glands; has no subcutaneous fat because the testes must be kept cool. Its functions are: To support the testes and help regulate the temperature of sperm. 2. Testes - are two ovoid glands, 2 to 3 cm wide, that rest in the scrotum. Each testis is encased by a protective white fibrous capsule and is composed of a number of lobules. Each lobule contains interstitial cells (Leydig cells) that produce testosterone and a seminiferous tubule that produces spermatozoa. 3. Epididymis - a tightly coiled tube about 6m (20 ft) long that caps the superior part of the testis. - is responsible for conducting sperm from the tubule to the vas deferens. 4.Vas Deferens (Ductus Deferens) - is an additional hollow tube surrounded by arteries and veins and protected by a thick fibrous coating, which, altogether, are referred to as the spermatic cord. 5. Seminal Vesicles - are two convoluted pouches that lie along the lower portion of the bladder and empty into the urethra by ejaculatory ducts. These glands secrete a viscous alkaline liquid with a high sugar, protein, and prostaglandin content. Sperm become increasingly motile because this added fluid surrounds them with a more favorable pH environment. 6. Ejaculatory Duct – pass through the urethra and then, connect the seminal vesicles to  8. Bulbourethral Glands. Two bulbourethral, or Cowper’s, glands lie beside the prostate gland and empty by short ducts into the urethra. They supply one more source of alkaline fluid to help ensure the safe passage of spermatozoa. 9. Urethra. The urethra is a hollow tube leading from the base of the bladder, which, after passing through the prostate gland, continues to the outside through the shaft and glans of the penis. It is about 8 in. (18 to 20 cm) long. Like other urinary tract structures, it is lined with mucous membrane. The Female breasts are accessory organs of reproduction meant to provide the infant with the most ideal nourishment after birth. They are situated over the pectoralis major muscles, between the second and sixth ribs. The breasts are supported by the cowper’s ligaments. Gynecomastia - boys, especially those who are obese, may notice a temporary increase in breast size at puberty.  External Structures: 1.Nipple or Mammary Papillae – located at the center of the anterior surface of each breast. has 15-20 opening connected to lactiferous ducts and in which milk flows out. 2. Areola – the pigmented skin that surrounds the nipple. 3. Montgomery Tubercles – Glands in the areola that secrete an oily substance that keeps the areola and nipple lubricated. Breasts are located anterior to the pectoral muscle and, in many women, breast tissue extends well into the axilla. When palpating for breast health, always include the axillary region in the examination, or this breast tissue can be missed. It is not uncommon for women or men to have supernumerary breast tissue along mammary lines on the front of their body. The nipple on these auxiliary sites may look like a mole, so adolescents may report this as a “mole changing in color” or be concerned they have skin cancer. You can assure them supernumerary breast tissue or nipples are not uncommon and are innocent findingsBreasts are located anterior to the pectoral muscle and, in many women, breast tissue extends well into the axilla. When palpating for breast health, always include the axillary region in the examination, or this breast tissue can be missed. The nipple on these auxiliary sites may look like a mole, so adolescents may report this as a “mole changing in color” or be concerned they have skin cancer.  Internal Structures 1.Lobes – 15 to 20 lobes are found in the breast that are divided into several lobules. 2.Lobules – Composed of clusters of acini cells 3.Acini cells – are the milk secreting cells of the breasts that are stimulated by prolactin hormone. 4.Lactiferous ducts – ducts that serve as passageway of milk. 5.Lactiferous Sinus – dilated portions of the ducts located behind the nipple that  Hormones affecting the development of breast 1. Estrogen – stimulates the development of ductile structures of breast. 2. Progesterone – stimulates the development of the acinar structures of the breast 3. Human placental lactogen – promotes breast development during pregnancy. 4. Oxytocin – let-down reflex. This hormone is inhibited by progesterone. 5. Prolactin – stimulates milk production. This hormone is inhibited by estrogen.  Physiology of Menstruation Menarche (the first menstrual period) - the average age at which it occurs is 12.4 years of age It may occur as early as age 9 years or as late as age 17 years. - Irregular menstrual periods are the rule rather than the exception for the first year or two. - Menstrual periods do not become regular until ovulation occurs consistently and this does not tend to happen until 1 to 2 years after menarche. MENSTRUATION A menstrual cycle (the chromosomal female reproductive cycle) is episodic uterine bleeding in response to cyclic hormonal changes. Purpose: is to bring an ovum to maturity and renew a uterine tissue bed that will be necessary for the ovum’s growth should it be fertilized. The length of menstrual cycles differs from woman to woman the average length is 28 days (from the beginning of one menstrual flow to the beginning of the next). It is not unusual for cycles to be as short as 23 days or as long as 35 days. The length of the average menstrual flow termed menses) is 4 to 6 days, although women may have flows as short as 2 days or as long as 9 days (Ledger, 2018). Four body structures are involved in the physiology of the menstrual cycle: 1.The hypothalamus 2. The pituitary gland 3. The ovaries 4. The uterus Ovulation is a phase of the female menstrual cycle that involves the release of an egg (ovum) from one of the ovaries. It generally occurs about two weeks before the start of the menstrual period  Human Sexuality Human sexuality is the way people experience and express themselves sexually involves biological, psychological, physical, erotic, emotional, so cial, or spiritual feelings and behaviors. Because it is a broad term, which has varied with historical contexts over time, it lacks a precise definition. Sexual identity describes how a person identifies related to their sexual orientation. Hence a man who exclusively prefers women will usually have a straight or heterosexual sexual identity, and a woman who exclusively prefers women usually a lesbian or homosexual sexual identity. Gender identity describes the gender with which a person identifies (i.e, whether one perceives oneself to be a man, a woman, or describes oneself in some less conventional way. Gender identity may be affected by a variety of social structures, including the person's ethnic group, employment status, religion or irreligion, and family. Gender role a set of perceived behavioral norms associated particularly with males or females, in a given social group or system.  The Human Sexual Response Sexuality has always been a part of human life, but only in the past few decades has it been studied scientifically. One common finding of researchers has been that feelings and attitudes about sex vary widely across cultures and individuals. Although the sexual experience is unique to each individual, sexual physiology (how the body responds to sexual arousal) has common features (Kimmel & Rogers, 2011). The Sexual Response Cycle Two of the earliest researchers of sexual response were Masters and Johnson. In 1966, they published the results of a major study based on more than 10,000 episodes of sexual activity among more than 600 men and women (Masters et al., 1998). In this study, they described the human sexual response as a cycle with four discrete stages: excitement, plateau, orgasm, and resolution  Human Sexual Response Phase 1: Excitement Phase 2: Plateau If a person continues to receive sexual stimulation after the Sexual excitement, also called arousal, is the first phase excitement phase, they move into the second stage: plateau. of the sexual response cycle. This phase happens in response to thoughts, sensations, or events that make a In the plateau phase, the responses initiated during the person feel aroused. excitement phase intensify. Examples of things that can trigger the excitement phase Blood flow, heart rate, muscle tension, breathing rate, and include viewing pornography, having sexual fantasies, or kissing. sensitivity continue to increase. During the excitement phase, a person may experience: People with a vagina may also experience: darkening of the wall of the vagina, which expands, increased heart rate, breathing rate, and blood pressure elevating the uterus increased muscle tension increasing sensitivity in the clitoris increased blood flow to the genitals increasing lubrication of the vagina increased sensitivity to touch People with a penis may release some pre-seminal fluid, nipple hardening also known as pre-ejaculate or pre-cum, or experience an erection in those with a penis further drawing in of the scrotal sack to the body. The plateau phase ends when the third stage, orgasm, the start of vaginal lubrication in those with a vagina begins. enlargement of the testes and tightening of the scrotal sack in those with testes Phase 3: Orgasm Phase 4: Resolution The orgasm phase happens when a person is at the peak The resolution phase returns the body to its pre- of sexual excitement. It is also known as a “climax.” aroused state. In this phase, a person “recovers” This phase happens when a person continues to receive from sexual intercourse and orgasm. sexual stimulation after the plateau phase. Stimulation A person’s heartbeat and breathing slow down, that may cause an orgasm includes touching the genitals, blood pressure and muscle tension return to normal, breasts, nipples, and other body parts. and the genitals become smaller and less engorged. Features of orgasm include involuntary muscle A person may feel satisfied and tired. contractions, a feeling of euphoria, and a release of After orgasm, a person enters the refractory period. tension. The refractory period refers to a period after an During the orgasm phase, a person with a penis may also orgasm where a person’s body no longer responds experience contraction of the penile muscles and to sexual stimuli. ejaculation, which is the release of semen from the In people with a penis, the penis becomes flaccid, urethra. and the person no longer responds to stimulation. A person with a vagina may experience contraction of the How long a person’s refractory period pelvic muscles and a release of muscle tension. lasts depends on their age, how often they have As well as these physical changes, the brain releases a sexual intercourse, how intimate they are with their chemical called oxytocin, which results in emotional partner, and the newness of the experience. well-being and the forming of social bonds following the orgasm. The brain also releases dopamine, which results in a state of relaxation following intercourse  DISORDERS OF SEXUAL FUNCTIONING Disorders involving sexual functioning can be lifelong (primary) or acquired (secondary). They can have a psychogenic origin (produced by psychic rather than organic factors), a biogenic origin (produced by biologic processes), or both. They occur in both men and women. Failure to Achieve Orgasm The failure of a woman to achieve orgasm can be a result of poor sexual technique, concentrating too hard on achievement, or negative attitudes toward sexual relationships. Treatment is aimed at relieving the underlying cause. It may include instruction and counseling for the couple about sexual feelings and needs. Female Viagra (often referred to as “pink” Viagra) is not yet available in the United States. Caution women to use online prescription sites carefully to avoid purchasing inactive or possibly harmful medications advertised as pink Erectile Dysfunction Erectile dysfunction (ED), formerly referred to as impotence, is the inability of a man to produce or maintain an erection long enough for penetration or partner satisfaction (Ghanem, Salonia, & Martin- Morales, 2013). It affects as many as 40% of men by age 40 years and 65% of men by age 65 years. Most causes of ED are physical, such as aging, atherosclerosis, or diabetes, all of which are conditions that limit blood supply to the penis. It may also occur as a side effect of certain drugs, such as antidepressants (Burnett, 2011) or after discontinuation of finasteride, a drug for male pattern baldness (Irwig & Kolukula, 2011). Premature ejaculation is ejaculation before the sexual partner’s satisfaction has been achieved (Mulhall, 2012). It applies to both same sex and opposite sex couples. Premature ejaculation can be unsatisfactory and frustrating for both partners. The cause, like that of ED, can be psychological. Masturbating to orgasm (in which orgasm is achieved quickly because of lack of time) may play a role. Other reasons suggested are doubt about masculinity and fear of impregnating a partner, which prevent the man from sustaining an erection. Persistent Sexual Arousal Syndrome Persistent sexual arousal syndrome (PSAS) occurs in women and is the excessive and unrelenting sexual arousal in the absence of desire (Brotto, Bitzer, Laan, et al., 2010). It may be triggered by either medications or psychological factors and is associated with restless leg syndrome and overactive bladder. When assessing someone with the disorder, be certain to ask if the person is taking any herbal remedies such as ginkgo biloba or a partner is using a treatment for male pattern baldness as these can have arousal effects. Pain Disorders Because the reproductive system has a sensitive nerve supply, when pain occurs in response to sexual activities, it can be acute and severe and can impair a person’s ability to enjoy this aspect of their life. Vaginismus is involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted, which prohibits penile penetration (Reissing, 2012). Vaginismus may occur in women who have been raped. Other causes are unknown, but it could also be the result of early learning patterns in which sexual relations were viewed as bad or sinful. As with other sexual problems, sexual or psychological counseling to reduce this response may be necessary.  Dyspareunia is pain during coitus. Dyspareunia can occur because of endometriosis (abnormal placement of endometrial tissue), vestibulitis (inflammation of the vestibule), vaginal infection, or hormonal changes such as those that occur with menopause and cause vaginal drying. A psychological component may be present. Treatment is aimed at the underlying cause. Encouraging open communication between sexual partners can be instrumental in resolving the problem. The Individual With a Disability Individuals who are physically challenged have sexual desires and needs the same as all others (Meaney-Tavares & Gavidia- Payne, 2012). They may, however, have difficulty with sexual identity or sexual fulfillment because of their disability. Males with upper spinal cord injury, for example, may have difficulty with erections and ejaculation because these actions are governed at the spinal level. Manual stimulation of the penis or psychological stimulation can, however, achieve erection in most men with spinal cord lesions, allowing the man a satisfying sexual relationship with his partner. Most women with spinal cord injuries cannot experience orgasm but are able to conceive and have children. The Individual With a Hypoactive Sexual Desire Lessened interest in sexual relations is normal in some circumstances, such as after the death of a family member, a divorce, or a stressful job change. The support of a caring sexual partner or relief of the tension causing the stress allows a return in sexual interest.