Maternal & Child Health Nursing (Part 1) Quiz PDF

LESSON 1: FRAMEWORK FOR SCOPE OF PRACTICE MATERNAL & CHILD HEALTH NURSING 1. Preconception health care 2. Care of women during three trimesters of (PART 1)...

LESSON 1: FRAMEWORK FOR SCOPE OF PRACTICE MATERNAL & CHILD HEALTH NURSING 1. Preconception health care 2. Care of women during three trimesters of (PART 1) pregnancy and the puerperium (the 6 weeks GOALS AND PHILOSOPHIES after childbirth, sometimes termed the fourth Primary Goal: trimester of pregnancy) Promotion and maintenance of optimal family 3. Care of infants during the perinatal period (6 health. weeks before conception to 6 weeks after birth) 4. Care of children from birth through late Maternal and child health nursing extends from adolescence. preconception to menopause with an 5. Care in a variety of hospital and home care expansive array of health issues and healthcare settings providers. MATERNAL AND CHILD HEALTH NURSING ADVANCES IN MATERNAL AND CHILD ★ Family centered: HEALTHCARE ○ Assessment should always include the ★ Through immunization, childhood diseases family as well as an individual. such as measles and poliomyelitis almost have ★ Evidence based: been eradicated ○ This is the means whereby critical ★ New fertility drugs and fertility techniques knowledge increases. allow more couples to conceive ★ Community centered: ○ Fertility Awareness Methods ○ The health of families is both affected by Calendar (Rhythm) Method and influences the health of Basal Body Temperature communities. Method Cervical Mucus Method PHILOSOPHY OF MATERNAL AND CHILD (Billing's Method) HEALTH NURSING ★ Fetal health disorders are identified through 1. Considers the family as a whole and as a medical testing procedures. partner in care when planning or implementing ○ Amniocentesis or evaluating the effectiveness of care. ○ Transcervical Chorionic Villus Sampling 2. Serves as an advocate to protect the rights of all family members, including the fetus. STEM CELL THERAPY 3. Demonstrates a high degree of independent ➔ make it possible to replace diseased cells with nursing functions because teaching and new growth cells and cure these illnesses. counseling are major interventions. 4. Promotes health and disease prevention REGENERATIVE MEDICINE because these protect the health of the next ➔ promotes the repair response of diseased, generation. dysfunctional or injured tissue using stem cells 5. Serves as an important resource for families or their derivatives. during childbearing and childrearing as these ➔ it is the next chapter in organ transplantation can be extremely stressful times in a life cycle. and uses cells instead of donor organs, which 6. Respects personal, cultural, and spiritual are limited in supply. attitudes and beliefs as these so strongly influence the meaning and impact of Researchers grow stem cells in a lab. childbearing and childrearing. Manipulated to specialize into specific types of 7. Encourages developmental stimulation cells, such as heart muscle cells, blood cells or during both health and illness so children can nerve cells. reach their ultimate capacity in adult life. Implanted into a person. 8. Assesses families for strengths as well as specific needs or challenges. EXAMPLE: 9. Encourages family bonding through rooming-in Patient with heart disease, the cells could be and family visiting in maternal and child injected into the heart muscle. healthcare The healthy transplanted heart muscle cells 10. Encourages early hospital discharge options could then contribute to repairing the injured to reunite families as soon as possible in order heart muscle to create a seamless, helpful transition process. 11. Encourages families to reach out to their community so the family can develop a wealth of support people they can call on in a time of family crisis.  PHASES OF HEALTHCARE 3.2: For every woman and newborn who requires referral, the (1) Health Promotion: referral follows a pre-established plan that can be implemented ➔ Educating clients to be aware of good health without delay at any time. through teaching and role modeling 3.3: For every woman and newborn referred within or between health facilities, there is appropriate information exchange and (2) Health Maintenance: feedback to relevant health care staff. ➔ Intervening to maintain health when risk of illness is present Standard 4: (3) Health Restoration: Communication with women and their families is effective and ➔ Promptly diagnosing and treating illness responds to their needs and preferences. using interventions that will return client to wellness most rapidly. 4.1: All women and their families receive information about the care and have effective interactions with staff. 4.2: All women and their families experience coordinated care, with (4) Health Rehabilitation: clear, accurate information exchange between relevant health and ➔ Preventing further complications from an social care professionals. illness; bringing an ill client back to an optimal state of wellness or helping a client to accept inevitable death Standard 5: Women and newborns receive care with respect and STANDARDS OF CARE AND MEASURES OF preservation of their dignity. QUALITY (by WHO) 5.1: All women and newborns have privacy around the time of Standard 1: labour and childbirth, and their confidentiality is respected Every woman and newborn receives routine, evidence-based 5.2: No woman or newborn is subjected to mistreatment, such as care and management of complications during labor, childbirth physical, sexual or verbal abuse, discrimination, neglect, and the early postnatal period, according to WHO guidelines. detainment, extortion or denial of services. 5.3: All women have informed choices in the services they receive, 1.1a: Women are assessed routinely on admission and and the reasons for interventions or outcomes are clearly during labour and childbirth and are given timely, explained. appropriate care. 1.1b: Newborns receive routine care immediately after birth. Standard 6: 1.1c: Mothers and newborns receive routine postnatal Every woman and her family are provided with emotional care. support that is sensitive to their needs and strengthens the 1.2: Women with pre-eclampsia or eclampsia promptly receive woman’s capability. appropriate interventions, according to WHO guidelines. 1.3: Women with postpartum haemorrhage promptly receive 6.1: Every woman is offered the option to experience labor and appropriate interventions, according to WHO guidelines. childbirth with the companion of her choice. 6.2: Every woman receives support to strengthen her capability during childbirth. Standard 2: The health information system enables use of data to ensure early, appropriate action Standard 7: For every woman and newborn, competent, motivated staff are 2.1: Every woman and newborn has a complete, accurate, consistently available to provide routine care and manage standardized medical record during labour childbirth and the early complications. postnatal period. 2.2: Every health facility has a mechanism for data collection, 7.1 Every woman and child has access at all times to at least one analysis and feedback as part of its activities for monitoring and skilled birth attendant and support staff for routine care and improving performance around the time of childbirth to improve the management of complications. care of every woman and newborn. 7.2: The skilled birth attendants and support staff have appropriate competence and skills mix to meet the requirements of labour, childbirth and the early postnatal period. Standard 3: 7.3: Every health facility has managerial and clinical leadership that Every woman and newborn with condition(s) that cannot be is collectively responsible for developing and implementing dealt with effectively with the available resources is appropriate policies and fosters an environment that supports appropriately referred. facility staff in continuous quality improvement. 3.1: Every woman and newborn is appropriately assessed on admission, during labour and in the early postnatal period to determine whether referral is required, and the decision to refer is made without delay. Standard 8: The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications. 8.1: Water, energy, sanitation, hand hygiene and waste disposal facilities are functional, reliable, safe and sufficient to meet the needs of staff, women and their families. 8.2: Areas for labor, childbirth and postnatal care are designed, organized and maintained so that every woman and newborn can be cared for according to their needs in private, to facilitate the continuity of care. 8.3: An adequate stock of medicines, supplies and equipment is available for routine care and management of complications  LESSON 1: FRAMEWORK FOR (7) Pediatric Nurse Practitioner (PNP): ➔ A nurse prepared with extensive skills in MATERNAL & CHILD HEALTH NURSING physical assessment, interviewing, and (PART 2) well-child counseling and care. NURSING THEORY Dorothea Orem: (8) Neonatal Nurse Practitioner: ➔ Concentrates on examining patients' ability to ➔ An advanced-practice role for nurses who are perform self- care. (Self-care Deficit Theory) skilled in the care of newborns, both well and ill. Sister Callista Roy: (9) Family Nurse Practitioner (FNP): ➔ Stresses that an important role of the nurse is to ➔ Is an advanced-practice role that provides help patients adapt to change caused by illness health care not only to women and children but or other stressors. (Adaptation Model Theory) also to the family as a whole. Patricia Benner: (10) Certified Nurse Midwife (CNM): ➔ Describes the way nurses move from novice to ➔ An individual educated in the two disciplines of expert as they become more experienced and nursing and midwifery and licensed. prepared to give interprofessional care. (Novice to Expert Theory) LEGAL CONSIDERATIONS OF MATERNAL-CHILD NURSING PRACTICE ADVANCED-PRACTICE ROLES FOR NURSES: "Unseen Client" (1) Clinical Nurse Specialists: ➔ Nurses prepared at the master's or doctorate ❖ Nurses are legally responsible for protecting the degree level. rights of their clients, including confidentiality, ➔ Capable of acting as consultants in their area of and are accountable for the quality of their expertise, as well as serving as role models, individual nursing care and that of other health researchers, and teachers of quality nursing care team members. care. ❖ Understanding the scope of practice and standards of care can help nurses practice (2) Neonatal Nurse Specialists: within appropriate legal parameters. ➔ Manage the care of infants at birth and in ❖ Documentation is essential for protecting a intensive care settings. nurse and justifying his or her actions. ❖ Nurses need to be conscientious about (3) Lactation Consultants: obtaining informed consent for invasive ➔ Educate women about breastfeeding and procedures and determining that pregnant support them while they learn how to do this. women are aware of any risk to the fetus associated with a procedure or test. (4) Case Manager: ❖ Be mindful of adolescents who support ➔ A graduate-level nurse who supervises a group themselves or who are pregnant are termed of patients from the time they enter a health care "emancipated minors" and have the right to setting until they are discharged from the setting. sign for their own health care. (5) Genetic Nurse Counselor: ETHICAL CONSIDERATIONS OF PRACTICE ➔ Consult with families about patterns of Conception issues, especially those related to inheritance and offer support to families with a in vitro fertilization, embryo transfer, ownership child who has inherited a genetic disorder of frozen oocytes or sperm, cloning, stem cell research, and surrogate mothers (6) Nurse Practitioner (NP): Abortion particularly partial-birth abortions ➔ Are nurses educated at the master's or Fetal rights versus rights of the mother doctoral level. Use of fetal tissue for research ➔ Recent advances in technology, research, and Resuscitation (for how long should it be knowledge have amplified the need for longer continued?) and more in-depth education for nurse Number of procedures or degree of pain that practitioners as they play pivotal roles in today's a child should be asked to endure to achieve health care system a degree of better health ➔ They perform physical exams, diagnose and treat diseases and other health conditions, and prescribe medication.  LESSON 1: FRAMEWORK FOR Ways To Reduce The Risk Of Sudden Infant Death Syndrome (SIDS) MATERNAL & CHILD HEALTH NURSING Avoid sleeping with your baby in the bed, couch, (PART 3) sofa, or armchair MEASURING MATERNAL AND CHILD Always place your baby on their back to sleep, HEALTH use a firm, flat mattress with a fitted sheet (1) Mortality : Keep the sleep area clear of soft objects like ➔ number of deaths that occur in a population pillows and blankets, Keep the room at a comfortable temperature (2) Rate: and never dress them in more layers than what ➔ number of things per some other number, an adult would wear at that temperature usually 100 or 1,000 or some other multiple of Don't rely on breathing monitors, make sure to 10 do regular check ups (3) Morbidity: (10) Infant Mortality Rate: ➔ state of being unhealthy for a particular disease ➔ The number of deaths per 1,000 live births or situation occurring at birth or in the first 12 months of life. ➔ how often a disease or illness occurs in a ◆ The infant mortality rate of a country is a specific population over a set period of time good index of its general health. (4) Birth Rate: (11) Childhood Mortality Rate: ➔ The number of births per 1,000 population ➔ The number of deaths per 1,000 population in children aged 1 to 14 years. (5) Fertility Rate: ➔ The number of pregnancies per 1,000 women of Major Causes of Death in Childhood childbearing age. UNDER 1 YEAR 1) Congenital malformations and chromosomal (6) Fetal Death Rate: abnormalities ➔ The number of fetal deaths (over 500 g) per 2) Disorders related to short gestation age and low 1,000 live births. birth weight 3) Maternal complications of pregnancy (7) Neonatal Death Rate: 4) Sudden infant death syndrome ➔ The number of deaths per 1,000 live births 5) Unintentional injuries (accidents) occurring at birth or in the first 28 days of life. ➔ This rate reflects not only the quality of care 1 TO 4 YEARS available to women during pregnancy and 1) Unintentional injuries (accidents) childbirth but also the quality of care 2) Congenital malformations and chromosomal available to infants during the first month of abnormalities life. 3) Homicide 4) Malignant neoplasms (8) Perinatal Death Rate: 5) Diseases of the heart ➔ The number of deaths during the perinatal time period 5 TO 9 YEARS ➔ (beginning when a fetus reaches 500 g, about 1) Unintentional injuries (accidents) week 20 of pregnancy, and ending about 4 to 6 2) Malignant neoplasms weeks after birth) 3) Congenital anomalies 4) Homicide (9) Maternal Mortality Rate: 5) Diseases of the heart ➔ The number of maternal deaths per 100,000 live births that occur as a direct result of the 10 ΤΟ 14 YEARS reproductive process. 1) Unintentional injuries (accidents) ◆ General improvements in the rates of 2) Suicide maternal mortality can be attributed to 3) Malignant neoplasms improved preconception, prenatal, labor 4) Congenital anomalies and birth, and postnatal care 5) Homicide ◆ Nurses who are alert to the signs and symptoms of hypertension are invaluable guardians of the health of pregnant women and newborns  WORLD HEALTH ORGANIZATION'S 17 Goal 6: CLEAN WATER AND SANITATION SUSTAINABLE DEVELOPMENT GOALS (SDG) Safe and affordable drinking water for all by 2030 requires we The two main overarching national health goals are: invest in adequate infrastructure, provide sanitation facilities, and ❖ To increase quality and years of healthy life. encourage hygiene. ❖ To eliminate health disparities. Protecting and restoring water-related ecosystems is essential. ★ 1979: U.S. Public Health Service first formulated Goal 7: AFFORDABLE AND CLEAN ENERGY healthcare objectives for the nation. Investing in solar, wind and thermal power, improving energy ★ 2010: US Department of Health and Human productivity, and ensuring energy for all is vital if we are to achieve SDG 7 by 2030. Services New Goals achieved for 2020 ★ 2020: New Goals achieved for 2023 Goal 8: DECENT WORK AND ECONOMIC GROWTH According to the International Labour Organization, more than 204 Healthcare goals are reviewed every 10 years million people were unemployed in 2015. Intended to help citizens more easily understand Encouraging entrepreneurship and job creation are key to this, as the importance of health promotion and disease are effective measures to eradicate forced labour, slavery and prevention and to encourage wide participation human trafficking. in improving health in the next decade. Many of these objectives directly involve Goal 9: INDUSTRY, INNOVATION AND INFRASTRUCTURE maternal and child health care because Investment in infrastructure and innovation are crucial drivers of improving the health of these age groups will economic growth and development. have long-term effects on the population. It's important for maternal and child health Goal 10: REDUCED INEQUALITIES nurses to be familiar with these goals because Income inequality requires global solutions. nurses play such a vital role in helping the nation This involves improving the regulation and monitoring of financial achieve these objectives through both practice markets and institutions. and research Facilitating the safe migration and mobility of people is also key to bridging the widening divide. Goal 1: NO POVERTY Goal 11: SUSTAINABLE CITIES AND COMMUNITIES This involves targeting the most vulnerable, increasing basic Making cities sustainable means creating career and business resources and services, and supporting communities affected by opportunities, safe and affordable housing, and building resilient conflict and climate-related disasters. societies and economies. It involves investment in public transport, creating green public Goal 2: ZERO HUNGER spaces, and improving urban planning and management in Making sure all people–especially children–have sufficient and participatory and inclusive ways. nutritious food all year. This involves promoting sustainable agricultural, supporting Goal 12: RESPONSIBLE CONSUMPTION AND PRODUCTION small-scale farmers and equal access to land, technology and The efficient management of our shared natural resources, and the markets. way we dispose of toxic waste and pollutants, are important targets to achieve this goal. Goal 3: GOOD HEALTH AND WELL-BEING Encouraging industries, businesses and consumers to recycle and We have made great progress against several leading causes of reduce waste is equally important. death and disease. Life expectancy has increased dramatically; infant and maternal Goal 13: CLIMATE ACTION mortality rates have declined, we’ve turned the tide on HIV and There is no country that is not experiencing the drastic effects of malaria deaths have halved. climate change. The goal aims to mobilize US$100 billion annually by 2020 to Goal 4: QUALITY EDUCATION address the needs of developing countries to both adapt to climate Ensures that all girls and boys complete free primary and change and invest in low-carbon development. secondary schooling by 2030. It also aims to provide equal access to affordable vocational Goal 14: LIFE BELOW WATER training, to eliminate gender and wealth disparities, and achieve Oceans also absorb about 30 percent of the carbon dioxide universal access to a quality higher education. produced by humans, and we are seeing a 26 percent rise in ocean acidification since the beginning of the industrial revolution. Goal 5: GENDER EQUALITY The aim is to sustainably manage and protect marine and coastal Ending all discrimination against women and girls is not only a ecosystems from pollution, as well as address the impacts of ocean basic human right, it’s crucial for a sustainable future; it’s proven acidification. that empowering women and girls helps economic growth and development. Goal 15: LIFE ON LAND Every year, 13 million hectares of forests are lost. While 15 percent of land is protected, biodiversity is still at risk. Urgent action must be taken to reduce the loss of natural habitats. Goal 16: PEACE, JUSTICE AND STRONG INSTITUTIONS The aim is to significantly reduce all forms of violence, and work with governments and communities to end conflict and insecurity. Promoting the rule of law and human rights are key to this process, as is reducing the flow of illicit arms and strengthening the participation of developing countries in the institutions of global governance. Goal 17: PARTNERSHIPS FOR THE GOALS Coordinating policies to help developing countries manage their debt, as well as promoting investment for the least developed, is vital for sustainable growth and development.  LESSON 2: REPRODUCTIVE AND 3) Bisexuality ➔ They achieve sexual satisfaction from both SEXUAL HEALTH homosexual and heterosexual relationships. (PART 1) ➔ Like men who have sex with men, bisexual SEXUALITY men may be at greater risk for HIV and STIs A multidimensional phenomenon that includes than are others. feelings, attitudes, and actions. ➔ Female partners of bisexual men need to be It has both biologic and cultural diversity aware that they are also at increased risk for components. HIV and other STIs. It encompasses and gives direction to a person's physical, emotional, social, and intellectual 4) Transsexual or transgender responses throughout life. ➔ Although of one biologic gender, feels as if he or Although the sexual experience is unique to she is of the opposite gender. each individual, sexual physiology (how the ➔ Such people may have sex change operations body responds to sexual arousal) has common so that they appear cosmetically as the gender features they feel that they are. 1) Biologic Gender: ➔ is the term used to denote a person's Types of Sexual Expression: chromosomal sex: male (XY) or female (XX). 1) Sexual abstinence (celibacy) ➔ is separation from sexual activity. 2) Gender identity or Sexual Identity: ➔ It is a vowed state of certain religious orders. ➔ is the inner sense a person has of being male or ➔ It is also a way of life for many adults. female, which may be the same as or different from biologic gender. 2) Masturbation ➔ is self-stimulation for erotic pleasure. 3) Gender Role: ➔ It can also be a mutually enjoyable activity ➔ is the male or female behavior a person exhibits, for sexual partners. which, again, may or may not be the same as ➔ It offers sexual release, which may be biologic gender or gender identity. interpreted by the person as overall tension or anxiety relief. SEXUAL ORIENTATION ➔ Women may find masturbation to orgasm the The direction of one's romantic and sexual most satisfying sexual expression and use it attraction-to either the opposite, the same, or more commonly than men. both sexes. 3) Erotic stimulation ➔ is the use of visual materials such as magazines Types of Sexual Orientation: or photographs for sexual arousal. Sexual gratification is experienced in several ➔ Although this is thought to be mostly a male ways. phenomenon, there is increasing interest in The act of providing sexual arousal or pleasure, centerfold photographs in magazines marketed or appealing to prurient interest. primarily to women. What is considered normal varies greatly among 4) Fetishism cultures. ➔ is sexual arousal resulting from the use of General components of accepted sexual activity certain objects or situations. are that it is an activity of adults and privacy, ➔ The object of stimulation does not just consent are included. enhance the experience; rather, it becomes a focus of arousal and a person may come to 1) Heterosexual require the object or situation for stimulation. ➔ is a person who finds sexual fulfillment with a 5) Transvestite member of the opposite gender. ➔ is an individual who dresses in the clothes of the opposite sex. 2) Homosexual ➔ Transvestites can be heterosexual, ➔ is a person who finds sexual fulfillment with a homosexual, or bisexual. member of his or her own sex. 6) Sadomasochism ➔ "Gay” refers to a homosexual man. ➔ involves inflicting pain (sadism) or receiving pain ➔ "Lesbian” refers to a homosexual woman. (masochism) to achieve sexual satisfaction. ➔ Many young adults are worried about the stigma ➔ It is a practice generally considered to be within of being labeled homosexual and therefore keep the limits of normal sexual expression as long as their identity secret from heterosexual the pain involved is minimal and the experience acquaintances. is satisfying to both sexual partners.  SEXUAL RESPONSE CYCLE MEN ★ muscle contractions surrounding the seminal Whether stages are vessels and prostate project semen into the felt as separate proximal urethra. steps or blended ★ these contractions are followed immediately by into one smooth 3-7 propulsive ejaculatory contractions, process of desire, occurring at the same time interval as in the arousal, and woman, which force semen from the penis. orgasm is individualized. (4) Resolution: ➔ a 30-minute period during which the external (1) Excitement: and internal genital organs return to an ➔ physical and psychological stimulation (i.e., unaroused state. sight, sound, emotion, or thought) WOMEN ➔ parasympathetic nerve stimulation ★ Do not go through this refractory period, so it is ➔ arterial dilation and venous constriction in the possible for women who are interested and genital area. properly stimulated to have additional ➔ increased blood supply leads to orgasms immediately after the first. vasocongestion and increasing muscular MEN tension. ★ a refractory period occurs during which further ➔ in both sexes, there is an increase in heart and orgasm is impossible. respiratory rates and blood pressure. DISORDERS OF SEXUAL FUNCTIONING WOMEN A) Inhibited Sexual Desire: ★ vasocongestion causes the clitoris to increase Lessened interest in sexual relations is normal in in size and mucoid fluid to appear on vaginal some circumstances, such as: walls as lubrication. ○ after the death of a family member ★ the vagina widens in diameter and increases in ○ a divorce length. ○ a stressful job change ★ the nipples become erect. Side effects of many medicines. MEN ○ Chronic diseases: ★ penile erection occurs, as well as scrotal peptic ulcers or chronic thickening and elevation of the testes. pulmonary disorders that causes frequent pain or (2) Plateau: discomfort may interfere with a ➔ reached just before orgasm man's or a woman's overall well- WOMEN being and interest in sexual ★ the clitoris is drawn forward and retracts under activity. the clitoral prepuce ○ During perimenopause. ★ the lower part of the vagina becomes extremely Administration of androgen congested (formation of the orgasmic platform), (testosterone) to women may be ★ there is increased nipple elevation. helpful at that time, because it MEN can improve interest in sexual ★ the vasocongestion leads to distention of the activity. penis. ★ heart rate increases to 100 to 175 beats per B) Failure to Achieve Orgasm: minute and respiratory rate to approximately 40 Result of: respirations per minute. ○ poor sexual technique ○ concentrating too hard on achievement (3) Orgasm: ○ negative attitudes toward sexual ➔ body suddenly discharges accumulated sexual relationships tension. Treatment is aimed at relieving the underlying ➔ A vigorous contraction of muscles in the pelvic cause. area expels or dissipates blood and fluid from It may include instruction and counseling for the the area of congestion. couple about sexual feelings and needs WOMEN ★ the average number of contractions for a woman is 8 to 15 contractions at intervals of C) Erectile Dysfunction: 1 every 0.8 seconds. formerly referred to as impotence Inability of a man to produce or maintain an erection long enough for vaginal penetration or partner satisfaction.  ○ CAUSES: the paramesonephric duct develops into female Aging reproductive organs Atherosclerosis Diabetes, which limit blood supply. side effect of certain Males Gonads - testes drugs. Female Gonads - ovaries DRUGS prescribed today for ED sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), which are taken up to once a day to stimulate penile erection. Pubertal Development: ★ Puberty D) Premature Ejaculation: is the stage of life at which secondary ejaculation before penile-vaginal contact. sex changes begin. ejaculation before the sexual partner's As puberty approaches (usually satisfaction has been achieved. between ages 10 and 14), the ○ REASONS: hypothalamus makes (GnRH) doubt about masculinity gonadotropin-releasing hormone, fear of impregnating a partner, which starts the changes toward sexual which prevent the man from maturity. sustaining an erection. ★ Gonadotropin-releasing hormone (GnRH) Sexual counseling for both partners to reduce is a hormone that causes the pituitary stress, as well as serotonergic antidepressants gland to produce and secrete such as Mirtazapine, may be helpful in follicle-stimulating hormone (FSH) alleviating the problem. and luteinizing hormone (LH). ★ Follicle-stimulating hormone (FSH) and E) Persistent Sexual Arousal Syndrome (PSAS): Luteinizing hormone (LH) excessive and unrelenting sexual arousal in the initiate the production of androgen and absence of desire. estrogen which in turn initiate secondary It may be triggered by medications or sex characteristics, the visible signs of psychological factors. maturity. Role of Androgen: F) Vaginismus: ★ Androgenic hormones is involuntary contraction of the muscles at the are the hormones responsible for outlet of the vagina when coitus is attempted muscular development, physical growth, that prohibits penile penetration. and the increase in sebaceous gland ○ Vaginismus may occur in women secretions that causes typical acne in who have been raped. both boys and girls. Other causes are unknown. In males, androgenic hormones are produced by the adrenal cortex and the REPRODUCTIVE DEVELOPMENT testes Intrauterine Development: In females, by the adrenal cortex and ➔ The sex of an individual is determined at the the ovaries moment of conception by the chromosome Role of Estrogen: information supplied by the particular ovum and when triggered at puberty by FSH, ovarian sperm that joined to create the new life. follicles in females begin to excrete a high level of the hormone estrogen.. Gonad: primary function of estrogens is development of ➔ is a body organ that produces the cells female secondary sexual characteristics necessary for reproduction (the ovary in This hormone is actually not one substance but females, the testis in males). three compounds ➔ At approximately WEEK 5 of intrauterine life, ○ estrone [E1] primitive gonadal tissue is already formed. ○ estradiol [E2] WEEK 7 or 8: in chromosomal males, this early ○ estriol [E3] gonadal tissue differentiates into primitive testes and begins formation of testosterone, Under the influence of testosterone, the mesonephric duct begins to develop into the male reproductive organs, and the paramesonephric duct regresses WEEK 10: If testosterone is not present, the gonadal tissue differentiates into ovaries, and  SECONDARY SEX CHARACTERISTICS In Girls: ❖ pubertal changes typically are manifest as: ★ Growth spurt ★ Increase in the transverse diameter of the pelvis ★ Breast development ★ Growth of pubic hair ★ Onset of menstruation ★ Growth of axillary hair ★ Vaginal secretions In Boys: ❖ usually occur in the order of: ★ Increase in weight ★ Growth of testes ★ Growth of face, axillary, and pubic hair ★ Voice changes ★ Penile growth ★ Increase in height ★ Spermatogenesis (production of sperm)  LESSON 2: REPRODUCTIVE AND ➔ Because of this, testes tend to slide past each other more readily on sitting or muscular activity, SEXUAL HEALTH and there is less possibility of trauma to them. (PART 2) ➔ its main function is the production of sperm or MALE REPRODUCTIVE SYSTEM spermatozoa ★ Spermatozoa do not survive at a temperature as high as that of the internal body, so the location of the testes outside the body, where the temperature is about 1°F lower than body temperature, provides protection for sperm survival ➔ Normal testes feel firm and smooth and are egg shaped. ➔ Beginning in early adolescence, boys need to learn testicular self-examination so they can detect tenderness or any abnormal growth in testes (3) Penis Male External Structures: ➔ Composed of three cylindrical masses of (1) Scrotum erectile tissue in the penis shaft: two termed ➔ A rugated, skin covered, muscular pouch the corpus cavernosa, and a third termed the suspended from the perineum. corpus spongiosum. ➔ Its functions are to support the testes and to ➔ Serve as both the outlet for the urinary and help regulate the temperature of sperm. reproductive tracts in men. ➔ At the distal end of the organ is a bulging, ★ In very cold weather, the scrotal muscle sensitive ridge of tissue, the glans. contracts to bring the testes closer to the body ➔ A retractable casing of skin, the prepuce, ★ In very hot weather, or in the presence of protects the nerve-sensitive glans at birth. fever, the muscle relaxes, allowing the testes to ★ With sexual excitement, nitric oxide is released fall away from the body from the endothelium of blood vessels. ★ This causes dilation and an increase in blood flow to the arteries of the penis (engorgement). ★ The ischiocavernosus muscle at the base of the penis, under stimulation of the parasympathetic nervous system, then contracts, trapping both venous and arterial blood in the three sections of erectile tissue. ★ This leads to distention (and erection) of the penis. A circumcised and an uncircumcised penis. (2) The Testes ➔ The testes are two ovoid glands, 2 to 3 cm Male Internal Structures: wide, that rest in the scrotum. (1) Epididymis ➔ Each testis is encased by a protective white ➔ Responsible for conducting sperm from the fibrous capsule and is composed of a number of tubule to the vas deferens, the next step in the lobules, with each lobule containing interstitial passage to the outside. cells (Leydig’s cells) and a seminiferous ➔ Because each epididymis is so tightly coiled, tubule. its length is extremely deceptive ◆ Seminiferous tubules produce ➔ it is actually over 20 ft long. spermatozoa. ➔ Sperm are immobile and incapable of ◆ Leydig’s cells are responsible for the fertilization as they pass through or are stored at production of testosterone. the epididymis level. ➔ In most males, one testis is slightly larger than ◆ aspermia (absence of sperm) the other and is suspended slightly lower in the ◆ oligospermia (20 million sperm/mL) scrotum than the other (usually the left one). ★ 12 to 20 days sperm travels ★ 65 to 75 days to reach full maturity (2) The Vas Deferens (Ductus Deferens) (7) The Urethra ➔ It carries sperm from the epididymis through the ➔ A hollow tube leading from the base of the inguinal canal into the abdominal cavity, where it bladder, which, after passing through the ends at the seminal vesicles and the ejaculatory prostate gland, continues to the outside through ducts below the bladder. the shaft and glans of the penis. ➔ Sperm complete maturation as they pass ➔ It is about 8 in. (18 to 20 cm) long through the vas deferens. FEMALE REPRODUCTIVE SYSTEM (3) The Seminal Vesicles ➔ 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 Female External Structure: favorable pH environment. (1) Mons Veneris ➔ A pad of adipose tissue located over the (4) Ejaculatory Ducts symphysis pubis, the pubic bone joint. ➔ The two ejaculatory ducts pass through the ➔ Covered by a triangle of coarse, curly hairs prostate gland and join the seminal vesicles to ➔ PURPOSE: protect the junction of the pubic the urethra. bone from trauma. (5) The Prostate Gland (2) Labia Minora ➔ The prostate is a chestnut-sized gland that lies ➔ Two hairless folds of connective tissue just below the bladder and allows the urethra to ★ Before menarche, these folds are fairly thin pass through the center of it, like the hole in a ★ By childbearing age, they have become firm doughnut. and full ★ PURPOSE is to secrete a thin, alkaline fluid, ★ After menopause, they atrophy and again which, when added to the secretion from the become much smaller seminal vesicles, further protects sperm by ➔ Normally, the folds of the labia minora are pink increasing the naturally low pH level of the in color urethra. ➔ the internal surface is covered with mucous membrane ➔ the external surface is covered with skin. (3) Labia Majora ➔ two folds of tissue, positioned lateral to the labia minora and composed of loose connective tissue covered by epithelium and pubic hair. ➔ It serves as protection for the external genitalia; they shield the outlets to the urethra and vagina. (4) Vestibule ➔ is the flattened, smooth surface inside the labia. ➔ the openings to the bladder (the urethra) and the uterus (the vagina) both arise from the (6) The Bulbourethral Glands vestibule ➔ Two bulbourethral, or Cowper's, glands lie beside the prostate gland and empty by short (5) Clitoris ducts into the urethra ➔ is a small (approximately 1 to 2 cm), rounded ➔ They supply one more source of alkaline fluid to organ of erectile tissue at the forward junction of help ensure the safe passage of spermatozoa. the labia minora. ★ Semen ➔ it's covered by a fold of skin, the prepuce ○ prostate gland (60%), ➔ is sensitive to touch and temperature ○ the seminal vesicles (30%), ➔ is the center of sexual arousal and orgasm in a ○ the epididymis (5%), woman ○ the bulbourethral glands (5%). In nations which allow it, young girls approaching puberty may be circumcised or have their clitoris removed with the labia minora excised as well.  Aside from being a very painful procedure, ➔ ADVANTAGE is that it contributes to the rapid female circumcision can lead to contractions and healing of any tears in the area after childbirth or scarring of the vulva that make vaginal childbirth other injury difficult because the vagina is unable to expand with birth b) Vulvar Nerve Supply ➔ rich nerve supply makes the area extremely sensitive to touch, pressure, pain, and temperature. ➔ Luckily, at the time of birth, normal stretching of the perineum causes a temporary loss of sensation to the area, limiting the amount of local pain felt during childbirth. Female Internal Structure: (1) Ovaries ➔ The ovaries are approximately 4 cm long by 2 cm in diameter and approximately 1.5 cm thick, or the size and shape of almonds. ➔ They are grayish white and appear pitted, or (6) 2 Skene glands (paraurethral glands) with minute indentations on the surface. ➔ are located on each side of the urinary meatus ➔ Function of the two ovaries is to produce, ➔ their ducts open into the urethra. mature, and discharge ova (the egg cells). ➔ In the process of producing ova, the ovaries (7) 2 Bartholin glands (vulvovaginal glands) also produce estrogen and progesterone and ➔ are located on each side of the vaginal opening initiate and regulate menstrual cycles ➔ their ducts that open into the proximal vagina near the labia minora and hymen. ➔ At birth, each ovary contains approximately 2 million immature ova (oocytes), which were Secretions from both of these glands help to formed during the first 5 months of intrauterine lubricate the external genitalia during coitus. life. The alkaline pH of their secretions helps to ➔ By age 7 years, only approximately 500,000 are improve sperm survival in the vagina. present in each ovary; ➔ By 22 years, there are approximately 300,000; (8) Fourchette and by menopause, none are left (all have either ➔ is the ridge of tissue formed by the posterior matured or atrophied). joining of the labia minora and the labia majora. ➔ This is the structure that sometimes tears THREE PRINCIPAL DIVISIONS OF OVARIES (laceration) or is cut (episiotomy) during 1. Protective layer of surface epithelium childbirth to enlarge the vaginal opening. 2. Cortex, where the immature (primordial) oocytes mature into ova and large amounts of (9) Hymen estrogen and progesterone are produced ➔ a tough but elastic semicircle of tissue that 3. Central medulla, which contains the nerves, covers the opening to the vagina during blood vessels, lymphatic tissue, and some childhood. smooth muscle tissue ➔ It is often torn during the time of first sexual intercourse. (2) Fallopian Tubes ➔ However, because of the use of tampons and ➔ approximately 10 cm long in a mature woman active sports participation, many girls who have ➔ This open pathway is what makes conception not had sexual relations can also have torn possible. hymens at the time of their first pelvic ➔ Their function is to convey the ovum from the examination. ovaries to the uterus and to provide a place for ★ Occasionally, a girl has an imperforate hymen, fertilization of the ovum by sperm. or a hymen so complete that it does not allow ➔ It also, however, can lead to infection of the for the passage of menstrual blood from the peritoneum (peritonitis) if germs spread from vagina (hematocolpometra) or for sexual the perineum through the uterus and tubes to relations until it is surgically incised the pelvic cavity. ➔ Clean technique must be used during pelvic a) Vulvar Blood Supply examinations. ➔ DISADVANTAGE of this rich blood supply is that ➔ During labor and birth, vaginal examinations are trauma to the area, such as occurs from done with sterile technique to ensure no pressure during childbirth or a bicycle seat injury, organisms can enter by this route. can cause large hematomas. PRINCIPAL DIVISIONS OF FALLOPIAN TUBES THREE DIVISIONS OF THE UTERUS 1. Interstitial portion (most proximal division) During pregnancy, the body of the uterus is the Lies within the uterine wall. portion of the structure that expands to contain Only about 1 cm in length. the growing fetus. Lumen of the tube is only 1 mm in 1. Fundus. diameter. between the points of attachment of the fallopian tubes 2. Isthmus (next distal portion) Approximately 2 cm in length. 2. Isthmus Extremely narrow. short segment between the body and the cervix. This portion is cut or sealed in a tubal most commonly cut when a fetus is born by a ligation or tubal sterilization procedure. cesarean birth. Nonpregnant uterus: 1 to 2 mm in length. 3. Ampulla (third and longest portion) Approximately 5 cm in length. 3. Cervix Fertilization of an ovum usually occurs lowest portion of the uterus. here. one third of the total uterus size and is approximately 2 to 5 cm long. 4. Infundibular portion (most distal segment) ○ internal cervical os - opening of the Approximately 2 cm long. canal at the junction of the cervix and Funnel-shaped. isthmus The rim is covered by fimbria (small ○ external cervical os - the distal opening hairs) that help guide the ovum into the to the vagina is the fallopian tube. (3) The Uterus ➔ With maturity, a uterus is about 5 to 7 cm long, 5 cm wide, and, in its widest upper part, 2.5 cm deep. ★ In a nonpregnant state, it weighs approximately 60 g. ➔ FUNCTION: ◆ receive the ovum from the fallopian tube ◆ provide a place for implantation and nourishment ◆ furnish protection to a growing fetus ◆ at maturity of the fetus, expel it from a LAYERS OF THE UTERUS woman's body 1. Perimetrium - a part of visceral peritoneum ★ After a pregnancy, the uterus never returns to 2. Myometrium - bulk of uterus - three layers of exactly its nonpregnant size but remains muscle that contract under influence of oxytocin approximately 9 cm long, 6 cm wide, 3 cm during labor. thick, and 80 g in weight. 3. Endometrium - highly vascular mucosa a. Stratum functionalis - shed during menstruation b. Stratum basalis - deeper, permanent layer, gives rise to new stratum functionalis UTERINE DEVIATIONS ➔ The same rich blood supply, however, is also ➔ A number of uterine deviations (i.e., shape and the reason any vaginal trauma at birth heals position) can interfere with fertility or pregnancy rapidly. and so are helpful to recognize (5) Breasts ➔ The mammary glands, or breasts, form early in intrauterine life. ➔ They then remain in a halted stage of development until a rise in estrogen at puberty causes them to increase in size ★ The glandular tissue of the breasts, necessary for successful breastfeeding, remains undeveloped until a first pregnancy begins. ★ Milk glands of the breasts are divided by connective tissue partitions into approximately (A) normal uterus. 20 lobes. (B) bicornuate uterus. ➔ All of the glands in each lobe produce milk by (C) septum-dividing uterus. acinar cells and deliver it to the nipple via a (D) double uterus. lactiferous duct. ➔ Abnormal shapes of uterus allow less placenta ★ The nipple has approximately 20 small implantation space. openings through which milk is secreted. ➔ Ordinarily, the body of the uterus tips slightly ★ An ampulla portion of the duct, located just forward. posterior to the nipple, serves as a reservoir for milk before breastfeeding. POSITIONAL DEVIATIONS (A) Nonpregnant (B) Pregnant (C) During lactation (A) Anteversion: The entire uterus tips far forward. (B) Anteflexion: The body of the uterus is bent sharply forward at the junction with the cervix. (C) Retroversion: The entire uterus tips far back. (D) Retroflexion: The body of the uterus is bent sharply back just above the cervix. (4) Vagina ➔ FUNCTION: act as the organ of intercourse and to convey sperm to the cervix. ★ With childbirth, it expands to serve as the birth canal. ➔ The folds make the vagina very elastic and able to expand so much that at the end of pregnancy, a full-term baby can pass through without tearing. ★ Vaginal tears at childbirth tend to bleed profusely because of this rich blood supply.  LESSON 2: REPRODUCTIVE AND MENSTRUATION OVARIES SEXUAL HEALTH FSH and LH (gonadotropic hormones) - stimulates growth in the gonads (ovaries) (PART 3) ★ Every month = fertile period MENSTRUATION ★ 1 oocyte activated by FSH = grow and mature ➔ A menstrual cycle (the female reproductive ★ Produce clear fluid (follicular fluid) = cycle) is episodic uterine bleeding in response to increased estrogen and progesterone cyclic hormonal changes. Follicle moves to the surface of the ovary ➔ PURPOSE: Bring an ovum to maturity and Fully matured follicle seen as clear water blister renew a uterine tissue bed that will be necessary - GRAAFIAN FOLLICLE - surrounds the small for the ova's growth should it be fertilized ovum ★ Day 14 - midpoint of 28 day menstrual cycle CHARACTERISTICS OF NORMAL Ovum undergoes Mitotic and meiotic division MENSTRUAL CYCLES Increased LH from pituitary gland - prostaglandins released BEGINNING Average age at onset, 12.4 years; (MENARCH) Average range, 9-17 years Graafian follicle ruptures ★ OVULATION - ovum is set free from the surface INTERVAL Average, 28 days; of ovary; then swept into the open end of BETWEEN CYCLES Cycles of 23-35 days not unusual fallopian tube ○ 14 days before end of cycle DURATION OF Average flow, 4-6 days; ★ Ovum + follicular fluid = discharged to ovary MENSTRUAL FLOW Ranges of 2-9 days not abnormal FSH decreases in amount AMOUNT OF Difficult to estimate; average 30-80 ml per ★ LH increases = directs follicle cells to produce MENSTRUAL FLOW menstrual period; saturating a pad or lutein = CORPUS LUTEUM (yellow body) tampon in less than 1 hr is heavy bleeding ❖ MENSTRUAL CYCLE COLOR OF Dark red; a combination of blood, mucus, 44 days — 14 days = 30 MENSTRUAL FLOW and endometrial cells menstrual flow 30 th day of MC — start of ovulation ODOR Similar to marigolds 20 days — 14 days = 6 6th day of MC — start of ovulation PHYSIOLOGY OF MENSTRUATION ❖ FERTILIZATION - fertilized by the spermatozoa Hypothalamus: ❖ CONCEPTION - implants on the endometrium of stimulates anterior pituitary gland to begin uterus production of gonadotropic hormones. ○ Corpus luteum remains until 16-20 ★ GnRH is transmitted from the hypothalamus to weeks of pregnancy the anterior pituitary gland and signals the gland ❖ NO CONCEPTION - unfertilized ovum atrophies to begin producing the gonadotropic hormones after 4-5 days FSH and LH. ○ Corpus luteum remains for 8-10 days The release of GnRH initiates the menstrual then replaced by white fibrous tissue cycle. PHASES OF THE MENSTRUAL CYCLE Pituitary Gland: 1. Menstrual Phase under the influence of LHRH, the anterior This is the first phase, beginning on the first day pituitary gland produces 2 hormones that act on of menstruation (bleeding). the ovaries to further influence menstruation. The shedding of the uterine lining ★ FSH, a hormone that is active early in the cycle (endometrium) occurs due to a drop in and is responsible for maturation of the ovum. estrogen and progesterone levels. ★ LH, a hormone that becomes most active at the Typically lasts 3-7 days. midpoint of the cycle and is responsible for: ○ ovulation, or release of the mature egg 2. Follicular Phase cell from the ovary Starts on the first day of menstruation and ○ growth of the uterine lining during the continues until ovulation. second half of the menstrual cycle The pituitary gland releases Ovaries: follicle-stimulating hormone (FSH), one ovum matures in one or the other ovary & is stimulating the growth of follicles in the ovaries. discharge from it each month. One dominant follicle matures, and estrogen levels rise, thickening the uterine lining in Uterus: preparation for potential pregnancy. stimulation from the hormones produced by the ovaries causes specific monthly effects on the uterus  3. Ovulation Phase The Third Phase of the Menstrual Cycle: Usually occurs around day 14 of a typical 28-day NO FERTILIZATION corpus luteum in the ovary cycle. begins to regress after 8 to 10 days, production A surge in luteinizing hormone (LH) causes of progesterone decreases. the mature egg to be released from the ovary With the withdrawal of progesterone, the into the fallopian tube. endometrium of the uterus begins to degenerate This is the most fertile period in the cycle. (at about day 24 or day 25 of the cycle). The capillaries rupture, with minute 4. Luteal Phase hemorrhages, and the endometrium sloughs off. After ovulation, the ruptured follicle transforms into the corpus luteum, which ★ Ischemic secretes progesterone. Progesterone maintains the thickened uterine The Fourth Phase of the Menstrual Cycle: lining in case of pregnancy. Menses, or a menstrual flow, is composed of a If the egg is not fertilized, the corpus luteum mixture of: breaks down, causing progesterone levels to blood from the ruptured capillaries drop, leading to the start of menstruation. mucin fragments of endometrial tissue microscopic, atrophied unfertilized ovum. ★ Menses ❖ The first day of menstrual flow is used to mark the beginning day of a new menstrual cycle. ❖ Contains only 30 to 80 ml of blood if it seems to be more, it is because of the accompanying mucus and endometrial shreds. ❖ 11 mg - The iron loss in a typical menstrual flow The First Phase of the Menstrual Cycle: Immediately after a menstrual flow (which HOW MUCH IRON DO WE NEED? occurs during the first 4 or 5 days of a cycle), QUANTITIES PER DAY Endometrium = very thin, approximately one cell layer in depth. as the ovary begins to produce estrogen thickness of the endometrium increases eightfold from day 5 to day 14 ★ Proliferative ★ Estrogenic ★ Follicular ★ Postmenstrual phase The Second Phase of the Menstrual Cycle: After ovulation, the formation of progesterone ➔ Despite the variability of a woman's cycle (23-35 in the corpus luteum (under the direction of days), ovulation occurs exactly 2 weeks LH) causes the glands of the uterine before the next menstruation. endometrium to become corkscrew or twisted ➔ The first 14 days of the cycle is variable. in appearance and dilated with quantities of ➔ Thus, ovulation occurs NOT on the 14th day of glycogen (an elementary sugar) and mucin (a the cycle but 14 days prior to the first day of protein). the next menstrual cycle unless a pregnancy It takes on the appearance of rich, spongy occurs. velvet. MENSTRUAL CYCLE ★ Progestational ★ First day of the cycle = the first day of ★ Luteal menstruation ★ Premenstrual ★ One menstrual cycle = from the first day of the ★ Secretory phase menstrual period till the first day of the next cycle. Amenorrhea: ★ thick and scant — cervical mucus at the ➔ markedly diminished menstrual flow beginning of each cycle, when estrogen secretion from the ovary is low. Menorrhagia: ○ Sperm survival is poor. ➔ excessive bleeding during regular menstruation. ★ thin, stretchy (spinnbarkeit), and copious — cervical mucus at the time of ovulation, when the Polymenorrhea: estrogen level has risen to a high point. ➔ frequent menstruation occurring at intervals of ○ Sperm penetration and survival both less than 3 weeks. excellent ★ Second half of the cycle — progesterone Dysmenorrhea: becomes the major influencing hormone ➔ is the medical term for pain with menstruation. ○ cervical mucus again thickens and sperm survival is again poor. OVARIAN CYCLE ❖ The Follicular Phase: SPINNBARKEIT TEST Days 1 through 13 the property of cervical mucus to stretch a In response to follicle stimulating distance before breaking. hormone (FSH) released from the A woman can do this herself by stretching a mucus pituitary gland in the brain, ultimately sample between thumb and finger, or it can be tested in one egg matures. an examining room by smearing a cervical mucus ❖ Ovulation: specimen on a slide and stretching the mucus between Day 14 the slide and cover slip At about day 14, in response to a surge Sperm penetration and survival in this thin of luteinizing hormone, the egg is mucus are both excellent. released from the ovary. The egg travels through the fallopian FERN TEST tube toward the uterus Arborization or Ferning ❖ Luteal Phase: Cervical mucus just before ovulation when Days 14 through 28 estrogen levels are high is the ability to form The remains of the follicle become the fernlike patterns on a microscope slide when corpus luteum which releases allowed to dry. progesterone Can be examined at midcycle When progesterone is the dominant UTERINE CYCLE hormone, as it is just after ovulation, this fern ❖ Proliferative Phase: pattern is no longer discernible. Days 5 -14 The uterine lining increases rapidly in SUMMARY OF HORMONAL CHANGES thickness, and the uterine glands ↑ ESTROGEN ↑ PROGESTERONE proliferate and grow. ❖ Secretory Phase: Endometrium Second half of the Days 14 through 28 thickens menstrual cycle When an egg is not fertilized, the Corkscrew Just after ovulation corpus luteum gradually disappears, endometrium Cervical mucus Just before ovulation thickens estrogen and progesterone levels drop, / midcycle Ferning is NOT and the thickened uterine lining is shed. Cervical mucus is thin discernable This is menses (your period). and stretchy Ferning is evident SIGNS & SYMPTOMS OF OVULATION ★ Mittelschmerz – abdominal tenderness on Effects of Estrogen to the body: left/right iliac regions, brought about by - Inhibits production of FHS. peritoneal irritation due to blood coming out from - Causes hypertrophy and hyperplasia of the graafian follicle. myometrium ★ Spinnbarkeit – vaginal secretion is clear - Stimulates the growth of ductile structures of the andtransparent breast - Increases quantity and pH of cervical mucus CERVICAL CHANGES causing it to become watery and can be to a The mucus of the uterine cervix also changes distance of 10-13 cm. (Spinnbarkeit test of in structure and consistency each month during dilation). a menstrual cycle. Effects of progesterone in the body: A combination of peristaltic action of the - Inhibits production of LH. tube and movements of the tube cilia help - Facilitates transport of fertilized ovum through propel the ovum along the length of the tube. the fallopian tubes. - Causes fluid retention At the time of ovulation, there is a reduction in - Decreased hemoglobin and hematocrit levels the viscosity (thickness) of the cervical mucus, - Increased basal body temperature after which makes it easy for spermatozoa to ovulation because of the presence of penetrate it. progesterone. ★ Sperm Transport FERTILIZATION ○ is so efficient close to ovulation that ➔ the beginning of pregnancy spermatozoa deposited in the vagina ➔ Fertilization (also referred to as conception generally reach the cervix within 90 and impregnation) is the union of an ovum and seconds and the outer end of a fallopian a spermatozoon. tube within 5 minutes after deposition. ➔ this usually occurs in the outer third of a fallopian tube, the ampullar portion ★ Spermatozoa ○ move through the cervix and the body of Usually only one of a woman's ova will reach the uterus and into the fallopian tubes, maturity each month. toward the waiting ovum by the Once the mature ovum is released, fertilization combination of movement by their must occur fairly quickly because an ovum is flagella (tails) and uterine contractions. capable of fertilization for only 24 hours (48 ○ An ejaculation of semen averages 2.5 hours at the most). ml of fluid containing 50 to 200 Because the functional life of a spermatozoon million spermatozoa per milliliter or is also about 48 hours, possibly as long as 72 an average of 400 million sperm per hours, the total critical time span during ejaculation which sexual relations must occur for fertilization to be successful is about 72 hours ★ Capacitation (48 hours before ovulation plus 24 hours ○ is a final process that sperm must afterward). undergo to be ready for fertilization. After that time, it atrophies and becomes ○ sperm move toward the ovum, consists nonfunctional. of changes in the plasma membrane of the sperm head, which reveal the sperm-binding receptor sites. ★ Hyaluronidase (A Proteolytic Enzyme) ○ is released by the spermatozoa and dissolves the layer of cells protecting the ovum. Under ordinary circumstances, only one spermatozoon is able to penetrate the cell membrane of the ovum. Once it penetrates the cell, the cell membrane changes composition to become impervious to other spermatozoa. Immediately after penetration of the ovum, the As the ovum is extruded from the graafian chromosomal material of the ovum and follicle of an ovary with ovulation, it is spermatozoon fuse to form a zygote. surrounded by a ring of mucopolysaccharide Because the spermatozoon and ovum each fluid (the zona pellucida) and a circle of cells carried 23 chromosomes (22 autosomes and (the corona radiata). 1 sex chromosome), the fertilized ovum has 46 PURPOSE: increase the bulk of the ovum and chromosomes. serve as protective buffers against injury The ovum is propelled into a nearby fallopian tube by currents initiated by the fimbriae fine, hairlike structures that line the openings of the fallopian tubes. ❖ If an X-carrying spermatozoon entered the Implantation is an important step in pregnancy ovum because as many as 50% of zygotes never the resulting child will have two X achieve it. chromosomes and will be female (XX). In these instances, the pregnancy ends as early ❖ If a Y-carrying spermatozoon fertilized the as & to 10 days after conception, often before a ovum woman is even aware she was pregnant. the resulting child will have an X and a Y Occasionally, a small amount of vaginal spotting chromosome and will be male (XY). appears on the day of implantation because ❖ Next 3 to 4 days capillaries are ruptured by the implanting zygote migrates over the toward the trophoblast cells. body of the uterus, A woman who normally has a particularly scant aided by the currents initiated by the menstrual flow could mistake implantation bleeding for muscular contractions of the fallopian her menstrual period. tubes. IMPLANTATION BLEEDING or YOUR PERIOD During this time, mitotic cell division, or Implantation Bleeding Your Period cleavage, begins. Color Pinkish/brown Red IMPLANTATION ➔ The first cleavage occurs at about 24 hours; Consistency Thin, watery Thick with occasional ➔ cleavage divisions continue to occur at a rate clots of about one every 22 hours. Flow Light spotting or Heavy and more ➔ By the time the zygote reaches the body of the discharge consistent uterus, it consists of 16 to 50 cells. Cramping Minor or nonexistent Minor or nonexistent ★ Blastocyst ○ large cells tend to collect at the Duration 1-2 days 5-7 days periphery of the ball, leaving a fluid space surrounding an inner cell mass. ★ Trophoblast ○ cells in the outer ring are cells. ○ they are the part of the structure that will later form the placenta and membranes. ★ Embryoblast ○ the inner cell mass is the portion of the structure that will form the embryo Implantation usually occurs high in the uterus on the posterior surface. If the point of implantation is low in the uterus, the growing placenta may occlude the cervix and make birth of the child difficult (placenta previa) because the placenta can block the birth canal. Almost immediately, the blastocyst burrows deeply into the endometrium and establishes an effective communication network with the blood system of the endometrium. Once implanted, the zygote is called an embryo.  LESSON 2: Assessment Family genograms for the incidence of REPRODUCTIVE AND SEXUAL HEALTH inherited disorders, a number of common (PART 4) findings are usually discovered when a HUMAN GENETICS dominantly inherited pattern is present in the Genetics: family ➔ is the study of the ways such disorders occur. Genetic Disorders: Vertical Transmission Picture: ➔ are disorders resulting from a defect in the One of the parents have the disorder and structure or number of genes or chromosomes passes on one of the child The sex of the affected individual is unimportant NATURE OF INHERITANCE in terms of inheritance Genes: There is usually a history of the disorder in other ➔ are the basic units of hereditary that determine family member