Reproduction & Sexuality Past Paper PDF

**[Table of contents]** [1 Puberty 3](#puberty) [2 Sexuality and gender identity 8](#sexuality-and-gender-identity) [3 Male and female reproductive organs 15](#male-and-female-reproductive-organs) [4 Contraceptives and STI\'s 28](#contraceptives-and-stis) [5 Pregnancy and childbirth 36](#pregna...

**[Table of contents]** [1 Puberty 3](#puberty) [2 Sexuality and gender identity 8](#sexuality-and-gender-identity) [3 Male and female reproductive organs 15](#male-and-female-reproductive-organs) [4 Contraceptives and STI\'s 28](#contraceptives-and-stis) [5 Pregnancy and childbirth 36](#pregnancy-and-childbirth) [6 Appendices 45](#appendices) **\ ** **Important instructions** This booklet contains the assignments associated with the topic: Reproduction and sexuality. You can prove that you have done the assignments in the following way: - Do the exercises in your exercise book (unless instructed otherwise!). Write the number of each exercise in the margin and leave a line after each question. - **Bold**-marked words are **key terms.** - You will be given two marks for this theme: - Knowledge test on the subject of Reproduction & Sexuality - Practical test on the subject of Genetics - Remember: - The work in your exercise book should be neat and legible! - Leave a line between each question. - Write the numbers of the exercises neatly in the margin. - Do all the exercises, questions for each lesson. Correct them where necessary! **Good luck and have fun!** 1 Puberty ========= **Learning goals:** **At the end of this chapter I am able to\...** 1. **\... list and recognise primary and secondary sex characteristics.** 2. **\... describe the physical, mental and social changes that occur during puberty.** **Life phases** Throughout your life, you go through different stages. For the first year and a half of your life, you are a **baby** Babies grow very fast. Such a period of rapid growth is called a **growth spurt**. After this stage of life, you will become a **toddler**. Toddlers learn to talk, walk and build with blocks. After the 4th year, a child is called a **pre-schooler**. Pre-schoolers learn to play games, ride bikes and play with other children. From the 6th year, a child is called a **schoolchild**. During this period, you learn to write and do arithmetic. From about the age of 12 to 16, you are a **teenager** or adolescent. A lot of physical development takes place during **puberty**. For instance, girls develop breasts and boys grow beards. You will also develop a lot mentally. Feelings change and your mood can also change quickly. Many people start thinking about themselves, interact differently with friends and family and fall in love for the first time. After puberty, you become a **young adult**. You learn to be independent and may start living on your own. Most **adults** are completely independent. Many of them work and have children. After the age of 65, a person is an **elderly** or **senior citizen.** These people often suffer from physical problems and sometimes need help. During all these stages of life, you can develop in different ways**. Physical developments** cause the body to change; for example, when you get pubic hair at puberty. With **mental development** changes your thoughts and feelings, for example when you learn to do maths as a schoolchild or you react to emotions differently. **Social development** changes your contact with other people, for instance when you learn to talk as a toddler, or when you want to belong to a different group of friends as an adolescent. Finally, in **motor development**, your motor skills change. This is your way of moving. For example, when a toddler learns to hold a pen or when you learn a handstand in gymnastics. 1.  Make a timeline with all the life stages. Use: *Baby, toddler, pre-schooler, schoolchild, teenager, adolescent, adult, senior citizen*. Name a characteristic for each phase. Also indicate the approximate age of the person. If you don\'t know how to make a timeline, look it up on the internet. 2. Copy the table in your notebook, and fill it in. Use the following terms to match the descriptions. You may use them more than once: *infant, toddler, pre-schooler, schoolchild, teenager, adolescent, adult, senior citizen**.*** **Description** **Life stage** ------------------------------------------------------------------------------------- ---------------- 0 - 1.5 years 1.5 - 4 years 4 -- 6 years 6 -- 12 years 12-16 years 16 -- 21 years 21 -- 65 years 65 years and older In this life phase a huge growth spurt is taking place In this life phase a person learns to be totally independent In this life phase the reproductive organs mature Important period for mental development; including writing, reading and mathematics In this life phase your feelings change and develop During this stage, gross motor development such as walking and standing takes place In this phase, major changes in social development such as talking take place **Primary and secondary sex characteristics** In a baby/infant that has just been born, you can usually quickly tell whether it is a boy or a girl. We call this the **sex**. The features by which you recognise this are called **primary sexual characteristics** (see Figure 1). In a boy, these are the **penis** and the **scrotum**. In a girl, the **vulva** (labia, opening of the vagina and clitoris). In the Netherlands, on average once a week a baby is born with both female and male sex characteristics. We call this **intersex**. In puberty (around the age of 12), many **physical changes** occur. These are changes to the body. Because these are not already present at birth but occur throughout your life, we call them **secondary sexual characteristics**. For example, men and women both get **pubic hair**. In addition, women usually get rounder body shapes and breasts. Men, on the other hand, get a more muscular physique, beard growth, chest hair and lower voice. 3. What is the meaning of the word "Sex characteristics"? 4. What is the difference between primary and secondary sex characteristics? Figure 1: Male and female sex characteristics 5. Copy and fill in the following table, using the Figure 1 and the text above. Table 1: Sex characteristics **Woman** **Man** --------------------------------- ----------------------------------- --------------------------------- ----------------------------------- **Primary sex characteristics** **Secondary sex characteristics** **Primary sex characteristics** **Secondary sex characteristics** 6. Is armpit hair a sex characteristic? Explain your answer. 7. Answer the following questions using **primary sex characteristics** or ***secondary sex characteristics*** a. Male: scrotum b. Female: breasts c. Male: beard growth d. Female: pubic hair e. Male: penis f. Female: vagina g. Male: lower voice h. Female: vulva / labia i. Female: hairy armpits j. Female: wider hips k. Male: chest hair l. Male: muscular body **Changes during puberty** Besides the secondary sexual characteristics that develop at puberty, **mental changes** also take place during this period. These are changes that take place mainly in your thoughts and feelings. For example, many adolescents become more interested in other people than they were as children. They find friendships and sexuality more important and may fall in love. In addition, many adolescents start behaving differently towards their parents, as they may feel they are being treated childishly. Also, emotions can sometimes be more intense and can change rapidly. These physical and mental changes can take place in a different order and at a different time for everyone. So everyone is unique in this. Sometimes changes stay away (almost) completely. Therefore, there is no need to worry if you are \'late\' or very \'early\'. The way you come out of puberty can also be different for everyone. Some girls get large breasts, others small. Often the breasts are not the same size, or the shape of the nipples is different. Some boys get a lot of hair while others get almost none. The length and width of the penis can also be very different in boys. Puberty can be fun, but sometimes you can also feel sad or lonely. This is unfortunately part of it. As you get older, it doesn\'t bother you as much. Sometimes adolescents worry because they compare themselves to \'perfect\' people in the media. However, these photos are often fake or a filter is used. Normal people look very different. For example, take a good look at your family members, or at people in the swimming pool. 8. m. Name four mental changes that take place during puberty. n. Do all teenagers grow beards at exactly the same age? o. A girl has already started her period, but her breasts have not yet started growing. Her friends all have breast growth already. Should the girl be worried? p. Why is it not smart to compare yourself to people in the media? 9. Watch the video and answer the following questions.Link to the video: q. What part of the body signals the sex organs to mature using hormones? r. What is the name of the male sex organ that receives this hormone? s. What cells does this organ produce? t. What is the name of the female sex organ that receives this hormone? u. What cells does this organ produce? And do you know the common name for both cells? v. What hormones are being produced by the sex organs of a male? And a female? w. Because of these hormones, the bodies of boys and girls change. Write down the changes for both sexes. 10. Name 3 physical changes happening during puberty which are the same for boys and girls. 2 Sexuality and gender identity =============================== **Learning objectives:** **At the end of this chapter I am able to\...** 1. **\... describe what is meant by sexuality.** 2. **\... name how gender and sexual orientation can differ.** 3. **\... know how wishes and limits can be set and respected in a sexual relationship.** **Sexuality** **Sexuality** includes all feelings, thoughts and actions related to sex or sexual acts (such as kissing and caressing). People engage in sexuality for different reasons. For example, for pleasure, intimacy and procreation. Many people enjoy being sexually aroused. This is called **sexual arousal** **(lust)**. People can be aroused by different things. For instance, by touching someone or looking at someone who they find attractive. Sexuality can also play a role in maintaining a love relationship. This is called **intimacy**. You like to hug or caress each other regularly. Having intercourse (sex) can also give a sense of connection. Finally, sexuality can also play a role in **reproduction** (having children). **Gender** **Gender** is not about the physical characteristics you are born with, but about how a person feels and behaves in doing so. Your **gender identity** is the sex you identify with. **Gender expression** is about how someone expresses themselves. People can be very different in this. For example, some boys like things that many people see as something mostly girls like. Someone who was born as one gender, but would like to act like someone of the other gender and look like that, is called **transgender**. Between transgender people can also be a lot of differences. **Sexual orientation** Your sexual orientation indicates who you can fall in love with. In this, too, there are many different forms. Below are the most well-known ones described: - **Heterosexual**: A person who falls in love with a person of the opposite sex. - **Lesbian**: A woman who falls in love with a woman. - **Homosexual**: A man who falls in love with a man. - **Bisexual**: A man or woman who falls in love with both men and women. - **Transgender**: Someone whose sex does not match their gender. - **Asexual**: Someone who does not fall in love and/or is not sexually attracted to anyone else. - **Pansexual**: Someone who falls in love with someone regardless of their gender. - **Queer**: Someone who does not want to put themselves in any of these boxes. 11.  You are going to have a discussion in groups of 4-5 students on the topic of gender and sexuality. The teacher introduces the topic with a thesis statement (this is on the board). Each group chooses a discussion leader and a note-taker. You engage in a discussion about the proposition. The note- taker briefly writes down the results/ opinions for each person. Then you switch roles so that everyone has had a discussion within your group. After everyone in the group has had a discussion a class discussion follows led by the teacher. 12. Look up the following words in a digital dictionary, such as and write down their meaning. x. Sexuality y. Gender (identity) 13. Go to and watch the video "Genderdiversiteit -- VO". Answer the following questions (and try to do that in English!): z. Ikbal loves to wear boys clothes. More and more often she gets the question: are you a boy or a girl? What do you think about Ikbal always getting this question? a. Ikbal doesn't feel like a boy or girl. They are a bit in between. What do you think of that? b. How would you react when your sister decides to cut her hair short or your brother wearing a skirt? c. Ikbals' mom doesn't want her daughter to change and dress and behave like a boy. What is your opinion on this reaction? 14. Fill the dotted lines of the Genderbread person in *Figure* *2* using this video: 15. a. Which gender identities do you know? Please also give their meaning. b. Which gender expressions do you know? Please also give their meaning. c. What is the difference between transgender and drag? d. Many people experiment with people of different sexes. Does this say anything about their sexual orientation? **Assignment 16.** Write down the correct term after each description. You may use the following terms: lesbian, gay, bisexual, transgender, intersex, queer, asexual, pansexual. d. People who do not identify with the gender given at birth. So someone born a man does not feel like a man or someone born a woman does not feel like a woman. e. A woman who is emotionally/physically attracted to women. f. People who are attracted to all gender identities and biological sexes. They fall for a person\'s character or personality. g. People who are not sexually attracted to others. h. A man who is emotionally/physically attracted to men. i. People who prefer not to pigeonhole their sexual preference. Thus, one prefers not to identify as lesbian, heterosexual, bisexual or pansexual. j. A term for people where innate body characteristics differ from what medics consider the norm for male and female bodies. The difference in innate body characteristics is very diverse and can manifest itself in many ways. An example is a woman born with both male sex characteristics and female sex characteristics. k. A man or woman who is both emotionally and physically attracted to men and women. **\ ** **Coming out** The term coming-out means coming out of the closet, openly expressing your feelings if you want to. For most people this happens in stages. First they tell their closest friends, for example, maybe later to their parents and family and then to others. The word coming-out suggests that it is a one-off: when you told once, then you are done with it. This isn't the case. With every move, new job or meeting, LGBTIQ+ people decide again whether or not to tell their sexual preference. You decide to tell something to someone. Some choose not to do an explicit coming-out. **[Advice/ tips for coming-out:]** 16. Read the text above this question about coming out, and answer the following questions: l. A person has the freedom of choice to come out of the closet. Why would someone choose not to come out of the come out of the closet? m. What can be positive effects of coming-out? n. Imagine: you feel you can\'t fully be yourself. What would that do to you? o. Imagine: you are in love with someone of the same sex or are attracted to both sexes. Or: gender does not matter to you when looking for a partner. Who would be the first person you would tell? Why them? 17. Answer the following questions: p. Imagine: your best friend is in love with someone of the same sex or both sexes. Or: gender doesn\'t matter to your best friend. Can your friend come out of the closet in this class? Try to explain. q. What can you do if you see someone being bullied because of their sexual orientation? r. Does anyone here in class/school ever gets called \'gay\'? How might this affect someone who is unsure about their orientation or is attracted to someone of the same sex? s. How can you support someone who wants to come out of the closet? **Setting sexual boundaries** Lust, sex and intimacy are topics that many people find enjoyable and interesting. Yet unpleasant situations can also arise when your boundary is crossed, or when you yourself cross someone\'s boundary. Boundaries are very personal. Many young people do not yet know their own boundaries very well. If you feel a boundary with yourself, you often notice it because you don\'t like something, or because you feel insecure or restless. Take this feeling seriously and try to tell someone else honestly. If you don\'t, you may feel uncomfortable later. If someone else indicates that their limit has been reached, this may not be fun to hear. Still, it is better to listen to the other person. This way, you won\'t make the other person feel unpleasant. Also, if you cross their limit, another person may not want to be in contact with you anymore. To make sure you do not cross each other\'s boundaries, it can help to talk to each other about what you like and dislike when you are intimate with each other. You can also direct someone\'s hand to a place you like or don\'t like. If you don\'t want something try saying so. When doing so, indicate what the other person should do. For example: \"I don\'t like this. I want you to stop doing this\". If someone does not listen to this then that person does not respect you enough and you can decide to leave. It can also be good to talk about this with someone you trust (preferably an adult). For example, a parent, a confidant, a mentor or a close friend. 18. It sometimes happens that someone has sex for a reason other than his/her own pleasure. You can use the following 6 \'sex rules\' from the following video to check whether you are both doing it for pleasure. Write down the 6 sex rules from the film and see if you can translate them to English. **Crossing sexual boundaries** If someone performs sexual acts, or makes sexual comments that you don\'t want, this is called **unacceptable sexual behaviour**. Victims of unacceptable sexual behaviour often have the idea that this is their own mistake or feel ashamed about the situation. However, if sexual behaviour occurs between an adult and somebody under the age of 18, it is never the mistake of the younger person. Not even if the adult says that it is. Victims of unacceptable sexual behaviour often suffer or contract emotional or physical problems. It is important to seek help for this. By example by talking with someone that you trust (preferably an adult person). By doing so, these problems may pass. Unacceptable sexual behaviour occurs in in difference forms. If sexual acts are forced by someone on somebody else, this is called **sexual assault.** **Rape** involves sexual intercourse. When any of these acts happen within a family, it is called **incest**. Because boundaries vary from person to person, something that feels harmless to one person may not feel right to another. Sexual assault is prohibited by law. People who do this can face prison sentences. This can also happen when sexual violence takes place over the internet. For example, when an adult forces a child to take pictures of their private parts/ genitals. Or when someone threatens to share nude photos. A **loverboy** is a boy who is very nice to (usually) a girl by giving her lots of attention and sometimes expensive gifts. Also, this girl is then only allowed to hang out with him. In this way, the boy gains power over the girl. This may force the girl into prostitution (making money by having sex). 19. t. What is unacceptable sexual behaviour? u. A girl slaps a boy\'s bottom. This boy finds this annoying and gets a nasty feeling. Is this unacceptable sexual behaviour? v. What could be the consequences for someone who has suffered from unacceptable sexual behaviour? w. Write down the words below one after the other, followed by the corresponding number. The words are: *rape, incest, sexual assault, internet, loverboy*. 1. A boy who makes money from it by forcing a girl into prostitution. 2. Sexual intercourse between family members. 3. Forcing sexual acts through violence. 4. Sexual violence not only takes place in real life but can occur on it. 5. Through violence, sexual intercourse is enforced. 3 Male and female reproductive organs ===================================== **Learning objectives:** **[Female reproductive system]** **At the end of this chapter I am able to\...** 1. **\... recognise the parts of a woman\'s reproductive system.** 2. **\... know the characteristics and function of each female reproductive part.** 3. **\... describe the menstrual cycle.** 4. **\... name the characteristics of egg cells.** **[Male reproductive system ]** **At the end of this chapter I am able to\...** 1. **\... recognise the parts of a man\'s reproductive system.** 2. **\... know the characteristics and function of each man\'s reproductive part.** 3. **\... name the characteristics of sperm.** **External female reproductive system** A woman\'s external sex organs is called the **vulva**. The vulva then consists of the outer and inner labia, part of the clitoris and the opening of the vagina (Figure 6 and 7). The **outer labia** are the folds of skin, often containing pubic hair. Between the outer labia lie the **inner labia**. At the top of the inner labia lies the sheen (glans) of the clitoris. The **clitoral glans** is sensitive to touch. Surrounding the clitoral glans is a fold of skin called the **clitoral hood**. Below the inner and outer labia are the **swelling bodies** of the clitoris. These swelling bodies fill with blood during sexual arousal. This causes the wall of the inner labia to produce vaginal fluid. This makes the entrance to the vagina smoother. The inside of the vagina is lined with a **mucous membrane**. At the beginning of the vagina, this mucous membrane forms a somewhat thicker rim known as the **hymen**. In Dutch, this is called maagdenvlies. Contrary to its Dutch name, this is not a membrane (vlies), but a somewhat thicker rim at the beginning of the vagina. During the first intercourse, the hymen stretches a little, which can cause it to bleed. Figure 6: Outer view of the vulva  Figure 7: Beneath the vulva + parts of the clitoris **Internal female reproductive system** The remaining parts of a woman\'s reproductive system lie in the lower abdomen (see Figure 8). The **ovaries** contain cells that can develop into eggs. Once every four weeks, an egg cell \'matures\'. The egg cell is then released from the ovary. The released egg cell is collected in the funnel-shaped end of the fallopian tube. The **fallopian tubes** transport the egg cell to the **uterus**. In the fallopian tube, the egg cell can be fertilised by a sperm cell. From puberty, egg cells can start to be released and this continues until **menopause**. Menopause starts for most women around the age of 50. After that, no more cells mature. The wall of the **uterus** consists of a thick layer of muscle. On the inside, the **uterine wall** is lined with a **mucous membrane**. Inside the uterus, a fertilised egg can develop into an embryo. Below the uterus is the **vagina (sheath)**. This connects the uterus to the outside of the body. Afbeelding met joint, schets, kunst Automatisch gegenereerde beschrijving Figure 8: Female internal sex organs 20.  Individually make a mind map about what you know about the female and male reproductive systems. Write down everything you know and draw things next to it. Give examples as well. Later discuss this in pairs and then in class if necessary. 21. Match the words with the numbers in the *Figure 9*. Every word can be used once. If you do not know what a word means, look up the translation or a picture on the internet. Use: *Ureter -- Fallopian tube -- Labia majora -- Anus -- Urethra -- Ovary -- Rectum -- Clitoris -- Spine -- Uterus -- Funnel -- Vagina -- Bladder -- Labia minora -- Cervix -- Pubic bone* Afbeelding met kunst Beschrijving automatisch gegenereerd met lage betrouwbaarheid Figure 9: Female reproductive organs 22. Use the following link to study the [functions] of the female reproductive organs. 23. Print Appendix 2 and puzzle the female reproductive system together. Put a picture in your notebook. **The menstrual cycle** The wall of the **uterus** consists of a thick layer of muscle lined inside with the **endometrium**. This mucous membrane contains many blood vessels. About once a month, the endometrium loosens partially. The loosening releases blood. The contraction of the muscle layer of the uterine wall allows the mucous membrane to be drained with blood. This shedding of part of the endometrium is called **menstruation** or getting your **period** (see *Figure 10*).  Figure 10: The uterus during menstruation Most girls menstruate for the first time between the ages of 10 and 16. The duration of menstruation can vary between one day and sometimes up to seven days. The contractions of the uterine wall can feel like painful abdominal cramps. Girls and women may feel miserable or sad just before and during their periods. They may also suffer from headaches, abdominal pain, backache or muscle aches. Some women do not suffer from anything. **Collecting menstrual blood** To collect the mucous membrane and blood, products such as sanitary pads, tampons, menstrual cups and menstrual pants have been developed (see Figure 11). Afbeelding met onderbroek, Ondergoed, onderbroeken, Slipje Automatisch gegenereerde beschrijving Figure 11: Tools/ devices to collect endometrium and/ or menstrual blood. You stick **(sanitary) pads** in your underwear, so that the top sits against the opening of the vagina (Figure 12.1). A **tampon,** you insert into the vagina, where it sucks up the mucous membrane and blood (Figure 12.2). A **menstrual cup** you insert into the vagina, where it slowly fills up (figure 12.3). On average, you should empty, rinse and reinsert the menstrual cup every four to six hours. Sanitary pads and tampons should be changed at least every three hours. Sanitary pads, tampons and menstrual cups come in different sizes. Which size you need depends on several factors such as your build and the amount of blood you lose.  Figure 12: Different ways to collect blood/ endometrium during menstruation. **The menstrual cycle** After menstruation, the endometrium rebuilds. The mucous membrane becomes ever so slightly thicker and starts to contain more blood vessels. This is necessary for a possible pregnancy. Figure 13 shows a woman\'s endometrium for five weeks. Afbeelding met tekst, schermopname Automatisch gegenereerde beschrijving Figure 13:Woman\'s endometrium for 4 weeks. ### **Ovulation** During **ovulation**, the egg is released from the ovaries. This occurs about a fortnight after the start of the last menstrual period. If a released egg cell is not fertilised, it will die. The endometrium is then no longer maintained and is shed. In the process, blood is released. The mucous membrane leaves the body with mucus and blood through the vagina. This is called **menstruation** or having your **period**. If the egg cell is not fertilised, the next menstruation starts approximately on the 29th day. The recurrent building up and shedding of the endometrium is also called your **menstrual cycle**. When a girl starts menstruating, the cycle is often irregular. It is only after a few years that the cycle usually becomes more regular. 24. In the picture shown below there is a timeline of 75 days. A woman gets her period which lasts for 4 days. 4 weeks after her first day of menstruation she gets her period again. This period lasts 4 days again. After that (4 weeks after day 1) 4 days again. x. Colour the days, in which this woman has her period, red. y. Put an asterisk (*sterretje*) on the days when ovulation is likely to occur for this woman  Menstrual cycle Time in days \--\> 25. Watch this video: z. If you\'re a person that can have their period: will you give eco-friendly products a try? Why / why not? a. Think of a plan to promote environmentally friendly period products here at Panora. **External reproductive organs of men** The penis and scrotum are the external sex organs of men (see Figure 3). The **penis** consists of the shaft, glans and foreskin. The **glans** is sensitive to touch. The **foreskin** wraps around the glans and protects the glans. The penis can become larger and stiffer as the **erectile tissue** fills with blood. The man gets an **erection** when the man is sexually aroused, but it can also happen at other times. Under the foreskin, fluid is produced. This is where bacteria live. When this is not cleaned properly, it starts smelling foul and can become inflamed. This is why it is important that while showering, the man sometimes pulls back his foreskin and rinses the glans and foreskin with water. For some boys and men, their foreskin, or part of it, is removed. This is done during a **circumcision**. This may be done for a religious, medical or hygienic reason. Afbeelding met tekst, Vlees Automatisch gegenereerde beschrijving Figure 3: External male sex organs; penis in normal-, and erect state. With cross-section of penis below. **Internal sex organs** The remaining parts of a man\'s reproductive system lie in the lower abdomen (see Figure 4). The **scrotum** is a fold of skin that lies below the penis. It contains the testes and epididymis. From puberty onwards, the **testes** (**testicles**) make millions of new sperm cells every day. The sperm cells are temporarily stored in the **epididymis**. During ejaculation, as many as fifty to one hundred and fifty million sperm cells leave the body. This happens as follows: 1\. The **vas deferens (*sperm duct)*** transport sperm cells from the epididymis towards the prostate. 2\. The **seminal vesicles** add fluid to the sperm cells. 3\. The **prostate** also adds fluid to the sperm cells. 4\. From the prostate, **sperm** (the sperm cells and fluid together) enter the **urethra**. 5\. Semen exits the penis through the glans. Semen consists of sperm cells and fluid which comes from the seminal vesicles and the prostate. The fluid allows the sperm cells to move easily. The fluid also contains nutrients for the sperm cells. The urethra transports urine from the bladder to the outside. Before ejaculation, **pre-cum** often comes out of the urethra first. This is important for cleaning the urethra. This way, the acid of the urine cannot affect the sperm cells. However, the pre-cum often already contains a small number of sperm cells. When there is no ejaculation, the body dissolves the sperm cells itself. There is then room again for new sperm cells.  Figure 4: Internal male sex organs 26. Match the words with the numbers in the *Figure 5*. Every word can be used once. If you do not know the word, look up the translation or a picture on the internet. Use: *Pubic bone -- Erectile tissue -- Seminal vesicle -- Rectum -- Ureter-- Anus - Epididymis -- Scrotum -- Bladder -- Urethra -- Prostate -- Vas deferens -- Testis -- Penis -- Glans* Afbeelding met kunst Beschrijving automatisch gegenereerd met gemiddelde betrouwbaarheid Figure 5: Male reproductive system 27. Write the function of each part after the number and word you\'ve written down in assignment 21. **Sperm and oocytes (egg cells)** Sperm cells are the male **sex cells**. They have an elongated shape with a movable tail (**flagellum**), which helps them to propel themselves towards the egg cell for fertilisation (see figure 15)  Figure 15: The sperm cell The head of the sperm cell contains the hereditary characteristics of the male (23 single chromosomes). Sperm cells can survive in the female reproductive system for several days, waiting for the egg cell to arrive. **Oocytes** are the female **sex cells** (see figure 16). They are much larger than sperm cells and contain nutrients to nourish a fertilised egg in its early stages. Women are born with a fixed number of eggs, and after puberty, one egg cell matures monthly during the menstrual cycle. An egg is fertile for only a short time after ovulation (ovulation) and must be fertilised within 12 to 24 hours to result in pregnancy. The egg contains the hereditary material (23 single chromosomes). Afbeelding met ongewerveld dier, Ongewervelde zeedieren, aquarium, Organisme Automatisch gegenereerde beschrijving Figure 16: Female egg cell, and male sperm cell 28. Words have been erased from the following text. Can you fill in the blanks? *In the reproductive system of the..(a).., eggs mature in the..(b)\... When an egg cell is..(c).., it enters the..(d)\... There, the egg begins its journey towards the..(e)\... During its journey, the egg cell is pushed forward by..(f)\... The egg cell must be fertilised by a..(h).. cell within..(g).. hours, otherwise it breaks down. If that is successful, then the fertilised egg can develop into an embryo in..(i).. and then into a foetus.* *The process of the embryo/foetus developing is called the..(j).. and the process of the foetus coming into the world is called the..(k)\... When that happens, we call the foetus a..(l)\... At least, until it is 1.5 years old, when the next stage of life begins.* *By the way, the..(h)..cell of the male consists of an..(m).. and an..(n)\... The..(m).. contains the..(o).. material, abbreviated..(p).., and the..(n).. allows the cell to move.* 4 Contraceptives and STI\'s =========================== **Learning objectives:** **At the end of this chapter I am able to\...** 1. **\... name some methods of birth control or the prevention of STIs.** 2. **\... name some STIs and explain how to prevent them.** 3. **\... explain the function of a condom and know how to use it.** **Contraceptives -- Unreliable methods** If you become sexually active but do not want children yet, you can use contraceptives (birth control pills). This ensures that fertilisation cannot take place. This is also known as birth control. However, some methods are more reliable than others. Birth control without contraceptives are not reliable. Two most common unreliable methods are: - **Periodic abstinence** - **Coitus interruptus** **Periodic abstinence** involves a man and woman not having sexual intercourse around the fertile period. However, this method is unreliable. This is because you can never determine exactly when your ovulation occurs. Besides, sperm can survive in a woman\'s body for a few days. **Coitus interruptus** is a procedure, in which the man withdraws his penis from the vagina when he feels his orgasm coming. Ejaculation then takes place outside the vagina. However, this method is unreliable because pre-cum can also contain sperm cells. **Contraceptives - Reliable methods** Using contraception significantly reduces the risk of pregnancy. There are different types of contraception, some with hormones and others without (refer to Table 2 for details). Table 2: Different kinds of contraceptives Without hormones With hormones -------------------------------------------- ------------------------- Condom Birth control pill Copper-containing IUD Contraceptive patch Pessary [with] spermicidal gel Hormone-releasing IUD Sterilisation Birth control implant NuvaRing Contraceptive injection Hormonal contraceptives prevent the maturation and release of eggs. They also prevent sperm cells from moving easily through the cervical mucus. In addition, hormones prevent the build-up of endometrium, which prevents the implantation of a fertilised egg. ***Condom*** The **condom** is the only contraceptive that protects against both sexually transmitted diseases and pregnancy. There are condoms for both men and women, with the male condom being the most common (see Figure 17).  Figure 17: Putting on a male condom Condoms are usually made of latex, a type of rubber that retains sperm cells. The male condom is rolled around the [erect] penis. It is important to be careful with nails and jewelry. The female condom is inserted into the vagina and can be placed several hours before sexual intercourse (see Figure 18). The male condom, on the other hand, must be put on during sex. Both the male and female condoms are intended for single use. Afbeelding met tekst, hart, Cosmetica Automatisch gegenereerde beschrijving Figure 18: The female condom ***Intrauterine device (IUD)*** An **intrauterine device (IUD)** is a flexible plastic object. It is inserted into the uterus by a doctor (see Figure 19). After insertion, you may experience abdominal cramps and bleeding for the first two months.  Figure 19: IUD implanted inside the uterus There are two types of IUDs: - Copper-containing IUD - Hormone-containing IUD A **copper-containing IUD** contains no hormones. The copper wire wrapped around the IUD damages the sperm cells. This prevents them from fertilising the egg. Copper also makes the implantation of fertilized eggs cells virtually impossible. A copper IUD can stay in place for between five and 10 years. A **hormone-containing IUD** continuously releases a small amount of hormones. This quantity is smaller than that of the birth control pill. The monthly bleeding is often less intense. Sometimes the bleeding stays away altogether. After about 5 years, the hormone coil wears off. It must then be removed or replaced (by a doctor). Een koperspiraal of hormoonspiraal? Dit zijn de verschillen  Figure 20: The copper-containing IUD (right) and hormone-containing IUD (left). ***Pessary (diaphragm)*** A **pessary** is a soft rubber dome (see Figure 21). This dome covers the cervix. You can insert the pessary yourself before sexual intercourse. The correct shape and size should be determined by a doctor. The doctor will also teach you how to insert the pessary. To ensure the pessary is reliable contraceptive, it should be smeared with a **spermicidal gel**. This is a gel that is able to kill all the sperm cells. After intercourse, it should be left in place for at least eight hours.  Figure 21: Pessary (with spermicidal gel) **Sterilisation** Someone who does not want to have children (anymore) can also get **sterilised**. This involves using an operation to make you infertile. In a man, the vas deferens are interrupted (see figure 18.1). The production of sperm continues normally. The man can still have ejaculation, only the sperm no longer contains sperm. In a woman, a doctor either interrupts or blocks the fallopian tubes. This prevents the sperm cells from reaching the egg. Egg cells will continue to mature each month, and hormones continue to be released. So, a sterilised woman will still get her period. https://sh24.org.uk/assets/mvp2/female\_sterilisation/female\_sterilisation\_how\_why2-920444582c1e232d8fcfcbc14615c8e072e2e8547da604718cf18a5c328b0c84.png Figure 22: Sterilisation in women ***Birth control pill (contraceptive pill)*** The contraceptive pill (popularly called "the pill") is a strip of pills for three weeks (see Figure 23). You have to take one every day. After three weeks, there is a stop week. You then don\'t take the pill for a week. During the stop week, you get light bleeding, often less heavy than your period. For some women, a heavy or painful period is therefore a reason to take the pill. You need a doctor's prescription to be able to get the pill. After the first prescription, you can always get the pill from the pharmacy with a repeat prescription. 29. In the image 8 different methods of contraception are shown. First, read the descriptions in the third column. After that, do a till d. Afbeelding met handschrift, nagel, vinger, persoon Automatisch gegenereerde beschrijving Figure 23: Different contraceptives b. Fill the first column with the numbers shown in the picture. **Attention: a few methods do not have a picture shown! Just write NP (no picture) in that instance.** c. Fill in the second column with the names of the contraceptive methods. d. Does this contraceptive protect against STI\'s? Write *yes* or *no* in the fourth column. e. Mark all the types of contraceptives used by women green, and all the types used by men blue. Table 3: Summary table for contraceptives **Number** **Contraceptive name** **Description** **Protection against STI\'s** ------------ ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- Rubber sleeve around the penis. With correct use the protection rate is 95-98%. This anchor is placed in the uterus. Prevents an egg from implanting for several years. Very reliable (99%). The man pulls out before ejaculating. Very unreliable. Must be taken daily and contains hormones to prevent ovulation. Reliability depends on user / antibiotics / other medicine. This silicone ring must be inserted into the vagina around the cervix and contains hormones which prevent ovulation. Must be switched out monthly. Very reliable (99%). This rubber sleeve is inserted in the vagina, preventing sperm from reaching the egg. Very reliable (99%). Hormones that prevent ovulation are injected every three months. Very reliable. Match-sized rod inserted under the skin and releases hormones for 2-3 years, preventing ovulation from taking place. Very reliable. The vas deferens are cut in men and the fallopian tubes in women. **Sexually transmitted infections (STI's)** Some diseases you only get through sexual intercourse or other intimate contact. This is called an STI (Sexually transmitted infection). You cannot catch an STI from a dirty toilet or drinking out of someone\'s glass. The most common STI in the Netherlands is chlamydia. AIDS is very well known, but is fortunately becoming less common. To find out if you have an STI, you can do an STI test. You can do this at the GGD. ***Chlamydia*** **Chlamydia** is caused by a bacterium. In a large proportion of people with this bacterium, no symptoms develop. These people do not notice anything about the infection, but they can still transmit it to someone else. Chlamydia bacteria can cause inflammation of the cervix, anus or urethra. If not treated in time, the infection can migrate to the fallopian tubes or epididymis. A woman can also become infertile. Symptoms of chlamydia in boys include discharge from the penis, pain when urinating, pain during intercourse. Symptoms of chlamydia in girls are pain on urination, pain on intercourse, pain in the lower abdomen. ***HIV and AIDS*** The disease **AIDS** is caused by the **HIV** virus. A person may be infected with it without having AIDS. The HIV virus can be transmitted by unprotected sex, through blood, semen, vaginal fluid or pre-cum of an infected person. A person with HIV should take HIV inhibitors as soon as possible. This reduces the ability of the virus to multiply in the body. The earlier someone starts taking HIV inhibitors, the less likely that person will get AIDS. If someone has AIDS, their immune system is affected. This makes the body less able to ward off diseases and so a person gets sick faster. AIDS therefore has no specific disease symptoms. 30.  Do the STI-speed dating practical [during] the lesson. Fill in the forms and keep them somewhere safe (inside your notebook). 5 Pregnancy and childbirth ========================== **Learning objectives:** **At the end of this chapter, I am able to\...** 1. **\... describe how fertilisation occurs in humans\' step by step.** 2. **\... describe how pregnancy proceeds step by step.** 3. **\... explain what prenatal screening is and give examples.** 4. **\... describe how childbirth proceeds.** **Conception/ fertilisation** To become pregnant, fertilisation must first take place. In biology, we talk about **conception** (***fertilisation***) (see Figure 24) at the moment the nucleus of the sperm cell meets the nucleus of the egg cell. This proceeds as follows: 1. During sexual intercourse, sperm enters the vagina. 2. The sperm swim towards the uterus and fallopian tubes. This is where the egg is located. 3. In the uterus or fallopian tubes, fertilisation takes place: the head of the sperm enters the egg and the tail remains behind. 4. The outer layer of the egg cell becomes impenetrable. This prevents other sperm cells from entering the egg cell. Afbeelding met ongewerveld dier Automatisch gegenereerde beschrijving Figure 24: Conception **Implantation** After fertilisation, implantation takes place (see Figure 25). This proceeds as follows: 1. After fertilisation, the egg starts dividing several times. 2. This group of cells passes through the fallopian tube to the uterus. 3. This group of cells goes into the lining of the uterus. This is called **implantation**. The mucous membrane is very thick after ovulation, and it also contains many blood vessels. After implantation, the woman no longer gets her period.  Figure 25: Development from ovulation to implantation **Phases of pregnancy** In the first weeks, the unborn child is called an **embryo**. At that time, the endometrium provides nutrition for the embryo. Between the eighth week and birth, it is called a **foetus**. From then on, the **placenta** provides food for the embryo (see Figure 26). In the placenta, blood vessels of the mother flow along those of the embryo. This allows nutrients, oxygen and waste products to pass from the mother to the child or from the child to the mother. So, the blood itself is not exchanged, only the substances within the blood. The placenta is attached to the baby through the **umbilical cord**. Afbeelding met tekst, huid, Vlees Automatisch gegenereerde beschrijving Figure 26: Embryo in the uterus Inside the abdomen, the foetus is located in a kind of sac (see Figure 27). This sac contains amniotic fluid in which the foetus floats. The outside of the balloon is called the amniotic membrane. The amniotic fluid protects the foetus but still allows it to move easily. After nine months, the baby can be born.  Figure 27: Foetus in amniotic sac. 31. Match the words / phrases to the numbers in the image. You may use every word once (see figure 28): *Uterus -- fertilisation -- vagina -- fallopian tubes -- fertilised egg cell (zygote) - cervix -- implantation -- maturing egg cells (follicles) -- ovary -- ovulation -- cell* Figure 28: Parts of the female reproductive system 32. Match the words / phrases to the numbers in the image. You may use every word once (see Figure 29): *Endometrium of the uterine wall -- Umbilical cord -- Foetal blood vessels - Placenta -- Maternal blood vessels -- Amniotic membrane -- Embryo -- Muscle layer of uterine wall -- Amniotic fluid* Figure 29: Embryo in the uterus 33. Look at the following website and try to answer the next questions: a. In which week is the embryo as big as a poppy seed? b. What are pregnancy symptoms in this week? c. At 12 weeks of pregnancy the name of the embryo changes to foetus. From that moment onwards you might be able to hear a heartbeat with specialised equipment. How big is the foetus at that time? 34. Embryo sizes in the uterus are sometimes compared to different types of veggies. Use the following website to answer the following questions. f. After how many weeks of pregnancy is the embryo the size of a blueberry (1.27 cm)? g. What can the woman suffer from during this week (*symptoms*)? h. After 11 weeks of pregnancy, baby in the belly is no longer called an embryo, but a foetus. From that moment you can hear (with special equipment) the heart beating. How big is the baby then? **Prenatal and neonatal care** **Prenatal screening** is examination done when the baby is in the womb. There are different forms of prenatal testing. Most prenatal tests are free and not compulsory. - **Ultrasonography (ultrasound):** This creates an image of the foetus in the womb. The midwife can see approximately how long the woman has been pregnant and approximately when the baby will be born. The ultrasound is done around the 10th week of pregnancy. - **Triple test**: This tests for Down\'s syndrome. This involves a blood test on the mother and an ultrasound to measure the foetus\'s neck fold. This is done between the 9th and 14th week of pregnancy. - **Non-invasive prenatal test (NIPT):** This tests whether there is a higher risk of a hereditary disease. For this, blood is taken from the mother and DNA from the baby is examined in it. NIPT can be done after 11 weeks of pregnancy. - **20-week ultrasound**: This examines the foetus for various birth defects. Now the gender can also be determined. - **'Fun ultrasound'**: This allows a photo or video to be taken. This is not free of charge. After birth the nurses in the hospital or midwife (*verloskundige*) check the new-born. We call this **neonatal screening.** 35. Fill in the table 3 below about 4 possible (prenatal) screenings using this website: Table 4: Prenatal screening **Name of the screening** **Prenatal or neonatal** **What is investigated** --------------------------- -------------------------- -------------------------- 36.  In a group of four students, you will individually look up information on a topic. You are \'expert\' on this topic. Divide the topics within your group: *conception*, *stages of pregnancy*, *prenatal screening* and *childbirth*. Write down all the important things about your topic. Then tell your groupmates everything you now know about your topic. Everyone should have told the group about his/her topic. **Childbirth** Labour proceeds in several stages: dilation, expulsion and afterbirth. 1. **Dilation**: The muscles of the mother\'s uterine wall constantly contract (**contractions**). The cervix and cervix mouth widen (see figure 30). This is called **dilation**. The amniotic membranes also rupture. This phase can last up to 20 hours. Figure 30: Dilation 2. **Expulsion** (active labour): Not only the muscles of the uterine wall, but also those of the abdominal wall squeeze together. These are called **push contractions**. This pushes the baby out (see Figure 31). This phase can last from a few seconds to two hours.  Figure 31: Expulsion The baby can lie in the abdomen in different ways (see Figure 32). Usually, the baby\'s head comes out first. Sometimes it may also be **breeching** **position**. This means it comes out with its bottom or foot first. Finally, the baby may also be in a **transverse position**. This is not that common. In a breech or transverse position, the baby may be delivered via **caesarean section** (c-section). This is an operation through the mother\'s abdominal wall. After birth, the baby\'s umbilical cord is cut. A part remains behind and falls off after about a week. This leaves a scar: the navel (*belly button*). The baby usually starts crying immediately. This indicates that the baby has started breathing. 3. **Afterbirth**: After the baby is born, the placenta, remains of the umbilical cord and amniotic membranes are also pushed out (see Figure 33). This happens about 15 minutes after the baby is out of the body. Figure 32: Foetal positions Afbeelding met tekenfilm, clipart, tekening, illustratie Automatisch gegenereerde beschrijving Figure 33: Afterbirth 37. In the image shown above you can see the different ways a foetus can lie in the abdomen. A baby\'s skull bones are not yet attached to each other, so the head can still change shape slightly. There is also space in between the bones, called *fontanelles*. a. Why is this an advantage during delivery of the baby? b. What position is the best for the baby to be born like? And why? Try to explain your answer. 38. Words are missing from their spot in the text. There are letters instead. Match the letters and words so the text will be complete again. Use the following words: *contractions - head - navel - abdominal wall - push contractions - caesarean section - uterine wall - amniotic fluid - amniotic membrane - breech presentation - afterbirth - dilation - expulsion - placenta - mucus - umbilical cord.* 39. Watch the following video: With all your knowledge of pregnancy and childbirth, does this video paint a realistic picture of the events? 6 Appendices ============ **Puzzle female reproductive system** Below is an image of the woman in which part of the torso can be seen. You will immediately notice that quite a few organs are missing, including the genitals. 1. It is up to you to place the sexual organs in the figure. On the last page you can cut out the (parts of the) sex organs and stick them into the figure below. 2. Name each organ/part you paste into the drawing by writing the names next to the drawing and connecting them to the drawing with a line.  3. Then indicate the function of each part in the table. **Organ / part** **Function / description** -------------------------- ---------------------------- Intestine Oviduct / Fallopian tube Ovary Uterus Cervix Vagina Labia minora Labia majora Clitoris Urethra Bladder **Similarities men and women** 4. Even though the construction of the sexual organs differs in men and women, similarities can be found. They may be based on construction and on function. Look for these similarities and write them down.