REPRODUCTIVE SYSTEM AND

REPRODUCTIVE HEALTH
NCM 107 - Maternal | Lecture

REPRODUCTIVE DEVELOPMENT ROLE OF ANDROGEN

 Sex of an individual is determined at the
moment of conception by the chromosome Androgenic hormones
information of particular ovum and sperm  are the hormones responsible for muscular
that joined the new life. development, physical growth, and the
increase in sebaceous gland secretions that
 Gonad – is a body that produces sex cells causes typical acne in both boys and girls.
(ovary in females; testis in males)  In males, androgenic hormones are
produced by the adrenal cortex and the
INTRAUTERINE DEVELOPMENT testes; in females, by the adrenal cortex
and the ovaries.
WEEK 5 primitive gonadal tissue is already formed.  The level of the primary androgenic
mesonephric and paramesonephric (2
undifferentiated ducts) ducts are present in hormone, testosterone, is low in males until
both sexes puberty (approximately age 12 to 14 years).
WEEK 7/8 gonadal tissues differentiate into primitive
testes and begins formation of testosterone.
 In girls, testosterone influences enlargement
under the influence of testosterone, the of the labia majora and clitoris and
mesonephric duct begins to develop into formation of axillary and pubic hair.
male reproductive organs and the
paramesonephric duct regresses  ADRENARCHE - development of pubic and
WEEK 10 if the testosterone is not present, the axillary hair because of androgen
gonadal tissues differentiate into ovaries.
paramesonephric duct develops into female
stimulation
reproductive organs.
oocytes (cells that develop into eggs ROLE OF ESTROGEN
throughout the mature years) are early
formed in the ovaries at this stage.
 When triggered at puberty by FSH, ovarian
WEEK 12 external genitals become visible. follicles in females begin to excrete a high
in males under influence of testosterone
penile tissue elongates level of the hormone estrogen.
males: urogenital fold on the ventral surface  The increase in estrogen levels in the
of the penis closes to form the urethra. female at puberty influences the
females: with no testosterone present:
urogenital fold remains open to form labia development of the uterus, fallopian tubes,
minora; what would be formed as scrotal and vagina; typical female fat distribution
tissue in males become labia majora in
female. and hair patterns; breast development; and
an end to growth because it closes the
epiphyses of long bones.
PUBERTAL DEVELOPMENT  THELARCHE - is the beginning of breast
development.
Puberty - is the stage of life at which secondary
sex changes begin.

 FSH and LH initiate the production of

androgen and estrogen, which in turn
initiate secondary sex characteristics, the
visible signs of maturity.
 Girls are beginning dramatic development
and maturation of reproductive organs at
earlier ages than ever before (9 to 12 years)

PBE | 1
 DEVELOPMENT OF SECONDARY 2. Testes
 Two ovoid glands, 2 to 3 cm wide that lie in
SEX CHARACTERISTICS
the scrotum.
 First form in utero in the pelvic cavity.
GIRLS (10-18 YEARS)  Descend into the scrotal sac late in uterine
life (34th to 38th week).
1. Growth spurt  Many preterm born infants have
2. Increase in the transverse diameter of the pelvis undescended testes.(cryptorchidism)
3. Breast development  Spermatozoa do not survive at a
 THELARCHE - increase in the size of the temperature as high as that of the body.
breast  location of the testes outside the body,
4. Growth of pubic hair where the temperature is approximately 1oF
5. Onset of menstruation than the body temperature, provides
 MENARCHE – onset of menstruation protection for sperm survival.
 average age occurs at 12.5 years.
 may occur as early as 9 or as late as age 3. Penis
17.  Is composed of three cylindrical masses of
 menstrual period do not become regular erectile tissue in the penis shaft: two termed
until ovulation consistently occurs which the corpus cavernosa, and a third termed
tends to happen 1 to 2 years after the corpus spongiosum.
menarche.  is an external male sex organ (intromittent
6. Growth of axillary hair organ) that serves as a passage for
7. Vaginal secretions excretion of urine and ejaculation of semen.
 With sexual excitement, nitric oxide is
BOYS
released from the endothelium of blood
vessels.
1. Increase in weight
 penile erection is stimulated by the
2. Growth of testes
parasympathetic nerve innervation.
3. Growth of face, axillary, and pubic hair
 Glans – is the distal part of the penis and is
4. Voice changes
homologous to the female’s clitoris.
5. Penile growth
 Prepuce – is the skin covering the glans.
6. Increase in height
7. Spermatogenesis (production of sperm)
MALE (INTERNAL)

GYNECOLOGY - The study of the female 1. EPIDIDYMIS

reproductive organs  (the tube that carries sperm away from the
testes) can be palpated as a firm swelling
ANDROLOGY - is the study of the male on the superior aspect of testes.
reproductive organs  encase by a protective white fibrous capsule
and is composed of a number of lobules.
ANATOMY AND PHYSIOLOGY  each lobule containing interstitial cells
(leydig’s cells) and seminiferous tubule.
MALE (EXTERNAL)
 the seminiferous tubules of the testes leads
to tightly coiled tube.
1. Scrotum  it is approximately 20 ft. long.
 A male reproductive structure located under  responsible for conducting sperm from the
the penis. testis to the vas deferens.
 Rugated skin covered muscular pouch  stores sperm
suspended from the perineum.  it takes 12-20 days for the sperm to travel
 Function: to support the testes and help the length of the epididymis, and a total of
regulate temperature of sperm. 64 days for them to reach maturity.
 Composed of Dartos muscle and cremaster  Aspermia – absence of sperm.
muscle  Oligospermia – fewer than 20 million
sperm per milliliter.

SEMEN

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 7. URETHRA
 male ejaculate is composed of
spermatozoa (2% to 5%) and seminal  a hollow tube leading from the base of the
fluid (95% to 98%) bladder, which after passing through the
 alkaline pH: 7.2 to 7.4 prostate gland, continues to the outside
 average volume of ejaculate: 2.5 to 5 mL; through the shaft and glans of the penis.
may vary from 1-10 Ml  approx. 8 inches long
 Repeated ejaculation may lead to
decreased volume. FEMALE REPRODUCTIVE ORGAN
 Normal sperm count: 100 million per mL.
 Once expelled, sperm can live up to 24-
48 hours.  The structures that form the female external
genitalia are termed the vulva (from the
Latin word for “covering”)
2. VAS DEFERENS (DUCTUS DEFERENS)
 Hollow tube surrounded by arteries and FEMALE (EXTERNAL)
veins and protected by a thick fibrous
coating. 1. MONS VENERIS
 Carries sperm from the epididymis through  Pad of adipose tissue located over the
the inguinal canal into the abdominal cavity symphysis pubis, the pubis bone joint.
where it ends at the seminal vesicles and  Covered by a triangle of coarse, curly hairs.
the ejaculatory ducts. Protect the junction of the pubic bone from
 sperm mature as they pass through the vas trauma
deferens.
 blood vessels and vas deferens are referred 2. LABIA MINORA
as the spermatic cord.  Posterior to mons veneris spread two
hairless folds of connective tissue.
3. SEMINAL VESICLES  Pink, covered with mucous membrane, and
 Two convoluted pouches that lie along the external surface with skin.
lower portion of the posterior surface of the  Abundant with sebaceous glands.
bladder and empty into the urethra by way  Before menarche they are fairly small.
of the ejaculatory ducts.  By childbearing age, they are firm and full.
 Secrete viscous portion of the semen, which  After menopause they atrophy and again
has a high content of a basic sugar, protein, become smaller
and prostaglandins and is alkaline.
 Sperm becomes motile. 3. LABIA MAJORA
 Positioned lateral to the labia minora.
4.EJACULATORY DUCTS  Covered by pubic hair.
 pass through the prostate gland and join the  Serve as protection for the external genitalia
seminal vesicles to the urethra. and the distal urethra and vagina.
 Two folds of adipose tissue covered by
5. PROSTATE GLAND loose connective tissue and epithelium.
 Chestnut-sized gland that lies just below the
bladder. OTHER EXTERNAL ORGANS
 The urethra passes through the center of it,
like the hole in a doughnut. 4. VESTIBULE
 Secretes a thin, alkaline fluid  flattened smooth surface inside the labia
 The openings to the bladder (the urethra)
6. BULBOURETHRAL GLANDS (COWPER’S and the uterus (the vagina) both arise from
GLAND) the vestibule.
 lies beside the prostate gland and empty by
short ducts into the urethra.
 secrete an alkaline fluid that helps
counteract the acid secretion of the urethra
and ensure safe passage of spermatozoa
 semen is derived from prostate (60%), 5. CLITORIS
seminal vesicles (30%), epididymis (5%),  1 to 2 cm small rounded organ of erectile
bulbourethral (5%). tissue at the forward junction of labia minora

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  sensitive to touch and temperature and is  anterior portion of the vulva derives its
the center of arousal sexual arousal and nerve supply from the ilioinguinal and
orgasm in a woman. genitofemoral nerves.
 posterior portion of the vulva and vagina are
6. SKENE’S GLANDS (PARAURETHRAL supplied by the pudendal nerve
GLANDS)
 located just lateral to the vaginal opening on FEMALE (INTERNAL)
both sides.
 secretions help lubricate the external 1. OVARIES
genitalia during coitus.  4cm long and 2 cm in diameter, approx. 1.5
 alkaline secretion helps improve sperm cm thick.
survival in the vagina  size of shape almonds.
 located close to and on both sides of the
7. FOURCHETTE uterus.
 Ridge of tissue formed by the posterior  held suspended and in close contact with
joining of the two labia minora and labia ends of the fallopian tubes by three strong
majora. supporting ligaments.
 This is the structure that is sometimes cut  produce mature and discharge ova (egg
(episiotomy) during childbirth to enlarge cells).
vaginal opening  produce estrogen and progesterone
 initiate and regulate menstrual cycle.
8. PERINUEM  necessary for maturation and maintenance
 Muscular area easily stretched during of secondary sex characteristics in females.
childbirth to allow enlargement of the vagina  estrogen secreted also prevents
and passage of the fetal head osteoporosis.
 Kegel’s exercise aimed at making perineal
muscle more flexible to allow easier DIVISION OF REPRODUCTIVE CELL (GEMETES)

expansion during birth without tearing the

tissue.  at birth each ovary contains approx. 2
million immature ova (oocytes) which were
9. HYMEN formed during the first 5 months of
 Tough but elastic semicircle of tissue that intrauterine life.
covers the opening at the vagina in  nucleus of all other human body cells
childhood. contains 46 chromosomes; consisting of 22
 Often torn during time of first sexual pairs of autosomes and one pair of sex
intercourse. chromosomes in the females and X and Y
chromosome in the male
VULVAR BLOOD SUPPLY  Reproductive cells have only half the usual
number of chromosomes, so that when they
 blood supply of external genitalis is through combine during fertilization the new
the pudendal artery and inferior rectus individual formed from them will have
artery. normal number, 46 chromosomes
 venous return is through the pudendal vein.
 pressure on the pudendal vein by fetal head MATURATION OF OOCYTES

can cause extensive back-pressure and

development of varicosities (distended vein)  each oocyte lies in the ovary surrounded by
in the labia majora. a protective sac, or thin layer of cells called
a follicle.
 underdeveloped follicle is called primordial
follicle.
 between 5 and 7 million of this are found in
the utero.
 the majority never develop beyond the
VULVAR NERVE SUPPLY primitive state and actually atrophy so that
at birth only 2 million are present.
 by age 7 years, only approximately 500,000
are present in each ovary.

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  by 22 years,300,000 a) Body of the Uterus
 by menopause or end of fertile period in - is the uppermost part and forms the bulk of
females none are left. the organ.
- The lining of the cavity is continuous with
Menopause - the point at which no functioning that of the fallopian tubes, which enter at its
oocytes remain in the ovaries. upper aspects (the cornua).
- During pregnancy, the body of the uterus is
2. FALLOPIAN TUBES the portion of the structure that expands to
 arise from each upper corner of the uterine contain the growing fetus.
body and extend outward and backward
until each open to the ovary. Fundus - portion of the uterus between the
 approximately 10 cm in length points of attachment of the fallopian tubes.
 lining is composed of mucous membrane - expands to contain the growing fetus
which contains mucous secreting and - Fundus can be palpated to
ciliated (hair covered cells) determine the amount of the uterine
 also composed of connective tissue and growth occurring during pregnancy
circular muscle layer - Assessed if uterus is returning to
 the muscle layer produces peristaltic nonpregnant state after childbirth
motions that help conduct ovum to the
length of the tube b) Isthmus
 the mucus produce also acts as source of - short segment between the body and the
nourishment for fertilized egg, because it
cervix
contains protein water and salts.
- 1-2 mm in length
 convey the ovum from the ovaries to the
- Also enlarges greatly to aid in
uterus and to provide a place for fertilization
accommodating the growing fetus
of the ovum by sperm
- is the portion that is most commonly cut
 divided into interstitial (1 cm), isthmus (5
when fetus is born by cesarean birth.
cm) and infundibulum (2 cm funnel shape)

c) Cervix
3. UTERUS
- the lowest portion of the uterus
 hollow, muscular, pear-shaped organ
located in the lower pelvis - represents approximately one third of the
 posterior to the bladder and anterior to the total uterus size
rectum - 1-2 cm long
 during childhood approximately the size of - the central cavity is termed as the cervical
an olive canal
 when a girl reaches 8 years of age, an - internal cervical os
increase in size of uterus begins - External cervical os
 17 years old-reaches an adult size
 with maturity the size is: 5-7 cm long, 5 cm 3 COATS/LAYERS OF TISSUE (UTERINE WALL)
wide
 in none pregnant state it weighs a) Endometrium
approximately 60 g - inner mucous membrane of the uterus
 functions to receive the ovum from the - important for menstrual function
fallopian tube - formed by 2 layers: basal layer not
 provide a place for implantation and influenced by hormone and inner glandular
nourishment during fetal growth layer influenced by estrogen and
 furnish a protection to a growing fetus progesterone
 After pregnancy 9 cm long,6 cm wide, 3 cm - Inner glandular- grows and become so
thick and 80g in weight thick and responsive each month under the
influence of estrogen and progesterone
capable of supporting pregnancy, if
pregnancy does not occur this is the layer
that is shed as the menstrual flow
3 DIVISIONS - mucous membrane lining the cervix is
termed as endocervix

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- during pregnancy the endocervix becomes  bicornuate uterus-oddly shaped “horns” at
plugged with mucous, forming a seal to the junction of the fallopian tubes.
keep out ascending infections(operculum)  Anteverted Uterus - normal presentation of
the uterus, the body of the uterus is tipped
b) Myometrium slightly forward.
- muscle of the uterus, composed of  Ordinarily, the body of the uterus is tipped
interwoven layers of smooth muscle slightly forward.
- serves the important function of constricting
the tubal junctions and preventing 1. Anteversion- a condition in which the
regurgitation of menstrual blood into the entire uterus is tipped far forward
tubes 2. Retroversion- a condition in which the
- holds the internal cervical os closed during entire uterus is tipped backward
pregnancy 3. Anteflexion -a condition in which the
body of the uterus is bent sharply forward at
c) Perimetrium the junction with the cervix
- outermost layer of uterus 4. Retroflexion- a condition in which the
- adds strength and support to structure body is bent sharply back just above the
cervix
UTERINE SUPPORT
4. VAGINA
a) Broad Ligaments  hollow musculo-membraneous canal
- two folds of peritoneum that cover the located posterior to the bladder and anterior
uterus front and back and extend to the to the rectum
pelvis sides  extend from the cervix to the external vulva
 acts as the organ of intercourse
b) Posterior ligament  conveys sperm to the cervix so that sperm
- a fold of peritoneum behind the uterus can meet with the ovum in the fallopian tube
- forms a pouch(Douglas’ cul-de-sac)  expand to serve as birth canal during child
between the rectum and uterus birth
 Ph is acidic due to the action of
c) Round Ligaments Doderlerein’s Bacillus
- two fibrous muscular cords that pass from
BREAST
the body of the uterus near the attachments
 remain in a halted stage of development
of the fallopian tubes, through the broad
until a rise in estrogen at puberty produces
ligaments and into inguinal canal inserting
a marked increase in their size
into the fascia of the vulva
 Gynecomastia-temporary increase in
- causes a quick sharp pain of frightening
breast size in boys during puberty
intensity in one of the lower abdominal  Milk glands divided by connective tissue
quadrants that can be mistaken for labor partitions into approx. 20 lobes
pain
ACINAR CELLS (ACINI OR ALVEOLI)
UTERINE DEVIATIONS

 Responsible for the production of

 Several uterine deviations (shape and COLOSTRUM during pregnancy (starting @
position) may interfere with fertility or 4th month) under the influence of placental
pregnancy. hormones Human Placental Lactogen (HPL)
 In the fetus, the uterus first forms with a  Responsible for the production of Breast
septum or a fibrous division, longitudinally Milk after delivery with the action of
separating it into two portions. PROLACTIN
 As the fetus matures, this septum dissolves,
so that typically at birth no remnant of the
division remains. In some women, the
septum never atrophies, and so the uterus
remains as two separate compartments. In OXYTOXIN – responsible for the milk letdown
others, half of the septum is still present. reflex.

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  Nipple has approximately 20 small Pelvic inlet
openings through which milk is secreted.  Aka: pelvic brim or os coxae (13cm)
 Ampulla portion of the duct located just  Is the entrance to the true pelvis
posterior to the nipples serves as reservoir  It is at the level of the linea terminalis
for milk before breast-feeding.  The widest diameter of the pelvic inlet is
 the nipple is surrounded by darkly sideways(transverse)
pigmented area of epithelium approximately  The greatest diameter of the fetal skull is
4 cm in diameter termed as areola the a-p diameter (12.5cm)
 the areola contains many sebaceous gland
called montgomery’s tubercles Pelvic outlet
 Inferior portion of the pelvis
PELVIS  The portion bounded by the following:
 Back- sacrum
 support and protect the reproductive and  Front-symphysis pubis
other pelvic organs  Sides- ischial tuberosity
 formed by two innominate (flaring hip),which  The greatest diameter of the pelvic outlet is
form the anterior and lateral portion of the the antero-postero diameter
ring, and the coccyx and sacrum, which
form the posterior aspect. Pelvic cavity
 each innominate bone is divided into ilium,  The space between pelvic inlet and pelvic
ischium, and pubis outlet
 Curved passage- slows and controls the
other Landmarks: speed of birth

Symphysis pubis MENSTRUAL CYCLE

 The junction of the innominate bones at the
front of the pelvis  episodic uterine bleeding in response to
cyclic hormonal changes.
Sacrum  it starts on day 1 of the menstrual period.
 Forms the upper posterior portion of the
pelvic ring CHARACTERISTICS OF NORMAL MESTRUAL CYCLE
 Sacral prominence(promontory)
 The prominent part of the sacrum  Beginning/menarche - ave. age at
onset,11-13 yrs; average range 9-17.
Coccynx  Interval between cycle - ave. 28 days; 23-
 Just below the sacrum it is pressed 35 days
backward allowing room for fetal head as it  Duration of menstrual flow - ave.2-7 days;
passes through the bony pelvic ring at birth. ranges from 1-9 days not abnormal
 Amount of the menstrual flow – ave. of
PELVIC DIVISION 30-80 ml per menstrual period
 Color of menstrual flow - dark red,
1. False Pelvis combination of blood, mucus, and
 superior half endometrial cells.
 supports the uterus during late months of
pregnancy and aids in directing the fetus
into the true pelvis

2. True Pelvis
 the inferior half
 False pelvis is divided from true pelvis by an
imaginary line Linea terminalis.

Other important terms: PHYSIOLOGY

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 ORGANS
PHASE 1 – MESNTRUAL PHASE
A. Hypothalamus
 Releases GnRH in response to hormonal  The first day of bleeding is considered day
changes one of the menstrual cycle.
 On this day, the hormone progesterone
B. Anterior Pituitary Gland plunges, which causes the uterine lining to
 Releases FSH and LH in response to the shed, AKA “the period". Often, a period
GnRH lasts between 3 and 7 days.
 During this week, the women's energy is the
C. Ovaries lowest in the cycle and may feel tired and
 Releases Estrogen and Progesterone in withdrawn.
response to FSH and LH.  If energy is on the low side, limit exercise to
gentle movement and stretching
D. Uterus like yoga and walking.
 Responds to the fluctuating levels of
Estrogen and Progesterone PHASE 2 – FOLLICULAR PHASE

HORMONES  This phase follows just after menstruation.

 It's called the Follicular phase because
A. Gonadotropic-Releasing Hormone (GnRH) pituitary gland releases a hormone called
 Follicle Stimulating Hormone-Releasing Follicle Stimulating Hormone (FSH), which
Hormone (FSHRH) stimulates the follicles in ovaries to mature.
 Luteinizing Hormone-Releasing Hormone  Estrogen and testosterone start to rise
(LHRH) during this phase.
 This will bring a boost of energy and can
B. Follicle Stimulating Hormone often improve mood.
 Stimulates the development of the Graafian  May even feel more assertive and willing to
follicle beginning on day 6. take risks.
 Testosterone stimulates libido while
C. Luteinizing Hormone estrogen makes feel more extroverted and
 Ruptures the Graafian Follicle to develop suppresses appetite.
Corpus Luteum on the day following  This is a time when women may feel a wide
ovulation variety of feelings related to self-sufficiency

D. Estrogen PHASE 3 – OVULATORY PHASE

 Produced by the Graafian Follicle
 Ovulation is the culmination of all the hard
E. Progesterone work the body has been doing over the last
 Produced by the Corpus Luteum couple of weeks.
 An egg gets released from its follicle in the
STRUCTURES
ovary and will survive for 12-24 hours
 Estrogen and testosterone rise to peak
A. Graafian follicle
levels, boosting the effects of the follicular
 Present in the ovary from day 6 until the day
phase. You may feel that you look better
of ovulation
and feel more confident so it will be easier
to verbalize your thoughts and feelings.
B. Corpus Luteum
Plus, your sex drive will be at its highest.
 Present following the day of ovulation until
the day of next menstruation

C. Corpus Albicans
 Present on the surface of the ovary during
menstruation
PHASE 4 – LUTEAL PHASE
FOUR PHASES OF MENSTRUAL
CYCLE

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 The first 2 to 3 days of this phase will feel a estrogenic, follicular, or postmenstrual
lot like the ovulatory phase. That changes phase.
when estrogen and testosterone decline,
and your body starts SECRETORY (SECOND PHASE)
producing progesterone
 After ovulation, the formation of
Symptoms progesterone in the corpus luteum (under
the direction of LH) causes the glands of the
 Since progesterone is an anti-anxiety uterine endometrium to become corkscrew
hormone, so you will find yourself beginning or twisted in appearance and dilated with
to wind down. Now is a good time for quantities of glycogen (an elementary
nesting, chores and taking care of your to- sugar) and mucin (a protein).
do lists.  The capillaries of the endometrium increase
 The second half of this phase, however, is in amount until the lining takes on the
notoriously difficult for many women. You appearance of rich, spongy velvet.
might feel PMS symptoms like cravings for  This second phase of the menstrual cycle is
carbohydrate-heavy comfort foods, bloating, termed the pregestational, luteal,
breast tenderness, headaches, anxiety and premenstrual, or secretory phase
moodiness. These symptoms are not all in
your head, but they aren't something you ISCHEMIC (THIRD PHASE)
should suffer through either.
 If fertilization does not occur, the corpus
Action steps luteum in the ovary begins to regress after 8
 Practice good self-care during the week to 10 days.
before your period and you'll likely notice  As it regresses, the production of
less PMS. Try spending extra time  progesterone and estrogen decreases.
alone, eating healthy foods, taking  With the withdrawal of progesterone
a restorative yoga class, or receiving stress- stimulation, the endometrium of the uterus
relieving treatments, like a massage or begins to degenerate (at approximately day
acupuncture. Taking magnesium 24 or day 25 of the cycle).
supplements can also be helpful in reducing  The capillaries rupture, with minute
headaches and muscle tension. When you hemorrhages, and the endometrium sloughs
honor your body's innate need for rest and off.
relaxation during this phase, you will
enhance your ability to get more out of the MENSES (FOURTH PHASE)
active phases of your cycle
 Menses, or the menstrual flow, is composed
PROLIFERATIVE (FIRST PHASE) of:
 Blood from the ruptured capillaries
 Immediately after a menstrual flow (which  Mucin from the glands
occurs during the first 4 or 5 days of a  Fragments of endometrial tissue
cycle), the endometrium, or lining of the  The microscopic, atrophied, and
uterus, is very thin, approximately one cell unfertilized ovum
layer in depth.  Menses is actually the end of an arbitrarily
 As the ovary begins to produce estrogen (in defined menstrual cycle.
the follicular fluid, under the direction of the  Because it is the only external marker of the
pituitary FSH), the endometrium begins to cycle, however, the first day of menstrual
proliferate. flow is used to mark the beginning day of a
 This growth is very rapid and increases the new menstrual cycle.
thickness of the endometrium approximately  Contrary to common belief, a menstrual flow
eightfold. contains only approximately 30 to 80 mL of
 This increase continues for the first half of blood; if it seems like more, it is because of
the menstrual cycle (from approximately day the accompanying mucus and endometrial
5 to day14). This half of a menstrual cycle is shreds.
termed interchangeably the proliferative,  The iron loss in a typical menstrual flow is
approximately 11 mg.

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 This is enough loss that many women need 1.Biologic Gender-the term used to denote a
to take a daily iron supplement to prevent person’s chromosomal sex: male(xy) or (xx).
iron depletion during their menstruating
years. 2. Gender Identity or Sexual Identity-is the inner
 If estrogen is at its highest, it is a sign of sense a person has of being male or female, which
ovulation, therefore the woman is fertile. may be the same as or different from biologic
 The cervix also responds to the increased gender.
level of estrogen, the cervix increases its
blood supply which then stimulates the 3. Gender Role-is the male or female behavior a
GLAND OF NABOTH which produces person exhibits, which again, may or may not be
operculum that becomes thin, alkaline, and the same as biologic gender or gender identity.
stretchable (SPINNBARKEIT TEST)
 Fern test - High levels of estrogen are HUMAN SEXUAL RESPONSE
present just before ovulation cervical mucus
forms fernlike patterns when it is placed on 1. EXCITEMENT
a glass slide and allowed to dry  occurs with physical and physical and
 If estrogen is at its highest, Progesterone is psychological stimulation (sight, sound,
at its lowest, because the Graafian follicle emotion or thought) that causes
does not produce progesterone. parasympathetic nerve stimulation.
 This leads to arterial dilation and venous
MENSTRUAL DISORDER constriction in the genital area.
 The resulting increased blood supply leads
1. Dysmenorrhea (painful menstruation) to vasocongestion and increasing muscular
2. Menorrhagia (abnormally heavy menstrual tension.
flows)  In women, this vasocongestion causes the
3. Metrorrhagia (bleeding between menstrual clitoris to increase in size and mucoid fluid
periods) to appear on vaginal walls as lubrication.
4. Menstrual migraines The vagina widens in diameter and
5. Premenstrual dysphoric syndrome increases in length. The nipples become
erect.
 In women who are beginning menopause,  In men, penile erection occurs, as both
menses may typically consist of a few days sexes, there is an increase in heart and
of spotting before a heavy flow, or a heavy respiratory rates and blood pressure.
flow followed by a few days of spotting,
because progesterone withdrawal is more 2. PLATEAU
sluggish or tends to “staircase” rather than  In woman clitoris is drawn forward and
withdraw smoothly. retracts under the clitoral prepuce, the lower
part of the vagina becomes extremely
MENOPAUSE congested and there is increased nipple
elevation.
 Is the cessation of menstrual cycles.
 Perimenopausal is a term used to denote 3. ORGASM
the period during which menopausal  Proceeds through the plateau stage to
changes occur. appoint at which the body suddenly
 Postmenopausal describes the time of life discharges accumulated sexual tension.
following the final menses.  A vigorous contraction of muscles in the
 The age range at which menopause occurs pelvic area expels or dissipates blood and
is wide, between approximately 40 and 55 fluid from the area of congestion.
years of age with a mean age of 51.3.  The average number of contractions for the
woman is 8 to 15 contractions at intervals of
one every 0.8 seconds.
 In men, muscle contractions surrounding
the seminal vessels and prostate project
semen into the proximal urethra.
SEXUALITY AND SEXUAL IDENTITY  These contractions are followed
immediately by three to seven propulsive

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 ejaculatory contractions, occurring at the 9. Pedophiles – individuals who are interested in
same time interval as in the woman, which sexual encounters with children.
force semen from the penis.
 Shortest stage in sexual response cycle SEXUAL HARASSMENT

4. RESOLUTION  Sexual harassment is unwanted and

 period during which the external and repeated sexual advances, remarks, or
internal genital organs return to an behavior toward another that
unaroused state. (a) is offensive to the recipient and
 usually takes 30 minutes for both men and (b) interferes with job or school
women. performance.
 It can involve actions as obvious as a job
TYPES OF SEXUAL ORIENTATION superior demanding sexual favors or a job
superior sending sexist jokes by e-mail to a
1. Heterosexuality - finds sexual fulfillment with a person supervised.
member of the opposite gender.  In school it can refer to bullying
 Sexual harassment rules apply to same-
2. Homosexuality – finds sexual fulfillment with a gender as well as opposite-gender
member of his or her own sex. Lesbian and Gay harassment.
 In addition to causing occupational
3. Bisexuality - achieve sexual satisfaction from disruption, sexual harassment may be so
both homosexual and heterosexual relationships. distressing that it leads to short- and long-
term psychosocial consequences for victims
4. Transexuality – or transgender person is an and their families such as emotional distress
individual who, although of one biologic gender, (anxiety, depression, posttraumatic stress
feels as if he or she should be of opposite gender. disorder, substance abuse), interpersonal
People who have sex change. conflict, and impaired intimacy and sexual
functioning
TYPES OF SEXUAL EXPRESSION
TYPES OF SEXUAL HARASSMENT
1. Celibacy – abstinence from sexual activity. Ex.
Priest 1. QUID PRO QUO (an equal exchange)
 in which an employer asks for something in
2. Masturbation – is self-stimulation for erotic return for sexual favors, such as a hiring or
pleasure. promotion preference.

3.Erotic Stimulation – is the use of visual 2. HOSTILE WORK ENVIRONMENT

materials such as magazines or photographs  In which an employer creates an
environment in which an employee feels
for sexual arousal. uncomfortable and exploited (e.g., being
addressed as “honey,” asked to wear
4. Fetishism – is sexual arousal resulting from the revealing clothing, working where walls are
use of certain objects or situations. decorated with sexist posters).

5. Transvestism – an individual who dresses to DISORDERS OF SEXUAL FUNCTIONING

take on the role of opposite sex.  Disorders involving sexual functioning can
be lifelong (primary) or acquired
6. Voyeurism – obtaining sexual arousal by looking (secondary).
at another’s person’s body.  They can have a psychogenic origin
(produced by psychic rather than organic
7. Sadomasochism – involves inflicting pain factors), a biogenic origin (produced by
(sadism ) or receiving pain (masochism ) biologic processes), or both.
to achieve sexual satisfaction.  They occur in both men and women.

8. Exhibitionism – revealing one’s genitals in

public.

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1. Inhibited Sexual Desire  The problem is compounded by doubt about
the ability to perform and reluctance to
 Lessened interest in sexual relations is discuss the problem with health care
normal in some circumstances, such as providers.
after the death of a family member, a  Examples of drugs prescribed today for ED
divorce, or a stressful job change. are sildenafil (Viagra), tadalafil(Cialis), and
 The support of a caring sexual partner or vardenafil (Levitra), which are taken up to
relief of the tension causing the stress once a day to stimulate penile erection.
allows a return to sexual interest
 Decreased sexual desire can also be a side 4. Premature ejaculation
effect of many  is ejaculation before penile–vaginal contact.
 medicines.  The term also is often used to mean
 Chronic diseases, such as peptic ulcers or ejaculation before the sexual partner’s
chronic pulmonary disorders, that cause satisfaction has been achieved.
frequent pain or discomfort may interfere  Premature ejaculation can be unsatisfactory
with a man’s or a woman’s and frustrating for both partners
 overall well-being and interest in sexual  The cause, like that of ED, can be
activity. psychological.
 Obese men and women may not feel as  Masturbating to orgasm (in which orgasm is
much satisfaction from sexual relations as achieved quickly because of lack of time)
others, because they have difficulty may play a role.
achieving deep penetration because of the  Other reasons suggested are doubt about
bulk of their abdomens masculinity and fear of impregnating a
 Some women experience a decrease in partner, which prevent the man from
sexual desire during perimenopause. sustaining an erection.
 Administration of androgen (testosterone) to  Sexual counseling for both partners to
women may be helpful at that time, because reduce stress, as well as serotonergic
it can improve interest in sexual activity antidepressants such as Mirtazapine, may
be helpful in alleviating the problem
2. Failure to Achieve Orgasm
5. Persistent Sexual Arousal Syndrome (PSAS)
 The failure of a woman to achieve orgasm
can be a result of poor sexual technique,  is excessive and unrelenting sexual arousal
concentrating too hard on achievement, or in the absence of desire.
negative attitudes toward sexual  It may be triggered by medications or
relationships. psychological factors.
 Treatment is aimed at relieving the  When assessing someone with the disorder,
underlying cause. be certain to ask if the person is taking any
 It may include instruction and counseling for herbal remedies such as Ginkgo biloba
the couple about sexual feelings and needs. because some of these can have arousal
effects.
3. Erectile Dysfunction

 Erectile dysfunction (ED), formerly referred

to as impotence, is the inability of a man to
produce or maintain an erection long
enough for vaginal penetration or partner
satisfaction
 Most causes of ED are physical, such as
aging, atherosclerosis, or diabetes, which
limit blood supply.
 It may also occur as a side effect of certain
drugs

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 PAIN DISORDERS

 Because the reproductive system has a

sensitive nerve supply, when pain occurs in
response to sexual activities, it can be acute
and severe and impair a person’s ability to
enjoy this segment of their life.

1. Vaginismus

 Vaginismus is involuntary contraction of the

muscles at the outlet of the vagina when
coitus is attempted that prohibits penile
penetration .
 Vaginismus may occur in women who have
been raped.
 Other causes are unknown, but it could also
be the result of early learning patterns in
which sexual relations were viewed as bad
or sinful.

2. Dyspareunia and Vestibulitis

DYSPAREUNIA -is pain during coitus.

 This can occur because of endometriosis
(abnormal placement of endometrial tissue)

VESTIBULITIS -inflammation of the vestibule

 can occur because of vaginal infection, or
hormonal changes such as those that occur
with menopause and cause vaginal drying
 A psychological component may be present.
 Treatment is aimed at the underlying cause.
 Encouraging open communication between
sexual partners can be instrumental in
resolving the problem.

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