Chapter Five

1. Female Sexual Anatomy Chapter Five

2. Agenda • Discuss Female Sexual & Reproductive System • Describe Female Maturation Cycle • Discuss Female Reproductive and Sexual Health

3. External Sex Organs Internal Sex Organs Other Sex Organs The Female Sexual and Reproductive System

4. Video: The Vagina Monologues • What is your reaction to the video?

5. External Sex Organs • Vulva/Pudendum – entire female region of external sex organs • Mons Veneris • protective, fatty cushion over the pubic bone; • covered with pubic hair • Labia Majora • outer lips; • tissue folds from mons to perineum surrounding the rest of the female genitals; • engorge with blood if excited

6. External Sex Organs • Labia Minora • inner lips; • pink tissue folds between vestibule and labia majora; • no hair; • many oil glands; • darken if sexually aroused • Clitoris • small cylindrical erectile tissue beneath the prepuce; • rich in blood supply and nerve endings; • solely to provide sexual pleasure, primarily via indirect stimulation

7. External Sex Organs • Vestibule – region between the labia minora; urethral and vaginal openings, Bartholin’s glands ducts • Urethral Meatus – between clitoris and vagina • Perineum – between anus and vagina

8. The external genital structures of the mature female.

9. Internal Sex Organs • Vagina • 4 inch, thin-walled accordion-like tube from the introitus to the cervix, tilted back; • organ of intercourse and canal for menses and babies; • lubricant secreted from vaginal wall openings when engorged; • first 1/3 contains many nerve endings, • inner 2/3 has little nerves

10. Internal Sex Organs • Grafenberg Spot (G-spot) – dime to quarter sized spot in the lower third of anterior vaginal wall (2-3 inches up), just past the pubic bone; • sensitive area; • Controversy: • Female ejaculation – powerful orgasms and expulsion of fluid (up to 4 ounces) due to stimulation of the G-spot in some women; • may be Skene’s glands fluid or urine

11. Internal Sex Organs • Uterus – 1-inch thick walls, hollow, muscular organ between the bladder and rectum; monthly cycle of change; menstruation, protects fetus, contractions to expel menses and fetus; 3 inches long, 2 inches wide • 3 uterine wall layers: • Perimetrium • Myometrium • Endometrium

12. Internal Sex Organs • Cervix – at bottom of the uterus; doughnut-shaped; secretes mucus to help or impede sperm, depending on the monthly cycle • Os – opening leading into the uterus

13. Internal Sex Organs • Fallopian Tubes (oviducts) – two 4-inch long trumpet shaped tubes that extend from the sides of the uterus and curve up to and around the ovaries • Ampulla – typical site of fertilization • Infundibulum – has fimbriae surrounding the ovaries to collect an egg upon release • Ovaries – form of an almond shell; contain 250,000 ova each; produce estrogen

14. The female internal reproductive system (side view).

15. The female internal reproductive system (front view).

16. Other Sex Organs • Any area can be arousing depending on the type of stimulation and the perceptions of the recipient • Breasts (mammary glands) – modified sweat glands that produce milk; fatty tissue, 15 to 20 lobes, and milk-producing glands (alveoli) Nipple, areola • Sucking stimulates pituitary gland to release prolactin (begin milk synthesis) and oxytocin (release of milk)

17. The female breast.

18. Female Puberty Menstruation Menopause The Female Maturation Cycle

19. Female Puberty • Begins anywhere from 8 to 15 years of age • Earlier onset of menstruation may be due to being overweight; can vary with race • Puberty lasts about 3 to 5 years • Begins when pituitary gland initiates release of FSH and LH, which increases the ovaries production of estrogen • Increased size of Fallopian tubes, uterus, vagina, breasts, buttocks, thighs

20. Female Puberty • Pelvis widens • Pubic hair grows • During puberty (usually 11 or 12 years), ovulation commences • Menarche occurs during this time as well, although it may be a few months before or after ovulation begins

21. Menstruation • Menstruation – uterine lining is shed if no pregnancy; tissue and blood exit the introitus • Menstrual cycle – lasts about 24 to 35 days, average is 28 days • Menstrual cycle has four phases: • Follicular phase • Ovulation phase • Luteal phase • Menstrual phase

22. Menstruation: Menstrual Cycle • Follicular phase – begins after menstruation ends; lasts 6-13 days; ovarian follicles begin to ripen; estrogen promotes development of endometrium to 2-5 millimeters thick • Ovulation phase – around day 14, an ovum is released due to FSH and LH that have ripened primary follicles; one follicle matures completely (secondary follicle) and ruptures, releasing the egg to be caught by the fimbriae

23. Menstruation: Menstrual Cycle • Luteal phase – corpus luteum forms on the ovary where the secondary follicle ruptured; it secretes progesterone and estrogen for 10-12 days to further develop the endometrium to 4-6 millimeters thick; without fertilization, the progesterone and estrogen levels signal to the hypothalamus to decrease LH and the corpus luteum deteriorates and estrogen and progesterone drop significantly

24. Menstruation • Menstrual phase – endometrial buildup is expelled through uterine contractions for 3-7 days; volume of menses is about 2-4 tablespoons of fluid

25. The cycle of female hormones.

26. Variations in Menstruation • Amenorrhea – absence of menstruation • Primary amenorrhea – never begins menstruation; physical, health, emotional causes • Secondary amenorrhea – menses cease before reaching menopause; pregnancy, lifestyle, emotional, physical causes • Menorrhagia – excessive menses; oral contraceptives can help control

27. Variations in Menstruation • Dysfunctional uterine bleeding (DUB) – bleeding for long periods, or intermittent bleeding; hormonal, lifestyle, physical causes • Dysmenorrhea – painful menstruation; caused by inflammations, constipation, psychological stress; recommend medication, relaxation, yoga, massage, and stress relief

28. Variations in Menstruation • Premenstrual Syndrome (PMS) – physical or emotional symptoms that occur during the last few weeks of the menstrual cycle • Premenstrual Dysphoric Disorder (PMDD) – mood, behavioral, somatic, and cognitive symptoms; medication (SSRIs) and lifestyle changes provide relief • Variations in Menstruation • Risk factors for PMS and PMDD: history of depression, sexual abuse, PTSD, smoking

29. Menstrual Manipulation and Suppression • Women can experience up to 450 periods • Ways to stem growth of the endometrium: • Continuous birth control pills • Progesterone intrauterine devices • Injections • It is possible to relieve many physical symptoms related to menstruation • Some see menses as indicating health • No medical basis to avoid sex during a period

30. The Instead Softcup can be used during a woman’s period to make sexual activity less messy.

31. Menopause • A woman’s final menstrual period • Climacteric – period of decreased estrogen production and menstruation stops; 40-58 years, average 51 years • Typically have irregular cycles, rather than a sudden stop • Sexual glands decrease in size • Secondary sex characteristics change

32. Menopause • Hormonal changes – hot flashes, headaches, sleep disturbances • Sexual complaints • Menopause can be induced by surgically removing the ovaries; doctors try to keep at least one in if surgery is necessary

33. Menopause • Hormone replacement therapy – was a standard treatment, but there are a lot of health risks and not typically used today • Nutritional, vitamin, and herbal remedies are commonly used today

34. Gynecological Health Concerns Cancer of the Female Reproductive Organs Female Reproductive and Sexual Health

35. Female Reproductive and Sexual Health • Genital self-exams are recommended for women to be familiar with their genitals and any possible abnormalities • Routine gynecological examinations recommended once menstruating • Medical history and checkup • Pelvic examination (internal and external) • Breast examination • Pap smear – cervical swab

36. Gynecological Health Concerns • Most prevalent: • Endometriosis • Toxic Shock Syndrome • Uterine Fibroids • Vulvodynia • Vaginal Infections

37. Endometriosis • Endometrial cells deposit outside of the uterus • Will engorge/weaken with the menstrual cycle • Symptoms: painful periods, lower abdominal or pelvic pain, pain on defecation, pain during intercourse • Typically childless women between 25 and 40 • Cause is unknown • Treatment: hormones, surgery, laser therapy

38. Toxic Shock Syndrome • Caused by prolonged use of a single tampon which creates a buildup and subsequent infection of bacteria • Symptoms: fever, diarrhea, vomiting, sore throat, muscle ache, rash, • May cause: dizziness, respiratory distress, kidney failure, heart failure, death • Avoid by changing tampons regularly, using less absorbent tampons, using sanitary pads

39. Uterine Fibroids • Hard tissue masses in the uterus; size range • Affect 20-40% (maybe 77%) of women over 35 years • Symptoms: pelvic pain and pressure, heavy cramping, heavy or prolonged bleeding, constipation, frequent urination, painful sex • Treatment: hormones, drugs, laser therapy, surgery, cryotherapy

40. Vulvodynia • Chronic pain and soreness of the vulva • Symptoms: vaginal burning, itching, rawness, stinging, stabbing of vagina/vulva • The pain may be intermittent or constant • Cause is unknown • Treatment: biofeedback, drugs, dietary changes, nerve blocks, surgery, pelvic floor muscle strengthening

41. Infections • Non-sexually transmitted infections can occur • Bartholin’s glands • Urinary tract • May be due to poor hygiene practices and/or frequent intercourse • Treated by draining infected gland (if necessary) and use of antibiotics • Douches change the vaginal pH level and can increase risk of infection

42. Breast Uterine Cervical Endometrial Ovarian Cancer Associated with Female Reproductive Organs

43. Breast Cancer • Worldwide, the most common cancer • One in 7 American women will develop it • Risk factors: fat intake, aging, early menarche, prolonged estrogen, inactive lifestyle, alcohol consumption, genetics • Breastfeeding, early pregnancy reduces risk • Early detection is critical: breast self-examinations, gynecological checkups, mammography

44. Breast exam (in Feature box)

45. Breast Cancer • Symptoms: breast lump, breast pain, nipple discharge, puckering of skin, change in nipple shape • If untreated, the cancer will spread to other parts of the body • Treatment: partial/modified mastectomy, radical mastectomy, lumpectomy, radiation, chemotherapy

46. Breast Cancer : Education and Support Groups

47. Cervical Cancer • 1 in 130 American women • Pap smear is used for detection; should be screened every year by 21 years of age • High cure rates • Risk factors: early intercourse, many sexual partners, teenage mothers, cervicitis, genital viral infections, extended oral contraceptive use • Treatment: surgery, radiation, hysterectomy

48. Endometrial Cancer • Symptoms: abnormal bleeding, spotting • Detection most successful with dilation and curettage • Treatment: surgery, radiation, hormones, chemotherapy • Over 90% survival rate • Oral contraceptives decrease risk

49. Ovarian Cancer • Less common than breast, uterine cancers • Most deadly • Symptoms: few early signs, ovarian cyst, slight abdominal discomfort, appetite loss, indigestion, abdominal swelling, nausea, vomiting • Risk factors: childlessness, early menopause, high-fat diet, higher SES, lactose-intolerant, use talc powder on the vulva

50. Ovarian Cancer • Decreased risk with having children and using birth control pills, tubal ligation • Detection techniques: blood tests, pelvic exams, ultrasound • Unfortunately, most diagnosed after cancer has spread beyond the ovary because of the lack of early warning signs • Treatment: remove ovaries, radiation, chemotherapy