Transcript Chapter 6 Sexual Arousal and Response

Chapter 3
Female Sexual Anatomy and
Physiology
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
The external genital structures of the mature female.
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
The external genital structures of the mature female.
The Underlying Structures of the Vulva
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
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
– 3 layers: mucous, muscle, fibrous
Internal Sex Organs
• Vaginal Lubrication
– Lubrication changes vaginal pH (↑alkaline)
and increases pleasure
– Vasocongestion – Engorgement of blood
vessels
• 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
– Counterpart to the prostate gland
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
The female internal reproductive system (side view).
Internal Sex Organs
• Uterus – 1-inch thick walls, hollow,
muscular organ between the bladder and
rectum; protects fetus, contractions to
expel menses and fetus; 3 inches long, 2
inches wide
– 3 uterine wall layers:
•Perimetrium
•Myometrium
•Endometrium
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.
– (At birth, females have up to 400,000 immature
follicles. )
The female internal reproductive system (front view).
Breasts
• Breasts (mammary glands) – modified
sweat glands that produce milk; fatty
tissue, 15 to 20 lobes, and milkproducing glands (alveoli)
Nipple, areola
– Sucking stimulates pituitary gland to
release prolactin (begin milk synthesis) and
oxytocin (release of milk)
The Female Maturation Cycle
Female Puberty
Menstruation
Menopause
Female Puberty
• Begins anywhere from 8 to 17 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
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
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:
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Menstrual phase
Follicular phase
Ovulation phase
Luteal phase
Menstrual Cycle
1
5
14
1. Menstrual phase – Days 1-5
2. Follicular phase – Days 6-13
3. Ovulation phase – Day 14
4. Luteal phase – Days 15-28
28
Menstruation
• Menstrual phase
– Endometrial buildup is expelled through
uterine contractions for 3-7 days;
– Volume of menses is about 2-4 tablespoons
of fluid
Menstruation: Menstrual Cycle
• Follicular (Proliferative) 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
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
Changes During the Menstrual Cycle
The cycle of female hormones.
Fertilization
1
• Egg
5
14
28
is viable for
24 hours
• Sperm is viable for
3 to 5 days
Pregnancy can occur if intercourse occurs from…
day 9 to 15 if ovulation occurs on day 14
day 7 to 17 could be unsafe
Variations in Menstruation
• Menstrual Synchrony / Pheromones
– Women’s cycles synchronize
– Women may be influenced by men
• Sexual Desire
– Some studies have shown
• An increase of desire and fantasies.
• More attentive to “maleness” features.
• Men are more attracted to ovulating women.
• Smell increased testosterone.
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
Variations in Menstruation
• Dysfunctional uterine bleeding (DUB)
– Bleeding for long periods, or intermittent
bleeding; hormonal, lifestyle, physical causes
• Menorrhagia
– Excessive menses; oral contraceptives can help
control it.
– 9-15% experience heavy bleeding. 5% seek
help.
– Age, Endometriosis, etc.
Variations in Menstruation
• Dysmenorrhea
– Painful menstruation; 72% of women have
pain, 15% enough to disrupt activities.
– Primary – No known abnormalities
– Secondary – Pelvic abnormalities, like
Endometriosis or PID.
– Often related to an overproduction of
Prostoglandins.
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) –
– Depression, anxiety, stress, irritability; medication
(SSRIs) and lifestyle changes provide relief
Menstrual Manipulation and
Suppression
• Women can experience up to 450 periods.
• Ways to stem growth of the endometrium:
– Continuous birth control pills
• Seasonale and Seasonique – 84 days
• Sybrel – a year or longer.
– Progesterone intrauterine devices
– Injections
• Recommended for Military or Athletes, now a lifestyle
choice.
• No medical basis to avoid sex during a period.
The Instead Softcup can be used during a woman’s period to make sexual activity less messy.
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
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
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
Female Reproductive and
Sexual Health
Gynecological Health Concerns
Cancer of the Female
Reproductive Organs
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
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Medical history and checkup
Pelvic examination (internal and external)
Breast examination
Pap smear – cervical swab
Gynecological Health Concerns
• Most prevalent:
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Endometriosis
Toxic Shock Syndrome
Uterine Fibroids
Vulvodynia
Vaginal Infections
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
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
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
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
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
Cancer Associated with
Female Reproductive Organs
Breast
Uterine
Cervical
Endometrial
Ovarian
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 selfexaminations, gynecological checkups,
mammography
Breast exam (in Feature box)
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
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
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
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
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