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Introduction 10

Chapter 1: Anatomy of the
   Human Reproductive
   System 19
The	Male	Reproductive	System			20
	 External	Genitalia			21
	 The	Penis			23                         21
	 The	Scrotum			26
	 The	Testes			27
	 Structures	of	the	Sperm	
   Canal			31
	 Accessory	Organs			35
The	Female	Reproductive	System			38
	 External	Genitalia			38
	 Internal	Structures			40

Chapter 2: Hormones and
  Reproductive Maturity			52
Sex	Hormones			52
	 Androgens			52
	 Estrogens			57
	 Progesterone			61
	 Gonadotropins			62
Puberty			65
	 Reproductive	Organs	and	
    Secondary	Sex	Characteristics			66
	 Normal	Variations			70
	 Physical	and	Behavioral	
    Interactions			71
Menstruation			74
	 Phases	of	the	Menstrual	Cycle			76
	 Hormonal	Control	of	the	
    Menstrual	Cycle			78
      	 Ovulation	and	the	Fertile		
        Phase			80
      	 Menarche			81
      	 Normal	Menstruation			82
      Menopause			82

      Chapter 3: Reproduction and
          Pregnancy 87
      Sexual	Intercourse			87
      Sperm	and	Ova			89

99    Fertilization			92
      Development	of	the	Reproductive	
          Organs			95
      Implantation			97
      Pregnancy			98
      	 Development	of	the	Placenta			99

115   	 Changes	to	Reproductive	
          Tissues		104	
      	 Pregnancy	Tests			109
      	 Prenatal	Care	and	Testing			109
      Multiple	Birth			113
      	 Twins	and	Twinning			113
      	 Other	Multiple	Births			116

      Chapter 4: Disorders of
         Reproductive Development
         and Function 118
      Genetic	and	Congenital	
         Abnormalities			118
      	 Abnormalities	in	Males			119
      	 Abnormalities	in	Females			122
      	 Intersexuality			124
      Disorders	of	Sexual	Maturity			133
      	 Precocious	Puberty			133
      	 Delayed	Puberty			136
      Disorders	Affecting	Menstruation			138
      	 Dysmenorrhea			138
      	 Menorrhagia			139
	  Metrorrhagia			140
	  Amenorrhea			141
	  Oligomenorrhea			142
	  Dysfunctional	Uterine		
   Bleeding			143                               153
	 Premenstrual	Syndrome			143
	 Stein-Leventhal	Syndrome			145
Disorders	of	the	Testes	and	Penis			148
	 Hydrocele			148
	 Priapism			149

Chapter 5: Infections and
   Cancers of the
   Reproductive System 151
Sexually	Transmitted	Diseases			151
	 Syphilis	and	Gonorrhea			152
	 Genital	Herpes			154
	 AIDS			155
	 Chlamydia			158
	 Trichomoniasis	and		
   Candidiasis			158
	 Genital	Warts			158
	 Chancroid	and	Granuloma			159
	 Cytomegalovirus	and		
   Hepatitis	B			159                      156
	 Pubic	Lice			160
Other	Infections	of	the	Reproductive	
   System			160
	 Puerperal	Fever			160
	 Tuberculosis			161
	 Balanitis,	Posthitis,	and	
   Epididymitis			162
	 Orchitis			162
	 Vesiculitis			164
	 Leukorrhea			164
	 Vaginitis			165
	 Vulvitis			166
	 Cervicitis			168
            	 Mastitis			169
            	 Pelvic	Inflammatory	Disease			171
            Hyperplasia	and	Major	Cancers	of	the	
173            Reproductive	Organs			172
            	 Benign	Prostatic	Hyperplasia			173
            	 Testicular	Cancer			174
            	 Prostate	Cancer			174
            	 Vulvar	Cancer			175
            	 Cervical	Cancer			175
            	 Uterine	and	Ovarian	Cancer			176

            Chapter 6: Infertility and
              Disorders of Pregnancy 178
            Infertility			178
            	 Female	Infertility			180
            	 Male	Infertility			185
            	 Assistive	Reproductive	
                Technologies	and	Artificial	
                Insemination			186
            Abnormal	Changes	in	Pregnancy			192
            	 Ectopic	Pregnancy			192
            	 Miscarriage			197

            Disorders	of	the	Placenta			199
            	 Placenta	Praevia			199
            	 Placentae	Abruptio			200
            	 Placenta	Accreta			200
            	 Other	Abnormalities	of		
                Placenta			201
            Other	Disorders	of	Pregnancy			202
            	 Anomalies	of	the	Umbilical		
                Cord			202
            	 Hydramnios			203
            	 Oligohydramnios			205
            	 Hydatidiform	Mole			205
            	 Choriocarcinoma			206
      187   	 Gestational	Diabetes			207
            	 Preeclampsia	and	Eclampsia			208
Chapter 7: Issues Concerning
    Birth Control and
    Abortion 211
History	of	Birth	Control			212
Early	Advocates			214
The	Population	Explosion			217
Birth	Control	and	Health			218
Family	Planning			219
Methods	of	Birth	Control			221
	 Abstinence			221
	 Breast-Feeding			221
	 Coital	Techniques			222
	 Barrier	Methods			223
	 Periodic	Abstinence			223
	 Hormonal	Contraceptives			224
	 Intrauterine	Devices			227
	 Voluntary	Sterilization			229
The	Legality	of	Birth	Control			230
The	Ethics	of	Birth	Control			231
The	Significance	of	Birth		
    Control			238
Abortion			240
	 Procedures			240
	 Legality	of	Abortion			242
	 A	Divisive	Issue			244

Conclusion 246
Glossary 248
Bibliography 251
Index 253                             234
                    7     Introduction   7

A     s	far	back	as	the	biblical	story	of	Adam	and	Eve,	peo-
      ple	have	understood	that	human	reproduction	is	the	
result	of	sexual	union	between	a	man	and	a	woman.	Over	
the	centuries,	however,	theories	on	exactly	how	it	occurs	
varied	wildly.	The	early	Greek	physicians	Hippocrates	and	
Galen	 believed	 that	 the	 male	 and	 female	 reproductive	
organs	were	opposite	counterparts	of	each	other	in	form	
but	similar	in	function,	both	producing	semen	or	“seeds.”	
Conversely,	the	Greek	philosopher	Aristotle	posited	that	
the	male	contributed	the	human	essence	and	the	woman	
provided	 only	 the	 physical	 matter	 that	 nurtured	 that	
essence	into	an	infant.	Even	as	late	as	the	17th	century,	sci-
entists	continued	to	argue	over	whether	the	human	being	
was	formed	from	an	egg	or	from	a	miniature	human	“ani-
malcule”	in	the	sperm.
    Today	 it	 is	 known	 that	 reproduction	 occurs	 through	
the	 joining	 of	 an	 egg,	 contributed	 by	 the	 female,	 and	 a	
sperm,	 contributed	 by	 the	 male.	 Much	 more	 is	 known,	
too,	about	how	that	initial	fertilized	egg	develops	during	
pregnancy.	 In	 fact,	 scientists’	 understanding	 is	 now	 so	
complete	that	doctors	fertilize	eggs	outside	the	body,	or	
“in	 vitro,”	 to	 help	 treat	 certain	 types	 of	 infertility.	
Pregnancy	 can	 even	 be	 prevented	 through	 a	 variety	 of	
birth	 control	 methods.	 But	 as	 science	 advances	 in	 the	
understanding	of	human	reproduction,	it	also	leads	to	new	
ethical	and	societal	issues	that	must	be	resolved.
    This	 book	 explores	 both	 the	 science	 and	 the	 social	
issues	 surrounding	 the	 human	 reproductive	 system.	The	
differences	 between	 the	 male	 and	 female	 reproductive	
organs	 are	 highlighted,	 in	 addition	 to	 the	 different	 hor-
mones	 controlling	 their	 development	 and	 function.	The	
book	 outlines	 the	 process	 of	 reproduction	 and	 how	
the	fetus	develops,	as	well	as	issues	that	can	interfere	with	
those	processes.	Ethical	debates	range	from	birth	control	
to	infertility	treatments.		

               7     The Reproductive System    7

     Sexual	 reproduction	 is	 a	 trait	 shared	 by	 humans	 and	
most	 other	 complex	 life-forms,	 which	 means	 that	 the	
male	 and	 the	 female	 each	 have	 a	 distinct	 role	 to	 play	   	
in	 the	 process.	 Each	 individual’s	 gender	 determines	 not	
only	the	physical	characteristics	of	his	or	her	reproductive	
organs,	but	also	secondary	sexual	characteristics	that	are	
controlled	 by	 male	 and	 female	 reproductive	 hormones.	
The	physical	structure	of	the	organs	is	present	from	birth,	
but	the	process	of	sexual	maturation	typically	takes	place	
in	 the	 early	 to	 mid-teens	 for	 boys	 as	 well	 as	 girls.	 The	
male	 reproductive	organs	include	the	 external	penis	and	
scrotum	as	well	as	a	variety	of	internal	organs	for	the	pro-
duction	of	sperm	and	seminal	fluid.	Female	reproductive	
organs	are	mostly	internal	and	include	the	ovaries,	where	
eggs	 develop	 and	 are	 stored;	 the	 fallopian	 tubes,	 which	
deliver	them	to	the	uterus;	and	the	uterus	itself,	where	the	
fertilized	 egg	 develops	 into	 a	 viable	 fetus	 until	 delivery	
through	the	birth	canal.	
     In	both	boys	and	girls,	puberty	occurs	between	approx-
imately	11	and	16	years	of	age.	The	process	is	generated	in	
both	 sexes	 by	 the	 release	 of	 hormones,	 with	 estrogen	
secreted	by	the	ovaries	in	girls	and	testosterone	secreted	
by	the	testes	in	boys.	During	this	period	the	sexual	organs	
reach	maturity	and	the	individual	is	capable	of	reproduc-
tion.	 Other	 changes	 occur,	 too,	 giving	 rise	 to	 secondary	
sex	characteristics.	Boys	and	girls	both	develop	pubic	and	
underarm	hair.	Boys	begin	to	display	chest	and	facial	hair,	
whereas	girls	develop	breast	tissue.	Boys	also	experience	a	
sudden	voice	change	to	a	deeper	register	when	the	larynx	
lengthens,	which	is	caused	by	the	male	hormone	testoster-
one.	 For	 girls	 the	 most	 definitive	 indication	 of	 sexual	
maturity	is	the	first	menstruation,	called	menarche.
     Menstruation	 is	 in	 essence	 the	 body’s	 response	 to	 a	
potential	pregnancy	that	never	occurred.	Each	month	the	

                    7 Introduction        7

ovaries	 release	 one	 or	 occasionally	 multiple	 eggs.	 The	
release	of	the	ovum,	or	egg,	sets	off	a	series	of	hormonal	
responses.	The	inner	wall	of	the	uterus,	called	the	endo-
metrium,	 begins	 to	 thicken	 and	 swell	 with	 fluid	 as	 it	
prepares	to	nourish	a	fertilized	embryo.	If	the	egg	is	not	
fertilized,	the	endometrial	tissue	breaks	down	and	flows	
out	as	menstruation.	Conversely,	if	sperm	is	present	and	
fertilizes	the	egg	within	a	few	days	after	ovulation,	preg-
nancy	 occurs.	 Many	 forms	 of	 birth	 control	 are	 based	 on	
changing	the	levels	of	the	hormones	occurring	during	the	
ovulation	cycle,	with	the	result	that	changes	in	menstrua-
tion	may	also	occur.	
    The	study	of	human	reproduction,	however,	is	essen-
tially	 the	 study	 of	 pregnancy:	 how	 it	 occurs	 and	 what	
happens	during	gestation.	A	new	life	is	created	when	an	
active	sperm	enters	the	nucleus	of	a	fertile	egg.	This	nor-
mally	happens	when	the	male	deposits	semen,	typically	
containing	millions	of	sperm	cells	per	cubic	centimeter,	
in	the	female’s	vagina.	The	sperm	cells	then	“swim”	up	to	
meet	the	egg	in	the	fallopian	tube	on	its	way	to	the	uterus.	
One	of	these	sperm	cells	penetrates	the	outer	wall	of	the	
ovum	 and	 enters	 the	 cell	 nucleus.	 The	 sperm	 and	 egg	
cells	are	the	only	cells	in	the	human	body	with	only	one	
set	of	chromosomes,	rather	than	a	paired	set.	When	the	
sperm	 fertilizes	 the	 egg,	 their	 chromosomes	 become	
paired,	 forming	 a	 new	 individual	 with	 a	 unique	 genetic	
makeup	created	by	the	combination	of	DNA	from	both	
parent	cells.	
    Once	the	egg	is	fertilized,	it	begins	the	process	of	cell	
division	 and	 growth.	 By	 the	 time	 the	 fertilized	 egg,	 now	
called	a	zygote,	has	arrived	in	the	uterus,	it	is	a	multi-celled	
blastocyst.	Within	about	five	to	six	days	after	conception,	
the	 blastocyst	 has	 embedded	 itself	 into	 the	 uterine	       	
wall	 and	 begins	 to	 develop	 specialized	 cells	 to	 allow	 for	

               7 The Reproductive System         7

embryonic	growth	and	development.	Twins	or	other	mul-
tiple	 births	 may	 occur	 if	 more	 than	 one	 egg	 has	 been	
released	and	fertilized,	in	which	case	the	twins	are	frater-
nal,	 or	 if	 the	 early	 cell	 divisions	 result	 in	 two	 separate	
zygotes,	in	which	case	the	twins	are	identical	and	share	the	
same	DNA.
    During	the	period	of	pregnancy,	the	fetus	is	essentially	
sharing	the	mother’s	blood	supply	through	the	placenta.	
Thus	doctors	strongly	discourage	smoking,	drinking	alco-
hol,	 and	 taking	 most	 kinds	 of	 drugs	 during	 pregnancy	
because	they	may	lead	to	low	birth	weight,	birth	defects,	
premature	birth,	or	other	problems.	Even	drug	addiction	
on	the	part	of	the	newborn	is	possible.	
    Although	 most	 pregnancies	 and	 births	 proceed	 nor-
mally	 and	 the	 reproductive	 system	 performs	 properly,	
there	are	many	potential	disorders	of	both	the	male	and	            	
female	 reproductive	 systems,	 as	 well	 as	 possible	 risks	 of	
pregnancy.	This	book	provides	an	overview	of	those	disor-
ders,	 describing	 how	 they	 alter	 the	 normal,	 healthy	
function	 of	 the	 reproductive	 system.	There	 are	 also	 dis-
eases	 and	 infections	 that	 may	 affect	 the	 reproductive	
organs.	Many	of	these	conditions	are	preventable,	partic-
ularly	 sexually	 transmitted	 diseases,	 such	 as	 syphilis,	
gonorrhea,	chlamydia,	genital	herpes,	and	AIDS.	
    Some	individuals	also	experience	difficulty	either	con-
ceiving	or	carrying	a	child	to	term.	These	are	both	generally	
treated	under	the	broad	category	of	infertility	and	may	be	
caused	by	either	partner.	There	may	be	problems	with	the	
viability	of	the	eggs,	particularly	as	a	woman	reaches	the	
end	of	her	reproductive	years,	or	a	woman	may	fail	to	ovu-
late	 regularly.	There	 may	 also	 be	 issues	 with	 the	 uterine	
environment	 that	 make	 it	 difficult	 for	 the	 embryo	 to	
become	implanted	or	develop.	In	some	cases,	miscarriage,	
also	 known	 as	 spontaneous	 abortion,	 may	 occur	 for	

                   7 Introduction       7

unknown	reasons.	In	the	male,	sperm	count	may	be	low,	or	
the	sperm	may	not	be	active	in	moving	up	from	the	vagina	
to	the	fallopian	tubes,	conditions	that	may	also	be	affected	
by	age.	Some	infertility	issues	may	also	be	caused	by	pre-
ventable	activities,	such	as	smoking,	sexually	transmitted	
diseases,	alcohol	consumption,	and	drug	use.	
    Today	 many	 infertile	 couples	 can	 receive	 help	 with	
conceiving	and	having	children.	Treatments	include	hor-
monal	 injections	 to	 stimulate	 the	 release	 of	 multiple	
eggs;	artificial	insemination,	in	which	active	sperm	from	
either	 the	 husband	 or	 another	 male	 donor	 is	 inserted	
into	the	woman’s	vagina	by	syringe;	and	in	vitro	fertiliza-
tion	 (IVF),	 in	 which	 egg	 and	 sperm	 are	 removed	 from	
the	female	and	male,	respectively,	combined	outside	the	
body,	 and	 reinserted	 into	 the	 uterus	 to	 be	 carried	 to	
term.		All	these	techniques	are	relatively	recent,	with	the	
first	successful	birth	of	a	human	child	from	IVF	occur-
ring	 in	 1978.	 Today,	 however,	 infertility	 treatment	 is	
relatively	commonplace	with	a	reasonably	high	success	
rate.	One	side	effect	has	been	a	dramatic	increase	in	the	
incidence	 of	 multiple	 births,	 particularly	 from	 IVF	 in	
which	 multiple	 embryos	 may	 be	 used	 to	 maximize	 the	
likelihood	 of	 at	 least	 one	 embryo	 successfully	 implant-
ing	in	the	uterus.		
    IVF,	 and	 even	 more	 recently	 surrogate	 motherhood	
using	 IVF,	 has	 also	 engendered	 ethical	 controversy.	     	
The	 Roman	 Catholic	 Church	 has	 opposed	 IVF	 on	           	
several	 grounds:	 the	 destruction	 of	 human	 embryos	       	
not	 used	 for	 implantation;	 the	 possibility	 of	 in	 vitro		
fertilization	 by	 a	 donor	 other	 than	 the	 husband,	 thus	
removing	reproduction	from	the	marital	context;	and	the	
severing	 of	 an	 essential	 connection	 between	 the	         	
conjugal	act	and	procreation.	IVF	has	also	raised	a	num-
ber	 of	 unresolved	 moral	 issues	 concerning	 the	 freezing	


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