Chp4_ss_Female_Sex_A_and_P by niusheng11


									    Chapter 4

   Female Sexual
Anatomy & Physiology
            Genital Self-Exam

• Increases sexual comfort
  – Feeling familiar and comfortable with one’s
    anatomy can enhance sexual experiences
• Monitor for changes related to health
  – If you don’t know what “normal” looks like, you
    can’t know if something seems abnormal and
    requires medical attention.
                   The Vulva
• Vulva = all female external genital structures
  – Includes hair, folds of skin, and urinary and vaginal
  – Appearance varies from person to person
                        The Vulva (cont.)

Fig. 4.1 The structures and variations of the vulva: (a) external structures.
                     Tour of the Vulva
Mons veneris (from Latin “mound of Venus”):
- Triangular mound over the pubic bone.
- Consists of pads of fatty tissue btwn. pubic bone and skin.
- Touch and pressure can be pleasurable due to numerous nerve endings.
- At puberty, becomes covered with hair
   - Purpose of hair is to trap pheromones from vaginal secretions, adding to sensory
   erotic pleasure.

Labia majora (outer lips):
- Extend downward from mons
  veneris on each side of vulva.
- Like mons veneris, touch and
  pressure can be pleasurable
  due to numerous nerve endings.
                     Tour of the Vulva
Labia minora (inner lips):
- Located within outer lips and may protrude between them.
- Hairless folds of skin that join at the prepuce (clitoral hood) and
  extend down past urinary and vaginal openings
- Contain sweat glands, blood vessels, and nerve endings.
- Vary considerably in size, shape, and color; become darker in
  color during pregnancy.
                   Tour of the Vulva
- Highly sensitive structure of the female
  external genitals.
- Is the only organ in the human body
   whose only function is pleasure.
- Consists of:
      - glans
      - shaft: has small spongy structures
        that engorge with blood during
        sexual arousal.
      - internal crura (roots)
- Covered by clitoral hood
- Stimulation of clitoris is the most
  common way that most women
  achieve orgasm.
- External part of the clitoris has
  about the same # of nerve
  endings as the head of the penis.
                   Tour of the Vulva
- Area inside labia minora.
- Urinary and vaginal openings are located within the vestibule.

- Area of skin between the
vaginal opening and the
- Urinary and vaginal
openings are located within
the vestibule.
           Female Genital Cutting
• Circumcision: cutting off the clitoral hood.
• Clitoridectomy: removal of the clitoris.
• Genital infibulation:
   – Removal of the clitoris
   – Labia are cut off
   – Both sides of the vulva are stitched together
• Procedures done w/o anesthetics, disinfectants, or
  sterile instruments
• Cultural tradition in >40 countries in Africa, the
  Middle East, and Asia--clitoris is seen as male b/c it
  gets erect; ensures marriageability of girls
• Serious gynecological and obstetric complications
  result from infibulation
CNN movie: Female Circumcision
Underlying Structures of the Vulva
                                                       (Fig 4.2)

–Fill with blood during arousal,
causing vulva to swell and vagina
to increase in length.
–Similar in structure and function   Secrete drop or two of
to tissue in penis that engorges     fluid just before orgasm.
during arousal, causing erection.
 Underlying Structures of the Vulva

                                                       more on Kegel
                                                       exercises in Chp. 5…
Fig. 4.3 The underlying muscles of the vulva. These muscles can be strengthened
using the Kegel exercises described in the text.
           Internal Structures (cont.)

Fig. 4.4 Internal female sexual anatomy: front view of the internal organs. Parts of the
ovaries, uterus, and vagina are shown cut away.
         Internal Structures (cont.)

Fig. 4.4 Internal female sexual anatomy: (a) cross-sectional side view of female
internal structures.
               Internal Structures
• Vagina
  – Approx. 3-5 in. long--can elongate during arousal, stretch
    during childbirth, etc.
  – 3 layers: mucous, muscle, fibrous
  – Arousal and vaginal lubrication
     • Vaginal tissue blood vessels become engorged, causing clear
       fluid from the tissues to moisten the inside of the vaginal wall.
     • lubrication changes () vaginal pH and increases pleasure
  – Grafenberg (G) spot
     • Anterior (front) wall of vagina
     • Female equivalent of prostate gland
  – Secretions & chemical balance
     • Douching, feminine hygiene                              sprays,
       etc. are not only                         unnecessary, they
       cause                               numerous health problems.
            Internal Structures
• Cervix
  – At the upper/back end of the vagina
  – Leads into uterus
    • Os: the small opening in the cervix that leads into
  – Dilates to 10 cm opening during labor & birth
              Internal Structures
• Uterus (or womb)
  – Hollow, thick, pear-shaped organ
  – 3 in. long, 2 in. wide in woman who has not had
    a child.
  – Walls consist of 3 layers
     • External: perimetrium
     • Middle: myometrium
        – (stretching, contraction)
     • Inner: endometrium
        – (nourishes zygote, sheds             each
          month if no fertilization           during
               Internal Structures
• Fallopian tubes
  – Extend from uterus to each ovary (each tube about 4 in.)
  – Lined with cilia to help move ovum along tube
  – Outside end of each tube is shaped like a funnel, with
    fringelike projections called fimbriae
     • When egg leaves ovary, it’s drawn into                fallopian
       tube by the fimbriae.
  – Ectopic pregnancy: when                                     occurs fairly
    ovum implants                                              close
                                                   outside of theto ovary
    uterus                                  (usually in the fallopian
      • Can rupture the tube and                                cause
        uncontrolled bleeding
               Internal Structures
• Ovaries
  – Endocrine glands that produce ova (eggs) and sex
  – 3 types of hormones produced:
     • Estrogens
     • Progesterones
     • Testosterone
  – Ovulation: the maturation                         and
    release of an egg                           from the
    ovary into the                      fallopian tube
     • Up to 472,000 ova at birth
     • Only about 400 will mature
Group activity: female A & P flashcards
          One side: name of term
  Other side: definition, function, location

  Vulva                  Vagina
  Mons veneris       Cervix
  Labia majora       Uterus
  Labia minora           Fallopian tubes
  Clitoris               Ovaries
           Group activity:
Female reproductive anatomy & physiology

     I will describe a part of the female
   reproductive anatomy. Name the body
  part being described, and label it on your
            female anatomy handout.
Each student must label their own handout.
  No books allowed, but you can use any
   notes you have just taken, and you can
       help each other in your groups.
    Discussion question: (4-A)
   • What are some slang terms for female
  genitalia and breasts? Keep track of how
 many terms your group knows.              •
     Are these terms positive or negative?
• Why do people tend to use “nicknames” for
   parts of the female sexual anatomy? •
 How might men and women become more
 comfortable using correct terms for female
• Myths and negative attitudes
  – In the U.S., girls used to be taught that menstruation was
    dirty, something to be hidden.
     • Advertisements for “feminine hygiene products” often capitalized
       on these negative attitudes toward menstruation (see next slide)
  – Some cultural attitudes toward menstruation are positive
     • Association with transformation to adulthood, purification,
       spirituality, connectedness with natural cycles.
  – Today, even w/negative attitudes, most women associate
    regular menstruation with health.
  – Research has shown that women who have positive
    attitudes and comfort w/menstruation are more likely to
    be comfortable with their bodies and their sexuality.
                 Menstruation (cont.)
• Menarche (initial onset)
  – age 11-15 (avg: about 12.5 yr)
  – related to heredity, health,                                  altitude
  – Age has decreased over time:
       • Many reasons proposed,                                  including
         environmental                                  estrogens (in
         pesticides, etc.),                            obesity, stress.
• Menstrual physiology
  –   flow lasts from 2 to 6 days
  –   volume varies (6 to 8 ounces)
  –   duration varies (24 to 42 days)
  –   menstrual synchrony: simultaneous menstrual cycles that sometimes
      occur among women who live in close proximity.
                  Menstruation (cont.)

Fig. 4.7 Ovulation timing and cycle length. Regardless of the length of the cycle,
ovulation occurs approximately 14 days before menstruation.
Menstrual cycle: control by hormones
• hypothalamus releases GnRH that stimulates pituitary
• pituitary produces:
  – Follicle-stimulating hormone (FSH):
     • Estrogen production in ovaries
     • Ovum maturation in follicles inside ovaries
  – Luteinizing hormone (LH):
     • Stimulates release of mature ovum
     • Stimulates development of corpus luteum, the progesterone-
       secreting part of the follicle that remains after egg is released.
• Negative feedback mechanism
  – Each hormone is secreted until the organ it acts upon is
    stimulated--then that organ secretes a hormone that
    reduces secretion of the first hormone.
        Menstrual cycle: 3 phases
1) Menstrual phase: menstruation
  -   Menstrual flow=endometrial tissue, blood, and mucus
2) Proliferative phase: follicles mature, release ovum
  -    FSH: ovum (egg) matures inside follicle
  -   Egg produces estrogen: causes endometrium to thicken a
  -    LH: causes ovulation (relase of mature egg from follicle)
3) Secretory phase: corpus luteum develops
  -   Corpus luteum develops from follicle & secretes
  -    progesterone: endometrium thickens & engorges w/blood &
      nutrients in preparation for implantation of a fertilized egg
  -   If there is no implantation, corpus luteum degenerates, and
      estrogen & progesterone levels fall --> triggers menstruation.
Changes during
menstrual cycle

Gonadotropins (FSH, LH)

Changes in the ovary

Levels of estrogen &

Changes in the
         Proliferative phase:
     Changes to ovaries and uterus

• Follicle matures and releases ovum
• Uterine lining begins to thicken

                                       Fig 4.6a
          Secretory phase:
     Changes to ovaries and uterus

                                          Uterine lining
                                          continues to thicken

• Development of corpus luteum from follicle
(corpus luteum degenerates if there’s no implantation of a
fertilized egg in the uterus)
• Uterine lining continues to thicken
                                                                 Fig 4.6b
          Menstrual phase:
     Changes to ovaries and uterus

• Uterine endometrium is shed as menstrual flow
                                                  Fig 4.6c
           Menstruation (cont.)

• Sexual activity and the menstrual cycle
• Menstrual cycle problems
  – premenstrual syndrome:
     • Premenstrual Dysphoric Disorder
  – dysmenorrhea = painful menses
  – amenorrhea = no menses
  – toxic shock syndrome
  – self-help for menstrual symptoms
       Sexual activity and the
          menstrual cycle

• Libido is typically maximal around ovulation, as
  well as during menstruation
• There are no medical reasons to avoid sex
  during menstruation
• Orgasm during menstruation can be beneficial--
  relieves, backache, cramping, etc.
       Menstrual cycle problems
• Premenstrual syndrome (PMS) - catchall term
  for a number of symptoms of physical discomfort
  and emotional irritability 2-12 days before
  – PMDD (Premenstrual dysphoric disorder):
    Premenstrual symptoms severe enough to significantly
    affect a woman’s functioning
• Dysmenorrhea - pain or discomfort before or
  during menstruation - Can include cramping,
  backache, headache, nausea, fatigue
• Amenorrhea - absence of menstruation
  – Can be caused by too little body fat (amenorrhea is
    common in training athletes, women with anorexia nervosa)
   Discussion question (4-B):
  PART 1: What types of sexual activity
  are acceptable during menstruation?

PART 2: Where did you learn about female
sexual anatomy and the menstrual cycle?
  Was the information that you received
        accurate and thorough?

• Terms

  – Peri-menopause: time before menopause,
   when estrogen levels are decreasing

  – Menopause: permanent cessation of
    • Average age is 51 (range: 30s to 60s)
              Menopause (cont.)
• Symptoms vary from mild to strong (due
  mostly to the decline in estrogen levels)
  – hot flashes or warm spells from rapid dilation of
    blood vessels (about 75% of women experience these)
  – night sweats, interrupted sleep
  – headaches, poor concentration
  – depression, anxiety
  – vaginal dryness, reduced libido
         Hormone Therapy during
          and after menopause
• Hormone therapy: the use of supplemental
  hormones (estrogen, progesterone, testosterone)
  – Benefits: (mostly estrogen) can reduce hot
    flashes, night sweats, vaginal dryness, loss of
    bone density and (mostly testosterone) increase
    overall energy and sexual interest
  – Problems: Increased risk of endometrial, ovarian,
    and breast cancer; increased risk of blood clots,
    cardiovascular disease (prog. HT)
 Alternatives to Hormone Therapy
• Lifestyle factors
  – Women who are sexually active have fewer
    changes in vaginal tissues and lubrication.
  – Exercise, avoiding caffeine, tobacco, alcohol,
    and spicy foods can reduce hot flashes.
• Vitamins and herbs
  – Calcium supplements, vitamin D, and weight-
    bearing exercise can prevent osteoporosis.
  – Vitamin E, herbs (e.g. dong quai or black
    cohosh) can relieve symptoms such as hot
   Gynecological Health Concerns
• Urinary tract infections (UTIs)
  – Usually due to bacteria that enter urethral opening.
  – If infection spreads past bladder into kidneys, severe
    illness can result.
  – Treatable with antibiotics.
  * Prevention:
      Wiping from front to back (from vulva to anus)
      Avoiding introducing bacteria from the rectum from into
      the vagina during sexual activity
      Don’t wait to urinate--urinate as soon as you feel the urge
      to avoid stretching the bladder
      Use water-soluble lubricants during sexual activity (not
      petroleum jelly)
      Urinate after intercourse.
Gynecological Health Concerns (cont).
• Vaginal infections (aka vaginitis)
  – Include yeast infections, bacterial infections, etc.
    (more in Chp. 17)
  – Some factors that increase susceptibility to vaginitis:
     •   Diabetes
     •   Antibiotic use
     •   Stress
     •   Diet high in simple carbohydrates
     •   Intercourse w/o adequate lubrication
     •   Hormonal changes due to pregnancy or birth control pills
     •   Wearing nylon underwear or panty hose (trap heat and moisture)
     •   Douching
     •   Unprotected sex (STDs can cause vaginitis)
Gynecological Health Concerns (cont).
• Cysts
  – Fluid-filled sac that sometimes grow on the ovary
  – Fairly common, usually resolve on their own and are
  – Need to be monitored if they become painful
• Endometriosis
  – Condition in which uterine endometrial tissue grows on
    various parts of the pelvic cavity.
  – Cause pelvic pain, often quite severe
  – Can cause infertility
• Self-exams & vaginal health care
  – The greater awareness a woman has about her body, the
    better able she will be to diagnose problems.
                   The Pap Smear
• To screen for cervical cancer.
• Cells are taken from the                      cervix
  and examined under                        the
• Since widespread use of Pap
  smears began in 1950s, the                    death
  rate of cervical cancer                   has
  decreased dramatically b/c if cancer is found, it is
  usually at a very early stage.

          normal              dysplasia     cervical cancer
Surgical removal of the uterus or ovaries
 • Hysterectomy: surgical removal of the uterus.
 • Oophorectomy: surgical removal of the ovaries
 • Can be necessary due to bleeding disorders, pelvic
   infections, fibroids, cancer.
 • Most frequently performed operation in U.S.--1/3 of
   women will have a hysterectomy by age 65.
   – more frequently performed on low income, less educated
 • Can decrease sexual responsiveness due to
   hormonal changes, loss of nerves in the pelvis, loss
   of ability to have uterine contractions.
 • There are some alternatives to surgery--women
   should be fully informed about all options.
                        The Breast
• Mammary glands produce milk
   – fatty tissue determines size
   – There is little variation among women in amount of
     glandular tissue present
      • Therefore, amount of milk for breastfeeding doesn’t correlate with
        breast size.
• Areola is darker area
• Nipple is in center of areola
   – Has many nerve endings & has openings for milk.
• Breasts are secondary sex characteristics
   – Physical characteristics other than genitals that indicate
     sexual maturity (such as body hair, breasts, and deepened voice).
                      The Breast (cont.)

Fig. 4.8 Cross-section front and side views of the female breast.
Breasts come in lots of shapes and sizes
• Media/porn, etc. has distorted our idea of what a
  “normal” breast looks like
• Some normal breasts: (from
        Breast cancer screening
• Breast exams: early detection is best b/c
  treatments work better on early stage cancers
   – self-exam following menstruation
   – routine healthcare provider exams
    Breast cancer screening, (cont.)
• Mammography: X-ray of the breast
  – Can detect breast lump before it can be felt manually.
  – Recommended yearly for women over 50
  – Sometimes recommended for women between 40-50,
    though mammograms are                                  less
    effective in women                              under 50
    b/c the breast                            tissue is more
  – Can miss tumors--
     • better screening methods are needed.
                  Breast health
• Breast lumps: 3 types
  – cysts (fluid-filled sacs, benign)
  – fibroadenomas (solid, round, benign tumors)
  – malignant tumor (tumor made up of cancer cells)
• Breast cancer
  – Incidence: 1 in 9 women in North America; 190,000 new
    diagnoses each year.
  – Kills 40,000 women in U.S. each year and 370,000
    women worldwide each year.
  – In North America, one woman dies of breast cancer
    approximately every 12 minutes.
                        Breast cancer
• Early detection increases survival b/c cancer
  is usually found at an earlier stage.
• The 5-year survival rate is lower for minority
  women than for white women, most likely due
  to differences in access to preventive health

                                     Percentage of cancer      Survival Rate
    Stage of cancer                  diagnosed at this stage   at 5 years (%)
  Local (confined to breast)                  60                    98
  Regional (spread to lymph nodes)            31                    76
  Distant (spread to other organs)             6                    16
      Breast cancer: risk factors
• Risk rises with age
• Growing evidence indicates that synthetic chemicals
  found in plastics, pesticides, detergents, and
  cosmetics can increase the risk of breast cancer
• Cosmetics and personal care products are not
  tested by the Food and Drug Administration (FDA)
  because they are not foods and are not drugs
  – Nonetheless, chemicals in these products can penetrate
    our skin and our bodies.
• To check your personal care products and, if
  necessary, look for safer alternatives, go to:
       Breast cancer treatment

• Surgery
  – Mastectomy: surgical removal of all or most of
    the breast
  – Lumpectomy: removal of part of the breast
    containing the tumor and some surrounding
• Chemotherapy and/or radiation
  – Kills rapidly dividing cells (tumor cells generally
    divide more than normal cells)
         Breast cancer activism
• 3 local groups committed
  to increasing awareness of
  breast cancer and
  advocating for breast
  cancer prevention.
  – Breast Cancer Fund (S.F.)
  – Breast Cancer Action (S.F.)
  – Women’s Cancer Resource
    Center (Berkeley)
    • Resource library, support-
    Discussion question: (4-C)
  If you or your partner had a mastectomy
(removal of a breast), how do you think this
  would affect your sexual feelings toward
   yourself/your partner? What would the
    effects be if you or your partner had a
       hysterectomy (removal of uterus)

To top