REPRODUCTIVE AND SEXUAL HEALTH

PUBERTAL DEVELOPMENT:

Puberty is the stage of life at which the secondary sex changes

Girls- age 10 to13 years
Theory: must reach a critical weight of approx. 95lbs (43kgs)

Boys- age 12 to 14 years
The role of Androgen- hormones responsible for :
1. Muscular development
2. Physical growth
3. Increase sebaceous gland secretion (acne)
Testosterone -1 androgenic hormone

In girls, testosterone influences the development of
labia majora, clitoris, and axillary & pubic hair latter termed as
(adrenarche)
REPRODUCTIVE AND SEXUAL HEALTH
Secondary sex characteristic of boys occurs in order:
1. increase in weight
2. growth of testes
3. growth of face, axillary, and pubic hair
4. voice changes
5. penile growth
6. increase in height
7. spermatogenesis

Secondary sex characteristic of girls occurs in order:
1. growth spurt
2. increase in the traverse diameter of the pelvis
3. breast development (thelarche)
4. growth of pubic hair (adrenarche)
5. onset of menstruation (menarche 12.5 y/o ave.)
6. Ovulation occurs 1 2 years after menarche
7. growth of axillary hair (adrenarche)
8. vaginal secretion


FEMALE REPRODUCTIVE SYSTEM: GYNECOLOGY

A.External Structures

1. Mons pubis/ Mons veneris pad of adipose tissues, which
lives over the symphysis pubis, which protects the
surrounding delicate tissue from trauma.

2. Labia majora longitudal folds of pigmented skin extending
from the mons pubis to the perineum. Contains the Bartholins
gland that secretes yellowish mucus that acts as a lubricant
during sexual activity.

3. Labia minora soft longitudal skin folds between the Labia
majora.

4. Glans clitoris erectile tissue located at the upper end of
Labia minora; primary site of sexual arousal.
FEMALE REPRODUCTIVE SYSTEM:

A.External Structures continue

5. Vestibule a narrow space seen when labia minora are
separated that also contains the vaginal introitus,
Bartholins gland and urethral meatus.

6. Urethral Meatus small opening bet, the clitoris and vaginal
orifice for the purpose of urination.

7. Vaginal orifice/introitus/opening external opening of
the vagina that contains the hymen.

8. Hymen a membranous tissue ringing the vaginal introitus

9. Perineum tissue between the anus and vagina. Site of
episiotomy

The external genitalias blood supply:
Arteries: a. pudental artery b. inferior rectus artery.
Vein: Pudendal vein


FEMALE REPRODUCTIVE SYSTEM:

B. Internal Structures

1. Ovaries female sex glands located on each side of the uterus
with two ovaries (4 x 2 x 1.5 cm thick).

Ovaries are formed with 3 principal divisions:
a. A protective layer of surface epithelium
b. The cortex filled with the ovarian and graafian follicle
c. The central medulla containing nerves, blood vessels,
lymphatic tissue and some smooth muscle tissue

Fxn: -Ovulation (release of ovum) and Secretion of
hormones like estrogen and progesterone.

Estrogen- help to prevents osteoporosis, and atherosclerosis
and potential risk for breast cancer endometrial cancer


FEMALE REPRODUCTIVE SYSTEM:

B. Internal Structures continue

2. Fallopian Tubes 4 inches (10 cm) long from each sides of the
fundus;

Divided on four separate part:

1. Intramural portion- most proximal (1cm in length)

2. Isthmus portion- extremely narrow (2cm)
Important: tubal ligation

3. Ampulla- longest portion (5cm) and widest part
Function: site of fertilization

4. Infundibular portion- funnel shape with Fimbrae (2cm)
finger like projections.
Function: responsible for the transport of mature ovum from
ovary to uterus.

FEMALE REPRODUCTIVE SYSTEM:
B. Internal Structures continue

3. Uterus hollow pear-shaped muscular organ.
Size: 3 inches long (5-7cm), 2 inches wide(5cm) and 1 inch
thick (3x2x1)
Wt: 60 gms. in non pregnant Location: lower pelvis
Parts: Corpus, Isthmus, and Cervix
Position: anteverted and anteflexed
Layers: perimetrium, myometrium and endometrium

Function:
1. to receive the ova to fallopian tube place for implantation
and nourishment during fetal growth furnish protection
to a growing fetus
2. aids in labor and delivery

Cervix (2-5cm long)
Internal cervical os -an impt. relationship in estimating the
External cervical os level of dilatation of the fetus
in the birth canal before birth.
FEMALE REPRODUCTIVE SYSTEM:
Uterus continue

Nerve Supply:
Efferent (motor) nerve- spinal ganglia (T5 to T10)
Afferent (sensory) nerve - hypogastric plexus (T-11 & T-12)
Impt: Controlling pain in labor ( Epidural anesthesia)

Uterine Ligaments:
1. Broad Ligaments fr. the sides of uterus to pelvic walls

2. Round Ligaments fr. sides of uterus to mons pubis.

3. Cardinal and uterosacral ligaments- provides middle support

4. Pelvic muscular floor ligaments- provide lower support




FEMALE REPRODUCTIVE SYSTEM:

3. Vaginal Canal 3-4 inch long dilatable canal between the bladder
and the rectum; contains rugae that permits stretching without
tearing.

Anterior Vaginal wall- 6-7 cm (anterior fornices)
Posterior Vaginal wall- 8-9 cm (posterior fornices)

Function: 1. passageway for menstrual discharges
2. receives penis during intercourse and
3. serves as birth canal.

- lined with stratified squamous epithelium

- Bulbocavernosus: a circular muscle acts as voluntary sphincter
(Kegel exercises)

Blood supply to the vagina:
Arteries: vaginal artery branch of internal iliac artery
Vein: pudental vein
FEMALE REPRODUCTIVE SYSTEM:
Vagina continue

The external genitalias blood supply: mainly from the
a. pudental artery and
b. a portion of inferior rectus artery.

Nerve supply: has both parasympathetic & sympathetic
(S-1 to S-3 levels)

Nerve supply of the anterior portion: (L1)
a. Ilio-inguinal nerves b. Genito-femoral nerves
Nerve supply of the posterior portion: (S3)
Pudendal nerves

This is the reason why one type of anesthesia used for
childbirth is called Pudendal block.


MALE REPRODUCTIVE SYSTEM: ANDROLOGY
A. External Structures
1. Penis: the male organ of copulation; a cylindrical shaft
consisting of:
a. corpora cavernosa -two lateral columns of erectile
tissue
b. corpus spongiosum - encases the urethra

-The glans penis, a cone-shaped expansion of the corpus
spongiosum that is highly in express males.

-Erection is stimulated by parasympathetic nerve

2. Scrotum: a pouch hanging below the penis that contains
the testes.

3. Testes: two solid ovoid organs 4-5 cm long and 2-3 wide,
divided into lobes containing
Seminiferous tubules -produce spermatozoa.
Leydig cells - testosterone production.


MALE REPRODUCTIVE SYSTEM:

MALE REPRODUCTIVE SYSTEM:
A. External Structures continue

SPERMATOZOA are produced by:
Hypothalamus Control by
GnRH (+/-) feedback
Anterior Pituitary gland
FSH / LH
Testes

FSH - release of Androgen Binding Protein (ABP) which
promote SPERMATOGENESIS

LH - release of Testosterone.

Spermatozoa does not survive at body
temperature. They usually survive 1F lower
than body temperature.

MALE REPRODUCTIVE SYSTEM:
B. Internal Structures

1. Epididymis: serves as reservoir for sperm storage and
maturation. Approximately 20 ft. it takes 12-20 days for
the sperm to travel the length of Epididymis.

A total of 64 days before they reach maturity.
(Treatment= 2 months).
Aspermia - (absence of sperm)
Oligospermia- if < 20 million sperm/ ml

2. Vas deferens: a duct extending from epididymis to the
ejaculatory duct and seminal vesicle, providing a
passageway for sperm. (sperm mature).
Varicocele- varicosity of internal spermatic cord
Vasectomy (male birth control)

3. Seminal vesical: are two convoluted pouches that lie along
the lower portion of the bladder and empty into the urethra
by the way of ejaculatory ducts
MALE REPRODUCTIVE SYSTEM:
B. Internal Structures continue

4. Ejaculatory duct: the canal formed by the union of the vas
deferens and the excretory duct of the seminal vesicle, which
enters the urethra at the prostate gland.

5. Prostate Gland: located just below the urinal bladder. Secretes
alkaline and most of the seminal fluid.

6. Bulbourethral glands or Cowpers Gland: adds alkaline fluid
to the semen.

7. Urethra: the passageway for both urine and semen, extending
from the bladder to the urethral meatus. (8 inches in long)
MALE REPRODUCTIVE SYSTEM:
B. Internal Structures continue

SEMEN:
Is a thick whitish fluid ejaculated by the male during orgasm,
contains spermatozoa and fructose-rich nutrients.
During ejaculation, semen receives contributions of fluid from
Prostate gland (60%)
Seminal vesicle (30%)
Epididymis ( 5%)
Bulbourethral gland (5%)

Average pH = 7.5
The average amount of semen released during ejaculation is
2.5 -5 ml. It can live with in the female genital tract
for about 24 to 72 hours.
(50-200 million/ml of ejaculation ave. of 400 million/
ejaculation )
90 seconds- cervix
5 mins.- end of fallopian tube