REPRODUCTIVE SYSTEM & IMPLICATION ON GENDER

Devi Arine Kusumawardani, S.Keb., M.Kes.

OUR AGENDA

01 Anatomi & fisiologi sistem

reproduksi
02 Konsepsi & fertilitas

03 Perbedaan risiko patologi

Peran gender dalam

04
kesehatan reproduksi
1st section: Anatomy & Physiology of
Reproductive System
 Male Reproductive System

Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 1 SCROTUM (SKROTUM)

Testes are located in a skin-covered,

highly pigmented, muscular sack called
the scrotum
Dartos muscles divides the scrotum into
two compartments, each housing one
testis
Cremaster muscles cover each testis like
a muscular net

5
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 2 TESTES (TESTIS)

Paired ovals organ, 4-5 cm in length and

are housed within the scrotum

Produce both sperm and androgens

(testosteron)

Testes are covered by tunica vaginalis &

tunica albuginea

Tunica albuginea (septa) divide testis

into 300 to 400 lobules

Descent of testis in 7 months of

pregnancy
6
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 SPERM PRODUCTION

Sperm develop in structures called

seminiferous tubules
Process begins at puberty, 64 days per
cycle
New cycle starts every 16 days
Route of sperm cells:
1. Seminiferous tubules
2. Straight tubules
3. Rete testes
4. 15-20 efferent ductules cross tunica
albuginea
5. Epididimis (maturation)
7
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 SPERM PRODUCTION

Secrete signaling
Sertoli cells molecules to promote
sperm production

Sperm production Control germ cells live

or die

Germ cells Spermatogonia

(stem cell of testis)

8
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 SPERMATOGENESIS

9
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 STRUCTURE OF FORMED SPERM

• Volume of a sperm 85.000 smaller than female gamete

• 100 to 300 million sperm are produced each day
• Head : 5µm length, acrosome (cap)  lysosomal enzymes for fertilization
• Mid piece : mitochondria for produce ATP  power the flagellum  to move the entire
sperm cell

10
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 ACCESSORY GLANDS

1 2 3 4 5

EPIDIDYMIS DUCT SYSTEM SEMINAL VESICLES PROSTAT GLAND BULBOURETRAL /

COWPER’S GLAND

11
 ACCESSORY GLANDS

DUCT SEMINAL PROSTAT COWPER’S

EPIDIDYMIS
SYSTEM VESICLE GLAND GLAND
• Sperm • During • 60% fluid of • Excrete • Thick &
mature & ejaculation, semen alkaline, salty fluid
acquired sperm move volume semen • Lubricate
ability to to the • Large • Coagulate & the end of
move (12 ductus amounts of de- urethra &
days) – deferens fructose  coagulate vagina (pre-
stored in the (vas generate semen ejaculate sex
tail of deferens) ATP- following aroused)
epididymis movement ejaculation

12
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 3 PENIS

Male organ of copulation (sexual

intercourse)

Flaccid – non sexual action (urination);

Turgid – sexual arousal

Erection :
1. Sexual arousal and REM sleep
(during dreaming occurs)
2. Vasocongestion : engorgement of the
tissue b/o more arterial blood
flowing into the penis
3. Size can increase during erection ±
15 cm of length
13
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 4 TESTOSTERONE

Production :
Leydig cells (between seminiferous tubules in testes)
7th week of pregnancy - peak at 2nd trimester
Childhood low  increase during puberty
Function :
Keep the male reproductive system work properly
6-7 mg/day  spermatogenesis (testes)
Muscle development, bone growth, secondary sex characteristic,
libido (systemic)

14
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 REGULATION OF TESTOSTERONE PRODUCTION

15
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
Female Reproductive System
Female Reproductive System

• Vagina • Uterus • Breast

• Vulva • Fallopian tube
• Ovarium

External organ Internal organs Accessory

organ
 1 VULVA

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Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 1 VULVA

• Pad of fat at • Folds of hair- • Thinner & more

anterior over pubic covered skin pigmented folds
bone • Begin just posterior • Protect urethra &
• Covered by pubic to the mons pubis the entrance to the
hair (puberty) vagina
Mons pubis Labia majora Labia minora

• Abundant nerves • Membrane partially • Behind labia majora

• Sexual sensation & covers entrance to • Secrete mucous that
orgasm the vagina keeps the vestibular
area moist

Bartholin’s
Clitoris Hymen
glands

19
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 2 VAGINA

Muscular canal (10 cm length) that entrance to reproductive tract, exit from
uterus during menses and childbirth

The walls of the vagina are lined with an outer,

fibrous adventitia; a middle layer of smooth muscle; and an inner mucous
membrane with transverse folds called rugae

Flora normal vagina genus Lactobacillus

Secrete lactic acid  acidic pH (below 4.5)  self cleansing organ

20
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 3 OVARIES

Paired ovals, female gonads (2-3 cm in length like

almond)
Supported by mesovarium  broad ligament
(ovarian blood and lymph vessels)
Ovary is attached to the uterus via ovarian
ligament)
Oocytes develop within outer layer of stroma, each
surrounded by supporting cells  follicle

21
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 OVARIAN CYCLE - OOGENESIS

22
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 OVARIAN CYCLE - FOLLICULOGENESIS

23
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 4 THE UTERINE TUBES

24
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 4 THE UTERINE TUBES

Sections Ovulation
• Isthmus – connect to uterus • Oocyte release to peritoneal
• Infundibulum – fimbriae cavity
• Ampulla – fertilization often • Received by uterine tube
occurs • ↑ Estrogen induce
contraction, 4-8 “
• Beating of the cilia help
oocyte moves to the interior
of tube
• Fertilization occurs, sperm
meet the egg while it’s still
moving through the ampulla

25
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 THE WALL OF UTERUS

• Superficial layer • Middle layer • Innermost layer

• Serous membrane • Thick layer of smooth • Connective tissue,
• Epithelial tissue muscle lamina propria
covers exterior • Uterine contraction • Layer : stratum
portion of uterus (labor, mens, basalis & stratum
facilitate the functionalis (shed
transport of sperm) during
menstruation)

Perimetrium Myometrium Endometrium

26
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 THE MENSTRUAL CYCLE

27
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 THE MENSTRUAL CYCLE

28
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 5 THE BREAST

29
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 5 THE BREAST

Function Section Hormonal change

• Lactation : supply milk • 15-20 lactiferous ducts • Menstrual cycle :

to an infant (nipple) swelling & tenderness
• Breast milk is produced • Lactiferous sinous (secretory phase)
by mammary glands (connect to a glandular • Pregnancy :
• Size of breast : lobes lobe) enlargement of breast
(fat tissue), size ≠ • Alveoli (milk-secreting dan mammary tissue
amount of milk cell)
produced

30
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
2nd section: Fertilization
 FERTILIZATION

Fertilization occurs when a sperm and an oocyte (egg) combine and their nuclei fuse
Haploid cell  diploid cell  zygote

Process : transit of sperm & contact between sperm and oocyte

TRANSIT OF SPERM
1. Ejaculation: hundreds of millions of sperm(spermatozoa) are released into the
vagina
2. Sperm may be blocked by thick cervical mucus, acidity of vagina (pH 3.8),
destroyed by phagocytic uterine leukocytes
3. Uterine tubes : facilitated by uterine contraction (30 min-2 hours), survive 3-5
days
4. Oocyte can survive 24 hours following ovulation

32
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 FERTILIZATION

CAPACITATION
1. Fluids in the female
reproductive tract prepare the
sperm for fertilization
through a process called
capacitation
2. Function: ↑ sperm motility,
facilitate release of the
lysosomal(digestive) enzymes
 penetrate oocyte

33
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 CONTACT BETWEEN SPERM & OOCYTE

Sperm contact
Ovulation : oocyte
sperm-binding
released by the Sperm reach the
receptors on the
ovary along the oocyte
oocyte’s plasma
uterine tube
membrane

Acrosomal reaction Plasma membrane

Fertilization must
(enzyme-filled of sperm fuses with
occur in distal
“cap” of the oocyte’s plasma
uterine tube
sperm/acrosome) membrane

Sperm penetrate The head and mid-

The oocyte
two protective piece of the
encounters the
layers : corona “winning” sperm
survivng
radiata, zona enter the oocyte
capacitated sperm
pellucida interior

34
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
 THE ZYGOTE

At the point of fertilization, the oocyte has not yet completed meiosis, all secondary
oocytes remain arrested in metaphase of meiosis II until fertilization.

When fertilization the oocyte complete meiosis  become ovum (female haploid
gamete)  2n haploid nuclei  pro-nuclei  single-celled diploid zygote

A woman releases a single egg during ovulation cycle

1. 1% ovulation cycles, 2 eggs are released and both fertilized  two zygotes 
dizygotic (fraternal) twins
2. A zygote can divide into 2 separate offspring during early development 
monozygotic (identical) twins

35
Source: Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and Physiology. Texas : Rice University
3rd section: The Risk of pathology
Mortality Differentials by Sex
Sex differences in mortality have varied in different countries, historical
periods, and age groups.

During the last quarter of 21st century, males had higher mortality than females
at all ages in all developed countries and in most less developed countries.

However, higher mortality for females was relatively common among young
children in less developed countries.

During the mid 21st century, females had higher mortality among older children,
teenagers, young adults in some less developed countries, particularly in South
Asia. 37
What are some of the key differences
in the burden of disease between
males and females?

What are sources of those

differences?

Why can it be said that “being born

female is dangerous to your health?”

38
 THE PROBLEM

Health needs of women can be broadly classified under 4 categories:

1. Women have specific health needs related to the sexual and reproductive function
2. Women have an elaborate reproductive system that is vulnerable to dysfunction or
disease, even before it is put to function or after it has been put out of function
3. Women are subject to the same diseases of other body systems that can affect men
4. Women are subject to social diseases which impact on their physical, mental, or
social health (female genital mutilation, sexual abuse, domestic violence)

39
 THE PROBLEM

The reproductive system in function, dysfunction and disease plays a central role in
women’s health. And it’s different from the case with men.

A major burden of the disease in females is related to their reproductive function and
reproductive system, and the way society treats or mistreats them because of their
gender.

While more men die because of their “vices”, women often suffer because of their
nature-assigned physiological duty for the survival of the species, and the tasks related
to it.

40
THE PROBLEM

41
4th section: Gender in Reproductive Health
 HEALTH SEEKING BEHAVIOR

Men might not be more reluctant to see a doctor than women are, as is popularly
believed, but may simply have different trigger points for seeking health-care
The threshold for making an appointment with a family doctor seems to be lower
among women, while older women also tend to live longer with disabling conditions
than men do, so more of them will be accessing primary care, the findings indicate.

Women tend to live longer than men after a serious illness, with their greater use of
primary healthcare, and therefore greater likelihood of timely diagnosis, often
suggested as the explanation for this particular advantage.

Men and women may be just as likely to put off seeing a doctor when they don't
consider symptoms to require urgent attention or when they ignore them,

Source: Andreas Höhn, Jutta Gampe, Rune Lindahl-Jacobsen, Kaare Christensen, Anna Oksuyzan. Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in
primary healthcare use after first hospitalisation at ages 60 in Denmark. Journal of Epidemiology and Community Health, 2020; jech-2019-213435 DOI: 10.1136/jech-2019-213435 43
 GENDER EQUITY & SEXUAL REPRODUCTIVE HEALTH

Gender inequalities to be common across a range of health issues relating sexual &
reproductive health (SRH) w/ women being particularly disadvantaged.
Social and biological determinants combined to increase women’s vulnerability to
maternal mortality, HIV, and gender-based violence.

Health systems significantly disadvantaged women in terms of access to care.

Men fared worse in relation to HIV testing and care w/social norms leading to men
presenting later for treatment.
Gender inequity in SRH requires multiple complementary approaches to address the
structural drivers of unequal health outcomes.

Source: MacPherson EE, Richards E, Namakhoma I, Kaare Christensen, Theobald S. Gender equity and sexual and reproductive health in Eastern
and Southern Africa: a critical overview of the literature. Glob Health Action, 2014(7): 1-10 44
 REFERENSI

Andreas Höhn, Jutta Gampe, Rune Lindahl-Jacobsen, Kaare Christensen, Anna Oksuyzan. Do men
avoid seeking medical advice? A register-based analysis of gender-specific changes in primary
healthcare use after first hospitalisation at ages 60 in Denmark. Journal of Epidemiology and
Community Health, 2020; jech-2019-213435 DOI: 10.1136/jech-2019-213435
Betts J.G, Desaix P, Johnson E, Johnson J.E, Korol O, Kruse D, Poe B, et al. (2017). Anatomy and
Physiology. Texas : Rice University
Brown, Lester R., et al, 1999, Beyond Malthus Nineteen Dimensions of The Population Challenge, WW
Norton & Company, New York
Demeny, Paul, Geoffrey McNicoll, 2003, Encyclopedia of Population, McMillan Reference, New York
MacPherson EE, Richards E, Namakhoma I, Kaare Christensen, Theobald S. Gender equity and sexual
and reproductive health in Eastern and Southern Africa: a critical overview of the literature.
Glob Health Action, 2014(7): 1-10
Poston, Dudley L., Michael Micklin, 2005, Handbook of Population, Kluwer Academic/Plenum
Publisher, New York
Regitz-Zagrosek V. (2012). Sex and gender differences in health. Embo Reports 13(7): 1-8
THANK YOU

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