Reproductive and

Sexual Health

Cherry Joyce G. Basco, RN, LPT

REPRODUCTIVE DEVELOPMENT
Re pr oduc tive de ve lopment be gins at the mo me nt o f c o nc e ption and c o ntinues thr o ugh
life .

I N TRAU TERINE DEVELOPM ENT

✓ S e x a s s i g n e d at b i r t h i s g en era l ly d et er m in e d at t h e m o m en t o f c o n c ep t i on b y ch r o m os o m e
i n fo r m a t i o n , w h i c h i s s u p p l i e d b y t h e s p e r m t h a t j o i n s w i t h t h e o v u m t o c r e a t e t h e n e w l i fe .

✓ A go na d i s a b o d y o rg an t h a t p r o d u c e s t h e ce l l s n e c e s s a r y fo r r e p r o d u c t i on ( t h e ov ar y in
fe m a l e s , t h e t e s t i s i n m a l e s ) .

✓ A t ap p r ox im at e ly w eek 5 o f i nt ra ut er i ne l ife , m e s on ep h r ic (w o l f f i a n ) an d p a ram e s on ep h r ic

( m ü l l e r i a n ) d u c t s , t h e t i s s u e t h a t w i l l b e c o m e o v a r i e s a n d t e s t e s , h a v e a l r e a d y fo r m e d .

✓ By w e ek 7 or 8, in ch r om o s o m a l m a le s , this e ar ly g on ad a l tissue b eg in s fo r m a t io n of
t e st o s t er on e . U n d er t h e in f lu en ce o f t e st o st er o n e , t h e m e s on ep h r i c d u c t d ev e l op s in t o m a l e
r e p r o d u c t iv e or g an s an d t h e p ara m e s o n e p h ri c d u c t r eg r e s s e s . I f t es t o s t er on e i s n o t p re s e n t b y
w e ek 1 0 , t h e p ar a m e s o n ep h r ic d u ct b ec o m es d o m in an t an d d e ve lo p s in t o fem a le re p r od u c t i ve
organs.

✓ A t a b ou t w e ek 1 2 o f in t rau t er in e l i fe , t h e ex t e rn a l g en it a l s b eg in t o d ev e l o p . In m a le s , p en i l e
t i s s u e e l on g at e s an d t h e ven t ra l s u r f a ce o f t h e p en i s c l o s e s t o form a u re t h ra . In fem a les , w i t h
n o t e s t o s t e r o n e p r e s e n t , t h e u t e r u s , l a b i a m i n o ra , a n d l a b i a m a j o r a fo r m .
REPRODUCTIVE DEVELOPMENT

Re pr oduc tive de ve lopment be gins at the mo me nt o f c o nc e ption and c o ntinues thr o ugh
life .

PU B ERTAL DEVELOPM ENT

✓ Pube r ty is the stage o f life at w hic h se c ondar y se x c hange s be gin .

✓ In most gir ls, these c hanges are stimulate d w he n the hypo thalamus sy nthesize s
and releas es go nado t ro pin releas ing ho rmo ne (GnRH), whic h then tr iggers the
anter ior pituitar y to releas e follicle st imulat ing ho rmo ne (FS H) and lut einizing
ho rm o ne (LH).

✓ FSH and LH are t erm ed g o nad o tro pin (go nad = “ovar y ”; tr o pin = “gr o w th”)
hor mones not only be c ause the y be gin the p ro d uct io n o f and ro g en and es t ro g en ,
w hic h in tur n initiate se c ondar y se x c harac teristics, but also be c ause they co ntinue
t o caus e t he pro duct io n o f eg g s and inf luence m ens t rual cycles t hro ug ho ut
wo m en’s lives (Egge r s, Ohne so r g, & S inc lair, 2014).

✓ The hypot halam us appare ntly ser ves as a g o na dos tat o r reg ulatio n m echanism to
“ t urn o n” g o nad funct io ning .
 The Role of Androgen

✓ A n dro ge n i c ho rmo ne s a r e the ho rmo n e s re s pon s ibl e for m u sc ula r de velop me n t,

p hysi ca l g ro wth , a nd the i ncr ea se i n seba ceou s gla nd se c re tio n s tha t ca u s e typi cal
a c n e i n b o th b oys a n d g i r l s d u r i n g a d o l es c e nc e .

✓ I n m ale s , a nd roge ni c ho rmo ne s ar e p rod uc ed by t he a dre n al c o r tex an d the

t e s te s a n d , i n f e m a l e s , b y t h e a d r e n a l c o r t ex a n d t h e ova r i e s.

✓ T he l e vel of t h e p rima r y and rog e nic ho rmon e , te sto s te ro ne , i s low i n mal e s u ntil
p ub er t y ( be twe e n age s 12 and 14 ye a r s) wh e n i t ri ses to i nf l u e nc e pu be r ta l
c h a n g e s i n t he te s te s , s c r o t um , pe n i s , pr o s ta te , a nd s em i nal v e s i c le s ; th e
a p p e a ra nc e of m a le pu bi c , axi l l a r y, and fa c ia l h a ir ; l a r y n ge a l e n lar g e m e n t w i th i t s
a c c om pa ny i n g v o i ce change ; matu rati o n o f s pe r m a toz o a ; and c lo s u r e o f gr ow th
p l a t e s i n l o n g bo n e s ( te r m e d a dr en ar c he ) .

✓ I n g i r l s , te s to ste ron e in f lu e nc e s e nl a r g em e n t o f th e l a bi a m a jo ra and c l i to ri s a nd the

f o r m a t i o n o f axi l l ar y a n d pu bi c hai r .
The Role of Estrogen

✓ When triggered at puberty by FSH , ovarian follicles in females

begin to excrete a high level of the hormone estrogen.
✓ This increase influences the development of the uterus,
fallopian tubes, and vagina; typical female fat distribution ;
hair patterns; and breast development.
✓ It also closes the epiphyses of long bones in girls the same
way testosterone closes the growth plate in boys.
✓ The beginning of breast development is termed thelarche,
which usually starts 1 to 2 years before menstruation.
Terminologies

Thelarche is the onset of female breast development.

Pubarche is the appearance of sexual hair.
Adrenarche is the onset of androgen-dependent body changes such as
growth of axillary and pubic hair, body odor, and acne.
 Secondary Sex
Characteristics

I n g i r l s , p u b e r tal c h a n g e s typ i c all y o c c u r a s : S e c o n dar y s e x c h a ra c te r is ti cs o f b oys

u s u a l l y o c c u r i n th e o r d e r o f :
• G r o wth sp ur t
• I n c r e a s e i n we i g h t
• I n c r e a s e i n th e tra n s ve r s e d i a m e te r o f th e
p e l vi s • G r o wth o f te s te s

• Br e a s t d e ve l o pm en t • G r o wth o f f a c e , a x i l la r y, a n d p u b i c h a i r

• G r o wth o f p u b i c h a i r • Vo i c e c h a n g e s

• O nse t o f m e nstr ua ti on • Pe n i l e g r o wth

• G r o wth o f a x i l l ar y h a i r • Increase in height

• Va g i nal se c r e ti ons • S p e r m atoge n es i s ( p r o du c tion o f s p e r m )

MALE EXTERNAL STRUCTURES
External genital organs of the male include the testes (which
are encased in the scrotal sac), the scrotum and the penis.
MALE INTERNAL STRUCTURES
The male internal reproductive organs are the epididymis, the vas
deferens, the seminal vesicles, the ejaculatory ducts, the prostate
gland, the urethra, and the bulbourethral glands.
Two Skene glands (paraurethral glands) are
located on each side of the urinary meatus;
their ducts open into the urethra. Bartholin
glands (vulvovaginal glands) are located on
each side of the vaginal opening with ducts
that open into the proximal vagina near the
labia minora and hymen.
✓ Secretions from both of these glands help
to lubricate the external genitalia during
coitus.
✓ The alkaline pH of their secretions also
helps to improve sperm survival in the
vagina.
FEMALE INTERNAL STRUCTURES
Female internal reproductive organs (Fig. 5.4) include the ovaries, the
fallopian tubes, the uterus, and the vagina.
 MENSTRUATION
✓ A menstrual cycle (the female reproductive cycle) is episodic uterine bleeding in
response to cyclic hormonal changes.
✓ The purpose of a menstrual cycle is to bring an ovum to maturity and renew a
uterine tissue bed that will be necessary for the ova’s growth should it be
fertilized .
✓ Because menarche may occur as early as 9 years of age, it is good to include
health teaching information on menstruation to both school-age children and
their parents as early as fourth grade as part of routine care.
✓ It is a poor introduction to sexuality and womanhood for a girl to begin
menstruation unwarned and unprepared for the important internal function it
represents.
✓ The length of menstrual cycles differs from woman to woman, but the average
length is 28 days (from the beginning of one menstrual flow to the beginning of
the next).
✓ It is not unusual for cycles to be as short as 23 days or as long as 35 days. The
length of the average menstrual flow (termed menses) is 4 to 6 days, although
women may have flows as short as 2 days or as long as 9 days (Ledger, 2012).
 The Physiology of Menstruation

✓ Four body structures are involved in

the physiology of the menstrual
cycle: the hypothalamus, the
pituitary gland, the ovaries, and the
uterus.

✓ For a menstrual cycle to be

complete, all four organs must
contribute their part; inactivity of
any part results in an incomplete or
ineffective cycle (Fig. 5.11).
Menstrual Cycle
Phases of Menstrual Cycle
Phases of Menstrual Cycle
 Cervical Changes

✓ T he m u cu s of th e u ter i ne c e r vi x a l so c ha nge s i n s tr uc tu re a nd co n si s te n c y ea ch mo nth

d u r i n g a m e n s tr u a l c yc l e .

✓ At the beg inni ng o f ea c h c ycle , whe n e strog e n se c re tio n fro m the ova r y i s low, c er vical
m u c u s i s th i c k a n d s c a n t . S p e r m s u r vival i n th i s typ e o f m u c u s i s p o o r.

✓ At th e tim e of ovul ation , wh e n the e s trog e n le ve l ha s r i se n to a h igh poi nt, ce r vi cal mu c us

b eco me s th in , s tr e tc hy ( s pi nnb ar kei t ), a nd copio u s . Sp e rm p en e tratio n a nd s u r vival i n this
t h i n m u c u s a r e b o th e xc e l l e n t.

✓ Be c au s e p roge ste ro ne be com e s t h e majo r inf lue nc ing ho rmo ne du r i ng the s eco nd h alf of
t h e c yc l e , c e r vi c a l m u c u s a g a i n th i c ke n s a n d s p e r m s u r vi va l i s a g a i n p o o r.

✓ Wom e n ca n a nal yz e c e r vi cal mu c u s c ha nge s to h elp p la n coi tus s o it coin cid e s wi th

ov ul a tio n if th e y wa nt t o i n cr ea s e th ei r ch an ce o f b e comi ng pr eg na nt o r pla n to avo id coi tus
a t th e tim e o f ovula tion to p r e ven t p reg na n cy ( n atu ral f ami l y pla nn i ng ; se e Chap te r 6 ) by
a n a l y z in g h o w th i c k o r th i n i s c e r vi c a l m u c u s .

✓ D u r ing ovul ation , th e bod y o f th e c e r vix i s so f te r a nd the o s i s sligh tl y op e n com pa red with
t h e r e s t o f th e c yc l e wh e n i t i s f i r m a n d th e o s i s c l o s e d a s a n o th e r i n d i c ation of ovu l a tion .
T h e F e r n Te s t T h e S p i n n b a r k e i t Te s t

✓ An interesting property of cer vical mucus just before ✓ A t t h e h e i g h t o f e s t r o g e n s e c r e t io n , y e t a n o t h e r

ovulat ion when e stro gen levels are high is the ability p r o p e r t y o f c e r v i c a l m u c u s i s t h e a b i l i ty t o s t r e t c h
t o f o r m f e r n l i ke p a t t e r n s o n a m i c r o s c o p e s l i d e w h e n into long strands, a contrast to its thick, viscous
state when progesterone is the dominant hormone.
a l l o w e d t o d r y. T h i s p a t t e r n i s k n o w n a s a r b o r i z a t i o n
or ferning. ✓ That means per forming this test, known as
s p i n n b a r ke i t , a t t h e m i d p o i n t o f a m e n s t r u a l c y c l e
✓ When progesterone is the dominant hormone, as it is
i s a n o t h e r w a y t o d e m o n s t ra t e h i g h l e v e l s o f
just after ovulation, this fern pattern is no longer
e s t r o ge n a r e b e i n g p r o d u c e d a n d , b y i m p l i c a t i o n ,
discernible . Cervical mucus, therefore, can be o v u l a t i o n i s a b o u t t o o c c u r.
examined at midcycle for ferning to detect whether a
high estrogen surge is present.
✓ A woman can do this herself by stretching a mucus
s a m p l e b e t w e e n t h u m b a n d f i n g e r, o r i t c a n b e
✓ Wo m e n w h o d o n o t o v u l a t e u s u a l l y s h o w a f e r n i n g tested in an examining room by smearing a cer vical
pattern throughout their menstrual cycle mucus specimen on a slide and stretching the
(progesterone levels never become dominant), or they mucus between the slide and cover slip (Fig. 5.14).
never demo nst rate it because their estrogen levels
never rise.
 SEXUAL HEALTH
Se xual He alth

✓ S exuality is a m ultid im ens io nal p henomeno n that inc lud es feelings , attitud es, and
ac tio ns.

✓ It has bo th b io log ic and c ultural d ivers ity co mpo nents . It encom passes and g ives
d irec tio n to a p erso n’s p hys ic al, emo tio nal, so c ial, and intellec tual respo nses
thro ug ho ut lif e .

✓ S exuality has always b een a p ar t o f hum an lif e, b ut o nly in the p as t few d ecades has it
b een s tud ied sc ientif ic ally. One com mo n f ind ing of res earc her s has been that f eelings
and attitud es ab o ut s ex var y w id ely ac ro s s c ultures and ind ivid uals .
T H E S E X U AL R E S P O NSE CYCL E

✓ Two of the ea rl ie s t re se a rc h er s o f se x ual r e spo n se we re Ma s ter s a nd J o h n s o n. I n 1 966 , they

p ubl i shed the re sul ts of a majo r stud y ba se d on mor e tha n 1 0 ,0 00 epi sod e s of se xual
a c ti vi ty a m o n g m o r e th a n 6 0 0 m e n a n d wo m e n ( M a s te r s , J o h n s o n , & Ko lodny, 1 9 9 8 ) .

✓ I n thi s stud y, the y de s c rib ed th e hu ma n se x ual r e spon s e a s a c yc l e with fou r di s c rete

s tag e s : exci te me n t, pla tea u, o rg a sm , a nd r es ol u tion . W he t he r s tage s a r e f el t a s s ep ara te
s tep s thi s way or bl en d ed i nto o n e smoo th p roc e s s o f d e si re , a ro u sal , a nd o rga s m is
i n d i vi du aliz ed .
 THE SEXUAL RESPONSE CYCLE
E xc i t e m e nt

✓ E x ci t e m ent o c c ur s wi t h p hy s i c a l a nd p s y c ho l o gi ca l s t i m ul a t i o n ( s i g ht , s o u nd , em o t i o n , o r t h o u g ht ) t ha t
c a u s e s p a r a s y m p a th e t i c n e r v e s t i m ul a t i o n .

✓ T hi s l ea d s t o a r t er i a l d i l a t i o n a nd v e no us co ns t ri c t i o n i n t h e g eni t a l a r ea . T h e r es ul t i n g i n cr ea s ed b l o o d
s u p p l y l e a d s t o v a s o c o ng e s t i o n a n d i n c r e a s i ng m u s c u l a r t e n s i o n .

✓ I n wo m e n, t hi s va s o c o ng e st i o n ca u s e s t h e c l i t o ri s t o i n cr ea s e i n s i z e a nd m u co i d f l ui d t o a p p ea r o n
va gi na l wa l l s fo r l ub r i ca t i o n . T h e va gi n a wi d en s i n d i a m et er a nd i n c re a s es i n l en gt h . B r ea s t ni p p l es
become erect.

✓ I n m e n , p e n i l e e r e c t i o n o c c u r s a s w e l l a s s c r o t a l t h i c k e n i ng a n d e l e v a t i o n o f t h e t e s t e s .

✓ I n b o t h s e x e s , t h e r e i s a n i n c r e a s e i n h e a r t a n d r e s p i ra t o r y ra t e a n d b l o o d p r e s s u re .

Plateau

✓ The plateau stage is reached just before orgasm.

✓ I n t h e wo ma n , t h e cl i t o r i s i s d ra w n f o r wa rd a nd r et ra ct s und e r t h e c l i to ra l p r ep u c e , t h e l o w e r p a r t o f
t h e va gi na b e co m es ext r e m el y c o n g e st ed ( f o rma t i o n o f t h e o r ga s mi c p l a t f o rm) , a nd t h er e i s i nc r e a s ed
breast nipple elevation.

✓ I n m en , va s o co n g es t i o n l ea d s t o d i s t e nt i o n o f t h e p eni s . H ea r t ra t e i n cr e a s e s t o 1 0 0 t o 1 7 5 b ea t s / mi n
a n d r e s p i ra t o r y ra t e t o a b o u t 4 0 b r e a t hs / mi n .
 THE SEXUAL RESPONSE CYCLE
Orgasm

✓ O r ga s m o c c ur s wh e n s t im ul a t i o n p r o c e ed s t hr o u g h t h e p l a t ea u s t a g e t o a p o i nt a t w hi ch a v i g o ro us
c o nt ra ct i o n o f m us cl e s i n t h e p el v i c a r ea exp el s o r d i s s i p a t e s b l o o d a nd f l ui d fro m t h e a r e a o f
congestion.

✓ T h e a v e ra g e n umb er o f c o nt ra ct i o n s f o r t h e w o m a n i s 8 t o 1 5 c o nt ra ct io n s a t i nt er va l s o f 1 eve r y 0 . 8
seconds.

✓ I n m e n , m us cl e co nt ra ct i o ns s ur ro und i n g t h e s e m i na l v e s s el s a nd p r o s t a t e p r o j e ct s e m en i nto t h e
p r ox i ma l u r et hr a . T h es e co nt ra ct i o ns a r e fo l l o w e d i mm ed i a t el y b y t h r e e t o s ev e n p r o p ul s i v e
e j a c ul a t o r y co nt ra ct i o ns , o c c urri n g a t t h e s a me t i m e i nt er va l a s i n t he w o ma n , w hi ch f o r c e s e m en
f r o m t h e p e n i s ( M a s t e r s e t a l ., 1 9 9 8 ) .

✓ A s t h e s ho r t e s t s t a g e i n t h e s ex ua l r es p o n s e c yc l e , o r ga s m i s u s ua l l y exp e ri en c e d a s i nt en s e p l e a s ure
a f f e c t i n g t h e w ho l e b o d y, no t j us t t h e p el v i c a r ea . It i s a l s o a hi g hl y p e rs o na l e xp eri e n c e : D e s cri p t i o ns
of orgasms vary greatly from person to person.

R e s o l ut i o n

✓ T h e r es o l ut i o n i s a 3 0 - mi n ut e p e ri o d d u ri n g wh i ch t h e ext er na l a nd i nt er na l g eni t a l o r ga n s ret urn t o

an unaroused state.

✓ F o r t h e m a l e , a r e f r a c t o r y p e r i o d o c c u r s d u r i ng w h i c h f u r t h e r o r g a s m i s i m p o s s i b l e .

✓ Wo m e n d o no t go t hr o ug h t hi s r e f ra ct o r y p e ri o d , s o i t i s p o s s i b l e f o r w o m e n wh o a r e i nt er e s t e d a nd
p r o p e r l y s t i m ul a t e d t o h a v e a d d i t i o n a l o r g a s m s i m m e d i a t e l y a f t e r t h e f i r s t .
Assignment:

Identify the internal and external structure of Male and Female

Reproductive System and briefly describe its function.
Prepare for a QUIZ next meeting.