Sexual education

Human sex physiology

 Both sexes have reproductive organs called Genitals and Genitalia designed for the purpose of
intercourse and conception.

Female reproductive system

 Female reproductive organs are for intercourse, reproduction, urination, pregnancy and
childbirth.
Ovary (ovaries)

 Two solid egg - shaped structured

 They are attached to the uterus by ligaments.
 Ovaries have two main functions:
- Store and release the ova or female egg cell. Some of the ova disappear, others are dormant
until each is ripened and released after puberty.
- Produce female sex hormones “estrogen” and “progesterone”.

Ova

 The female reproductive cell.

 They are the largest cell in the female body.
 The female baby is born with all the ova she will ever have.
 About 400-500 ova mature and are released over a lifetime.

Estrogen

 Estrogen is responsible for the secondary sex characteristics and the sex drive in females. It spurs
the onset of puberty and is responsible for “ovulation”.

Progesterone

 Progesterone builds up the lining of the uterus called the endometrium in preparation for the
fertilized ovum.

Ovulation

 When the egg is released from the ovary.

 Starts in puberty.
 The ovum moves to the surface of the ovary in bursts out
 The ova fall into the fallopian tube and waits for fertilization.
 This happens every 28 days.
 It happens at about the 14th day of the menstrual cycle.
 The window of fertilization of the ova is 12 – 24h every 28 days.

Fallopian tubes (oviducts)

 Two tubes attached on either side of the uterus.

 They are about 10 cm long and 0.5 cm in diameter. (As the size of a spaghetti noodle.)
 The oviducts carry egg cells toward the uterus and sperm cells towards the egg cell.
 Fertilization takes place in the upper third of oviduct.

Uterus

 A hollow, muscular organ (shaped somewhat like an upside-down pear, about the size of a fist).  
 The uterus is lined with endometrium (a blood lining.)  
 The uterus has one main function—to protect and nourish a fetus.
 The walls of the uterus have the ability to stretch to the size of a small watermelon.   
  After childbirth the uterus shrinks back to the original shape in 6-8 weeks, but it can take up to
nine months for the uterus to fully recover. 
Cervix

 The neck or opening of the uterus.  

 A normal healthy cervix is the strongest muscle in the body.  
 It dips down about half an inch into the vagina.  
 It is normally plugged by mucus.  It stays tightly closed during pregnancy but thins and opens for
the delivery of the baby.
Vagina

 Female organ used for intercourse; it is an empty passageway leading from the vaginal opening to
the uterus.  
 It is only 3-4 inches long but will lengthen during arousal.  
 The vaginal walls are made of many small folds of membrane that stretch greatly to
accommodate a baby during birth.  
 The vaginal wall also secretes a fluid that helps to make intercourse easier.  

Women’s menstrual cycle

 Day 1 – Menstruation begins (bleeding)

 Day 5 – Menstruation is usually ended 
 Day 14 – Ovum has matured and bursts out of the ovary 
 Day 15 – After 24 hours the egg is done
 Day 26 – In the absence of fertilization, estrogen/progesterone levels drop, and the endometrium
lining breads down 
 Day 28 – Menstruation begins again.    

Women’s timeline

 Ages 9-12 

- Secondary sex characteristics appear

 Ages 11-14

- Menstrual cycle begins (Menarche)

 Late 20-30's

- Peak sexual urges

 Ages 45-55

- Menopause (cycle stops, but sex urge continues)

Male reproductive system

 Male reproductive organs are for intercourse, reproduction, and urination

Scrotum

 A sac-like pouch located behind the penis that holds each testis and helps regulate temperature
for sperm production.
 Temperature in scrotum is a couple of degrees lower than the rest of the human body, ca 34⁰ C. 

Testicles or testis

 The two testes are small organs that lie in the scrotum and produce sperm and the male hormone
testosterone.  
 The testicles are the male sex gland. 
 The testicles are outside the body because the male sperm that is manufactured in the testes
need cooler-than-body temperature for normal growth and development.  
 Loss of one does not impair the function of the other.
 Four to five billion sperm cells are produced each month.
Testosterone

 The male reproductive hormone made by the testicles which causes the changes of puberty. 
 This hormone causes secondary sex characteristics, production of sperm and sexual urge.  
 It is produced in the testicles and enters the bloodstream at a fairly constant rate.

Sperm

 The microscopic cells produced by the male’s testicles which can fertilize the female’s ovum.
 They are tiny, living cells 100 times smaller than a pencil dot. (The smallest cell in the male’s
body.)
 Enough sperm would fit on the head of a pin to re-populate the earth sperm fertilized an egg.
 It is destroyed by warm body temperature, acidic environment.
 It can survive in a women’s body for the 5-8 days.

Swimming for your life

 A sperm is a tiny package with a big responsibility; to fertilize the egg and create a human
life. That tiny package is loaded with “gear” for its important journey.

A few facts:

 Daily sperm production by a healthily man:

- 10 million to 50 million
 Contents of an average ejaculation:
- 50 million sperm, 25 million moving, 20 million deformed.
 Maturation: 
- 72 days
 Average swimming speed of a sperm: 
- 20 cm per hour
 Survival time in a woman: 
- 2 to 7 days

Epididymis
 The structure that forms a mass over the back and upper part of each testis.
 Sperm are stored there for as long as six weeks while they ripen to maturity.  

Cowper’s gland

 Two small pea-sized glands located beneath the prostate gland on both sides of the base of the
penis.  
 They secrete a clear, sticky fluid that helps to neutralize the acidity of the urethra.

Vas deferens

 Two long, thin tubes that serve as a passageway for sperm and a place for sperm storage.
 The contraction of the vas deferens along with the action of the cilia help transport the sperm
through the vas deferens.
Seminal vesicles

 Two small glands that secrete a fluid that nourishes and enables the sperm to move.

Prostate gland

 Surround the urethra beneath the bladder.  The gland secretes an alkaline fluid that neutralizes
the acid found in the male urethra and the female reproductive tract.  
 Without the action of the secretions of the prostate gland, many sperm would die, and
fertilization of an ovum would be impossible.

Urethra

 A dual-purpose tube that both semen and urine pass through to leave the body. Semen and urine
never mix.
 Special muscles or sphincters surround the urethra.
 During urination, one sphincter will relax so that the pressure from the bladder will push urine out
of the body.
 During ejaculation, another sphincter will relax so that semen can flow through the urethra to the
outside of the body.
Penis

 The male organ for sexual intercourse, reproduction, and urination.  

 The reproductive purpose of the penis is to deposit semen in the vagina during sexual
intercourse.  
 The head of the penis or glans contains many nerve endings.  The glans is covered by a loosely
fitting skin called the foreskin.

Semen

 A combination of sperms combined with fluid that is produced in the seminal vesicles, prostate
gland, and Cowper's gland.  This fluid nourishes and helps sperm move through the urethra.

Ejaculation

 The passage of sperm from the penis, a result of a series of muscular contractions.

Male’s timeline

 Infancy
- Erections begin

 Ages 11-14
- Secondary sex characteristics appear
  Ages 13-16
- Sperm produced in adult amounts (puberty)

 Late teens
- Peak sexual urges for boys

 Throughout life
- If good health is present, there is the sex urge and ability to father children
Erectile Dysfunction

 Impotence is the inability of a man to have an erection.

o Causes may include:
- Injury to nerves, arteries, are muscles.
- Medications for high blood pressure, antihistamines, and depression.
- Psychological factors such as anxiety, guilt, depression, and fear of sexual failure cause up to
20 % of all cases.
Development of fetus
Menstrual cycle phases

 The menses phase: This phase, which typically lasts from day one to day five, is the time when
the lining of the uterus is actually shed out through the vagina if pregnancy has not occurred.
Most women bleed for three to five days, but a period lasting only two days to as many as seven
days is still considered normal.
 The follicular phase: This phase typically takes place from days six to 14. During this time, the
level of the hormone estrogen rises, which causes the lining of the uterus (called the
endometrium) to grow and thicken. In addition, another hormone—follicle-stimulating hormone
—causes follicles in the ovaries to grow. During days 10 to 14, one of the developing follicles will
form a fully mature egg (ovum).
 Ovulation: This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden
increase in another hormone—luteinizing hormone—causes the ovary to release its egg. This
event is called ovulation.
 The luteal phase: This phase lasts from about day 15 to day 28. After the egg is released from
the ovary it begins to travel through the fallopian tubes to the uterus. The level of the hormone
progesterone rises to help prepare the uterine lining for pregnancy. If the egg becomes fertilized
by a sperm and attaches itself to the uterine wall, the woman becomes pregnant. If pregnancy
does not occur, estrogen and progesterone levels drop, and the thickened lining of the uterus is
shed during the menstrual period.

STD - sexually transmitted diseases:

Infections that are most commonly passed through sexual contact:

- Oral
- Vaginal
- Anal
- Skin – to – skin

Transmission:

In order for transmission to occur, it is necessary to have:

- A body fluid with the germ in it

- A way of spreading the germ from one person to another; ex: vaginal, oral, or anal sex

Methods of transmission:

Low or no risk:

- Hugging
- Kissing
- Holding hands
- Dancing
- Sitting on toilets
- Sharing lip balm
 - Massage
- Sharing forks, knives, etc.

High risk:

- Sexual Intercourse 
- Vaginal
- Anal 
- Oral
- Blood-to-blood contact 
- Sharing needles or other drug-use equipment
- Tattoo or body piercing
- Infected mother to her baby

Infection control act:

Some STDs are included in the infection control act. All infections are reported to Folkhälsomyndigheten.
Which means that if you are infected you have to:
- Go to a doctor (VC, UMO)
- Name all your sexually contacts
- Inform your sexual contact that you have the disease 
- Otherwise, you can be prosecuted and be sentenced to fines. 

Chlamydia (Chlamydophila trachomatis):

Most common SDT in Sweden, 40 000 is infected each year. Included in Infection Control Act.

- Can lead to sterility if not treated

- Caused by a bacterium and can be treated with antibiotic

Female symptoms:

- Vaginal discharge (white or grey) or burning with urination

- Lower abdominal pain
- Bleeding between menstrual periods
- Low-grade fever (later symptom)

Male symptoms:

- Discharge from the penis and/or burning when urinating

- Burning and itching around the opening of the penis
- Pain and swelling in the testicles
- Low-grade fever (associated with epididymis – inflammation of the testicle)

Gonorrhea (Neisseria gonorrhoeae):

Included in the Infection Control Act.

- Each year approximately 650,000 people in the United States are infected with gonorrhea. In
Sweden 600-1000 people are infected from it each year.
- People get gonorrhea from close sexual contact (anal, oral, and vaginal sex)
 - Gonorrhea can also be spread from mother to child during birth. 
- Gonorrhea infection can spread to other unlikely parts of the body 
- Caused by a bacterium and can be treated by antibiotic
- Gonorrhea can lead to sterility in females in severe cases

Symptoms of Gonorrhea:

- Appear 5-7 days or can take up to 30 days to appear

- Sore or red throat if you have gonorrhea in the throat from oral sex 
- Rectal pain
- Blood and pus in bowel movements if you have gonorrhea in the rectum from anal sex.

Female symptoms:

- Symptoms may show up 2-21 days after having sex

- May notice a yellow or white discharge from the vagina
- May be a burning or pain when urinating
- Bleeding between periods
- Heavier and more painful periods
- Cramps or pain in the lower abdomen, sometimes with nausea or fever

Male symptoms:

- Yellow or white drip/discharge from penis

- Burning or pain when urinating
- Frequent urinating
- Swollen testicles

Syphilis (Treponema pallidum):

- Included in the Infection Control Act.

- The long-range effects can be very serious, including death. 
- In the United States, an estimated 70,000 new cases of syphilis in adults. In Sweden 349
cases were reported in 2016.
- Passed from person to person through direct contact with a syphilis sore 
- Sores mainly occur on the external genitalia, vagina, anus, or rectum.  Sores can also occur
on the lips and in the mouth.  
- Transmission of the organism occurs during vaginal, anal, or oral sex. 
- Is caused by a bacterium and can be treated with antibiotics.
- Is thought to come to Europe with sailors that went to America with Columbus

Symptoms - stage 1:
  Symptoms usually appear 10-90 days after
contact.
- An infected person gets a sore (chancre), which may be painful at the point of contact
(mouth, anus, rectum, throat, or the sex organ). 
- The chancre lasts 1-5 weeks and heals on its own.
- In the female, the chancre is often internal and cannot be seen.

Secondary stage:

- Lasts 3-6 weeks.  

- After the chancre comes a copper-colored skin rash which may appear on the palms of the
hands, soles of the feet, or in more severe cases covers the entire body.  
- The rash may be accompanied by fever, headaches, indigestion, loss of appetite, or loss of
hair in spots over the scalp.

Third stage – latent period:

- All symptoms disappear so that the victim thinks he/she is cured.  

- If not received treatment the bacterium remains in the body and begins to damage the
internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and
joints.

Fourth stage – tertiary:

- The results of the internal damage from the 3 rd stage shows up many years later.
- Ten, twenty, even thirty years after the initial infection - sudden heart attack, failure of
vision, loss of motor coordination or mental disturbances.

Herpes (Herpes simplex):

- Virus – cannot be treated with antibiotics.

- Symptoms usually show 2-20 days after contact.
- May be extremely painful or very mild. 
- “Outbreaks” of blisters and ulcers.  
- Once infected with HSV, people remain infected for life. 
- Stress, bruising, other viral infection like a cold, or a woman’s period may cause an onset of
the disease. 

Female symptoms:

- Blisters in or around the vagina, or mouth fever and headaches.

Male symptoms:

- Small sore or cluster of blisters on the penis, or mouth.

Human Papilloma Virus (HPV):

  Growths that appear on the vagina or penis,
near the anus, and sometimes in the throat. 
- They are caused by viruses and spread through sexual contact. 
- The virus that causes genital warts is spread by vaginal or anal intercourse and by oral sex.
- Warts may appear within several weeks after sex with a person who has HPV; or they may
take months or years to appear; or they may never appear.    
- A person can be infected and pass on the virus without knowing it. 
- There are a few ways of treating the disease and the immune system often defeats the
disease after 8-13 months. 
- Three out of four Americans between the ages of 15 and 49 have been infected with genital
HPV in their lifetimes.
- Is called “Kondylom” in Swedish.
- Some serotypes of the HPV can give cervical cancer. 
- Girls and now even boys are vaccinated against HPV (in Sweden).
- Women between 23-49 years in age are tested every third year.
- Women between 50-64 are tested every seventh year. 

Symptoms:

- Usually, the warts look like tiny cauliflowers, but sometimes they are flat.  
- The warts may cause itching, burning and some pain, but often don’t cause any pain at all.  
- Warts may be inside the vagina or on the cervix, or in the rectum or throat, so you might not
notice them. 
- They might also be so small that you cannot see them.

Pubic lice = crabs:

 Pubic lice are called “crabs” because

they look like crabs.
- Crabs are frequently the color and size of small freckles.  These very small lice (crabs) usually
attack the sexual (pubic) areas of the body. 
- Found under arms, eyelashes, moustaches.  
- Spread through direct physical contact. Close body contact with an infected person.  
- Easy to treat.

Symptoms:

- A terrible, persisting itch in the genital, rectal (sexual) area.

Human Immunodeficiency Virus infection / Acquired Immune Deficiency Syndrome  (HIV/AIDS):

- Included in the Infection Control Act

 - HIV is a virus that destroys the immune system (helper T-cells) over time, robbing the body
of its ability to fight other infections and illnesses
- Once the immune system is weakened, other infections occur, and AIDS develops (the fatal
stage of HIV infection)
- The virus is present in blood, semen, vaginal secretions & breast milk
- The virus is thought to have been transferred to humans from other primates in the 20 th
century. First confirmed death from AIDS was a man in Zaire in 1959.
- The virus was discovered in 1982 by a Frenchman, Montagnier. He received the Nobel prize
in medicine for the discovery in 2008.

HIV / AIDS – Signs & Symptoms:

- 2 to 4 weeks after exposure, some people experience mild flu-like symptoms that last a few
weeks, then disappear
- Many people have NO symptoms until years after exposure
- The only way to know is to get TESTED!
- There is no treatment against the disease but there are medicines that helps patients to not
develop AIDS and slows down the progression of the infection. These drugs are very
expensive and people in the third world do not afford to buy them. Patients in Sweden get
them and do not need to pay for them.
 Most common STD in Sweden, 40 000 is infected each year (0.37 % of the
population). Included in Infection Control Act.
