2Genital Self-Exam Increases sexual comfort Feeling familiar and comfortable with one’s anatomy can enhance sexual experiencesMonitor for changes related to health concernsIf you don’t know what “normal” looks like, you can’t know if something seems abnormal and requires medical attention.
3The Vulva Vulva = all female external genital structures Includes hair, folds of skin, and urinary and vaginal openingsAppearance varies from person to person
4The Vulva (cont.)Fig. 4.1 The structures and variations of the vulva: (a) external structures.
5Tour 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 hairPurpose of hair is to trap pheromones from vaginal secretions, adding to sensoryerotic pleasure.Labia majora (outer lips):Extend downward from monsveneris on each side of vulva.Like mons veneris, touch andpressure can be pleasurabledue to numerous nerve endings.
6Tour 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) andextend down past urinary and vaginal openingsContain sweat glands, blood vessels, and nerve endings.Vary considerably in size, shape, and color; become darker incolor during pregnancy.
7Tour of the Vulva Clitoris: Highly sensitive structure of the female external genitals.Is the only organ in the human bodywhose only function is pleasure.Consists of:glansshaft: has small spongy structuresthat engorge with blood duringsexual arousal.internal crura (roots)Covered by clitoral hoodStimulation of clitoris is the mostcommon way that most womenachieve orgasm.External part of the clitoris hasabout the same # of nerveendings as the head of the penis.
8Tour of the Vulva Vestibule: Perineum: Area inside labia minora. Urinary and vaginal openings are located within the vestibule.Perineum:Area of skin between the vaginal opening and the anusUrinary and vaginal openings are located within the vestibule.
9Female Genital Cutting Circumcision: cutting off the clitoral hood.Clitoridectomy: removal of the clitoris.Genital infibulation:Removal of the clitorisLabia are cut offBoth sides of the vulva are stitched togetherProcedures done w/o anesthetics, disinfectants, or sterile instrumentsCultural tradition in >40 countries in Africa, the Middle East, and Asia--clitoris is seen as male b/c it gets erect; ensures marriageability of girlsSerious gynecological and obstetric complications result from infibulation
10Underlying 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 to tissue in penis that engorges during arousal, causing erection.Secrete drop or two of fluid just before orgasm.
11Underlying 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.
12Internal 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.
13Internal Structures (cont.) Fig. 4.4 Internal female sexual anatomy: (a) cross-sectional side view of female internal structures.
14Internal Structures Vagina Approx. 3-5 in. long--can elongate during arousal, stretch during childbirth, etc.3 layers: mucous, muscle, fibrousArousal and vaginal lubricationVaginal 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 pleasureGrafenberg (G) spotAnterior (front) wall of vaginaFemale equivalent of prostate glandSecretions & chemical balanceDouching, feminine hygiene sprays, etc. are not only unnecessary, they cause numerous health problems.
15Internal Structures Cervix At the upper/back end of the vagina Leads into uterusOs: the small opening in the cervix that leads into uterusDilates to 10 cm opening during labor & birth
16Internal 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 layersExternal: perimetriumMiddle: myometrium(stretching, contraction)Inner: endometrium(nourishes zygote, sheds each month if no fertilization during menstruation)
17Internal Structures Fallopian tubes Extend from uterus to each ovary (each tube about 4 in.)Lined with cilia to help move ovum along tubeOutside end of each tube is shaped like a funnel, with fringelike projections called fimbriaeWhen egg leaves ovary, it’s drawn into fallopian tube by the fimbriae.Ectopic pregnancy: when fertilized ovum implants outside of the uterus (usually in the fallopian tube).Can rupture the tube and cause uncontrolled bleedingFertilizationoccurs fairlyclose to ovary
18Internal Structures Ovaries Endocrine glands that produce ova (eggs) and sex hormones.3 types of hormones produced:EstrogensProgesteronesTestosteroneOvulation: the maturation and release of an egg from the ovary into the fallopian tubeUp to 472,000 ova at birthOnly about 400 will mature
19Group activity: female A & P flashcards One side: name of termOther side: definition, function, locationTERMS:Vulva VaginaMons veneris CervixLabia majora UterusLabia minora Fallopian tubesClitoris OvariesPerineum
20Discussion 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 anatomy?
21Menstruation 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 positiveAssociation 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.
23Menstruation (cont.) Menarche (initial onset) Menstrual physiology age (avg: about 12.5 yr)related to heredity, health, altitudeAge has decreased over time:Many reasons proposed, including environmental estrogens (in pesticides, etc.), obesity, stress.Menstrual physiologyflow lasts from 2 to 6 daysvolume 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.
24Menstruation (cont.)Fig. 4.7 Ovulation timing and cycle length. Regardless of the length of the cycle, ovulation occurs approximately 14 days before menstruation.
25Menstrual cycle: control by hormones hypothalamus releases GnRH that stimulates pituitarypituitary produces:Follicle-stimulating hormone (FSH):Estrogen production in ovariesOvum maturation in follicles inside ovariesLuteinizing hormone (LH):Stimulates release of mature ovumStimulates development of corpus luteum, the progesterone-secreting part of the follicle that remains after egg is released.Negative feedback mechanismEach hormone is secreted until the organ it acts upon is stimulated--then that organ secretes a hormone that reduces secretion of the first hormone.
26Menstrual cycle: 3 phases Menstrual phase: menstruationMenstrual flow=endometrial tissue, blood, and mucusProliferative phase: follicles mature, release ovum FSH: ovum (egg) matures inside follicleEgg produces estrogen: causes endometrium to thicken a little LH: causes ovulation (release of mature egg from follicle)Secretory phase: corpus luteum developsCorpus luteum develops from follicle & secretes progesterone progesterone: endometrium thickens & engorges w/blood & nutrients in preparation for implantation of a fertilized eggIf there is no implantation, corpus luteum degenerates, and estrogen & progesterone levels fall --> triggers menstruation.
27Changes during menstrual cycle Gonadotropins (FSH, LH)Changes in the ovaryLevels of estrogen & progesteroneChanges in the endometrium
28Proliferative phase: Changes to ovaries and uterus • Follicle matures and releases ovum• Uterine lining begins to thickenFig 4.6a
29Secretory phase: Changes to ovaries and uterus Uterine liningcontinues 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 thickenFig 4.6b
30Menstrual phase: Changes to ovaries and uterus • Uterine endometrium is shed as menstrual flowFig 4.6c
31Menstruation (cont.) Sexual activity and the menstrual cycle Menstrual cycle problemspremenstrual syndrome:Premenstrual Dysphoric Disorderdysmenorrhea = painful mensesamenorrhea = no mensestoxic shock syndromeself-help for menstrual symptoms
32Sexual activity and the menstrual cycle Libido is typically maximal around ovulation, as well as during menstruationThere are no medical reasons to avoid sex during menstruationOrgasm during menstruation can be beneficial--relieves, backache, cramping, etc.
33Menstrual cycle problems Premenstrual syndrome (PMS) - catchall term for a number of symptoms of physical discomfort and emotional irritability 2-12 days before menstruationPMDD (Premenstrual dysphoric disorder): Premenstrual symptoms severe enough to significantly affect a woman’s functioningDysmenorrhea - pain or discomfort before or during menstruation - Can include cramping, backache, headache, nausea, fatigueAmenorrhea - absence of menstruationCan be caused by too little body fat (amenorrhea is common in training athletes, women with anorexia nervosa)
34Discussion question (4-B): PART 1: What types of sexual activityare 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?
35MenopauseTermsPeri-menopause: time before menopause, when estrogen levels are decreasingMenopause: permanent cessation of menstruationAverage age is 51 (range: 30s to 60s)
36Menopause (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 sleepheadaches, poor concentrationdepression, anxietyvaginal dryness, reduced libido
37Hormone 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 interestProblems: Increased risk of endometrial, ovarian, and breast cancer; increased risk of blood clots, cardiovascular disease (prog. HT)
38Alternatives to Hormone Therapy Lifestyle factorsWomen 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 herbsCalcium 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 flashes.
39Gynecological 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.
40Gynecological Health Concerns (cont). Vaginal infections (aka vaginitis)Include yeast infections, bacterial infections, etc (more in Chp. 17)Some factors that increase susceptibility to vaginitis:DiabetesAntibiotic useStressDiet high in simple carbohydratesIntercourse w/o adequate lubricationHormonal changes due to pregnancy or birth control pillsWearing nylon underwear or panty hose (trap heat and moisture)DouchingUnprotected sex (STDs can cause vaginitis)
41Gynecological Health Concerns (cont). CystsFluid-filled sac that sometimes grow on the ovaryFairly common, usually resolve on their own and are unnoticeableNeed to be monitored if they become painfulEndometriosisCondition in which uterine endometrial tissue grows on various parts of the pelvic cavity.Cause pelvic pain, often quite severeCan cause infertilitySelf-exams & vaginal health careThe greater awareness a woman has about her body, the better able she will be to diagnose problems.
42The Pap Smear To screen for cervical cancer. Cells are taken from the cervix and examined under the microscopeSince 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.cervical cancernormaldysplasia
43Surgical removal of the uterus or ovaries Hysterectomy: surgical removal of the uterus.Oophorectomy: surgical removal of the ovariesCan 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 womenCan 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.
44The Breast Mammary glands produce milk Areola is darker area fatty tissue determines sizeThere is little variation among women in amount of glandular tissue presentTherefore, amount of milk for breastfeeding doesn’t correlate with breast size.Areola is darker areaNipple is in center of areolaHas many nerve endings & has openings for milk.Breasts are secondary sex characteristicsPhysical characteristics other than genitals that indicate sexual maturity (such as body hair, breasts, and deepened voice).
45The Breast (cont.)Fig. 4.8 Cross-section front and side views of the female breast.
46Breasts come in lots of shapes and sizes Media/porn, etc. has distorted our idea of what a “normal” breast looks likeSome normal breasts: (from
47Breast cancer screening Breast exams: early detection is best b/c treatments work better on early stage cancersself-exam following menstruationroutine healthcare provider exams
48Breast cancer screening, (cont.) Mammography: X-ray of the breastCan detect breast lump before it can be felt manually.Recommended yearly for women over 50Sometimes recommended for women between 40-50, though mammograms are less effective in women under 50 b/c the breast tissue is more dense.Can miss tumors--better screening methods are needed.
49Breast health Breast lumps: 3 types Breast cancer cysts (fluid-filled sacs, benign)fibroadenomas (solid, round, benign tumors)malignant tumor (tumor made up of cancer cells)Breast cancerIncidence: 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.
50diagnosed at this stage Breast cancerEarly 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 care.Local (confined to breast)Regional (spread to lymph nodes)Distant (spread to other organs)Percentage of cancerdiagnosed at this stageSurvival Rateat 5 years (%)Stage of cancer
51Breast cancer: risk factors Risk rises with ageGrowing evidence indicates that synthetic chemicals found in plastics, pesticides, detergents, and cosmetics can increase the risk of breast cancer
52Cosmetics and personal care products are not tested by the Food and Drug Administration (FDA) because they are not foods and are not drugsNonetheless, 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:
53Breast cancer treatment SurgeryMastectomy: surgical removal of all or most of the breastLumpectomy: removal of part of the breast containing the tumor and some surrounding tissue.Chemotherapy and/or radiationKills rapidly dividing cells (tumor cells generally divide more than normal cells)
54Breast 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-groups
55Discussion 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)