1. Chapter 3 Female Sexual Anatomy and Physiology

2. External Sex Organs
Vulva/Pudendum – entire female region of external sex organs
Mons Veneris
Protective, fatty cushion over the pubic bone
Covered with pubic hair
Labia Majora
Outer lips;
Tissue folds from mons to perineum surrounding the rest of the female genitals
Engorge with blood if excited

3. The external genital structures of the mature female.

4. External Sex Organs Labia Minora
Inner lips; pink tissue folds between vestibule and labia majora
No hair; many oil glands;
Darken if sexually aroused
Clitoris
Small cylindrical erectile tissue beneath the prepuce
Rich in blood supply and nerve endings;
Solely to provide sexual pleasure, primarily via indirect stimulation

5. The external genital structures of the mature female.

6. The Underlying Structures of the Vulva
Caption: The underlying structures of the vulva.

7. External Sex Organs Vestibule Urethral Meatus Perineum
Region between the labia minora
Urethral and vaginal openings, Bartholin’s glands ducts
Urethral Meatus
Between clitoris and vagina
Perineum
Between anus and vagina

8. Internal Sex Organs Vagina
4 inch, thin-walled accordion-like tube from the introitus to the cervix, tilted back;
Organ of intercourse and canal for menses and babies;
Lubricant secreted from vaginal wall openings when engorged;
First 1/3 contains many nerve endings,
Inner 2/3 has little nerves
3 layers: mucous, muscle, fibrous

9. Internal Sex Organs Vaginal Lubrication
Lubrication changes vaginal pH (↑alkaline) and increases pleasure
Vasocongestion – Engorgement of blood vessels
Grafenberg Spot (G-spot) – dime to quarter sized spot in the lower third of anterior vaginal wall (2-3 inches up), just past the pubic bone
Sensitive area
Analogous to the prostate gland

10. Internal Sex Organs Cervix – At bottom of the uterus; Doughnut-shaped
Secretes mucus to help or impede sperm, depending on the monthly cycle
Os - opening leading into the uterus

11. The female internal reproductive system (side view).

12. Internal Sex Organs
Uterus – 1-inch thick walls, hollow, muscular organ between the bladder and rectum; protects fetus, contractions to expel menses and fetus; 3 inches long, 2 inches wide
3 uterine wall layers:
Perimetrium
Myometrium
Endometrium

13. Internal Sex Organs
Fallopian Tubes (oviducts) – two 4-inch long trumpet shaped tubes that extend from the sides of the uterus and curve up to and around the ovaries
Ampulla – typical site of fertilization
Infundibulum – has fimbriae surrounding the ovaries to collect an egg upon release
Ovaries – form of an almond shell; contain 250,000 ova each; produce estrogen;

14. The female internal reproductive system (front view).

15. Other Sex Organs
Any area can be arousing depending on the type of stimulation and the perceptions of the recipient
Breasts (mammary glands) – modified sweat glands that produce milk; fatty tissue, 15 to 20 lobes, and milk-producing glands (alveoli)
Nipple, areola
Sucking stimulates pituitary gland to release prolactin (begin milk synthesis) and oxytocin (release of milk)

16. The Female Maturation Cycle
Female Puberty
Menstruation
Menopause

17. Female Puberty Begins anywhere from 8 to 17 years of age
Earlier onset of menstruation may be due to being overweight; can vary with race
Puberty lasts about 3 to 5 years
Begins when pituitary gland initiates release of FSH and LH, which increases the ovaries production of estrogen
Increased size of Fallopian tubes, uterus, vagina, breasts, buttocks, thighs

18. Female Puberty Pelvis widens Pubic hair grows
During puberty (usually 11 or 12 years), ovulation commences
Menarche occurs during this time as well, although it may be a few months before or after ovulation begins

19. Menstruation
Menstruation – uterine lining is shed if no pregnancy; tissue and blood exit the introitus
Menstrual cycle – lasts about 24 to 35 days, average is 28 days
Menstrual cycle has four phases:
Menstrual phase
Follicular phase
Ovulation phase
Luteal phase

20. Menstrual phase – Days 1-5 Follicular phase – Days 6-13
Menstrual Cycle 1 5 14 28
Menstrual phase – Days 1-5
Follicular phase – Days 6-13
Ovulation phase – Day 14
Luteal phase – Days 15-28

21. Menstruation Menstrual phase
Endometrial buildup is expelled through uterine contractions for 3-7 days;
Volume of menses is about 2-4 tablespoons of fluid

22. Menstruation: Menstrual Cycle
Follicular (Proliferative) phase – begins after menstruation ends; lasts 6-13 days; ovarian follicles begin to ripen; estrogen promotes development of endometrium to 2-5 millimeters thick
Ovulation phase – around day 14, an ovum is released due to FSH and LH that have ripened primary follicles; one follicle matures completely (secondary follicle) and ruptures, releasing the egg to be caught by the fimbriae

23. Menstruation: Menstrual Cycle
Luteal phase –
Corpus luteum forms on the ovary where the secondary follicle ruptured; it secretes progesterone and estrogen for days to further develop the endometrium to 4-6 millimeters thick;
Without fertilization, the progesterone and estrogen levels signal to the hypothalamus to decrease LH and the corpus luteum deteriorates and estrogen and progesterone drop significantly

24. Changes During the Menstrual Cycle
Caption:

25. The cycle of female hormones.

26. Pregnancy can occur if intercourse occurs from…
Fertilization 1 5 14 28
Egg is viable for
24 hours
Sperm is viable for
3 to 5 days
Pregnancy can occur if intercourse occurs from…
day 9 to 15 if ovulation occurs on day 14
day 7 to 17 could be unsafe

27. Variations in Menstruation
Amenorrhea – absence of menstruation
Primary amenorrhea – never begins menstruation; physical, health, emotional causes
Secondary amenorrhea – menses cease before reaching menopause; pregnancy, lifestyle, emotional, physical causes
Menorrhagia – excessive menses; oral contraceptives can help control

28. Variations in Menstruation
Dysfunctional uterine bleeding (DUB) – bleeding for long periods, or intermittent bleeding; hormonal, lifestyle, physical causes
Dysmenorrhea – painful menstruation; caused by inflammations, constipation, psychological stress; recommend medication, relaxation, yoga, massage, and stress relief

29. Variations in Menstruation
Premenstrual Syndrome (PMS) – physical or emotional symptoms that occur during the last few weeks of the menstrual cycle
Premenstrual Dysphoric Disorder (PMDD) – mood, behavioral, somatic, and cognitive symptoms; medication (SSRIs) and lifestyle changes provide relief
Variations in Menstruation
Risk factors for PMS and PMDD: history of depression, sexual abuse, PTSD, smoking

30. Menstrual Manipulation and Suppression
Women can experience up to 450 periods
Ways to stem growth of the endometrium:
Continuous birth control pills
Progesterone intrauterine devices
Injections
It is possible to relieve many physical symptoms related to menstruation
Some see menses as indicating health
No medical basis to avoid sex during a period

31. The Instead Softcup can be used during a woman’s period to make sexual activity less messy.

32. Menopause A woman’s final menstrual period
Climacteric – period of decreased estrogen production and menstruation stops; years, average 51 years
Typically have irregular cycles, rather than a sudden stop
Sexual glands decrease in size
Secondary sex characteristics change

33. Menopause
Hormonal changes – hot flashes, headaches, sleep disturbances
Sexual complaints
Menopause can be induced by surgically removing the ovaries; doctors try to keep at least one in if surgery is necessary

34. Menopause
Hormone replacement therapy – was a standard treatment, but there are a lot of health risks and not typically used today
Nutritional, vitamin, and herbal remedies are commonly used today

35. Female Reproductive and Sexual Health
Gynecological Health Concerns
Cancer of the Female Reproductive Organs

36. Female Reproductive and Sexual Health
Genital self-exams are recommended for women to be familiar with their genitals and any possible abnormalities
Routine gynecological examinations recommended once menstruating
Medical history and checkup
Pelvic examination (internal and external)
Breast examination
Pap smear – cervical swab

37. Gynecological Health Concerns
Most prevalent:
Endometriosis
Toxic Shock Syndrome
Uterine Fibroids
Vulvodynia
Vaginal Infections

38. Endometriosis Endometrial cells deposit outside of the uterus
Will engorge/weaken with the menstrual cycle
Symptoms: painful periods, lower abdominal or pelvic pain, pain on defecation, pain during intercourse
Typically childless women between 25 and 40
Cause is unknown
Treatment: hormones, surgery, laser therapy

39. Toxic Shock Syndrome
Caused by prolonged use of a single tampon which creates a buildup and subsequent infection of bacteria
Symptoms: fever, diarrhea, vomiting, sore throat, muscle ache, rash,
May cause: dizziness, respiratory distress, kidney failure, heart failure, death
Avoid by changing tampons regularly, using less absorbent tampons, using sanitary pads

40. Uterine Fibroids Hard tissue masses in the uterus; size range
Affect 20-40% (maybe 77%) of women over 35 years
Symptoms: pelvic pain and pressure, heavy cramping, heavy or prolonged bleeding, constipation, frequent urination, painful sex
Treatment: hormones, drugs, laser therapy, surgery, cryotherapy

41. Vulvodynia Chronic pain and soreness of the vulva
Symptoms: vaginal burning, itching, rawness, stinging, stabbing of vagina/vulva
The pain may be intermittent or constant
Cause is unknown
Treatment: biofeedback, drugs, dietary changes, nerve blocks, surgery, pelvic floor muscle strengthening

42. Infections Non-sexually transmitted infections can occur
Bartholin’s glands
Urinary tract
May be due to poor hygiene practices and/or frequent intercourse
Treated by draining infected gland (if necessary) and use of antibiotics
Douches change the vaginal pH level and can increase risk of infection

43. Cancer Associated with Female Reproductive Organs
Breast
Uterine
Cervical
Endometrial
Ovarian

44. Breast Cancer Worldwide, the most common cancer
One in 7 American women will develop it
Risk factors: fat intake, aging, early menarche, prolonged estrogen, inactive lifestyle, alcohol consumption, genetics
Breastfeeding, early pregnancy reduces risk
Early detection is critical: breast self-examinations, gynecological checkups, mammography

45. Breast exam (in Feature box)

46. Breast Cancer
Symptoms: breast lump, breast pain, nipple discharge, puckering of skin, change in nipple shape
If untreated, the cancer will spread to other parts of the body
Treatment: partial/modified mastectomy, radical mastectomy, lumpectomy, radiation, chemotherapy

47. Cervical Cancer 1 in 130 American women
Pap smear is used for detection; should be screened every year by 21 years of age
High cure rates
Risk factors: early intercourse, many sexual partners, teenage mothers, cervicitis, genital viral infections, extended oral contraceptive use
Treatment: surgery, radiation, hysterectomy

48. Endometrial Cancer Symptoms: abnormal bleeding, spotting
Detection most successful with dilation and curettage
Treatment: surgery, radiation, hormones, chemotherapy
Over 90% survival rate
Oral contraceptives decrease risk

49. Ovarian Cancer Less common than breast, uterine cancers Most deadly
Symptoms: few early signs, ovarian cyst, slight abdominal discomfort, appetite loss, indigestion, abdominal swelling, nausea, vomiting
Risk factors: childlessness, early menopause, high-fat diet, higher SES, lactose-intolerant, use talc powder on the vulva

50. Ovarian Cancer
Decreased risk with having children and using birth control pills, tubal ligation
Detection techniques: blood tests, pelvic exams, ultrasound
Unfortunately, most diagnosed after cancer has spread beyond the ovary because of the lack of early warning signs
Treatment: remove ovaries, radiation, chemotherapy