Chapter 3 Female Sexual Anatomy and Physiology

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

The external genital structures of the mature female.

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

The external genital structures of the mature female.

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

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

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

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

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

The female internal reproductive system (side view).

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

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;

The female internal reproductive system (front view).

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)

The Female Maturation Cycle Female Puberty Menstruation Menopause

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

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

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

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

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

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

Menstruation: Menstrual Cycle Luteal phase – Corpus luteum forms on the ovary where the secondary follicle ruptured; it secretes progesterone and estrogen for 10-12 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

Changes During the Menstrual Cycle Caption:

The cycle of female hormones.

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

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

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

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

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

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

Menopause A woman’s final menstrual period Climacteric – period of decreased estrogen production and menstruation stops; 40-58 years, average 51 years Typically have irregular cycles, rather than a sudden stop Sexual glands decrease in size Secondary sex characteristics change

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

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

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

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

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

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

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

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

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

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

Cancer Associated with Female Reproductive Organs Breast Uterine Cervical Endometrial Ovarian

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

Breast exam (in Feature box)

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

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

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

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

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