Chapter 17 The Reproductive System: Replacement and Repair.

Chapter 17 The Reproductive System: Replacement and Repair

Multimedia Directory Slide 21 Cell Division Video
Slide 22 Human Genome Project Video Slide 25 Egg Fertilization Video Slide 52 Female Reproductive System Animation Slide 53 Female Reproductive System Exercise Slide 75 Oogenesis Animation Slide 76 Oogenesis and Spermatogenesis Exercise Slide 119 Spermatogenesis Animation Slide 129 Male Reproductive System Animation Slide 130 Male Reproductive System Exercise Slide 141 Fetal Lie Video Slide 142 First Stage of Labor Video 2

Multimedia Directory (cont’d)
Slide 143 Transition Stage of Labor Video Slide 144 Second Stage of Labor Video Slide 145 Vacuum Extraction Video Slide 146 Infant APGAR Scoring Video Slide 147 Caesarean Section Delivery Video Slide 148 Placenta Video Slide 149 Post Partum Assessment Video Slide 150 Nurse Midwives Video Slide 164 Breast Cancer Video Slide 173 Erectile Dysfunction Video 3

Introduction Cells and tissues get damaged or simply wear out
Asexual reproduction, or mitosis, is the process by which cells make exact copies of themselves, and is essential to maintain a healthy body 4

Introduction Ultimately, cellular reproduction leads to complicated process by which humans produce new humans, or sexual reproduction Without this ability, the human species would die out and journey for human race would end 5

Learning Objectives Differentiate mitosis from meiosis
Locate and describe the male and female reproductive organs Describe the function of the male and female reproductive organs Discuss the phases of the menstrual cycle 6

Learning Objectives (cont’d)
Discuss the effects of hormonal control on the male and female reproductive system Describe the stages of labor and delivery Explain the common disorders of the male and female reproductive systems 7

Pronunciation Guide Bulbourethral gland Clitoris Corpus luteum
Click on the megaphone icon before each item to hear the pronunciation. Bulbourethral gland Clitoris Corpus luteum Cytokinesis Endometriosis Endometrium Epididymis Eukaryotic cell Fimbria (BUHL boh yoo REE thral) (KLIT oh riss) (KOR pus LOU tee um) (SIGH toe kih NEE suss) (EHN doh MEE tree oh sis) (EHN doh MEE tree um) (ep ih DID ih miss) (you care ee AH tic sell) (FIM bree ah) 8

Pronunciation Guide (cont’d)
Click on the megaphone icon before each item to hear the pronunciation. Follice-stimulating hormone Gametes Genitalia Gonadotropin-releasing hormone Human chorionic gonodatropin Labia majora Labia minora Luteal phase (FALL ih kle stim you LAY ting HOR mohn) (ga MEETS) (jen ih TALE ya) (GO nad oh TROH pin) (HUE man core ee AH nik GO nad oh TROH pin) (LAY bee ah mah JOR ah) (LAY bee ah mih NOR ah) (LOO tee al faze) 9

Click on the megaphone icon before each item to hear the pronunciation. Luteinizing hormone Meiosis Menses Menstruation Myometrium Oocyte Oogenesis Perimetrium Primordial follicles Progesterone (LOO tee ah NIZE ing) (my OH sis) (MEN seez) (MEN stroo AY shun) (MY oh MEE tree um) (OH oh site) (OH jenn eh siss) (pair ee MEE tree um) (pry MORE dee all FALL ih klz) (proh JESS ter ohn) 10

Click on the megaphone icon before each item to hear the pronunciation. Pudendal cleft Seminal vesicles Seminiferous tubules Sertoli cells Spermatocytes Spermatids Spermatogonia Spermatozoa Testis, testes (PEW den dall cleft) (SEM ih nal VESS ih klz) (SEN ih NIF er uss TOO byoolz) (sir TOW lee sells) (sper MAT oh sites) (sper MAT ids) (sper MAT oh GO nee ah) (sper MAT oh ZOE ah) (TESS tiss, TESS teez) 11

Click on the megaphone icon before each item to hear the pronunciation. Testicles Testosterone Urethra Uterus Vagina Vas Deferens Vulva Zygote (TESS tih klz) (tess TOSS ter ohn) (yoo REE thrah) (YOO ter uss) (vah GYE nah) (VAS DEF er enz) (VULL vah) (ZIGH goht) 12

Mitosis Asexual cellular reproduction
Needed for repair and regeneration of tissues Growth is accomplished through mitosis 13

Sexual Reproduction Needed for perpetuation of species
Requires assistance of another individual to produce offspring that are not identical to themselves Involves union of cell from one organism with cell from another organism of same species to form unique new organism 14

Meiosis In animals, females produce eggs, males produce sperm, and these special cells called gametes Gametes produced by meiosis, or reduction division, because daughter cells produced at end of meiosis have half as many chromosomes as original 15

Meiosis (cont’d) Daughter cells fuse together with gamete from another organism, which also has half as many chromosomes, forming cell that will have total number of chromosomes needed when both cells are added together In humans, total number of chromosomes needed is 46, 23 from mother and 23 from father 16

Meiosis (cont’d) If not for meiosis, new cell would have 92 chromosomes; too many or too few chromosomes often results in cell death 17

Meiosis (cont’d) 46 chromosomes are paired, so there are 23 pairs of chromosomes Each pair consists of one from father and one from mother Chromosomes are matched based on size, shape, and genes they carry Chromosomes named by number 1–23 18

Meiosis (cont’d) 23rd pair is sex chromosome, so named because they determine sex of baby XX is female, XY is male; thus the father determines sex of the baby because the mother can only contribute X chromosomes 19

Figure Photo of human chromosome profile: Both an X and a Y chromosome appear in the image; therefore, this is a male sample. (Source: CNRI/SPL, Photo Researchers, Inc.) 20

Click here to view a video on the topic of cell division.
Cell Division Video Click here to view a video on the topic of cell division. Back to Directory 21

Human Genome Project Video
Click here to view a video on the topic of the human genome project. Back to Directory 22

The Human Life Cycle Mitosis and meiosis are absolutely necessary parts of human life cycle, needed for cell replacement, repair, and production of new organisms Eggs and sperm, with only half as many chromosomes as other cells, are produced by meiosis in specialized organs known as gonads (testes and ovaries) 23

The Human Life Cycle During sexual reproduction, gametes unite and combine their genetic material; the union is called fertilization Fertilized egg, zygote, has 46 chromosomes; zygote reproduces millions of times via mitosis and develops within female to change from embryo to fetus 24

Egg Fertilization Video
Click here to view a video on the sperm and fertilization of the egg. Back to Directory 25

Figure 17-2 The early stages of the human life cycle.
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The Human Reproductive System
Reproductive organs called genitalia Genitalia divided into: Primary genitalia: gonads that produce gametes Secondary genitalia: other structures that aid in reproductive process 27

Female Anatomy In females, primary genitalia are ovaries
Secondary genitalia are fallopian tubes, uterus, vagina, and external genitalia called vulva Ovaries are paired structures, about 3 cm long, in peritoneal cavity 28

Female Anatomy There is one ovary on either side of uterus
Several ligaments suspend or anchor each ovary Mesovarium suspends ovary 29

Female Anatomy (cont’d)
Suspensory ligament attaches ovary to lateral pelvic wall Ovarian ligament anchors ovary to uterine wall Blood vessels, ovarian artery, and ovarian branch of uterine artery travel through mesovarium and suspensory ligament, supplying ovary with oxygenated blood 30

Figure 17-3 Internal female reproductive organs.
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Figure 17-3 (continued) Internal female reproductive organs.
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The Ovary Covered by fibrous capsule called tunica albuginea made of cuboidal epithelium Interior divided into cortex, which contains eggs, and medulla, which contains blood vessels, nerves, and lymphatic tissue surrounded by loose connective tissue Anatomy of cortex is relatively complicated and will be described during discussion of physiology 33

The Uterine Tubes Uterine tubes, also called oviducts or fallopian tubes, are passageways for eggs to get to uterus Each tube begins as large funnel, infundibulum, surrounded by ciliated projections called fimbria Infundibulum leads to widened area, ampulla, followed by a longer, narrower portion known as isthmus 34

The Uterine Tubes Uterine tubes are connected to superior portion of uterus Constructed of sheets of smooth muscle lined with highly folded, ciliated, simple columnar epithelium Outside is covered by visceral peritoneum and suspended by mesentery known as mesosalpinx 35

The Uterus Found in pelvic cavity posterior and superior to urinary bladder and anterior to rectum Major portion called body; rounded superior portion between uterine tubes is fundus and narrow inferior portion is isthmus Cervix is valve-like portion of uterus that protrudes into vagina, while cervical canal communicates with vagina 36

The Uterus (cont’d) Like ovaries, the uterus is suspended and anchored by series of ligaments Mesometrium attaches uterus to lateral pelvic walls Combination of mesometrium and mesovarium called broad ligament 37

The Uterus (cont’d) Lateral cervical ligaments attach cervix and vagina to lateral pelvic walls Uterus anchored to anterior wall of pelvic cavity by round ligaments 38

The Uterus (cont’d) Consists of 3 layers:
Perimetrium: outermost layer, visceral peritoneum Myometrium: consists of smooth muscle Endometrium: inner lining is mucosa layer of columnar epithelium and secretory cells with two divisions Basal layer: responsible for regenerating uterine lining each month Functional layer: sheds about every 28 days when woman has her period 39

The Uterus (cont’d) Endometrium is highly vascular
Blood supplied by uterine artery, which branches from internal iliac arteries on each side Uterine arteries split into actuate arteries, supplying myometrium, and radial arteries, which supply blood to endometrium Straight radial arteries supply basal layer 40

The Uterus (cont’d) Spiral radial arteries supply functional layer, decaying and regenerating every month as part of menstrual cycle, and undergoing spasms which contribute to shedding of endometrium each month Blood returns to circulation via network of venus sinuses 41

Pathology Connection: Endometriosis
Occurs when endometrial tissue escapes uterus and implants in abdominal cavity Builds up and decays each month with hormonal changes Symptoms Abdominal and back pain during menstruation Painful intercourse Chronic pelvic pain Painful urination and bowel movements, especially during menstruation 42

Pathology Connection: Endometriosis (cont’d)
Untreated, endometriosis can cause scar tissue, reproductive problems, digestive problems; most common cause of infertility 43

Diagnosis may include Detailed history and physical exam Ultrasound, which can detect large implants of endometrial tissue outside uterus Laparoscopic examination of pelvic cavity Only way to diagnose endometriosis with certainty Suspected endometrial implants biopsied to confirm they are endometrial tissue 44

Treatment Pain can be treated with NSAIDs To prevent progression of implants, you can Remove implants (and associated scar tissue) surgically Suppress implants using hormones Severe cases may require hysterectomy with removal of ovaries Hormonal treatments can include Contraceptives (combined estrogen and progesterone) GnRH agonists Synthetic male hormones (androgens) 45

Figure 17-4 Location of endometriosis outside the uterus.
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The Vagina Tube, approximately 10 cm long, running from uterus to outside of body Purpose is to receive penis during intercourse and allow for passage of menstrual fluid out of uterus Also called birth canal, since another function is to allow movement of baby out of uterus during childbirth 47

The Vagina External opening may be covered a perforated membrane, the hymen Torn hymen once thought to prove that woman had intercourse, but many hymens are highly perforated and easily ruptured by day to day activities such as riding a bike or jogging; intact hymen not valid test for virginity 48

The External Genitalia
Collectively known as vulva and is complex and important part of reproduction Vulva surrounded by two prominences called labia majora, rounded fat deposits that meet and protect rest of external genitalia Labia majora meet anteriorly to form mons pubis, covered by pubic hair 49

The External Genitalia
Between the labia majora is opening known as pudendal cleft, with vestibule located within that contains urethra and vagina Several glands surround vestibule to keep it moist Lateral border of vestibule formed by thin labia minora, which meet anteriorly to form prepuce 50

The External Genitalia (cont’d)
Posterior to prepuce is clitoris, small erectile structure, 2 cm in diameter Like penis, clitoris engorges with blood during sexual arousal; however, clitoris increases in diameter, not length Clitoris has shaft, body, and glans (tip) 51

Female Reproductive System Animation
Click here to view an animation of the female reproductive system. Back to Directory 52

Female Reproductive System Exercise
Click here to view an interactive labeling exercise of the features of the female reproductive system. Back to Directory 53

Figure 17-5 The external female genitalia (vulva).
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Mammary Glands Another set of external accessory sexual organs in female; are milk production glands housed in breasts; in young children, mammary glands virtually identical in boys and girls At puberty, estrogen and progesterone stimulate breast development in girls 55

Mammary Glands In adult females, breast consists of glandular lobes and lots of adipose tissue; each lobe divided into smaller lobules which house milk secreting sacs called alveoli when woman is lactating Milk made in alveoli travels through series of ducts and sinuses, eventually reaching areola or nipple Milk production controlled by hormone prolactin 56

Figure 17-6 The mammary glands.
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Reproductive Physiology: Female
Closely tied to regulated cycle Cycle is normally regulated via hormonal control 58

The Menstrual Cycle Takes approximately 28 days, involves ovaries and uterus Ovarian cycle involves monthly maturation and release of eggs from ovary Uterine cycle consists of monthly buildup, decaying, and shedding of uterine lining 59

The Menstrual Cycle (cont’d)
Cycles begin in woman’s teen years, during puberty, and end during her 40s or 50s in menopause Goal is to release egg for fertilization, prepare uterus to receive fertilized egg, and nourish fertilized egg should pregnancy result If pregnancy doesn’t result, uterine lining will shed and cycle will begin again 60

Begins with first day of menses Menstruation is term referring to actual shedding of endometrium, “period” itself Menses refers to time during which woman is menstruating, time when woman is having her “period” Menses usually lasts 4–5 days, but can be longer or shorter in different women, can vary month to month in same woman 61

Once menses is over, endometrium begins to proliferate, readying itself for egg about to be released from ovary (ovulation) From day 1–14 oocyte, or egg cell, is undergoing a number of developmental changes getting ready for ovulation on day 14 Ovulation is release of mature egg from ovary 62

Egg travels from ovary to uterus, which has been preparing for it If oocyte is fertilized by sperm, it will implant in thickened endometrium If it doesn’t implant within few days, endometrium will begin to decay and menstruation will occur within 2 weeks 63

Time between end of menses and ovulation is known as follicular, or proliferative, phase During this time endometrium is proliferating and follicles (eggs and associated helper cells) are maturing in ovary 64

Time between ovulation and menses known as luteal, or secretory, phase because of development of structure called corpus luteum in ovary and beginning of secretion in uterus 65

Oogenesis, Follicle Development, and Ovulation
Process of egg production called oogenesis Oogenesis begins with birth of oogonia, or egg stem cells, in ovary Oogonia undergo mitosis, producing millions of primary oocytes; happens very early in woman’s life, with millions of primary oocytes produced as fetus Women have all eggs they will ever have five months before they are born 66

Oogenesis, Follicle Development, and Ovulation (cont’d)
Primary oocytes, since they are born via mitosis, still have 46 chromosomes They must undergo meiosis to become gametes, with only 23 chromosomes, allowing them to combine with another gamete and ending with total of 46 chromosomes Primary oocytes stay in kind of suspended animation until puberty, when they finish developing 67

Primary oocytes eventually surrounded by helper cells, called granulosa cells; at this point they are called primordial follicles, and stay dormant until puberty Hormonal signals during puberty cause some primordial follicles to enlarge and increase number of granulosa cells Enlarged cells called primary follicles 68

Figure 17-7 Maturation of follicle and oocyte.
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Once a girl reaches puberty, one primary follicle will become secondary follicle Secondary follicle will not complete development unless it is ovulated and fertilized Just before ovulation, secondary follicle fills with fluid and moves toward surface of ovary, where it becomes a visible lump 70

Fimbria of uterine tubes brush surface of ovary, causing follicle to rupture When follicle ruptures, egg (actually an oocyte) is released into peritoneal cavity and fimbria pull it toward funnel, drawing it into uterine tube 71

As egg travels down uterine tube it will either be fertilized or not If sperm present in uterine tube and all conditions are right, sperm will penetrate egg, fertilizing it and triggering rest of egg development 72

Successfully fertilized egg has 46 chromosomes and now called zygote Zygote enters uterus and implants into proliferated endometrium, stopping woman from experiencing menses Ruptured follicle left behind in ovary will become corpus luteum and secrete hormones to help maintain thickened endometrium to nourish embryo 73

If there no sperm in uterine tube, conditions are not right, or something goes wrong after fertilization, zygote will not implant in uterus If there is no implantation within few days, uterine lining will begin to degenerate and woman will have her period, with egg swept out in menstrual flow Corpus luteum will become corpus albicans and eventually disappear 74

Click here to view an animation on the topic of oogenesis.
Oogenesis Animation Click here to view an animation on the topic of oogenesis. Back to Directory 75

Oogenesis and Spermatogenesis Exercise
Click here for an interactive labeling activity of oogenesis and spermatogenesis. Back to Directory 76

Hormonal Control Hormones from hypothalamus, pituitary, and ovary control female cycle Hormone levels generally controlled by negative feedback loop Hormones often released as part of hierarchy, with hypothalamus releasing hormone that controls pituitary, which then releases hormone that controls another organ 77

Hormonal Control (cont’d)
Four hormones control menstrual cycle: estrogen and progesterone from ovary, and luteinizing hormone (LH) and follicle stimulation hormone (FSH) from pituitary Estrogen and progesterone levels increase at puberty Release of gonadotropin releasing hormone (GnRH) from hypothalamus causes increase in secretion of LH and FSH from pituitary 78

FSH initiates development of primary follicles each month, while LH triggers ovulation During follicular stage, estrogen levels continue to rise as more and more is secreted by developing follicle, stimulating proliferation of uterine lining 79

Estrogen exerts positive influence on hypothalamus, increasing secretion of GnRH, thus increasing LH and FSH Positive feedback loop continues, raising hormone levels until ovulation occurs, when feedback loop reverses itself 80

Once ovulation occurs, feedback loop reverses itself Corpus luteum begins to secrete progesterone, as well as a little estrogen Estrogen, under influence of progesterone, exerts negative feedback on hypothalamus and pituitary, decreasing GnRH, LH, and FSH secretion 81

Progesterone also exerts negative feedback on hypothalamus and pituitary Thus, during luteal or secretory phase, LH, FSH, and estrogen levels drop while progesterone levels rise Hormonal changes prevent another egg from maturing 82

For about 10 days after ovulation, progesterone levels remain high as corpus luteum continues to secrete hormone Progesterone’s effect on uterus is to maintain buildup of endometrium and to decrease uterine contractions If no pregnancy results, corpus luteum degenerates and progesterone will no longer be produced 83

Decreasing progesterone levels cause degeneration of endometrium, followed by menstruation Decreased progesterone levels release hypothalamus and pituitary from its inhibitory effects, and FSH and LH levels begin to rise and cycle begins again 84

Figure 17-8 The menstrual cycle.
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If pregnancy does result, implanted fertilized egg secretes hormone called human chorionic gonadotropin (HCG) HCG stimulates corpus luteum to keep secreting progesterone and little estrogen to maintain uterine lining At about three month’s gestation, placenta begins to secrete its own progesterone and estrogen, thus becoming endocrine organ 86

Table 17-1 Hormones Controlling Pregnancy
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Figure 17-9 Oxytocin and breast feeding.
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Pathology Connection: Menstrual Disorders
Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD) Both characterized by predictable cognitive, physical, emotional and behavioral symptoms associated with woman’s luteal phase Possible symptoms Affective (psychological) symptoms: depression, anger, irritability, anxiety, confusion, withdrawal Physical signs and symptoms: breast tenderness, bloating, swelling extremities, headache 89

Pathology Connection: Menstrual Disorders (cont’d)
Diagnosis based on presence of symptoms Symptoms must start five days prior to menses, cease four days into menses, and not recur until following cycle; to make diagnosis, symptoms must have been repeated for the last three cycles 90

Diagnosis based on presence of symptoms PMS diagnosed if woman has one affective and one physical symptom PMDD diagnosed if woman has five symptoms and at least one of them is affective 91

Treatment depends on severity of disease Mild/moderate: good nutrition, regular exercise, complex carbohydrates, calcium supplements NSAIDs or hormonal suppression if lifestyle changes are insufficient If affective symptoms are severe, psychiatric medications (like SSRIs or anti-anxiety meds) can be used 92

Polycystic ovarian syndrome (PCOS) Disorder characterized by Formation of multiple cysts on ovaries Hormonal abnormalities Infertility Obesity Insulin resistance 93

Polycystic ovarian syndrome (PCOS) Etiology: Ovaries produce too much testosterone and estrogen, but too little progesterone Symptoms Failure to ovulate Excess facial hair Male pattern baldness Irregular menstrual cycles 94

Polycystic ovarian syndrome (PCOS) In addition, women with PCOS are more likely to have characteristics of metabolic syndrome and/or type II diabetes, such as being Overweight Insulin resistant (even if not overweight) Hypertensive Hyperlipidemic 95

Polycystic ovarian syndrome (PCOS) Diagnosis Blood work: looking for elevated levels of LH testosterone, prolactin, insulin Ultrasound: looking for large ovaries (greater than 10cm3) with 12 or more large follicles (2-3 cm diameter) 96

Polycystic ovarian syndrome (PCOS) Treatment consists mainly of symptom relief Weight loss: can decrease severity of most other symptoms (including infertility) Birth control pills: can regulate menstrual cycle Drugs: can treat hyperlipidemia and hyperinsulinemia Infertility can be treated with fertility drugs and/or with surgical repair of damaged ovaries 97

Male Anatomy Testes: primary genitalia, producing male gamete, sperm
Unlike female, primary male genitalia is external Secondary genitalia: penis (sperm delivery organ), epididymis, vas deferens, urethra (sperm ducts), and several accessory glands including prostate gland, seminal vesicles, and bulbourethral glands 98

Figure 17-10 Male reproductive anatomy.
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The Testes (Testicles)
Paired organs suspended in sac called scrotum, hanging on either side of penis During fetal development, testes formed in abdomen; in last three months of development, migrate to normal position in scrotum 100

The Testes (Testicles)
If testes fail to descend into scrotal sac, called cryptorchidism May require surgical intervention It testes remain undescended, man may become sterile; internal body temperature too hot for viable sperm to develop 101

The Testes (Testicles) (cont’d)
Hydrocele: abnormal collection of fluid in testes 102

The Testes (Testicles) (cont’d)
Each testis is surrounded by serous membrane, called tunica vaginalis, originating from peritoneum Deep in tunica vaginalis is tunica albuginea Inside of testes divided into 250 to 300 wedges called lobules, each contain 1-4 seminiferous tubules Seminiferous tubules made of epithelium and areolar tissue and contain sperm stem cells and sperm helper cells called sertoli cells or nurse cells 103

The Penis From Latin word for “tail”
Sperm delivery organ that transfers sperm from male to female Attached portion called root, while freely moving part called shaft or body Glans penis (tip) is covered by loose section of skin called foreskin unless man has been circumcised 104

The Penis Internally, penis contains urethra, a transport passage for both sperm and urine Has three erectile bodies, tubes with sponge-like network of blood sinuses 105

The Epididymis Several ducts in male reproductive system
Epididymis is comma shaped duct on posterior and lateral part of testes Tube is highly coiled, if unraveled, would measure six meters long Made of pseudostratified ciliated epithelium and smooth muscle Sperm mature here 106

The Vas Deferens Short tube, only 45 cm long
Lined with ciliated pseudostratified epithelium, like epididymis, but has thick smooth muscle layer and is surrounded by connective tissue layer called adventitia Runs from anterior part of scrotum as pair of tubes, one on each side, into abdominal wall (through inguinal canal) and pelvic cavity, medially over urethra, and along posterior bladder wall 107

The Vas Deferens Posterior to bladder, joins seminal vesicle to form ejaculatory duct, which then passes through prostate gland and empties into urethra Between scrotum and inguinal canal, it runs through a tube with blood vessels and nerves, collectively called spermatic cord 108

Accessory Glands Three accessory glands in male reproductive system
Seminal vesicles: highly coiled, posterior to bladder, made of pseudostratified epithelium, smooth muscle, and connective tissue Prostate gland: chestnut-sized gland surrounding urethra just inferior to bladder made up of dense mass of connective tissue and smooth muscle with embedded glands Bulbourethral glands: pea sized glands inferior to prostate 109

Pathology Connection: Male Reproductive Diseases
Benign Prostatic Hyperplasia (BPH) Non-cancerous enlargement of prostate Symptoms: enlarged prostate impinges upon urethra, causing Weak urine stream Incomplete voiding Urinary frequency Night time urination Urinary urgency 110

Pathology Connection: Male Reproductive Diseases (cont’d)
Benign Prostatic Hyperplasia (BPH) Diagnosis Detailed history and physical exam (including exam of prostate) Prostate specific antigen (PSA) blood levels Rule out other urinary conditions (like infection, etc.) 111

Benign Prostatic Hyperplasia (BPH) Treatment Drug treatments: decrease testosterone and shrink prostate; relax smooth muscle in prostate, improving urine stream Surgical treatments: minimally invasive laser or microwave ablation. placement of stent in urethra, removal of part or all of prostate 112

Figure 17-11 Benign prostatic hyperplasia.
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Prostate Cancer Most common non-skin cancer affecting American men Prostate specific antigen (PSA) blood test can be used to screen for it Prostate cancer screening should begin at age 50 (or earlier if family history) 114

Spermatogenesis Sperm production, in testes, is continuous process beginning when boy reaches puberty and continuing until death Sperm production, called spermatogenesis, is much less complicated than process of ovulation Spermatogonia, sperm stem cells, undergo mitosis to form primary spermatocytes Primary spermatocytes form two secondary spermatocytes 115

Spermatogenesis Sperm production, called spermatogenesis, is much less complicated than control of ovulation Spermatocytes complete meiosis to form spermatids Spermatids go through period of development to form immature spermatozoa (sperm) 116

Spermatogenesis All of this takes place in testes in seminiferous tubules Spermatogonia line up against walls of tubules Mature sperm cluster near lumen of tubules Sperm then travel from seminiferous tubules to epididymis where sperm spend about two weeks maturing and gaining ability to swim 117

Figure 17-12 Spermatogenesis.
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Spermatogenesis Animation
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Hormonal Control of Male Reproduction
Testosterone is most important sex hormone In utero, secretion of HCG by placenta stimulates embryonic secretion of testosterone, masculinizing fetus; those not exposed to or insensitive to testosterone become female After birth little testosterone secreted until puberty 120

Hormonal Control of Male Reproduction (cont’d)
At puberty, two hormonal changes occur that signal beginnings of maturity First, testosterone secretion by testes increases Second, testosterone inhibits GnRH, and therefore FSH and LH, further enhancing testosterone production, creating major positive feedback loop 121

Testosterone secretion at puberty brings about male secondary sexual characteristics development including: Body, facial, and pubic hair growth Deepening of the voice Increased muscle and bone mass 122

LH and FSH affect males exactly as they do females Stimulate gamete development Regulated same way in males as in females GnRH released from hypothalamus which stimulates LH and FSH secretion from pituitary 123

Erection and Ejaculation
When man sexually aroused erectile bodies in penis (sponge-like tissue with blood spaces) will become engorged with blood, stiffening and expanding penis, producing erection In order for sperm to leave body, ejaculation, expulsion of semen (sperm and assorted chemicals), must occur 124

Erection and Ejaculation
Smooth muscle contracts throughout ducts and glands of male reproductive system and propels sperm from epididymis into vas deferens, and into pelvic cavity As sperm passes seminal vesicles sugar and chemicals added 125

Erection and Ejaculation (cont’d)
Sperm and chemicals enter ejaculatory duct, passing though prostate gland, where fluid is added, liquefying semen and protecting sperm from acid environment of vagina by secreting alkaline substance Semen passes by bulbourethral gland, adding mucus to semen Finally, semen enters urethra and is carried outside body 126

If man having sexual intercourse (coitus) with woman and ejaculates, sperm enter vagina and make their way into uterine tubes Female reproductive system not hospitable to sperm and many will not survive journey If there is an egg waiting to be fertilized, sperm will find egg and attempt to penetrate it for fertilization 127

New research suggests that egg is not passive participant in fertilization, but may actually engulf sperm and even choose which to allow inside Only one sperm will fertilize egg 128

Male Reproductive System Animation
Click here to view an animation of the male reproductive system. Back to Directory 129

Male Reproductive System Exercise
Click here to view an interactive labeling exercise of the features of the male reproductive system. Back to Directory 130

Pathology Connection: Erectile Dysfunction (ED)
Long-term inability to maintain erection (over period of three months or more) Very common; affects 50% of men ages 40-70 131

Pathology Connection: Erectile Dysfunction (ED)
Causes Organic: caused by underlying endocrine, neurological, anatomical, or vascular condition Psychogenic: having underlying emotional cause Mixed: combination of organic and psychogenic 132

Pathology Connection: Erectile Dysfunction (ED) (cont’d)
Diagnosis Medical history/questionnaires Physical exam and testing to try to determine underlying cause of ED; tests may include: PSA, testosterone levels, blood glucose, cholesterol levels Treatments Treat underlying cause Drugs Penile prosthetics 133

Pregnancy Occurs when egg fertilized by sperm and implants in uterus
Period of time when developing baby grows within uterus called gestation period, approximately 40 weeks Baby born before 36–37 weeks gestation considered premature 134

Figure 17-13 A human from fertilization to the early fetal stage.
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Pregnancy (cont’d) First eight weeks of gestation developing fertilized egg called embryo; during this time organs and systems are fundamentally formed After eight weeks is called fetus Growing fetus nourished by spongy structure called placenta, attached to fetus and mother by umbilical cord Fetus is encased in membranous sac, called the amnion, containing amniotic fluid 136

Pregnancy (cont’d) Amniotic fluid can be tested in procedure called amniocentesis Here, amniotic sac is punctured, and fluid is withdrawn Fluid can be tested for chromosomal abnormalities leading to birth defects and biochemical disorders Labor is process in which fetus is delivered from uterus through vagina 137

Figure 17-14 Amniocentesis
Figure Amniocentesis. The woman is usually scanned by ultrasound to determine the placental site and to locate a pocket of fluid. As the needle is inserted, three levels of resistance are felt when the needle penetrates the skin, fascia, and the uterine wall. When the needle is placed within the amniotic cavity, amniotic fluid is withdrawn. 138

Pregnancy (cont’d) Labor consists of three stages
First stage is dilation, where uterine smooth muscles begin to contract, moving fetus down uterus and causing cervix to begin to dilate Second stage begins when cervix fully dilated to 10 cm and fetus actually delivered; generally, head presents first (called crowning) and baby’s mouth is suctioned before it takes its first breath to avoid breathing mucus into respiratory tract; breech presentation is when buttocks appear first instead of head Last stage of labor, placental stage, is delivery of placenta from final uterine contractions 139

Figure 17-15 Stages of labor.
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Click here to view a video on the topic of fetal lie.
Fetal Lie Video Click here to view a video on the topic of fetal lie. Back to Directory 141

First Stage of Labor Video
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Transition Stage of Labor Video
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Second Stage of Labor Video
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Vacuum Extraction Video
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Infant APGAR Scoring Video
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Caesarean Section Delivery Video
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Click here to view a video on the topic of the placenta.
Placenta Video Click here to view a video on the topic of the placenta. Back to Directory 148

Post Partum Assessment Video
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Click here to view a video on nurse midwives.
Nurse Midwives Video Click here to view a video on nurse midwives. Back to Directory 150

Pathology Connection: Breast Health
Mastitis: inflammation of breast Usually occurs in lactating females Bacteria enter break in nipple tissue Result: breast pain, redness, swelling, and difficulty getting milk to flow Treatment Application of heat Analgesics Antibiotics 151

Pathology Connection: Breast Health (cont’d)
Breast cancer One of leading causes of death in women between ages of 32 and 52; men can also develop breast cancer (though less common) Treatments may include chemotherapy, radiation therapy, partial or full mastectomy Some women with family history of breast cancer elect to have mastectomy before cancer occurs (somewhat controversial) Earlier cancer is detected, greater chance for survival; self-breast examination important in early detection 152

Figure 17-16 Breast self-examination (BSE).
153

Common Diseases of the Reproductive System - Females
Amenorrhea/Dysmenorrhea Etiology: absent or painful menstruation; may be due to many different causes Signs and symptoms: lack of menstrual period/pain during period Diagnostic tests: physical exam, hormone levels, imaging, exploratory surgery Treatments: hormones, NSAIDS, surgery, treat underlying conditions 154

Premenstrual Syndrome (PMS) / Premenstrual Dysphoric Disorder (PMDD) Etiology: exact cause not determined; may be due to irregular levels of estrogen or progesterone Signs and symptoms: constipation, nausea, headache, backache, edema, malaise, irritability, mental confusion, depression 155

Premenstrual Syndrome (PMS) / Premenstrual Dysphoric Disorder (PMDD) Diagnostic tests: currently PMS diagnosed if woman has one affective (psychological) and one physical symptom; woman diagnosed with PMDD if she has five of criteria Treatments: treat symptoms; proper nutrition, complex carbohydrates, anti-depressants, analgesics and hormone therapy 156

Endometriosis Etiology: implantation of endometrial tissue in pelvic cavity; cause unknown Signs and symptoms: hematuria, dysuria, painful intercourse and excessive menstrual bleeding; increasing painful periods; lower back, vaginal and abdominal pain Diagnostic Tests: patient history and exam, laparoscopic exam 157

Endometriosis Treatments: early diagnosis critical, use of oral contraceptives and other hormones appear to delay onset; analgesics for relief of discomfort; surgery for severe cases 158

Polycystic Ovarian Syndrome Etiology: ovaries produce too much testosterone and estrogen, but too little progesterone Signs and symptoms: multiple cysts on ovaries, hormonal abnormalities, infertility, obesity and insulin resistance; failure to ovulate, excess facial hair, and irregular menstrual cycles 159

Polycystic Ovarian Syndrome Diagnostic tests: imaging and blood work.; increased blood levels of LH, testosterone, prolactin and insulin 160

Polycystic Ovarian Syndrome Treatments, mainly symptom relief: weight control; birth control pills to regulate woman's menstrual cycle; treat hyperlipidemia and hyperinsulinemia if present 161

Breast Cancer Etiology: most common malignancy of American women and leading cause of death between ages 40-55; uncontrolled growth of breast tissue; familial history Signs and symptoms: bloody, brown, or serous nipple discharge , noticeable lump, changes in breast tissue 162

Breast Cancer Diagnostic tests: mammogram, Imaging, biopsy Treatments: lumpectomy, mastectomy, chemotherapy, radiation, etc 163

Click here to view a video on breast cancer.
Breast Cancer Video Click here to view a video on breast cancer. Back to Directory 164

Cervical Cancer Etiology: research shows relationship to human papilloma virus and early and frequent sexually activity; may be genetic predisposition; most common in women ages 30-50 Signs and symptoms: asymptomatic in early stage; watery vaginal discharge; occasional spotting of blood; later stages, foul smelling vaginal discharge

Cervical Cancer Diagnostic tests: PAP smears with microscopic examination, patient history and exam. Treatments: cryotherapy (freezing) or laser surgery, hysterectomy (removal of uterus); radiation

Vaginitis Etiology: inflammation of vagina (infection, irritation, menopause) Signs and symptoms: discharge, itching, pain Diagnostic tests: pelvic exam, lab tests, patient history Treatments: depending on cause: antibiotics, antifungals, vaginal creams, avoid irritants

Abruptio Placenta Etiology: placenta separates from uterus Signs and symptoms: bleeding, pain, preterm labor Diagnostic tests: ultrasound Treatments, depends on severity: ranges from nothing to emergency caesarian section

Placenta Previa Etiology: placenta grows over cervix; causes unknown Signs and symptoms: bleeding late in pregnancy, pain Diagnostic tests: ultrasound Treatments: transfusions, medication, caesarian

Ectopic (tubal) pregnancy: when embryo implants in uterine tube Etiology: scarring, endometriosis Signs and symptoms: bleeding, abdominal pain, nausea, unconsciousness and shock if tube ruptures Diagnostic tests: ultrasound, exploratory surgery, blood tests, pregnancy test Treatments: termination of pregnancy, treatment of symptoms

Postpartum depression Etiology: changes in hormone levels after pregnancy Signs and symptoms: fatigue, anxiety, worthlessness Diagnostic tests: exam Treatments: counseling, medication

Common Diseases of the Reproductive System - Males
Erectile Dysfunction (ED) Etiology: many underlying causes Signs and symptoms: inability to maintain erection (problem lasts three months or more) Diagnostic tests: exam, blood work Treatments: medication, counseling

Erectile Dysfunction Video
Click here to view a video on the topic of erectile dysfunction. Back to Directory 173

Common Diseases of the Reproductive System – Males
Benign Prostatic Hyperplasia Etiology: unknown, age related hormone changes perhaps Signs and symptoms: lower urinary tract symptoms similar to UTI or overactive bladder Diagnostic tests: exam, blood work, rule out other causes Treatments: medication, surgery

Common Diseases of the Reproductive System – Males
Prostate cancer Etiology: uncontrolled growth of prostate cells which can spread Signs and symptoms: lower urinary tract symptoms similar to UTI or overactive bladder Diagnostic tests: exam, blood work, rule out other causes Treatments: prostatectomy, chemotherapy, etc.

Pharmacology Corner - Females
Oral contraceptives Usual composition: combination of estrogen and progesterone General uses: prevention of pregnancy and regulation of menstrual cycles Mechanism of action: preventing ovulation and decreasing menstruation

Progestins (synthetic progesterone drugs) Can be administered orally or by injection Use: regulate menstrual cycle Mechanism of action: prevent ovulation, decrease menstruation

Gonadotropin Releasing Hormone (GnRH) Agonists Can be administered by injection or as nasal spray Often given in combination with low dose estrogen/progesterone Best hormonal therapy for endometriosis May cause menopause-like side effects (hot flashes, bone loss)

Danazol (synthetic androgen) Previous treatment for endometriosis (rarely used today) Improved endometriosis symptoms, but side effects severe and sometimes permanent (including voice deepening, excess facial and body hair growth, acne hyperlipidemia, decreased sex derive, weight gain)

Pharmacology Corner - Males
Drugs for Benign Prostatic Hyperplasia (BPH) 5-alpha-reducatase inhibitors Mechanism of action: decrease testosterone levels Effects: prevent further enlargement of prostate; may help shrink prostate Alpha blockers Mechanism of action: relax smooth muscles in urethra Effects: increases urine stream

Pharmacology Corner - Males
Drugs for Erectile Dysfunction (ED) Phosphodiesterase type 5 inhibitors Examples: Viagra, Levitra, Cialis Mechanism of action: increase blood accumulation in erectile tissue Effects: increase likelihood of erection

Snapshots from the Journey
If organism is going to reproduce sexually must use specialized cells called gametes, with only half typical number of chromosomes for that organism; when fertilized, both parents contribute half, resulting in cell containing full complement of chromosomes that will grow into new organism 182

Snapshots from the Journey (cont’d)
In humans, gametes are eggs and sperm, produced by meiosis, or reduction division; reduction division produces four daughter cells, each with 23 chromosomes; these cells not identical to one another, or to mother cell 183

Cells undergoing meiosis go through two divisions; chief difference between meiosis and mitosis is pairing of homologous chromosomes (alike in size, shape, and genetic content) during prophase 1 of meiosis 184

Human reproduction can be described as cycle, known as human life cycle; adult humans have specialized organs called gonads (ovaries and testes) which produce gametes via meiosis 185

Gametes get together during sexual reproduction in process known as fertilization; fertilized egg called zygote which undergoes many rounds of mitosis eventually becoming embryo, fetus, baby, child, and finally adult 186

Female reproductive system consists of several internal genitalia; gonads (ovaries) produce eggs (gametes); uterine tubes provide passageway for egg to get to uterus 187

Uterus is incubator for fertilized eggs; vagina is birth canal, connecting uterus with outside world External genitalia include external opening of vagina and several protective structures 188

Female reproductive physiology is relatively complicated, organized around monthly cycle of changes in both ovaries and uterus, collectively known as menstrual cycle Cycle begins with menstruation, shedding of uterine lining, after lining (endometrium) has finished shedding, begins to build up again in process called proliferation 189

As endometrium is proliferating, egg (follicle) is maturing in ovary; eventually, follicle will be released from ovary (ovulation) and travel to uterus If fertilization occurs, then fertilized egg will implant in thickened endometrium and pregnancy will result; if egg not fertilized, endometrium will degenerate and menstruation will occur 190

Control of menstrual cycle accomplished by four hormones: estrogen, progesterone, FSH, and LH During puberty, ovaries begin to secrete larger amounts of estrogen and progesterone causing development of female secondary sexual characteristics and setting cycle in motion

Hypothalamus releases GnRH, causing pituitary to increase secretion of FSH and LH, causing follicles to develop and eventually triggering ovulation Estrogen levels continue to rise as developing follicle secretes more and more estrogen; estrogen causes positive feedback to hypothalamus and pituitary, and increases levels of FSH and LH until ovulation occurs

If fertilization does not occur, progesterone decreases, endometrium decays, and cycle begins all over again

At ovulation, ruptured follicle secretes progesterone, reducing estrogen; progesterone reverses feedback loop, causing it to become negative feedback loop; thus FSH and LH levels drop; progesterone levels continue to rise, maintaining thickened endometrium in case fertilization occurs

Male reproductive system has more obvious external genitalia, penis (sperm delivery organ), and testes (gonads); internal genitalia include series of ducts, vas deferens, ejaculatory duct, and urethra, and series of glands, seminal vesicles, prostate, and bulbourethral glands

Sperm, like eggs, develop via meiosis, under control of LH and FSH, in testes; sperm mature in epididymis

During arousal penis becomes engorged with blood (erection); ejaculation moves sperm from epididymis in testes, through vas deferens, ejaculatory duct, out urethra in penis, and out of body Seminal vesicles, prostate, and bulbourethral glands add sugar, chemicals, and mucus to sperm to form semen

Testosterone is chief male hormone, secreted by testes, responsible for masculinization of fetus, triggering LH and FSH production, and development of male secondary sexual characteristics

Case Study—Maria’s Story
Maria has always wanted to have children but she has read horror stories about diabetes and pregnancy. Her doctor has told her that if she is healthy, she could try to get pregnant when the time is right. There are significant risks, however, including a high birth weight baby.

Case Study (cont’d) What characteristic of diabetes mellitus would contribute to increased birth weight? How can the condition be prevented? What other conditions might Maria need to take care to prevent?

Chapter 17 The Reproductive System: Replacement and Repair.

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Chapter 17 The Reproductive System: Replacement and Repair.

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Presentation on theme: "Chapter 17 The Reproductive System: Replacement and Repair."— Presentation transcript:

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