1. Nursing 330 Human Reproductive Health
NOTE: This is Handout #1 of 2 Be sure to also print out Handout #2
January 10, 2011
Nursing 330
Human Reproductive Health

2. Office Hours Turnitin Course packets Mondays, 5:30pm – 6pm Room TBA
Course ID:
Password: NURS330
Course packets

3. Course Website Syllabus Reading Assignments Quarter Schedule
Evaluation Methods
Lecture Notes
Print out or download on to laptop
May be taken down at anytime so it is your responsibility to print or download before each lecture

4. Important Dates Mid-term: February 7, 2011
Essay Due: February 14, 2011
Electronically [Turnitin]
Hard Copy + Article [In Class]
Extra Credit Due: February 21, 2011
Final Exam: March 7, 2011

5. Puberty

6. Puberty Not a synonym for adolescence
Defined as the biological state when reproduction becomes possible
Refers to physical changes that occur during adolescence

7. Puberty (cont) Pubertal changes in girls begin between ages 9 and 14.
Pubertal changes in boys generally begin about 2 years later than in girls.

8. Physical occurrences from puberty
Growth Spurt
The primary sex characteristics develop
The secondary sex characteristics develop

9. Growth Spurt 1. Limbs 2. Body’s trunk 3. Shoulders and chest
Bones become harder and more dense
Muscle and fat contribute to an adolescent increase in weight

10. Body Composition Boys Girls Wider shoulders Develop Breast
More muscular neck
Lose fat during adolescence
Girls
Develop Breast
Acquire Hips
Higher fat to muscle ratio

11. Primary Sex Characteristics
Differences in male and female anatomy which are present at birth
–ovaries and testes
Defined as the change necessary to prepare girls’ and boys’ bodies to produce children
Marker events
Girls
Menarche
Boys
Spermarche
As the primary sex organs mature, the secondary sex characteristics distinguish males from females

12. Secondary Sex Characteristics
Defined as changes that make boys and girls look like mature men and women
Girls
-Breast Development -Body Odor
-Body fat -Body Hair
Boys
-Voice Deepens -Body Odor
-Shoulders broaden -Body Hair

13. Tanner Classification of Sexual Maturity
Puberty is divided into five stages, called Tanner Stages (numbered 1-5). Each stage represents the extent of breast, pubic and genital hair growth.

14. Phases of Development - girls
Usual Age Range Earliest Age
Latest Age
Approximate Average Age
1. Beginning of breast development
8 – ¾ years
13 – ¼ years
11 years
2. Appearance of pubic hair
9 years
13 ½ years
3. Beginning of most rapid growth
10 ½ years
14 ½ years
12 years
4. Menarche
2-3 years after
1st signs of puberty
10 ¾ years
15 ½ years
12 ½ years

15. Phases of Development - boys
Usual Age Range Earliest Age
Latest Age
Approximate Average Age
1. Beginning of enlargement of testes
9 ½ years
13 ½ years
12 years
2. Growth of the penis
10 years
14 years
12 ¼ years
3. Appearance of pubic hair
12 ½ years
4. Beginning of most rapid growth in height
11 ½ years
16 years

16. Nocturnal Emissions Aka
Wet Dreams
Involuntary Orgasm
An ejaculation of semen experienced during sleep

17. DISCUSSION QUESTION

18. Hormones Estrogen Testosterone
Responsible for many changes that occur during puberty.
Cause the breasts, uterus, and vagina to mature and the body to take feminine proportions
Contribute to regulation of the menstrual cycle
Testosterone
Responsible for changes of male puberty
Leads to muscle growth, body and facial hair, and other male sex characteristics
Contributes to gains in body size

19. Sexual Anatomy & Physiology

20. Female Sex Organs:
All embryos appear as female at first. Genetic and hormonal signals trigger the development of male organs in those embryos destined to be male.
Sex organs serve a reproductive purpose, but they perform other functions also: giving pleasure, attracting sex partners, and bonding in relationships.

21. Vulva
The external female genitals are known collectively as the vulva. It includes:
Mons pubis
Clitoris
Clitoral Hood (or Prepuce)
Labia Majora
Labia Minora
Urethral Opening
Anus

22. Vulva (cont)
mons pubis is a pad of fatty tissue that covers the area of the pubic bone.
clitoris is the center of sexual arousal in the female.
labia majora (outer lips) are two folds of spongy flesh extending from the mons pubis and enclosing the other external genitals.
labia minora (inner lips) are smooth, hairless folds within the labia majora that meet above the clitoris.

23. Diagram of the Female Reproductive System (external view)

24. Female Genital Mutilation (FGM)
aka Female Circumcision
What is it?
Types
Areas where it is practiced

25. What is FGM?

26. Types of FGM Type I Type II
excision of the prepuce, with or without excision of part or all of the clitoris
Type II
excision of the clitoris with partial or total excision of the labia minora

27. Types of FGM (cont) Type III Type IV
Aka infibulation; the most extreme
excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening
Type IV
pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue

28. Where is FGM practiced?

29. Why is FGM practiced?

30. Internal Organs The internal female sexual structures and
reproductive organs include:
Vagina
Uterus
Cervix
Ovaries
Fallopian tubes

31. The Vagina
A flexible muscular organ, approximately 3-4 inches long (in unaroused state) that has the vaginal opening at one end and the cervix at the other.
Purpose of the vagina:
Menstruation
Childbirth
Intercourse

32. The Vagina (cont) Introitus or Vaginal Os Hymen
The opening of the vagina
Hymen
a thin, perforated membrane, that covers the introitus prior to first intercourse or other intrusion.
a Greek word meaning "virginal membrane" or "thin skin".

33. Cervix Located between the vagina and the uterus Cervical Os
Opening to the vagina
Allows menstrual blood to flow out of the uterus into the vagina

34. Uterus Also known as the womb
A pear-shaped organ located between the bladder and the lower intestine
Consists of three parts
Body of the uterus (about the size of a fist in a non-pregnant female)
Cervix
Fundus
Endometrium
Lining of the uterus
is built up and then shed and expelled through the cervical os (opening) during menstruation.

35. Ovaries Egg-producing organs
Hold between 200,000 and 400,000 follicles (sacks)
Found on each side of the uterus

36. Fallopian Tube Also known as the Uterine Tube or Oviduct
Two leading off each side of the uterus
Site of fertilization

37. Diagram of the Female Reproductive System (internal view)

38. Female Reproductive System
Use handout from course pack to identify:
Page 13
Anus Rectum
Bladder Urethra
Cervix Uterus
Fallopian tube Vagina/Vaginal
Ovary Opening

39. G-Spot
Controversial research has posited the existence of an erotically sensitive area, the Grafenberg spot (G-spot), on the front wall of the vagina midway between the introitus and the cervix.

40. Female Sexual Physiology
At birth, the human female’s ovaries contain
400, ,000 female gametes (sex cells).
During puberty hormones trigger the completion of oogenesis, the production of oocytes, commonly called eggs or ova.

41. The Menstrual Cycle Follicular (Proliferative) phase
Days 1 through 6
Beginning of menstrual flow to end of blood flow
Days 7 – 13 endometrium thickens
Luteal (Secretory) phase
aka premenstrual phase
Days 15 to 28
The endometrium thickens to prepare the egg for implantation
These two phases are separated by:
Ovulation
Day 14

42. Ovulation
The process in the menstrual cycle by which a mature ovarian follicle ruptures and releases an ovum (also known as an egg or an oocyte)
The released egg, unless fertilized, only lasts 12 to 24 hours.

43. Menstrual Cycle Order of the Menstrual Cycle:
Menstrual → Proliferative → Secretory
The menstrual cycle is divided into 3 phases.
1. Menstruation
2. Proliferative Phase: Endometrial tissue builds up during this phase
3. Secretory Phase: Produces nutrients to sustain an embryo

44. Follicular (Proliferative) Phase Also known as Pre-ovulatory phase
Menstrual Phases
Typical No. of Days
Hormonal Actions
Follicular (Proliferative)
Phase
Also known as
Pre-ovulatory phase
Cycle Days 1 through 6
Beginning of menstruation to end
of blood flow
Estrogen and progesterone start
out at their lowest levels
FSH levels rise to stimulate
maturity of follicles. Ovaries start
producing estrogen and levels
rise, while progesterone levels
remain low.
Cycle Days 7 -13: The
endometrium (the inner lining of
the uterus) thickens to prepare for
the egg implantation
Ovulation
Cycle Day 14
Surge in LH. Largest follicle
bursts and releases egg into
fallopian
Luteal (Secretory)
Premenstrual phase
Cycle Days 15 – 28
Depends on whether fertilization
occurs or not.

45. Corpus Luteum A mound of yellow tissue
Develops as a result of the ruptured follicle
During pregnancy, it serves to produce estrogen and progesterone

47. If fertilization occurs,
Fertilized egg attaches to blanket of blood vessels which supplies nutrients for the developing placenta. Corpus luteum continues to produce estrogen and progesterone.
If fertilization does NOT occur:
Corpus luteum deteriorates. Estrogen and progesterone levels drop. The blood vessel lining sloughs off and menstruation begins.

48. Hormones
Hormones are chemical substances that serve as messengers, traveling through the bloodstream.

49. Hormones Pituitary Hormones Ovarian Hormomes Luteinizing Hormone (LH)
Follicle Stimulating Hormone (FSH)
Ovarian Hormomes
Estrogen
Progesterone

50. The egg, unless fertilized, only survives 12-24 hours.
The Path of the Egg
Reaches uterus about 2-4 days after ovulation
Released from follicle
Swept into fallopian tube
Moves slowly toward uterus
Reaches uterus in about 4 days
Moves slowly toward uterus
Swept into fallopian tube
Released from follicle
The egg, unless fertilized, only survives hours.

51. The Menstrual Cycle

52. PMS
Premenstrual syndrome (PMS) is a group of symptoms related to the menstrual cycle

53. PMS Physical and emotional disorder Caused by hormonal changes
Widely recognized as a medical condition
85% of menstruating women have at least one symptom
5-10% debilitating symptoms
Symptoms present two weeks before menstruation

54. Remedies: Dietary Recommendations
Low fat
High fiber
3 meals a day and 3 snacks containing starchy foods
Drink plenty of water
Avoid caffeine
Low salt
High calcium

55. Menstrual Conditions Two types Amenorrhea Dysmenorrhea Primary
failure to start having a period by the age of 16
Secondary
temporary or permanent ending of periods in a woman who has menstruated normally in the past

56. Menstrual Disorders (Cont)
Dysmenorrhea - Painful menstrual periods (aka cramps)
Primary
no physical abnormality and usually begins within three years after you begin menstruating
Secondary
involves an underlying physical cause, such as endometriosis or uterine fibroids

57. Discussion Question: