1. Chapter 4 Female Sexual Anatomy and Physiology

2. Genital Self-Exam Increases sexual comfort
Monitor for changes related to health concerns

3. The Vulva
External female genitalia
Mons Veneris
Labia majora & minora

4. The Vulva (cont.)
Fig. 4.1 The structures and variations of the vulva: (a) external structures.

5. The Vulva (cont.) Clitoris (analogous to penis)
external shaft & glans, internal crura clitoral hood
only function = sexual arousal
Clitoral stimulation most common way woman achieve orgasm
Female genital mutilation

6. The Vulva (cont.)
Fig 4.2 The underlying structures of the vulva.

7. The Vulva (cont.) Vestibule urethral opening
vaginal introitus (opening)
hymen
Perineum
episiotomy

8. Underlying Structures
Vestibular bulbs
Bartholin's glands
Pelvic floor muscles
Kegel exercises

9. Underlying Structures
Fig. 4.3 The underlying muscles of the vulva. These muscles can be strengthened using the Kegel exercises described in the text.

10. Internal Structures Vagina 3 layers: mucous, muscle, fibrous
Arousal and vaginal lubrication
lubrication changes vaginal ph and increases pleasure
Grafenberg (G) spot
Secretions & chemical balance

11. Internal Structures (cont.)
Fig. 4.4 Internal female sexual anatomy: (a) cross-sectional side view of female internal structures; (b) front view of the internal organs. Parts of the ovaries, uterus, and vagina are shown cut away.

12. Internal Structures (cont.)
Cervix
Uterus
3 layers: perimetrium, myometrium, endometrium
fundus (top)

13. Internal Structures (cont.)
Fallopian tubes
fimbriae
cilia (hairlike cells that move ovum)
fertilization occurs when egg is still close to ovary
Ectopic pregnancy

14. Internal Structures (cont.)
Ovaries
up to 472,000 immature ova at birth; 400 mature in lifetime
ovulation = release of ovum

15. Menstruation Myths and negative attitudes Menarche (initial onset)
age 11-15
related to heredity, health, altitude

16. Menstruation (cont.) Menstrual physiology flow lasts from 2 to 6 days
volume varies (6 to 8 ounces)
duration varies (24 to 42 days)
menstrual synchrony

17. Menstruation (cont.)
Fig. 4.7 Ovulation timing and cycle length. Regardless of the length of the cycle, ovulation occurs 14 days before menstruation.

18. Menstruation (cont.) The menstrual cycle
hypothalamus releases GnRH that stimulates pituitary
pituitary produces:
Follicle Stimulating Hormone
Luteinizing Hormone
Negative feedback mechanism

19. Menstruation (cont.)
Fig. 4.5 Changes during the menstrual cycle (a) indicates the hypothalamus in the brain measuring levels of hormones and releasing GnRh to stimulate the pituitary to secrete FSH and LH into the bloodstream (b) shows how the levels of FSH (red line) and LH (purple line) vary during the complete cycle. Note the midcycle peak of LH that stimulates ovulation (c) shows the ovarian changes during the phases of the cycle and (d) shows the fluctuations in blood levels of estrogen and progesterone produced by the ovaries and (e) indicates these hormonal effects on the lining of the uterus. After ovulation, the glands and ducts inside the endometrium (drawn and vertical tubes and spirals) develop and secrete nutrients that, if a woman became pregnant, would support the embryo.

20. Menstruation (cont.) Three phases of menstrual cycle
menstrual: shedding of endometrium
proliferative: thickening of endometrium & follicle maturation, ovulation
secretory: corpus luteum development further thickening of endometrium

21. Menstruation (cont.)
Fig 4.6 The changes to the ovaries and uterus during (a) the proliferative phase, including ovulation.

22. Menstruation (cont.)
Fig. 4.8 The changes to the ovaries and uterus during (b) the secretory phase, and (c) the menstrual phase of the menstrual cycle.

23. Menstruation (cont.) Sexual activity and the menstrual cycle
Menstrual cycle problems
premenstrual syndrome:
Premenstrual Dysphoric Disorder
dysmenorrhea = painful menses
amenorrhea = no menses
toxic shock syndrome
self-help for menstrual symptoms

24. Menopause Terms climacteric peri-menopause: time before menopause
menopause: permanent cessation of menstruation

25. Menopause (cont.) Symptoms vary from mild to strong
amenorrhea, then menopause
hot flashes or warm spells
night sweats, interrupted sleep
headaches, poor concentration
depression, anxiety

26. Menopause (cont.) Hormone replacement therapy
estrogen reduces hot flashes and psychological symptoms
controversies with data reporting hazardous effects
increased risk of breast cancer with exclusive use of estrogen
alternatives to HRT

27. Gynecological Health Concerns
Urinary tract infections
Vaginal infections
Self-exams & vaginal health care

28. Gynecological Health Concerns (cont.)
Pap smear screens for cervical cancer
Hysterectomy or oophorectomy
most frequently performed U.S. operation, more frequently performed on low income, less educated women
nonsurgical alternatives

29. The Breast mammary glands produce milk fatty tissue determines size
areola is darker area
nipple is in center of areola & has openings for milk

30. The Breast (cont.)
Fig. 4.8 Cross-section front and side views of the female breast.

31. The Breast (cont.) Breast exams self-exam following menstruation
routine healthcare provider exams
mammography

32. The Breast (cont.) Breast exams
Fig. 4.9 It is helpful to use a chart similar to this one to keep track of lumps in the breasts.

33. The Breast (cont.) Breast lumps cysts (fluid-filled sacs)
fibroadenomas (solid, round, benign tumors)
malignant tumor
Breast cancer
treatments
risk factors
reconstructive breast surgery
benefits of early detection & treatment

34. The Breast (cont.)
Fig Breast Self-Exam

35. The Breast (cont.)
Table 4.4 Risk Factors for Breast Cancer