Chapter 1 Flashcards
1
Q
The care of women during childbirth
A
Obstetrics
2
Q
Obstetrics, or the care of women during childbirth, is derived from the Greek word ______ , which means “to keep watch”
A
Obstare
3
Q
Pediatrics is a word derived from the Greek word _______, meaning “child.”
A
Pais
3
Q
Pediatrics is a word derived from the Greek word _______, meaning “child.”
A
Pais
4
Q
The nurse’s role in all these phases focuses on ___________ and ___________
A
- promoting healthy growth
- development of the child and family in both health and illness
5
Q
The field of nursing typically divides its concerns for families during childbearing and childrearing into two separate entities, ___________
A
Maternity care and child health care
6
Q
The primary goal of ______________ can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal child-bearing and childrearing.
A
maternal and child health nursing care
7
Q
Scope of practice (the range of services and care that may be provided by a nurse based on state requirements) in maternal and child health nursing care are:
A
- Preconceptual health care
- Care of women during three trimesters of pregnancy and the puerperium
- Care of infants during the perinatal period
- Care of children from birth through adolescence
- Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home
8
Q
The 6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy
A
Puerperium
9
Q
6 weeks before conception to 6 weeks after birth
A
Perinatal period
10
Q
The level of ______ affects the health status of its members.
A
family’s functioning
11
Q
Enables nurses to better understand individuals and their effect on others and, in turn, to provide holistic care.
A
Family-centered approach
12
Q
Maternal and child health nursing is family centered; assessment must include both _________ and ____________
A
- family
- individual assessment data.
13
Q
Maternal and child health nursing is __________ ; the health of families depends on and influences the health of communities.
A
community centered
13
Q
Maternal and child health nursing is __________ ; the health of families depends on and influences the health of communities.
A
community centered
14
Q
Maternal and child health nursing is _____________ because this is the means whereby critical knowledge increases.
A
evidence based
15
Q
A maternal and child health nurse serves as an advocate to protect the rights of all family members, including the _______.
A
fetus
16
Q
Maternal and child health nursing includes a high degree of independent nursing functions, because ___________ and _________ are major interventions.
A
- teaching
- counseling
17
Q
_________ and _______ are important nursing roles because these protect the health of the next generation.
A
- Promoting health
- disease prevention
18
Q
___________ serve as important resources for families during childbearing and childrearing as these can be extremely stressful times in a life cycle.
A
Maternal and child health nurses
19
Q
Influence the meaning and impact of childbearing and childrearing on families.
A
Personal, cultural, and religious attitudes and beliefs.
20
Q
Circumstances such as _________ are meaningful only in the context of a total life.
A
illness or pregnancy
21
Q
____________ is a challenging role for nurses and a major factor in keeping families well and optimally functioning.
A
Maternal and child health nursing
22
Q
Maternal and child health nursing includes care of the pregnant woman, child, and family. (A) During a __________, a nurse assesses that a pregnant woman’s uterus is expanding normally. (B) During a ____________ , a nurse assesses a child’s growth and development.
A
prenatal visit
health maintenance visit
23
Evidence obtained from at least one properly de-signed randomized controlled trial.
Level I
24
Evidence obtained from well-designed controlled trials without randomization, well designed cohort or case control analytic studies, or multiple time series with or without an intervention. Evidence obtained from dramatic results in uncontrolled trials might also be regarded as this type of evidence.
Level II
25
Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Level III
26
Is a type of congenital uterine malformation or müllerian duct anomaly in which the uterus appears to be heart-shaped
Bicornuate uterus
27
Failure to produce semen, or absence of sperm in the semen
aspermia
28
Is a condition in which the femoral neck leans forward with respect to the rest of the femur.
Femoral anteversion
29
Bending forward of an organ, especially of the body of the uterus.
Anteflexion
30
Is the medical specialty that deals with male health, particularly relating to the problems of the male reproductive system and urological problems that are unique to men.
Andrology
31
Refers to the maturation of the zona reticularis of the adrenal gland, resulting in increased production of adrenal androgens associated with secondary sexual characteristics, such as the development of pubic hair (pubarche), axillary hair, body odor, and acne.
Adrenarche
32
Is an endoscopic procedure performed to examine the rectouterine pouch and pelvic viscera by the introduction of a culdoscope through the posterior vaginal wall
Culdoscopy
33
Also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina
Cystocele
34
Is the term for recurring pain in the genital area or within the pelvis during sexual intercourse.
Dyspareunia
35
Is the inability to get and keep an erection firm enough for sex.
Erectile dysfunction (impotence)
36
Are the male and female primary reproductive organs.
Gonads
37
Is the medical practice dealing with the health of the female reproductive system.
Gynecology
38
Is an enlargement or swelling of breast tissue in males.
Gynecomastia
39
Is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera.
Laparoscopy
40
Is the medical term for menstrual periods with abnormally heavy or prolonged bleeding.
Menorrhagia
41
Uterine bleeding at irregular intervals, particularly between the expected menstrual periods
Metrorrhagia
42
Is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina.
Rectocele
43
The state of being bent backespecially : the bending back of an organ (such as a uterus) upon itself
Retroflexion
44
The condition of being tilted abnormally backward.
Retroversion
45
Is the onset of secondary breast development, which often represents the beginning of pubertal development
Thelarche
46
Is a condition involving a muscle spasm in the pelvic floor muscles
Vaginismus
47
Is defined as an interest in observing unsuspecting people while they undress, are naked, or engage in sexual activities. The interest is usually more in the act of watching, rather than in the person being watched.
Voyeurism
48
Is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation.
Premenstrual dysphoric disorder (PMDD)
49
Refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle.
Premenstrual Syndrome
50
A ________ is a body organ that produces the cells necessary for reproduction (the ovary in females, the testis in males).
Gonad
51
At approximately week _________ , primitive gonadal tissue is already formed
5 of intrauterine life
52
In both sexes, two undifferentiated ducts, the _________ and ________ , are present.
```
Mesonephric ducts ( wolffian )
Paramesonephric ( mullerian )
```
52
In both sexes, two undifferentiated ducts, the _________ and ________ , are present.
```
Mesonephric ducts ( wolffian )
Paramesonephric ( mullerian )
```
53
By week _____ , in chromosomal males, this early gonadal tissue differentiates into ________ and begins formation of testosterone.
7 or 8
| primitive testes
54
Under the influence of ________, the ________ begins to develop into the male reproductive organs, and the __________ regresses
testosterone
mesonephric duct
paramesonephric duct
55
If testosterone is not present by week 10, the gonadal tissue differentiates into ________, and the paramesonephric duct develops into _________
ovaries
| female reproductive organs.
56
All of the ________ (cells that will develop into eggs throughout the woman’s mature years) are already formed in ovaries at this stage
oocytes
57
At about ________, the external genitals develop.
week 12
58
In males, under the influence of testosterone, ________ elongates and the ________ on the ventral surface of the penis closes to form the urethra;
penile tissue
| urogenital fold
59
In females, with no testosterone present, the urogenital fold remains open to form the ___________;
labia minora
60
What would be formed as _________ in the male becomes the labia majora in the female
scrotal tissue
61
If testosterone secretion is halted in utero, a chromosomal male could be born with ___________
female appearing genitalia
62
If a woman should be prescribed a form of testosterone during pregnancy or if the woman, because of a metabolic abnormality, produces a high level of testosterone, a chromosomal female could be born with _________
male-appearing genitalia
63
Secondary sex changes are stimulated when the __________ synthesizes and releases gonadotropin-releasing hormone (GnRH)
hypothalamus
64
Gonadotropin-releasing hormone (GnRH) released by the hypothalamus triggers the __________ to begin the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
Anterior pituitary
65
_____ and ______ initiate the production of androgen and estrogen, which in turn initiate secondary sex characteristics, the visible signs of maturity.
FSH and LH
66
Girls are beginning dramatic development and maturation of reproductive organs at earlier ages than ever before ________
(9 to 12 years)
67
___________, under the direction of the central nervous system, may serve as a gonadostat or regulation mechanism set to “turn on” gonad functioning at this age
hypothalamus
68
Although it is not proved, the theory is that a girl must reach a critical weight of approximately ___________ or develop a critical mass of body fat before the hypothalamus is triggered to send initial stimulation to the anterior pituitary gland to begin the formation of gonadotropic hormones.
95 lb (43 kg)
69
____________ are the hormones responsible for mus-cular development, physical growth, and the increase in se-baceous gland secretions that causes typical acne in both boys and girls
Androgenic hormones
70
In males, androgenic hormones are produced by the _________ and the _________
adrenal cortex
| testes
71
In females, adrogenic hormones are produced by the _________ and the ________.
adrenal cortex
| ovaries
72
The level of the primary androgenic hormone, ___________, is low in males until puberty (approximately age 12 to 14 years).
testosterone
73
At the __________ testosterone levels rise to influence the further development of the testes, scrotum, penis, prostate, and seminal vesicles; the appearance of male pubic, axillary, and facial hair; laryngeal enlargement and its accompanying voice change; maturation of spermatozoa; and closure of growth in long bones.
Puberty, approx. (age of 12 to 14 years)
74
In girls, ________ influences enlargement of the labia majora and clitoris and formation of axillary and pubic hair
testosterone
75
This development of pubic and axillary hair because of androgen stimulation is termed ________.
adrenarche
76
When triggered at puberty by FSH, _________ in females begin to excrete a high level of the hormone estrogen
ovarian follicles
77
Estrogen is actually not one substance but three compounds ___________
(estrone [E1], estradiol [E2], and estriol [E3])
78
The increase in _________ in the female at puberty influences the development of the uterus, fallopian tubes, and vagina; typical female fat distribution and hair patterns;
breast development; and an end to growth because it closes the epiphyses of long bones.
Estrogen levels
79
The beginning of breast development is termed __________.
thelarche
80
The average age at which menarche (the first menstrual pe-riod) occurs is ______
12.4 years
81
It may occur as early as age __ or as late as age _____, however, and still be within a normal age range.
9
| 17
82
________ menstrual periods are the rule rather than the exception for the first year.
Irregular
83
Menstrual periods do not become regular until ________ occurs with them.
ovulation consistently
84
When menstrual periods consistently occurs with ovulation (menstruation is not dependent on ovulation), and this does not tend to happen until _______________ after menarche.
1 to 2 years
85
This is one reason why _____________ are not commonly recommended until a girl’s menstrual periods have become stabilized or are ovulatory (to prevent administering a compound to halt ovulation before it is firmly established).
estrogen-based oral contraceptives
86
In boys, production of spermatozoa does not begin in __________ as does the production of ova, nor are spermatozoa produced in a _________ as are ova; rather, they are produced in a ________.
intrauterine life
cyclic pattern
continuous process
87
The production of _____ stops at menopause (the end of the fertile period in females)
ova
88
_____ production continues from puberty throughout the male’s life.
sperm
89
The study of the female reproductive organs is called _________.
gynecology
90
_________ is the study of the male reproductive organs.
Andrology
91
Is a rugated, skin-covered, muscular pouch suspended from the perineum.Its functions are to support the testes and to help regulate the temperature of sperm.
Scrotum
92
In very cold weather, the scrotal muscle ________ to bring the testes closer to the body;
contracts
93
In very hot weather, or in the presence of fever, the muscle _________ , allowing the testes to fall away from the body
relaxes
94
The contraction and relaxation of the muscles enables the temperature of the testes to remain as even as possible to promote the production and viability of _______.
sperm
95
Are two ovoid glands, 2 to 3 cm wide, that lie in the scrotum.
Testes
96
Each testis is encased by a protective white fibrous capsule and is composed of several lobules, with each lobule containing _________ and a __________.
```
interstitial cells (Leydig’s cells)
seminiferous tubule
```
97
___________ produce spermatozoa.
Seminiferous tubules
98
Are responsible for the production of testosterone.
Leydig’s cells
99
Testes in a fetus first form in the ________.
pelvic cavity
100
Testis descend, late in intrauterine life (about the 34th to 38th week), into the _______.
scrotal sac
101
These infants need to be monitored closely to see that the testes do descend when the infant reaches what would have been the 34th to 38th week of gestational age.
Male preterm infants born with undescended testes
102
Does not occur as readily in extrauterine life as it does in utero.
Testicular descent
103
Testes that remain in the pelvic cavity may not produce _______ and are associated with a 4 to 7 times higher incidence of _________
viable sperm
| testicular cancer
104
Spermatozoa are produced in the _______, they reach maturity, surrounded by _______, in the ________ through a complex sequence of regulatory events
testes
semen
external structures
105
The complex sequence of regulatory events. First, the hypothalamus releases _____, which in turn influences the anterior pituitary gland to release ___ and ___.
GnRH
FSH
LH
106
FSH is then responsible for the release of _____________.
androgen-binding protein (ABP)
107
LH is responsible for the release of __________.
testosterone
108
________ promotes sperm formation.
ABP binding of testosterone
109
As the amount of _______ increases, a feedback effect on the hypothalamus and anterior pituitary gland is created that ___________ and ultimately decreases or regulates sperm production.
testosterone
| slows the production of FSH and LH
110
In most males, one testis is slightly than the other and is suspended slightly ______ in the scrotum than the other (usually the left one).
larger
| lower
111
Because one testis is larger and lower than the other, testes tend to slide past each other more readily on _________ and there is less possibility of trauma to them.
sitting or muscular activity
112
___________ do not survive at a temperature as high as that of the body.
Spermatozoa
113
Allows the spermatozoa to survive. Provides protection for sperm survival.
Location of the testes outside the body, where the temperature is approximately 1° F lower than body temperature.
114
Beginning in ________, boys need to learn testicular self-examination so that they can detect tenderness or any abnormal growth in the testes
early adolescence
115
Normal testes feel ______, _______, and _______.
firm, smooth, and egg shaped
116
The _______ (the tube that carries sperm away from the testes) can be palpated as a firm swelling on the superior aspect of the testes.
epididymis
117
The _______ is composed of three cylindrical masses of erectile tissue.
Penis
118
In the penis shaft: two termed the __________ and a third termed the _________.
corpus cavernosa
| corpus spongiosum
119
The ______ passes through these layers of erectile tissue, making the penis serve as the outlet for both the urinary and the reproductive tracts in men.
urethra
120
With sexual excitement, __________ is released from the endothelium of blood vessels.
nitric oxide
121
The release of nitric oxide from the endothelium of blood vessels results in ________ of blood vessels and an increase in blood flow to the ________ of the penis (engorgement).
dilation
| arteries
122
The ___________ at the base of the penis then contracts, trapping both venous and arterial blood in the three sections of erectile tissue and leading to __________
Ischiocavernosus muscle
| distention and erection of the penis.
123
The _________, a branch of the pudendal artery, provides the blood supply for the penis.
penile artery
124
Penile erecrion is stimulated by ____________
parasympathetic nerve innervation.
125
At the distal end of the organ is a bulging, sensitive ridge of tissue, the ________.
glans
126
A retractable casing of skin, the _______, protects the nerve-sensitive glans at birth
prepuce
127
The male internal reproductive organs are the ________, the _________, the ________ the _______ the __________, the __________ , and __________
```
epididymis
vas deferens
seminal vesicles
ejaculatory ducts
prostate gland
urethra
the bulbourethral glands
```
128
The _________ of each testis leads to a tightly coiled tube, the epididymis.
Seminiferous tubule
129
Is responsible for conducting sperm from the tubule to the vas deferens, the next step in the passage to the outside.
Epididymis
130
Each epididymis is so tightly coiled, its length is extremely deceptive: it is actually over ____ long.
20 ft
131
Some sperm are stored in the epididymis, and a portion of the ________ that will surround sperm at maturity is produced by the _____________________
Alkaline fluid
| Cells lining the epididymis.
132
Semen, or seminal fluid that contains a basic sugar and ______, a form of protein
mucin
133
Because the epididymis is so narrow along its entire length, infection of the epididymis can easily lead to ________ that then prohibits passage of sperm beyond the scarred point.
scarring of the lumen
134
Sperm are immobile and incapable of fertilization as they pass or are stored at the ________________.
epididymis level
135
It takes at least ___________ for them to travel the length of the epididymis and a total of __________ for them to reach maturity.
12 to 20 days
| 64 days
136
Absence of sperm.
aspermia
137
<20 million sperm/mL
oligospermia
138
This is one reason that aspermia and oligospermia are problems that do not appear to respond immediately to therapy but rather only after _______
2 months.
139
The _________ is an additional hollow tube surrounded by arteries and veins and protected by a thick fibrous coating
Vas Deferens (Ductus Deferens).
140
Vas deferens carries sperm from the epididymis through the inguinal canal into the ________ where it ends at the seminal vesicles and the ejaculatory ducts.
abdominal cavity
141
Sperm mature as they pass through the __________. They are still _________ at this point, however, probably because of the _________ of the semen produced at this level.
Vas deferens
not mobile
fairly acidic medium
142
The blood vessels and vas deferens together are referred to as the ____________
spermatic cord
143
A __________ , or a varicosity of the internal spermatic vein, was once thought to contribute to male subfertility by causing congestion with increased warmth in the testes but this appears to actually make little difference
varicocele
144
__________ (severing of the vas deferens to prevent passage of sperm) is a popular means of male birth control
Vasectomy
145
The _________ are two convoluted pouches that lie along the lower portion of the posterior surface of the bladder and empty into the urethra by way of the ejaculatory ducts.
Seminal vesicles
146
Seminal vesicles secrete a viscous alkaline liquid that has a _______, ________, and ___________ .
Sugar
protein
prostaglandin content
147
Sperm become increasingly motile with this added fluid, because it surrounds them with ______ and a __________
Alkaline fluid secreted by the seminal vesicles.
Nutrients
More favorable pH.
148
The two ejaculatory ducts pass through the prostate gland and join the ________ to the urethra.
seminal vesicles
149
Is a chestnut-sized gland that lies just below the bladder
Prostate Gland
150
The _________ passes through the center of prostate gland it, like the hole in a doughnut.
urethra
151
The prostate gland secretes a thin, alkaline fluid. When added to the secretion from the seminal vesicles and the accompanying sperm from the epididymis, this alkaline fluid further protects sperm from being ________ by the _____________
immobilized
| naturally low pH level of the urethra.
152
In middle life, many men develop _____________
benign hypertrophy of the prostate
153
The swelling of benign hypertrophy of prostate gland interferes with both ______ and ______.
fertility
| urination
154
A benign condition, it can be relieved by medical therapy or surgery but needs to be differentiated from ___________
prostate cancer
155
__________ lie beside the prostate gland and empty via short ducts into the urethra
Two bulbourethral or Cowper’s glands
156
Like the prostate gland and seminal vesicles, bulbourethral glands secrete an alkaline fluid that helps counteract the acid secretion of the urethra and ensure the safe passage of ________.
spermatozoa
157
Semen, therefore, is derived from the prostate gland ______, the seminal vesicles _____, the epididymis ______, and the bulbourethral glands ____.
(60%)
(30%)
(5%)
(5%)
158
Is a hollow tube leading from the base of the bladder, which, after passing through the prostate gland, continues to the outside through the shaft and glans of the penis.
The urethra
159
Urethra is approximately ___________ long.
8 in (18 to 20 cm)
160
Urethra is lined with __________
Mucuous membrane
161
The structures that form the female external genitalia are termed the ______ (from the Latin word for “covering”)
vulva
162
Is a pad of adipose tissue located over the symphysis pubis, the pubic bone joint.
Mons Veneris.
163
The purpose of the mons veneris is to protect the junction of the ________ from trauma.
pubic bone
164
Just posterior to the mons veneris spread two hairless folds of connective tissue, the labia minora.
Labia Minora.
165
Before _______ , these folds ( labia minora) are fairly small; by ________ , they are firm and full; , _________ they atrophy and again become much smaller.
menarche
childbearing age
after menopause
166
Normally the folds of the labia minora are ______; the internal surface is covered with ________, and the external surface with _____.
pink
mucous membrane
skin
167
The area of labia minora abundant with ________, so localized sebaceous cysts may occur here.
sebaceous glands
168
Women who perform monthly vulvar examinations are able to detect infection or other abnormalities of the vulva such as ___________.
sebaceous cysts
169
Are two folds of adipose tissue covered by ______________ and ___________ that are positioned lateral to the labia minora.
Labia Majora
loose connective tissue
epithelium
170
Covered by pubic hair, the labia majora serve as protection for the __________ and the __________ and _________.
external genitalia
distal urethra
vagina
171
Labia majora are fused _________ but separated ____________.
anteriorly
| posteriorly
172
Trauma to the area of labia majora such as occurs from childbirth or rape, can lead to ___________ because of the ______________
extensive edema formation
| looseness of the connective tissue base.
173
The _______ is the flattened, smooth surface inside the labia. The openings to the bladder _______ and the __________ both arise from the vestibule
vestibule
(the urethra)
uterus (the vagina)
174
The _______ is a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora.
clitoris
175
Clirotis is covered by a fold of skin, the ___________
Prepuce
176
The clitoris is sensitive to ______ and ___________ and is the ______________ and _________ in a woman.
touch
temperature
center of sexual arousal
orgasm
177
___________ supply for the clitoris is plentiful.
Arterial blood
178
_____________ surrounding it contracts with sexual arousal, the ____________ for the clitoris is blocked, leading to clitoral erection.
Ischiocavernosus muscle
| venous outflow
179
Two _____________ are located just lateral to the urinary meatus, one on each side.
Skene’s glands (paraurethral glands)
180
Two _____________ are located just lateral to the urinary meatus, one on each side.
Skene’s glands (paraurethral glands)
181
Skene's gland ducts open into the _______.
urethra
182
Are located just lateral to the vaginal opening on both sides.
Bartholin’s glands (vulvovaginal glands)
183
Bartholin's gland ducts open into the ______.
distal vagina
184
Secretions from both skene's gland and bartholin's gland help to lubricate the _________ during coitus.
external genitalia
185
The alkaline pH of the secretions of bartholin's gland and skene's gland helps to improve _________ in the vagina
sperm survival
186
Both Skene’s glands and Bartholin’s glands may become infected and produce a ________ and __________
discharge
| local pain
187
The __________ is the ridge of tissue formed by the poste-rior joining of the two labia minora and the labia majora.
fourchette
188
Fourchette is the structure that is sometimes cut (episiotomy) during childbirth to __________________.
enlarge the vaginal opening
189
Posterior to the fourchette is the ____________.
perineal muscle or the perineal body
190
Because the perineal muscle or perineal body is a muscular area, it is easily stretched during childbirth to _____________ and _____________.
allow for enlargement of the vagina
| passage of the fetal head
191
Many exercises suggested for pregnancy (such as Kegel’s, squatting, and tailor-sitting) are aimed at making the __________ more flexible to allow easier expansion during birth without tearing of this tissue.
perineal muscle
192
What are the exercises suggested for pregnancy that are aimed at making the perinral musclr more flexible
Kegel’s, squatting, and tailor-sitting
193
The ________ is a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood.
hymen
194
Occasionally, a girl has an ____________ that it does not allow for passage of menstrual blood from the vagina or for sexual relations until it is surgically incised
imperforate hymen, or a hymen so complete
195
Vulvar Blood Supply. The blood supply of the external genitalia is mainly from the ________ and a portion of the __________.
pudendal artery
| inferior rectus artery
196
Vulvar blood supply. Venous return is through the ___________.
pudendal vein
197
Pressure on the pudendal vein by the fetal head can cause extensive back pressure and development of varicosities (distended veins) in the ___________.
labia majora
198
Because of the rich blood supply, trauma to the area, such as occurs from pressure during childbirth, can cause large ___________.
hematomas
199
Vulvar Nerve Supply. The anterior portion of the vulva derives its nerve supply from the ________ and _______________
```
ilioinguinal
genitofemoral nerves (L1 level).
```
200
The posterior portions of the vulva and vagina are supplied by the _______.
pudendal nerve (S3 level)
201
Normal stretching of the perineum with childbirth causes temporary _________ in the area.
loss of sensation
202
Anesthesia for childbirth may be administered locally to block the ________, further eliminating pain sensation at the perineum during birth.
pudendal nerve
203
Female internal reproductive organs
ovaries, the fallopian tubes, the uterus, and the vagina.
204
The ovaries are approximately _____ cm long by ____ cm in diameter and approximately ____ cm thick, or the size and shape of ________.
4 cm long by 2 cm in diameter
1.5 cm thick
almonds
205
Ovaries are color ______ and appear _____, or with ____________ on the surface.
grayish white
pitted
minute indentations
206
An unruptured, glistening, clear, fluid-filled _________ (an ovum about to be discharged) or a __________ (the structure left behind after the ovum has been discharged) often can be observed on the surface of an ovary.
graafian follicle
| miniature yellow corpus luteum
207
Ovaries are located close to and on both sides of the _______ in the lower abdomen.
uterus
208
Ovary is difficult to locate by ________ because they are situated so low in the abdomen.
abdominal palpation
209
If an abnormality is present, such as an enlarging ovarian cyst, the resulting tenderness may be evident on ________________
lower-left or lower-right abdominal palpation.
210
The function of the two ovaries (the female gonads) is to _____, ________, __________
produce, mature, and discharge ova (the egg cells).
211
In the process, the ovaries produce _________ and __________ and initiate and regulate _________________
estrogen
progesterone
menstrual cycles.
212
If the ovaries are removed before puberty (or are nonfunctional), the resulting absence of __________ prevents breasts from maturing at puberty;
in addition, pubic hair distribution assumes a ___________ than normal.
estrogen
| more male pattern
213
After menopause, or cessation of ovarian function, the ________, ________ , and _______ all undergo atrophy or a reduction in size because of a lack of _________.
uterus, breasts, ovaries
| estrogen
214
__________, therefore, is necessary for maturation and maintenance of secondary sex characteristics in females.
Ovarian function
215
The estrogen secreted by ovaries is also important to prevent ________, or weakness of bones, because of withdrawal of calcium from bones.
osteoporosis
216
women after menopause, women are prone to serious spinal, hip, and wrist fractures because of
Lack of estrogen
217
Because ________ is incorporated into estrogen, the production of estrogen is thought to also keep _________ levels reduced, thus limiting the effects of ____________ in women.
cholesterol
| atherosclerosis (artery disease)
218
__________ used to be prescribed for women at menopause to help prevent osteoporosis and cardiovascular disease.
Estrogen
219
However, this type of long-term estrogen supplementation may contribute to __________ and ____________, so it is no longer routinely recommended
breast cancer
| cerebrovascular accidents
220
The ovaries are held suspended and in close contact with the ends of the fallopian tubes by ________ strong supporting ligaments attached to the ____________.
three
| uterus or the pelvic wall
221
Ovaries are unique among pelvic structures in that they are not covered by a layer of ___________ .
peritoneum
222
Because the ovaries are not encased in peritoneum, ______ can escape from them and enter the uterus by way of the fallopian tubes.
ova
223
Because ovaries are ______ rather than being firmly fixed in place, an abnormal tumor or cyst growing on them can enlarge to a size easily twice that of the organ before pressure on surrounding organs or the ovarian blood supply leads to symptoms of compression.
suspended in position
224
This is the reason that ovarian cancer continues to be one of the leading causes of death from cancer in women
the tumor grows without symptoms for an extended period
225
Ovaries have three principal divisions:
- Protective layer of surface epithelium
- Cortex
- Central medulla
226
Where the immature (primordial) oocytes mature into ova and large amounts of estrogen and progesterone are produced
Cortex
227
Division of Reproductive Cells (Gametes).
| At birth, each ovary contains approximately ___________ which were formed during the ____________________
2 million immature ova (oocytes)
| first 5 months of intrauterine life.
228
Part of ovary Which contains the nerves, blood vessels, lymphatic tissue, and some smooth muscle tissue.
Central Medulla
229
Although the reproductive cells have the unique ability to produce a new individual, they basically contain the usual components of cells:
a cell membrane, an area of clear cytoplasm, and a nucleus containing chromosomes.
230
The oocytes, like sperm, differ from all other body cells in the __________ they contain in the nucleus.
Number of chromosomes
231
Reproductive cells (both ova and spermatozoa) have only ___________, so that, when they combine (fertilization), the new individual formed from them will have the normal number of
half the usual number of chromosomes (23 chromosomes)
232
There is a difference in the way reproductive cells _______ that causes this change in chromosome number.
divide
233
Cells in the body, such as skin cells, undergo cell division by _________.
mitosis, or daughter cell division
234
In this type of division, all the chromosomes are duplicated in each cell just before cell division, giving every new cell the same number of chromosomes as the original parent cell.
Mitosis
235
Oocytes divide in intrauterine life by _____________
one mitotic division
236
Oocytes' division activity then appears to halt until _________, when a second type of cell division, _____________, occurs.
at least puberty
| meiosis (cell reduction division)
237
In the male, this reduction division (meiosis) occurs just before the ____________.
spermatozoa mature
238
In the female, meiosis occurs just before ________
ovulation
239
After this meiosis, an _____ has 22 autosomes and an X sex chromosome, whereas a _________ has 22 autosomes and either an X or a Y sex chromosome.
Ovum
| Spermatozoon
240
New individual formed from the union of an ovum and an X-carrying spermatozoon will be _____
female (an XX chromosome pattern);
241
Individual formed from the union of an ovum and a Y-carrying spermatozoon will be ___________
male (an XY chromosome pattern).
242
Maturation of Oocytes.
| Each oocyte lies in the ovary surrounded by a protective sac, or thin layer of cells, called a _________
primordial follicle
243
Between _________ ova form in utero
5 and 7 million
244
The majority of ova never develop beyond the primitive state and actually atrophy, so that by birth only _______ are present.
2 million
245
By age 7 years, only approximately ____________ ova are present in each ovary.
500,000
246
By 22 years, there are approximately __________ ova;
300,000
247
By menopause, _________ ova are left
none (all have either matured or atrophied).
248
The point at which no function-ing oocytes remain in the ovaries” is one definition of __________.
menopause
249
_______ arise from each upper corner of the uterine body and extend outward and backward until each opens at its distal end, next to an ovary.
The fallopian tubes
250
Fallopian tubes are approximately _____ long in a mature woman
10 cm
251
A fallopian tube is a smooth, hollow tunnel, it is anatomically divided into _________
four separate parts
252
The most proximal division, the ________, is that part of the tube that lies within the uterine wall.
interstitial portion
253
The interstitial portion is only about _____ in length; the lumen of the tube is only _____ in diameter at this point.
1 cm
| 1 mm
254
The _______ is the next distal portion to interstitial portion.
Isthmus
255
Isthmus is approximately ____ in length and like the interstitial tube, is extremely narrow.
2 cm
256
This is the portion of the tube that is cut or sealed in a tubal ligation, or tubal sterilization procedure
Isthmus
257
The ______ is the third and also the longest portion of the fallopian tube.
ampulla
258
Ampulla is approximately ____ in length.
5 cm
259
It is in this portion that fertilization of an ovum usually occurs
Ampulla
260
The ________ is the most distal segment of the fallopian tube.
infundibular portion
261
Infundibulum is approximately ____ long and is funnel shaped.
2 cm
262
The rim of the funnel is covered by __________ that help to guide the ovum into the fallopian tube.
fimbria (small hairs)
263
The lining of the entire fallopian tube is composed of ______________
Mucous membrane
264
Lining of the entire fallopian tube, mucous membrane contains both ____________ and __________.
mucus-secreting
| ciliated (hair-covered) cells
265
Beneath the mucous lining is __________ and a __________.
connective tissue
| circular muscle layer
266
The ________________ produces peristaltic motions that help conduct the ovum the length of the tube.
muscle layer of the fallopian tube
267
Migration of the ovum is also aided by the action of the _______ and the ______, which acts as a lubricant.
ciliated lining
| mucus
268
The mucus produced of the cells contained in the mucous membrane in the lining of the fallopian tube may also act as a _______ for the fertilized egg .
source of nourishment
269
The mucus secreted the cells contained in the mucous membrane in the lining of the fallopuan tubes contains _____,______,_____
Protein, water, salt
270
Because the fallopian tubes are open at their distal ends, a _________ exists from the external organs, through the vagina to the uterus and tubes, to the peritoneum.
direct pathway
271
The direct pathway which exists because of the fallopian tubes makes _______ possible.
conception
272
The direct pathway produced by the fallopian tubes can also lead to ________ if disease spreads from the perineum through the tubes to the pelvic cavity.
infection of the peritoneum (peritonitis)
273
The _______ is a hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum.
uterus
274
During childhood, uterus is approximately the size of an _____, and its proportions are ______ from what they are later
olive
| reversed
275
During the childhood the uterus' _____ is the largest portion of the organ; the ______ is the smallest
Cervix
| uterine body
276
When a girl reaches approximately ______ of age, an increase in the size of the uterus begins
8 years
277
An adolescent is closer to ______ before the uterus reaches its adult size.
17 years old
278
This may be a contributing factor to the low-birth-weight babies typically born to adolescents younger than this age.
An adolescent is closer to 17 years old before the uterus develop into adult size
279
With maturity, a uterus is approximately ____ long, _____ wide, and, in its widest upper part, ______ deep. In a nonpregnant state, it weighs approximately ____.
5 to 7 cm
5 cm
2.5 cm
60 g
280
The function of the uterus is to __________ , ____________; ______________and, at maturity of the fetus __________
receive the ovum from the fallopian tube;
provide a place for implantation and nourishment
furnish protection to a growing fetus;
expel it from a woman’s body.
281
After a pregnancy, the uterus _______ to its non-pregnant size but remains approximately ______ long ______ wide, _____ thick, and _____ in weight.
```
never returns
9 cm
6 cm
3 cm
80 g
```
282
Anatomically, the uterus consists of three divisions: the ________, the ________, and the ________.
body or corpus
isthmus
cervix
283
The ____ of the uterus is the uppermost part and forms the bulk of the organ
body
284
The lining of the cavity of the uterus is continuous with that of the fallopian tubes, which enter at its ________.
upper aspects (the cornua)
285
The lining of the cavity of the uterus is continuous with that of the fallopian tubes, which enter at its ________.
upper aspects (the cornua)
286
During pregnancy, the _________ is the portion of the structure that expands to contain the growing fetus.
body of the uterus
287
The portion of the uterus between the points of attachment of the fallopian tubes is termed the _______.
fundus
288
The fundus is also the portion that can be palpated abdominally to ______________, to _____________, and ___________
determine the amount of uterine growth occurring during pregnancy,
measure the force of uterine contractions during labor
assess that the uterus is returning to its nonpregnant state after childbirth.
289
The _________ is a short segment between the body and the cervix.
isthmus of the uterus
290
In the nonpregnant uterus, isthmus of the uterud is only _______ in length.
1 to 2 mm
291
The ________ is the lowest portion of the uterus. It represents approximately ______ of the total uterus size and is approximately ______ long.
cervix
one third
2 to 5 cm
292
____________ arise from the myometrium
Myomas, or benign fibroid (leiomyoma) tumors,
293
The __________, or the outermost layer of the uterus, serves the purpose of adding strength and support to the structure.
perimetrium
294
It is the portion of the uterus that is most commonly cut when a fetus is born by a cesarean birth.
Isthmus
295
Cervix central cavity is termed the _______
cervical canal.
296
The opening of the canal at the junction of the cervix and isthmus is ___________
the cervical internal os;
297
The distal opening to the vagina is __________.
the external cervi-cal os
298
The level of the external os is at the level of the _________
ischial spines (an important relationship in estimating the level of the fetus in the birth canal).
299
Uterine and Cervical Coats.
| The uterine wall consists of three separate coats or layers of tissue _______, _________, __________
(the endometrium)
(the myometrium)
(the perimetrium).
300
An inner layer of the uterine wall , one of mucous membrane
(the endometrium),
301
Middle of uterine wall of muscle fibers
(the myometrium)
302
The outer layer of the uterine wall, connective tissue
(the perimetrium)
303
The __________ of the uterus is the one that is important for menstrual function.
endometrium layer
304
Endometrium is formed by ____ layers of cells.
two
305
The layer closest to the uterine wall, ______, remains stable, uninfluenced by hormones.
Basal layer
306
This is the inner layer of the endometrium that is greatly influenced by both ______ and _______.
glandular layer
estrogen
progesterone
307
Glandular layer grows and becomes so thick and responsive _______ under the influence of estrogen and progesterone that it is capable of supporting a pregnancy.
each month
308
If pregnancy does not occur, this is the layer that is shed as the menstrual flow
Glandular layer
309
The mucous membrane lining the cervix is termed the ______.
endocervix
310
The endocervix, continuous with the ________, is also affected by ______, but changes are manifested in a more subtle way.
endometrium
| hormones
311
The cells of the cervical lining secrete ________ to provide a lubricated surface so that spermatozoa can readily pass through the cervix; the efficiency of this lubrication increases or wanes depending on ___________
mucus
| hormone stimulation
312
At the point in the menstrual cycle when estrogen production is at its peak, as much as ______ of mucus per day is produced;
at the point that estrogen is very low, only a few milliliters are produced.
700 mL
313
Because mucus is ________, it helps to decrease the acidity of the upper vagina, aiding in sperm survival
alkaline
314
During pregnancy, the _______ becomes plugged with mucus, forming a seal to keep out ascending infections (the operculum).
endocervix
315
The lower surface of the cervix and the lower third of the cervical canal are lined not with mucous membrane but with _______________ similar to that lining the vagina.
stratified squamous epithelium
316
Locating the point at which this tissue changes from epithelium to mucous membrane is important when obtaining a __________, because this tissue interface is most often the origin of cervical cancer
Papanicolaou smear (a test for cervical cancer)
317
The ___________, or muscle layer of the uterus, is composed of three interwoven layers of ______ the fi bers of which are arranged in _________,___________ and _________ directions
myometrium
smooth muscle,
longitudinal, transverse, and oblique.
318
This ________ offers extreme strength to the organ.
network (myometrium arrangement)
319
The myometrium serves the important function of constricting the _______ and __________ into the tubes
tubal junctions
| preventing regurgitation of menstrual blood
320
Myometrium also holds the __________ closed during pregnancy to prevent a preterm birth.
internal cervical os
321
When the uterus contracts at the end of pregnancy to expel the fetus, _________ is exerted at all points throughout the cavity because of myometrium's ______________.
equal pressure
| unique arrangement of muscle fibers
322
After childbirth, this interlacing network of fibers of myometrium is able to __________ coursing through the layers, thereby limiting the loss of blood in the woman
constrict the blood vessels
323
Uterine Blood Supply.
| The large descending abdominal aorta divides to form _________;
two iliac arteries
324
Main divisions of the iliac arteries are the __________
hypogastric arteries
325
Hypogastric arteries further divide to form the ________ and supply the uterus
uterine arteries
326
Because the uterine blood supply is ______________, it is copious and adequate to supply the growing needs of a fetus.
not far removed from the aorta
327
As an additional safeguard, after supplying the ovary with blood, the _______ (a direct subdivision of the aorta) joins the uterine artery as a fail-safe system to ensure that the uterus will have an adequate blood supply.
ovarian artery
328
The blood vessels that supply the cells and lining of the uterus are tortuous against the _____________in nonpregnant women.
sides of the uterine body
329
As a uterus enlarges with pregnancy, the vessels ________ and so can stretch to maintain an adequate blood supply as the organ enlarges.
“unwind”
330
The uterine veins follow the same twisting course as the arteries; they empty into the ____________
internal iliac veins.
331
An important organ relationship to be aware of is the association of _____________ and the _________.
uterine vessels
| ureters
332
The _________ from the kidneys pass directly in back of the ovarian vessels, near the fallopian tubes.
ureters
333
This close anatomic relationship of the uterine vessels and ovary has implications in procedures such as ________, _________, ________ because uterus may be injured by a ______ if bleeding is controlled by _______ of the uterine or ovarian vessels
tubal ligation, cesarean birth, and hysterectomy (removal of the uterus)
clamp
clamping
334
Uterine Nerve Supply.
| The uterus is supplied by ________, and ________
both efferent (motor) and afferent (sensory) nerves.
335
The efferent nerves that supplies the uterus arise from the ___________
T5 through T10 spinal ganglia.
335
The efferent nerves that supplies the uterus arise from the ___________
T5 through T10 spinal ganglia.
336
The afferent nerves (sensory nerves) in the uterine nerve supply join the __________ and enter __________
hypogastric plexus
| the spinal column at T11 and T12.
337
The fact that sensory innervation from the uterus registers lower in the spinal column than does motor control has implications in __________
controlling pain in labor.
338
An anesthetic solution can be injected near the spinal column to stop the pain of uterine contractions at the ____________ without stopping motor control or contractions (registered higher, at the T5 to T10 level).
T11 and T12 levels
339
An anesthetic solution can be injected near the spinal column to stop the pain of uterine contractions at the T11 and T12 levels without stopping motor control or contrac-tions (registered higher, at the T5 to T10 level). This is the principle of _______ and ________
epidural and spinal anesthesia
340
Uterine Supports.
The uterus is suspended in the pelvic cavity by __________ that also help support the bladder and is further supported by a combination of ______ and ________.
several ligaments
fascia
muscle
341
Because it is ______ , the uterus is _________ without discomfort during pregnancy.
not fixed
| free to enlarge
342
If its ligaments become overstretched during pregnancy, they may not support the bladder well afterward, and the bladder can then ___________.
herniate into the anterior vagina (a cystocele)
343
If the rectum pouches into the vaginal wall, a _______ develops
rectocele
344
A fold of _________ behind the uterus forms the posterior ligament. This creates a _________between the rectum and uterus.
peritoneum
| pouch (Douglas’ cul-de-sac)
345
Because the __________/ is the lowest point of the pelvis, any fluid such as blood that accumulates from a condition such as a __________ tends to colllect in this space.
```
(Douglas’ cul-de-sac)
ruptured tubal (ectopic) pregnancy
```
346
The Cul-de-sac of Douglas can be examined for the presence of fluid or blood to help in diagnosis by inserting a _________ or a __________
- culdoscope through the posterior vaginal wall (culdoscopy)
| - laparoscope through the abdominal wall (laparoscopy).
347
The _________ are two folds of peritoneum that cover the uterus front and back and extend to the pelvic sides to help steady the uterus.
broad ligaments
348
The _________ are two fibrous, muscular cords that pass from the body of the uterus near the attachments of the fallopian tubes, through the broad ligaments and into the inguinal canal, inserting into the fascia of the vulva.
round ligaments
349
In the fetus, the uterus first forms with a ______ or ______ longitudinally separating it into two portions.
septum or a fibrous division
350
As the fetus matures, this ______ dissolves, so that typically at birth no remnant of the division remains.
septum
351
In some women, the septum never ________, and so the uterus remains as two separate compartments.In others, __________ is still present.
atrophies
| half of the septum
352
Still other women have oddly shaped “horns” at the junction of the fallopian tubes, termed a ___________
bicornuate uterus.
353
Ordinarily, the body of the uterus is tipped ____________
slightly forward
354
Positional deviations of the uterus commonly seen are
Anteversion
Retroversion
Anteflexion
Retroflexion
355
A condition in which the entire uterus is tipped far forward
Anteversion
356
A condition in which the entire uterus is tipped backward
Retroversion
357
A condition in which the body of the uterus is bent sharply forward at the junction with the cervix
Anteflexion
358
A condition in which the body is bent sharply back just above the cervix
Retroflexion
359
Abnormal shapes of uterus allow ____________ space.
less placenta implantation
360
Extreme abnormal flexion or version positions may interfere with fertility, because they can ____________
block the deposition or migration of sperm
361
Is a hollow, musculomembranous canal located posterior to the bladder and anterior to the rectum
Vagina.
362
Vagina extends from the __________ to the __________
cervix of the uterus
| external vulva.
363
Vagina's function is to act as the organ of intercourse and to convey sperm to the _____ so that sperm can meet with the ovum in the ________
cervix
| fallopian tube.
364
With childbirth, vagina expands to serve as the __________.
birth canal
365
When a woman is lying on her back, as she does for a pelvic examination, the course of the vagina is _________ and ___________.
inward
| downward
366
Because of this downward slant and the angle of the uterine cervix (when a woman is lying on her back) the length of the anterior wall of the vagina is approximately ________; the posterior wall is _________.
6 to 7 cm
| 8 to 9 cm
367
At the cervical end of the structure, there are recesses on all sides of the cervix, termed ______.
fornices
368
Behind the cervix is the ______; at the front, the _______; and at the sides, the ______.
posterior fornix
anterior fornix
lateral fornices
369
The _______ serves as a place for the pooling of semen after coitus; this allows a large number of sperm to remain close to the cervix and encourages sperm migration into the cervix.
posterior fornix
370
The vaginal wall is so thin at the_____
fornices
371
The ______ can be palpated through the anterior fornix, the ______ through the lateral fornices, and the ______ through the posterior fornix.
bladder
ovaries
rectum
372
The vagina is lined with _________ similar to that covering the cervix.
stratified squamous epithelium
373
Vagina has a _____________ and a _____________.
middle connective tissue layer
| strong muscular wall
374
Normally, the muscular walls of vagina contain many ______ that lie in close approximation to each other. These make the vagina very elastic and able to expand at the end of pregnancy to allow a full-term baby to pass through without tearing.
folds or rugae
375
A circular muscle, the __________, at the external opening of the vagina acts as a voluntary sphincter.
bulbocavernosus
376
Relaxing and tensing this ______________ a set number of times each day makes it more supple for birth and helps maintain tone after birth. ____________
external vaginal sphincter muscle
| Kegel’s exercises
377
The blood supply to the vagina is furnished by the ________ , a branch of the internal iliac artery. Vaginal tears at childbirth tend to bleed profusely because of this rich blood supply. The same rich blood supply is also the reason that any vaginal trauma at birth heals rapidly.
vaginal artery
378
The vagina has both sympathetic and parasympathetic nerve innervations originating at the _____ to _____ levels.
S1 to S3 levels
379
Sexual excitement, often attributed to vaginal stimulation, is influenced mainly by _______
clitoral stimulation
380
The mucus produced by the vaginal lining has a _________.
rich glycogen content
381
When this glycogen from the mucus prodyced by the vvaginal lining is broken down by the lactose fermenting bacteria that frequent the vagina (__________), ______ is formed.
Döderlein’s bacillus
| lactic acid
382
Lactic acid makes the usual pH of the vagina acid, a condition detrimental to the growth of ________, so that even though the vagina connects directly to the external surface, infection does not readily occur.
pathologic bacteria
383
Instruct women not to use vaginal douches or sprays as a daily hygiene measure because they may clean away this _______of the vagina, inviting vaginal infections.
natural acid medium
384
After _______, the pH of the vagina becomes closer to 7.5 or slightly alkaline, a reason that ________ occur more frequently in women in this age group
menopause
| vulvovaginitis infections
385
The mammary glands, or breasts, form from __________ early in utero.
ectodermic tissue
386
Breast then remain in a halted stage of development until a rise in _______ at puberty produces a marked increase in their size.
estrogen
387
The size of the breast increase occurs mainly because of an increase of __________ plus ____________.
connective tissue
| deposition of fat
388
The size of the breast increase occurs mainly because of an increase of __________ plus ____________.
connective tissue
| deposition of fat
389
The ___________ of the breasts, necessary for success-ful breastfeeding, remains undeveloped until a first pregnancy begins.
glandular tissue
390
The ___________ of the breasts, necessary for success-ful breastfeeding, remains undeveloped until a first pregnancy begins.
glandular tissue
391
Boys may notice a temporary increase in breast size at puberty, termed _________
gynecomastia
392
Breasts are located anterior to the ________ and in many women breast tissue extends well into the _________
pectoral muscle
| Axilla
393
Breast __________ are not as effective in detecting early breast lesions as once believed and so are no longer routinely recommended.
self-examinations
394
Breast __________ are not as effective in detecting early breast lesions as once believed and so are no longer routinely recommended.
self-examinations
395
Women should have a ______ breast examination done by a health care professional, however, as this can detect breast disease.
yearly
396
When palpating for breast health this way, always include the _________ in the examination, or some breast tissue can be missed.
axillary region
397
Milk glands of the breasts are divided by ___________________ into approximately _____.
connective tissue partitions
| 20 lobes
398
All of the milk glands in each lobe produce milk by __________ and deliver it to the nipple via a _________.
acinar cells
| lactiferous duct
399
The nipple has approximately _________ through which milk is secreted.
20 small openings
400
An ________ of the lactiferous duct, located just posterior to the nipple, serves as a reservoir for milk before breastfeeding
ampulla portion
401
A nipple is composed of _______ that is capable of erection on manual or sucking stimulation.
smooth muscle
402
On stimulation, nipple transmits sensations to the _________ to release ___________.
posterior pituitary gland
| oxytocin
403
_______ acts to constrict milk gland cells and push milk forward into the ducts that lead to the nipple.
Oxytocin
404
The skin surrounding the nipples is darkly pigmented out to approximately 4 cm and is termed the _____.
areola
405
The areola appears rough on the surface because it contains many sebaceous glands, called ___________
Montgomery’s tubercles
406
The blood supply to the breasts is profuse because it is supplied by ______________, ____________, and _____________.
thoracic branches of the axillary, internal mammary, and intercostal arteries
407
Beginning (menarche) , average age at onset, _______; average range ___-___ years
12.4 years; average range, 9–17 years
408
Interval between cycles of menstrual flow
Average, 28 days; cycles of 23–35 days not unusual
409
Duration of menstrual flow
Average flow, 2–7 days; ranges of 1–9 days not abnormal
410
Amount of menstrual flow
Difficult to estimate; average 30–80 mL per menstrual period; saturating pad or tampon in less than an hour is heavy bleeding
411
Color of menstrual flow
Dark red; a combination of blood, mucus, and endometrial cells
412
Odor of menstrual flow
Similar to that of marigolds
413
A ________________ is episodic uterine bleeding in response to cyclic hormonal changes.
menstrual cycle (a female reproductive cycle)
414
The purpose of a menstrual cycle is to bring an ___________ and _____________ that will be responsible for the ova’s growth should it be fertilized.
ovum to maturity
| renew a uterine tissue bed
415
Uterine tissue bed is responsible for the ova’s growth should it be fertilized. It is the process that allows for ________ and ______________.
conception
| implantation of a new life
416
The length of menstrual cycles differs from woman to woman, but the average length is 28 days (from the _________ of one menstrual flow to the ________ of the next).
beginning
| beginning
417
The length of the average menstrual flow (termed menses) is ___ to __ days, although women may have periods as short as 2 days or as long as 7 days
4 .
| 6
418
Four body structures are involved in the physiology of the menstrual cycle: the _______, the _______, the ______, and the _______.
hypothalamus
pituitary gland
ovaries
uterus
419
The release of _________ by the hypothalamus initiates the menstrual cycle
GnRH (also called luteinizing hormone– releasing hormone, or LHRH)
420
When the level of _______ (produced by the ovaries) rises, release of the hormone is repressed, and menstrual cycles do not occur. The principle of _____________ use to eliminate menstrual flow.
estrogen
| the principle that birth control pills use to eliminate menstrual flow
421
During ______, the hypothalamus is apparently so sensitive to the small amount of estrogen produced by the __________ that release of the hormone is suppressed.
childhood
| adrenal glands
422
Beginning with _______, the hypothalamus becomes less sensitive to estrogen feedback; this results in the __________.
puberty
| Initiation every month in females of the hormone GnRH
423
GnRH is transmitted from the hypothalamus to the ____________ and signals the gland to begin producing the ______ and ______.
anterior pituitary gland
| gonadotropic hormones FSH and LH
424
Because production of _____ is cyclic, menstrual periods also cycle.
GnRH
425
Diseases of the hypothalamus that cause deficiency of this releasing factor can result in _______. Likewise, a disease that causes ______________ can lead to abnormally early sexual development or precocious puberty.
delayed puberty
| early activation of GnRH
426
In addition to the inhibitory feedback mechanism of estrogen and progesterone that halts production of the releasing factor for the remainder of each month, high levels of pituitary-based hormones such us ____, ____, ___ can also inhibit the production of GnRH.
prolactin, FSH, or LH
427
Under the influence of GnRH, the ________ of the pituitary gland produces two hormones (FSH, LH) that act on the ______ to further influence the menstrual cycle:
```
anterior lobe (the adenohypophysis)
ovaries
```
428
A hormone that is active early in the cycle and is responsible for maturation of the ovum,
FSH
429
A hormone that becomes most active at the midpoint of the cycle and is responsible for ovulation, or release of the mature egg cell from the ovary, and growth of the uterine lining during the second half of the menstrual cycle.
LH
430
FSH and LH are called _______ because they cause growth (trophy) in the gonads (ovaries)
gonadotropic hormones
431
Every month during the fertile period of a woman’s life (from menarche to menopause), one of the ovary’s _______ is activated by FSH to begin to grow and mature.
primordial follicles
432
As the primordial cell grows, its cells produce a _______ that contains a high degree of _________ and some ______.
clear fluid (follicular fluid)
estrogen (mainly estradiol)
progesterone
433
As the follicle reaches its maximum size, it is propelled toward the _________.
surface of the ovary
434
At full maturity, primodrdial follicle is visible on the surface of the ovary as a ___________ approximately ,____ to ____ inches across.
clear water blister
| 0.25 to 0.5 inches
435
(Full maturity of Primoridial follicle) At this stage of maturation, the _______ (barely visible to the naked eye, approximately the size of a printed period), with its surrounding follicle membrane and fluid, is termed a ,_______
small ovum
| graafian follicle.
436
By day ____, before the end of a menstrual cycle (the mid-point of a typical 28-day cycle), the ovum has divided by ______ into two separate bodies: primary oocyte and secondarg oocyte
14
| mitotic division
437
contains the bulk of the cytoplasm
Primary oocyte
438
Contains so little cytoplasm that it is not functional.
Secondary oocyte
439
The structure ( ovum,primary oocyte and secondary oocyte) also has accomplished its________, reducing its number of chromosomes to the _______ number of 23.
meiotic division
| haploid (having only one member of a pair)
440
After an upsurge of LH from the pituitary, ________ are released and the _________ ruptures.
prostaglandins
| graafian follicle
441
When the graafian follicle ruptures, the ovum is set free from the surface of the ovary, a process termed _______. It is swept into the open end of a ___________
ovulation
| fallopian tube
442
Teach women that ovulation occurs on approximately the ___ day before the onset of the next cycle, not necessarily at a cycle’s midpoint
14th
443
If their cycle is only 20 days long, however, their day of ovulation would be day __
6 (14 days from the end of the cycle).
444
After the ovum and the follicular fluid have been discharged from the ovary, the cells of the follicle remain in the form of a _______,_______.
hollow, empty pit
445
After the ovum and the follicular fl uid have been dis-charged from the ovary, the cells of the follicle remain in the form of a hollow, empty pit. The ____ has done its work at this point and now decreases in amount.
FSH
446
After the ovum and the follicular fluid have been discharged from the ovary. The second pituitary hormone, ____, continues to rise in amount and acts on the follicle cells of the ovary.
LH
447
LH influences the follicle cells to produce _____, a bright-yellow fluid
lutein
448
Lutein is high in ______ and contains some _______, whereas the follicular fluid was high in ________ with some _________.
progesterone
estrogen
estrogen
progesterone
449
This yellow fluid lutein fills the empty follicle, which is then termed a __________
corpus luteum (yellow body).
450
The basal body temperature of a woman drops slightly _______ just before the day of ovulation, because of the extremely ____________ that is present at that time.
low level of progesterone
451
It rises by ____ on the day after ovulation, because of the ____________ that is present at that time. The woman’s temperature remains at this level until approximately _________ when the progesterone level again decrease
concentration of progesterone (which is thermogenic)
| day 24 of the men-strual cycle
452
If conception (fertilization by a spermatozoon) occurs as the ovum proceeds down a fallopian tube and the fertilized ovum implants on the ________ of the uterus,
endometrium
453
The corpus luteum remains throughout the major portion of the pregnancy approximately _______
16 to 20 weeks
454
If conception does not occur, the unfertilized ovum atrophies ________, and the corpus luteum (called a “false” corpus luteum) remains for _______
after 4 or 5 days
| only 8 to 10 days.
455
As the corpus luteum regresses, it is gradually replaced by white fibrous tissue, and the resulting structure is termed a ____________.
corpus albicans (white body)
456
First Phase of Menstrual Cycle called ________. Immediately after a menstrual flow (which occurs during the first 4 or 5 days of a cycle), the endometrium, or lining of the uterus, is _____________
Proliferative
| very thin, approximately one cell layer in depth.
457
As the ovary begins to produce estrogen (in the follicular fluid, under the direction of the pituitary FSH), the endometrium begins to ______.
proliferate
458
This growth is very rapid and increases the thickness of the endometrium approximately _______.This increase continues for the ____________
first half of the menstrual cycle (from approximately day 5 to day 14).
459
This half of a menstrual cycle is termed interchangeably the __________, ___________, _________
proliferative, estrogenic, follicular, or postmenstrual phase.
460
The second phase of Menstrual Cycle also called as _________. After ovulation, the formation of progesterone in the corpus luteum (under the direction of LH) causes the glands of the uterine endometrium to become _________ and ___________ and ________.
Secretory
corkscrew or twisted in appearance
dilated with quantities of glycogen (an elementary sugar)
Mucin ( a protein)
461
In the second phase, the ________ of the endometrium increase in amount until the lining takes on the appearance of rich and spongy velvet
capillaries
462
This second phase of the menstrual cycle is termed the ______, ______, _______ or _______
progestational, luteal, premenstrual, or secretory phase.
463
Third Phase of Menstrual Cycle _______ . If fertilization does not occur, the _______ in the ovary begins to regress after 8 to 10 days.
Ischemic
| Corpus Luteum
464
In the third phase, as the corpus luteum regresses the _____ and _____decreases
Estrogen and progesterone
465
In the third phase. With the withdrawal of ____________, the endometrium of the uterus begins to degenerate at approx ______ or ______
progesterone stimulation
| day 24 or day 25 of the cycle
466
Fourth Phase of a Menstrual Cycle is _______.
Menses
467
Menses, or the menstrual flow, is composed of:
* Blood from the ruptured capillaries
* Mucin from the glands
* Fragments of endometrial tissue
* The microscopic, atrophied, and unfertilized ovum
468
____ is actually the end of an arbitrarily defined menstrual cycle. Because it is the only external marker of the cycle.
Menses
469
The _______ is used to mark the beginning day of a new menstrual cycle
first day of menstrual flow
470
A menstrual flow contains only approximately _________ of blood; if it seems like more, it is because of the accompanying _____ and ________.
30 to 80 mL
mucus
Endometrial sheds
471
The iron loss in a typical menstrual flow is approximately ____.
11 mg
472
In women who are beginning menopause, menses may typically consist of a few days of spotting before a heavy flow, or a heavy flow followed by a few days of spotting, because ______________ is more sluggish or tends to “stair-case” rather than withdraw smoothly.
progesterone withdrawal
473
The ___________, as well as the _________ , changes each month during the menstrual cycle.
mucus of the uterine cervix
| uterine body
474
During the first half of the cycle, when hormone secretion from the ovary is ___, cervical mucus is ____ and ____. Sperm survival in this type of mucus is poor.
low
thick
scant
475
At the time of ovulation, when the _______ is high, cervical mucus becomes ______ and ______. Sperm penetration and survival at the time of ovulation in this thin mucus are excellent.
estrogen level
thin
copious
476
As _______ becomes the major influencing hormone during the second half of the cycle, cervical mucus again becomes ____ and sperm survival is again poor.
progesterone
| thick
477
Fern Test. When high levels of estrogen are present in the body, as they are just before ovulation, the cervical mucus forms fernlike patterns caused by the crystallization of ________ on _______ when it is placed on a glass slide and allowed to dry.This pattern is known as arborization or ______.
sodium chloride
mucus fibers
ferning ( Fern Test )
478
Cervical mucus can be examined at mid-cycle to detect whether ferning, which suggests a _______^ , is present.
High estrogen surge
479
Women who _____ continue to show the fern pattern throughout the menstrual cycle (i.e., progesterone levels never become dominant), or they never demonstrate it because their ________ levels never rise.
do not ovulate
| estrogen
480
At the height of estrogen secretion, cervical mucus not only becomes thin and watery but also can be ________ This stretchability is in contrast to its thick, viscous state when ________ is the dominant hormone.
stretched into long strands
| progesterone
481
Performing _________ at the midpoint of a menstrual cycle is another way to demonstrate that high levels of estrogen are being produced and, by implication, that ovulation is about to occur. A woman can do this herself by stretching a mucus sample between thumb and finger, or it can be tested in an examining room by smearing a cervical mucus specimen on a slide and stretching the mucus between the slide and coverslip
Spinnbarkeit Test
482
Painful menstruation
dysmenorrhea
483
Abnormally heavy menstrual flows
menorrhagia
484
Bleeding between menstrual periods
metrorrhagia
485
___________ such as ibuprofen (Motrin) are most effective for menstrual pain.
Prostaglandin inhibitors
486
Adolescents under age 18 should not take aspirin because of the association between this and ____________.
Reye’s syndrome
487
_________ is the cessation of menstrual cycles.
Menopause
488
___________ is a term used to denote the period during which menopausal changes occur.
Perimenopausal
489
________ describes the time of life following the final menses
Postmenopausal
490
The age range atwhich menopause occurs is wide, between approximately ____ and ____ years of age with a mean age of ____
40
55
51.3
491
The age at which menopause symptoms begin appears to be _______ or at least is not associated with age of menarche.
genetically influenced
492
Women who ______ tend to have earlier menopause
smoke
493
Menopause can cause physiologic stress as ovaries are a woman’s chief source of ________.
estrogen
494
In menopause. When ovaries begin to atrophy, reducing estrogen production, ______, ,________, or _______ occurs. Urinary incontinence from lack of _______ can also occur
“hot flashes,”
vaginal dryness
osteoporosis (lack of bone mineral density [BMD])
bladder support
495
Hot flashes can be accompanied by___________ and can occur up to ___ to ____ episodes a day; episodes commonly last for __ to __ minutes at a time.
```
heart palpitations
20
30
3
5
```
496
Hormone Replacement Therapy is no longer prescribed routinely as such therapy does not appear to reduce cardiac risk or prevent osteoporosis and may be associated with _______, ___________, and perhaps _______
```
endometrial cancer
cerebrovascular accidents (strokes)
breast cancer
```
497
HR may be prescribed on a _____________ if a woman has symptoms so severe
short-term basis (1 to 2 years)
498
Women should not receive __________ indefinitely because of the possible adverse effects
estrogen replacement therapy
499
Women who notice excessive vaginal dryness can be advised to use a _________ prior to sexual relations. Other possibilities are application of ______ or ________ that dispenses low-dose estrogen.
lubricating jelly
estrogen cream
insertion of a vaginal ring
500
_________ can also be prescribed to increase sexual libido.
Low-dose estrogen or testosterone
501
Practicing ________ can help strengthen bladder supports and reduce urinary incontinence.
Kegel’s exercises
502
Osteoporosis occurs in as many as __ to __ of women over age __.
13%
18%
50
503
________ is seen most frequently in women who are Asian, have a low body weight, have a positive family history, participate in few weight-bearing exercises, have a low intake of calcium, are cigarette smokers, have an early surgical menopause, or take certain anticonvulsant medications or corticosteroids.
Osteoporosis
504
As _____ is withdrawn from bones, women notice a decrease in height and back pain from _________
calcium
| shortening of the vertebral column.
505
_________ are helpful in diagnosis
BMD scans ( Bone Mineral Density)
506
To help prevent osteoporosis, women should be sure to ingest _____ daily along with ___________, in addition to beginning a program of __________ such as walking or low-impact aerobics.
1200 mg calcium
400 to 800 IU of vitamin D
weight-bearing exercises
507
________, a thyroid hormone that regulates body calcium, may be prescribed as a nasal spray.
Calcitonin
508
Other drugs commonly prescribed are _____________ such as Evista and _________ such as Fosamax that regulate calcium by aiding bone reabsorption.
selective estrogen receptor modulators (SERMS)
| bisphosphonates
509
If a woman lives to be ____, she will spend a third of her life postmenopausal.
80
510
Is a multidimensional phenomenon that includes feelings, attitudes, and actions. It has both biologic and cultural components.
Sexuality
511
Is the term used to denote a person’s chromosomal sex: male (XY) or female (XX).
Biologic gender
512
_________ is the inner sense a person has of being male or female, which may be the same as or different from biologic gender.
Gender identity or sexual identity
513
________ is the male or female behavior a person exhibits, which, again, may or may not be the same as biologic gender or gender identity
Gender role
514
The amount of _____________ may affect how gender develops.
testosterone secreted in utero (a process termed sex typing)
514
The amount of _____________ may affect how gender develops.
testosterone secreted in utero (a process termed sex typing)
515
Children can distinguish between males and females as early as _ years of age.
2
516
By age __ or __ years, they can say what sex they are, and they have absorbed cultural expectations of that sex role.
3
| 4
517
_________ is reinforced through behavior toward and expectations of the child, as well as from such things as the color and décor of the child’s room and the child’s clothing.
Sex role modeling
518
Although the development of an ________ (the strong emotional attachment of a preschool boy for his mother or a preschool girl for her father) may have been overstated by Freud as a result of sexual bias, many children exhibit behavior that suggests such a phenomenon does occur during this time.
Oedipus complex
519
_______ children typically spend play time imitating adult roles as a way of learning gender roles
Early school-age
520
50% of adolescents past the age of ___ are already sexually active
15
521
Early in pregnancy, a woman may experience a decreased desire for coitus because of the increased _______ in her body.
estrogen
522
As pregnancy advances and her abdomen increases in size, she and her sexual partner may need to use new positions for intercourse such as a _____ position or the woman in a _______
side-by-side
| superior position.
523
Certain medications, such as _________, __________, and _______, may diminish sexual response in both men and women.
antihypertensives, antianxiety agents, narcotics
524
Both ovaries are also removed
oophorectomy
525
Older women may have less vaginal secretions because they have less ______ after menopause.
estrogen
526
Males with _________ may have difficulty with erection and ejaculation, because these actions are governed at the ______.
upper spinal cord injury
| spinal level
527
_____________ or ____________ achieves erection in most men with spinal cord lesions, allowing the man a satisfying sexual relationship with his partner.
Manual stimulation of the penis
| psychological stimulation
528
Most women with spinal cord injuries cannot experience ______ but are able to conceive and have children.
orgasm
529
Excitement occurs with physical and psychological stimula-tion (i.e., sight, sound, emotion, or thought) that causes ________.
parasympathetic nerve stimulation.
530
Parasympathetic nerve stimulation leads to ___________ and _________ in the genital area.
arterial dilation
| venous constriction
531
The resulting increased blood supply in the genital area leads to _____________ and _________
vasocongestion
| increasing muscular tension
532
In women, this vasocongestion causes the clitoris to ________ and _______ to appear on vaginal walls as lubrication. The vagina ______ and ________. The nipples become _____
```
increase in size
mucoid fluid
widens in diameter
increases in length
erect
```
533
Parasympathetic nerve stimulation in men leads to _______ occurs, as well as scrotal _______ and ________ of the testes.
penile erection
thickening
elevation
534
In both sexes parasympathetic nerve stimulation causes an _______ in heart and respiratory rates and blood pressure.
increase
535
In woman the plateau stage, the clitoris is drawn _____ and __________; the ___________ becomes extremely congested (formation of the orgasmic platform), and there is _______ nipple elevation.
forward
retracts under the clitoral prepuce
lower part of the vagina
increased
536
The plateau phase in men, the vasocongestion leads to _______ of the penis. Heart rate increases to 100 to ______ beats per minute and respiratory rate to approximately ____ respirations per minute.
distention
175
40
537
_______ occurs when stimulation proceeds through the plateau stage to a point at which the body suddenly dis-charges accumulated sexual tension.
Orgasm
538
Orgasm. A vigorous contraction of muscles in the pelvic area expels or dissipates ____________.
blood and fluid from the area of congestion
539
Orgasm. The average number of contractions for a woman is ___ to ___ contractions at intervals of 1 every ___ seconds.
8
15
0.8
540
Orgasm. In men, muscle contractions surrounding the ________ and ______ project semen into the proximal urethra. These contractions are followed immediately by ____ to ____ ________ contractions, occurring at the same time interval as in the woman, which force semen from the penis.
```
seminal vessels
prostate
three
seven
propulsive ejaculatory
```
541
Resolution is a ____ period during which the external and internal genital organs return to an unaroused state.
30-minute
542
For the male, a _________ occurs during which further orgasm is impossible.
refractory period
543
Women do not go through this __________, so it is possible for women who are interested and properly stimulated to have additional orgasms immediately after the first.
refractory period
544
G spot, presumably located on the _________, halfway between the ______ and the _____, has been promoted as an area of heightened erotic sensitivity
inner portion of the vaginal wall
| pubic bone and cervix
545
Phase in menstrual cycle where there is increased fluid retention and vasocongestion in a woman’s lower pelvis.
luteal phase
546
Because some _______ is already present during luteal phase in lower pelvis at the beginning of the excitement stage of the sexual response, women appear to reach the plateau stage more quickly and achieve orgasm more readily during this time.
vasocongestion
547
Pregnancy is another time in life when there is vasocongestion of the lower pelvis because of the ________ by a rapidly growing fetus. This causes some women to experience a _________ during their first pregnancy.
blood supply needed
| first orgasm
548
Following a pregnancy, many women experience increased sexual interest because the ___________ during pregnancy lasts for some time and continues to facilitate pelvic vasocongestion.
new growth of blood vessels
549
is the extreme practice of causing oxygen deficiency (usually by hanging) during masturbation with the goal of producing a feeling of extreme sexual excitement.
Autoerotic asphyxia
550
Is the use of visual materials such as mag-azines or photographs for sexual arousal.
Erotic stimulation
551
Is sexual arousal resulting from the use of certain objects or situations.
Fetishism
552
A ________ an individual who dresses in the clothes of the opposite sex
transvestiteis
553
Is obtaining sexual arousal by looking at another person’s body.
Voyeurism
554
It involves inf mlicting pain (sadism) or receiving pain (masochism) to achieve sexual satisfaction.
Sadomasochism
555
Is revealing one’s genitals in public.
Exhibitionism
556
___________ is sexual relations with animals.
Bestiality
557
(an equal exchange), in which an employer asks for something in return for sexual favors, such as a hiring or promotion preference
quid pro quo
558
_________, in which an employer creates an environment in which an employee feels uncomfortable and exploited (e.g., being addressed as “honey,” asked to wear revealing clothing, working where walls are decorated with sex-ist posters).
hostile work environment
559
Chronic diseases, such as , that cause ______ or ________ frequent pain or discomfort may interfere with a man’s or a woman’s overall well-being and interest in sexual activity
peptic ulcers or chronic pulmonary disorders
560
Chronic diseases, such as ________ or __________, that cause frequent pain or discomfort may interfere with a man’s or a woman’s overall well-being and interest in sexual activity
peptic ulcers
| chronic pulmonary disorders
561
Some women experience a decrease in sexual desire during __________.
perimenopause
562
Administration of __________ to women may be helpful at that time, because it can improve interest in sexual activity
androgen (testosterone)
563
_______ formerly referred to as impotence, is the inability of a man to produce or maintain an erec-tion long enough for vaginal penetration or partner satisfac-tion
Erectile dysfunction (ED),
564
Most causes of Erectile dysfunction (ED) are physical, such as _____, ________, ________ which limit blood supply.May also occur as a ___________
aging, atherosclerosis, or diabetes
| side effect of certain drugs
565
Examples of drugs prescribed today for ED are __________, __________, _________ which are taken up to once a day to stimulate penile erection.(they are contradicted in men with a risk of _________ and in those who are taking medications that contain _______.
sildenafil (Viagra), tadalafill (Cialis), and vardenafil (Levitra),
cardiovascular illness
nitrates
566
A surgical implant is done when medications ia not possible to aid erection. Surgical implant is done by the use of _______ is a possible alternative
vacuum pressure
567
Various herbal products such as _______ are available for women that may improve sexual libido. _________ are also available to increase clitoral enlargement and sexual arousal in women.
fennel extracts
| Vibration or vacuum devices
568
Sildenafil citrate (Viagra) can be used with women taking ___________ who notice decreased sexual arousal
serotonin reuptake inhibitors
569
```
Sildenafil Citrate (Viagra)
is a _____________ inhibitor.
Prescribed as therapy for erectile dysfunction; also _____________
```
phosphodiesterase (PDE)
| pulmonary artery hypertension
570
Sidenafil causes ______ relaxation and inflow of blood to the _________of the penis, achieving erection.
smooth muscle
| corpus cavernosum
571
Sidenafil Dosage: ___ mg PO prn __ hour before sexual activity, up to one dose per day
50
| 1
572
Sidenafil Possible Adverse Effects: The most common side effects are _______, _________ and _______ . Less commonly, _________, _______, _________, _________ or ________ may briefly occur.
headache, facial flushing, and upset stomach
| ventricular arrhythmia, bluish vision, blurred vision, impairment of blue/green discrimination, or sensitivity to light
573
Advise patients not to take sidenafil within ___ hours of taking an _______ agent.
4
| alpha-blocker
574
Nursing Implications in prescribing sidenafil to patient, assess patient for pre-existing ________ risk.
cardiovascular
575
After taking sidenafil, erection lasting more than ______ can occur. Caution patient to alert health care provider if this occurs to avoid penile tissue damage.
4 hours (priapism)
576
In rare instances, men taking PDE5 inhibitors with sidenafil have reported a sudden ____________
decrease or loss of vision.
577
___________ such as Mirtazapine, may be helpful in alleviating the problem behind prematire ejaculation.
serotonergic antidepressants
578
_________ is excessive and unrelenting sexual arousal in the absence of desire. It may be triggered by _______ or ________.
When assessing someone with the disorder, be certain to ask if the person is taking any herbal remedies such as _______ because some of these can have arousal effects.
Persistent sexual arousal syndrome (PSAS)
medications or psychological factors
Ginkgo biloba
579
_______ is involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted that prohibits penile penetration. May occur in women who have been raped_____.
Vaginismus
| raped
580
______ is pain during coitus. This can occur because of __________ (abnormal placement of endometrial tissue), ________ (inf lammation of the vestibule), _________ or _______ such as those that occur menopause and cause vaginal drying
```
Dyspareunia
endometriosis
vestibulitis
vaginal infection,
hormonal changes
```
