Chapter 28: The Reproductive Systems

Question 1

describe the location, structure, and functions of the organs of the male reproductive system.

Answer 1

sexual reproduction – process by which organisms produce offspring by making germ cells.

1. Gametes – a male or female reproductive cell; a sperm cell or a secondary oocyte
2. Fertilization – penetration of a secondary oocyte by a sperm cell, meiotic division of secondary oocyte to form an ovum, and subsequent union of the nuclei of the gametes
3. Gonads – a gland that produces gametes and hormones
4. Ducts – structures that store and transport the gametes
5. accessory sex glands – produce substances that protect the gametes and facilitate their movement
6. supporting structures – assist the delivery of gametes, site for growth of embryo/fetus during pregnancy. Include penis in males, uterus in females.
7. male reproductive system – includes testes, system of ducts, accessory sex glands, and supportinh structures

The male reproductive system arises from Mesonephric (Wolffian) ducts

Functions of the male reproductive system:

1. Testes produce sperm and testosterone
2. Ducts transport, store, and assist in maturation of sperm
3. Accessory sex glands secrete most of the liquid portion of semen
4. Penis contains urethra, passageway for ejaculation of semen and excretion of urine

Scrotum – supporting structure for the testes

Raphe – median ridge that separates the scrotum into lateral portions

scrotal septum – internally divides the scrotum into two sacs, each containing a single testis. Made up of a subcut layer and muscle tissue

dartos muscle – muscle tissue composed of bundles of smooth muscle fibers that makes up the scrotal septum. Is also found in the subcut layer of the scrotum

cremaster muscle – a series of small bands of skeletal muscle that descend as an extension of the internal oblique muscle through the spermatic cord to surround the testes.

1. Location of scrotum and contraction of its muscle fibers regulate the temperature of the testes. regulated by the dartos muscles
2. Sperm production requires a temp 2-3 Celsius less than body temp.
3. Contraction of the cremaster muscles moves the testes closer to the body to absorb body heat
4. Contraction of the dartos muscle causes the scrotum to become tight and wrinkled, which reduces heat loss.

testicle or testis (plural is testes) – paired oval glands in the scrotum

1. male gonad that produces sperm and hormones testosterone and inhibin.
2. Develop near the kidneys in the posterior portion of the abdomen
3. Usually begin descent into the scrotum through the inguinal canals during the latter half of 7th month of fetal development.

tunica vaginalis – serous membrane derived from the peritoneum that forms during the descent of the testes

• partially covers the testes

tunica albuginea – internal to the tunica vaginalis

• white fibrous capsule composed of dense irregular connective tissue that surrounds the testes.
• It extends inward, dividing the testes into a series of internal compartments called lobules
  
  • 200-300 lobules

Lobules – internal compartments formed by the tunica albuginea extending inwards

seminiferous tubules – tightly coiled duct in the testis where sperm are produced.

• Each lobule contains 1-3 seminiferous tubules

Spermatogenesis – the process by which the seminiferous tubules of the testes produce sperm

spermatogenic cells – sperm forming cells

spermatogonium (plural is spermatogonia) – stem cells that develop from primordial germ cells that arise from the yolk sac and enter the testes in the 5th week of development.

• In the embryo, the primordial germ cells differentiate into spermatogonia which remain dormant during childhood and begin producing sperm at puberty

spermatozoon (plural is spermatozoa) – a sperm cell. A mature male gamete

Sertoli cells or sustentacular cells – a supporting cell in the seminiferous tubule

1. Extend from the basement membrane to the lumen of the tubule
2. Tight junctions join neighboring sustentacular cells to one another
3. Several functions in supporting spermatogenesis
4. Secretes fluid for supplying nutrients to sperm
5. Secretes inhibin
6. Removes excess cytoplasm from spermatogenic cells
7. Mediates the effects of FSH and testosterone on spermatogenesis
   
   • Secrete testosterone

blood-testis barrier – formed by the tight junctions of the sustentacular cells of the seminiferous tubules

1. an obstruction that requires substances to first pass through sustentacular cells before they can reach the developing sperm.
2. By isolating the developing gametes from the blood, the blood-testis barrier prevents an immune response against the spermatogenic cell’s surface antigens which are recognized as foreign by the immune system
3. The blood testis barrier does not include spermatogonia.

Leydig cells or interstitial cells – clusters of cells located in the spaces between adjacent seminiferous tubules.

CELLS THAT SECRETE TESTOSTERONE

LH stimulates Leydig cells to secrete testosterone.

Androgen – a hormone that promotes development of masculine characteristics.

Testosterone – the most prevalent andogen.

• Promotes a man’s libido

Suspensory ligament arises from the pubic symphysis in males

Question 2

discuss the process of spermatogenesis in the testes.

Answer 2

Spermatogenesis – takes 65-75 days.

Spermatogonia​ eventually become spermatozoa.

• Begins with spermatogonia – stem cells with diploid number of chromosomes.
• When they undergo mitosis, some remain near the basement membrane in an undifferentiated state to serve as a reservoir of cells for future cell division and subsequent sperm production
• The rest lose contact with the basement membrane, squeeze through the tight junctions, undergo developmental changes, and differentiate into primary spermatocytes
• Throughout the process, the cells do not separate completely.

1. Cells remain in contact via cytoplasmic bridges throughout their entire development.
2. This pattern likely accounts for synchronized sperm production in any given area of a seminiferous tubule.
3. Also might have survival value because the sperm containing X chromosomes may have important genes for sperm production lacking on the Y chromosome.

B. primary spermatocytes – diploid, 46 chromosomes. A single primary spermatocyte produces 4 spermatids via 2 rounds of cell division.

Shortly after forming, the primary spermatocyte replicates its DNA and meiosis begins.

1. In Meiosis I, homologous chromosome pairs line up at the metaphase plate and crossing-over occurs
2. The meiotic spindle pulls one chromosome of each pair to the opposite pole of the dividing cell
3. The two cells formed by meiosis I are called secondary spermatocytes

C. secondary spermatocytes – the two cells formed by Meiosis I. Each contains 23 chromosomes, the haploid number.

• Each chromosome is still composed of two chromatids (two copies of the DNA) attached by a centromere
• In Meiosis II, the chromosomes line up at the metaphase plate and the chromatids separate.
• 4 haploid cells result

D. Spermatids – the 4 haploid cells that result from Meiosis II.

E. Spermiogenesis – the final stage of spermatogenesis.

• The development of haploid spermatids into sperm
• No cell division occurs
• Each spermatid becomes a single sperm cell transforming from spherical cell to elongated sperm.

sperm cell or spermatozoon – the male gamete

spermiation – event in which sperm are released from their connections to sustentacular cells and enter the lumen of the seminiferous tubule

sperm – about 300 million complete the process of spermatogenesis daily

• head – flattened pointed portion.
• Nucleus – contained within the head
• Acrosome – caplike vesicle covering the anterior 2/3 of the head. a. Contains enzymes that help a sperm penetrate a secondary oocyte to cause fertilization.
• Tail – elongated portion subdivided into 4 parts:
  
  • Neck – constricted region just behind the head.
    
    • Contains the centrioles
    • The centrioles form the microtubules that comprise the remainder of the tail.
• middle piece – contains mitochondria arranged in a spiral
• principal piece – the longest portion of the tail
• end piece – the terminal tapering portion of the tail.

I. hormonal control of the testes

gonadotropin-releasing hormone (GnRH) – stimulates gonadotrophs in the anterior pituitary to increase their secretion of two gonadotropins: LH and FSH

• at puberty, hypothalamic neurosecretory cells increase their secretion of GnRH

luteinizing hormone (LH) – stimulates interstitial cells located between seminiferous tubules in the testes in males to secrete testosterone

follicle-stimulating hormone (FSH) – initiates sperm production in males

a. acts indirectly to stimulate spermatogenesis
b. FSH and testosterone act synergistically on the sustentacular cells to simulation secretion of androgen- binding protein (ANP)

testosterone – steroid hormone synthesized from cholesterol in the testes

1. the principal androgen
2. lipid-soluble
3. readily diffuses out of interstitial cells into the interstitial fluid and into blood.
4. Via negative feedback, testosterone suppresses LH secretion by anterior pituitary gonadotrophs and suppresses secretion of GnRH by hypothalamic neurosecretory cells.
5. In some target cells, the enzyme 5 alpha-reductase converts testosterone to another androgen called dihydrotestosterone
6. Testosterone stimulates the final steps of spermatogenesis in the seminiferous tubules

androgen-binding protein (ABP) – binds to testosterone, keeping its concentration high.

Inhibin – released by sustentacular cells once the amount of spermatogenesis required for male reproductive functions has been achieved.

1. Protein hormone that inhibits FSH secretion by the anterior pituitary
2. If spermatogenesis is proceeding too slowly, less inhibin is released, allowing more FSH secretion and an increased rate of spermatogenesis

J. reproductive system ducts

ducts of the testis – system of ducts that allow movement of sperm along the lumen of seminiferous tubules due to pressure caused by fluid secreted by sustentacular cells.

straight tubules – very short ducts leading from a convoluted seminiferous tubule to the rete testis
rete testis – network of ducts in the testes leading to efferent ducts

efferent ducts – coiled ducts in the epididymis that empty into the ductus epididymis
ductus epididymis – single tightly coiled tube inside the epididymis

1. lined with pseudostratified columnar epithelium
2. encircled by layers of smooth muscle
3. connective tissue around the muscle layer attaches the

loops of the ductus epididymis and carries blood vessels and nerves.

stereocilia – long branching microvilli (not cilia) that increase the surface area for reabsorption of degenerated sperm.

• Contained on the free surfaces of the columnar cells of the ductus epididymis.

epididymis – comma-shaped organ along the posterior border of the testis that contains the ductus epididymis in which sperm undergo maturation. Also stores sperm up to several months

1. 3 portions of the epididymis: head, body, tail
2. Head – larger, superior portion
3. Body – narrow midportion
4. Tail – smaller, inferior portion that continues as the ductus (vas) deferens

sperm maturation – the process by which sperm acquire motility and the ability to fertilize an ovum

• occurs over a period of about 14 days

ductus deferens or vas deferens – the duct that carries sperm from the epididymis to the ejaculatory duct.

• About 45cm long, ascends along the posterior border of the epididymis through the spermatic cord and then enters the pelvic cavity, loops over the ureter and passes over the side and down the posterior surface of the urinary bladder.
• Its mucosa consists of pseudostratified columnar epithelium and lamina propria (areolar connective tissue)
• Muscularis is composed of three layers of smooth muscle: inner and outer longitudinal, middle circular layer
• Functions to convey sperm during sexual arousal from the epididymis toward the urethra by peristaltic contractions of its muscular coat.
• Like the epididymis, can store sperm for several months before they are eventually reabsorbed if not ejaculated.

Ampulla – dilated terminal portion of the ductus deferens spermatic cord – supporting structure of the male reproductive system

1. ascends out of the scrotum from a testis to the deep inguinal ring
2. consists of the ductus deferens, testicular artery, veins that drain the testes, autonomic nerves, lymphatic vessels, and the cremaster muscle.
3. Spermatic cord and ilioinguinal nerve pass through the inguinal canal – an oblique passageway in the anterior abdominal wall just superior and parallel to the medial half of the inguinal ligament.

ejaculatory ducts – 2; one on each side. A tube that transports sperm from the ductus deferens to the prostatic urethra

1. formed by the union of the duct from the seminal vesicle and the ampulla of the ductus deferens
2. form just superiorly to the base (superior portion) of the prostate and pass inferiorly and anterior through the prostate.
3. Terminate in the prostatic urethra, where they eject sperm and seminal vesicle secretions just before the release of semen from the urethra to the exterior.

Urethra – in males, the shared terminal duct of the reproductive and urinary systems.

• Subdivided into 3 portions as it passes through the prostate, deep muscles of the perineum, and the penis.
  
  • Citric acid – used by sperm for ATP production via the Krebs cycle
  • Several proteolytic enzymes – that break down the clotting proteins from the seminal vesicles
    
    • Prostate-specific antigen (PSA)
    • Pepsinogen
    • Lysozyme
    • hyaluronidase

prostatic urethra – about 2-3cm or 1 inch long, passes through the prostate

membranous urethra AKA intermediate urethra – about 1cm long where it passes through the deep muscles of the perineum

spongy urethra or penile urethra – where the urethra passes through the corpus spongiosum of the penis and extends to the outside

external urethral orifice – the end of the urethra

K. accessory sex glands – include seminal vesicles, prostate, and bulbourethral glands

seminal vesicles – paired convoluted pouchlike structures posterior the base of the urinary bladder and anterior to the rectum.

1. Secrete an alkaline, viscous fluid that contains fructose, prostaglandins, and clotting proteins different from those in the blood.
2. The alkaline nature of the seminal fluid helps neutralize the acidic environment of the male urethral and the female reproductive tract that would otherwise kill sperm
3. The fructose is used for ATP production by sperm
4. Prostaglandins contribute to sperm motility and viability and may stimulate smooth muscle contractions within the female reproductive tract
5. The clotting proteins help semen coagulate after ejaculation.
6. Normally constitutes about 60% of the volume of semen.

Prostate – a single, golf ball sized doughnut-shaped gland.

1. Inferior to the urinary bladder
2. Surrounds the prostatic urethra
3. Slowly increases in size from birth to puberty and then rapidly expands in size until about age 30
4. May enlarge further around age 45
5. Secretes a milky, slightly acidic fluid that contains several substances.

• Acid phosphatase – function unknown
• Seminalplasmin – an antibiotic that can destroy bacteria. May help decrease naturally occurring bacteria in semen and lower female reproductive tract.

6. Secretions of the prostate enter the prostatic urethra through many prostatic ducts
7. Prostatic secretions make up about 25% volume of semen and contribute to sperm motility and viability.

bulbourethral glands or Cowper’s glands – paired glands about the size of peas

1. located inferior to the prostate on either side of the membranous urethral within the deep muscles of the perineum
2. their ducts open into the spongy urethra
3. secrete an alkaline fluid into the urethra that protects the passing sperm by neutralizing acids from urine in the urethra
4. also secrete mucus that lubricates the end of the penis and the lining of the urethra, decreasing the number of sperm damaged during ejaculation

Semen – a mixture of sperm and seminal fluid

1. The volume of semen in a typical ejaculation is 2.5-5mL with 50-150 million sperm per mL
2. When the number falls below 20 million per mL, the male is likely infertile.
3. A very large number of sperm is required because only a tiny fraction ever reach the secondary oocyte.
4. Semen has a slightly alkaline pH of 7.2 – 7.7 due to the higher pH and larger volume of fluid from the seminal vesicles vs the prostatic acidic fluid.

seminal fluid – Consists of secretions of the seminiferous tubules, seminal vesicles, prostate, and bulbourethral glands.

L. Penis – cylindrical in shape, consists of a body, glans penis, and root

Body of the penis – composed of 3 cylindrical masses of tissue, each surrounded by fibrous tissue called the tunica albuginea

• All 3 masses enclosed by a subcut layer and skin
• Two dorsolateral masses and smaller midventral mass that consist of erectile tissue
• *corpora cavernosa penis** – the two dorsolateral masses of the body of the penis
• *corpus spongiosum penis** – the smaller midventral mass of the penis.
• Contains the spongy urethra and keeps it open during ejaculation

erectile tissue – composed of numerous blood sinuses lined by endothelial cells and surrounded by smooth muscle and elastic connective tissue.

glans penis – distal end of the corpus spongiosum penis

a. slightly enlarged, acorn-shaped region
b. its margin is called the corona
c. the distal urethra enlarges within the glans penis and forms a terminal slit like opening

external urethral orifice – the terminal slit like opening of the urethra

prepuce or foreskin – loosely fitting skin covering the glans of the penis in uncircumcised males.

Root of the Penis – the attached, proximal, portion that consists of the bulb of the penis and the crura of the penis (singular crus).

1. The bulb is attached to the inferior surface of the deep muscles of the perineum and is enclosed by the bulbospongiosus muscle.
2. Each crus of the penis bends laterally away from the bulb to attach to the ischial and inferior pubic rami and is surrounded by the ischiocavernosus muscle.

M. Erection – the enlarged and stiff stated of the penis resulting from the engorgement of the spongy erectile tissue with blood

• Initiated and maintained by parasympathetic fibers from the sacral portion of the spinal cord producing NO that causes smooth muscle in the walls of the arterioles supplying erectile tissue to relax, allowing these blood vessels to dilate.
• NO also causes smooth muscle within the erectile tissue to relax, causing a widening of the blood sinuses.
• Combination of increased blood flow and widening of blood sinuses results in an erection.

N. Ejaculation – the reflex ejection or expulsion of semen from the penis

• Sympathetic reflex coordinated by the lumbar portion of the spinal cord
• The smooth muscle sphincter at the base of the urinary bladder closes, preventing urine from being expelled during ejaculation and semen from entering the urinary bladder.

O. Emission – the discharge of a small amount of semen before ejaculation

• Caused by the peristaltic contractions of the epididymis, ductus deferens, seminal vesicles, ejaculatory ducts, and prostate propelling sperm into the penile portion of the urethra.

Path of the sperm cell

Sperm mature in the epididymis. From there, they travel through the ductus (Vas) deferens through the abdominal cavity to the ampulla of the ductus deferens which merges with the duct of the seminal vesicle to form the ejaculatory duct. Sperm and the alkaline, fructose-rich fluid from the seminal vesicle move from the ejaculatory duct into the prostatic urethra, where they are mixed with a slightly acidic mucoid fluid from the prostate. Next the sperm and fluid pass through the membranous urethra and are mixed with additional alkaline secretions from the bulbourethral glands. The combination of sperm and secretions is called semen. The mixture travels through the penile urethra as it is ejaculated.

Dihydrotestosterone - In male embryos, which hormone is responsible for the development of the urethra, prostate, and external genitals

Question 3

describe the location, structure, and functions of the organs of the female reproductive system.

Answer 3

Female reproductive system arises from Paramesonephric (Mullerian) ducts

A. female reproductive system – includes the ovaries, uterine tubes, uterus, vagina, and external organs. Also mammary glands

Functions of the female reproductive system:

1. Ovaries produce secondary oocytes and hormones
2. Uterine tubes transport a secondary oocyte to the uterus and are the usual site of fertilization
3. The uterus is the site of implantation of a fertilized ovum and place of growth of fetus
4. Vagina receives the penis during intercourse, is a passageway for birth
5. Mammary glands synthesize, secrete, and eject milk for child nourishment

ovaries and their ligaments – ovaries are the female gonads

1. paired glands, resemble unshelled almonds in size/shape
2. homologous to the testes
3. ovaries produce 1. Gametes and 2. Hormones
4. ovaries descend to the brim of the superior portion of the pelvic cavity during 3rd month of fetal development
5. several ligaments hold them in place:

• broad ligament of the uterus – a fold of the parietal peritoneum. Attaches to the ovaries by a double- layered fold of peritoneum called the mesovarium
• ovarian ligament – anchors the ovaries to the uterus
• suspensory ligament – attaches ovaries to the pelvic wall

histology of the ovary

1. germinal epithelium – a layer of simple epithelium that covers the surface of the ovary
2. tunica albuginea – whitish capsule of dense irregular connective tissue located immediately deep to the germinal epithelium
3. ovarian cortex – region just deep to the tunica albuginea. Consists of ovarian follicles surrounded by dense irregular connective tissue that contains collagen fibers and fibroblast-like calls called stromal cells
4. ovarian medulla – deep to the ovarian cortex. Medulla consists of more loosely arranged connective tissue and contains blood vessels, lymphatic vessels, and nerves.
5. ovarian follicles – located in the cortex. Consist of oocytes in various stages of development plus the cells surrounding them.
6. Oocytes
7. follicular cells – initial phase when the surrounding cells form a single layer
8. granulosa cells – later in development, the cells form several layers called granulosa cells. The surrounding cells nourish the developing oocyte and begin to secrete estrogens as the follicle grows larger. Major hormone secreted: Estrogen
9. mature follicle or Graafian follicle – a large, fluid-filled follicle that is ready to rupture and expel its secondary oocyte.
10. Ovulation – the rupture of a mature follicle with discharge of a secondary oocyte into the pelvic cavity
11. corpus luteum – contains the remnants of a mature follicle after ovulation.

• Produces progesterone, estrogens, relaxin, and inhibin until it degenerates
• Progesterone is secreted after ovulation.

l. corpus albicans – fibrous scar tissue that is the degenerated corpus luteum

Paraurethral (Skene’s) glands secrete mucus

Question 4

discuss the process of oogenesis in the ovaries.

Answer 4

A. Oogenesis – the formation of gametes in the ovaries. Begins in females before they are born.

oogonium (plural is oogonia) – diploid stem cells that divide mitotically to produce millions of germ cells.

• Derived from primordial germ cells that migrate from the yolk sac to the ovaries and differentiate into oogonia.
• Many undergo atresia even before birth but some develop into larger cells called primary oocytes

Atresia – degeneration and reabsorption of an ovarian follicle before it fully matures and ruptures

primary oocytes – larger cells developed from oogonia that enter prophase of meiosis I during fetal development but do not complete that phase until after puberty.

• During this arrested stage of development, each primary oocyte is surrounded by a singly later of flat follicular cells.

primordial follicles – the entire structure of primary oocyte and surrounding single layer of flat follicular cells.

primary follicles – consists of a primary oocyte that is surrounded in a later stage of development by several layers of cells called granulosa cells.

• Developed from primordial follicles each month after puberty and until menopause
• Typically several develop but only one will reach maturity needed for ovulation

granulosa cells – cells surrounding the primary oocyte in several layers

zona pellucida – a clear glycoprotein layer between the primary oocyte and the granulosa cells

theca folliculi – an organized layer formed by stromal cells surrounding the basement membrane.
secondary follicle – develops from a primary follicle by continuing maturation

• granulosa cells begin to secrete follicular fluid which builds up in a cavity called the antrum in the center of the secondary follicle.
• the theca differentiates into two layers
  
  • theca interna – highly vascularized internal layer of cuboidal secretory cells that secrete estrogens
  • theca externa – outer layer of stromal cells and collagen fibers

corona radiata – the innermost layer of granulosa cells that is firmly attached to the zona pellucida around a secondary oocyte. mature (Graafian) follicle – larger, developed secondary oocyte

• while in this follicle and just before ovulation, the diploid primary oocyte completes meiosis I, producing two haploid cells of unequal size.

first polar body – the smaller cell produced by meiosis I.

• essentially a packet of discarded nuclear material.
  b. May or may not divide again to produce 2 polar bodies.

secondary oocyte – the larger cell produced by meiosis I.

• receives most of the cytoplasm.
• Once formed, begins meiosis II but stops at metaphase.

Ovulation – the rupture and release of a secondary oocyte by the mature follicle.

1. The secondary oocyte and first polar body are expelled into the pelvic cavity – normally swept into the fallopian tube by the hair-like projections.
2. If fertilization does not occur, the cells degenerate.
3. If a sperm penetrates the secondary oocyte, meiosis II resumes.

Ovum – larger cell produced by meiosis II

• The single gamete produced by meiosis I and II of the oocyte. The other 3 cells are primary and secondary polar bodies.

second polar body – smaller cell produced by meiosis

II. Zygote – diploid cell that results from the union of the nuclei of the sperm and ovum.

B. uterine tubes or Fallopian tubes or oviducts – extend laterally from the uterus. Measure roughly 10cm long. Lie within folds of the broad ligaments of the uterus.

Infundibulum – the funnel shaped portion of each uterine tube. Close to the ovary but open to the pelvic cavity

Fimbriae – fringe of fingerlike projections

• One is attached to the lateral end of the ovary

Ampulla – the widest, longest portion of the uterine tube

• Lateral 2/3 of the uterine tube length

Isthmus – the more medial, short, narrow, thick-walled portion that joins the uterus.

Layers of the uterine tubes: 3 layers: mucosa, muscularis, serosa

a. Mucosa – epithelium and lamina propria (areolar connective tissue)

1. Epithelium contains ciliated simple columnar cells, which function as a ciliary conveyer belt to help move the ovum or secondary oocyte within the uterine tube toward the uterus
2. Epithelium also contains peg cells – nonciliated cells that have microvilli and secrete a fluid that provides nourishment for the ovum.

b. Muscularis – middle layer. 2 layers: inner circular thick ring of smooth muscle and an outer, thin region of longitudinal smooth muscle 1. Peristaltic contractions of the muscularis and ciliary action of the mucosa help move the oocyte or ovum toward the uterus
c. Serosa – serous membrane outer layer of the uterine tubes.

Uterus – hollow, muscular organ in females that is the site of menstruation, development of the fetus, and labor.

1. Pathway for sperm to reach the uterine tubes.
2. Located between the urinary bladder and the rectum
3. Size and shape of an inverted pear
4. Females that have never been pregnant, it is roughly 7.5cm long, 5cm wide, 2.5cm thick.
5. Larger in females who have recently been pregnant and smaller when sex hormones are low as after menopause.
6. Several ligaments maintain uterus position but allow movement:
7. Uterosacral ligaments – paired, peritoneal extensions that lie on either side of the rectum and connect the uterus to the sacrum
8. Broad ligaments – double folds of peritoneum attaching the uterus to either side of the pelvic cavity.
9. Cardinal ligaments – located inferior to the bases of the broad ligaments and extend from the pelvic wall to the cervix and vagina.
10. Round ligaments – bands of fibrous connective tissue between the layers of the broad ligament 1. Extend from a point on the uterus just inferior to the uterine tubes to a portion of the labia majora

Fundus – dome-shaped portion superior to the uterine tubes

Body – tapering central portion

Cervix – inferior narrow portion that opens into the vagina.

• Projects inferiorly and posteriorly and enters the anterior wall of the vagina at nearly a right angle.

uterine cavity – the interior of the body of the uterus cervical canal – interior of the cervix

• opens into the uterine cavity at the internal os and into the vagina at the external os

anteflexion – the normal position of the uterus, projecting anteriorly and superiorly over the urinary bladder.

• Retroflexion – a posterior tilting of the uterus; harmless variation of the normal position. Often no cause, may occur after childbirth. Ligaments provide enough movement that this can happen.

Histology – uterus consists of 3 layers of tissue: perimetrium, myometrium, endometrium

Perimetrium – outer layer. AKA serosa. Is part of the visceral peritoneum.

1. Composted of simple squamous epithelium and areolar connective tissue.
2. Laterally becomes the broad ligament
3. Anteriorly it covers the urinary bladder and forms a shallow pouch, the vesicouterine pouch.
4. Posteriorly it covers the rectum and forms a deep pouch between the uterus and urinary bladder, the rectouterine pouch.

Myometrium – the middle layer of the uterus

1. Consists of 3 layers of smooth muscle fibers that are thickest in the fundus and thinnest in the cervix.
2. Thicker middle layer is circular. Inner and outer layers are longitudinal or oblique.
3. Coordinated contractions of myometrium in response to oxytocin from the posterior pituitary help expel the fetus from the uterus.

Endometrium – inner layer of the uterus

a. Highly vascularized and has 3 components:

1. An innermost layer composed of simple columnar epithelium lines the lumen
2. An underlying endometrial stroma is a very thick region of lamina propria (areolar connective tissue)
3. Endometrial glands develop as invaginations of the luminal epithelium and extend almost to the myometrium

b. Endometrium is divided into 2 layers: stratum functionalis and stratum basalis

stratum functionalis – lines the uterine cavity.

• Sloughs off during menstruation

stratum basalis – the deeper layer.

• Permanent and gives rise to a new stratum functionalis after each menstruation.

uterine arteries – branches of the internal iliac artery that supply blood to the uterus

arcuate arteries – branches off the uterine arteries that are arranged in a circular fashion in the myometrium

radial arteries – branches from arcuate arteries that penetrate deeply into the myometrium.

• Just before entering the endometrium, they divide into two kinds of arterioles: straight arterioles and spiral arterioles

Straight arterioles – supply the stratum basalis with the materials needed to regenerate the stratum functionalis. spiral arterioles – supply the stratum functionalis and change markedly during the menstrual cycle.

cervical mucus – a mixture of water, glycoproteins, lipids, enzymes, and inorganic salts produced by the secretory cells of the mucosa of the cervix.

1. Secrete 20-60mL of cervical mucus per day in reproductive years.
2. Becomes less viscous and more alkaline around ovulation time, making it more hospitable to sperm.
3. At other times, a more viscous mucus forms a cervical plus that physically impedes sperm penetration
4. Cervical mucus supplements the energy needs of sperm and helps protect sperm from phagocytes and the otherwise hostile environment of the vagina and uterus.
5. Also may play a role in capacitation – a series of functional changes that sperm undergo in the female reproductive tract before they are able to fertilize a secondary oocyte. Causes a sperm cell’s tail to beat more vigorously and prepares the sperm cell’s plasma membrane to fuse with the oocyte’s plasma membrane.

Vagina – tubular 10cm long fibromuscular canal lined with mucous membrane that extends from the exterior of the body to the uterine cervix.

1. The receptacle for the penis during sexual intercourse
2. The outlet for menstrual flow
3. The passageway for childbirth
4. Between the urinary bladder and the rectum, directed superiorly and posteriorly where it attaches to the uterus

Fornix – a recess that surrounds the vaginal attachment to the cervix.

• A contraceptive diaphragm rests in the fornix when properly inserted

Mucosa – of the vagina – is continuous with that of the uterus

• Consists of nonkeratinized stratified squamous epithelium and areolar connective tissue that lies in a series of transverse folds called rugae

Rugae – connective tissue that lies a series of transverse folds in the vagina.

XXIV.

Muscularis – composed of an outer circular layer and an inner longitudinal layer of smooth muscle that can stretch considerable
Adventitia – superficial layer of the vagina, consists of areolar connective tissue.

• Anchors the vagina to adjacent organs such as the urethra and urinary bladder anteriorly and the rectum and anal canal posteriorly.

Hymen – a thin fold of vascularized mucous membrane that forms a border around and partially closes the inferior end of the vaginal opening to the exterior.

• Imperforate hymen – when the hymen completely covers the orifice. Surgery may be needed to permit the discharge of menstrual flow.

vaginal orifice – the vaginal opening to the exterior

vulva or pudendum – term that refers to the external genitals of the female. Made up of several components:

• mons pubis – anterior to the vaginal and urethral openings; an elevation of adipose tissue covered by skin and coarse pubic hair that cushions the pubic symphysis.
• labia majora – two longitudinal folds of skin that extend inferiorly and posteriorly from the mons pubis.
• Singular is labium majus
• Covered by pubic hair and contain and abundance of adipose tissue, sebaceous glands, and apocrine sudoriferous glands.
• Homologous to the scrotum

labia minora – medial to the labia majora

• two smaller folds of skin
• singular is labium minus
• no pubic hair or fat and have only a few sudoriferous glands
• do contain many sebaceous glands
• homologous to the spongy urethra
  
  • Appears rough because it has modified sebaceous glands

clitoris – small cylindrical mass composed of two small erectile bodies the corpora cavernosa and several nerves and blood vessels.

prepuce of the clitoris – a layer of skin formed at the point where the labia minor unit and cover the body of the clitoris

glans clitoris – the exposed portion of the clitoris

a. homologous to the glans penis in males.
b. Capable of enlargement on tactile stimulation and has a role in sexual excitement in the female.

**external urethral orifice** – the opening of the urethra to the exterior
greater vestibular (Bartholin’s) glands – on either side of the vaginal orifice itself.

1. Open by ducts into a groove between the hymen and labia minora
2. Produce a small quantity of mucus during sexual arousal and intercourse that adds to cervical mucus and provides lubrication.
3. Homologous to the bulbourethral glands in males.

bulb of the vestibule – consists of two elongated masses of erectile tissue just deep to the labia on either side of the vaginal orifice.

1. Becomes engorged with blood during sexual arousal, narrowing the vaginal orifice and placing pressure on the penis during intercourse.
2. Homologous to the corpus spongiosum and bulb of the penis in males.

Perineum – the pelvic floor, the space between the anus and the scrotum in males and anus and vulva in females

1. Diamond shaped area medial to the thighs and buttocks of both males and females.
2. Contains the external genitals and anus
3. Borders: pubic symphysis anteriorly, ischial tuberosities

laterally, and coccyx posteriorly.

C. mammary glands

breast – hemispheric projection anterior to the pectoralis major muscle and serratus anterior muscles and attached to them by a layer of fascia composed of dense irregular connective tissue.

Nipple – pigmented projection that has a series of closely spaced openings form ducts

lactiferous ducts – closely spaced openings of ducts where milk emerges from the nipple.

Areola – circular pigmented area of skin surrounding the nipple

Suspensory ligaments of the breast – run between the skin and fascia and support the breast.

• Become looser with age or excessive strain
• Wearing a supportive bra can help maintain the strength of the suspensory ligaments.

mammary gland – modified sudoriferous gland that produces milk.

Lobes – 15-20 compartments separated by a variable amount of adipose tissue.

Lobules – smaller compartments within lobes composed of grapelike clusters of milk secreting glands called alveoli

Alveoli – milk secreting portion of a mammary gland. myoepithelial cells – cells that surround the alveoli and contract to help propel milk toward the nipples

secondary tubules – series of tubules that connect the alveoli to the mammary ducts
mammary ducts – ducts that receive milk from the secondary tubues

lactiferous sinuses – expanded ends of mammary ducts near the nipple where some milk may be stored before draining into the lactiferous duct.

Lactation – synthesis, secretion, and ejection of milk

1. Associated with pregnancy and childbirth
2. Stimulated largely by the hormone prolactin from the anterior pituitary, with contributions from progesterone and estrogens.
3. Ejection of milk is stimulated by oxytocin, released from the posterior pituitary in response to the sucking of an infant on the mother’s nipple.

Question 5

compare the major events of the ovarian and uterine cycles.

Answer 5

1. female reproductive cycle – encompasses the ovarian and uterine cycles, the hormonal changes that regulate them, and related cyclical changes in the breasts and cervix.
   
   1. ovarian cycle – a monthly series of events in the ovary associated with the maturation of a secondary oocyte
   2. uterine cycle or menstrual cycle – a series of changes in the endometrium of the uterus to prepare it for the arrival and development of a fertilized ovum
2. hormonal regulation
   
   1. gonadotropin-releasing hormone (GnRH) – secreted by the hypothalamus
      
      1. controls the ovarian and uterine cycles
      2. stimulates the release of FSH and LH from the anterior pituitary
   2. follicle-stimulating hormone (FSH) – initiates follicular growth
   3. luteinizing hormone (LH) – stimulates further development of the ovarian follicles 1. both FSH and LH stimulate the ovarian follicles to secrete estrogens
   4. LH stimulates the theca cells of a developing follicle to produce androgens

• Under the influence of FSH, the androgens are taken up by the granular cells of the follicle and converted into estrogens
• At midcycle, LH triggers ovulation and then promotes formation of the corpus luteum
• Stimulated by LH, the corpus luteum produces and secretes estrogens, progesterone, relaxin, and inhibin.

1. Estrogens – at least 6 different ones have been isolated from plasma of human females but only 3 are significant.

• Beta-estradiol – most common in a non-pregnant female
• Synthesized from cholesterol in the ovaries
• Estrone
• Estriol
• Estrogen functions:

1. Promote development and maintenance of female reproductive structures, secondary sex characteristics (distribution of adipose tissue in breasts, abdomen, mons pubis, and hips; voice pitch, broad pelvis, pattern of hair growth on head and body), and the breasts.
2. Increase protein anabolism, including the building of strong bones. Synergistic with hGH
3. Lower blood cholesterol, probably accounts for lower risk of CAD in women under 50 than men of comparable age.
4. Moderate levels in the blood inhibit both the release of GnRH by the hypothalamus and secretion of LH and FSH by the anterior pituitary.
5. Progesterone – secreted mainly by cells of the corpus luteum
6. Cooperates with estrogens to prepare and maintain the endometrium for implantation of a fertilized ovum and to prepare the mammary glands for milk secretion
7. High levels of progesterone also inhibit secretion of GnRh and LH
8. Relaxin – small quantity produced by the corpus luteum each month
   
   1. Relaxes the uterus by inhibiting contractions of the myometrium
   2. During pregnancy, the placenta produces much more relaxin, which continues to relax uterine smooth muscle.
   3. At the end of pregnancy, relaxin also increases the flexibility of the pubic symphysis and may help dilate the uterine cervix
9. Inhibin – secreted by granulosa cells of growing follicles and by the corpus luteum after ovulation. 1. Inhibits the secretion of FSH and to a lesser extent, LH

C. phases of the female reproductive cycle – typically 24-36 days, divided into 4 phases: menstrual, preovulatory, ovulation, postovulatory

D. menstrual phase or menstruation or menses – lasts roughly first 5 days of the cycle

• first day of menstruation is day 1 of a new cycle
• events in the ovaries – under influence of FSH, several primordial follicles develop into primary follicles and then into secondary follicles 1. this developmental process may take months to occur, therefore a follicle that begins to develop at the beginning of a particular menstrual cycle may not reach maturity and ovulate until several cycles later.
• events in the uterus – menstrual flow from uterus consists of 50- 150mL blood, tissue fluid, mucus, and epithelial cells shed from the endometrium

1. the discharge occurs because the declining levels of progesterone and estrogens stimulate release of prostaglandins that cause the uterine spiral arterioles to contract.
2. As a result, the cells they supply become oxygen deprived and die
3. Eventually, the entire stratum functionalis sloughs off.
4. Now the endometrium is very thin, only 2-5m, because only the stratum basalis remains.

preovulatory phase – the time between end of menstruation and ovulation

1. most variable phase length and accounts for most of the differences in length of cycle. Lasts from days 6-13 in a 28 day cycle
2. events in the ovaries – some of the secondary follicles begin to secrete estrogens and inhibin
   
   1. by about day 6, a single secondary follicle in one of the two ovaries has outgrown all the others to become a dominant follicle
   2. estrogens and inhibins released by the dominant follicle decreases the secretion of FSH, which causes other, less well-developed follicles to stop growing and undergo atresia
   3. fraternal multiples result when 2 or more secondary follicles become codominant and are ovulated and fertilized around the same time.
   4. dominant follicle – the one follicle that outgrows the rest
   5. mature follicle or Graafian follicle – next phase of the dominant follicles
   6. continues to enlarge until about 20mm in diameter and ready for ovulation
   7. forms a blisterlike bulge due to the swelling antrum on the surface of the ovary.
   8. During final maturation process, the mature follicle continues to increase its production of estrogens.

follicular phase – the menstrual and preovulatory phases together

• named so because the follicles are growing and developing.
• events in the uterus – estrogens released into the blood by growing ovarian follicles stimulate repair of the endometrium
• cells of the stratum basale undergo mitosis and produce a new stratum functionalis.
• As the endometrium thickens, the short, straight endometrial glands develop, and the arterioles coil and lengthen as they penetrate the stratum functionalis.
• The thickness of the endometrium approximately doubles, to 4- 10mm.

proliferative phase – with reference to the uterine cycle, the preovulatory phase is AKA proliferative phase because the endometrium is proliferating.

Ovulation – 3rd phase. The rupture of the mature follicle and the release of the secondary oocyte into the pelvic cavity

• Usually occurs on day 14 in a 28 day cycle
• During ovulation, the secondary oocyte remains surrounded by its zona pellucida and corona radiata
• The high levels of estrogens during the last part of the preovulatory phase exhibit a positive feedback effect on the cells that secrete LH and GnRH and cause ovulation as follows:
• High concentration of estrogens stimulates more frequent release of GnRH from the hypothalamus. It also directly stimulates gonadotrophs in the anterior pituitary to release LH
• GnRH promotes release of FSH and additional LH by the anterior pituitary
• LH causes rupture of the mature follicle and expulsion of a secondary oocyte about 9 hours after the peak of the LH surge. The ovulated oocyte and its corona radiata cells are usually swept into the uterine tube.
• Mittelschmerz – the pain caused by a small amount of blood that sometimes leaks into the pelvic cavity from the ruptured follicle.

postovulatory phase – the time between ovulation and the onset of the next menses

• its duration is the most constant part of the female reproductive cycle, lasts for 14 days in a 28 day cycle, from day 15-28
• events in one ovary – after ovulation, the mature follicle collapses, the basement membrane between the granulosa cells and theca interna breaks down.
• Once a blood clot forms from minor bleeding of the ruptured follicle, the follicle becomes the corpus hemorrhagicum
• Theca interna cells mix with granulosa cells as they all become transformed into corpus luteum cells under the influence of LH.
• Stimulated by LH, the corpus luteum secretes progesterone, estrogens, relaxin, and inhibin
• The luteal cells also absorb the blood clot

luteal phase – with respect to the ovarian cycle, this phase is AKA the luteal phase.

• Later events depend on whether the ovulated oocyte is fertilized or not.
  
  • These preparatory changes peak about 1 week after ovulation, at the time that a fertilized ovum might arrive in the uterus.

1. If NOT fertilized, the corpus luteum has a life span of about 2 weeks.
2. Then its secretory activity declines and it degenerates into a corpus albicans.
3. As the levels of progesterone, estrogens, and inhibin decrease, release of GnRH, FSH, and LH rises due to loss of negative feedback suppression by the ovarian hormones
4. Follicular growth resumes and a new ovarian cycle begins.

J. human chorionic gonadotropin (hCG) – hormone produced by the

chorion of the embryo beginning about 8 days after fertilization and then the developing placenta that maintains the corpus luteum

• if the secondary oocyte IS fertilized and begins to divide, the corpus luteum persists and is rescued by hCG.
• hCG stimulates the secretory activity of the corpus luteum

events in the uterus – progesterone and estrogens produced by the corpus luteum promote growth and coiling of the endometrial glands, vascularization of the superficial endometrium, and thickening of the endometrium to 12-18mm.

secretory phase – this phase is AKA secretory phase of the uterine cycle because of the secretory activity of the endometrial glands which begin to secrete glycogen.

• If fertilization does not occur, the levels of progesterone and estrogens decline due to degeneration of the corpus luteum.
• Withdrawal of progesterone and estrogens causes menstruation.

Positive feedback loop of ovulation

A high concentration of estrogens stimulates more frequent release of GnRH from the hypothalamus. It also directly stimulates gonadotrophs in the anterior pituitary to secrete LH. GnRH promotes the release of FSH and additional LH by the anterior pituitary. LH causes rupture of the mature ovarian follicle and expulsion of a secondary oocyte about 9 hours after the peak of the LH surge. The ovulated oocyte and its corona radiata cells are usually swept into the uterine tube.

Question 6

compare the sexual responses of males and females.

Answer 6

During heterosexual sexual intercourse, also called

copulation or coitus (KO- -i-tus), the erect penis is inserted into

the vagina. The similar sequence of physiological and

emotional changes experienced by both males and females

before, during, and after intercourse is termed the human

sexual response. William Masters and Virginia Johnson, who

began their pioneering research on human sexuality in the late

1950s, divided the human sexual response into four phases:

excitement, plateau, orgasm, and resolution.

• During the excitement phase, there is vasocongestion—*
• engorgement with blood—of genital tissues, resulting in erection of*
• the penis in men and erection of the clitoris and swelling of the labia*
• and vagina in women. In addition, vasocongestion causes the breasts*
• to swell and the nipples to become erect. The excitement phase is also*
• associated with an increase in the secretion of fluid that lubricates the*
• walls of the vagina. When the connective tissue of the vagina becomes*
• engorged with blood, lubricating fluid oozes from the capillaries and*
• seeps through the epithelial lining via a process called transudation.*
• Glands within the cervical mucosa and the greater vestibular (Bartholin’s)*
• glands contribute a small quantity of lubricating mucus. Without*
• satisfactory lubrication, sexual intercourse is diff icult and painful for*
• both partners and inhibits orgasm. Other changes that occur during*
• the excitement phase include increased heart rate and blood pressure,*
• increased skeletal muscle tone throughout the body, and hyperventilation.*
• Direct physical contact (as in kissing or touching), especially of*
• the penis, clitoris, nipples of the breasts, and earlobes is a potent initiator*
• of excitement. However, anticipation or fear; memories; visual,*
• olfactory, and auditory sensations; and fantasies can can enhance or*
• diminish the likelihood that excitement will occur.*
• The changes that begin during excitement are sustained at an intense*
• level in the plateau phase, which may last for only a few seconds*
• or for many minutes. During this phase, many females and some*
• males display a sex flush, a rashlike redness of the face and chest due*
• to vasodilation of blood vessels in those parts of the body. The head*
• of the penis increases in diameter and the testes swell. Late in the*
• plateau phase, pronounced vasocongestion of the lower third of the*
• vagina swells the tissue and narrows the opening. Because of this*
• response, the vagina grips the penis more firmly.*
• Generally, the briefest phase is orgasm (climax), during which*
• both sexes experience several rhythmic muscular contractions about*
• 0.8 sec apart, accompanied by intense, pleasurable sensations and a*
• further increase in blood pressure, heart rate, and respiratory rate.*
• The sex flush is also most prominent at this time. In males, contraction*
• of smooth muscle in the walls of the epididymis, vas deferens,*
• and ejaculatory ducts as well as secretion of fluid by the accessory*
• sex glands cause semen to move into the urethra (emission). Then,*
• rhythmic contractions of skeletal muscles at the base of the penis*
• propel semen out of the penis (ejaculation). In males, orgasm usually*
• accompanies ejaculation. In women, if eff ective sexual stimulation*
• continues, orgasm may occur, associated with 3–12 rhythmic contractions*
• of the skeletal muscles that underlie the vulva. Reception of the*
• ejaculate provides little stimulus for a female, especially if she is not*
• already at the plateau phase; this is why a female partner does not*
• automatically experience orgasm simultaneously with her partner. In both males and females, orgasm is a total body response that may produce milder sensations on some occasions and more intense, explosive sensations at other times. Whereas females may experience two or more orgasms in rapid succession, males enter a refractory period, a recovery time during which a second ejaculation and orgasm is physiologically impossible. In some males, the refractory period lasts only a few minutes; in others it lasts for several hours. A female does not have to experience an orgasm for fertilization to occur. In the final phase—resolution, which begins with a sense of profound relaxation—genital tissues heart rate, blood pressure, breathing, and muscle tone return to the unaroused state. If sexual excitement has*
• been intense but orgasm has not occurred, resolution takes place more*
• slowly.*
• The four phases of the human sexual response are not always*
• clearly separated from one another and may vary considerably among*
• diff erent people, and even in the same person at diff erent times*

Question 7

Birth Control

Answer 7

A. birth control methods

Abstinence – 100% effective if complete abstinence maintained. Vasectomy – a portion of each ductus deferens is removed

Incision or puncture is made

Ducts are located and cut. Each is tied in two places with

stitches and the portion between is cut

Sperm production continues in the testes but sperm can

no longer reach the exterior

No effect on blood testosterone levels, sexual desire, or

performance

Close to 100% effective if done right.

Reversible with 30-40% chance of regaining fertility

tubal ligation – both uterine tubes are tied and/or cut, sometimes cauterized.

a. Secondary oocyte cannot pass through the uterine tubes and sperm cannot reach the oocyte.

non-incisional sterilization – Essure – alternative to tubal ligation.

Downloaded by No name (swimming.co555@gmail.com)

V.

VI.

lOMoARcPSD|7277012

Soft micro-insert coil made of polyester fibers and metals is inserted with a catheter into the vagina, through the uterus, and into each uterine tube.

The insert stimulates tissue growth in and around itself, blocking the uterine tubes.

Secondary oocyte cannot pass through the uterine tube and sperm cannot reach the oocyte.

Does not require general anesthetic.

oral contraceptives – two kinds of pills, combined oral and progestin only

a. Combined oral – contain both progestin and estrogens

Primary action of COCs is to inhibit ovulation by suppressing the gonadotropins FSH and LH.

Low FSH and LH levels usually prevent the development of a dominant follicle in the ovary.

Therefore estrogen levels do not rise, no LH surge midcycle, and no ovulation takes place.

b. Progestin only – thicken cervical mucus and may block implantation in the uterus
1. Do not consistently inhibit ovulation
c. Benefits – control of menstrual cycle length, decreased menstrual flow, protection against endometrial and ovarian cancers, reduces risk of endometriosis.

Contraindications – women with history of blood clotting disorders, cerebral blood vessel damage, migraine headaches, Htn, liver malfunction, or heart disease. Also smoking increases risk of MI or CVA

Emergency Contraception – taken up to 72 hours after unprotected sex and again 12 hours later.

1. Contain high levels of progestin and estrogens that block natural secretion of same, declining the levels and shedding the uterine lining.

intrauterine device (IUD) - small object inserted by a health-care professional into the cavity of the uterus.

Prevent fertilization by blocking sperm from entering the uterine tubes.

Made of plastic, copper, or stainless steel.

Downloaded by No name (swimming.co555@gmail.com)

IX.

X.

lOMoARcPSD|7277012

Spermicides – various creams, jellies, suppositories, and douches that contain sperm-killing agents

Make the vagina unfavorable to sperm

Available without prescription

Placed in vagina prior to intercourse

More effective when used with a barrier method also.

Barrier Methods – use a physical barrier

Designed to prevent sperm from gaining access to uterus/uterine tubes

Some barrier methods decrease risk of STIs and HIV.

Condom – male or female

Diaphragm – rubber dome-shaped structure that fits over

the cervix and is used with a spermicide.

1. Cervical cap – smaller and fits snugly over the cervix. Fitted by a doctor.

rhythm method – periodic abstinence

Avoid intercourse 3 days before and after ovulation.

Varying cycle length decreases effectiveness.

Sympto-thermal method uses basal body temp and

cervical mucus changes to predict fertility.

Abortion – may be spontaneous (miscarriage) or induced (intentional)

a. 9 weeks or less – can take mifepristone (AKA RU 486) together with misoprostol

Mifepristone is an antiprogestin, blocks action of progesterone by binding to and blocking progesterone receptors

If progesterone level falls during pregnancy or the action of the hormone is blocked, menstruation occurs and the embryo sloughs off with the uterine lining.

Endometrium starts to degenerate within 12 hours after taking the med and within 72 hours sloughing off begins

b. Vacuum aspiration – can be performed up to 16 weeks pregnancy

VII.

VIII.

Downloaded by No name (swimming.co555@gmail.com)

I.

II.

lOMoARcPSD|7277012

1. Small flexible tube is inserted into the uterus through the vagina and fetus/embryo placenta, and uterine lining are removed by suction
   c. Dilation and evacuation – can be performed between 13- 16 weeks
2. Cervix is dilated, suction and forceps are used to remove the fetus, placenta, and uterine lining
   d. Late-stage abortion – from 16-24 weeks pregnancy

Surgical methods similar to D&C or nonsurgical methods using a saline solution or medications to induce abortion.

Labour may be induced by vaginal supps, IV infusion, or injections into the amniotic fluid through the uterus.

Question 8

Disorders

Answer 8

I.

II.

lOMoARcPSD|7277012

1. Small flexible tube is inserted into the uterus through the vagina and fetus/embryo placenta, and uterine lining are removed by suction
   c. Dilation and evacuation – can be performed between 13- 16 weeks
2. Cervix is dilated, suction and forceps are used to remove the fetus, placenta, and uterine lining
   d. Late-stage abortion – from 16-24 weeks pregnancy

Surgical methods similar to D&C or nonsurgical methods using a saline solution or medications to induce abortion.

Labour may be induced by vaginal supps, IV infusion, or injections into the amniotic fluid through the uterus.

B. disorders

testicular cancer - most common male cancer between ages 20- 35

More than 05% arise from spermatogenic cells within the seminiferous tubules

Early sign = mass in testicle often with sensation of testicular heaviness or a dull ache in the lower abdomen. Not usually pain.

Self-exam can help early detection

prostate disorders – infection, enlargement, or tumor of prostate can block flow of urine

Acute and chronic infections of the prostate are common in postpubescent males, often in association with inflammation of the urethra

Symptoms – fever, chills, urinary frequency, frequent night urination, difficulty urinating, burning or painful urination, low back pain, joint and muscle pain, blood in urine, painful ejaculation.

Often though, no symptoms

Acute prostatitis, chronic prostatitis

Prostate cancer – leading cause of death from cancer in

men in USA.

Downloaded by No name (swimming.co555@gmail.com)

IV.

V.

lOMoARcPSD|7277012

PSA increases with enlargement of the prostate and may indicate an infection, benign enlargement, or cancer.

Treatment includes surgery, cryotherapy, radiation, hormonal therapy, and chemo.

In men over 70, may just watch and wait as it grows very slowly.

erectile dysfunction (ED) - the consistent inability of an adult male to ejaculate or to attain or hold an erection long enough for sexual intercourse

a. Causes – insufficient release of NO which relaxes the smooth muscle of the penile arterioles and erectile tissue, also diabetes mellitus, physical abnormality of the penis, systemic disorders such as syphilis, vascular disturbances, neurological disorders, surgery, testosterone deficiency, drugs, and physiological factors such as anxiety, depression, fear of pregnancy and STIs, religious inhibitions and emotional immaturity.

premenstrual syndrome (PMS) - cyclical disorder of severe physical and emotional distress.

Appears during postovulatory (luteal) phase of the female reproductive cycle and dramatically disappears when menstruation begins

Signs and symptoms highly variable

1. May include: edema, weight gain, breast swelling and tenderness, abdominal distension, backache, joint pain, constipation, skin eruptions, fatigue and lethargy, sleepiness, depression or anxiety, irritability, mood swings, headache, poor coordination and clumsiness, cravings for sweet or salty foods.

c. Cause unknown.
d. Some treatments include: exercise, avoiding caffeine, salt,

and alcohol, diet high in complex carbs and lean proteins

Endometriosis - characterized by the growth of endometrial tissue outside of the uterus

a. Tissue enters pelvic cavity via the open uterine tubes and may be found in several sites: on the ovaries, rectouterine

III.

Downloaded by No name (swimming.co555@gmail.com)

VI.

VII.

lOMoARcPSD|7277012

pouch, outer surface of uterus, sigmoid colon, pelvic and abdominal lymph nodes, cervix, the abdominal wall, kidneys, and urinary bladder.

b. Endometrial tissue responds to hormonal fluctuations regardless of location.
1. With each cycle, tissue proliferates and then breaks down and bleeds, causing inflammation, pain, scarring, and infertility.
c. Symptoms include premenstrual pain or unusually severe menstrual pain.

breast cancer - 1/8 women

Second leading cause of cancer death in US after lung cancer

Rare in males

Approx 5% stem from inherited genetic mutations

2 genes identified that increase susceptibility to breast cancer: BRCA1 and BRCA2.

BRCA1 mutation also confers a high risk of ovarian cancer

Mutations of gene p53 also increase risk of breast cancer in males and females

Mutations of the androgen receptor gene associated with occurrence of breast cancer in some males

Early detection by self-exams and mammograms is best way to increase chance of survival

Factors that increase risk of breast cancer:

Family history of breast cancer, especially mother or sister

Nulliparity – never having born a child

Having a first child after age 35

Previous cancer in one breast

Exposure to ionizing radiation, such as xrays

Excessive alcohol intake

Cigarette smoking

ovarian cancer - 6th most common form but leading cause of gynecological cancer death (excl breast cancer)

a. Difficult to detect before it metastasizes

Downloaded by No name (swimming.co555@gmail.com)

IX.

lOMoARcPSD|7277012

b. Risk factors:

Age (over 50)

Race (whites higher risk)

Family history of ovarian cancer

More than 40 years active ovulation

Nulliparity or first pregnancy after age 30

High-fat, low fiber, vitamin A deficient diet

Prolonged exposure to asbestos or talc

c. Early signs and symptoms: abdominal discomfort, heartburn, nausea, loss of appetite, bloating, flatulence
d. Later-stage signs and symptoms: enlarged abdomen, abdominal and/or pelvic pain, persistent gastrointestinal disturbances, urinary complications, menstrual irregularities, heavy menstrual bleeding

cervical cancer - carcinoma of the cervix of the uterus

Begins as precancerous condition called cervical dysplasia: a change in the number, shape, and growth of cervical cells, usually the squamous cells

Sometimes the abnormal cells revert to normal, other times they progress to cancer, which usually develops slowly

Most cases detected in early stages by Pap tests

Almost all cases caused by several types of HPV

Signs and symptoms: abnormal vaginal bleeding

Decrease risk by avoiding high-risk sexual activities,

getting the HPV vaccine, having a healthy immune system

Treatment options: LEEP – loop electrosurgical excision

procedure, cryotherapy, laser therapy, hysterectomy, radical hysterectomy, pelvic exteneration (removal of all pelvic organs), radiation, chemotherapy

vulvovaginal candidiasis - inflammation of the vagina

Most common form, caused by candida albicans, a yeastlike fungus that commonly grows on mucous membranes of the GI and GU tracts

Signs and symptoms: severe itching, thick, yellow, cheesy discharge, yeasty odor, pain

Usually occurs after Abx for another condition

VIII.

Downloaded by No name (swimming.co555@gmail.com)

X.

lOMoARcPSD|7277012

d. Predisposing conditions include use of oral contraceptives, cortisone like medications, pregnancy, and diabetes

sexually transmitted diseases (STDs) - one that is spread by sexual contact

a. Chlamydia - caused by the bacterium chlamydia trachomatis

Unusual bacterium that cannot reproduce outside body cells.

Cloaks itself inside body cells where it divides.

Most prevalent STI in US

In most cases, the initial infection is asymptomatic

Males – urethritis is main result, causing clear

discharge, burning on urination, frequency, painful urination. Without treatment, epididymis may also become inflamed, leading to sterility

70% of females cases have no symptoms

Chlamydia is the leading cause of PID

Uterine tubes may also become inflamed,

which increases the risk of ectopic pregnancy and infertility due to formation of scar tissue in the tubes.

b. Gonorrhea - caused by bacterium Neisseria gonorrhoeae

Aka “the clap”

Can infect mouth and throat, vagina and penis,

newborn through birth canal, rectum

Males – usually experience urethritis with profuse

pus drainage and painful urination

1. The prostate and epididymis may become infected

Females – infection typically occurs in the vagina, with discharge of pus

Both males and females may be asymptomatic until the infection reaches an advanced stage, 5- 10% males, 50% females

If bacteria in birth canal are transmitted to the eyes of a newborn, blindness can result. 1% silver nitrate solution in the infants eyes at birth prevents infection

Downloaded by No name (swimming.co555@gmail.com)

lOMoARcPSD|7277012

c. Syphilis - caused by the bacterium Treponema pallidum

Transmitted through sexual contact or exchange of blood, or through placenta to a fetus

The disease progresses in stages:

1. Primary stage – chief sign is a painless open sore called a chancre at the point of contact
2. Heals within 1-5 weeks
3. Secondary stage – from 6-24 weeks later

Signs and symptoms: skin rash, fever, aches in joints and muscles

Systemic stage, the infection spreads to all major body systems

3. Tertiary stage – when signs of organ degeneration appear

If the nervous system is involved, the tertiary stage is called neurosyphilis

Motor areas become damaged extensively, resulting in loss of urine and bowel control, eventually becoming bedridden, unable to feed self, etc.

Damage to cerebral cortex causes memory loss, personality changes

d. genital herpes - an incurable STD caused by HSV-2 or HSV-1
1. Typically, HSV-2 caused genital and HSV-1 caused oral, but now are known to be interchangeable, despite what the textbook will tell you.
e. genital warts - typically appear as single or multiple bumps in the genital area and are caused by several types of HPV

Lesions can be flat or raised, small or large, or shaped like a cauliflower with multiple fingerlike projections.

Can be transmitted sexually

Can take weeks or months to appear

In most cases, the immune system defends against

HPV and cells revert to normal within 2 years

Downloaded by No name (swimming.co555@gmail.com)

I.

II.

III.

IV.

lOMoARcPSD|7277012

C. medical terminology

No cure, however topical gels are often used.

Gardasil protects against most genital warts.

endocervical curettage – AKA D & C; dilation and curettage

a. A procedure in which the cervix is dilated and the endometrium of the uterus is scraped out with a spoon- shaped instrument called a curette

ovarian cyst – the most common form of ovarian tumor

a. A fluid filled follicle or corpus luteum persists and continues growing

pelvic inflammatory disease (PID) - a collective term for any extensive bacterial infection of the pelvic organs, especially the uterus, uterine tubes, or ovaries

Characterized by pelvic soreness, lower back pain, abdominal pain, urethritis

Often early symptoms occur just after menstruation

As the infection spreads, fever may develop, along with

painful abscesses of the reproductive organs

Smegma - the secretion, consisting primarily of desquamated epithelial cells, found chiefly around the external genitals and especially under the foreskin of the male.