LM 4.2: Sexual Differentiation and Physiology of Human Sexual Function Flashcards

1
Q

what does species survival require?

A
  1. reproduction by parents
  2. rearing of offspring
  3. offspring reproduction
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2
Q

what is species survival insured by?

A
  1. sex drive and attraction
  2. social roles and values
  3. love
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3
Q

what is the general role of a male in species survival?

A
  1. relatively non-selective mating

2. goal is to spread genes

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4
Q

what is the general role of a female in species survival?

A
  1. generally selective mating

2. goal is reliable partner to assure success raising offspring

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5
Q

when do the gonads differentiate?

A

weeks 6-9

testis begins by 6 weeks –> sex determining region on Y chromosome (SRY gene) causes testis to develop

in absence of Y chromosome ovaries develop (weeks 7-9)

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6
Q

when do the internal reproductive ducts develop?

A

8-12 weeks

there are separate sets of primordia that transiently coexist in embryos of both sexes so there is potential for development of either

male offspring requires the positive influences of testosterone to grow Wolffian ducts and Müllerian Inhibiting Substance (MIS) to prevent Müllerian duct development

absence of testosterone and presence of MIS yields female ducts

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7
Q

when do external genitalia develop?

A

8-12 weeks

maleness requires the positive effect of Dihydrotestosterone (DHT) –> when androgen effect is intermediate, newborn male shows only partial virilization

if androgen (DHT) not present in first 12 weeks, masculinization never completed

genetic females with androgen over-stimulation may have complete phallic urethra and prostatic tissue

differentiation complete by 16th week

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8
Q

when do the biopotential hypothalamic neurons in the brain develop?

A

after week 16

certain hypothalamic neurons in the preoptic area and some limbic and cortical brain areas of both sexes are initially undifferentiated and are capable of becoming functionally male or female

then during 2nd trimester, androgen presence causes permanent, irreversible biochemical changes in these neurons and their connectivity

regardless of genetic sex, androgen presence prevents cyclic LH release that is required for normal menstruation –> androgen absence during this time would allow for a cyclic LH release pattern to develop

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9
Q

what conditions does chromosomal nondisjunction during meiosis lead to?

A
  1. Klinefelter syndrome

2. Turner Syndrome

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10
Q

what is Klinefelter syndrome?

A

XXY

47 chromosomes with male phenotype

1 in 500 male births

normal phenotypically as a child, but usually tall and with small testes

incomplete post pubertal virilization and gynecomastia due to low T and elevated E

an adult has azoospermia

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11
Q

what is Turner syndrome?

A

XO

45 chromosomes with female phenotype

1 in 2500 females

short stature, streak gonads (no ovaries), primary amenorrhea and sexually-undeveloped appearance due to low E

associated with many congenital abnormalities

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12
Q

what are some of the abnormal gonadal developments that can occur even in the presence of XX or XY?

A
  1. pure gonadal dysgenesis
  2. gene mutation based gonadal dysgenesis
  3. vanishing testis syndrome
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13
Q

what is pure gonadal dysgenesis?

A

an abnormal gonadal development despite presence of XX or XY

patients will present with streak gonads with a normal female phenotype due to absence of MIS and androgens

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14
Q

what is gene mutate based gonadal dysgenesis?

A

46 XY with mutations in one of the following:

  1. SRY
  2. WT1 (Wilms Tumor Related 1)
  3. SF1 (steroidogenic factor 1)
  4. SOX9
  5. DAX1
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15
Q

what is vanishing testis syndrome?

A

46 XY with absent or rudimentary testes

androgen present for some portion of gestation

effects vary from complete failure of virilization to normal male with anorchia

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16
Q

what is genetic XX with ambiguous or male phenotypic genitalia?

A

this is females with ovaries and normal Mullerian derivatives, but with excessive androgens during gestation

external genitalia at birth can range from simple clitoral enlargement to complete scrotum and penile urethra

most common cause is Congenital Adrenal Hyperplasia (CAH)

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17
Q

what is genetic XY with ambiguous or underdeveloped male phenotypic genitalia?

A

virilization defect during gestation in males with testes but insufficient androgen action or synthesis (and/or defective Mullerian duct regression)

most common defects are:
1. 5α-reductase deficiency (low DHT)

  1. androgen receptor deficiency (Androgen Insensitivity Syndrome)
18
Q

what are the common causes of external genitalia that don’t have the typical appearance of male or female?

A
  1. incomplete external genitalia development
  2. external genitalia complete but opposite of genetic sex like with:
    - CAH
    - androgen insensitivity syndrome
    - 5α-reductase deficiency
    - 17-α-hydrxoylas deficiency

incorrect sex assignment often won’t even be discovered till puberty when an androgen insensitive XY “girl’ doesn’t have menarche or when there isn’t male-type puberty despite fully male external genitalia in XX CAH

19
Q

what is gender identity disorder?

A

dissatisfaction with their own biological sex and a strong desire to be a member of the opposite sex

20
Q

what is gender dysphoria?

A

an emotional and psychological condition experienced when a person’s gender identity differs from their assigned sex

21
Q

when do you diagnose gender dysphoria?

A

only when the incongruity between birth sex and felt gender identity is marked and causes significant distress and/or significant functional impairmen

22
Q

when is sex reassignment surgery considered?

A

transsexuals should live in the opposite gender role for at least 1 yr before sex reassignment surgery is considered

23
Q

what are pheromones?

A

airborne molecules which act via the olfactory system to influence drives and behaviors

chemical messages from one organism to another

they xxpress a physiological/behavioral state to the recipient that yields a response from the recipient

they are involved in:
1. social recognition

  1. territorial marking
  2. location mapping
  3. sexual attraction
24
Q

what are the 2 main pheromones?

A
  1. volatile steroids

2. short chain alipathic acids

25
Q

what are volatile steroid pheromones?

A
  1. present in axillary sweat
  2. subtle emotion/mood effects
  3. can advance/retard ovulation
26
Q

what are short chain alipathic acid pheromones?

A

present in vaginal secretions

example: copulins
1. stimulate male libido

  1. highest production around ovulation
  2. decreased by oral contraceptives
27
Q

what are the 4 stages of sexual response?

A
  1. excitement

phsychological arousal, vasocongestion in females, erection in males

  1. plateau

continuation and intensification of excitement stage

  1. orgasm
  2. resolution

takes several minutes and even longer if no orgasm

28
Q

what is an orgasm?

A

complex integrated CNS and pelvic event

it’s repeated, rhythmic contractions of perineal musculature with sensory perception of these contractions in the CNS

when the orgasm threshold is reached in the CNS, there’s a massive motor nerve output via lumbar spinothalamic neurons that os focus on the genito-pelvic region

ejaculation of semen in male; little or no fluid in female but same contractions as male

29
Q

what is sexual dysfunction?

A

problems with the normal sexual response cycle

10-15% are physical while 85-90% are psychological

30
Q

what are the 6 major classifications of sexual disorders?

A
  1. sexual desire/interest disorder
  2. sexual arousal disorder
  3. orgasmic disorder
  4. vaginismus
  5. dyspareunia
  6. persistent genital arousal disorder

a sexual disorder is diagnosed when symptoms cause distress; some people may not be bothered by decreased/absent sex drive

31
Q

what is sexual desire/interest disorder?

A

absence of, or a decrease in, sexual interest, desire, sexual thoughts, and fantasies and an absence of responsive desire

32
Q

what is sexual arousal disorder?

A

lack of subjective or genital arousal or both

33
Q

what is orgasmic disorder?

A

orgasm is absent, markedly diminished in intensity, or markedly delayed in response to stimulation despite high levels of subjective arousal

34
Q

what is vaginismus?

A

reflexive tightening around the vagina when vaginal entry is attempted or completed, despite a woman’s expressed desire for penetration and when no structural or other physical abnormalities are present

35
Q

what is dyspareunia?

A

pain during attempted or completed vaginal penetration or intercourse

can occur in men

36
Q

what is persistent genital arousal disorder?

A

unwanted, excessive genital arousal, sometimes persisting for hours or days

can cause great distress, especially in older wome

thought to result from pelvic muscle hypertonicity

37
Q

what are the primary psychologic factors causing sexual dysfunction?

A
  1. mood disorders

treatment of MDD in women results in decrease in severity of dysfunction in up to 80% – fears of letting go, being vulnerable, being rejected, losing control can contribute – low self esteem plays a big role too

  1. previous experiences

past negative sexual experiences, prior abuse, early traumatic loss

  1. concerns about negative outcomes

pregnancy, STIs, inability to have an orgasm, sexual dysfunction in a partner

  1. distractions

family, work, friends

38
Q

what are the primary physical factors causing sexual dysfunction?

A
  1. genital lesions
  2. fatigue
  3. nerve damage
  4. pain from surgery
  5. medications/substanaces (alcohol, anticonvulsants, B-blockers, SSRIs)
39
Q

which drugs can reduce libido?

A
  1. weak androgen receptor antagonists like spironolactone or cimetidine
  2. LH RH agonists (leuprolide)
  3. antipandrogens (flutamide, bicalutamide)–used to treat prostate cancer
  4. 5-alpha-reductase inhibitors (finasteride, dutasteride)–used to treat benign prostatic hyperplasia
  5. CNS active drugs (especially SSRIs, tricyclic antidepressants, antipsychotics)

addition of bupropion or trazodone to these can sometimes improve symptoms

40
Q

what is erectile dysfunction?

A

inability to attain or sustain an erection satisfactory for sexual intercourse

41
Q

what controls ejaculation

A

the SNS

  1. neural stimulation of alpha-adrenergic receptors cause contractions of epididymis, vas deferens, seminal vesicles, and prostate
  2. semen is transported to posterior urethra
  3. rhythmic contractions of pelvic floor cause ejaculation of fluid; neck of bladder closes to prevent retrograde ejaculation into the bladder

SSRIs and alpha blockers can inhibit receptors and delay or inhibit ejaculation

42
Q

what is premature ejaculation?

A

ejaculation occurring sooner than desired by man or his partner, and causing distress to the couple

can be related to anxiety, inexperience, other psychologic factors

typically successfully treated with sex therapy, SSRIs, tricyclic antidepressants