Module 3: Sexual Health Flashcards
define sexual health
a state of physical, emotional, mental, and social well-being related to sexuality
list the perspectives on sexual health and sexuality
- culture and religion
- economic
- legal
- political
describe sexual health from a cultural and religious persepctive
- marriage is universal theme in all cultures
- sexual health and sexuality is defined by cultural values
list cultural values that define sexual health and sexuality
- normative sex roles
- acceptable types of sexual activity
- sexual restraint for females
- same-sex relationships
- contraception decision making
describe sexual health from an economic perspective
- value of bride = virginity
- sexual aggression = power and economic dynamics
- commercial sex industry/sex work
describe sexual health and sexuality from a legal perspective
- laws prohibiting certain types of sexual behavior/intimacy (cohabitation, sodomy)
- same-sex partners
- marriage, annulment, separation, divorce, child custody, child support
describe sexual health and sexuality from a political persepctive
- sex education in schools
- abstinence-only until marriage programs
- comprehensive or abstinence-plus programs
list the anatomical features of the breast
- pectoralis muscle
- stroma
- lobes of mammary glands
- lactiferous ducts
- lactiferous sinuses
what is the purpose of the pectoralis muscle for the breast
where breast tissue anchors
why is the pectoralis muscle in women less defined than in men
men have higher levels of testosterone which contributes to muscle development
what are the components of the stroma in the breast
- suspensory ligaments
- adipose tissue
what feature of the breast gives it the general shape and size
stroma (suspensory ligaments and adipose tissue)
what is the function of suspensory ligaments in the breast
- anchors the breast tissue to the pectoralis muscle
- holds mammary tissue in place
- helps to give shape to the breast
what is the function of the lobes of the mammary glands
produce milk
what is the function of the lactiferous ducts
move milk from the lobes of the mammary glands to the lactiferous sinuses
what is the function of the lactiferous sinuses
hold milk until it is ready to be expressed
describe why milk can come out around the areola
- the lactiferous sinuses can get too full
- milk leaks out in any way it can
what are the 3 times that nipples will vasocongest in women
- breastfeeding
- cold
- arousal
where are breast implants placed and why
- under the pectoralis muscle
- so the implant stays in place and doesn’t migrate around the chest
what is removed during a breast reduction
- adipose tissue
- skin
what happens to the nipple during a breast reduction
the surgeon will shift the nipple up to keep it in a normal place when breast tissue is removed
what is the main hormone that triggers milk production in the breasts
oxytocin
describe when and why a male could lactate
- males have all of the breast structures, just underdeveloped
- estrogen and progesterone contribute to breast development
- a male with low testosterone levels would have a higher ratio of estrogen and progesterone which could develop breast tissue
- a male could then produce oxytocin that could invoke lactation
define gynecomastia
male breast tissue
what is the general cause of gynecomastia
low testosterone
what are the two main causes of low testosterone (and therefore gynecomastia) in men
- aging
- anabolic steroids injections
describe how anabolic steroid use can lead to gynecomastia
- anabolic steroids have lots of testosterone
- testes will stop producing testosterone
- all testosterone from steroids will go to muscle growth
- estrogen and progesterone can overtake remaining testosterone and cause male breast tissue growth
what is the main purpose of bras
to distribute the weight of breasts across the shoulder and away from the back
describe why wearing a sports bra over long periods of time can be dangerous
- sports bras are compression garments
- they may compress the lymphatic system near the breast
- the lymph will get backed up and a cyst may grow
what are 3 ways to do a breast self exam
- in the shower
- in front of a mirror
- lying down
describe how to perform a breast self exam in the shower
- check the entire breast and armpit areas
- press down with light, medium, and firm pressure
- use three fingers with overlapping pressure
why is the shower a good place to do a breast self exam
the heat from the shower can help to relax breast tissue
describe how to perform a breast self exam in front of a mirror
- visually inspect the breasts with your arms at your sides
- then inspect the breasts with the arms raised overhead
describe how to perform a breast self exam lying down
- place a pillow under your shoulder and put your arm behind your head
- move the pads of your fingers around your breast gently covering the entire breast and armpit area
what position are clinical breast exams performed in
lying down
describe the area and direction you should be palpating on a breast self exam
- armpit to nipple
- nipple to armpit
what is the purpose of a breast self examination
check for your own normalcy to see if anything is changing
should you diagnose yourself with a breast self exam
no, only a physician should diagnose
should performing a breast self exam ever be painful
no
when should you perform a breast self exam
2 weeks after the start of your last period
list the anatomical features of the vulva
- mons veneris
- labia majora
- clitoral hood
- clitoris
- labia minora
- urethral orifice
- hymen
- vaginal orifice
what aspect of all vulvas will be the same
- all vulvas will look slightly different
- the general placement/arrangement of structures will be similar in all vulvas
what area of the female body has the most sweat glands per in
vulva
what does mons mean
mountain
what does veneris mean
venus/love
what does pubis mean
to become covered with hair
describe the mons veneris
- fat pad above the pelvic bone and above other vulvar structures
- covered with the majority of pubic hair
who is the term mons veneris and mons pubis used for
- mons veneris: women
- mons pubis: men and women
what is the function of the mons veneris
- protect the pubic bone
- limit friction with pubic hair
should you remove your pubic hair
- removal of pubic hair is an entirely personal choice
- is it not hygienic or unhygienic to remove or not remove pubic hair
what can happen if you remove your pubic hair by shaving
- ingrown hairs
- the pore grows over the blunt end of the hair, the hair begins to grow under the skin
how can you prevent ingrown hairs from shaving
- use a clean and sharp razor
- exfoliate before shaving
- use toner (witch hazel) after shaving
what does labia mean
lips
what does majora mean
large/major
what does minora mean
small/minor
describe the labia majora
- outermost lips of the vulva
- encircle the sensitive structures of the vulva
- is the first layer of protection for vulvar structures
describe the clitoral hood
- tissue covering the clitoris when unaroused
- protects the clitoris
- erectile tissue
what happens to the clitoral hood when aroused
- vasocongests (fills with blood)
- contracts to reveal the surface of the external clitoris
what is the most densely packed site of nerves in the female body
clitoris
what percent of women need clitoral stimulation to orgasm
70%
is the clitoris external or internal
- both
- small external surface
- wishbone shaped under the skin, extends down the vaginal canal
what is the function of the clitoris
pleasure
what type of tissue is the clitoris made of and what does this mean it can do
- erectile tissue
- vasocongests when aroused
what is the size of the external clitoris when unaroused and aroused
- unaroused: 1/2 inch
- aroused: 1-2 inches
what is the analogous structure to the clitoris in men
head/glands of the penis
describe the labia minora
- smaller inner lips
- provide extra protection for urethral and vaginal openings
- may extend beyond the labia majora in some women
describe the urethral orifice
- where urine exits the body
- opens to the urethra
describe why women are more likely to get UTIs than men
the urethral opening is in a moist, warm, and dark environment which is perfect for bacterial growth
describe why women are more likely to get bladder infections than men
- the female urethra is shorter than the male urethra
- bacteria have a shorter distance to travel to the bladder in females
what is the number one way to prevent UTIs
proper hygiene
list ways to prevent UTIs
- change your underwear often
- wear breathable underwear (cotton)
- wash the vulva with mild soap and water
- pee after sex, masturbation, or baths
- drink 100% cranberry juice everyday (or take supplement)
describe why peeing after sex or a bath can prevent UTIs
the acidic urine can flush out bacteria and kill bacteria
describe why taking cranberry supplements may not be a good way to prevent UTIs
- you must take them everyday for it to be effective
- supplements are not regulated by the FDA so it may not be good quality
where is the hymen located
- just inside the labia minora, around the vaginal opening
- is considered external anatomy because it can be visualized without an internal exam
what is the function of the hymen
it has no function
what are the 2 species that have hymens
- humans
- horses
describe the vaginal orifice
- opening to the vagina
- where menstrual blood/tissue passes through and a penis may enter
what is another name for the vagina
birth canal
how long is the vagina when unaroused and aroused
- unaroused: 3-4 inches
- aroused: 7-8 inches
describe the anatomy of the vagina
- muscular
- hollow
- elastic (able to stretch)
describe how the vagina can double in length during arousal
suspensory ligaments attached to the top of the uterus can contract which elongates the vagina
is the G spot real
yes
where is the G spot located
- 2 inches in from the vaginal opening
- anterior surface of the vagina
what is the official name of the G spot
grafenberg spot
describe the structure of the G spot
- densely packed nerves for sexual stimulation
- has a different texture than the rest of the vagina (thicker and less flexible)
are the perineum and anus part of the vulva
- no
- they are not reproductive anatomy
describe the perineum
- band of tissue that extends from the bottom of the vulva to the anus
- 1-2 inches long
what structure may tear during childbirth
perineum
will the hymen regenerate after it is ruptured
no
describe how the hymen can be ruptured
- during first penetrative sex
- any way that puts strain on the tissue
- surgically
- some women are born without a hymen
list the 5 types of hymens
- annular
- cribriform
- septate
- imperforate
- parous introitus
describe the annular hymen
- circle/ring of tissue surrounding the circumference of the vaginal opening
- the size of the opening in the hymen varies between women
can you still use a tampon with an annular hymen
possibly, depending on the size of the circular opening
what is the most common type of hymen women are born with
annular
describe the cribriform hymen
- multiple small perforations in the surface of the hymen
- still allows for the passage of period blood
what does cribri mean
sieve
can you still use a tampon with a cribriform hymen
depending on the size and number of holes, inserting a tampon may rupture the hymen
describe the septate hymen
- tissue dividing the vaginal opening
- two holes with a band of hymen tissue between
- not always even across the vaginal opening
describe the imperforate hymen
hymen completely covers the vaginal opening
which type of hymen is very rare, what percent of women have this type of hymen
- imperforate
- 1-2%
describe why having an imperforate hymen is problomatic
- nothing can exit the vagina (period blood)
- dead tissue will back up in the vagina causing infection or septic shock
what must happen if someone has an imperforate hymen
must be ruptured by a clinician so tissue can pass through the vaginal opening
describe the symptoms of infection
- rebore: redness
- tumore: swelling
- dulore: pain
- calore: heat
what does parous mean
to bring forth
describe the parous introitous hymen
- occurs after vaginal birth
- vaginal opening is completely exposed
- ruptures the entire hymen
define female genital mutilation
the cultural practice of partially or totally removing external female genitalia
describe the two forms of female genital mutilation
- minor form: clitoris is removed
- severe form: all external genitalia is removed, vaginal opening is stitched nearly closed
define infibulation
stitching the vaginal opening nearly closed
why is infibulation done
sexual pleasure of the male partner
why is circumcision not considered male genital mutilation
- circumcision has some clinical benefits of preventing infection
- female genital mutilation has no benefit
where is female genital mutilation often performed
- central Africa
- Middle East
what country has the highest rate of female genital mutilation
somolia
what perfect of girls in somolia have has some form of female genital mutilation
90%
how young is female genital mutilation performed
as young as 4 years old
do any religious texts mention female genital mutilation
no, some mention circumcision
why is female genital mutilation done
- superstitions
- social, economic, and political reasons
- some believe it will empower daughters, limit sexual activity, and stop sexual desire
how many women worldwide in 2024 have some form of female genital mutilation
200 million women
what are the gynecological and obstetric complications of female genital mutilation
- infection: not done in hospitals or with sterile equipment, anesthesia, or stitching
- stillbirth or maternal mortality: vaginal opening can’t stretch with an infibulation so the baby’s head may get stuck in the birth canal
- fistula between vaginal canal and bladder or colon
how big is an ovary
size of an almond
what are the 2 major functions of ovaries
- secrete estrogen and progesterone
- ovulate: create, hold, and release ovum
what do female sex hormones (estrogen and progesterone) do
- development of secondary sex characteristic
- regulate menstrual cycle and pregnancy
do women continuously make eggs throughout their life
- no
- a women is born with all the eggs she will ever have
how many eggs are women born with
millions
how many eggs are start to develop per month/cycle
1000
what happens to the eggs released that are not viable for fertilization
- they do not leave the ovary
- they are reabsorbed by the body
how many fully formed and viable eggs are released each month/cycle
- usually 1
- sometimes multiple can be, potentially resulting in fraternal siblings
describe how an egg matures and is released from an ovary
- egg matures inside a fluid filled pouch called a cyst
- the cyst ruptures and releases the egg into the pelvic region
define follicular attrition
eggs that do not fully develop during the menstrual cycle are reabsorbed by the body
are the ovaries and fallopian tubes connected
no
describe fimbriae
- fingerlike projections at the end of fallopian tubes
- sweeps around the ovaries to capture any released eggs
what is the site of fertilization
fallopian tubes
what is the diameter of a fallopian tube
spaghetti noodle
what is the purpose of cilia in the fallopian tubes
help move the egg towards the uterus
what can block fallopian tubes
- endometriosis
- scar tissue
what happens if fertilization occurs when a fallopian tube is blocked
- the egg gets stuck in the fallopian tube but sperm can still get past and fertilize the egg
- an ectopic pregnancy can occur in the fallopian tube
what happens if an ectopic pregnancy implants in the fallopian tube
- fallopian tube is not meant to expand so it may rupture
- increased heart rate, low blood pressure
describe the size and shape of the uterus
- size of a loose fist
- shape of an inverted pear
describe the fundus of the uterus
- top portion of uterus
- widest portion of uterus
- where fallopian tubes connect to uterus
what are the 3 layers of the uterus
- perimetrium
- myometrium
- endometrium
describe the perimetrium
- outermost surface
- in contact with other structures in the pelvic cavity
describe the myometrium
- middle layer
- long smooth muscle fibers
- contracts during period or labor
where do contractions in the uterus start during labor and why
- start at the top of the uterus
- contractions at the top of the uterus draw up the uterus and force the fetus down
describe the endometrium
- innermost layer
- grown and shed during the menstrual cycle
- where an embryo will implant
- makes a portion of the placenta
what makes the placenta
- endometrium
- embryo
where is the cervix located
bottom of uterus
define cervical os
opening to the cervix
what is the general purpose of the cervix
- stays tightly closed to prevent things from entering the uterus
- dilates when necessary
what are the 3 conditions where the cervix will dilate
- period
- labor
- orgasm
describe how male orgasm dilates the cervix
prostaglandins in semen stimulate the cervix to dilate
what is the normal texture of the cervix
nose cartilage
describe what it means if the cervix is unusually firm or unusually soft
- firm: cervical cancer
- soft: infection
describe the vagina
- hollow tube-shaped muscle
- connects the uterus to the outside of the body
- also called the birth canal
how long is the vagina unaroused and aroused
- unaroused: 3-4 inches
- aroused: 7-8 inches
describe how the vagina elongates during arousal
suspensory ligaments in the uterus contract to elevate the uterus which also elongates the vagina
define menarche
first period
what is the average age for onset of menarche
12 (can range from 8-16)
does the onset of menarche happen right at the beginning of puberty
no, the onset of puberty usually happens first and then the onset of menarche follows later
how long are eggs viable for once ovulated
24 hours
describe the ovarian cycle of the menstrual cycle
- follicular phase: low estrogen at the end of menses, hypothalamus secretes FSH, egg grows
- ovulation: LH stimulates ovulation
- luteal phase: estrogen drops, progesterone rises as the egg releases its own progesterone, if the egg is not fertilized it is reabsorbed
- menses begins
describe the uterine cycle of the menstrual cycle
- proliferative phase: influenced by estrogen, thickness of endometrium rapidly increases
- secretory phase: influenced by progesterone, lining becomes highly vascular and edematous
list 4 common menstrual problems
- dysmenorrhea
- premenstrual syndrome
- premenstrual dysphoric disorder
- amenorrhea
define dysmenorrhea
painful period
what is the #1 reason middle school girls miss school
dysmennorhea
what percent of women experience some premenstrual syndrome symptoms
80%
when does premenstrual syndrome occur
before menstrual phase (period)
why does premenstrual syndrome occur
estrogen and progesterone fall rapidly before period
what is estrogen related to that makes it a contributor to premenstrual syndrome
emotions
what are the 3 types of premenstrual syndrome
- PMSA: emotional/anxiety
- PMSB: bloating
- PMSC: carbohydrate craving
what are treatment options for the 3 types of premenstrual syndrome
- PMSA: SSRIs
- PMSB: drink more water, eat less salt
- PMSC: treat your self
what is a general treatment for premenstrual syndrome and why
- birth control
- supplements hormones so there is less of a rollercoaster of hormones throughout the cycle
describe premenstrual dysphoric disorder
- more intense PMS
- clinical diagnosis
- symptoms interfere with daily activities
what percent of women have premenstrual dysphoric disorder
8%
what is the treatment for premenstrual dysphoric disorder
birth control
describe amenorrhea
having no period
what are the causes of amenorrhea
- birth control
- pregnancy
- low body fat percentage
- stress
- sudden weight loss/gain
what are the 3 parts of a well woman exam
- visual exam
- clinical breast exam
- pap smear, bimanual exam
why do they make you scoot to the end of the exam table during a pap smear
- makes the pelvis tilt
- gives a better angle for visualization of the cervix and insertion of pap smear equipment
what are clinicians looking for during the visual exam portion of a well woman exam
external organ normalcy
is a clinical breast exam during a well woman exam a screening or a diagnostic tool
screening
what causes cervical cancer
HPV
describe what happens during a pap smear
- speculum is inserted into the vaginal canal, clicks into place to stay open
- clinician visualizes the vaginal walls and the cervix
- a brush is inserted to collect cervical cells (outside of cervix and cervical os)
- the brush is then inserted into a saline solution and swirled around
- the cells in the saline solution are examined for cervical dysplasia
what may a woman who just had a pap smear experience
cramping
when should you get your first pap smear
- 21 if sexually active
- 25 is not sexually active
describe a bimanual exam
- two fingers of one hand are inserted into the vagina, the other hand is placed over the pelvic bone externally
- palpation based exam
- checks for internal organ normalcy
- ideally, you shouldn’t be able to feel much
who created the sexual response cycle
masters and johnson
describe what aspects of the sexual response cycle are always the same and which can differ
- same: steps, order
- differ: intensity, duration
define refractory period
the time after orgasm for the body to remake the ejaculate (semen) in men
describe why women do not have a refractory period after orgasm
no ejaculate needs to be remade
describe why arousal takes longer for women than for men
- 70% of women need clitoral stimulation (penetration stimulates males but not females)
- many structures need time to vasocongest
what happens to the time of resolution when there is no orgasm and why
- resolution takes longer
- no sudden release of hormones to dissipate arousal symptoms
what are the steps of the sexual response cycle
- excitement
- plateau
- orgasm
- resolution
what are the physical aspects of the excitement stage of the sexual response cycle
- vaginal lubrication begins within 10-15 seconds of stimulation
- labia majora and minora darken as they vasocongest
- clitoris engorged with blood and increases in size and length
- uterus and cervix pull away from the vagina via suspensory ligaments
- breasts swell and nipples become erect
- sex flush may occur
where does sex flush start
chest
what are the physical aspects of the plateau stage of the sexual response cycle
- vagina continues to expand as suspensory ligaments elevate uterus unto the abdomen
- secretions occur from the Bartholin’s glands
- breasts continue to enlarge
- sex flush may continue and spread
describe Bartholin’s glands
- located within the vagina
- secrete a slippery, thin, and slightly opaque lubrication
what are the physical aspects of the orgasm stage of the sexual response cycle
- rhythmic uterine contractions of the uterine walls (3-15)
- respiration and heart rate increase
- blood pressure increases
- involuntary muscle spasms in the back, hands, feet, etc.
- vasocongestion an myotonia (muscle tension) release
- phenylethylamine (PEA) and oxytocin are released
which uterine contractions during orgasm are the most intense
the first 3-6
what is the purpose of uterine contractions during orgasm
propel semen further into the uterus and fallopian tubes
what do the chemicals released during orgasm do
- phenylethylamine (PEA) and oxytocin
- feel good chemicals
what are the physical aspects of the resolution stage of the sexual response cycle
- vasocongestion and myotonia dissipate rapidly
- uterus returns to unaroused state as suspensory ligaments relax
- labia majora and minora return to their normal size and shape
- swelling of breasts disappears