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Sem 4 > Repro 7: Conception And Contraception > Flashcards

Repro 7: Conception And Contraception Flashcards

1
Q

What are the 4 phases of coitus?

A

Excitement phase
Plateau phase
Orgasmic phase
Resolution phase

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2
Q

Outline what occurs the male excitement phase.

A

Parasympathetic so activated and sympathetics inhibited
ACh to M3 receptors on endothelial cells increases Ca2+ which activates eNOS so NO is produced
This causes arteriolar vasodilation in corpora cavernosa
Increased penile blood flow -> erection

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3
Q

Outline what occurs in the male plateau phase.

A

Contraction of ischiocavernous muscles impedes venous return (so penis remains full of blood)
Some secretions from Cowpers and Littres glands to lubricate distal urethral

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4
Q

Outline what occurs in the male orgasmic phase.

A

-Emission:
Sympathetics stimulated, contraction of SM in vas deferens, seminal vesicle and prostate, internal and external urethral sphincters contract and semen pools in urethral bulb

-Ejaculation:
External urethral sphincter relaxes, filling of internal urethra stimulates pudendal nerve, contraction of ischiocavernous and bulbocavernous, expulsion of semen

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5
Q

Outline what happens in the male resolution phase.

A

Sympathetics activated
Contraction of SM in corpus cavernosa enables venous return -> flaccidity
Testes descend and return to unstimulated size
Scrotum thins and resumes wrinkled appearance

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6
Q

Outline what occurs in the female excitement phase.

A 
Vaginal lubrication
Clitoris engorges with blood
Uterus elevates
Inner 2/3rds of vagina lengthens and expands
Increase in HR, BP and muscle tone
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7
Q

Outline what happens in the male plateau phase.

A

Further increases in muscle tone, HR and BP
Labia minora deepen in colour
Clitoris withdraws under hood
Bartholins gland secretion lubricates vestibule for entry of penis
Uterus fully elevated
Lower 1/3rd vagina forms orgasmic platform

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8
Q

Outline what happens in the female orgasmic phase.

A

Orgasmic platform contracts rhythmically 3-15 times
Uterus contracts, moving down towards cervix
Inner 2/3rd vagina remains motionless
Anal sphincter contracts

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9
Q

Why are multiple orgasms possible in women?

A

As there is no refractory period

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10
Q

Outline what happens in the female resolution phase.

A

Clitoris descends and engorgement subsides
Labia return to unaroused size and colour
Uterus descends
Vagina shortens and narrows

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11
Q

How do the breasts change during sex?

A

Increase in size, veins more distinct, nipples erect, areola increase in size, ‘sex flush’ on breasts and upper abdomen

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12
Q

What is the g spot?

A

Area of erotic sensitivity along anterior vaginal wall

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13
Q

How does Viagra work?

A

Inhibits cGMP breakdown in corpus cavernosa
Activates NO stimulated arteriolar vasodilation
So increased penile blood flow = erection

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14
Q

What is the normal volume of semen produced at ejaculation?

A

2-4 ml

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15
Q

How much sperm should be within each ml of semen?

A

20-200 million sperm per ml

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16
Q

What are the different constituents of semen?

A
  • 60% seminal vesicles alkaline fluid with fructose, prostaglandins, clotting factors
  • 25% prostate secretions, milky slightly acidic fluid with proteolytic enzymes eg PSA and pepsinogen to re-liquefy semen
  • 5% Cowpers (bulbourethral) glands secretion, alkaline fluid to lubricate tip of penis
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17
Q

How does cervical mucus change throughout the ovarian cycle?

A

Days 7-14 (oestrogen only) = abundant clear, non-viscous cervical mucus

Days 14-28 (oestrogen + progesterone) = thick, sticky mucus (avoids bacteria entry in case there’s a foetus and prevents sperm penetration)

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18
Q

Which days of the ovarian cycle are classed as the fertile period?

A

Approx days 12-17
(Ovulation at day 14, but sperm can survive in female genital tract for max 5 days and oocyte survives 6-24 hours before phagocytosis)

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19
Q

What are natural methods of contraception?

A
  • fertility awareness (to indicate fertile and infertile periods, eg tracking length of cycle, cervical secretions)
  • breastfeeding (delays the return of ovulation, but only up to 6 months)
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20
Q

What are positives and negatives of natural forms of contraception?

A

✅ no hormones, no contraindications

❌ unreliable, not as effective

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21
Q

What are different methods of barrier contraception?

A
  • male/ female condoms (physical barrier of sperm into cervix)
  • female diaphragm/ cup (contains spermicide so also a chemical barrier)
22
Q

What are positives and negatives of male/ female condoms?

A

✅ also prevent against STIs

❌ female condoms not widely available, male condoms can’t be used of latex allergy

23
Q

What are positives and negatives of a female diaphragm/ cup?

A

✅ can be inserted anytime before intercourse

❌spermicide can cause local reaction

24
Q

What is the combined oral contraceptive pill?

A

Pill containing combination of oestrogen and progesterone, taken for 21 days with a 7 day break

Primary action is to prevent ovulation
Secondary action is to thicken cervical mucus (so sperm can’t penetrate), and to reduce endometrial sensitivity to inhibit implantation

25
Q

What are positives and negatives of COCP?

A

✅ can relieve menstrual disorders, can reduce risk of ovarian cysts and cancer

❌ user dependent, many contraindications, side effect (eg mood swings, breast sensitivity, breakthrough bleeding), increased risk of venous thromboembolism and MI

26
Q

What is the progesterone depot?

A

Synthetic progesterone injection which can last for 8-13 weeks

Primary action is to prevent ovulation
Secondary action is to thicken cervical mucus and reduce endometrium sensitivity for implantation

27
Q

What are positives and negatives of the progesterone depot?

A

✅ convinent, can relive menstrual disorders

❌ small loss of bone mineral density -> # risk, loss of fertility for up to 1 year after stopping, irregular bleeding common, not quickly reversible

28
Q

What is the progesterone implant?

A

4cm flexible rod containing progesterone inserted subdermally into upper arm and can last up to 3 years

Primary action is to prevent ovulation
Secondary action is to thicken cervical mucus and reduce endometrial sensitivity to inhibit implantation

29
Q

What are positives and negatives of the progesterone implant?

A

✅ long lasting, convenient, can relive menstrual disorders

❌ small procedure to fit and remove, local adverse effects, can cause changing in bleeding pattern

30
Q

Which methods of contraception have the primary action of preventing ovulation?

A

COCP, progesterone depot, progesterone implant

31
Q

Which method of ovulation has the primary action to inhibit sperm transport?

A

Progesterone only pill

Low dose progesterone pill taken daily to thicken cervical mucus to impede sperm penetration

32
Q

Why does the progesterone only pill not prevent ovulation?

A

The pill is only a loss dose of progesterone, so it does not inhibit the LH surge so will still ovulate

At a high dose, progesterone would inhibit +ve feedback on oestrogen and so would prevent LH surge and prevent ovulation

33
Q

What are positives and negatives of POP?

A

✅ can use if COCP contraindicated

❌ menstrual disorders still likely, only 3hr margin to take each day

34
Q

What method of contraception inhibits implantation?

A

IUD (contains copper)

IUS (contains progesterone)

35
Q

What is an intrauterine system?

A

Small plastic device with slow release progesterone inserted into the uterus, lasting 3-5 years

Primary action is of progesterone to reduce endometrial proliferation to prevent implantation
Secondary action is to thicken cervical mucus

36
Q

What is an intrauterine device?

A

Small copper coil inserted into uterus, lasting 5-10 years

Primary action is the copper is toxic to ovum and sperm, so it prevents fertilisation
Secondary actions is to cause endometrial inflammation to prevent implantation and to also thicken cervical mucus

37
Q

What are positives and negatives of IUS?

A

✅ long lasting, convenient, can relive menstrual disorders

❌ coil explosion possible, unpleasant insertion, risk of uterine perforation, menstrual irregularity common for first 6 months

38
Q

What are positives and negatives of IUD?

A

✅ long lasting, convenient, can be used as emergency contraception up to 5 days after sex

❌ IUD expulsion possible, unpleasant insertion, heavier long and more painful periods, uterine perforation possible

39
Q

How does male sterilisation work?

A

Cut vas deferens to prevent sperm entering ejaculate
Done under local anaesthetic
Success confirmed via a post-op semen analysis

40
Q

How does female sterilisation work?

A

Fallopian tubes are cut or blocked under local or general anaesthetic

41
Q

What are positives and negatives of sterilisation?

A

✅ permanent, no hormonal side effects

❌ not always successful, can’t do if any doubt about wanting children in future

42
Q

What are some male factors for infertility?

A

Idiopathic oligospermia
Varicoele
Abnormal sperm production (eg testicular disease)
Hypothalamic/ pituitary dysfunction
Ductal obstruction (eg post infective epidymitis, post vasectomy)
Failure to deliver sperm to vagina (hypospadias, impotence)

43
Q

What tubal damage can cause infertility in females?

A
  • due to previous infection eg chlamydia
  • endometriosis
  • pelvic surgery
  • previous pregnancies
  • müllerian development abnormalities
44
Q

Which ovulation disorders can cause infertility in women?

A
  • PCOS
  • hypothalamic pituitary disorders
  • Turners
  • chemo/ radiotherapy
45
Q

What uterine/ peritoneal diseases can cause infertility?

A
  • uterine fibroids
  • cervical stenosis
  • Ashermans syndrome (adhesions of endometrium due to surgery)
  • endometriosis
  • cervical hostility (infection or anti sperm antibodies)
46
Q

What is looked at in a semen analysis,

A

Number of sperm
Sperm motility
Sperm morphology

47
Q

How does prolactin affect fertility?

A

Hyperprolactinaemia (will present with amenorrhoea and galactorrhea) causes infertility because prolactin inhibits GnRH secretion

(Type of hypogoandotrophic hypogonadism)

Can be caused by pituitary tumour prolactinoma that hypersecretes prolactin, or by dopamine antagonists (eg used in Schizophrenia)

48
Q

How is hyperprolactinaemia treated?

A

Dopamine agonist

49
Q

How can ovulation be inducted to treat infertility?

A
  • GnRH agonist
  • Dopamine agonist
  • Clomifene citrate (blocks oestrogen receptors in hypothalamus to reduce -ve feedback)
  • ovum donation
  • gonadototphins
  • weight loss/ gain
50
Q

What is the action of Clomifene citrate?

A

Blocks oestrogen receptors in the hypothalamus to reduce negative feedback

51
Q

How can male factors of infertility be managed?

A
  • dopamine agonist
  • artificial insenination
  • GnRH agonist
  • intra-cytoplasmic sperm injection
  • tubal surgery to re-anastamose occluded tubules

Sem 4 (25 decks)

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