Chapter Five Sexuality, Pregnancy and Childbirth Sexual Anatomy • Sex organs of men and women arise from the same structures and have similar functions • Each have gonads • Ovaries (females) • Testes (males) • Gonads produce germ cells and sex hormones • Ova (females) • Sperm (males) Female Reproductive System Figure 5-1a Be able to identify location/function of reproductive organs Male Reproductive System Figure 5-2a Be able to identify location/function of reproductive organs Action of Hormones • Hormones are chemical messengers secreted directly into the bloodstream by the endocrine system • Sex hormones, produced by either testis or ovary, have an important role within the reproductive system • Testes produce testosterone • Ovaries produce estrogen and progesterone • Adrenal glands produce androgens for both sexes Female Sexual Maturation • Major physical differences between the sexes occur at puberty • Changes are due to progesterone in females, testosterone in males • Physical changes for females at puberty are: • Breast development (ages 8-13) • Rounding of hips and buttocks • Pubic hair development Menstrual Cycle Figure 5-3 Breakdown of the endometrial lining and discharge of tissue (menses) Identify 4 Phases of the Menstrual Cycle 1. 2. 3. 4. Menses: menstrual flow (day 1to day 5) Estrogenic phase: menstrual flow ceases and anterior pituitary produces (FSH) follicle-stimulating hormone and (LH) lutenizing hormone as an ova matures, which produces estrogen Ovulation: ovum is released due to estrodiol present which creates large does of (LH) and small amounts of (FSH) Progestational phase: corpus luteum is produced by the follicle, producing high levels of progesterone, until menses Menstrual Problems • Premenstrual Syndrome (PMS): physical and psychological symptoms that recur during the same phase of the menstrual cycle • Premenstrual dysphoric disorder (PMDD): more severe symptoms than PMS • Dysmenorrhea (painful menstrual cycle) Male Sexual Maturation • Reproductive maturation occurs two years later compared to females (age 10-11) • Physical changes include: • • • • • • • Enlargement of the testes Development of pubic hair Growth of the penis Onset of ejaculation (age 11-12) Deepening of voice Facial hair Rapid physical growth Aging and Sexuality • Sexual activity does decline with age but a significant population of older adults remain sexually active • Changes in Women: vaginal lubrication decreases, reduction in orgasmic contractions • Changes in Men: erection process is prolonged, decrease in contractions at orgasm, ejaculation decreases in force and volume Master & Johnson’s Human Sexual Response Pattern • Excitement stage – arousal stage • Plateau stage – leveling off of arousal immediately before climax • Orgasm stage – neuromuscular tension is released • Resolution stage – return the body back to preexcitement stage Differences Between Men and Women in the Sexual Response Pattern • Men are not multi orgasmic • Men reach orgasm quicker during coitus • Men enter into a refractory period after orgasm • Women are multi orgasmic • Women reach orgasm as quickly as men during masturbation • Women do not have a refractory period Common Sexual Health Problems Conditions affecting Women • Vaginitis • Endometriosis • Pelvic inflammatory disease (PID) Conditions affecting Men • Prostatitis • Testicular cancer Common Sexual Dysfunctions Conditions affecting Women • Vaginismus • Orgasmic dysfunction Conditions affecting Men • Premature ejaculation • Retarded ejaculation • Erectile dysfunction Concepts of Sexual Orientation • Heterosexuality – sexual attraction to the opposite gender • Homosexuality – sexual attraction to the same gender – “gay” refers to a male homosexual – “lesbian” refers to a female homosexual Patterns of Sexual Behavior • Celibacy – self imposed avoidance of sexual intimacy • Masturbation – gratification by self stimulation of one’s genitals; sexual fantasy or desires are associated with masturbation • Erogenous zones/shared touching – areas of the body causing sexual arousal on contact – genital contact could be considered an erogenous zone and part of foreplay (arousal before intercourse) Patterns of Sexual Behavior, cont’d • Oral-genital stimulation – fellatio (oral stimulation of a male’s genitalia) – cunnilingus (oral stimulation of a female’s genitalia) • Sexual intercourse – penile to vaginal penetration (coitus) • Anal intercourse – sodomy performed by both heterosexual couples and gay men Atypical and Problematic Sexual Behaviors • Sexual fantasies and behaviors not always accepted by other adult partners, which could be considered harmful or illegal • Examples include: • • • • Paraphilias Sexual coercion Commercial sex (pornography)] Prostitution Responsible Sexual Behavior Include the following: • Open, Honest Communication • Agreed-On Sexual Activities • Sexual Privacy • • • • Using Contraception Safer Sex Sober Sex Taking Responsibility for Consequences Understanding Fertility • Conception involves an ovum from a woman and sperm from the man • The sperm and egg must meet in the fallopian tube, which after fertilization, will travel to the uterus for implantation (zygote) • It there is no union, the egg will disintegrate within 24 hours and expelled with the uterine lining during menstruation Causes of Infertility • • • • • Low sperm count Poor sperm motility Sperm abnormalities Lack of ovulation Obstruction of fallopian tubes – PID – Endrometrosis • Age Treating Infertility • • • • • Surgery Fertility drugs Surrogate Motherhood Intrauterine Insemination IVF, GIFT, and ZIFT • in vitro fertilization • gamete intrafallopian transfer • zygote intrafallopian transfer Early Signs of Pregnancy • Missed menstrual period after sexual intercourse the previous month • Morning sickness/nausea • Increase in size/tenderness of breasts • Slight bleeding • Sleepiness, fatigue, and emotional upset Continuing Changes in the Woman’s Body • • • • • Increased frequency of urination Enlargement of the uterus Breast enlargement and increased sensitivity Increased in the size of the abdomen Cervix becomes softer by the sixth week Changes During the Later Stages of Pregnancy • • • • Backaches from the baby’s weight Joint swelling Braxton Hicks contractions “Lightening” of the fetus Fetal Development (First Trimester) • After 30 hours, the fertilized egg goes through many forms of cell division • A Blastocyst is formed by the 4th day after fertilization • An embryo is created by the end of the 2nd week from the blastocyst separating into 3 layers • The outermost shell of cells becomes the placenta, umbilical cord, and amniotic sac • Between weeks 2-9, all major body structures are formed, including the heart, brain, liver, lungs, and sex organs After the second month, the embryo will become a fetus The Second Trimester • Growth improves to about 14 inches and the weight increases to 1.5 lbs. • All body systems are working and the fetal heartbeat can be heard • Fetal movements can be felt by the mother, beginning by the 4th to 5th month The Third Trimester • The fetus gains most of its weight during the last 3 months • Fat layers are acquired during the 8th month as well as acquired immunity from the mother • Importance is placed on providing the fetus with important nutrients • The respiratory and digestive organs are developing at this stage Diagnosing Fetal Abnormalities • • • • Ultrasonography (ultrasound) Amniocentesis (removal of fluid from uterus) Chorionic villus sampling (removal via cervix) Triple marker screen (TMS) The above methods are considered as a new area of study called Fetal Programming Importance of Prenatal Care • • • • • Regular Checkups Blood tests Prenatal Nutrition Tobacco Caffeine • Avoiding drugs and other environmental agents • Alcohol (FAS) • Accutane (acne drug) • STD’s and other infections • Proper activity/exercise Complications in Pregnancy and Pregnancy Loss • Ectopic pregnancy – implantation in the fallopian tube • Spontaneous Abortion (Miscarriage) – usually due to abnormalities in the first few weeks • Preeclampsia – blood pressure becomes elevated and could be life threatening • Low Birth Weight – (LBW) is when a baby weighs less than 5.5 lbs • Infant Mortality – death of a child less than one year of age i.e. (SIDS) 3 Stages of Labor 1. Effacement/Dilation of the cervix: cervix opens to 10cm during this stage 2. Delivery of the fetus: “crowning” of the fetus 3. Delivery of the placenta: within 30 minutes afterbirth is expelled The Postpartum Period • A stage of about 3 months following childbirth • It takes about 6-8 weeks before a woman’s reproductive organs to return to their prebirth condition • Lactation begins about 3 days after childbirth • The return of menstruation make take up to 6 months, depending upon hormonal activity • Fluctuating emotions are the result from the hormone level changes, which could result in “postpartum depression” or happiness of the new arrival Chapter Five Sexuality, Pregnancy and Childbirth