The Reproductive System

1
The Reproductive System

• Introduction

• Why be concerned about the reproductive
• system in old people?

• integral to maintaining self-esteem
• expression of love
• aging changes have emotional and psychological
  impact

• Many elderly are concerned about their
  sexuality
• and need/want sexual relationships.

2
The Reproductive System

• Review of structure and function

• Overview

• primary function of reproductive organs is
  continuance of species
• gametes are produced by the gonads
• external genitalia provide the mechanism by
  which the male sperm can be introduced into the
  female reproduc-tive system
• The female system provides the environment that
  supports development

• Gonads also produce the sex hormones

• male androgens (testosterone)
• female progesterone and estrogens

3
The Reproductive System

• Review of structure and function

• male reproductive system

• testes in the scrotum for temperature
  regulation
• ducts

• seminiferous tubules ?
• epididymis ?
• ductus (vas) deferens ?
• ejaculatory duct ?
• urethra

• glands

• seminal vesicles
• prostate gland
• bulbourethral glands

4
The Reproductive System

• Review of structure and function

• male reproductive system

• semen
• penis

• erectile tissue
• erection

• hormones

• luteinizing hormone
• follicle stimulating hormone
• testosterone

5
The Reproductive System

• Review of structure and function

• female reproductive system

• ovaries, oviducts, uterus, vagina, external
  genitalia

6
The Reproductive System

• Review of structure and function

• female reproductive system

• ovarian cycle

• follicular phase
• 1. initiated by FSH
• 2. results in estrogen secretion

• ovulation
• 1. initiated by LH
• 2. results in corpus luteum formation

• luteal phase phase
• 1. estrogens and progesterone secretion

• corpus luteum dies after 12 days

7
The Reproductive System

• Review of structure and function

• female reproductive system

• menstrual cycle

• proliferative phase
• 1. stimulated by estrogen
• 2. rebuilds endometrium

• secretory phase
• 1. stimulated by estrogen and
• progesterone
• 2. endometrium prepares for
• implantation

• menstrual phase
• 1. lack of estrogen/progesterone
• 2. removes endometrium

8
The Reproductive System

• Age-related changes

• changes in men

• testicular changes

• decrease in size and firmness
• very slow decline in testosterone secretion
• decrease in sperm number and motility (30
  reduction by 60)

• prostate gland changes

• atrophy begins at 50 and may reduce secretory
  capacity
• muscle fibers replaced with connective tissue
• volume and force of expulsion therefore
  decreased
• portions around the urethra enlarge often
  making urination difficult

9
The Reproductive System

• Age-related changes

• changes in men

• seminal vesicle changes

• decrease in size and storage capacity
• muscle fiber replacement with connective tissue

• bulbourethral gland changes

• penile changes

• some atrophy and tends to become smaller
• erectile tissue becomes more rigid and less
  elastic after 55, resulting in decreased ability
  to attain erection

• changes in sexual ability can lead to
  depression, mood swings, and general feelings of
  uneasiness

10
The Reproductive System

• Age-related changes

• changes in women

• ovarian changes

• first to occur as follicles are depleted
• decreasing estrogen and progesterone levels
  lead to degenerative changes in uterus and vagina

• menopause

• begins with cessation of the menstrual cycle
• remaining follicles become unresponsive to FSH
  and LH, generally occurring in the 40s or 50s
• adrenal glands become primary source of estrogen

11
The Reproductive System

• Age-related changes

• changes in women

• menopausal symptoms

• hot flashes, sweating, red patches on face and
  chest
• episodes of depression or irritability,
  headaches, insomnia
• most women experience mild versions of all of
  these

• postmenopausal changes

• progressive ovarian atrophy and formation of
  fibrous tissue
• loss of reproductive tract cyclical changes
• decrease in uterine wall with fibrous
  replacement of muscle
• atrophy of the endometrium
• atrophy of uterine tubes

12
The Reproductive System

• Age-related changes

• changes in women

• postmenopausal changes

• vaginal changes

• narrower and shorter, thinner and less elastic
  walls
• glands that lubricate vagina atrophy and
  secrete less, leading to dry vagina and painful
  intercourse
• vaginal environment becomes less acidic,
  leading to increased bacterial and yeast
  infections

• testosterone levels dont decrease greatly, so
  sexuality and enjoyment of sex does not diminish
  greatly

• other body changes

• fat accumulation in wrists, thighs, butt skin
  thins and sags hair thins and becomes coarse
  external genitalia atrophies glandular tissue of
  breasts replaced with fat, causing sagging

13
The Reproductive System

• Age-related dysfunctions

• cancer

• prostatic cancer very prevalent in older men
• incidence of ovarian, uterine, cervical, and
  breast cancers increase dramatically after
  menopause
• increase in cancer with age again points out
  need for regular exams

• atrophic vaginitis

• prolapse of the uterus

• ligament weakness allows uterus to drop through
  the cervical canal and protrude into the vagina
• previous births may contribute to likelihood of
  occurrence

14
The Reproductive System

• Age-related dysfunctions

• impotence

• most common and disturbing dysfunction in males
• failure to attain and/or maintain and erection
• progressively more frequent as men age
• (25 at 65, 55 at 75, 75 at 80)
• numerous causes
• numerous treatments

15
The Reproductive System

• Age-related dysfunctions

• diminished sexual functioning

• most common complaint is diminished ability to
  function sexually
• elderly persons frequently without a partner
• time to respond to sexual stimulation increases
• time to orgasm increases
• orgasms decrease in intensity and duration

16
The Reproductive System

• Take home messages about reproduction

• sexual interest and activity continue well into
  old age
• changes in reproductive organs affect sexual
  functioning
• males -- gradual decline in testosterone with
  accompanying changes in organs
• females atrophy of follicle cells leads to
  decreased estrogen and progesterone, culminating
  with menopause in the 40 50s loss of estrogen
  has multiple body effects