Chapter 4 Female Sexual Anatomy and Physiology

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Chapter 4Female Sexual Anatomy and Physiology
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Genital Self-Exam

• Increases sexual comfort
• Monitor for changes related to health concerns

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The Vulva

• External female genitalia
• Mons Veneris
• Labia majora minora

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The Vulva (cont.)
Fig. 4.1 The structures and variations of the
vulva (a) external structures.
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The Vulva (cont.)

• Clitoris (analogous to penis)
• external shaft glans, internal crura clitoral
  hood
• only function sexual arousal
• Clitoral stimulation most common way woman
  achieve orgasm
• Female genital mutilation

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The Vulva (cont.)
Fig 4.2 The underlying structures of the vulva.
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The Vulva (cont.)

• Vestibule
• urethral opening
• vaginal introitus (opening)
• hymen
• Perineum
• episiotomy

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Underlying Structures

• Vestibular bulbs
• Bartholin's glands
• Pelvic floor muscles
• Kegel exercises

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Underlying Structures
Fig. 4.3 The underlying muscles of the vulva.
These muscles can be strengthened using the Kegel
exercises described in the text.
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Internal Structures

• Vagina
• 3 layers mucous, muscle, fibrous
• Arousal and vaginal lubrication
• lubrication changes vaginal ph and increases
  pleasure
• Grafenberg (G) spot
• Secretions chemical balance

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Internal Structures (cont.)
Fig. 4.4 Internal female sexual anatomy (a)
cross-sectional side view of female internal
structures (b) front view of the internal
organs. Parts of the ovaries, uterus, and vagina
are shown cut away.
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Internal Structures (cont.)

• Cervix
• Uterus
• 3 layers perimetrium, myometrium, endometrium
• fundus (top)

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Internal Structures (cont.)

• Fallopian tubes
• fimbriae
• cilia (hairlike cells that move ovum)
• fertilization occurs when egg is still close to
  ovary
• Ectopic pregnancy

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Internal Structures (cont.)

• Ovaries
• up to 472,000 immature ova at birth 400 mature
  in lifetime
• ovulation release of ovum

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Menstruation

• Myths and negative attitudes
• Menarche (initial onset)
• age 11-15
• related to heredity, health, altitude

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Menstruation (cont.)

• Menstrual physiology
• flow lasts from 2 to 6 days
• volume varies (6 to 8 ounces)
• duration varies (24 to 42 days)
• menstrual synchrony

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Menstruation (cont.)
Fig. 4.7 Ovulation timing and cycle length.
Regardless of the length of the cycle, ovulation
occurs 14 days before menstruation.
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Menstruation (cont.)

• The menstrual cycle
• hypothalamus releases GnRH that stimulates
  pituitary
• pituitary produces
• Follicle Stimulating Hormone
• Luteinizing Hormone
• Negative feedback mechanism
• Follicle Stimulating Hormone
• Luteinizing Hormone

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Menstruation (cont.)

• Fig. 4.5 Changes during the menstrual cycle (a)
  indicates the hypothalamus in the brain measuring
  levels of hormones and releasing GnRh to
  stimulate the pituitary to secrete FSH and LH
  into the bloodstream (b) shows how the levels of
  FSH (red line) and LH (purple line) vary during
  the complete cycle. Note the midcycle peak of LH
  that stimulates ovulation (c) shows the ovarian
  changes during the phases of the cycle and (d)
  shows the fluctuations in blood levels of
  estrogen and progesterone produced by the ovaries
  and (e) indicates these hormonal effects on the
  lining of the uterus. After ovulation, the glands
  and ducts inside the endometrium (drawn and
  vertical tubes and spirals) develop and secrete
  nutrients that, if a woman became pregnant, would
  support the embryo.

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Menstruation (cont.)

• Three phases of menstrual cycle
• menstrual shedding of endometrium
• proliferative thickening of endometrium
  follicle maturation, ovulation
• secretory corpus luteum development further
  thickening of endometrium

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Menstruation (cont.)
Fig 4.6 The changes to the ovaries and uterus
during (a) the proliferative phase, including
ovulation.
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Menstruation (cont.)
Fig. 4.8 The changes to the ovaries and uterus
during (b) the secretory phase, and (c) the
menstrual phase of the menstrual cycle.
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Menstruation (cont.)

• Sexual activity and the menstrual cycle
• Menstrual cycle problems
• premenstrual syndrome
• Premenstrual Dysphoric Disorder
• dysmenorrhea painful menses
• amenorrhea no menses
• toxic shock syndrome
• self-help for menstrual symptoms

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Menopause

• Terms
• climacteric
• peri-menopause time before menopause
• menopause permanent cessation of menstruation

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Menopause (cont.)

• Symptoms vary from mild to strong
• amenorrhea, then menopause
• hot flashes or warm spells
• night sweats, interrupted sleep
• headaches, poor concentration
• depression, anxiety

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Menopause (cont.)

• Hormone replacement therapy
• estrogen reduces hot flashes and psychological
  symptoms
• controversies with data reporting hazardous
  effects
• increased risk of breast cancer with exclusive
  use of estrogen
• alternatives to HRT

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Gynecological Health Concerns

• Urinary tract infections
• Vaginal infections
• Self-exams vaginal health care

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Gynecological Health Concerns (cont.)

• Pap smear screens for cervical cancer
• Hysterectomy or oophorectomy
• most frequently performed U.S. operation, more
  frequently performed on low income, less educated
  women
• nonsurgical alternatives

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The Breast

• mammary glands produce milk
• fatty tissue determines size
• areola is darker area
• nipple is in center of areola has openings for
  milk

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The Breast (cont.)
Fig. 4.8 Cross-section front and side views of
the female breast.
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The Breast (cont.)

• Breast exams
• self-exam following menstruation
• routine healthcare provider exams
• mammography

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The Breast (cont.)

• Breast exams

Fig. 4.9 It is helpful to use a chart similar to
this one to keep track of lumps in the breasts.
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The Breast (cont.)

• Breast lumps
• cysts (fluid-filled sacs)
• fibroadenomas (solid, round, benign tumors)
• malignant tumor
• Breast cancer
• treatments
• risk factors
• reconstructive breast surgery
• benefits of early detection treatment

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The Breast (cont.)
Fig. 4.10 Breast Self-Exam
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The Breast (cont.)
Table 4.4 Risk Factors for Breast Cancer