Nursing 330 Human Reproductive Health NOTE: This is Handout #1 of 2 Be sure to also print out Handout #2 January 10, 2011 Nursing 330 Human Reproductive Health

Office Hours Turnitin Course packets Mondays, 5:30pm – 6pm Room TBA Course ID: 3734705 Password: NURS330 Course packets

Course Website Syllabus Reading Assignments Quarter Schedule Evaluation Methods Lecture Notes Print out or download on to laptop May be taken down at anytime so it is your responsibility to print or download before each lecture

Important Dates Mid-term: February 7, 2011 Essay Due: February 14, 2011 Electronically [Turnitin] Hard Copy + Article [In Class] Extra Credit Due: February 21, 2011 Final Exam: March 7, 2011

Puberty

Puberty Not a synonym for adolescence Defined as the biological state when reproduction becomes possible Refers to physical changes that occur during adolescence

Puberty (cont) Pubertal changes in girls begin between ages 9 and 14. Pubertal changes in boys generally begin about 2 years later than in girls.

Physical occurrences from puberty Growth Spurt The primary sex characteristics develop The secondary sex characteristics develop

Growth Spurt 1. Limbs 2. Body’s trunk 3. Shoulders and chest Bones become harder and more dense Muscle and fat contribute to an adolescent increase in weight

Body Composition Boys Girls Wider shoulders Develop Breast More muscular neck Lose fat during adolescence Girls Develop Breast Acquire Hips Higher fat to muscle ratio

Primary Sex Characteristics Differences in male and female anatomy which are present at birth –ovaries and testes Defined as the change necessary to prepare girls’ and boys’ bodies to produce children Marker events Girls Menarche Boys Spermarche As the primary sex organs mature, the secondary sex characteristics distinguish males from females

Secondary Sex Characteristics Defined as changes that make boys and girls look like mature men and women Girls -Breast Development -Body Odor -Body fat -Body Hair Boys -Voice Deepens -Body Odor -Shoulders broaden -Body Hair

Tanner Classification of Sexual Maturity Puberty is divided into five stages, called Tanner Stages (numbered 1-5). Each stage represents the extent of breast, pubic and genital hair growth.

Phases of Development - girls Usual Age Range Earliest Age Latest Age Approximate Average Age 1. Beginning of breast development 8 – ¾ years 13 – ¼ years 11 years 2. Appearance of pubic hair 9 years 13 ½ years 3. Beginning of most rapid growth 10 ½ years 14 ½ years 12 years 4. Menarche 2-3 years after 1st signs of puberty 10 ¾ years 15 ½ years 12 ½ years

Phases of Development - boys Usual Age Range Earliest Age Latest Age Approximate Average Age 1. Beginning of enlargement of testes 9 ½ years 13 ½ years 12 years 2. Growth of the penis 10 years 14 years 12 ¼ years 3. Appearance of pubic hair 12 ½ years 4. Beginning of most rapid growth in height 11 ½ years 16 years

Nocturnal Emissions Aka Wet Dreams Involuntary Orgasm An ejaculation of semen experienced during sleep

DISCUSSION QUESTION

Hormones Estrogen Testosterone Responsible for many changes that occur during puberty. Cause the breasts, uterus, and vagina to mature and the body to take feminine proportions Contribute to regulation of the menstrual cycle Testosterone Responsible for changes of male puberty Leads to muscle growth, body and facial hair, and other male sex characteristics Contributes to gains in body size

Sexual Anatomy & Physiology

Female Sex Organs: All embryos appear as female at first. Genetic and hormonal signals trigger the development of male organs in those embryos destined to be male. Sex organs serve a reproductive purpose, but they perform other functions also: giving pleasure, attracting sex partners, and bonding in relationships.

Vulva The external female genitals are known collectively as the vulva. It includes: Mons pubis Clitoris Clitoral Hood (or Prepuce) Labia Majora Labia Minora Urethral Opening Anus

Vulva (cont) mons pubis is a pad of fatty tissue that covers the area of the pubic bone. clitoris is the center of sexual arousal in the female. labia majora (outer lips) are two folds of spongy flesh extending from the mons pubis and enclosing the other external genitals. labia minora (inner lips) are smooth, hairless folds within the labia majora that meet above the clitoris.

Diagram of the Female Reproductive System (external view)

Female Genital Mutilation (FGM) aka Female Circumcision What is it? Types Areas where it is practiced

What is FGM?

Types of FGM Type I Type II excision of the prepuce, with or without excision of part or all of the clitoris Type II excision of the clitoris with partial or total excision of the labia minora

Types of FGM (cont) Type III Type IV Aka infibulation; the most extreme excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening Type IV pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue

Where is FGM practiced?

Why is FGM practiced?

Internal Organs The internal female sexual structures and reproductive organs include: Vagina Uterus Cervix Ovaries Fallopian tubes

The Vagina A flexible muscular organ, approximately 3-4 inches long (in unaroused state) that has the vaginal opening at one end and the cervix at the other. Purpose of the vagina: Menstruation Childbirth Intercourse

The Vagina (cont) Introitus or Vaginal Os Hymen The opening of the vagina Hymen a thin, perforated membrane, that covers the introitus prior to first intercourse or other intrusion. a Greek word meaning "virginal membrane" or "thin skin".

Cervix Located between the vagina and the uterus Cervical Os Opening to the vagina Allows menstrual blood to flow out of the uterus into the vagina

Uterus Also known as the womb A pear-shaped organ located between the bladder and the lower intestine Consists of three parts Body of the uterus (about the size of a fist in a non-pregnant female) Cervix Fundus Endometrium Lining of the uterus is built up and then shed and expelled through the cervical os (opening) during menstruation.

Ovaries Egg-producing organs Hold between 200,000 and 400,000 follicles (sacks) Found on each side of the uterus

Fallopian Tube Also known as the Uterine Tube or Oviduct Two leading off each side of the uterus Site of fertilization

Diagram of the Female Reproductive System (internal view)

Female Reproductive System Use handout from course pack to identify: Page 13 Anus Rectum Bladder Urethra Cervix Uterus Fallopian tube Vagina/Vaginal Ovary Opening

G-Spot Controversial research has posited the existence of an erotically sensitive area, the Grafenberg spot (G-spot), on the front wall of the vagina midway between the introitus and the cervix.

Female Sexual Physiology At birth, the human female’s ovaries contain 400,000-700,000 female gametes (sex cells). During puberty hormones trigger the completion of oogenesis, the production of oocytes, commonly called eggs or ova.

The Menstrual Cycle Follicular (Proliferative) phase Days 1 through 6 Beginning of menstrual flow to end of blood flow Days 7 – 13 endometrium thickens Luteal (Secretory) phase aka premenstrual phase Days 15 to 28 The endometrium thickens to prepare the egg for implantation These two phases are separated by: Ovulation Day 14

Ovulation The process in the menstrual cycle by which a mature ovarian follicle ruptures and releases an ovum (also known as an egg or an oocyte) The released egg, unless fertilized, only lasts 12 to 24 hours.

Menstrual Cycle Order of the Menstrual Cycle: Menstrual → Proliferative → Secretory The menstrual cycle is divided into 3 phases. 1. Menstruation 2. Proliferative Phase: Endometrial tissue builds up during this phase 3. Secretory Phase: Produces nutrients to sustain an embryo

Follicular (Proliferative) Phase Also known as Pre-ovulatory phase Menstrual Phases Typical No. of Days Hormonal Actions Follicular (Proliferative) Phase Also known as Pre-ovulatory phase Cycle Days 1 through 6 Beginning of menstruation to end of blood flow Estrogen and progesterone start out at their lowest levels FSH levels rise to stimulate maturity of follicles. Ovaries start producing estrogen and levels rise, while progesterone levels remain low. Cycle Days 7 -13: The endometrium (the inner lining of the uterus) thickens to prepare for the egg implantation Ovulation Cycle Day 14 Surge in LH. Largest follicle bursts and releases egg into fallopian Luteal (Secretory) Premenstrual phase Cycle Days 15 – 28 Depends on whether fertilization occurs or not.

Corpus Luteum A mound of yellow tissue Develops as a result of the ruptured follicle During pregnancy, it serves to produce estrogen and progesterone

If fertilization occurs, Fertilized egg attaches to blanket of blood vessels which supplies nutrients for the developing placenta. Corpus luteum continues to produce estrogen and progesterone. If fertilization does NOT occur: Corpus luteum deteriorates. Estrogen and progesterone levels drop. The blood vessel lining sloughs off and menstruation begins.

Hormones Hormones are chemical substances that serve as messengers, traveling through the bloodstream.

Hormones Pituitary Hormones Ovarian Hormomes Luteinizing Hormone (LH) Follicle Stimulating Hormone (FSH) Ovarian Hormomes Estrogen Progesterone

The egg, unless fertilized, only survives 12-24 hours. The Path of the Egg Reaches uterus about 2-4 days after ovulation Released from follicle Swept into fallopian tube Moves slowly toward uterus Reaches uterus in about 4 days Moves slowly toward uterus Swept into fallopian tube Released from follicle The egg, unless fertilized, only survives 12-24 hours.

The Menstrual Cycle

PMS Premenstrual syndrome (PMS) is a group of symptoms related to the menstrual cycle

PMS Physical and emotional disorder Caused by hormonal changes Widely recognized as a medical condition 85% of menstruating women have at least one symptom 5-10% debilitating symptoms Symptoms present two weeks before menstruation

Remedies: Dietary Recommendations Low fat High fiber 3 meals a day and 3 snacks containing starchy foods Drink plenty of water Avoid caffeine Low salt High calcium

Menstrual Conditions Two types Amenorrhea Dysmenorrhea Primary failure to start having a period by the age of 16 Secondary temporary or permanent ending of periods in a woman who has menstruated normally in the past

Menstrual Disorders (Cont) Dysmenorrhea - Painful menstrual periods (aka cramps) Primary no physical abnormality and usually begins within three years after you begin menstruating Secondary involves an underlying physical cause, such as endometriosis or uterine fibroids

Discussion Question: