Nursing 330 Human Reproductive Health NOTE: This is Handout #1 of 2 Be sure to also print out Handout #2 April 6, 2015 Nursing 330 Human Reproductive Health

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: 4/20/15 Quiz: 5/11/15 Class Project/Presentation: 5/18/15 Pick group members by 4/20/15 Make up Assignment Due: 6/1/15 (if applicable) Final Exam: 6/8/15 @ 7:30pm

Puberty

Puberty Not a synonym for adolescence When a child transforms into an adult normally capable of reproduction (procreation). Refers to physical changes that occur during adolescence

Puberty Increase in body size Change in shape and body composition Rapid development Reproductive organs Other characteristics marking sexual maturity

Puberty Beginning of pubertal changes occurs between ages 11 – 16. Varies Pubertal changes in boys generally begin about 2 years later than in girls.

Puberty in Girls Average peak age: 12 Duration/Maturation: 18 mos – 6 years Phases of Development: Breast Development Pubic Hair can precede this stage (1/3 of girls) Vagina and Uterus develop Pubic Hair (2/3 of girls) Height development/Peak in height Menarche

Puberty in Boys Average peak age: 14 Duration/Maturation: 2 yrs. – 5 yrs. Phases of Development: Testes and scrotum Pubic Hair Penis Growth Enlargement of: Seminal Vesicles, Prostate, Bulbourethral Glands Auxillary (Armpit) Hair Voice Deepening

Puberty (cont) Other Sebaceous and sweat glands Enlargement of pores Breast changes Height spurt

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

Secular Trend Tendency for children to become progressively larger at all ages Causes Better nutrition Lessening of disease

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

Seven Essential Features of Human Reproduction

Female Sex Organs: Female gonads are the ovaries 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

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

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

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

Female Sexual Physiology During puberty hormones trigger the completion of oogenesis, the production of oocytes, commonly called eggs or ova. Follicles Sac in which eggs are carried. Found inside the ovaries.

Female Sexual Physiology At birth 150,000 - 500,000 follicles. each containing an immature ova (egg) By beginning of reproductive life Diminishes to 34,000 follicles During active childbearing years (ages 13 – 50) 300 - 400.follicles undergo maturation

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 Menstrual Phases Typical No. of Days Hormonal Actions Follicular (Proliferative) 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) 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 is implanted in the wall of the uterus. Corpus luteum continues to produce progesterone for several months and will remain in ovary until the end of pregnancy. If fertilization does NOT occur: Corpus luteum becomes smaller. Progesterone levels drop. Uterine lining sloughs off and menstruation begins.

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

Hormones Pituitary Hormones Ovarian Hormones (aka sex hormones) Luteinizing Hormone (LH) Follicle Stimulating Hormone (FSH) Ovarian Hormones (aka sex hormones) 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.

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