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chapter 3: female sexual anatomy and physiology

Underlying Structures: Pelvic floor muscles Often weakened/damaged by childbirth and with age Can be strengthened by Kegel exercises Relative position of bladder and uterus shown in next slide Kegel: contract muscles and hold for a count of 3 then rest for 3. Do 3 sets of 10 repeats. Helps with incontinence which affects twice as many women as men 18 again video?

Internal female anatomy: the vagina Three layers of the vagina: Mucosa on the outside Muscle layer underneath: muscle thickest and strongest around the vaginal opening Fibrous tissue (shown in yellow) provides structural support Inner 2/3 of vagina is flexible, if air flows in and gets trapped by muscles, flow back out can make farting noise!

Internal female anatomy The cervix is at the intersection of the vagina and the uterus The uterus or (womb) is where a fetus develops and grows Uterus has 3 layers like the vagina Innermost layer is called the endometrium; this is what builds up and then sloughs off during menstruation Some people have uterus tipped forward or back Tipped back can make for greater menstrual discomfort

Internal female anatomy Ovaries: Release hormones, including estrogens Produce and release eggs Fallopian Tubes: Eggs released from ovaries travel through fallopian tubes to the uterus Can be the site of ectopic pregnancy

Internal female anatomy: the Grafenberg spot System of glands and ducts that surround the urethra Anatomically analogous to the male prostate gland In the front wall of the vagina about 1/3 to ½ way up “G spot” stimulation is rumored to elicit arousal, orgasm, and female ejaculation; some women do experience enhanced pleasure when this spot is stimulated and others do not

Arousal and lubrication 10-30 sec. after stimulation (may be either physical or psychological), increased blood flow to the vaginal mucosa results in secretion of a clear, slippery fluid Two functions: Increases sexual enjoyment; facilitates entry of penis (or whatever) into the vagina Also changes pH of vaginal canal to make it less acidic; this improves motility and survival of sperm Artificial lubrication can be used to replace or supplement natural lubrication Other aspects of arousal discussed in ch 6 Oil based lubricants will dissolve condoms!

Other vaginal secretions Vaginal walls and cervix both normally produce white or yellowish secretions Appearance, consistency, and odor can vary with a woman’s menstrual cycle Use of douches and other feminine hygiene sprays can negatively alter the chemical balance of the vagina and cause problems

Just add soap & water Douching can: increase the risk of pelvic inflammatory disease, endometriosis, HIV transmission, ectopic pregnancy, and decreased fertility Feminine hygiene sprays can cause irritation and infection Washing the vulva with soap & water is sufficient not good to kill off beneficial bacteria in vagina or to change pH balance

menstruation

Menstruation Many myths about menstruation and taboos against sexual activity during menstruation Sloughing off of uterine lining Menarche is the initial onset of menstruation Typically happens at age 11–15 Happens earlier today than it used to; higher body weights may explain this Proper nutrition is essential for menarche and continued menstruation Corsage worn by a menstruating woman will wilt

More about menstruation Menstrual cycle is defined as the time from the first day of one menstrual period to the start of the next; varies from 24–42 days Flow usually lasts 2–6 days and total volume is usually 6–8 ounces Ovulation (release of an egg) usually happens 2 weeks before onset of menstruation

Changes During the Menstrual Cycle Talk about how always call day 1 first day of period

What Happens During the Menstrual Cycle The events of the menstrual cycle are controlled by hormones Hormones are chemical messages released by one part of the body that travel to another part of the body Master controller of hormones during the menstrual cycle is part of the brain called the hypothalamus Hypothalamus releases a hormone, GnRH that stimulates the pituitary gland to release: Follicle Stimulating Hormone (FSH) Lutenizing Hormone (LH) In men, GnRH, FSH and LH control sperm production

What Happens During the Menstrual Cycle LH and FSH act on the ovary and stimulate the maturation and release of the egg; ovulation is the term for the release of the egg from its casing, called the corpus luteum The ovaries secrete the hormone estrogen and the corpus luteum secretes progesterone, which stimulate proliferation of the endometrium in preparation for possible pregnancy If pregnancy does not occur after ovulation, the pituitary gland shuts down release of LH and FSH, leading to a fall in estrogen and progesterone, and the initiation of menstruation

Sex and menstruation Studies of women’s sexual behavior during menstruation have produced conflicting results: some have shown no change in sexual interest, others have shown increased sexual interest Miller et al. looked at earnings of lap dancers during phases of the menstrual cycle and found that dancers made, on average: $70/hour during ovulation $50/hour between ovulation and menstruation $35/hour during menstruation Interestingly, dancers taking birth control pills made an average of $37/hour with no cycle fluctuations vs. $53/hour for women not taking the pill Talk about whether this was bc of women or bc of customers Were birth control and no pill groups the same?

Menstrual Cycle Problems Premenstrual syndrome (PMS) affects 85–90% of women and can cause physical and psychological symptoms such as: Bloating Food cravings Breast swelling Irritability Mood swings Depression Premenstrual Dysphoric Disorder (PMDD) affects <5% of women and results in more serious psychiatric symptoms that interfere with work or other normal activities Dysmenorrhea: pain (cramps, nausea, etc.) before or during menstruation PMS and PMDD have both been linked to the drop in estrogen that occurs before menstruation Self-help for menstrual symptoms Diet Exercise Toxic shock syndrome (TSS)

Treatment of menstrual cycle problems Many women find that their PMS and dysmenorrhea can be reduced by: Exercise Adequate hydration A low-salt, high-fiber diet Oral contraceptive use

Amenorrhea Lack of menstruation Can be due to: Hormone or other biological abnormalities A low-calorie diet Breastfeeding Prolonged amenorrhea can result in low estrogen levels, which can decrease bone density and contribute to osteoporosis The oral contraceptive Seasonale allows women to have only four periods a year http://www.hulu.com/watch/10234 = ‘Annuale”

Menopause Menopause: the permanent end of menstruation; occurs in late 40s to early 60s Preceded by perimenopause: irregular periods that may have abnormal bleeding Hormonal changes associated with menopause can have many other effects, including: Hot flashes Decreased vaginal lubrication Sleep disturbances Decreased bone density

Hormone Therapy in Menopause What are some positive effects of menopause? What are the potential benefits and risks of hormone replacement therapy?

Gynecological Health Concerns Urinary tract infections: usually treatable with antibiotics; cranberry juice can suppress symptoms Vaginal infections: can cause discomfort and discharge; includes bacterial and yeast infections Pap smear screens for cervical cancer/HPV testing