Sexuality, Pregnancy, and Childbirth Chapter 5 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Both men and women have gonads –Ovaries in female –Testes in male Gonads produce germ cells and sex hormones –Ova (eggs) in females –Sperm in males Ova and sperm are the basic units of reproduction –Union of two results in creation of new life Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 2 Sexual Anatomy

Female Sex Organs VulvaVagina External sex organs Mons pubis Labia majora Labia minora Clitoris Prepuce Urethral and vaginal openings Passage that leads to internal reproductive organs G-spot Uterus Cervix Ovaries Fallopian tubes Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 3

The Female Sex Organs Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 4

Male Sex Organs Penis –The glans Covered by foreskin –Circumcision –Shaft Scrotum –The pouch that contains and maintains the temperature of the testes Urethra –Carries urine and semen Cowper’s glands 5 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

6 The Male Sex Organs Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Journey of the sperm –Produced in testes; stored in epididymis –Move to vas deferens –Vasa deferentia merge into seminal vesicles Secretions provide nutrients for sperm Sperm pass through prostate gland –Pick up milky fluid and become semen –Flow into ejaculatory ducts Sperm 7 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Hormones and the Reproductive Life Cycle Male sex hormones made by the testes –Androgens Testosterone Estrogen, progesterone Female sex hormones produced by the ovaries –Estrogen and progestogens –Testosterone Adrenal glands also produce sex hormones Regulated by pituitary gland hormones –Controlled by hypothalamus hormones Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 8

Differentiation of the Embryo Conception—combining of 23 pairs of chromosomes –22 the same; 23rd is the sex chromosome Egg carries an X sex chromosome Sperm carries either an X or a Y chromosome XX provides the blueprint to produce a female XY provides the blueprint to produce a male –Testosterone is key to sexual differentiation Abnormalities sometimes occur –Klinefelter’s syndrome –Turner’s syndrome Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 9

Female Sexual Maturation Sexual differentiation is accentuated at puberty –In females: breast development (ages 8–13), rounding of the hips and buttocks Menarche Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 10

Female Sexual Maturation The menstrual cycle—four phases: –Menses, days 1–5 –Estrogenic phase, days 6–13 Egg matures Endometrium thickens –Ovulation, day 14 Ovum released Corpus luteum Most fertile time –Progestational phase, days 15–27 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 11

Menstrual Problems Dysmenorrhea Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD) –Causes of PMS and PMDD still unknown 12 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Menstrual Problems Lifestyle changes to reduce symptoms –Limit salt intake –Exercise –Don’t use alcohol or tobacco –Eat a nutritious diet –Relax If systems persist, keep a daily diary and discuss issues with your physician Pharmacological treatments 13 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Male Sexual Maturation Begins at about 10 or 11 years old –About 2 years later than girls Physical changes –Testicular growth –Penis growth –Pubic hair growth –Facial and body hair growth –Voice deepens –Height and weight increase Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 14

Aging and Human Sexuality Females –Menopause Ovaries gradually cease functioning –Decreasing estrogen HRT –Hot flashes and other symptoms –Osteoporosis Males –Gradual decrease of testosterone –Changes in arousal Erectile dysfunction Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 15

Reproductive Aging in Women Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16

Sexual Functioning Sexual stimulation –Physical stimulation Through the senses Erogenous zones –Psychological stimulation Fantasies Ideas Memories of past experience Mood Attitudes about sex Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 17

Sexual Response Cycle Physiological mechanisms –Vasocongestion –Muscular tension Four phases characterize the sexual response cycle –Excitement phase –Plateau phase –Orgasmic phase –Resolution phase Males (refractory phase) Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 18

Sexual Problems Conditions commonly affecting women: –Vaginitis –Vulvodynia –Endometriosis –Pelvic inflammatory disease (PID) 50–75% of PID cases are caused by STIs Conditions commonly affecting men: –Prostatitis –Prostate cancer –Testicular cancer –Epididymitis –Testicular torsion Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 19

Sexual Dysfunctions Systemic diseases Common sexual dysfunctions –Men Erectile dysfunction Premature ejaculation Delayed ejaculation –Women Orgasmic dysfunction Dyspareunia 20 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Sexual Dysfunctions Causes –Underlying medical conditions Vascular problems –Obesity –Smoking and alcohol –Medication 21 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Sexual Dysfunctions Treatment –Pharmaceutical –Therapy and counseling Psychosocial causes –Nondrug therapy Kegel exercises Practicing masturbation Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 22

Sexual Orientation Person’s preference in sex partners –Heterosexuality –Homosexuality –Bisexuality Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 23

Varieties of Human Sexual Behavior Celibacy –Abstinence Autoeroticism –Masturbation, erotic fantasy Touching and foreplay Oral-genital stimulation –Cunnilingus (stimulation of the female genitals) –Fellatio (stimulation of the penis) Anal intercourse Sexual intercourse –Sexual coercion Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 24

Commercial Sex Conflicting feelings about sexuality Society’s attitude toward sexually oriented material and prostitution Commercial sex –Pornography –Online porn and cybersex Sexting –Prostitution Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 25

Responsible Sexual Behavior Open, honest communication about intentions Agreed-on sexual activities Sexual privacy Safe sex Contraception use Sober sex Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 26

Understanding Fertility Conception –The fertilization of a woman’s egg by a man’s sperm –Each month a woman’s ovaries release an egg –The egg travels through the fallopian tubes to the uterus –The endometrium thickens in preparation for a fertilized egg (zygote) –If the egg is not fertilized, the woman’s body expels the egg’s remains and uterine lining during menstruation 27 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Understanding Fertility Fertilization –Enzymes from hundreds of sperm soften the egg’s outer layer, and one sperm cell is able to penetrate Fuses with the nucleus of the egg, and fertilization occurs –The zygote travels through the oviduct to the uterus; the now blastocyst attaches to the uterine wall –Ovum and sperm carry hereditary characteristics Each contain 23 chromosomes –Genes 28 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Understanding Fertility Twins –Fraternal (dizygotic) twins The ovaries release more than one egg, and both are fertilized 70% of twins –Identical (monozygotic) twins The division of a single fertilized egg into two cells that develop separately The babies share all genetic material 29 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Infertility The inability to conceive after trying for a year or more Female infertility –Tubal blockage (14%) Pelvic Inflammatory Disease Endometriosis –Failure to ovulate (21%) Age, behavior, exposure to toxic chemicals or radiation –Anatomical abnormalities, benign growths in uterus, thyroid disease, and other uncommon conditions (37%) –Unexplained (28%) 30 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Infertility Male infertility –Main categories: Hypothalamic pituitary disease (1–2%) Testicular disease (30–40%) Disorders of sperm transport or posttesticular disorders (0–20%) Unexplained (40–50%) 31 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Treating Infertility Assisted reproductive technology (ART) Intrauterine insemination In vitro fertilization (IVF) Gestational carrier –Surrogacy 32 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Pregnancy Pregnancy is viewed in trimesters –3 periods of about 3 months (13-week trimesters) Early signs and symptoms –Missed menstrual period or slight bleeding –Nausea –Breast tenderness –Increased urination –Sleepiness, fatigue, and emotional upset –Hegar’s sign; Chadwick’s sign 33 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Physiological Changes During Pregnancy 34 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Continuing Change in the Woman’s Body Uterus enlarges Breasts enlarge and are sensitive –Hyperpigmentation Muscles and ligaments soften and stretch Blood volume doubles Lungs and kidneys become more efficient Weight gain: average 27.5 pounds 35 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Changes During the Later Stages of Pregnancy The fetus’s increased needs place a burden on the mother’s lungs, heart, and kidneys The body retains more water Braxton Hicks contractions –Preliminary contractions as the body prepares for childbirth Lightening Emotional responses to pregnancy –Hormonal changes –Responses vary throughout the trimesters 36 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Fetal Development First trimester –Blastocyst Arrives in the uterus—4th day Attaches to wall of uterus—6th or 7th day –Embryo, end of second week Inner cells divide into three layers –Inner layer: inner body parts –Middle layer: muscle, bone, blood, kidneys, and sex glands –Third layer: skin, hair, and nervous tissue Outermost cells become placenta, umbilical cord, and amniotic sac CONTINUED… 37 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Fetal Development First trimester continued –All major body structures are formed between the 2nd and 9th weeks –The embryo becomes a fetus at the end of the second month –The fetus becomes active in the third month 38 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Fetal Development Second trimester –The fetus grows to about 14 inches and 1.5 pounds –The fetus requires large amounts of food, oxygen, and water Third trimester –The fetus gains most of its weight Brown fat –Respiratory and digestive organs develop 39 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

A Chronology of Milestones in Prenatal Development 40 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Diagnosing Fetal Abnormalities Noninvasive screening tests –Quadruple marker screen (QMS) Maternal blood test Estimates the probability of fetal abnormalities –Cell free DNA Used to identify chromosomal disorders 41 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Diagnosing Fetal Abnormalities Invasive diagnostic tests –Chorionic villus sampling (CVS) Removal of a tiny section of chorionic villi –Amniocentesis Fluid removal from around developing fetus –Ultrasonography (ultrasound) High frequency sound waves used to create a sonogram 42 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Diagnosing Fetal Abnormalities New fetal screening techniques –MaterniT21 Fetal programming –Focuses on how conditions in the womb may influence the risk of adult diseases 43 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Importance of Prenatal Care Regular medical checkups Blood tests –Rh factor Prenatal nutrition Avoiding drugs and other environmental hazards Teratogens—congenital malformations Alcohol—fetal alcohol syndrome (FAS) Tobacco, caffeine, drugs STIs and other infections 44 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Importance of Prenatal Care Activity and exercise –Kegel exercises –Prenatal exercise classes Preparing for birth –Childbirth classes 45 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Complications of Pregnancy and Pregnancy Loss Complications arise for many different reasons –Maternal diseases and exposures –Placental factors –Fetal conditions 46 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Complications of Pregnancy and Pregnancy Loss Complications: –Ectopic pregnancy –Spontaneous abortion, or miscarriage –Stillbirth –Preeclampsia/eclampsia –Placenta previa –Placental abruption –Gestational diabetes (GDM) –Preterm labor and birth –Labor Induction 47 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Ectopic Pregnancy in a Fallopian Tube 48 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Risks for Infants Low birth weight (LBW) and premature birth –LBW babies weigh less than 5.5 pounds at birth –Premature babies are born before 37th week of pregnancy Infant mortality –Sudden infant death syndrome (SIDS) 49 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Childbirth Choices in childbirth –Who is going to assist with the delivery? Physician Certified nurse-midwife –Where is the baby going to be delivered? Hospital Home 50 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Labor and Delivery First stage of labor –Cervical effacement –Contractions Last 30 seconds and occur every 15–20 minutes –Small amount of bleeding Mucus that blocked the cervical opening is expelled –The amniotic sac ruptures in some –The last part of first stage of labor: active labor Strong and frequent contractions Last 60–90 seconds and occur 1–3 minutes apart Cervix completely dilates (10 centimeters) 51 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Childbirth Second stage of labor –The baby is slowly pushed down The mother must bear down with contractions to help push the baby out –The head is usually delivered first Crowning –Amniotic fluid is forced out of the baby’s lungs Third stage of labor –Delivery of the placenta –Breast feeding helps control uterine bleeding 52 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Childbirth Apgar score of the baby –Heart rate, respiration, color, reflexes, and muscle tone evaluated –Total score is between 0 and Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Birth: Labor and Delivery 54 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Pain Relief during Labor and Delivery Childbirth preparation courses Breathing and relaxation techniques Laboring in water Narcotics –Epidural injection Local anesthesia for repair of any tear or episiotomy if mother has not used epidural for labor 55 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Cesarean Delivery Cesarean section –The baby is removed through a surgical incision in the abdominal wall and uterus –Necessary when a baby can’t be delivered vaginally Baby’s head is too large Mother has a serious health condition Mother is overweight or has diabetes Difficult labor Fetal distress Dangerous infections –90% of cesarean mothers will have subsequent deliveries by cesarean 56 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Postpartum Period Postpartum—3 months following childbirth –Critical family adjustment Breastfeeding –Lactation begins about 3 days post-childbirth Colostrum prior to lactation –American Academy of Pediatrics recommends 6 months of exclusive breastfeeding 57 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Postpartum Period Breastfeeding –Benefits: Suited for the baby’s nutritional, digestive needs; and contains antibodies Provides a sense of closeness and well-being for mother and child Helps the uterus return to normal Contributes to weight loss May reduce the risk of breast and ovarian cancers Can prevent return of menstruation CONTINUED… … 58 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Postpartum Period Breastfeeding –Breastfeeding is not feasible for all –Bottle feeding has some advantages: Easier to tell how much infant is taking in Infants tend to sleep longer Other caregivers can share in the nurturing process 59 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

The Postpartum Period “Baby blues” –Experienced by 50–80% of new mothers Postpartum depression –Prolonged period of anxiety, guilt, fear, self-blame –Experienced by 9–16% of new mothers Attachment –Develops between baby and an adult caregiver –Helps in the child’s social, emotional, and mental development 60 Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.