1. Sexuality, Pregnancy, and Childbirth
Chapter 5
Sexuality, Pregnancy, and Childbirth
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2. Sexual Anatomy 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
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3. Female Sex Organs Vulva Vagina 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
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4. The Female Sex Organs
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5. Male Sex Organs Penis Scrotum Urethra
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 (excretes preejaculatroy fluid)
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6. The Male Sex Organs
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7. Sperm 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
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8. 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
Adrenal glands also produce sex hormones
Regulated by pituitary gland hormones
Controlled by hypothalamus hormones
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9. 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 (two or more Xs and a Y)
Turner’s syndrome (a single complete Y)
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10. Female Sexual Maturation (1)
Sexual differentiation is accentuated at puberty
In females: breast development (ages 8–13), rounding of the hips and buttocks
Menarche
First menstrual cycle
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11. Female Sexual Maturation (2)
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
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12. Menstrual Problems (1) Dysmenorrhea Premenstrual syndrome (PMS)
Discomfort associated with menstruation
Premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMDD)
Causes of PMS and PMDD still unknown
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13. Menstrual Problems (2) 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
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14. 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
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15. Aging and Human Sexuality
Females
Menopause
Ovaries gradually cease functioning
Decreasing estrogen
HRT
Hot flashes and other symptoms
Osteoporosis (thinning of bones)
Males
Gradual decrease of testosterone
Changes in arousal
Erectile dysfunction
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16. Sexual Functioning Sexual stimulation Physical stimulation
Through the senses
Erogenous zones
Psychological stimulation
Fantasies
Ideas
Memories of past experience
Mood
Attitudes about sex
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17. Sexual Response Cycle Physiological mechanisms
Vasocongestion (accumulation of blood)
Muscular tension
Four phases characterize the sexual response cycle
Excitement phase
Plateau phase
Orgasmic phase
Resolution phase
Males (refractory phase)
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18. Sexual Problems Conditions commonly affecting women:
Vaginitis (vaginal inflamation)
Vulvodynia (chronic and unexplained vulvar pain)
Endometriosis (growth of endometrial-like tissue outside the uterus)
Pelvic inflammatory disease (PID) (uterine or ovarian infection)
50–75% of PID cases are caused by STIs
Conditions commonly affecting men:
Prostatitis (can be accute {usually bacterial})
Prostate cancer
Testicular cancer
Epididymitis (inflamation of the epididymis)
Testicular torsion (spermatic cord is twisted)
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19. Sexual Dysfunctions (1)
Systemic diseases (affect multiple body parts)
Common sexual dysfunctions
Men
Erectile dysfunction
Premature ejaculation
Delayed ejaculation
Women
Orgasmic dysfunction
Dyspareunia (pain during intercorse)
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20. Sexual Dysfunctions (2)
Causes
Underlying medical conditions
Vascular problems
Obesity
Smoking and alcohol
Medication
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21. Sexual Dysfunctions (3)
Treatment
Pharmaceutical
Therapy and counseling
Psychosocial causes
Nondrug therapy
Kegel exercises
Practicing masturbation
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22. 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
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23. Commercial Sex Conflicting feelings about sexuality
Society’s attitude toward sexually oriented material and prostitution
Commercial sex
Pornography
Online porn and cybersex
Sexting
Prostitution
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24. Responsible Sexual Behavior
Open, honest communication about intentions
Agreed-on sexual activities
Sexual privacy
Safe sex
Contraception use
Sober sex
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25. Understanding Fertility (1)
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
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26. Understanding Fertility (2)
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
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27. Understanding Fertility (3)
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
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28. Infertility (1)
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%)
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29. Infertility (2) 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%)
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30. Treating Infertility Assisted reproductive technology (ART)
Intrauterine insemination
In vitro fertilization (IVF)
Gestational carrier
Surrogacy
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31. Pregnancy Pregnancy is viewed in trimesters Early signs and symptoms
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
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32. 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
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33. 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
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34. Fetal Development (1) 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…
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35. Fetal Development (2) 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
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36. Fetal Development (3) Second trimester Third 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
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37. Diagnosing Fetal Abnormalities (1)
Noninvasive screening tests
Quadruple marker screen (QMS)
Maternal blood test
Estimates the probability of fetal abnormalities
Cell free DNA
Used to identify chromosomal disorders
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38. Diagnosing Fetal Abnormalities (2)
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
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39. Diagnosing Fetal Abnormalities (3)
New fetal screening techniques
MaterniT21
Fetal programming
Focuses on how conditions in the womb may influence the risk of adult diseases
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40. The Importance of Prenatal Care (1)
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
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41. The Importance of Prenatal Care (2)
Activity and exercise
Kegel exercises
Prenatal exercise classes
Preparing for birth
Childbirth classes
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42. Complications of Pregnancy and Pregnancy Loss (1)
Complications arise for many different reasons
Maternal diseases and exposures
Placental factors
Fetal conditions
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43. Complications of Pregnancy and Pregnancy Loss (2)
Ectopic pregnancy
Spontaneous abortion, or miscarriage
Stillbirth
Preeclampsia/eclampsia
Placenta previa
Placental abruption
Gestational diabetes (GDM)
Preterm labor and birth
Labor Induction
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44. Ectopic Pregnancy in a Fallopian Tube
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45. Labor and Delivery (1) 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)
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46. Labor and Delivery (2) Second stage of labor Third 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
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47. Birth: Labor and Delivery
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48. 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
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49. 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
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50. The Postpartum Period (1)
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
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51. The Postpartum Period (2)
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… …
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52. The Postpartum Period (3)
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
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53. The Postpartum Period (4)
“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
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