1. Female Sexual Anatomy & Physiology
Chapter 3

2. Structures of the Female Genitalia
The female genitals are divided into three sets of
structures:
The Vulva – all female external genital structures
Underlying Structures – structures of the vulva if hair, skin, and fatty pads were removed
Internal Structures – vagina, cervix, uterus, and ovaries

3. External Female Genitalia
All of the structures in this figure (except the perineum and anus) make up the vulva – note especially the location of the three openings into the body: urethral opening, introitus (to the vagina), and anus

4. Mons Veneris: fatty tissue covering the pubic bone – hairy – touch and pressure here can be sexually pleasurable because of the presence of many nerve endings
Labia Majora: outer lips – hairy, next to thigh, inner sides are hairless
Labia Minora: inner lips – hairless folds of skin that join on the anterior side at the prepuce (clitoral hood or covering)
Smegma: formed by genital secretions, skin cells, and bacteria - may form under the hood and cause pain during sexual arousal or activity – can prevent smegma from forming by pulling back the hood when washing the area
uncircumcised men also form smegma under the foreskin covering the head of the penis (recall that the clitoris and glans of the penis are homologous structures, as are the hood of the clitoris and the foreskin of the penis)

5. Note in the next slides the variability in appearance of the vulva of different women – women may worry that they are abnormal in appearance in this region, and often have no way to know that there is a lot of variability – there is not just one way that the vulva should look
For many years, photos including the vulva were airbrushed out or forbidden, and especially if any of the inner lips were shown, so women who had large labia thought they were deformed. This was true even of medical texts.
Today, porn shows mostly shaved vulva, but that is NOT the norm, if there is one.
I think it is more like fingerprints, no two vulvas are exactly alike

6. The structures and variations of the vulva: different colors and shapes. There are many common variations of external female genitals. Natural hair removal is rare.

7. For many years, labia like these were airbrushed out of photos, even in medical text books. Why do we need to believe that all women look like little babies? Why is pubic hair removal so popular?

8. Some people are creative with their vulvas…

9. Clitoris (homologous to penis)
External structures - shaft and glans – shaft contains two small spongy structures called cavernous bodies which engorge with blood during sexual arousal
8,000 nerve endings-twice as many as the penis and the most of any external structure in the body including fingers, lips and tongue.
Size, shape, and position of clitoris vary from woman to woman
How do I find it?
Click on “locating the clitoris”

10. All of the structures of the clitoris are homologous with structures in the penis
Glans of the clitoris is highly sensitive, like the glans or head of the penis, and usually has about the same number of nerve endings as the head of the penis (but concentrated into a much smaller space)
The clitoris is very important in sexual arousal and orgasm – stimulation of the clitoris is the most common way to produce orgasm in women – clitoral stimulation is more common than vaginal insertion during masturbation
Note that there has been a controversy regarding clitoral-induced versus vaginally-induced orgasms since Freud began his work – Freud felt that vaginal orgasms indicated that the woman was more “mature” – later research altered this notion and led to the idea that stimulation of the clitoris is almost always involved in orgasm – later research yet suggests that there is much variation in what leads individual women to arousal and orgasm
The only known purpose of the clitoris is sexual pleasure and arousal

11. Female Genital Cutting: Torture or Tradition?
Circumcision, mutilation, cutting….each carry a value judgment
Be sure to read the section on Female Genital Cutting: Torture or Tradition? P. 82
Note when and where female genital mutilation (FGM) has been practiced around the world
Note why FGM has been practiced
Think about whether FGM is an area in which we should tolerate and respect the practices of other cultures, or whether we should try to stop FGM from being practiced even though that means interfering with other cultures’ beliefs
A South African tribe’s point of view:

12. 1) Removal of part or all of clitoris 2) Removal of clitoris & labia minora (clitoridectomy or excision) 3) Removal of the clitoris, labia minora & majora (infibulation)

13. Vestibule : inside the Labia Minora. Contains the following:
Urethral Opening : opening of urethra which leads to the bladder
Vaginal Introitus: opening to the vagina
Hymen : fold of tissue which partially covers the opening to the vagina (also referred to as “cherry” or “maidenhead”)
allows menstrual blood flow before it is broken
may be broken during a woman’s first intercourse – many societies place significance on the hymen as a symbol of virginity, but it may be broken before intercourse in a variety of ways
hymen can cause a painful first intercourse (Kinsey scene), but not always – a woman can gradually stretch it first to minimize pain
Perineum : smooth skin between vagina and anus – sensitive to touch
may be torn in childbirth, and an incision called an episiotomy can be done to prevent tearing

14. Underlying Structures
Vestibular bulbs: Alongside vagina – engorge with blood during sexual excitement (similar to tissue in penis causing erection)
Bartholin’s glands: Two small glands slightly inside the vaginal opening that secrete a few drops of fluid during sexual arousal
Pelvic floor muscles: Complex musculature of the pelvic region which is helpful in allowing the vaginal opening to expand greatly during childbirth

15. Internal Structures
Vagina: Extends up and back from opening, normally 3”- 5” long, capable of great distension – receives semen from male, forms lower part of birth canal, allows uterine secretions and menstrual flow to exit
3 layers: mucous is inner layer, muscle is in the middle, fibrous is outer layer

16. Internal Structures Kegel exercises (p. 85)
used to train the pelvic floor muscles to contract voluntarily (these muscles contract involuntarily during orgasm)
Kegel exercises lead to increased sensation during intercourse and a general increase in genital sensitivity, help women regain urinary control (if this is a problem) after childbirth

17. Internal Structures
Vasocongestion : Upon sexual arousal, blood vessels around the vagina engorge with blood and clear fluid seeps from the walls for lubrication
Alkaline for sperm to travel
Vaginal secretions are normal, vary from white to yellow depending on hormone cycle
douching upsets the balance and is not necessary for cleanliness…..
However, media helps women spend about $500 million each year on douches! Hail to the V!

18. Internal Structures
Grafenberg (G) spot: located on the front wall of the vagina, about 1/3 to 1/2 way up its length
thought of as the female counterpart of male prostate – related to arousal, orgasm, and in some women to ejaculation
many women do not appear to have this area of increased sensation
How do I find it??
Click on the link: “The Female Prostate”
more on this in chapter 6….

19. Internal Structures Cervix: lower part of uterus
is found at the upper end of the vagina – a woman can inspect her own with a mirror and a speculum, or feel it if she inserts one or two fingers into her vagina
Let’s take a very graphic look into the cervix….
Uterus: pear-shaped – 3 in. long X 2 in. wide x 1 in. thick before having children

20. Uterus cont’ Has 3 layers
1. Endometrium - inner lining of mucous membrane - develops each month to receive fertilized egg - sloughs off as menstrual flow if egg not fertilized
2. Myometrium - three layers of muscles extending in all directions and giving the uterus great strength for pregnancy and labor
3. Perimetrium - covers outer surface of uterus
6 ligaments anchor the uterus in the pelvic cavity

21. Internal Structures Fallopian tubes: 2 tubes, extending from Uterus,
in which the egg & sperm travel
fallopian tubes - 4" long - fimbriae at ends draw egg into
uterus
hair like cilia move the egg down the fallopian tubes – the tubes are not connected to ovaries
fertilization usually occurs in tube when the egg is still close to the ovary
can implant in the fallopian tube, called an ectopic pregnancy, very dangerous
Ovaries: female gonads that produce ova & sex hormones
about the size and shape of almonds - located on either side of uterus - attached to uterus by ovarian ligament
ovaries develop and mature ova (eggs) - release about 450 in lifetime – usually only one ovum is discharged into the pelvic cavity at ovulation
ovaries secrete female hormones, i.e., estrogens and progesterone - regulate the menstrual cycle, ovulation and pregnancy - cause development of secondary sex characteristics

22. Ovaries cont’
Ovaries -
up to 472,000 immature ova at birth; 400 mature in lifetime
Ovulation : release of ovum – note that release always occurs 14 days before menstruation begins, regardless of length of menstrual cycle

23. Menstruation
Attitudes about menstruation involve many myths and negative attitudes in U.S. culture – note how attitudes affect people in different cultures
Menarche (initial onset) of menstruation, usually between age 11-15
timing related to heredity, general health, and attitude
many girls are not informed about menstruation and are frightened by their first menstrual periods
What was your experience, if you are female?

24. Menstruation Menstrual physiology
during the menstrual cycle, the uterine lining is prepared for the implantation of a fertilized egg
if conception does not occur, the lining sloughs off and is discharged as menstrual flow
flow lasts from 2 to 6 days
volume varies (6 to 8 ounces)
duration varies (24 to 42 days)
Menstrual synchrony: sometimes occurs among women who live together and have a lot of contact with each other, i.e., they have their periods at about the same time – don’t know the function of this – seems to be triggered by the sense of smell
menstrual cycle is regulated by complex relationships between the hypothalamus, the pituitary gland, and the ovaries…..

25. Menstruation Menstrual cycle problems:
premenstrual syndrome – 80-95% of women have mild discomfort premenstrually
Premenstrual Dysphoric Disorder - note that only 5% of women have symptoms severe enough for this diagnosis, i.e., symptoms severe enough to significantly affect their normal functioning
dysmenorrhea = painful menses
amenorrhea = no menses
self-help for menstrual problems, see text
toxic shock syndrome – rare disease, but can be life-threatening
women who use tampons should change them 3-4 times/day

26. Menopause Terms Symptoms vary from mild to strong
Climacteric: Physiological changes that occur during the transition period from fertility to infertility in both sexes
Perimenopause: time before menopause when estrogen is decreasing
Menopause: permanent cessation of menstruation as a result of the aging process or surgical removal of the ovaries
Symptoms vary from mild to strong
amenorrhea, then menopause
hot flashes or warm spells
night sweats, interrupted sleep
headaches, poor concentration
depression, anxiety
Hormone replacement therapy
estrogen reduces hot flashes and psychological symptoms
increased risk of endometrial and breast cancer with exclusive use of estrogen
alternatives to HRT

27. Gynecological Health Concerns
Study the causes and the preventative precautions for the following:
Urinary tract infections
Vaginitas: inflammation from infection
Self-exams & vaginal health care
Test for HPV, precursor to cervical cancer
Pap smear –screens for cervical cancer
Hysterectomy: Surgical removal of the uterus
most frequently performed in U.S. , more frequently performed on low income, less educated women
women should get a second opinion before having a hysterectomy, and they should explore non-surgical alternatives for treatment

28. The Breasts
Secondary sex characteristics - physical characteristics other than genitals that indicate sexual maturity and differentiate female and male
Present in both sexes - made up of fatty tissue and mammary glands
glandular tissue is fairly constant from woman to woman, so amount of milk produced does not vary with breast size
size differences are related to the amount of fatty tissue 

29. The Breasts Mammary glands produce milk, fatty tissue determines size
Nipple - contains openings of mammary gland ducts through which milk is secreted - surrounded by dark area called the areola

30. Much emphasis on breasts as sex symbols in our culture - many women feel badly about their breasts, e.g., feel they are too large, too small, wrong shape, nipples wrong - surgery to alter is common, even though very few women have the stereotypical “perfect” breasts

31. Breast Cancer
Breast self-exam (p. 104) and mammography important to maintain health
breast cancer occurs in 1 of 10 women (note factors affecting risk in
Table 4.3)
in 5-10% of women, breast cancer may develop from flaws in a gene that is now detectable – women with this gene flaw have up to an 85% chance of developing breast cancer – may decide to have a preventive mastectomy
most breast lumps are not cancerous - benign tumors account for 80% of breast lumps - fibrocystic disease
malignant tumor - radical mastectomy, partial mastectomy,
much debate over appropriate treatment for breast cancer
breast cancer and its treatments often adversely affect a woman’s sexuality, and can also affect her partner – reconstructive breast implants may be helpful

32. “The Right to Femininity” http://journeyman.booserver.com/home