1. Sexuality, Pregnancy and Childbirth Chapter 5 © 2012 McGraw-Hill Higher Education. All rights reserved.

2. 2 Sexual Anatomy (Female) 2 External Female Genitals (Vulva)External Female Genitals (Vulva) –Mons pubis –Labia majora –Labia minora –Prepuce –Clitoris –Urethra opening Internal Female GenitalsInternal Female Genitals –Vagina –Uterus –Cervix –Ovaries –Fallopian tubes –Hymen

3. 3 © 2012 McGraw-Hill Higher Education. All rights reserved. Figure 5.1 The female sex organs 3

4. 4 © 2012 McGraw-Hill Higher Education. All rights reserved. Sexual Anatomy (Male) 4 Penis The glans Corpus spongiosum Urethra Scrotum Function (maintaining temperature) Testes Epididymis Vas deferens Prostate gland Cowper’s glands Seminal vesicles Ejaculatory ducts

5. 5 © 2012 McGraw-Hill Higher Education. All rights reserved. Figure 5.2 The male sex organs 5

6. 6 © 2012 McGraw-Hill Higher Education. All rights reserved. Hormones and the Reproductive Life Cycle 6 Hormones –Androgens Testes produce testosterone in males Adrenal glands produce androgens in both males and females –Estrogens and Progestagens Ovaries produce estrogen and progesterone in females –Pituitary gland –Hypothalamus

7. 7 © 2012 McGraw-Hill Higher Education. All rights reserved. Differentiation of the Embryo 7 Determined by the fertilizing sperm at the time of conception –Conception - combining of 23 pairs of chromosomes 22 are the same and the 23rd contains the sex chromosomes Two possible configurations Females are XX Males are XY

8. 8 © 2012 McGraw-Hill Higher Education. All rights reserved. Female Sexual Maturation 8 Physical changes begins around 8-13 with breast development and rapid body growth between 9 and 15. The 4 Phases of the Menstrual Cycle –Menses Days 1-5 –Estrogenic phase –Ovulation phase –Progestational phase

9. 9 © 2012 McGraw-Hill Higher Education. All rights reserved. Menstrual Problems 9 Dysmenorrhea –Some symptoms caused from prostaglandins Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD) –Causes 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 –Pharmacological treatments

10. 10 © 2012 McGraw-Hill Higher Education. All rights reserved. Male Sexual Maturation 10 Occurs about 2 years later than girls Begins about 10 or 11 years old Physical changes –Testicular growth –Penis growth –Pubic hair growth –Facial and body hair growth –Voice deepens –Height growth

11. 11 © 2012 McGraw-Hill Higher Education. All rights reserved. Aging and Human Sexuality 11 Women: Menopause –Ovaries gradually cease functioning –Decreasing estrogen –Increased risk of disease Men –Gradual decrease of testosterone –Changes in arousal As men and women age, sexual activity can continue to be a source of pleasure and satisfaction

12. 12 Sexual Functioning 12 Sexual stimulation –Comes from both physical and psychological stimuli Physical stimulation –Through the senses –Erogenous zones Psychological stimulation –Fantasies –Ideas –Memories of past experience –Mood

13. 13 © 2012 McGraw-Hill Higher Education. All rights reserved. The Sexual Response Cycle 13 Physiological mechanisms –Vasocongestion –Muscular tension Four phases typically characterize the sexual response cycle: 1.Excitement phase 2.Plateau phase 3.Orgasmic phase Males (refractory phase) 4.Resolution phase

14. 14 © 2012 McGraw-Hill Higher Education. All rights reserved. Sexual Problems 14 Common sexual health problems Conditions affecting women: Vaginitis –Candida (yeast infection) –Trichomonas Endometriosis Pelvic Inflammatory Disease (PID) –50-75% of PID cases are caused by STDs Conditions affecting men: Prostatitis Testicular cancer –Most common in men in their twenties and thirties Epididymitis Testicular torsion

15. 15 © 2012 McGraw-Hill Higher Education. All rights reserved. Sexual Dysfunctions 15 Systematic diseases Common sexual dysfunctions –Men erectile dysfunction premature ejaculation retarded ejaculation –Women orgasmic dysfunction dyspareunia Treatment –Pharmaceutical –Psychosocial - troubled relationships –Behavioral –Relaxation and massage techniques

16. 16 © 2012 McGraw-Hill Higher Education. All rights reserved. Sexual Orientation 16 Person’s preference in sex partners –Heterosexuality –Homosexuality –Bisexuality Origins of sexual orientation –Biological and genetic factors –Cultural and social factors –Psychological factors –Complex series of biological, psychological, and social interactions

17. 17 © 2012 McGraw-Hill Higher Education. All rights reserved. Varieties of Human Sexual Behavior 17 Celibacy Autoeroticism and masturbation –Erotic fantasy Touching and foreplay Oral-genital stimulation –Cunnilingus (stimulation of the female genitals) –Fellatio (stimulation of the penis) Anal intercourse Sexual intercourse

18. 18 © 2012 McGraw-Hill Higher Education. All rights reserved. Atypical and Problematic Sexual Behaviors 18 Atypical versus harmful sex Issues of consent Society’s conflicting feelings about sexuality evident in attitudes toward commercial sex Commercial sex –Pornography –Online porn and cybersex –Prostitution

19. 19 © 2012 McGraw-Hill Higher Education. All rights reserved. Responsible Sexual Behavior 19 Taking responsibility for the consequences of sexual behavior Open, honest communication about intentions Agreed-on sexual activities Sexual privacy Using contraceptives Safer sex Sober sex

20. 20 © 2012 McGraw-Hill Higher Education. All rights reserved. Understanding Fertility Conception –Involves the fertilization of a women’s egg by a man’s sperm –Each month a women’s ovaries release an egg –Egg disintegrates after 24 hours if not fertilized –3-4 days: The egg travels through the fallopian tubes –Millions of sperm but only a few reach the uterus –Sperm release an enzyme that softens egg –Egg and sperm each carry 23 chromosomes Fraternal twins and identical twins 20

21. 21 © 2012 McGraw-Hill Higher Education. All rights reserved. Infertility Female infertility –One of two key causes Tubal blockage (40%) –Blocked fallopian tubes are most commonly caused by pelvic inflammatory disease (PID) –Endometriosis Failure to ovulate (40%) –Age, behavior, and exposure to toxic chemicals or radiation affect ovulation 21

22. 22 © 2012 McGraw-Hill Higher Education. All rights reserved. Infertility Male infertility –Accounts for about 20% of infertile couples –Four main categories Hypothalmic pituitary disease or congenital disorders Testicular disease Disorders of sperm transport Unexplained 22

23. 23 © 2012 McGraw-Hill Higher Education. All rights reserved. Treating Infertility Intrauterine insemination –Artificial intrauterine insemination IVF,GIFT, and ZIFT –In vitro fertilization (IVF) –Gamete intrafallopian transfer (GIFT) –Zygote intrafallopian transfer (ZIFT) Surrogate motherhood 23

24. 24 © 2012 McGraw-Hill Higher Education. All rights reserved. Pregnancy 3 periods of about 3 months (13 week trimesters) Early signs and symptoms –Missed menstrual period –Slight bleeding –Nausea –Breast tenderness –Increased urination –Sleepiness, fatigue and emotional upset 24

25. 25 © 2012 McGraw-Hill Higher Education. All rights reserved. 25 Figure 5.3 Physiological changes during pregnancy

26. 26 © 2012 McGraw-Hill Higher Education. All rights reserved. Continuing Changes in the Woman’s Body Uterus size –During the first 3 months, the uterus enlarges to about three times its nonpregnant size –4 th month – large enough to make abdomen protrude –7 th -8 th month – pushes up into the rib cage Breast changes –8 th week – Breasts may tingle or throb Muscles and ligaments loosen Blood volume doubles Weight gain 26

27. 27 © 2012 McGraw-Hill Higher Education. All rights reserved. Changes During the Later Stages of Pregnancy Increased needs placed on the mother’s lungs, heart, and kidneys Braxton Hicks contractions, or preliminary contractions Lightening Emotional responses to pregnancy 27

28. 28 © 2012 McGraw-Hill Higher Education. All rights reserved. Fetal Development First Trimester –Blastocyst Arrives in uterus – 4 th day Attaches to uterine wall - the 6 th or 7 th day –Embryo – End of second week Inner cells divide into 3 layers One layer – inner body parts Middle layer – muscle, bone, blood, kidneys, and sex glands Third layer – skin, hair, and nervous tissue –All major body structures are formed between 2 nd and 9th week –2 nd Month – Fetus 28

29. 29 © 2012 McGraw-Hill Higher Education. All rights reserved. Figure 5.4 A chronology of milestones in prenatal development 29

30. 30 © 2012 McGraw-Hill Higher Education. All rights reserved. Fetal Development Second Trimester –Fetus grows to about 14 inches and 1.5 pounds Third Trimester –Fetus gains weight and protective fat layers, respiratory and digestive organs develop 30

31. 31 © 2012 McGraw-Hill Higher Education. All rights reserved. Diagnosing Fetal Abnormalities Ultrasonography (Ultrasound) –High frequency sound waves Amniocentesis –Fluid removal from the uterus Chorionic villus sampling (CVS) –Removal of tiny section of chorionic villi Quadruple marker screen (QMS) –Maternal blood test –Analyzes four hormone levels and compares to appropriate standards Fetal programming –Conditions in the womb may influence the risk of adult diseases 31

32. 32 © 2012 McGraw-Hill Higher Education. All rights reserved. The Importance of Prenatal Care Regular medical checkups Blood tests Prenatal nutrition Avoiding drugs and other environmental hazards: –Teratogens 1 st trimester Congenital malformations –Alcohol –Tobacco –Caffeine –Drugs –STDs and other infections 32

33. 33 © 2012 McGraw-Hill Higher Education. All rights reserved. The Importance of Prenatal Care Prenatal activity and exercise –Work –Sleep –Physical activity –Kegel exercises Preparing for birth 33

34. 34 © 2012 McGraw-Hill Higher Education. All rights reserved. Complications of Pregnancy and Pregnancy Loss Ectopic pregnancy Spontaneous abortion, or miscarriage Stillbirth Preeclampsia/eclampsia Placenta previa Placental abruption Gestational diabetes Preterm labor Labor induction Low-birth weight (LBW) –Less than 5.5 pounds Premature birth Infant mortality –SIDS 34

35. 35 © 2012 McGraw-Hill Higher Education. All rights reserved. Childbirth Choices in childbirth –Who is going to assist with delivery? Physician –High risk? Certified Nurse-Midwife –Where is the baby going to be delivered? Hospital Home 35

36. 36 © 2012 McGraw-Hill Higher Education. All rights reserved. Labor and Delivery Entire process usually 2-36 hours First stage of labor –Average of 13 hours for a first birth –Cervix is completely dilated (10 centimeters) –Contractions (30 seconds and occur every 15-20 minutes) –Mucus plug is expelled and amniotic sac may rupture –Transition: Contractions may last 60-90 seconds and be 1-3 minutes apart 36

37. 37 © 2012 McGraw-Hill Higher Education. All rights reserved. Childbirth Second Stage of Labor –Baby slowly pushed into birth canal –Baby squeezes through pelvis –Head is usually delivered first –Umbilical cord is cut Third Stage of Labor –Delivery of the placenta –Stage typically lasts 5-30 minutes Apgar score of the baby –Heart rate –Respiration –Color –Reflexes –Muscle tone –Total score is between 0 and 10 37

38. 38 © 2012 McGraw-Hill Higher Education. All rights reserved. 38 Figure 5.6 Birth: labor and delivery 38

39. 39 © 2012 McGraw-Hill Higher Education. All rights reserved. Pain Relief During Labor and Delivery Childbirth preparation courses –Breathing and relaxation techniques –Lamaze or Bradley techniques Epidural Narcotics –Fentanyl or demerol –Provide less pain relief than a epidural 39

40. 40 © 2012 McGraw-Hill Higher Education. All rights reserved. Cesarean Deliveries 2008 about 32.3% of babies born in the U.S. Surgical removal of the baby –Baby’s head too large –Mother has a serious health condition –Mother who is overweight or diabetes –Difficult labor –Fetal distress –Dangerous infections –90% of cesarean mothers will have subsequent deliveries by cesarean 40

41. 41 © 2012 McGraw-Hill Higher Education. All rights reserved. The Postpartum Period 3 months following childbirth Critical family adjustment Breastfeeding –Lactation begins about 3 days post-childbirth –Colostrum is produced prior to lactation –American Academy of Pediatrics recommends 6 months of exclusive breastfeeding Postpartum depression Attachment 41

42. Sexuality, Pregnancy and Childbirth Chapter 5