1. MRKH (Mayer-Rokitansky-Küster- Hauser) Hannah Yim, Carley Wilvers, Tina Truong, Tiffany Tran, and Alberto Sosa-Parro HSc 425-26 (Tu/Th at 2pm) Professor Nathan Matza

2. The penis is the male sex organ, reaching its full size during puberty. In addition to its sexual function, the penis acts as a conduit for urine to leave the body. The penis is made of several parts: Glans (head) of the penis: In uncircumcised men, the glans is covered with pink, moist tissue called mucosa. Covering the glans is the foreskin (prepuce). In circumcised men, the foreskin is surgically removed and the mucosa on the glans transforms into dry skin. An erection results from changes in blood flow in the penis. When a man becomes sexually aroused, nerves cause penis blood vessels to expand. More blood flows in and less flows out of the penis, hardening the tissue in the corpus cavernosum. Function of the Penis

3. Male Structures

4. Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm. Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or farther away from the body to cool the temperature. How Semen is Produced

5. External Female Structures

6. Internal Female Structures

7. ● Mayer-Rokitansky-Küster-Hauser Syndrome. ● Causes the vagina and uterus to be underdeveloped or completely absent. ● Women will not have menstrual cycle due to absence or premature development of the uterus. ● Affected women still have regular female chromosomal pattern. ● Normal outside female genitila, vulva and pubic hair. MRKH Overview

8. ● Ovaries still function normally, but affected women are unable to carry a natural pregnancy. Although, they can conceive through assisted reproduction. ● Kidneys tend to be abnormally formed or positioned, often resulting in absence of one kidney. ● There can be skeletal abnormalities, specifically in the spine and vertebrae. ● Hearing loss and heart defects in some cases. How is the body affected?

9. Normal hormonal levels are guaranteed by fully functional ovaries Because the ovaries are producing hormones appropriately, women with MRKH have normal external gentelia and breast development MRKH’s Affect on Hormones

10. ● Specific cause of the syndrome is still unknown, research suggests that it is both genetic and environmental factors. ● Usually occurs with no history linked to family, but in cases that do show inheritance line, research suggests one identical copy gene. Currently there is no specific gene linked. ● Affects roughly 1 in every 4500 newborn girls every year. Genetic Component

11. What it looks like...

12. Do nothing Create a vagina, non-surgically Create a vagina, surgically Create a vagina through a combination of both, non-surgically and surgically Options for Women w/ MRKH

13. McIndo Procedure Williams Procedure Bowel Vagina Laparoscopy Vecchietti Procedure Vaginoplasty

15. 1.If treatment surgery is done, will the vagina feel “different” to the sexual partner? 2.Can women with MRKH still get sexually transmitted infections? 3.Do women with MRKH need to get the HPV vaccine? Common Questions

16. Review 1. T/F: The scrotum does not act as a climate control system for the testes. 2. T/F: The female genitilia has three openings (urethra, vagina, and anus). 3. T/F: The “blind pouch” made during vaginoplasty connects to the pelvis. 4. T/F: Women with MRKH have a less satisfying sex life. 5. T/F: MRKH is present upon birth, not developed later in life.