Chapter 4: Female Sexual Anatomy and Physiology

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyGenital Self-ExamChapter 4• Increases sexual comfort• Monitor for changes related to health concernsFemale Sexual Anatomy and PhysiologyOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe VulvaOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Vulva (cont.)• External female genitalia• Mons Veneris• Labia majora & minoraFig. 4.1 The structures and variations of the vulva: (a) external structures.Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Vulva (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Vulva (cont.)• Clitoris (analogous to penis)– external shaft & glans, internal crura clitoral hood– only function = sexual arousal– Clitoral stimulation most common way womanachieve orgasm• Female genital mutilationFig 4.2 The underlying structures of the vulva.1

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Vulva (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyUnderlying Structures• Vestibule– urethral opening– vaginal introitus (opening)•hymen• Perineum– episiotomy• Vestibular bulbs• Bartholin's glands• Pelvic floor muscles– Kegel exercisesOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyUnderlying StructuresOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyInternal Structures• Vagina– 3 layers: mucous, muscle, fibrous– Arousal and vaginal lubrication• lubrication changes vaginal ph and increasespleasure– Grafenberg (G) spot– Secretions & chemical balanceFig. 4.3 The underlying muscles of the vulva. These muscles can be strengthenedusing the Kegel exercises described in the text.Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyInternal Structures (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyInternal Structures (cont.)• Cervix• Uterus– 3 layers: perimetrium, myometrium, endometrium– fundus (top)Fig. 4.4 Internal female sexual anatomy: (a) cross-sectional side view of femaleinternal structures; (b) front view of the internal organs. Parts of the ovaries, uterus,and vagina are shown cut away.2

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyInternal Structures (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyInternal Structures (cont.)• Fallopian tubes–fimbriae– cilia (hairlike cells that move ovum)– fertilization occurs when egg is still close to ovary• Ectopic pregnancy• Ovaries– up to 472,000 immature ova at birth; 400 mature inlifetime– ovulation = release of ovumOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruationOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)• Myths and negative attitudes• Menarche (initial onset)– age 11-15– related to heredity, health, altitude• Menstrual physiology– flow lasts from 2 to 6 days– volume varies (6 to 8 ounces)– duration varies (24 to 42 days)– menstrual synchronyOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)• The menstrual cycle– hypothalamus releases GnRH that stimulates pituitary– pituitary produces:• Follicle Stimulating Hormone• Luteinizing Hormone– Negative feedback mechanism• Follicle Stimulating Hormone• Luteinizing HormoneFig. 4.7 Ovulation timing and cycle length. Regardless of the length of the cycle,ovulation occurs 14 days before menstruation.3

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)• Three phases of menstrual cycle– menstrual: shedding of endometrium– proliferative: thickening of endometrium & folliclematuration, ovulation– secretory: corpus luteum development furtherthickening of endometriumFig. 4.5 Changes during the menstrual cycle (a) indicates the hypothalamus in the brain measuring levels of hormonesand releasing GnRh to stimulate the pituitary to secrete FSH and LH into the bloodstream (b) shows how the levels ofFSH (red line) and LH (purple line) vary during the complete cycle. Note the midcycle peak of LH that stimulatesovulation (c) shows the ovarian changes during the phases of the cycle and (d) shows the fluctuations in blood levelsof estrogen and progesterone produced by the ovaries and (e) indicates these hormonal effects on the lining of theuterus. After ovulation, the glands and ducts inside the endometrium (drawn and vertical tubes and spirals) developand secrete nutrients that, if a woman became pregnant, would support the embryo.Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)Fig 4.6 The changes to the ovaries and uterus during (a) the proliferative phase,including ovulation.Fig. 4.8 The changes to the ovaries and uterus during (b) the secretory phase, and (c)the menstrual phase of the menstrual cycle.Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenstruation (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenopause• Sexual activity and the menstrual cycle• Menstrual cycle problems– premenstrual syndrome:• Premenstrual Dysphoric Disorder– dysmenorrhea = painful menses– amenorrhea = no menses– toxic shock syndrome– self-help for menstrual symptoms• Terms– climacteric– peri-menopause: time before menopause– menopause: permanent cessation of menstruation4

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenopause (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyMenopause (cont.)• 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 psychologicalsymptoms– controversies with data reporting hazardous effects– increased risk of breast cancer with exclusive use ofestrogen– alternatives to HRTOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyGynecological Health ConcernsOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyGynecological Health Concerns (cont.)• Urinary tract infections• Vaginal infections• Self-exams & vaginal health care• Pap smear screens for cervical cancer• Hysterectomy or oophorectomy– most frequently performed U.S. operation, morefrequently performed on low income, less educatedwomen– nonsurgical alternativesOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe BreastOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Breast (cont.)• mammary glands produce milk– fatty tissue determines size• areola is darker area• nipple is in center of areola & has openings for milkFig. 4.8 Cross-section front and side views of the female breast.5

Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Breast (cont.)• Breast exams– self-exam following menstruation– routine healthcare provider exams– mammographyOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and Physiology• Breast examsThe Breast (cont.)Fig. 4.9 It is helpful to use a chart similar to this one to keep track of lumps in thebreasts.Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Breast (cont.)Our Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Breast (cont.)• Breast lumps– cysts (fluid-filled sacs)– fibroadenomas (solid, round, benign tumors)– malignant tumor• Breast cancer– treatments– risk factors– reconstructive breast surgery– benefits of early detection & treatmentFig. 4.10 Breast Self-ExamOur Sexuality, 9th Edition, Robert L. CrooksChapter 4: Female Sexual Anatomy and PhysiologyThe Breast (cont.)Table 4.4 Risk Factors for Breast Cancer6