DOCSLIB.ORG

Anatomy and Physiology of Genital Organs – Women

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anatomy and Physiology of Genital Organs – Women Handbook of Clinical Neurology, Vol. 130 (3rd series) Neurology of Sexual and Bladder Disorders D.B. Vodusˇek and F. Boller, Editors © 2015 Elsevier B.V. All rights reserved Chapter 4 Anatomy and physiology of genital organs – women ALESSANDRA GRAZIOTTIN1* AND DANIA GAMBINI2 1Gynecology and Medical Sexology Center, Hospitale San Raffaele Resnati, and Graziottin Foundation for the Cure and Care of Pain in Women, Milan, Italy 2Department of Gynecology and Obstetrics, Hospitale San Raffaele, Milan, Italy INTRODUCTION the presence of androgens at male physiologic levels for the gestational age. The genital organs are comprised “Anatomy is destiny” (Wallace, 1983; Freud, 1895): Sig- of gonads, reproductive ducts, and external genitalia mund Freud’s intense consideration has a rich symbolic (Standring, 2008). The process of sexual differentiation and clinical meaning. It does not simply refer to the gen- is central for sexuality and reproduction. In sex develop- der issues, which is the more frequent reading of his sen- ment, it encompasses first the processes of sex determina- tence. It can be appropriately applied to the importance tion, that is, the developmental decision that directs the that human anatomy has in predetermining functions, undifferentiated embryo into a sexually dimorphic indi- dysfunctions, and related vulnerabilities, particularly in vidual. Sex determination equals gonadal development, the elusive domain of women’s sexuality. Freud, a skilled in human beings as in all mammals. The second process, physician and neurologist himself, knew and stressed the known as sex differentiation, takes place once the sex importance of basic anatomy and physiology for perceiv- determination decision has been made through factors ing the full meaning of what clinicians see and may read produced by the gonads that determine the development from human’s behavior. Son of his time, and with the sci- of the phenotypic sex. Generally, factors influencing sex entific limits of his historic period, he was nevertheless determination are transcriptional regulators, whereas fac- trying to bridge the anatomy of the brain with complex tors important for sex differentiation are secreted hor- mental functions, emotions, and dreams. mones and their receptors (Biason-Lauber, 2010). The quote is pertinent as a reminder that women’s Anatomically and morphologically, fetal sex develop- sexuality is deeply rooted in the anatomy and physiology ment consists of three sequential stages: of their whole bodies, with a specific focus here on their genital organs – a sexuality whose biologic anatomic and 1. the undifferentiated stage, when identical primitive functional basis is then modulated and reshaped structures develop in the XY and XX embryos throughout life by personal, relational, and context- 2. gonadal differentiation into testes or ovaries (key dependent events and affective dynamics (Graziottin for sex determination) et al., 2009; Lukasiewicz and Graziottin, 2014). 3. the sexual differentiation of internal and external The goal of this chapter is to offer an updated view of genitalia, which depends on the action of testicular women’s genital anatomy and physiology, with a clini- hormones. cally oriented perspective. Disorders of sex development, of the highest impor- EMBRYOLOGY OF WOMEN’S GENITAL tance for their sexual consequences, may result from ORGANS defects in any of these stages (Rey and Grinspon, 2011). The female genital organs differentiate in the feminine The gonads phenotype during the embryonic period without particular hormonalinfluences.Indeed,the“female”isthe“default” The gonads develop from primitive germ cells, the program, that can be differentiated into the “male” only in mesothelium of the posterior abdominal wall and *Correspondence to: Prof. Alessandra Graziottin, MD, via Panzacchi 6, 20123 Milan, Italy. Tel: +39-02-72002177, Mobile: +39-348- 3845007, E-mail: [email protected]; [email protected] 40 A. GRAZIOTTIN AND D. GAMBINI mesenchyme during the fifth fetal week, counting from the cranial end of the fused ducts yields the future uterus the first day of the last period (Netter, 2010). There are which contains mesoderm that will form the uterine three key directors of male gonad differentiation: endometrium and myometrium. The unfused cranial ends assume a funnel-shaped configuration (the fimbrial 1. the sex-determining region Y (SRY) protein, also portions of the fallopian tubes) and remain open to the known as testis-determining factor (Harley et al., future peritoneal cavity. The caudal end of the fused 2003). It is a protein that in humans is encoded by ducts gives origin to the upper two-thirds of the vagina the SRY gene, located in the Y chromosome. Its (Healey, 2012). The lower part of the vagina, urethra, expression causes the development of primary sex vaginal vestibule, and glands (urethral, paraurethral cords, which later develop into seminiferous and vestibular) arises from the urogenital sinus tubules. These cords form in the central part of (endoderm). the as yet undifferentiated gonad, turning it into a During development, the MDs undergo a dynamic testis. The now induced Leydig cells of the testis morphogenetic transformation from simple tubes con- then start secreting testosterone, while the Sertoli sisting of homogeneous epithelium and surrounding cells produce anti-mullerian€ hormone (AMH) mesenchyme into several distinct organs – the oviduct, 2. androgens, secreted by Leydig cells, further “force” uterus, cervix, and vagina. Following the formation of the basic program into the progressively male anatomically distinctive organs, the uniform MD epithe- fenotype lium (MDE) differentiates into diverse epithelial cell 3. AMH, produced by Sertoli cells in men and by gran- types with unique morphology and functions in each ulosa cells of the ovary in women. organ. Classic tissue recombination studies, in which In summary, the gonadal differentiation takes place the epithelium and mesenchyme isolated from the new- in the second month of fetal life: the female phenotype born mouse were recombined, have established that the depends therefore on the absence of sexual SRY protein, organ-specific epithelial cell fate of MDE is dictated by androgens, and AMH, leading to gonads composed of the underlying mesenchyme (Kurita, 2011). Tissue an inner medulla (ovarian stroma) and an outer cortex recombination studies have also demonstrated that there (parenchyma) (Standring, 2008). is a narrow developmental window for determination of the epithelial cell fate in MD-derived organs. If the sig- naling that controls epithelial differentiation is disrupted Internal genital organs: tubes, uterus, and at the critical developmental stage, the cell fate of upper vagina MD-derived epithelial tissues will be permanently In male mammals, AMH blocks the female “default” altered and can result in epithelial lesions in adult life. program, as it prevents the development of the mullerian€ Cervical/vaginal adenoses and uterine squamous epithe- ducts (MD) into the uterus and other mullerian€ struc- lium are examples of such incidences (Kurita, 2011). tures (Matuszczak et al., 2013). The effect is ipsilateral, Adenomyosis, i.e., the presence of endometrium, the that is, each testis suppresses mullerian€ development inner mucosal layer of the uterus, within the myome- only on its own side. In humans, this action takes place trium, could be the result of a disrupted epithelial differ- during the first 8 weeks of gestation. If the process is entiation, with serious clinical consequences, in terms of only ipsilateral, the co-presence of mixed internal geni- incapacitating dysmenorrhea, deep dyspareunia, and talia may result (AlJurayyan, 2013). If no AMH is pro- chronic pelvic pain (Graziottin et al., 2013). duced from the gonads, as normally happens in female subjects, or as happens in Turner syndrome (45,X0), the MD develop (Sajjad, 2010). Meanwhile the The external genitalia wolffian ducts, which are responsible for male reproduc- tive ducts, are progressively reabsorbed, occasionally The external genitalia remain sexually undifferentiated leaving only small cystic remnants (usually 1 cm in diam- until the seventh fetal week and then begin to develop eter or less) without any clinical meaning, that can be from the urogenital sinus, genital tubercle, and labio- palpated/visualized with the ecographic probe or mag- scrotal swellings. The corpora cavernosa of the clitoris netic resonance imaging in the vaginal lateral wall, on and the glands are formed from the genital tubercle; either side. the vestibule of the vagina, the labia minora, the vestib- The fallopian tubes, the uterus, and the upper part ular bulbs, and the female corpus spongiosum are (two-thirds) of the vagina originate from the mesoder- formed by the urogenital sinus and from the urogenital mal paramesonephric ducts (of Muller).€ This process folds which do not fuse together (O’Connell and De is referred to as mullerian€ organogenesis: the paired Lancey, 2005). The labioscrotal swelling does not fuse paramesonephric ducts (MD) fuse to form a confluence; either and forms the labia majora. ANATOMY AND PHYSIOLOGY OF GENITAL ORGANS – WOMEN 41 A knowledge of the embryonic differentiation of sex- THE ADULT GENITAL ORGANS ual apparatus is important to understand congenital mal- formations, so-called mullerian€ anomalies. They have a The external genitalia prevalence of 4–7% (Chan et al., 2011) and result from an The external genitalia consist of
Load more

Recommended publications
  • Te2, Part Iii
    TERMINOLOGIA EMBRYOLOGICA Second Edition International Embryological Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TE2, PART III Contents Caput V: Organogenesis Chapter 5: Organogenesis (continued) Systema respiratorium Respiratory system Systema urinarium Urinary system Systemata genitalia Genital systems Coeloma Coelom Glandulae endocrinae Endocrine glands Systema cardiovasculare Cardiovascular system Systema lymphoideum Lymphoid system Bibliographic Reference Citation: FIPAT. Terminologia Embryologica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, February 2017 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Embryologica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: ORGANOGENESIS Chapter 5: ORGANOGENESIS
    [Show full text]
  • Comparative Gene Expression Analysis of Genital Tubercle Development Reveals a Putative Appendicular Wnt7 Network for the Epidermal Differentiation
    Developmental Biology 344 (2010) 1071–1087 Contents lists available at ScienceDirect Developmental Biology journal homepage: www.elsevier.com/developmentalbiology Genomes & Developmental Control Comparative gene expression analysis of genital tubercle development reveals a putative appendicular Wnt7 network for the epidermal differentiation Han Sheng Chiu a, John C. Szucsik b, Kylie M. Georgas a, Julia L. Jones c, Bree A. Rumballe a, Dave Tang a, Sean M. Grimmond a, Alfor G. Lewis b, Bruce J. Aronow b,c, James L. Lessard b, Melissa H. Little a,⁎ a Institute for Molecular Bioscience, The University of Queensland, St. Lucia 4072, Australia b Division of Developmental Biology, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229, USA c Division of Biomedical Informatics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH 45229, USA article info abstract Article history: Here we describe the first detailed catalog of gene expression in the developing lower urinary tract (LUT), Received for publication 30 November 2009 including epithelial and mesenchymal portions of the developing bladder, urogenital sinus, urethra, and Revised 23 April 2010 genital tubercle (GT) at E13 and E14. Top compartment-specific genes implicated by the microarray data Accepted 15 May 2010 were validated using whole-mount in situ hybridization (ISH) over the entire LUT. To demonstrate the Available online 24 May 2010 potential of this resource to implicate developmentally critical features, we focused on gene expression Keywords: patterns and pathways in the sexually indeterminate, androgen-independent GT. GT expression patterns Genital tubercle development reinforced the proposed similarities between development of GT, limb, and craniofacial prominences. Lower urinary tract development Comparison of spatial expression patterns predicted a network of Wnt7a-associated GT-enriched epithelial Gene expression genes, including Gjb2, Dsc3, Krt5, and Sostdc1.
    [Show full text]
  • Study of Feasibility of Laparoscopic Inguinal Hernia
    STUDY OF FEASIBILITY OF LAPAROSCOPIC INGUINAL HERNIA SURGERY IN TAIPING HOSPITAL BY DR HASSLINDA BINTI ABU HASSAN M.D (UNIMAS) DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF MASTERS OF MEDICINE (GENERAL SURGERY) UNIVERSITI SAINS MALAYSIA 2010 [ii] II . ACKNOWLEDGEMENTS I wish to express my sincere thanks, gratitude and appreciation to the following individuals, without whom my dissertation would have not been possible: School of Medical Sciences, University Sains Malaysia and Department of Surgery, Hospital Universiti Sains Malaysia (HUSM), Kubang Kerian for granting me the approval to proceed with the study. Dr Syed Hassan Syed Aziz ,my supervisor for his guidance, beneficial advice and assistant to ensure successful completion of this dissertation. Dr Zulkarnain Hasan, my co-supervisor for his patience, guidance and encouragement on helping me to complete this study. Dr Zainal Mahamood, the previous Head of Department of Surgery, our current Head Dr Mohd Nor Gohar Rahman and all the lecturers in Department of Surgery, HUSM for their continuous support and encouragement. Prof Dr Syed Hatim for his knowledge and guidance in statistics and analysis. Dr. Vimal K.Vasudeavan and Dr Umasangar Ramasamy, my field supervisor and co- supervisor in Hospital Taiping whom has given undivided attention and support, supervision and assistant in the preparation of this study and throughout the duration of the program. [iii] Not forgotten, my colleagues from Hospital Taiping,Dr Satkunan Mark and Dr Calvin Dinash for helping me with the data collection, patient recruitment and follow up of the case study. My course mates, Dr Nik Marila, Dr Ismazizi, Dr Syauki and Dr Ainilhayat for their great assistance and encouragement upon completing these hard tasks.
    [Show full text]
  • MR Imaging of Vaginal Morphology, Paravaginal Attachments and Ligaments
    MR imaging of vaginal morph:ingynious 05/06/15 10:09 Pagina 53 Original article MR imaging of vaginal morphology, paravaginal attachments and ligaments. Normal features VITTORIO PILONI Iniziativa Medica, Diagnostic Imaging Centre, Monselice (Padova), Italy Abstract: Aim: To define the MR appearance of the intact vaginal and paravaginal anatomy. Method: the pelvic MR examinations achieved with external coil of 25 nulliparous women (group A), mean age 31.3 range 28-35 years without pelvic floor dysfunctions, were compared with those of 8 women who had cesarean delivery (group B), mean age 34.1 range 31-40 years, for evidence of (a) vaginal morphology, length and axis inclination; (b) perineal body’s position with respect to the hymen plane; and (c) visibility of paravaginal attachments and lig- aments. Results: in both groups, axial MR images showed that the upper vagina had an horizontal, linear shape in over 91%; the middle vagi- na an H-shape or W-shape in 74% and 26%, respectively; and the lower vagina a U-shape in 82% of cases. Vaginal length, axis inclination and distance of perineal body to the hymen were not significantly different between the two groups (mean ± SD 77.3 ± 3.2 mm vs 74.3 ± 5.2 mm; 70.1 ± 4.8 degrees vs 74.04 ± 1.6 degrees; and +3.2 ± 2.4 mm vs + 2.4 ± 1.8 mm, in group A and B, respectively, P > 0.05). Overall, the lower third vaginal morphology was the less easily identifiable structure (visibility score, 2); the uterosacral ligaments and the parau- rethral ligaments were the most frequently depicted attachments (visibility score, 3 and 4, respectively); the distance of the perineal body to the hymen was the most consistent reference landmark (mean +3 mm, range -2 to + 5 mm, visibility score 4).
    [Show full text]
  • Cranial Cavitry
    Embryology Endo, Energy, and Repro 2017-2018 EMBRYOLOGY OF THE REPRODUCTIVE SYSTEM Janine Prange-Kiel, Ph.D. Office: L1.106, Phone: 83117 Email: [email protected] LEARNING OBJECTIVES: • Name the structures in kidney development that contribute to the development of the reproductive organs. • Predict how the presence or absence of the Y chromosome and the expression of the SRY gene would influence the development of the gonads. • Predict how the presence or absence of testosterone, dihydrotestosterone, and anit- Mullerian hormone would influence the development of the genital ducts and indifferent primordia of the external genitalia. I. Introduction In general, the function of the genital (reproductive) system in males and females is the formation, nurture, and transport of germ cells. In females, an additional function is to provide the proper milieu for the fetal development after conception. Like the urinary system, the genital system derives from intermediate mesoderm. The development of these two systems is tightly interwoven as structures that develop as parts of the urinary system gain function in the genital system. In the adult, the sexual organs differ between males and females. The early genital system, however, is similar in both sexes, and the sexual differentiation of this initially indifferent, bipotential system starts only in the seventh week of embryonic development. The details on how sexual differentiation is determined will be discussed below, but it is worth mentioning here that irregularities in this process result in disorders of sexual differentiation (DSDs). DSDs occur in approximately 1 in 4,500 live births and will be discussed in a separate lecture.
    [Show full text]
  • Development of the Human Penis and Clitoris
    Differentiation xxx (xxxx) xxx–xxx Contents lists available at ScienceDirect Differentiation journal homepage: www.elsevier.com/locate/diff ☆ Development of the human penis and clitoris ⁎ ⁎⁎ Laurence Baskin , Joel Shen, Adriane Sinclair , Mei Cao, Xin Liu1, Ge Liu1, Dylan Isaacson, Maya Overland, Yi Li, Gerald R. Cunha UCSF, USA ARTICLE INFO ABSTRACT Keywords: The human penis and clitoris develop from the ambisexual genital tubercle. To compare and contrast the de- Development velopment of human penis and clitoris, we used macroscopic photography, optical projection tomography, light Human sheet microscopy, scanning electron microscopy, histology and immunohistochemistry. The human genital tu- Penis bercle differentiates into a penis under the influence of androgens forming a tubular urethra that develops by Clitoris canalization of the urethral plate to form a wide diamond-shaped urethral groove (opening zipper) whose edges Canalization and fusion (urethral folds) fuse in the midline (closing zipper). In contrast, in females, without the influence of androgens, the vestibular plate (homologue of the urethral plate) undergoes canalization to form a wide vestibular groove whose edges (vestibular folds) remain unfused, ultimately forming the labia minora defining the vaginal ves- tibule. The neurovascular anatomy is similar in both the developing human penis and clitoris and is the key to successful surgical reconstructions. 1. Introduction literature, in recent years we have recognized that the mouse is not the ideal model for normal human penile development and hypospadias for Male and female external genitalia play an essential role in human a host of reasons (Cunha et al., 2015; Liu et al., 2018b; Sinclair et al., reproduction, and disorders of structure and function of male and fe- 2016).
    [Show full text]
  • Temporal and Spatial Dissection of Shh Signaling in Genital Tubercle Development Congxing Lin1, Yan Yin1, G
    RESEARCH ARTICLE 3959 Development 136, 3959-3967 (2009) doi:10.1242/dev.039768 Temporal and spatial dissection of Shh signaling in genital tubercle development Congxing Lin1, Yan Yin1, G. Michael Veith1, Alexander V. Fisher1, Fanxin Long2,3 and Liang Ma1,3,* Genital tubercle (GT) initiation and outgrowth involve coordinated morphogenesis of surface ectoderm, cloacal mesoderm and hindgut endoderm. GT development appears to mirror that of the limb. Although Shh is essential for the development of both appendages, its role in GT development is much less clear than in the limb. Here, by removing Shh at different stages during GT development in mice, we demonstrate a continuous requirement for Shh in GT initiation and subsequent androgen-independent GT growth. Moreover, we investigated the Hh responsiveness of different tissue layers by removing or activating its signal transducer Smo with tissue-specific Cre lines, and established GT mesenchyme as the primary target tissue of Shh signaling. Lastly, we showed that Shh is required for the maintenance of the GT signaling center distal urethral epithelium (dUE). By restoring Wnt- Fgf8 signaling in Shh–/– cloacal endoderm genetically, we revealed that Shh relays its signal partly through the dUE, but regulates Hoxa13 and Hoxd13 expression independently of dUE signaling. Altogether, we propose that Shh plays a central role in GT development by simultaneously regulating patterning of the cloacal field and supporting an outgrowth signal. KEY WORDS: Shh, Genital tubercle, Cloaca, Hox, Mouse INTRODUCTION malformations are often accompanied by a persistent cloaca External genitalia (the penis in males and clitoris in females) are (Haraguchi et al., 2001; Haraguchi et al., 2007; Perriton et al., 2002; reproductive organs specialized for internal fertilization.
    [Show full text]
  • New Insights from One Case of Female Ejaculationjsm 2472 3500..3504
    3500 CASE REPORTS New Insights from One Case of Female Ejaculationjsm_2472 3500..3504 Alberto Rubio-Casillas, Biologist* and Emmanuele A. Jannini, MD† *Escuela Preparatoria Regional de Autlán, Biology Laboratory, Universidad de Guadalajara, Guadalajara, México; †Course of Endocrinology and Sexology, Department of Experimental Medicine, University of L’Aquila, Rome, Italy DOI: 10.1111/j.1743-6109.2011.02472.x ABSTRACT Introduction. Although there are historical records showing its existence for over 2,000 years, the so-called female ejaculation is still a controversial phenomenon. A shared paradigm has been created that includes any fluid expulsion during sexual activities with the name of “female ejaculation.” Aim. Todemonstrate that the “real” female ejaculation and the “squirting or gushing” are two different phenomena. Methods. Biochemical studies on female fluids expelled during orgasm. Results. In this case report, we provided new biochemical evidences demonstrating that the clear and abundant fluid that is ejected in gushes (squirting) is different from the real female ejaculation. While the first has the features of diluted urines (density: 1,001.67 Ϯ 2.89; urea: 417.0 Ϯ 42.88 mg/dL; creatinine: 21.37 Ϯ 4.16 mg/dL; uric acid: 10.37 Ϯ 1.48 mg/dL), the second is biochemically comparable to some components of male semen (prostate-specific antigen: 3.99 Ϯ 0.60 ¥ 103 ng/mL). Conclusions. Female ejaculation and squirting/gushing are two different phenomena. The organs and the mecha- nisms that produce them are bona fide different. The real female ejaculation is the release of a very scanty, thick, and whitish fluid from the female prostate, while the squirting is the expulsion of a diluted fluid from the urinary bladder.
    [Show full text]
  • 1- Development of Female Genital System
    Development of female genital systems Reproductive block …………………………………………………………………. Objectives : ✓ Describe the development of gonads (indifferent& different stages) ✓ Describe the development of the female gonad (ovary). ✓ Describe the development of the internal genital organs (uterine tubes, uterus & vagina). ✓ Describe the development of the external genitalia. ✓ List the main congenital anomalies. Resources : ✓ 435 embryology (males & females) lectures. ✓ BRS embryology Book. ✓ The Developing Human Clinically Oriented Embryology book. Color Index: ✓ EXTRA ✓ Important ✓ Day, Week, Month Team leaders : Afnan AlMalki & Helmi M AlSwerki. Helpful video Focus on female genital system INTRODUCTION Sex Determination - Chromosomal and genetic sex is established at fertilization and depends upon the presence of Y or X chromosome of the sperm. - Development of female phenotype requires two X chromosomes. - The type of sex chromosomes complex established at fertilization determine the type of gonad differentiated from the indifferent gonad - The Y chromosome has testis determining factor (TDF) testis determining factor. One of the important result of fertilization is sex determination. - The primary female sexual differentiation is determined by the presence of the X chromosome , and the absence of Y chromosome and does not depend on hormonal effect. - The type of gonad determines the type of sexual differentiation in the Sexual Ducts and External Genitalia. - The Female reproductive system development comprises of : Gonad (Ovary) , Genital Ducts ( Both male and female embryo have two pair of genital ducts , They do not depend on ovaries or hormones ) and External genitalia. DEVELOPMENT OF THE GONADS (ovaries) - Is Derived From Three Sources (Male Slides) 1. Mesothelium 2. Mesenchyme 3. Primordial Germ cells (mesodermal epithelium ) lining underlying embryonic appear among the Endodermal the posterior abdominal wall connective tissue cell s in the wall of the yolk sac).
    [Show full text]
  • And Sexual Behaviour of Local X Orgasm (Female)
    SINGAPORE MEDICAL JOURNAL SOME ASPECTS OF SEXUAL KNOWLEDGE AND SEXUAL BEHAVIOUR OF LOCAL WOMEN - RESULTS OF A SURVEY: X ORGASM (FEMALE) V Atputharajah SYNOPSIS 1012 sexually active females were interviewed regarding their sexual practices. 85 of 94 (90.4 percent) of those who masturbated reached orgasm while 5.3 percent did not. 63.5 percent of those who did reach orgasm by masturbation, thought that orgasm at intercourse felt better than that at mastur- bation. 15.3 percent felt that orgasm felt the same with either activity. 12.1 percent of the total sample (11.0 percent of married women and 20.7 percent of unmarried women) did not get orgasm at inter- course. 13.0 percent (13.3 percent of married women and 11.3 percent of unmarried women) orgasmed at every coital experience. 91 percent (91.9 percent of married women and 84.9 percent of unmarried women) said they enjoyed intercourse. Orgasm, its nature, onset and role and its significance and technique to achieve it are discussed. INTRODUCTION Orgasm is described as the ultimate and most fantastic sensa- tion ever experienced and is a cortical sensory experience. It is limited to a few seconds of physical release and is the acme of pleasure for most people. During the few seconds the vasocon- gestion and myotonia from Department of Obstetrics and Gynaecology developed sexual stimulation is Alexandra Hospital released. This release gives a great renewal of all the senses and Alexandra Road a complete relief of boredom (1,2,3). Singapore 0314 The female orgasm appears to be more vulnerable to inhibition than does the male's.
    [Show full text]
  • Controversy About Embryogenesis and Organisation of Human Female Urethra: a Review P
    October 2014 EAST AFRICAN MEDICAL JOURNAL 341 East African Medical Journal Vol. 91 No. 10 October 2014 CONTROVERSY ABOUT EMBRYOGENESIS AND ORGANISATION OF HUMAN FEMALE URETHRA: A REVIEW P. Gichangi, BSc (Anat Hons) MBChB, MMed (O/G), PhD, Department of Human Anatomy, University of Nairobi, P.O Box 2631-00202, Nairobi, Kenya CONTROVERSY ABOUT EMBRYOGENESIS AND ORGANISATION OF HUMAN FEMALE URETHRA: A REVIEW P. GICHANGI ABSTRACT Objective: To assess current knowledge on development and associated structures. Data sources: Current scientific publications in the pubmed data base on the development of human female urethra were reviewed. The embryology of human female urethra and its associated structures is presented. Study selection: The following search words: urethra development, female urethra development, and male urethra development were used. Data extraction: The first 100 publications from urethra development search and thereafter 100 publications excluding those in the first search were reviewed to determine whether they described development of female urethra. Data synthesis: There are limited studies describing the formation of female urethra. Unlike male urethra, female urethra does not undergo masculinisation meaning there is no formation of clitoral urethra. Like the male urethra, there are female urethra associated glands whose presence and functions remain speculative. Female urethra associated structures including Skene’s glands also referred to as female prostate, corpus spongiosum of female urethra and what has been described as the G-Spot may all be congenital malformations considering that they are not uniformly present. Conclusions: Female urethra development differs from that of males though there are some similarities. Studies to elucidate the development of female urethra are needed to clarify some of the misconceptions and to provide embryological explanation of gross and histological features of female urethra.
    [Show full text]
  • An International Urogynecological Association (IUGA)
    Received: 18 December 2017 | Accepted: 18 December 2017 DOI: 10.1002/nau.23508 TERMINOLOGY An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction Rebecca G. Rogers MD1 | Rachel N. Pauls MD2 | Ranee Thakar MD3 | Melanie Morin PhD4 | Annette Kuhn MD5 | Eckhard Petri Dd, PhD6 | Brigitte Fatton MD7 | Kristene Whitmore MD8 | Sheryl Kinsberg PhD9 | Joseph Lee MBChB, FRANZCOG10 1 Dell Medical School, University of Texas, Austin, Texas 2 TriHealth Good Samaritan Hospital, Cincinnati, Ohio 3 Croydon University Hospital Croydon, London, United Kingdom 4 Universite de Sherbrooke, Montreal, Quebec, Canada 5 University Teaching Hospital Berne (Inselspital), Bern, Switzerland 6 University of Greifswald, Schwerin, Germany 7 University Hospital Nîmes, Nimes, Languedoc-Roussillon, France 8 Drexel University College of Medicine, Philadelphia, Pennsylvania 9 Case Western Reserve University, Cleveland, Ohio 10 University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia Correspondence Aims: The terminology in current use for sexual function and dysfunction in women Rebecca G. Rogers, Department of Women's Health, 1301 W 38th Street, with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, Suit705, Dell Medical School, University and unintended ambiguity. The terminology for the sexual health of women with of Texas, Austin, TX 78705. pelvic floor dysfunction needs to be collated in a clinically-based consensus report. Email: [email protected] Methods: This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees.
    [Show full text]