Genital Self-Exam Discussion question (#3-A): • What are some slang terms for female • Increases sexual comfort! genitalia and breasts? Keep track of how – Feeling familiar and Chapter 3 comfortable with one’s many terms your group knows. ! anatomy can enhance sexual • Are these terms positive or negative?! experiences! Female Sexual • Why do people tend to use “nicknames” • Monitor for changes Anatomy & Physiology for parts of the female sexual anatomy? ! related to health! – If you don’t know what • How might men and women become “normal” looks like, you can’t more comfortable using correct terms for know if something seems female anatomy?! abnormal and requires medical attention.!
Vulvas are varied Tour of the Vulva Tour of the Vulva Labia minora (inner lips):! Mons veneris (from Latin “mound of Venus”):! • Vulva = all female external genital structures! - Within outer lips; may protrude between them.! - Triangular mound over the pubic bone.! - Hairless folds of skin that join at the prepuce (clitoral hood) and! – Includes hair, folds of skin, and urinary and vaginal - Pads of fatty tissue btwn. pubic bone and skin.! extend down past urinary and vaginal openings! openings! - Touch and pressure can be pleasurable—some nerve endings present! - Contain sweat glands, blood vessels, and nerve endings.! - At puberty, becomes covered with hair! - Vary considerably in size, shape, and color; become darker in! -THEORIES WHY:! - traps pheromones from vaginal secretions, adding to sensory erotic pleasure.! color during arousal & pregnancy.! - Reduces friction & skin irritation! - Keeps dirt out!
Labia majora (outer lips):! - Extend downward from mons ! veneris on each side of vulva.! - Like mons veneris, touch and ! pressure can be pleasurable ! due to numerous nerve endings!.
Tour of the Vulva Tour of the Vulva Underlying Structures of the Vulva Clitoris:! (Fig 4.2) - Highly sensitive structure in vulva. ! Vestibule:! - The only organ in the human body ! - Area inside labia minora.! whose only function is pleasure.! - Urinary and vaginal openings are located within the vestibule.! - Consists of:! - glans: ~ same # of nerve endings ! as glans of penis! -shaft : has small spongy structures ! that engorge with blood during ! sexual arousal.! - internal crura (roots)! Perineum:! - Covered by clitoral hood! - Area of skin between the – Fill with blood during arousal, - Stimulation of clitoris is the most! vaginal opening and the anus! causing vulva to swell and vagina to common way that most women! - Must stretch a lot during increase in length.! childbirth!! – Similar in structure and function to Secrete drop or two of fluid achieve orgasm. ! just before orgasm.! - Average length of entire clitoris (tip of tissue in penis that engorges during glans to ends of crura) is 4 inches!! arousal, causing erection.! Underlying Structures of the Vulva Kegel Exercises Internal Structures “THE PELVIC FLOOR” • WHY! • Vagina ! – All: prevent incontinence in older years! – ~3-5 in. long--elongates during arousal, stretches during childbirth, etc.! – All: increase sensation & orgasmic intensity! – Arousal and vaginal lubrication! – Women: regain urinary control after • Vaginal tissue blood vessels become engorged, causing clear childbirth! fluid from the tissues to moisten inside of vaginal wall.! – Men: increase ejaculatory control! • lubrication changes (!) vaginal pH and increases pleasure! • HOW! – Grafenberg (G) spot! – Locate muscles! • Anterior (front) wall of vagina! • Female equivalent of prostate gland! – Slow: Contract 10 sec, relax 10 sec, – Secretions & chemical balance !! repeat 10x (can start w/ 5 sec and work to 10)! • Douching, feminine hygiene – Fast: Contract and relax rapidly 10-25x! sprays, etc. are not only Fig. 4.3 The underlying muscles of the vulva. These muscles can be strengthened – Can be done 3x a day! unnecessary, they cause using the Kegel exercises described in the text. numerous health problems.!
Internal Structures Internal Structures • Cervix ! • Uterus (or womb) ! – At the upper/back end of the vagina! – Hollow, thick, pear-shaped – Leads into uterus! organ! • Os: the small opening in the cervix that leads into uterus! – 3 in. long, 2 in. wide in woman who has not had a child. ! – Dilates to 10 cm opening during labor & birth! – Walls consist of 3 layers! - Anterior • External: perimetrium! (front) wall of • Middle: myometrium ! vagina, about 2-3 – (stretching, contraction)! inches inside! • Inner: endometrium ! – (nourishes zygote, sheds each month if no fertilization End of cycle; this woman during menstruation)! During ovulation! has had 4 vaginal births!
[Images printed w/permission from www.beautifulcervix.com]!
Internal Structures Internal Structures The Breast • Fallopian tubes! • Ovaries! – Extend from uterus to each ovary (each tube about 4 in.)! – Endocrine glands that produce ova (eggs) and sex – Lined with cilia to help move ovum along tube! hormones.! – Outside end of each tube is shaped like a funnel, with – 3 types of hormones produced:! fringelike projections called fimbriae! • Estrogens! • Fimbriae draw egg into tube Fertilization • Progesterone! after it leaves the ovary! occurs fairly • Testosterone! close to ovary – Ectopic pregnancy: when – Ovulation: the release fertilized ovum implants of a mature egg (ovum) outside of the uterus from the ovary into the (usually in the fallopian tube).! fallopian tube! • Can rupture the tube and • ~400,000 ova at birth! cause uncontrolled bleeding ! • Only about 400 will mature! Only one ovary is generally releasing an egg! during each cycle! Cross-section front and side views of the female breast. Female Circumcision: The Breast Breasts come in lots of shapes and sizes • Mammary glands produce milk! Torture or Tradition? {Short documentary} • Media/porn, etc. has distorted our idea of what a – - fatty tissue determines size! “normal” breast looks like! – - amount of glandular tissue ! • Some normal breasts: (from http://www.007b.com/breast_gallery.php)! – is ~= among women! • • Therefore, amount of milk for ! • breastfeeding does NOT ! • correlate with breast size.!
• Areola is darker area ! • Nipple is in center of areola! – Has many nerve endings & has openings for milk.! • Practiced in >40 countries in Africa, the • Breasts are secondary sex characteristics! – Physical characteristics other than genitals that indicate sexual Middle East, and Asia maturity (such as body hair, breasts, and deepened voice).! • Approx. 130 million women/girls worldwide
Female Circumcision Discuss… Female Circumcision - Anatomical Parts Involved Cutting • A friend of yours confides in you that she bleeds even when she isn’t on her period and Procedures that she knows she had some sort of operation done on her genitalia when she Unaltered Vulva Clitoridectomy was younger and living in Egypt.
What kind of procedure could she have had? Explain each type of female circumcision procedure, being sure to address specific anatomical reproductive parts. Variation of Genital Clitoridectomy Infibulation
The first menstrual cycle: Menstrual physiology The Menstrual Cycle • Menarche (initial onset)! is necessary for pregnancy – age 11-15 (avg: about 12.5 yr)! • flow lasts from 2 to 6 days! – related to heredity, health, altitude! • volume varies (6 to 8 ounces)! – Age has decreased over time:! • Many reasons proposed, including • duration varies (24 to 42 days) ! environmental estrogens (in pesticides, etc.), obesity, stress.! • menstrual synchrony: • Menstrual physiology! simultaneous menstrual cycles – flow lasts from 2 to 6 days! that sometimes occur among – volume varies (6 to 8 ounces)! – duration varies (24 to 42 days) ! women who live together! – menstrual synchrony: simultaneous menstrual cycles that sometimes occur among women who live in close proximity.! Attitudes toward Menstruation What changes happen in a woman’s Day! body during the menstrual cycle? • In the U.S., girls used to be taught that menstruation 1"14! • hypothalamus releases hormone was dirty, something to be hidden.! that stimulates pituitary gland! – See ads “feminine hygiene products” (next slide)! • Some positive cultural attitudes toward menstruation! • pituitary produces:! – Association with transformation to adulthood, purification, – Follicle-stimulating hormone (FSH):! spirituality, connectedness with natural cycles.! • Induces Estrogen production in ovaries! • Today, even w/negative attitudes, most women • Ovum maturation in follicles inside ovaries! associate regular menstruation with health.! – Luteinizing hormone (LH):! • Research has shown that women who have positive • Stimulates release of mature attitudes and comfort w/menstruation are more likely ovum (this!is!“ovulation”)! to be comfortable with their bodies and their sexuality. !
(Menstruation!occurs!in!first!~7!days)!!
What changes happen in a woman’s Day! What changes happen in a woman’s Back! Changes during body during the menstrual cycle? 14"28! body during the menstrual cycle? to! menstrual cycle Day!1! again! FSH & LH levels!
Uterine lining Changes in the ovary! thickens!
Levels of estrogen & progesterone! • Egg takes a week to make its way down to the uterus! • After the follicle releases the egg, the follicle cells become Changes in the the corpus luteum, which releases progesterone that endometrium! thickens the uterine lining in case a fertilized egg needs to • Uterine lining (endometrium) is shed as menstrual flow! implant there.!
Menstrual cycle concept map Menstrual cycle problems Each term is linked to 1 or more terms with • Premenstrual syndrome (PMS) - catchall term for arrows; labels across arrows define the a number of symptoms of physical discomfort and connection between the terms emotional irritability 2-12 days before menstruation! Is!there!anything! – PMDD (Premenstrual dysphoric disorder): Premenstrual symptoms severe enough to significantly affect a woman’s a!woman!can!do! • endometrium • ovulation functioning! to!alleviate!her! • corpus luteum • follicle • Dysmenorrhea - pain or discomfort before or during menstruation - Can include cramping, backache, headache, symptoms!of!PMS?! • ovum • FSH nausea, fatigue! • LH • estrogen • Amenorrhea - absence of menstruation! • Implantation – Can be caused by too little body fat (amenorrhea is common in • Progesterone training athletes, women with anorexia nervosa) ! • pituitary gland • menstrual flow Sexual activity and the Menopause Yes!! menstrual cycle • Terms! • Libido is typically maximal around ovulation, as well as during menstruation! – Peri-menopause: time before menopause, when estrogen levels are decreasing! • There are no medical reasons to avoid sex during menstruation! • Orgasm during menstruation can be – Menopause: permanent cessation of menstruation! beneficial--relieves, backache, cramping, etc. ! • Average age is 51 (range: 30s to 60s)!
Menopause (cont.) Hormone Therapy during Alternatives to Hormone Therapy and after menopause • Lifestyle factors! • Symptoms vary from mild to strong (due mostly • Hormone therapy: the use of supplemental to the decline in estrogen levels)! – Women who are sexually active have fewer changes hormones (estrogen, progesterone, testosterone) ! in vaginal tissues and lubrication.! – hot flashes or warm spells from rapid dilation of blood – Benefits: (mostly estrogen) can reduce hot flashes, – Exercise, avoiding caffeine, tobacco, alcohol, and spicy vessels (about 75% of women experience these)! night sweats, vaginal dryness, loss of bone density and foods can reduce hot flashes.! – night sweats, interrupted sleep ! (mostly testosterone) increase overall energy and • Vitamins and herbs! – headaches, poor concentration! sexual interest! – Calcium supplements, vitamin D, and weight-bearing – depression, anxiety! – Problems: Increased risk of exercise can prevent osteoporosis.! – vaginal dryness, reduced libido! endometrial, ovarian, and breast – Vitamin E, herbs (e.g. dong quai or black cohosh) can cancer; increased risk of blood clots, relieve symptoms such as hot flashes.! cardiovascular disease (prog. HT)!
Gynecological Health Concerns Douching – Challenge Statement • Urinary tract infections (UTIs)! – Usually from bacteria that enter urethral opening.! – If infection spreads past bladder into kidneys, “Douching is a good thing Female A & P: severe illness can result.! because it gets rid of the – Treatable with antibiotics.! gross smell down there some health issues – Prevention: ! and contributes to a ! Wipe from front to back (from vulva to anus)! healthier vagina”! " Don’t introduce bacteria from rectum into the ! vagina during sexual activity.! # Don’t hold your pee.! Agree or disagree? What $ Only water-soluble lubricants! ! about this statement do % Urinate after intercourse.! you agree or disagree with?! Happy vagina Gynecological Health Concerns (cont). Gynecological Health Concerns (cont). says, “Don’t • Vaginal infections (aka vaginitis)! • Cysts! douche me!” – Include yeast infections, bacterial infections, etc. – Fluid-filled sacs that sometimes grow on the ovary! (more in Chp. 17)! – Fairly common, usually resolve on their own! • Douching destroys chemical and – Some factors that increase susceptibility to vaginitis:! – Need to be monitored if they become painful! bacterial balance! • Diabetes! • Endometriosis! – Vagina usually 4.5 pH—douching messes this up! • Antibiotic use! • Stress! – Condition in which uterine endometrial tissue grows • Promotes yeast and bacterial infections! on various parts of the pelvic cavity.! • If there is an infection, douching can push bacteria • Diet high in simple carbohydrates! • Intercourse w/o adequate lubrication! – Cause pelvic pain, often quite severe! up into uterus, fallopian tubes, ovaries! • Hormonal changes due to pregnancy or birth control pills! – Can cause infertility! • Correlated w/increased risk of ectopic pregnancy, • Wearing nylon underwear or panty hose (trap heat and • Self-exams & vaginal health care! endometriosis, pelvic inflammatory disease, HIV, ! moisture)! • Douching ! – The greater awareness a woman has about her body, • Correlated w/decreased fertility! the better able she will be to diagnose problems.! • Unprotected sex (STIs can cause vaginitis)!
Surgical removal of the uterus or ovaries Cancer Cancer: Out of Control Cell Division • Hysterectomy: surgical removal of the uterus.! • Why would a cell start dividing too often?! • Oophorectomy: surgical removal of the ovaries! • In women: ovarian, cervical, • Can be necessary due to bleeding disorders, pelvic uterine, breast cancers! – Mutations! infections, fibroids, cancer.! • Hysterectomy is most frequently performed operation • What is cancer?! in U.S.--1/3 of women <65 will have a hysterectomy! – cell division out of control! Mutation 1 – more frequently performed on low income, less educated Proto-Oncogene Oncogene women! • Controls Normal Cell Division • Rapid Cell Division • Can affect sexual responsiveness somewhat due to hormonal changes, loss of nerves in the pelvis, loss of Mutation 2 ability to have uterine contractions.! Cancer? • There are some alternatives to surgery--women should Tumor Suppressor Tumor Suppressor be fully informed about all options.! Protein No Longer Gene Works • Protein Kills Out of Control Cells
Multiple Mutations in DNA Blueprint Cancer Treatments Needed for Cancer • Proto-oncogene & Oncogene! – Rapid Cell Division!
X Multiple Mutations Burn! X Radiation!
Cut! Surgery! • Tumor Suppressor Gene & Turned Off! Poison! – Body Stops Killing Out of Control Cells! Chemotherapy! Why is it so important that breast tissue cells divide only at the Possible Timeline: Cancer appropriate time? Breast Cancer: Out of Control Cell Division in the Breasts
metastasis!
Normal Mammogram Cancer Mammogram
Breast cancer detection & prognosis Breast cancer screening Breast cancer screening, (cont.) • Breast exams: early detection is best b/c treatments • Mammography: X-ray of the breast! • Early detection increases survival b/c cancer is work better on early stage cancers! – Can detect breast lump before it can be felt manually.! usually found at an earlier stage.! – Recommended yearly for women over 50! – self-exam following menstruation! • Inequity: the 5-year survival rate is lower for – Sometimes recommended for women between 40-50, – routine healthcare provider exams! minority women than for white women, most though mammograms are less effective in women likely due to differences in access to preventive under 50 b/c the breast tissue is more dense.! health care.! – Can miss tumors--! • better screening methods are needed.! Percentage of cancer ! Survival Rate! Stage of cancer! diagnosed at this stage! at 5 years (%)! Local (confined to breast) ! ! 60 ! !! 98! Regional (spread to lymph nodes) ! 31 ! !! 76! Distant (spread to other organs) ! 6 ! !! 16!
The Pap Smear Not a Normal Trip to the Doctor Breast cancer: risk factors • Screens for cervical cancer.! • Risk rises with age! • Cells are taken from the cervix • Your friend tells you she recently had testing • Growing evidence indicates that synthetic chemicals and examined under the done at the doctor’s office, and the doctor found in plastics, pesticides, detergents, and cosmetics microscope! discovered a malignant tumor in one of her can increase the risk of breast cancer! • Since widespread use of Pap smears breasts that has metastasized. She is too upset to began in 1950s, the rate of death listen what the doctor has to say, and asks you to from cervical cancer has help her make sense of it all.! decreased dramatically b/c if cancer is found, it is usually at a very early stage.!
Explain to your friend your understanding of normal dysplasia cervical cancer how cancer is caused. Include the terms malignant, metastasis, mitosis, mutation, oncogene, proto-oncogene, and tumor suppressor gene in your response. Breast cancer activism • 3 local groups committed to increasing awareness of • Cosmetics and personal care products are not tested by breast cancer and advocating the Food and Drug Administration (FDA) because they for breast cancer prevention.! are not foods and are not drugs! – Breast Cancer Fund (S.F.)! – Nonetheless, chemicals in these products can penetrate our – Breast Cancer Action (S.F.)! skin and our bodies.! – Women’s Cancer Resource • To check your personal care Center (Berkeley)! products and, if necessary, look for • Resource library, support- safer alternatives, go to: groups! www.cosmeticsdatabase.com!