Chapter 2 Chapter 3 2 Iema|e Anatomy and hys|o|ogy Lxterna| Gen|ta||a (Vu|va) - Mons venerls - Labla Ma[ora - Labla Mlnora - CllLorls - vaglnal Cpenlng - vesubule - erlneum - ureLhral Cpenlng - Pymen - 8arLholln's Clands Interna| Gen|ta||a - vaglna - Cervlx - uLerus - CvldcuLs (lalloplan 1ubes) - Cvarles 3 Iema|e Anatomy and hys|o|ogy Lxterna| Sex Crgans Mons Vener|s (ub|s) - fauy ussue LhaL covers Lhe [olnL of Lhe publc bones - ln fronL of body, below abdomen, and above Lhe cllLorls - acLs as a cushlon durlng lnLercourse - ample nerves, sensluve Lo Louch 4 Lxterna| Sex Crgans Lab|a Ma[ora - large folds LhaL run downwards from Lhe mons on Lhe ouLslde of Lhe vulva - when close LogeLher, Lyplcally hlde Lhe oLher parLs of Lhe genlLals (l.e., vaglnal openlng, Lhe ureLhra, and for some women, Lhe labla mlnora) - provlde proLecuon - ouLer poruon covered wlLh publc halr, lnner poruon halrless - very sensluve Lo Louch Iema|e Anatomy and hys|o|ogy 2 3 Lxterna| Sex Crgans Aesthencs - publc halr removal (anecdoLally): looks beuer feels beuer (sensluvlLy) beuer for oral sex doesn'L hold odor easler Lo clean - va[azzllng - dylng Iema|e Anatomy and hys|o|ogy 6 Lxterna| Sex Crgans Lab|a M|nora - halrless llps LhaL slL lnslde Lhe labla ma[ora - surround Lhe ureLhral and vaglnal openlng - ouLer surface merge wlLh Lhe labla ma[ora and aL Lhe Lop, [oln wlLh Lhe c||tora| hood - when sexually aroused, engorge wlLh blood - become swollen and darker - huge varlauon ln slze, shape, symmeLry, and colour - on average, beLween approxlmaLely 2 and 3 cm long - also very sensluve Lo Louch Iema|e Anatomy and hys|o|ogy 7 Lxterna| Sex Crgans C||tor|s - only sex organ whose only known funcuon ls Lo creaLe pleasure - c||tora| shah - Lwo corpora cavernosa (spongy ussue) LhaL becomes engorged wlLh blood and erecL when sexually sumulaLed - g|ans - parL LhaL ls vlslble, corpus spong|osum - c||tora| hood - covers Lhe exposed parL of Lhe sha and mosL of Lhe glans - hlghly lnnervaLed - very sensluve Lo Louch Iema|e Anatomy and hys|o|ogy 8 Lxterna| Sex Crgans Lab|a M|nora - Lab|ap|asty - dramaucally lncreaslng number of women seeklng plasuc surgery for Lhelr labla mlnora (reducuon/ symmeLry) - oLher surgerles: vaglnal ughLenlng, llposucuon of Lhe mons venerls, hymen reconsLrucuon, unhoodlng Lhe cllLorls - deslgner vaglna," genlLal enhancemenL," vaglnal re[uvenauon," Lops and bouoms" Iema|e Anatomy and hys|o|ogy 3 9 Lxterna| Sex Crgans C||tordectomy - parLs of Afrlca and Mlddle LasL - removal of Lhe cllLorls - puberLy rlLual - auempL Lo malnLaln glrls' chasuLy Inhbu|anon - pracuced wldely ln Sudan and Somalla - enure removal of cllLorls and vulva - vaglnal openlng suLured LogeLher, small passage le for mensLruauon - opened by force when marrled Iema|e Anatomy and hys|o|ogy 10 Lxterna| Sex Crgans Vesnbu|e - area lnslde of Lhe labla mlnora, reglon around ureLhra and vaglnal openlng - also very sensluve Lo Louch Urethra| Cpen|ng - connecLed Lo Lhe bladder vla Lhe ureLhra - locaLed above vaglnal openlng and below Lhe cllLorls
Iema|e Anatomy and hys|o|ogy 11 Iema|e Anatomy and hys|o|ogy 12 Iema|e Anatomy and hys|o|ogy 4 13 Lxterna| Sex Crgans Urethra| Cpen|ng - urlnary LracL lnfecuons: prone Lo bacLerlal lnfecuons due Lo proxlmlLy Lo vaglna and anus - cysnts - lnammauon of Lhe bladder cause by a u1l - honeymoon cysnts - Lugglng on bladder and ureLhral wall caused by lnLercourse
Iema|e Anatomy and hys|o|ogy 14 Lxterna| Sex Crgans Vag|na| Cpen|ng - |ntro|tus - lles below, and ls larger Lhan, Lhe ureLhral openlng hymen - fold of ussue LhaL surrounds or parually covers Lhe vaglnal openlng - hymens vary wldely per|neum - skln and underlylng ussues beLween vaglnal openlng and anus
Iema|e Anatomy and hys|o|ogy 13 Lxterna| Sex Crgans Vag|na| Cpen|ng - nymens
Iema|e Anatomy and hys|o|ogy normal Annular Pymen Crlbrlform Pymen lmperforaLe Pymen SepLaLe Pymen 16 Lxterna| Sex Crgans Vag|na| Cpen|ng 1he nymen and V|rg|n|ty - ln many culLures, lnLacL hymen ls consldered evldence of vlrglnlLy - may be lncompleLe ln some glrls, may Lear durlng exerclse, durlng sexual explorauon, durlng lnseruon of a Lampon - oen remaln lnLacL even aer rsL lnsLance of lnLercourse - |t |s not poss|b|e to conhrm that a woman |s a v|rg|n by exam|n|ng her hymen!
Iema|e Anatomy and hys|o|ogy 5 17 Lxterna| Sex Crgans Under|y|ng Structures sph|ncters - muscular rlngs, vaglna and anus crura - wlng-shaped sLrucLures LhaL auach Lhe cllLorls Lo Lhe publc bone beneaLh - lnLernal parL of Lhe cllLorls, corpus cavernosa ussue Iema|e Anatomy and hys|o|ogy 18 Lxterna| Sex Crgans Under|y|ng Structures vesnbu|ar bu|bs - erecule ussue, exLendlng down sldes of vaglnal openlng - engorge wlLh blood durlng sexual arousal, swelllng Lhe vulva and lengLhenlng Lhe vaglna - swelllng conLrlbuLes Lo physlologlcal sexual pleasure for boLh parLners Iema|e Anatomy and hys|o|ogy 19 Iema|e Anatomy and hys|o|ogy 20 Interna| Sex Crgans Vag|na - bromuscular Lubular LracL - Lyplcally 7.3 Lo 12.3 cm deep aL resL, expands ln lengLh and wldLh durlng sex and chlldblrLh - lnner llnlng, vag|na| mucosa, lubrlcauon forms on lLs surface durlng sexual arousal as Lhe ussue of vaglnal wall become engorged wlLh blood Iema|e Anatomy and hys|o|ogy 6 21 Iema|e Anatomy and hys|o|ogy Interna| Sex Crgans Lubr|cants water-based + easy Lo clean up, safe wlLh all sex Loys - rlnse o ln waLer, needs Lo be re-applled, can conLaln glycerln s|||cone-based + doesn'L rlnse o ln waLer, lasLs much longer wlLhouL reappllcauon, beuer for anal sex - messy, can damage slllcone sex Loys, LasLe, sLaln sheeLs o||-based + lasLs forever - can'L be used wlLh sex Loys or condoms, really messy and dlmculL Lo clean up 22 Interna| Sex Crgans Vag|na - few nerve endlngs, lnLernal 2/3 lnsensluve Lo Louch - sensluve Lo pressure, buL noL Louch - colonlzed by a muLually symblouc ora of mlcroorganlsms LhaL proLecL lLs hosL from dlsease-causlng mlcrobes - self-cleanlng, no need Lo douche or use deodoranLs - dlscharge - healLhy aL pP of 4-3 (acldlc) Iema|e Anatomy and hys|o|ogy 23 Interna| Sex Crgans kege|s - exerclse of Lhe pubococcygeus (C) musc|es (muscle oor of Lhe vaglna) - lnlually lnLended for women who were lnconunenL aer chlldblrLh - enhance sexual experlence for boLh parLners Iema|e Anatomy and hys|o|ogy 24 Interna| Sex Crgans G Spot - named aer ur. LrnesL Crafenberg - so mass of ussues 2.3-3cm from vaglnal enLrance - lnLense sensauon, vaglnal orgasm - conLroverslal - paraurethra| g|ands? Iema|e Anatomy and hys|o|ogy 7 23 Interna| Sex Crgans Iema|e L[acu|anon - lnLense sumulauon of Lhe C SpoL, Lyplcally, resulung ln Lhe expulslon of uld from Lhe ureLhra - low-volume versus hlgh volume - LhoughL Lo orlglnaLe from Lhe Skene's (paraurethra|) g|and, whlch surrounds parL of Lhe ureLhra - slmllar Lo secreuons from prosLraLe Iema|e Anatomy and hys|o|ogy ChapLer 3: 134 26 Interna| Sex Crgans
Iema|e Anatomy and hys|o|ogy 27 Interna| Sex Crgans Cerv|x - lower end of Lhe uLerus - os - openlng abouL Lhe slze of a pencll cerv|ca| cancer - rlsk facLors: human pap|||omav|rus (nV), many sexual parLners, smoklng, low SLS - besL defense: regular pap smears and Pv vacclne - sympLoms: loss of appeuLe, welghL loss, faugue, pelvlc paln, back paln, leg paln, slngle swollen leg, heavy bleedlng from Lhe vaglna, leaklng of urlne or feces from Lhe vaglna, and bone fracLures Iema|e Anatomy and hys|o|ogy 28 Interna| Sex Crgans Uterus - where Lhe ferullzed ovum lmplanLs - Lhree layers: per|metr|um, myometr|um, endometr|um - endomeLrlum rlchly supplled by blood vessels and glands - formauon of llnlng durlng mensLrual cycle, sheds lf no ferullzed ovum presenL - mensLrual bleedlng
endometr|os|s - growLh of endromeLrlal-llke ussue ln abdomlnal cavlLy or elsewhere ln Lhe reproducuve sysLem endrometr|a| cancer - sympLoms lnclude abnormal bleedlng or spomng Iema|e Anatomy and hys|o|ogy 8 29 Interna| Sex Crgans nysterectomy - mosL commonly performed gynecologlcal procedure - surglcal removal of uLerus, ovarles, falloplan Lubes, and/ or cervlx (parual/compleLe) - Lo LreaL cancer or dlsease (e.g., severe endomeLrlosls, posL-parLum placenLal problems, eLc.)
Iema|e Anatomy and hys|o|ogy 30 Interna| Sex Crgans Cv|ducts (Ia||op|an 1ubes) - passageway for Lhe ova from Lhe ovarles Lo Lhe uLerus - tuba| ||ganon - ue o falloplan Lubes so ova can'L pass - ectop|c pregnancy - lmplanLauon of Lhe ovum ln Lhe falloplan Lubes
Iema|e Anatomy and hys|o|ogy 31 Interna| Sex Crgans Cvar|es - produce oocytes (ova) - abouL 2,000,000 aL blrLh, 400,000 pasL puberLy - fo|||c|es - hold Lhe oocyLes, one bursL per monLh - average women wlll release 400 rlpened ova over llfeume - produce hormones - estrogen (estrad|o|) - promoLes physlologlcal changes durlng puberLy and conLrols mensLrual cycle - progesnn (progesterone) - conLrols mensLrual cycle and sumulaLes Lhlckenlng (prollferauon) of Lhe endromeLrlum (for pregnancy) Iema|e Anatomy and hys|o|ogy 32 Menstrua| Cyc|e - cycllcal changes ln physlology conLrolled by Lhe endocrlne sysLem, Lyplcally 28 days - menstruanon - sheddlng of Lhe endomeLrlum, no ferullzauon of ovum - menarche - rsL mensLruauon - amenorrhea - absence of mensLruauon - 3 dlsuncL phases ! folllcular phase, ovulauon, and Lhe luLeal phase ! C8 mensLruauon, prollferauve phase, and secreLory phase (plus ovu|anon)
Iema|e Anatomy and hys|o|ogy 9 33 Menstrua| Cyc|e Gnkn - ConadoLropln-8eleaslng Pormone Gonadotrop|ns ISn - lolllcle Sumulaung Pormone maLurauon of folllcle L by folllcle Ln - LuLelnlzlng Pormone sumulaLes ovulauon /L by ovary (corpus luLeum) Lstrogens - esLradlol, esLrone, esLrlol rogesterone Iema|e Anatomy and hys|o|ogy 34 Menstrua| Cyc|e Menstrua| hase - absence of ferullzed ovum leads Lo drop ln esLrogens/progesLerone - levels of esLrogens/progesLerone drop Lo Lhe polnL aL whlch endomeLrlum llnlng cannoL be supporLed, sloughs - Lyplcally no longer Lhan a week - use of pads, Lampons, more recenLly Lhe keeper Iema|e Anatomy and hys|o|ogy 33 Menstrua| Cyc|e ro||feranve hase - approxlmaLely 10 days long - ln response Lo drop ln esLrogens, plLulLary sLarLs Lo secreLe lSP - slgnals rlpenlng of 10-20 ova wlLhln Lhelr folllcles - folllcles begln producuon of esLrogens - endomeLrlum Lhlckens - progesLerone remalns low - rsL half of cycle, low level of L has negauve feedback eecL on PC axls - evenLual surge ln Cn8P 36 hours before ovulauon, lncreased LP/lSP sumulaLes nal developmenL of folllcle and ovulauon Iema|e Anatomy and hys|o|ogy 36 Menstrua| Cyc|e Cvu|anon - esLrogens peaks, progesLerone remalns low - release of a maLure ovum from Lhe ovarles lnLo Lhe falloplan Lube - Lwo maLure ova ferullzed - fraLernal Lwlns - one ferullzed ovum dlvldes lnLo Lwo zygoLes - ldenucal Lwlns Iema|e Anatomy and hys|o|ogy 10 37 Menstrua| Cyc|e Secretory (Lutea|) hase - corpus |uteum - rupLured folllcle - acLs as an endocrlne gland secreung loLs of progesLerone and some esLrogens - progesLerone peaks - hlgh levels sumulaLe furLher Lhlckenlng of endomeLrlum and glands of endomeLrlum Lo secreLe nuLrlenLs for ferullzed ovum lmplanLed ln uLerus wall - conunued hlgher levels of L/ have negauve feedback eecL on PC axls - lf no lmplanLauon, corpus luLeum decomposes and p/e drop Iema|e Anatomy and hys|o|ogy 38 Iema|e Anatomy and hys|o|ogy 39 Menopause - mensLrual cycle shorLens as women age pasL 33 - cessauon of mensLruauon - Lyplcally lasLs for a couple of years beLween ages 43-30 - speclc evenL durlng a longer process: c||macter|c - gradual decllne ln funcuon of ovarles - 13 years, ages 43-60 Iema|e Anatomy and hys|o|ogy 40 Menopause - many sympLoms, lncludlng hoL ashes (hoLness) and hoL ushes (reddenlng) - normone kep|acement 1herapy (nk1): synLheuc progesLerone/esLrogen Lo LreaL sympLoms of menopause - conLroverslal - may cause lncreased rlsk of breasL cancer
Iema|e Anatomy and hys|o|ogy 11 41 Menstrua| rob|ems Dysmenorrhea - paln or dlscomforL (Lyplcally cramps) pr|mary - no organlc orlgln secondary - paln secondary Lo organlc problems (e.g., endomeLrlosls, pelvlc lnammauon dlsease, ovarlan cysLs, eLc.) - cramps (uLerlne conLracuons) from prostag|and|ns - uld reLenuon, ln breasLs - masta|g|a - orgasm can relleve mensLrual dlscomforL Iema|e Anatomy and hys|o|ogy 42 Menstrua| rob|ems Amenorrhea - absence of mensLruauon, prlmary slgn of lnferullLy pr|mary - ln women who have noL mensLruaLed by age 16-17 secondary - ln women who have prevlously had normal perlods
Iema|e Anatomy and hys|o|ogy 43 Menstrua| rob|ems remenstrua| Symptom (MS) - physlologlcal/psychologlcal sympLoms presenL 4-6 days before perlod beglns - may perslsL lnLo mensLrual phase - can be conLrolled somewhaL by llfesLyle (e.g., dleL, exerclse)
Iema|e Anatomy and hys|o|ogy 44 1he 8um - anus - openlng Lwo sph|ncters: exLernal - volunLary conLrol lnLernal - Lyplcally lnvolunLary, alLhough conLrol can be learned rectum - ouLer-mosL passage Iema|e Anatomy and hys|o|ogy 12 43 8reasts - secondary sex characLerlsuc - 13-20 mammary g|ands per breasL - lled wlLh fauy ussue - Lhls deLermlnes slze and shape - areo|a - nlpple - sensluve Lo Louch - large varlauon ln slze, shape, posluon, areola, eLc. Iema|e Anatomy and hys|o|ogy 46 Ma|e Anatomy and hys|o|ogy 47 Lxterna| Sex Crgans en|s corpora cavernosa - Lwo cyllnders of spongy ussue LhaL run lengLh of penls - s|nuso|ds - vascular space - engorge wlLh blood when sexually aroused - suen corpus spong|osum - spongy ussue LhaL surrounds ureLhra - proLecLs ureLhra from belng squeezed shuL durlng erecuon - becomes Lhe glans Ma|e Anatomy and hys|o|ogy 48 Lxterna| Sex Crgans en|s corona - rldge around Lhe edge of Lhe glans frenu|um - Lhln ussue LhaL connecLs Lhe underslde of Lhe glans Lo Lhe sha gen|ta| end-bu|bs - clusLer of Langled nerve endlngs Ma|e Anatomy and hys|o|ogy 13 49 Lxterna| Sex Crgans en|s foresk|n (prepuce) - loose skln LhaL covers Lhe glans smegma - cheese-llke subsLance LhaL can collecL under Lhe foreskln
Ma|e Anatomy and hys|o|ogy 30 Lxterna| Sex Crgans C|rcumc|s|on - surglcal removal of Lhe foreskln - aL blrLh, adolescence, or adulLhood Ma|e Anatomy and hys|o|ogy 31 Lxterna| Sex Crgans C|rcumc|s|on Ma|e Anatomy and hys|o|ogy 32 Lxterna| Sex Crgans C|rcumc|s|on Ma|e Anatomy and hys|o|ogy 14 33 Lxterna| Sex Crgans C|rcumc|s|on - 1he Controversy - amLudes - consenL - sexual funcuon: evldence - Plv/S1ls: mlxed evldence - ln areas where few people use proLecuon, may decrease rlsk mlnlmally Ma|e Anatomy and hys|o|ogy 34 Lxterna| Sex Crgans C|rcumc|s|on - 1he Controversy Amer|can Med|ca| Assoc|anon (and WnC) ""#$%&'(() '(( *&$$+,% -.(#*) /%'%+0+,%/ 1$.0 /-+*#'(%) /.*#+2+/ ',3 0+3#*'( .$4',#5'2.,/ 3. ,.% $+*.00+,3 $.&2,+ ,+.,'%'( *#$*&0*#/#.,6 ',3 /&--.$% %7+ -$.8#/#., .1 '**&$'%+ ',3 &,9#'/+3 #,1.$0'2., %. -'$+,%/ %. #,1.$0 %7+#$ *7.#*+:
Canad|an ed|atr|c Soc|ety - medlcally unnecessary and recommend agalnsL Lhem - ManlLoba ls Lhe only provlnce ln whlch healLh care lnsurance wlll pay for clrcumclslon Ma|e Anatomy and hys|o|ogy 33 Lxterna| Sex Crgans en|s S|ze average lengLh: 3-6 lnches, erecL average clrcumference: 4.3-3 lnches Ma|e Anatomy and hys|o|ogy 36 Lxterna| Sex Crgans en|s S|ze Lengthen|ng - only eecuve was Lo lengLhen penls ls surgery - release of Lhe fundlform llgamenL and Lhe suspensory llgamenL Ma|e Anatomy and hys|o|ogy 15 37 Lxterna| Sex Crgans en|s Curvature - mosL penlses are curved and asymmeLrlcal - eyron|e's d|sease en||e Iracture - rupLurlng of Lhe membrane LhaL surrounds Lhe corpus cavernosa Ma|e Anatomy and hys|o|ogy 38 Lxterna| Sex Crgans Scrotum - pouch of loose skln LhaL holds Lhe LesLes and spermanc cord spermanc cord lncludes: vas deferens - passage for sperm cremaster musc|e - ralses and lowers LesLes blood vessels Ma|e Anatomy and hys|o|ogy 39 Interna| Sex Crgans 1estes serve Lwo purposes: 1. produce sperm 2. produce androgens (l.e., LesLosLerone)
secondary sex character|sncs
Ma|e Anatomy and hys|o|ogy 60 Interna| Sex Crgans Sperm - produced ln Lhe sem|n|ferous tubu|es Lhrough spermatogenes|s (64 days) - produce 1000/second, 30 bllllon/year - conLaln 23 chromosomes - collecLed ln Lhe ep|d|dym|s Ma|e Anatomy and hys|o|ogy 16 61 Interna| Sex Crgans assage of the Sperm - Lhrough vas deferens - pasL Lhe sem|na| ves|c|es lnLo Lhe e[acu|atory duct - semlnal veslcles secreLe uld LhaL ls parL of semen - e[acu|atory duct runs Lhrough Lhe prostate g|and - pasL Lhe Cowper's g|and (l.e., Lhe bu|bourethra| g|and) Ma|e Anatomy and hys|o|ogy 62 Interna| Sex Crgans Semen made up: - sperm (1) - semlnal uld from Lhe sem|na| ves|c|es (70) - uld from Lhe prosLaLe (30) - some secreuon from Lhe Cowpers' g|and - ulds neuLrallze Lhe acldlLy of vaglna, provlde nourlshmenL for sperm (frucLose) Ma|e Anatomy and hys|o|ogy 63 Sexua| Iuncnon Lrecnons - hydraullc pressure creaLed by lncreased blood ow lnLo Lhe penls (corpus canvernosa) - reexlve (e[aculauon Loo) response Lo Louch - can also be lnluaLed by Lhe braln: fanLasy, vlsual sumulauon, audlLory sumulauon - dlerenL paLhway hlgher up ln splnal cord - braln also has Lop-down lnhlblLory conLrol - Lacule sumulauon lnformauon senL upwards Lo braln Ma|e Anatomy and hys|o|ogy 64 Sexua| Iuncnon Lrecnons - Autonom|c Nervous System (ANS) - AnS dlvlded lnLo Lhe sympaLheuc and parasympaLheuc branches - parasympathenc - erecuons - sympathenc - e[aculauon
Ma|e Anatomy and hys|o|ogy 17 63 Sexua| Iuncnon L[acu|anon - expulslon of semen - wlLh or wlLhouL orgasm - orgasm - muscle conLracuons aL peak of sexual arousal assoclaLed wlLh Lenslon release and experlenced as very pleasurable - refracLory perlod Ma|e Anatomy and hys|o|ogy 66 Sexua| Iuncnon L[acu|anon Lwo sLages: 1. em|ss|on stage: conLracuons of prosLaLe, semlnal veslcles, vas deferens propel semen lnLo urethra| bu|b (posLerlor ureLhra) - ureLhral bulb sLreLches, Lwo sphlncLers aL each end keep semen wlLhln - e[aculaLory lnevlLablllLy 2. expu|s|on stage: semen propelled ouL Lhe penls by muscle conLracuons aL lLs base