Review of Extended Pubertal Development
Weight Increase: Boys also experience a growth
Lecture
Introduction:
The lecture expertly delves further into the complex
realm of puberty, where the emergence of secondary
sexual traits and reproductive preparedness intertwines.
It maintains its refined structure, illuminating the
distinctive trajectories for girls and boys guided by the
choreography of hormones and physiological
transformations.
Puberty Onset and Androgenic Role:
A resonating introduction to the lecture reveals puberty's
gender-specific dawn: girls (9-12 years) and boys (12-14
years).
The spotlight is on testosterone, the maestro hormone
orchestrating transformations:
 Initiating a symphony of muscle development.
 Fueling the crescendo of physical growth spurts.
 Governing the dance of sebaceous glands and the
intricate choreography of acne development.
Pubertal Changes in Girls:
1. Growth Spurt: Girls experience a significant growth
spurt during puberty, which means they grow taller
at a faster rate.
2. Pelvic Transverse Diameter: This is the widening and
preparation of the pelvis for potential future
childbirth. It's one of the physical changes that occurs
during puberty.
3. Breast Development (Thelarche): Girls' breasts start
to develop, which is a noticeable secondary sexual
characteristic.
4. Pubic Hair Growth: Pubic hair begins to grow, which
is another sign of the body's transition into
adulthood.
5. Menarche: marks the onset of menstruation in girls,
typically occurring around 12.5 years of age,
signifying their ability to reproduce.
6. Axillary Hair Growth (Adrenarche): Girls also
experience the growth of underarm hair, another
secondary sexual characteristic.
7. Vaginal Secretions: This represents the body's
preparation for potential reproductive readiness and
menstruation.
Pubertal Changes in Boys:
1.
spurt during puberty, leading to an overall increase in
body weight.
2. Testes Growth: The testes, which are the primary
male reproductive organs, mature and increase in
size during puberty.
3. Hair Growth: Boys undergo intricate development of
facial, axillary (underarm), and pubic hair as part of
their secondary sexual characteristics.
4. Voice Changes: The vocal cords undergo alteration,
leading to a deeper voice in boys.
5. Penile Growth: The penis grows in size during
puberty, which is essential for male reproduction.
6. Height Increase: Similar to girls, boys also experience
a harmonious continuation of overall stature growth
during puberty.
7. Spermatogenesis: Puberty is marked by the
development of sperm cells, which eventually reach
maturity in a process called spermatogenesis.
Mammary Glands:
The lecture unveils the complex orchestra of mammary gland
anatomy, where lobes, lobules, ducts, ligaments, and
specialized components harmoniously collaborate:
Lobes: Foundational units, 15-20 per breast, shaping
mammary tissue architecture.
Lobules: Clusters of acinic cells within lobes, dedicated to
vital milk production.
Ducts: Lactiferous conduits, essential for the
transportation of milk, linking lobules to the nipple.
Ligaments: Suspensory support system, upholding the
structural harmony within the breast.
Areola: Encircling the nipple, with aesthetic appeal and
housing lubricating glands.
Montgomery Tubercle: Modest yet meaningful, secreting
a lubricating fatty substance to enrich breastfeeding.
Nipple: Elevated central point, featuring 15-20 openings
connecting to lactiferous ducts.
Cooper's Ligament: Providing strength and stability,
enhancing the form and function of the mammary
ensemble.
Physiology of Milk Production:
The lecture deepens its exploration of breast milk's
genesis post-birth, orchestrated by the symphony of
decreasing estrogen and progesterone.
Prolactin, released after placental departure, beckons the
acini cells to perform, creating and preserving milk in
lactiferous ducts.
The crescendo of infant sucking triggers oxytocin's melody,
birthing the let-down reflex as contracting sinuses
perform a harmonious symphony of milk ejection.
Laws about Breastfeeding:
 The legal movements of breastfeeding are interwoven
seamlessly, with:
RA 7600: The Rooming-in and Breastfeeding Act of 1992,
which emphasizes the importance of rooming-in practices
to nurture the connection between mothers and
newborns.
RE10028: The Expanded Promotion of Breastfeeding Act,
aimed at fostering a supportive environment for
breastfeeding by promoting its significance in various
settings, from healthcare institutions to workplaces.
EO 51: The Milk Code, a robust regulation that safeguards
infant health by governing the marketing of breast milk
substitutes, prioritizing the well-being of infants and
encouraging breastfeeding.
MENSTRUAL CYCLE / FEMALE REPRODUCTIVE CYCLE:
Unveiling episodic uterine bleeding, a responsive dance to
hormonal shifts.
A rhythmic recurrence spanning the journey from puberty
to menopause, sculpting the landscape of the uterus and
its companions.
Tracing this phenomenon for six (6) consecutive months,
capturing the delicate interplay of cycle commencement
and culmination.
MENSTRUATION:
 Illuminate the essence of menstruation, painting a vivid
picture of its timing (a clockwork 28 days, with a spectrum
of 25 to 35 days), and its distinctive characteristics:
 acing its innate flow without clotting tendencies.
 Portraying its color as a rich, deep red akin to venous
blood.
 Eliciting its distinct identity with a familiar and flesh-like
aroma.
Body Structures Involved in Menstruation:
Accentuating the pivotal cast of contributors:
 HYPOTHALAMUS – The key initiator of the menstrual
cycle. It secretes GnRH and releases FSHRF during the
cycle's first half, followed by LHRF in the second half.
 ANTERIOR PITUITARY GLAND – Releases essential
gonadotropin hormones (FSH & LH) crucial for the cycle.
 OVARIES – The site of ovulation and the production of
estrogen and progesterone.
 UTERUS – The organ where menstrual discharge forms.
Changes in the uterine lining are influenced by ovarian
hormones.
Pituitary Hormones:
 FSH (Follicle Stimulating Hormone): Sparks follicle growth
and estrogen release, setting the cycle's foundation.
 LH (Luteinizing Hormone): Triggers ovulation and propels
progesterone production, vital for uterine lining
maintenance.
Ovarian Hormones:
 ESTROGEN: Women's hormone, from the graafian follicle,
nurturing the endometrium and secondary traits.
 PROGESTERONE: Mothers' hormone, by the corpus
luteum, sustaining the uterine lining and supporting
embryo implantation.
Phases of the Menstrual Cycle:
 MENSTRUAL PHASE: The curtain rises with the shedding
of the endometrial layer, marking the start of the cycle.
 PROLIFERATIVE/FOLLICULAR/ESTROGENIC/PREOVULATO
RY/POSTMESTRUAL PHASE: A dynamic crescendo fueled
by rising estrogen levels, renewing the endometrial
canvas in preparation for potential embryo implantation.
 SECRETORY LUTEAL/ PROGESTATIONAL /POST
OVULATORY PHASE: The stage shifts to progesterone's
graceful lead, nurturing the endometrial masterpiece and
creating an environment conducive to embryo support.
 PREMENSTRUAL PHASE: Harmonious closure
orchestrated by harmonizing hormones, paving the way
for the curtain to fall, and the cycle to begin anew.
The Uterine Cycle:
A symphony of phases shaping the uterine landscape:
 MENSTRUAL PHASE: The opening act, characterized by
endometrial shedding, marks the beginning of this cycle.
 PROLIFERATIVE PHASE: Like a crescendo, estrogen
orchestrates the renewal of the endometrium, preparing
it for potential embryo implantation.
 SECRETORY PHASE: The stage transitions to
progesterone, nurturing the endometrial canvas to foster
an embryo- friendly environment.
 ISCHEMIC PHASE: A contemplative finale, where hormone
levels adjust, signaling the closure of the curtain on the
current cycle.
The Ovarian Cycle:
A triad of phases shaping the ovary's journey:
 PRE-OVULATORY (FOLLICULAR) PHASE: The curtain rises
with follicle growth, orchestrated by rising FSH levels,
gearing up for ovulation.
 OVULATORY PHASE: The pivotal climax, LH surges,
triggering the release of a mature egg from the ovary.
 POST-OVULATORY (LUTEAL) PHASE: As the ovary
transforms into the corpus luteum, progesterone takes
the lead, preparing the endometrium for potential
implantation.
Uterine Cycle: Menstrual Phase (Bleeding Phase):
 Duration: Day 1 to Day 5.
 Commences with the onset of bleeding, defining the
cycle's first day.
 Stratum functionale is shed.
 Represents a period of absolute infertility.
 Blood loss varies (30-80 ml), with an average of 60 ml.
 Exceeding 80 ml prompts consideration of iron
supplementation.
 Daily iron loss ranges from 0.5 to 1 mg.
Uterine Cycle: Proliferative Phase (Estrogenic,
Follicular):
 Duration: Day 6 to Day 14 of a 28-day cycle.
 Menstruation's low estrogen stimulates hypothalamus,
triggering FSHRF release.
 FSH secretion by the anterior pituitary gland follows.
 Estrogen reaches its nadir on the 3rd day, peaking a day
before ovulation.
Uterine Cycle: Secretory Phase:
 Duration: Day 15 to Day 28.
 Endometrium thickens, glands produce nutrients.
 Uterus prepares for potential implantation, thanks to
progesterone.
 If no fertilization occurs, vessel constriction leads to
menstruation.
Uterine Cycle: Ischemic Phase:
 Triggers if fertilization is absent.
 Corpus luteum degenerates after 8-10 days from
ovulation.
 By Day 26 of a 28-day cycle, no pregnancy leads to corpus
albicans formation.
 Two days later, menstruation commences.
Ovarian Cycle: Preovulatory/Follicular:
 Duration: Variable (Day 6 to Day 13).
 Dominant follicle matures into graafian follicle with
primary oocyte.
 FSH initially increases, then declines due to estrogen rise.
Ovarian Cycle: Ovulatory Phase:
 Duration: Day 14.
 Graafian follicle ruptures, releasing the secondary oocyte.
 Peak fertility period.
 LH surge prompts this phase.
 Accompanied by MITTELSCHMERZ, pain during follicle
rupture.
Ovarian Cycle: Post-Ovulatory/Luteal Phase:
 Duration: Day 15 to Day 28.
 Remarkably consistent at 14 days post-ovulation.
 Corpus luteum secretes progesterone.
 In the absence of fertilization, corpus luteum becomes
corpus albicans, eventually regressing.
 Decreased estrogen and progesterone characterize this
phase.
Signs of Ovulation:
Mittelschmerz: A distinct pain felt in the lower left or
right iliac area during ovulation.
Cervical Mucus Method or Billing’s Method: Monitoring
changes in cervical mucus secretions, specifically noting a
shift to clear, elastic, and watery consistency – considered
the most reliable sign of ovulation.
Spinnbarkeit: This term describes the quality of cervical
mucus that becomes thin, watery, transparent, abundant,
and highly stretchable. While it doesn't pinpoint ovulation
timing, it indicates its approach. A dried sample viewed
under a microscope exhibits a fern pattern due to
increased sodium chloride levels.
Cervical Changes:
Ferning or Arborization of Cervical Mucus: Notable
at the estrogen-stimulated peak just before
ovulation, ferning is the result of sodium chloride
crystallization on mucus fibers.
Basal Body Temperature (BBT):
Tracking temperature upon waking up, before
getting out of bed.
A slight temperature drop about 24 hours before
ovulation, followed by a rise of around 0.5 degrees F,
lasting up to three days – considered the unsafe
period.
 More effective when combined with calendar and
mucus methods.
Mood Changes: Fluctuating hormonal levels can lead to
mood swings during ovulation.
Breast Changes and Enlargement: Nipples become erect,
and breasts may undergo changes and enlargement.
Increased Libido: Hormonal changes during ovulation can
result in heightened sexual desire.
Functions of Estrogen:
Assists Primary Follicle Maturation: Aids in the
development of the primary ovarian follicle.
Endometrial Thickening: Induces thickening of the
endometrial lining and promotes the growth of the uterus
and vagina.
Secondary Sex Characteristics: Responsible for the
development of secondary sex traits, notably breast
development.
FSH Inhibition: Exhibits negative feedback to inhibit FSH
production.
Myometrial Contractions: Increases contractions of the
uterine myometrium.
Fallopian Tube Contractions: Enhances contractions in
the fallopian tubes.
Cervical Mucus Changes: Elevates the quantity and pH of
cervical mucus, rendering it thin, clear, colorless, watery,
stringy, slippery, and stretchable – as observed in the
Spinnbarkeit test of elasticity.
Functions of Progesterone:
Increased Basal Body Temperature (BBT): Exhibits a
thermogenic effect, leading to an increase in BBT.
Endometrial Preparation: Prepares the endometrium for
potential implantation by enhancing glycogen, arterial
blood supply, secretory glands, amino acids, and water
content.
Pregnancy Maintenance: Sustains pregnancy by inhibiting
uterine contractions.
LH Production Inhibition: Suppresses the production of
LH.
Acini Cell Growth in Breasts: Promotes the growth of
acini cells within the breast tissue.
Endometrial Preparations for Implantation:
The hormone progesterone ushers in significant changes
within the endometrium, creating an environment that is
optimally receptive to embryo implantation.
Influence on Cervical Mucus:
Progesterone's effects extend to cervical mucus, causing
it to adopt an infertile state: thick, opaque, sticky, and
non-stretchable. When this mucus dries, it does not
exhibit the fern pattern that typically indicates fertility,
making it a reliable negative indicator for conception.
Pituitary Hormone Functions:
Follicle Stimulating Hormone (FSH):
Catalyst for Follicular Development: FSH is the catalyst
behind the nurturing of the Graafian follicle, ensuring its
maturation and the ovum within it.
Facilitator of Ovum Maturity: FSH plays a pivotal role in
bringing the ovum to a state of readiness.
Luteinizing Hormone (LH):
Ovulation Orchestrator: LH takes charge of initiating
ovulation, propelling the release of the mature ovum, and
fostering the formation of the corpus luteum.
Sexual Response Cycle:
Excitement Phase: This phase unfolds with physical,
psychological (stimuli like sight, sound, emotion, or
thought), and parasympathetic nerve stimulation. It
manifests as vaginal lubrication, dilation of genital
arteries, venous constriction, and heightened muscle
tension. In men, it corresponds to erection and an
increase in CR, RR, and BP.
Plateau Phase: During this phase, nipples and genitalia
experience further engorgement. In men, vascongestion
leads to full penile distention, accompanied by flushing
and deeper breathing. Notably, CR, RR, and BP rise
significantly.
Orgasmic Phase: The shortest phase, characterized by
intense muscular contractions, both voluntary and
involuntary. This leads to a doubling of RR, CR, and a
notable increase in BP, sometimes up to a third above
normal.
Resolution Phase: Generally lasting around 30 minutes,
this phase induces muscle relaxation and reverts external
and internal organs to their unaroused state.
Refractory Phase in Men: After orgasm, men experience
a refractory phase, a variable period during which further
sexual arousal or erection is inhibited.