Female Sexual Anatomy and Physiology

Female Sexual Anatomy and Physiology Lucy Capuano Brewer, Psychology Psy 25 – Chapter 4

Some things to think about… • Name all the feminine hygiene products you can think of? • Name all the masculine hygiene products you can think of? Is there a masculine hygiene aisle? Why not? • What is society’s message about the women’s sexual anatomy? • What are the ramifications? • Is it a coincidence that the word pudendum which refers to the external female genitals is derived from the Latin term meaning: “something to be ashamed of?”

Feminine Hygiene Products • Take a walk through a pharmacy and notice the array of feminine hygiene products: • Douches, pads, tampons, feminine deodorants, vaginal moisturizers, sprays, powders, towelettes, creams, soaps, etc. • What are the psychological and social repercussions? • Shame, Fear, Sexual Dysfunctions, Anger, Unfulfilled Sexual Lives, Vulnerable to Sexual Assaults, Eating Disorders, Low Self-Esteem, Distorted Body Images, etc

Female Anatomy Female External Anatomy Female Internal Anatomy • This information is important because it will raise your level of awareness and understanding about your physical body. It is imperative that you learn the changes you can expect to experience from menarche to menopause as you live with your female reproductive system

Female Genital Mutilation (FGM) • Between 85 and 114 million women and girls living today have undergone FGM, and approximately 2 million are subjected to it annually. • Typically performed on young girls (as young as three) • Chances of infection high • Tools of the trade include: • Broken glass • Scissors • Razor blades • Anesthetics rarely used • Endanger physical and mental well-being • Primarily done to ensure abstinence before marriage, and fidelity after marriage. • If women get no pleasure from intercourse, they will not have sex when unnecessary for procreation or marital relations. • Done under the blanket of “Tradition”

FGM in a variety of its forms is practiced in Middle Eastern countries, Africa – although mostly Muslim practice – exceptions exist The term FGM covers three main varieties of genital mutilation: "Sunna" circumcision: Consists of the removal of the prepuce and/or the tip of the clitoris. Sunna in Arabic means "tradition". Clitoridectomy (also referred to as excision): Consists of the removal of the entire clitoris (both prepuce and glans), and the removal of the adjacent labia. Infibulation: (also referred to as pharaonic circumcision) This most extreme form, consists of the removal of the clitoris, the adjacent labia (majora and minora), and the joining of the scraped sides of the vulva across the vagina, where they are secured with thorns or sewn with catgut or thread. A small opening is kept to allow passage of urine and menstrual blood. An infibulated woman must be cut open to allow intercourse on the wedding night and is closed again afterwards to secure fidelity to the husband.

The vulva refers to those parts that are outwardly visible The vulva includes: Mons pubis Labia majora Labia minora Clitoris Urethral opening Vaginal opening Perineum Individual differences in: Size Coloration Shape are common External Genitalia

MONS PUBIS The triangular mound of fatty tissue that covers the pubic bone During adolescence sex hormones trigger the growth of pubic hair on the mons pubis Hair varies in coarseness curliness, amount, color and thickness LABIA MAJORA Referred to as the outer lips They have a darker pigmentation Protect the introitus and urethral openings Are covered with hair and sebaceous glands Tend to be smooth, moist, and hairless LABIA MINORA Referred to as the “inner lips” Made up of erectile, connective tissue that darkens and swells during sexual arousal Located inside the labia majora They are more sensitive and responsive to touch than the labia majora The labia minora tightens during intercourse CLITORIS Highly sensitive organ composed of nerves, blood vessels, and erectile tissue Located under the prepuce It is made up of a shaft and a glans Becomes engorged with blood during sexual stimulation Key to sexual pleasure for most women Urethral opening is located directly below clitoris

Vaginal Opening - Introitus • Opening may be covered by a thin sheath called the hymen • Using the presence of an intact hymen for determining virginity is erroneous • Some women are born without hymens • The hymen can be perforated by many different events

Perineum • The muscle and tissue located between the vaginal opening and anal canal • Contains an abundance of nerve endings that make it sensitive to touch • An episiotomy is an incision of the perineum used during childbirth for widening the vaginalopening

INTERNAL GENITALIA The internal Genitalia consists of the: • Vagina • Cervix • Uterus • Fallopian Tubes • Ovaries

Pelvic Exam and Pap Smear Once a year, twice year Beginning in teenage years; Baseline (even if not sexually active) Speculum: inspect the cervix and Vaginal walls for discharges, discoloration, lesions, or growths. Pap smear: to detect cervical cancer. Bimanual vaginal exam: to examine the location, shape, size, and movability of the Internal sexual organs, searching for abnormal growths and symptoms of other problems. Recto-vaginal exam: to gather information about the ligaments of the uterus, the ovaries, and the Fallopian tubes. It also helps to determine the health of the rectum.

Vagina • The vagina connects the cervix to the external genitals • It is located between the bladder and rectum • It functions • As a passageway for the menstrual flow • For uterine secretions to pass down through the introitus • As the birth canal during labor • With the help of two Bartholin’s glands becomes lubricated during sexual arousal

Cervix • The cervix connects the uterus to the vagina • The cervical opening to the vagina is small • This acts as a safety precaution against foreign bodies entering the uterus • During childbirth, the cervix dilates to accommodate the passage of the fetus • This dilation is a sign that laborhas begun (10 cm)

Once was the leading cause of death for women in the U.S. Last 40 years, incidence and mortality declined significantly due to widespread use of the Papanicolaou (Pap) test . More than 12,000 women were diagnosed and nearly 4,000 women died (2002) More than $2 billion per year: treatment of cervical cancer. Best Screening: Pap Smear  detects precancerous cells Risk factors Infection with certain types of human papillomavirus (HPV). A high number of sexual partners. Many full-term pregnancies. Use of oral contraceptives. Infrequent Pap tests and cervical examinations. Smoking. Diet low in fruits and vegetables Cervical Cancer(Source CDC: Centers for Disease Control and Prevention)

Uterus • Commonly referred to as the womb • A pear shaped organ about the size of a clenched fist • It is made up of the endometrium, myometrium and perimetrium • Consists of blood-enriched tissue that sloughs off each month during menstrual cycle • The powerful muscles of the uterus expand to accommodate a growing fetus and push it through the birth canal

Fallopian Tubes • Serve as a pathway for the ovum to the uterus • Are the site of fertilization by the male sperm • Often referred to as the oviducts or uterine tubes • Fertilized egg takes approximately 6 to 10 days to travel through the fallopian tube to implant in the uterine lining • Site of Ectopic Pregnancy • Tubal Ligation: Sterilization

Ovaries • The female gonads or sex glands • They develop and expel an ovum each month • A woman is born with approximately 400,000 immature eggs called follicles • In a lifetime: about 400 to 500 fully matured eggs for fertilization • The follicles in the ovaries produce the female sex hormones, progesterone and estrogen • These hormones prepare the uterus for implantation of the fertilized egg

Seventh most common cancer and the fifth leading cause of cancer death. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. Mortality and incidence rates are higher for white women than for any other racial or ethnic group. $2.2 billion (in 2004 dollars) is spent each year on the treatment of ovarian cancer. Risk Factors Most cases in women aged 50 years or older. Young women can still get it. Risk increase as a woman gets older. Close relatives (i.e., mother, daughter, or sister) has had history of breast, endometrial, or colon cancer Screening At this time, there is no evidence that any screening test—CA-125, ultrasound, or pelvic examination—reduces deaths from ovarian cancer. Ovarian Cancer (Source CDC)

Breasts • Organs of sexual arousal • Contain mammary glands • Consist of connective tissue that serves as support • Each breast contain 15-25 clusters called lobes • Each lobule is connected by ducts that open into the nipples • The nipples are made up of erectile tissue • The pigmented around the nipples are called the areola • Breast size is determined primarily by heredity • Size also depends on the existing fat and glandular tissue • Breasts may exhibit cyclical changes, including increased swelling and tenderness prior to menstruation • Fibrocystic disease: Lumps thatare noncancerous

Breast Self Examination • BSE: Women need to examine their breasts monthly • This is a proactive approach to detect possible breast cancer • A supplement to clinical exams and mammography • Best time for a BSE is a week after menstruation • For detailed instructions and video demonstration go to: http://www.komen.org/bse/

Breast Cancer • Most commonly diagnosed cancer among women in the United States, after skin cancer. • Second most common cause of cancer death, after lung cancer, among American women. • More than 182,000 women were diagnosed with breast cancer in 2002; more than 41,000 women died in 2002 • More than $7 billion per year (in 2000 dollars) is spent in the United States on the treatment of breast cancer. • White women are more likely to be diagnosed with breast cancer than are women of any other race or ethnicity in the United States. • African American women are more likely to die from the disease than are women of any other race or ethnicity in this country. • Trends: the number of new cases of breast cancer diagnosed each year (incidence) has either remained stable or decreased significantly during the past 10 years. (Source: CDC) Breast Enhancement: pros and cons

Breast Cancer Risk Factors • Older age. • Younger age at onset of menstrual periods. • Older age at onset of menopause. • Older age at first birth. • Never having given birth. • Personal history of breast cancer or certain benign breast diseases. • Family history of breast cancer (mother, sister, daughter). • Treatment with radiation therapy to the breast/chest. • Being overweight (increases risk for breast cancer after menopause). • Long-term use of hormone replacement therapy (estrogen and progesterone combined). • Genetic predisposition, such as certain mutations in BRCA1 or BRCA2 genes. • Use of oral contraceptives. • Drinking alcohol. • Physical inactivity.

Breast Cancer Screening • Mammography is the best method to detect breast cancer in its earliest, most treatable stage. • Women aged 40 years or older should have a screening mammogram every 1 to 2 years. • Early detection of breast cancer can save lives (20% - 25% reduction in deaths. • Men also run a risk; need to conduct BSE • Lumpectomy: Surgical removal of a lump from the breast. • Mastectomy: Surgical removal of the entire breast. Most lumps in the breasts are not cancerous

Menstruation • Menarche, the onset of menstruation signals the bodily changes that transform a female body • Average age is 12.8 (Lowering due to Secular Trend • Amount of bleeding varies from woman to woman • Blood color can vary from bright red to dark maroon • Usually occurs every 25 to 32 days • Women can experience fluid retention, cramping, mood swings, weight gain, breast tenderness, diarrhea, and constipation

Sex Hormones: Menstrual Cycle • Follicle stimulating hormone FHS- • Luteinizing hormone LH-signals ovulation • Estrogen- produced throughout the menstrual cycle • Progesterone-produced during second half of cycle • Contributes to thickening of the endometrium which is shed during menstrual phase if fertilization does not take place • Both FHS and LH are produced in the pituitary gland • Both estrogen and progesterone are produced by the follicles in the ovaries

Premenstrual Syndrome (PMS) SYMPTOMS The symptoms of premenstrual syndrome recur during the same phase of the menstrual cycle, usually seven to 10 days before your period begins. • Weight gain from fluid retention; abdominal bloating • Breast tenderness • Tension or anxiety • Depressed mood • Crying spells • Mood swings and irritability or anger • Appetite changes and food cravings • Trouble falling asleep (insomnia) • Joint or muscle pain • Headache • Fatigue Treatment: Regular exercise, getting enough sleep, and diet changes reducing your intake of caffeine, sugar, salt, dairy products and white flour); Calcium supplements: Studies had shown that women with PMS are more likely to develop osteoporosis

The Female Climacteric & Menopause • Starting about age 45, women enter a period known as the FEMALE CLIMACTERIC, the transition from being able to bear children to being unable to do so. • This period lasts about 15 to 20 years. • The most notable sign is MENOPAUSE, the cessation of menstruation. • PERIMENOPAUSE may impact development with similar symptoms (changes in hormones beginning about 10 years prior to menopause). • For most women, menstrual periods become irregular for about 2 years, starting at about age 47 or 48. • After a year goes by without a menstrual period, menopause is said to have occurred. • The production of estrogen and progesterone drop. • Symptoms such as "hot flashes", headaches, feeling dizzy, heart palpitations, and aching joints are common during menopause. Half of women report no symptoms at all.

DYSMENORRHEA Painful menstrual cramps Painful menses without evidence of a physical abnormality Believed to be normal body response to uterine contractions Other symptoms : Nausea, vomiting, gastrointestinal disturbances, and fainting Prostaglandins cause forceful, frequent uterine contractions called cramps Fibroids, polyps, IUD, PID, or endometriosis ENDOMETRIOSIS Common cause of dysmennorrhea,dyspareunia, and infertility Endometrium fragments and lodges in other parts of the pelvic cavity Causes inflammation, bleeding, scarring,and adhesions Causes are still being studied Tx: Hormonal therapy, laparoscopic surgery, or surgery

Female Sexual Anatomy and Physiology