The Reproductive System

1. The Reproductive System A. Introduction Why be concerned about reproduction in old people? Integral to maintaining self-esteem Expression of love Aging changes have emotional and psychological impact 2. Many elderly are concerned about their sexuality and need/want sexual relationships

2. The Reproductive System B. Review of structure and function Overview Primary function of reproductive organs is continuation of the species Gametes (sperm and ova) are produced by the gonads External genitalia provide the mechanism by which male sperm are introduced into the female reproductive system The female system provides the environment that supports development 2. Gonads also produce the sex hormones Male = androgens (testosterone) Female = progesterone and estrogens

3. The Reproductive System B. Review of structure and function 3. Male reproductive system Testes in scrotum to regulate temperature Ducts Seminiferous tubules  Ductus epididymis  Ductus (vas) deferens  Ejaculatory duct  Urethra c. Glands Bulbourethral glands Seminal vesicles Prostate gland

4. The Reproductive System B. Review of structure and function 3. Male reproductive system • Semen • Penis Erectile tissue Erection f. Hormones Interstitial cell stimulating hormone (ICSH) Follicle stimulating hormone (FSH) Testosterone

5. The Reproductive System B. Review of structure and function 4. Female reproductive system Organs Ovaries Oviducts Uterus Vagina and external genitalia b. Hormones Follicle stimulating hormone (FSH) Luteinizing hormone (LH) Estrogens Progesterone

6. The Reproductive System B. Review of structure and function 4. Female reproductive system c. Ovarian cycle Follicular phase Initiated by FSH Results in estrogen secretion ii. Ovulation Initiated by LH Results in corpus luteum formation • Luteal phase – estrogens and progesterone secretion • Corpus luteum begins to die at day 12; dead at day 14

7. The Reproductive System B. Review of structure and function 4. Female reproductive system FSH LH Menstrual cycle Proliferative phase estrogen Initiated by estrogen Rebuilds endometrium progesterone ii. Secretory phase proliferative secretory Initiated by estrogen and progesterone Endometrium prepares for implantation iii. Menstrual phase Lack of estrogen and progesterone Removes endometrium

8. The Reproductive System C. Age-related changes • Changes in men Testicular changes Decrease in size and firmness Very slow decline in testosterone secretion Decrease in sperm number and motility (30% reduction by age 60) b. Prostate gland changes Atrophy begins at ~50, reducing secretory capacity Muscle fibers replaced by connective tissue Volume and force of expulsion therefore decreased Enlarges around urethra; may make making urination difficult

9. The Reproductive System C. Age-related changes • Changes in men c. Seminal vesicle changes Decrease in size and storage capacity Muscle fiber replacement with connective tissue • Bulbourethral gland changes • Penile changes Some atrophy and tends to become smaller Erectile tissue becomes more rigid, less elastic after ~55, resulting in decreased ability to attain erection f. Changes in sexual ability can lead to depression, mood swings, and general feelings of uneasiness

10. The Reproductive System C. Age-related changes 2. Changes in women Ovarian changes First to occur as follicles are depleted Decreasing estrogen and progesterone levels lead to degenerative changes in uterus and vagina b. Menopause Begins with cessation of the menstrual cycle Remaining follicles become unresponsive to FSH and LH, generally occurring in the 40 – 50s Adrenal glands become primary source of estrogen

11. The Reproductive System C. Age-related changes 2. Changes in women c. Menopausal symptoms Hot flashes, sweating, red patches on face and chest Episodes of depression or irritability, headaches, insomnia Most women experience mild versions of all these d. Postmenopausal changes Progressive ovarian atrophy and formation of fibrous tissue Loss of reproductive cyclical changes Decrease in uterine wall thickness; muscle replaced with connective tissue Atrophy of the endometrium and uterine tubes

12. The Reproductive System C. Age-related changes 2. Changes in women d. Postmenopausal symptoms v. Vaginal changes Narrower and shorter, thinner and less elastic walls Vestibular glands atrophy and secrete less, leading to a dry vagina and painful intercourse Vaginal environment becomes less acidic, leading to increased bacterial and yeast infections vi. Testosterone levels don’t decrease greatly, so sexuality and enjoyment of sex does not diminish greatly vii. Other changes – fact accumulation in wrists, thighs, butt; skin thins and sags; hair thins and coarsens; external genitalia atrophy; glandular breast tissue replaced with fat

13. The Reproductive System D. Age-related dysfunctions • Cancer Prostatic cancer very prevalent in older men Incidence of ovarian, uterine, cervical, and breast cancers increase dramatically after menopause Increase in cancer with age again points out need for regular exams • Atrophic vaginitis • Prolapse of the uterus Ligament weakness allows uterus to drop through cervical canal and protrude into the vagina Previous births may contribute to occurrence

14. The Reproductive System D. Age-related dysfunctions 4. Impotence Most common and disturbing dysfunction in males Failure to attain and/or maintain an erection Progressively more frequent as men age (25% at age 65, 55% at age 75, 75% at age 80 Numerous causes Numerous treatments

15. The Reproductive System D. Age-related dysfunctions 5. Diminished sexual functioning Most common complaint is decreased ability to function sexually Elderly persons frequently without a partner Time to respond to sexual stimulation increases Time to orgasm increases Orgasms decrease in intensity and duration

16. The Reproductive System E. Take home messages • Sexual interest and activity continue well into old age • Changes in reproductive organs affect sexual function • Males – gradual decline in testosterone with accompanying changes in organs • Females – loss of follicles leads to decreased estrogen and progesterone, culminating with menopause in the 40 – 50s; loss of estrogen has multiple effects end