Reproductive and Sexual Health Gynecomastia- an overdevelopment or

enlargement of the breast tissue in men or

Adrenache- ‘’ the awakening of the adrenal boys.
gland. The adrenal gland is responsible for
making hormones including androgens Laparoscopy- a type of surgical procedure
that allows a surgeon to access the inside of
Andrology- the specialty of medical the abdomen (tummy) and pelvis without
science that deals with male reproductive having to make large incisions in the skin.
functions under physiological and
pathological conditions. Menarche- the onset of menstruation

Anteflexion- a bending forward of an Oocyte- an immature egg (an immature

organ, especially of the body of the uterus ovum)

Anteversion- leaning forward

Puberty - breast development in females
Aspermia- complete lack of semen with (thelarche), pubic hair development
ejaculation (pubarche), genital changes in males, voice
changes, an increase in height, and the
Bicornuate uterus- a uterine malformation onset of menstruation (menarche)
that is produced due to impairment in the
fusion of Mullerian ducts.
Retroflexion
Culdoscopy- an endoscopic examination
through a puncture in the posterior vaginal
fornix Retroversion

Cystocele- when the wall between the

bladder and the vagina weakens. Spermatic cord

Rectocele- a type of prolapse where the

supportive wall of tissue between a The male gametes are called
woman’s rectum and vaginal wall weakens. spermatozoa
The female gametes are called ova.
Gonad- the testes in male and the ovaries
in females. Andrology: study of the male
reproductive system.
Gynecology-the area of medicine that
involves the treatment of women's diseases,
especially those of the reproductive organs.
 glands and are the equivalent of the
ovaries in the female.
They are about 4.5 cm long, 2.5 cm wide
and 3 cm thick and are suspended in the
scrotum by the spermatic cords.
They are surrounded by three layers of
tissue.
An Uncircumcised and a circumcised Penis
1) Tunica vaginalis.
2) Tunica albuginea.
❖ production, maturation and
3) Tunica vasculosa.
storage of spermatozoa
❖ delivery of spermatozoa in semen
into the female reproductive
tract.

Scrotum
- is a pouch of pigmented skin, fibrous
and connective tissue and smooth muscle.
- It is divided into two compartments,
each of which contains one testis, one
epididymis and the testicular end of a
spermatic cord.

Structure
•In each testis are 200–300 lobules, and
within each lobule are 1–4 convoluted
loops of germinal epithelial cells, called
seminiferous tubules.
• Between the tubules are groups of
interstitial cells (of Leydig) that secrete
the hormone testosterone after puberty.

Functions
• Spermatozoa (sperm) are produced in
the seminiferous tubules of the testes
Testes
The testes are the male reproductive
Spermatic cords
- The spermatic cords suspend the
testes in the scrotum. Each cord
contains a testicular artery,
testicular veins, lymphatics
Seminal vesicles
- is a 5 cm long tube that joins with
the different duct to form the
common ejaculatory duct.
Functions
The seminal vesicles contract and expel Urethra
their stored contents, seminal fluid, ● 19-20 cm long
during ejaculation. Seminal fluid, which ● Prostatic urethra
forms 60% of the volume of semen, ● Membranous urethra
● Penile urethra
Ejaculatory ducts
● The ejaculatory ducts are two tubes ● Two sphincter.
about 2 cm long, each formed by the
union of the duct from a seminal
vesicle and a deferent duct.
● They pass through the prostate gland
and join the prostatic urethra,
carrying seminal fluid and
spermatozoa to the urethra
 Gynecology: study of the female
reproductive system

An anterior view of female

reproductive organs showing the
relationship of the fallopian tubes and
body of the uterus.

The functions of the female reproductive

system
● formation of ova
● reception of spermatozoa
● provision of suitable environments
for fertilisation and fetal
development parturition (childbirth)
● lactation, the production of breast
milk, which provides complete
nourishment for the baby in its early
100 million spermatozoa per mL. life.
If not ejaculated, sperm gradually
lose their fertility after several
months and are reabsorbed by the
epididymis.
Anatomy and Physiology of the
Reproductive System: The Female
 numerous sebaceous and eccrine
External genitalia (vulva) sweat glands.
- or "lesser lips" are the thin hairless
The external genitalia are known
ridges at the entrance of the vagina,
collectively as the vulva, and consist
which joins behind and in front.
of the :
- In front they split to enclose the
• labia majora and labia minora, clitoris
• the clitoris,
• the vaginal orifice, Clitoris
• the vestibule, - The clitoris corresponds to the penis
the hymen and the in the male and contains sensory
vestibular glands (Bartholin’s nerve endings and erectile tissue.
glands) - The clitoris is a small pea-shaped
structure.
- It plays an important part in sexual
excitement in females.

Vestibular glands
- The vestibular glands (Bartholin’s
glands) are situated one on each side
near the vaginal opening. They are
about the size of a small pea and
their ducts open into the vestibule
immediately lateral to the attachment
of the hymen.
- They secrete mucus that keeps the
Labia majora
vulva moist.
- These are the two large folds
forming the boundary of the vulva.
- They are composed of skin, fibrous
tissue and fat and contain large
numbers of sebaceous and eccrine
sweat glands.
- Labia majora or "greater lips" are
the part around the vagina containing
two glands (Bartholin’s glands)
which helps lubrication during
intercourse.
- At puberty, hair grows on the mons pubis
and on the lateral surfaces of the labia
majora.

Labia minora
- These are two smaller folds of skin
between the labia majora, containing
Blood supply to the uterus.
Internal genitalia
Blood supply, lymph drainage and nerve
supply ● vagina
● uterus
Arterial supply ● two uterine tubes
- This is by branches from the internal ● two ovaries
pudendal arteries that branch from
the internal iliac arteries and by
external pudendal arteries that Vagina
branch from the femoral arteries.
Venous drainage
- This forms a large plexus which The vagina is a fibromuscular tube
eventually drains into the internal lined with stratified squamous
iliac veins. epithelium
• It runs obliquely upwards and
backwards at an angle of about 45°
Lymph drainage between the bladder in front and
- This is through the superficial rectum and anus behind.
inguinal nodes. • • In the adult, the anterior wall is
Nerve supply about 7.5 cm long and the posterior
- This is by branches from pudendal wall about 9 cm long.
nerves. The difference is due to the angle of
insertion of the cervix through the
Perineum anterior wall.
● The perineum is a roughly triangular
area extending from the base of the Hymen
labia minora to the anal canal.
● It consists of connective tissue,
muscle and fat. The hymen is a thin layer of mucous
● It gives attachment to the muscles of membrane that partially occludes the
the pelvic floor opening of the vagina.
• It is normally incomplete to allow
for passage of menstrual flow and is
stretched or completely torn away by
sexual intercourse, insertion of a
tampon or childbirth.

Structure of the vagina

The vaginal wall has three layers:
• an outer covering of areolar
tissue
• a middle layer of smooth
 muscle during childbirth
• and an inner lining of stratified
squamous epithelium that forms .Uterus
ridges or rugae. It has no ● The uterus is a hollow muscular
secretory glands but the surface pear-shaped organ that is located
is kept moist by cervical anteroposteriorly in the pelvic cavity.
secretions. Between puberty and ● It lies in the pelvic cavity between
the menopause, the urinary bladder and the rectum
● It is about 7.5 cm long, 5 cm wide
Lactobacillus acidophilus and its walls are about 2.5 cm thick.
● It weighs between 30 and 40 grams
- bacteria that secrete lactic acid,
are normally present maintaining
the pH between 4.9 and 3.5. The
acidity inhibits the growth of
most other microorganisms that
may enter the vagina from the
perineum or during sexual
intercourse.

Blood supply, lymph drainage and nerve

supply

Arterial supply
- An arterial plexus is formed round
the vagina, derived from the uterine Parts of the uterus
and vaginal arteries, which are
❖ Fundus
branches of the internal iliac arteries.
❖ Body
Venous drainage ❖ Cervix
- A venous plexus, situated in the
muscular wall, drains into the
Fundus.
internal iliac veins.
- This is the dome-shaped part of the
Lymph drainage.
uterus above the openings of the
- - This is through the deep and uterine tubes.
superficial iliac glands.
Body
- This is the main part. It is narrowest
Functions of the vagina inferiorly at the internal os where it
is continuous with the cervix.
● vagina acts as the receptacle for Cervix (‘neck’ of the uterus)
the penis during sexual - This protrudes through the anterior
intercourse (coitus) wall of the vagina, opening into it at
● provides an elastic passageway the external os.
through which the baby passes
 Myometrium

● This is the thickest layer of tissue

in the uterine wall.
● It is a mass of smooth muscle
Layers of the uterus fibres interlaced with areolar
❖ Perimetrium tissue, blood vessels and nerves.
❖ Myometrium
❖ Endometrium Endometrium
● Made up of the Columnar
Perimetrium epithelial cells
● This is peritoneum, which is ● Consist mucous secreting tubular
distributed differently on the glands Endometrium
various surfaces of the uterus.
• Anteriorly it lies over the fundus
and the body where it is folded on to Blood supply, lymph drainage and nerve
the upper surface of the urinary
bladder. This fold of peritoneum supply
forms the vesicouterine pouch.
• Posteriorly the peritoneum covers Arterial supply This is by the uterine
the fundus, the body and the cervix, arteries, branches of the internal iliac
then it folds back on to the rectum to arteries.
form the rectouterine pouch (of Venous drainage internal illiac vein
Douglas). Lymph drainage. Deep and superficial
lymph vessels drain lymph from the uterus
and the uterine tubes to the aortic lymph
nodes and groups of nodes associated with
the iliac blood vessels.

Supporting structures to the uterus

 ❖ into the peritoneal cavity close to the
❖ The uterus is supported in the pelvic ovaries.
cavity by surrounding organs, ❖ The end of each tube has fingerlike,
muscles of the pelvic floor and projections called fimbriae.
ligaments that suspend it from the ❖ The longest of these is the ovarian
walls of the pelvis fimbria, which is in close association
with the ovary.
Broad ligaments
- These are formed by a double fold
of peritoneum, one on each side of Structure
the uterus. •
Round ligaments ❖ The uterine tubes are covered with
- These are bands of fibrous tissue peritoneum (broad ligament),
between the two layers of broad ❖ have a middle layer of smooth
ligament. muscle and are lined with ciliated
epithelium.
❖ Blood and nerve supply and
lymphatic drainage are as for the
uterus.

Functions
❖ The uterine tubes propel the ovum
from the ovary to the uterus by
peristalsis and ciliary movement.
❖ The secretions of the uterine tube
nourish both ovum and spermatozoa.
❖ Fertilization of the ovum usually
Uterosacral ligaments takes place in the uterine tube, and
- These originate from the posterior the zygote is propelled into the
walls of the cervix and vagina and uterus for implantation.
extend backwards, one on each side Ovaries
of the rectum, to the sacrum. ❖ The ovaries are the female gonads
Transverse cervical (cardinal) ligaments (glands producing sex hormones and
- These extend one from each side of the ova), and they lie in a shallow
the cervix and vagina to the side fossa on the lateral walls of the
walls of the pelvis. pelvis.
❖ They are 2.5–3.5 cm long, 2 cm wide
Uterine tubes
and 1 cm thick. Each is attached to
❖ The uterine (Fallopian) tubes are the upper part of the uterus by the
about 10 cm long and extend from ovarian ligament and to the back of
the sides of the uterus between the the broad ligament by a broad band
body and the fundus. of tissue, the mesovarium.
❖ They lie in the upper free border of ❖ Blood vessels and nerves pass to the
the broad ligament and their ovary through the mesovarium
trumpet-shaped lateral ends,
penetrate the posterior wall, opening
 ❖
❖ Lobules open into lactiferous ducts,
which drain milk towards the nipple.
❖ breast itself is covered in
Structure subcutaneous fat.
The ovaries have two layers of tissue. ❖ In the lactating breast, glandular
A. Medulla. This lies in the tissue proliferates (hyperplasia) to
centre and consists of fibrous support milk production, and recedes
tissue, blood vessels and again after lactation stops.
nerves.
B. Cortex. This surrounds the
The nipple
medulla. It has a framework
of connective tissue, or ❖ This is a small conical eminence at
stroma, covered by germinal the centre of the breast surrounded
epithelium. by a pigmented area, the areola.
❖ On the surface of the areola are
It contains ovarian follicles in various
numerous sebaceous glands
stages of maturity, each of which contains an
(Montgomery’s tubercles), which
ovum.
lubricate the nipple during lactation.

Functions
Blood supply, lymph drainage and nerve
❖ The ovary is the organ in which the supply
female gametes are stored and
Arterial supply. The breasts are supplied
develop prior to ovulation.
❖ Their maturation is controlled by the with blood from the thoracic branches of the
hypothalamus and the anterior axillary arteries and from the internal
pituitary gland, mammary and intercostal arteries.
Venous drainage. This is formed by an
anastomotic circle round the base of the
Breasts nipple from which branches carry the
❖ The breasts or mammary glands are venous blood to the circumference, and end
accessory glands of the female in the axillary and mammary veins.
reproductive system.
❖ They exist also in the male, but in
Lymph drainage. This is mainly into the
only a rudimentary form.
superficial axillary lymph vessels and nodes.
Nerve supply. The breasts are supplied by
Structure branches from the 4th, 5th and 6th thoracic
nerves,
• The mammary glands or breasts
consist of varying amounts of
glandular tissue, responsible for milk Reproductive Development
❖ Reproductive development begins at
❖ Each breast contains about 20 lobes, the moment of conception and
each of which contains a number of continues through life.
glandular structures called lobules,
where milk is produced.
 elongates and the ventral
surface of the penis closes to
INTRAUTERINE DEVELOPMENT form a urethra.
❖ Sex assigned at birth is generally ❖ In females, with no
determined at the moment of testosterone present, the
conception by chromosome uterus, labia minora, and
information, which is supplied by the labia majora form.
sperm that joins with the ovum to
create the new life.
❖ A gonad is a body organ that PUBERTAL DEVELOPMENT
produces the cells necessary ❖ Puberty is the stage of life at which
for reproduction (the ovary in secondary sex changes begin.
females, the testis in males). ❖ In most girls, these changes
❖ At approximately week 5 of are stimulated when the
intrauterine life, mesonephric hypothalamus synthesizes
(wolffian) and and releases
paramesonephric (müllerian) gonadotropin-releasing
ducts, the tissue that will hormone (GnRH), which then
become ovaries and testes, triggers the anterior pituitary
have already formed. to release follicle-stimulating
❖ By week 7 or 8, in hormone (FSH) and
chromosomal males, this luteinizing hormone (LH).
early gonadal tissue begins ❖ FSH and LH are termed
formation of testosterone. gonadotropin (gonad =
Under the influence of “ovary”; tropin = “growth”)
testosterone, the mesonephric hormones not only because
duct develops into male they begin the production of
reproductive organs and the androgen and estrogen,
paramesonephric duct which in turn initiate
regresses. secondary sex
characteristics, but also
❖ If testosterone is not present because they continue to
by week 10, the cause the production of eggs
paramesonephric duct and influence menstrual
becomes dominant and cycles throughout women’s
develops into female lives (Eggers, Ohnesorg, &
reproductive organs. When Sinclair, 2014).
ovaries form, all of the
oocytes (cells that will
develop into eggs throughout The Role of Androgen
the woman’s mature years) ❖ Androgenic hormones are the
are already present. hormones responsible for muscular
❖ At about week 12 of development, physical growth, and
intrauterine life, the external the increase in sebaceous gland
genitals begin to develop. secretions that cause typical acne in
❖ In males, penile tissue both boys and girls during
 adolescence. development.
❖ It also closes the epiphyses of long
❖ In males, androgenic bones in girls the same way
hormones are produced by testosterone closes the growth plate
the adrenal cortex and the in boys. The beginning of breast
testes and, development is termed thelarche,
❖ in females, by the adrenal which usually starts 1 to 2 years
cortex and the ovaries. before menstruation.

The level of the primary Female Secondary Sex Characteristics

androgenic hormone,
testosterone, is low in males ● Growth spurt
until puberty (between ages ● Increase in the transverse
12 and 14 years) when it rises diameter of the pelvis
to influence pubertal changes ● Breast development
in the testes, scrotum, penis, ● Growth of pubic hair
prostate, and seminal ● Onset of menstruation
vesicles; the appearance of ● Growth of axillary hair
male pubic, axillary, and ● Vaginal secretions
facial hair; laryngeal
enlargement with its Male Secondary Sex Characteristics
accompanying voice change; ● Increase in weight
maturation of spermatozoa; ● Growth of testes
and closure of growth plates ● Growth of face, axillary, and pubic
in long bones (termed hair
adrenarche). ● Voice changes
In girls, testosterone ● Penile growth
influences enlargement of the ● Increase in height
labia majora and clitoris and ● Spermatogenesis (production of
the formation of axillary and sperm)
pubic hair.

❖ In girls, testosterone influences

Sexual Health
Sexuality
enlargement of the labia majora and
clitoris and the formation of axillary - is a multidimensional phenomenon
and pubic hair. that includes feelings, attitudes, and
actions. It has both biologic and
The Role of Estrogen
cultural diversity components.
❖ When triggered at puberty by FSH, - It encompasses and gives
ovarian follicles in females begin to direction to a person’s
excrete a high level of the hormone physical, emotional, social,
estrogen. and intellectual responses
❖ This increase influences the throughout life.
development of the uterus, fallopian
tubes, and vagina; typical female fat
distribution; hair patterns; and breast
THE SEXUAL RESPONSE CYCLE

❖ Two of the earliest researchers of Orgasm

sexual response were Masters and
Johnson. In 1966, they published the ● Orgasm occurs when stimulation
results of a major study based on proceeds through the plateau stage to
more than 10,000 episodes of sexual a point at which a vigorous
activity among more than 600 men contraction of muscles in the pelvic
and women (Masters, Johnson, & area expels or dissipates blood and
Kolodny, 1998). fluid from the area of congestion.
❖ In this study, they described ● The average number of contractions
the human sexual response as for the woman is 8 to 15 contractions
a cycle with four discrete at intervals of 1 every 0.8 seconds.
stages: excitement, plateau,
orgasm, and resolution. ● In men, muscle contractions
Whether stages are felt as surrounding the seminal vessels and
separate steps this way or prostate project semen into the
blended into one smooth proximal urethra. These contractions
process of desire, arousal, are followed immediately by three to
and orgasm is individualized. seven propulsive ejaculatory
contractions, occurring at the same
Stages of Sexual Response time interval as in the woman, which
force semen from the penis (Masters
et al., 1998).
1. excitement ● As the shortest stage in the sexual
2. plateau response cycle, orgasm is usually
3. orgasm experienced as intense pleasure
4. Resolution affecting the whole body, not just the
pelvic area.
Plateau ● It is also a highly personal
● The plateau stage is reached just experience: Descriptions of orgasms
before orgasm. vary greatly from person to person.
● In the woman, the clitoris is
drawn forward and retracts under Resolution
the clitoral prepuce, the lower
part of the vagina becomes ● The resolution is a 30-minute period
extremely congested (formation
during which the external and
of the orgasmic platform), and
internal genital organs return to an
there is increased breast nipple
unaroused state.
elevation.
● For the male, a refractory period
● In men, vasocongestion leads to occurs during which further orgasm
is impossible.
distention of the penis. Heart rate
● Women do not go through this
increases to 100 to 175 beats/min
refractory period, so it is possible for
and respiratory rate to about 40
women who are interested and
breaths/min.
properly stimulated to have
additional orgasms immediately after
the first.