FEMALE ANATOMY AND PHYSIOLOGY

Part A – Female Pelvis

female sexual anatomy and physiology

genital self exam

vulva

underlying structures

internal structures

menstruation

menopause

gynecologic health concerns

breasts

genital self exam

become more comfortable

with anatomy and sexuality

detect small changes

seek medical attention promptly

(STDs, cancer, etc.)

gynecology – the medical specialty

for female sexual and reproductive anatomy

the vulva: the external genitals of the female, including the:

mons veneris, labia majora, labia minora, clitoris,

and urinary and vaginal openings

[picture of vulva]

the mons Veneris (“the mound of venus”) or mons

pad of fatty tissue covering pubic bone

numerous nerve endings

at puberty becomes covered with hair

pubic hair varies in color, texture, and thickness

[picture of mons Veneris]

labia majora (outer lips)

have nerve endings and fatty tissue

partially covered with hair

[picture of labia majora]

labia minora (inner lips)

hairless folds of skin join at the prepuce / clitoral hood

contain sweat and oil glands, blood vessels, nerve endings

[picture of labia minora]

clitoris

external shaft and glans covered by clitoral hood/prepuce

internal crura or roots

[picture of clitoris]

[another picture of clitoris and vulva]

[another picture of clitoris glans, shaft, and crura]

smegma (secretions, skin cells, and bacteria)

may accumulate under the hood

the shaft contains cavernous bodies

which engorge with blood during sexual arousal

[pictures of cavernous bodies]

the clitoris

has about the same number of nerve endings

as the head of the penis

[pictures of penis and clitoris]

vestibule = area of the vulva inside the labia minora

rich in blood vessels and nerve endings

[picture of vestibule]

urethral opening

where urine passes out of a woman’s body

[picture of urethral opening]

introitus = opening of the vagina

[picture of introitus]

hymen

thin, vascularized membrane

separates vagina from vestibule

shows great variations

[4 pictures of various types of hymen]

hymen

between vestibule and vagina

[picture of hymen]

imperforate hymen

completely covers the vaginal opening

causes menstrual flow to collect inside the vagina

[picture of imperforate hymen]

first intercourse

pain and bleeding may occur as the hymen tears

hymen can be partial, flexible, or thin enough

for there to be no discomfort or bleeding

it may even remain intact after intercourse

one study found the following with first intercourse:

25% of women reported no pain

40% of women reported moderate pain

33% of women reported severe pain

perineum

area of smooth skin between vaginal opening and anus

endowed with nerve endings

[picture of perineum]

episiotomy = incision made in perineum

to prevent ragged tearing of tissues

[picture of location of episiotomy]

Female Genital Mutilation (FGM)

“Female Circumcision”

read about it on your own if interested

Waris Dirie

[picture of desert flower book cover]

[picture of desert flower movie poster]

Body Drama

Miss America swimsuit winner 2004

Honors degree in women’s studies Harvard

…when I study the different vulvas,

I see elements of my own here and there,

and I realize that no one’s exactly the same.

I also have been able to release

a lot of the embarrassment

I always carried around about my own vag.

I hope that these pages will do the same for you!

p. 118

[picture of Body Drama book cover]

[photos of 24 different vulvas]

vestibular bulbs fill with blood during sexual excitement

vagina increases in length

vulvar area becomes swollen

[picture of vestibular bulbs]

Bartholin’s glands

once believed to be the source of vaginal lubrication

typically produce only 1-2 drops just prior to orgasm

Bartholin’s gland:

anatomical location & infected gland

[pictures of Bartholin’s glands]

pelvic floor muscles

multidirectional design allows vaginal opening

to expand and contract

muscles can be trained through Kegel exercises

Kegel exercises

purpose

regain urinary control after childbirth

increase in genital sensitivity

increase sensation during intercourse

steps

learn how to locate and control the muscles

squeeze the muscles repeatedly

10-25x in a row

exercise about 3x/day

Kegelmaster 2000

LadyCare Vaginal Exercise Weights

[pictures of devices that have been marketed to strengthen pelvic floor muscles]

vagina = canal that extends into the body angling upward

unaroused length = 3-5 inches

[picture of vagina]

inserting a tampon

insert it parallel

…not perpendicular

[pictures of how - and how not - to insert tampon]

cardboard ---- barrel grip plunger

plastic ---- barrel grip plunger

tampon

[pictures of cardboard applicator, plastic applicator, and tampon without applicator]

[picture of how to hold tampon applicator]

[picture of empty vagina]

[pictures of how - and how not - to insert tampon]

now push the plunger in

[picture of plunger inside applicator inside vagina]

the tampon is now in place!

[picture of tampon in vagina]

This tampon is not fully inserted

[picture of tampon half-in and half-out of the vagina]

http://www.theperiodblog.com /how-to-guides/how-to-insert-tampon/

PICTURES from The Period Blog

Tampon types: paper, plastic & no applicator

How to hold the applicator

How to insert in multiple steps

https://www.youtube.com /watch?v =JbKkOd0LIpw

You tube video on how to use tampon

Originally found on center for young women’s health website:

http://youngwomenshealth.org /2012/09/27/tampons/

wall contains: mucosa, muscle, fibrous tissue

walls & cervix make white or yellow secretions – pH 4-5

best to avoid douching & deoderants

[picture of vagina]

cervix = small end of pear-shaped uterus

os = opening at the center of cervix

cervix can be seen using a speculum

[picture of cervix]

cervix can be felt with the fingers

consistency like end of nose (firm and round)

[picture of cervix]

cervix

portion of uterus that can be seen and felt

at the end of the vagina tunnel

[picture of cervix]

uterus (womb) = hollow, thick, pear-shaped organ

approximately 3” x 2” in nulliparous woman

[picture of uterus]

uterine wall:

perimetrium = thin outer membrane

myometrium = thick muscle

endometrium = thin inner lining

[picture of uterine wall]

[picture of model of female pelvis cut in half in the midline]

[picture of model of female pelvis with a baby inside the uterus]

position of uterus may vary from anteflexed to retroflexed

positions may contribute to variations in

menstrual discomfort & difficulty inserting diaphragms

[picture showing possible positions of uterus]

fallopian tubes – 4 inches long

fimbriae (plural of fimbria) – extensions that cover ovary

[picture of fallopian tubes with fimbriae]

egg remains viable about 24-48 hrs

fertilization usually occurs inside the upper tube area

[picture of fallopian tubes]

cilia move egg

1 inch / 24 hours

[picture of cilia]

ovaries

about the size and shape of almonds

produce estrogen and progesterone compounds

[picture of ovaries]

ovaries contain up to 472,000 immature ova at birth

average woman releases 400 eggs / lifetime

ovulation occurs at a specific point in the menstrual cycle

[picture of ovaries]

menstruation – sloughing off of endometrium

if conception has not occurred

menarche – the onset of menstruation

(US average age = 12)

menopause – the cessation of menstrual cycles

(age 45-55)

http://en.wikipedia.org /wiki/List_of_youngest_birth_mothers

CrackedHistory

On May 14, 1939, in Peru, 5 ½ year old Lina Medina became

the youngest documented human mother in history. Giving

birth to a 6 pound healthy boy.

[pictures of Lina Medina and her son]

[more pictures of Lina Medina]

One study found

43% of women reported feeling

confused, frightened, panicky, or ill

when they started their first period

one-third of the women surveyed

did not know about menstruation

before they began to menstruate

books can help you educate your children

[picture of book cover – It’s NOT the Stork!]

[picture of book cover – IT’S SO AMAZING]

[picture of book cover – It’s Perfectly Normal]

[picture of book cover – BODY DRAMA]

menstrual cycle

begins with

first day of blood flow

duration: 2-6 days

volume: 6-8 ounces

cycle length: 24-42 days

time between ovulation

and onset of menstruation: 14 days

a dramatic change

in the usual pattern

should prompt medical evaluation

menstrual synchrony:

women who live together

(e.g. college dormitory roommates)

often synchronize their cycles

[diagram from textbook graphically illustrating the

14 day interval between ovulation and menstruation]

[diagram from textbook graphically illustrating the

changing levels of hormones in the bloodstream

and the changes in follicles in the ovary

and the changes in thickness of the endometrium

during different phases of the menstrual cycle]

[diagrams illustrating how events in the ovary and uterus

differ in a menstrual cycle in which pregnancy occurs
vs. a menstrual cycle in which no pregnancy occurs]

phases of the menstrual cycle

menstrual phase:

uterus sheds part of endometrium

flow consists of blood, mucus, & tissue

proliferative phase:

FSH stimulates follicles in ovary to mature

estrogen causes endometrium to thicken

approx. 14 days before the onset of the next bleed

ovulation occurs

ovulation may be accompanied by a

twinge, cramp, or pressure (Mittelschmerz)

secretory phase:

corpus luteum forms from ruptured follicle

corpus luteum secretes progesterone

corpus luteum degenerates

[REPEAT OF EARLIER SLIDE WITH

diagram from textbook graphically illustrating the

changing levels of hormones in the bloodstream

and the changes in follicles in the ovary

and the changes in thickness of the endometrium

during different phases of the menstrual cycle]

sexual activity and the menstrual cycle

many people avoid intercourse during menstruation

uncomfortable physical symptoms

messiness

religious or cultural beliefs

people who have sexual activity during menstruation may

use a diaphragm

use a tampon

find that orgasms may reduce

backache, feelings of pelvic fullness, and cramping

most women undergo some

physical changes

or mood changes

or both

during their menstrual cycles

premenstrual syndrome (PMS)

10-20% have severe symptoms

30-50% have mild or moderate symptoms

negative emotions

anxiety, irritability, depression, anger, insomnia,

confusion, tearfulness, social withdrawal

uncomfortable physical symptoms

fluid retention, breast tenderness, weight gain, headaches,

nausea, increased appetite, craving for sweets

measures to improve well-being

eat a well-balanced diet

eliminate smoking

exercise

relax

dysmenorrhea – painful menstruation

causes:

overproduction of prostaglandins (especially in adolescence)

causing abdominal aching and/or cramping

(+/- nausea, vomiting, diarrhea, headache, dizziness,

fatigue, irritability, nervousness)

presence of intrauterine device (IUD)

pelvic inflammatory disease (PID)

benign uterine tumors

obstruction of cervical opening

endometriosis

PID (Pelvic Inflammatory Disease)

signs/symptoms:

disrupted periods, pelvic pain, nausea, vomiting, headache

[picture of PID]

fibroids (leiomyoma)

occur in perhaps 50 percent of women

collections of whorls of interlacing, smooth muscle fibers

vary tremendously in size

[picture of fibroids]

cervical polyp

[picture of cervical polyp]

prevalence of endometriosis estimated at 1% to 50%

dysmenorrhea reported in 25% to 67% of women with endometriosis

[picture of possible locations of endometriosis]

76% to 90% of women have retrograde flow…

(found in women undergoing peritoneal dialysis and

laparoscopy at time of menses)

[picture of routes of blood flow]

amenorrhea – the absence of menstruation

primary amenorrhea – the failure to begin menstruation at puberty

causes:

abnormalities of the reproductive organs

hormonal imbalances

poor health

imperforate hymen

secondary amenorrhea – absence of menstruation,

for 3 months or more, after the normal menstruation pattern

has been established

causes:

pregnancy

breast feeding

poor health

emotional causes

approaching menopause

rigorous athletic training

anorexia nervosa

Toxic Shock Syndrome (TSS)

cause: toxins produced by the bacterium Staphylococcus aureus

symptoms: fever, sore throat, nausea, vomiting, diarrhea,

red skin flush, dizziness, low blood pressure

TSS course: rapid progression can cause death

consult physician immediately

prevention:

use pads instead of tampons

use regular instead of super-absorbent tampons

change tampons 3-4x/day and alternate with pads once a day

climacteric – physiological changes that occur

during the transition period from fertility to infertility

in both sexes

perimenopause – the period prior to

complete cessation of menstruation

menopause – permanent cessation of menstruation

(mean age = 51)

possible effects of menopause

freedom from concern about

pregnancy

contraception

menstruation

“hot flashes”

night sweats

sleep disturbance

hormone replacement therapy (HRT)

the taking of supplemental

estrogen, progesterone,

and possibly testosterone

to compensate for

the decrease in natural hormone production

that occurs during the female climacteric

benefits of HRT

increases sense of well-being

reduces hot flashes, depression, sleep disturbances, anxiety

increased protection against osteoporosis (bone loss)

and resultant fractures (especially hip fractures)

assists in maintaining urethral and vaginal tissues,

vaginal lubrication, clitoral sensitivity,

orgasmic response, and sexual interest

previously erroneously thought to provide protection from

cardiovascular disease and dementia

HRT – increases risk of:

endometrial cancer

(especially estrogen without progesterone)

breast cancer

ovarian cancer

heart attack

stroke and other vascular events

*********************************************************************

RELATIVE AND ABSOLUTE RISK OR BENEFIT SEEN IN

ESTROGEN PLUS PROGESTIN ARM OF WOMEN’S

HEALTH INITIATIVE (WHI) n = 16,608, placebo and study drug

Health Event Relative Risk Increased Increased

vs. Placebo Absolute Risk Absolute Benefit

Group per 10,000 per 10,000

at 5.2 Years Women/Year Women/Year

Heart Attacks 1.29 7

Strokes 1.41 8

Breast Cancer 1.26 8

Thromboembolic Events 2.11 18

Colorectal Cancer 0.63 6

Hip Fractures 0.66 5

Wyeth Pharmaceutical letter to physicians Adapted from WHI HRT Update, June 2002

*******************************************************************************

clinical manifestations of osteoporosis

[pictures of effects of osteoporosis on the body]

Normal bone Osteoporotic bone

[pictures of normal and osteoporotic bone]

[pictures of vertebral column affected by osteoporosis]

osteoporosis will cause a broken bone in

one out of every two white women over age 50

osteoporosis is the cause of more than

1.5 million spine, hip, and wrist fractures

In the U.S. each year

one in five women who sustains a hip fracture

dies within one year of complications

precipitated by the bed rest required for recovery

p.4 Smart Women: Strong Bones

1/5 of women will have at least one UTI

symptoms

frequency, burning, blood or pus in urine, lower pelvic pain

cause

usually bacteria from the rectum or vagina

or a partner’s sexual organs

[picture of bladder and urethra]

preventing UTIs

proper wiping, good hygiene, not waiting to urinate,

washing before intercourse, urinating after intercourse,

drinking lots of liquids

[picture of bladder and urethra]

vaginitis = vaginal infection or inflammation

symptoms – irritation, itching, discharge, odor

get infections treated promptly (avoid PID and CA)

[picture of vagina]

vaginitis predisposing factors

diabetes

antibiotics

emotional stress

high carbohydrate diet

pregnancy and OCP

chemical irritants

coitus without adequate lubrication

nylon underwear and pantyhose (3x yeast infections)

menstrual flow (via pH)

pap smear = screening test for cervical cancer

other testing/treatment methods:

colposcopy, biopsy, cryosurgery

[picture of speculum in vagina]

factors increasing the risk of developing cervical cancer -

genital warts, several sexual partners, cigarette smoke

first coitus at early age

partners with occupational exposure to toxins

[pictures of tools that scrape off cervical cells]

[pictures of what pap smear cells look like through microscope]

transformation zone

where stratified squamous epithelium

meets columnar epithelium

[picture of transformation zone]

colposcope

[picture of colposcope]

[pictures of cervix as seen through colposcope]

the bimanual exam can screen for

ovarian tumors and other abnormalities

[pictures of bimanual exam]

hysterectomy = surgical removal of uterus

oopherectomy = surgical removal of ovaries

salpingectomy = surgical removal of fallopian tubes

some reasons for hysterectomy

bleeding disorders

cancers

tumors

severe infections

side effects of hysterectomy / oophorectomy

may or may not effect sexual response

(no uterine vasocongestion, elevation, or contractions)

(no more pregnancies or menstruation)

removal of ovaries

will cause early menopause

without HRT

emotional or psychological interpretations

may affect couple

[picture of uterus, fallopian tubes, and ovaries]

33% of US women have a hysterectomy by age 65

“An American woman has

two to three times the chance of having a hysterectomy

as her counterpart in England, France, or West Germany,

and foreign doctors joke about

American “birthday hysterectomies”…”

Medicine and Culture p.125

Penguin Books