Chapter 5

Female Sexual Anatomy and Physiology

Figure 5.1 The external genital structures of the mature female.

Figure 5.2 Side inner view of the erect clitoris.

Figure 5.3 The female internal reproductive system (side view).

This photo shows the release of a mature ovum at ovulation. The ovum (orange) is surrounded by remnants of cells and liquid from the ruptured

ovarian follicle. Mature ova develop in the ovaries from follicles that remain dormant until sexual maturity.

Figure 5.4 The female internal reproductive system (front view).

Figure 5.5 The Female Breast

Female Puberty

• Menarche: As early as age 7, usually 11-12 yrs• Pituitary gland FSH and LH estrogen • size of Fallopian tubes, uterus, vagina,

breasts, buttocks, thighs• Pelvis widens• Pubic hair grows• Mittelschmerz – slight pain in some women

with ovulation

Menstruation

• Menstruation – uterine lining is shed if no pregnancy; tissue and blood are released

• Menstrual cycle – about 24 to 35 days; average is 28 days

• Menstrual cycle has four phases:– Follicular phase– Ovulatory phase– Luteal phase– Menstrual phase

Figure 5.7 The ovarian and menstrual cycles.

Figure 5.8 The cycle of female hormones.

Variations in Menstruation

• Amenorrhea – absence of menstruation– Primary amenorrhea – Secondary amenorrhea – Dysmenorrhea

• Dysfunctional uterine bleeding (DUB)• Menorrhagia

Variations in Menstruation (Cont.)

• Premenstrual Syndrome (PMS) • Premenstrual Dysphoric Disorder (PMDD)

Menopause

• Climacteric – period of decreased estrogen production and menstruation stops; 40-58 years, average 51 years

• Irregular cycles, rather than a sudden stop• Hormonal changes – hot flashes, headaches, sleep

disturbances• Sexual complaints• Menopause can be induced by surgically by removing

the ovaries; doctors try to keep at least one in if surgery is necessary

Menopause (Cont.)

• Hormone replacement therapy – was a standard treatment, but there are a lot of health risks and not typically used today

• Newer therapies with lower levels of hormones may be used

• Nutritional, vitamin, and herbal remedies are commonly used today

Female Reproductive and Sexual Health

• Genital self-exams are recommended for women to be familiar with their genitals and any possible abnormalities

• Routine gynecological examinations recommended once menstruating– Medical history and checkup– Pelvic examination (internal and external)– Breast examination– Pap smear – cervical swab

Gynecological Health Concerns

• Most prevalent:– Endometriosis– Menstrual Toxic Shock Syndrome– Polycystic Ovarian Syndrome

Gynecological Health Concerns (cont.)

• Most prevalent:– Uterine Fibroids– Vulvodynia

Cancer of the Female Reproductive Organs

• Breast Cancer• Uterine Cancer• Cervical Cancer• Endometrial Cancer• Ovarian Cancer

Breast Cancer

• One of most common cancers • Early detection is critical: breast self-

examinations, gynecological checkups, mammography beginning at age 40

• Symptoms: breast lump, breast pain, nipple discharge, puckering of skin, change in nipple shape

• If untreated, the cancer will spread to other parts of the body - Metastasize

Breast Cancer (cont.)

• Treatment: partial/modified mastectomy, radical mastectomy, lumpectomy, radiation, chemotherapy

• Risk factors: fat intake, aging, early menarche, prolonged estrogen, inactive lifestyle, alcohol consumption, genetics

• Breastfeeding, early pregnancy reduces risk

Cervical Cancer

• Rates decreased over past several decades• Pap smear is used for detection• High cure rates• HPV is main cause• Risk factors: early intercourse, many sexual

partners, teenage mothers, cervicitis, genital viral infections, extended oral contraceptive use

• Treatment: surgery, radiation, hysterectomy

Endometrial Cancer

• Symptoms: abnormal bleeding, spotting• Detection most successful with dilation and

curettage• Treatment: surgery, radiation, hormones,

chemotherapy• Over 90% survival rate• Oral contraceptives decrease risk

Ovarian Cancer

• Less common than breast, uterine cancers• Most deadly• Symptoms: few early signs, ovarian cyst, slight

abdominal discomfort, appetite loss, indigestion, abdominal swelling, nausea, vomiting

• Risk factors: childlessness, early menopause, high-fat diet, higher SES, lactose-intolerant, use talc powder on the vulva

Ovarian Cancer (Cont.)

• Decreased risk with having children and using birth control pills, tubal ligation

• Detection techniques: blood tests, pelvic exams, ultrasound

• Unfortunately, most diagnosed after cancer has spread beyond the ovary because of the lack of early warning signs

• Treatment: remove ovaries, radiation, chemotherapy