physiology of women exam one

Period poverty

Lack of money or access to menstrual hygiene products, 1 in 4 US students experience period poverty

puberty

transition from childhood to adulthood, puberty is not mensuration, it begins a year before mensuration occurs

when does puberty occur in females

8-13 but is happening earlier every year

what is menarche?

onset of menstrual periods influenced by genetic, social and economic factors, also influenced by 1. body fat(high and low body fat can delay menarche), 2. nutrition (must be healthy enough to support a regular cycle), 3. sleep

basal body temperature

-BBT

-temperature first thing in the morning Hormonal influence

-must be taken before any activity (basal=at rest)

-can be used as a way to track your cycle

Menstrual migraines

-occurs just before the onset of menstruation due to estrogen dropping

-more severe, last longer and often do not respond to medication

-attempts to prevent: avoid triggers, increasing phytoestrogens, and maintaining blood sugar levels

male reproductive cycle

-Equivalent to what is occurring in women just shorter

-LH—secrete testosterone—leading to sperm development and testosterone release

FSH- sperm development and the release of inhibin

uterine cycle phase names

1. menses

2. proliferative

3. secretory

menses phase

• days 1-7

• low levels of estrogen and progesterone

• lost of stratum functionalis layer (part of the endometrium that sheds) and blood

proliferative phase

• days 8-14

• estrogen stimulates the stratum functionalis to thicken

  • lining is being told to rebuild via estrogen

secretory phase

• days 15-28

• high levels of progesterone tells the stratum functionalis to thicken/dilation of glands

• drop in estrogen and progesterone around day 21 induces stratum functionalis breakdown.

what is happening during the uterine (endometrial cycle)

1. the endometrium/stratum functionalis is thickening

2. the stratum functionalis layer is shedding (if the egg is not fertilized)

ovarian cycle phases

1. follicular

2. ovulation

3. luteal

Follicular phase

• FSH induces follicular growth and secretion of estrogen

• follicle secretes estrogen to promotes follicle development

• days 1-13

ovulation

• day 14, only occurs on a single day

• estrogen surge

• LH surge

• Secretion of progesterone begins

• egg is released from ovary

Luteral Phase

• days 15-28

• follicle, now the corpus ludium secretes both estrogen and progesterone

• Progesterone secretion is higher

• Hormone secretion drops around day 21 or 7 days after ovulation

What is occurring in the ovary during the ovarian cycle? look at pic for steps

• Steps 1-3

  • Primary follicle surrounds the egg and supports development

  • follicle releases estrogen

  • the follicle gets bigger as the egg develops

• Step 4

  • continued development

  • follicle at its largest

• Step 5

  • Egg is released from ovary and will enter to fallopian tube

• Steps 6-7

  • follicle becomes the corpus luteum

  • releases both estrogen and progesterone but main hormone is progesterone

• Step 8

  • becomes the corpus albicans and dies

Extras:

1. egg/ovum development and release-1 egg per month

2. Hormones are released-estrogen and progesterone

BPA

• endocrine disruptor

• can bind to both estrogen and testosterone receptors

• linked to menstrual cycle irregularities, miscarriages, and breast, ovary, and prostate cancer

Endocrine Disruptors

• Chemicals with similar structures to hormones

• can bind to hormone receptors

• activate or block hormone receptor activity

Hormones Activity

• hormone binds to a receptor

• activation of the receptor causes a response

• i.e. uterus-thickening of lining

Androgen (Testosterone)

• male characteristics

• increase facial and body hair

• reduce scalp hair

• increase muscle mass

• increase size/strength of skeleton

• increase metabolic rate

• increase red blood cells

Progesterone (Progestin)

• uterus

  • prepares for implantation of embryo

• cervical

  • thickens mucus

• contractions during labor

• breast tissue

  • tenderness

  • proliferation of milk glands during pregnancy

Estrogen (estradiol, estriol, estrone)

• female characteristics

• breast tissue

  • fat deposits

• hips and back of arms

  • fat deposits

• bones

  • increase growth

  • close epiphyseal plate

• uterus

  • Thicken lining

• cervical

  • thins mucus

• bruising

  • increase strength of capillary walls

• lower LDL “bad cholesterol levels

• reduces livers metabolism of alcohol and drugs

• Inhibits immune function

Reproductive sex hormones

female

• estrogen(estradiol, estrdiol, estrone)

• progesterone(progestin)

male

• testosterone(androgen)

hormones of the menstrual cycle

Gonadotropic Hormones

• Gonadotropic releasing hormone

  • GnRH

• Luteinizing Hormone

  • LH

• Follicle Stimulating Hormone

  • FSH

Reproductive Sex Hormones

• estrogen

• Progesterone

• testosterone

Gonadotropic Hormones

• controls secretion of reproductive hormones

Hypothalamus

• GnRH

Pituitary Gland

• FSH
  LH

Endocrine System

• hormones

• Regulate body functions using hormones

organs/structures of the endocrine system

Brain:

• hypothalamus and pituitary gland

  • make hormones

reproductive system:

• ovary gland

  • an endocrine organ

• when these three systems work together, they regulate the menstrual cycle

cycle

Series of events that are regularly repeated in the same order

the reproductive system

• produces sex cells(sperm and eggs)

  • also known as gametes

• fertilization through sexual intercourse

  • main job is fertilization and procreation

• support growth and development of fetus(women only)

sex differentiation of reproductive organs

• differentiation of sex organs does not occur until week 6 or 7 weeks of development

• syr gene indicates male reproductive organs

  • lack of this will produce female reproductive organs

homologous structures in reproductive system

• these structures are of the same origin

  • differ depending on if the person is male or female

  • ie- ovary and testes or clitoris and penis

gonads male versus female

• homologous structures

• male

  • testis

  • reproductive organ

  • produces sperm

  • produces testosterone

• female

  • reproductive organ

  • produces egg/ovum

  • produces estrogen and progesterone

female gonad-ovary

• produces egg

• all a females eggs are present in the fetus and are depleted over time

  • actual number is debated

• this is where the egg/ovum develops and is released during ovulation

fallopian tube and fimbria

• fallopian tube

  • site of fertilization

• fimbria

  • pull egg into fallopian tube

• fallopian tube and fimbria are connected

• egg will travel through fallopian tube to get to the uterus

uterus

• location of menstruation and fetal development/growth

• uterus gets bigger as development occurs

uterine layers

• has three layers

  • endometrium

    • most inner layer

    • tissue that changes during mensuration, the part that sheds

  • myometrium

    • muscle

      • like this for labor/delivery

    • will shrink after birth because its very pliable

  • perimetrium

    • thin

    • covers muscle

      • just a membrane

cervix

• connects uterus to vagina

• opens only during ovulation and childbirth

  • a gateway between vagina and uterus

• cervical mucus is normally thick but will thin during ovulation

• body wants to prepare itself for fertilization

  • closed cervix + thick mucus= not ready for sperm

  • open cervix + thin mucus = ready for fertilization

vagina

• internal muscular tube leading to the uterus

• protective lining

  • low pH

    • normal flora/bacteria

    • low pH to protect from infections

    • anti-biotics can disrupt this

  • vaginal lubrication

    • secretions that coat the vagina 

• high distensibility

• very stretchy—when not stretched, it will collapse on itself

• entry for sperm

• most vulnerable spot in the female reproductive tract because it is the entry from the outside

vulva

• external genitalia

• mons pubis

  • fatty tissue

• clitoris

  • erectile tissue

• labia

  • folds of skin

• vestibule

  • area inside labia, has openings for vagina and urethra

pelvic floor muscles

• muscles that support the bladder, uterus, vagina, and rectum

• labor and delivery put a lot of stress on these muscles

  • they may not go back to 100%

    • pelvic floor exercises may help this-kegels

      • strengthen and ton these muscles

      • help improve urinary control, reduce incontinences and support pelvic health

gynecological exams

• physical exams to look for infection, abnormal changes in reproductive systems

  • Palpitation of abdomen

    • Enlargement or tenderness

  • inspection of external genitalia

    • Inflammation or sores

  • inspection of vagina and cervix

    • infections or cancers

  • inspection of uterus, ovaries, fallopian tubes

    • size, position, shape, position, sensitivity

  • inspection of breast tissue

    • palpation for abnormal growth

  • pap smear

    • samples of cervical cells

      • precancerous cells

      • cancer cells

      • human papillomavirus (HPV)

• Recommended annually

prep for pap smear

• do not have vaginal sex for two days before the exam

• do not use tampons, vaginal creams, foams, jellies, lubricants, douches or medicines for two days before

• schedule the apt. for after your period ends

testes/testicles

• sperm develops in the testes

  • millions per day

• Descend just before birth

• located outside the body cavity

  • to lower temperature for sperm development

male reproductive system 

• accessory ducts

  • transport sperm outside the body

    • epididymus

    • vas deferens

    • urethra

  • Accessory glands

    • make fluid for semen

      • seminal vesicle

      • prostate gland

    • penis

      • organ for reproduction and urine elimination

intersex conditions

• reproductive anatomy or physiology that do not match what is typically defined as female or male

gender affirming care

• puberty blockers

• hormone therapy

• Surgeries 

female v. male body stuctures

• similar

• same at the base level

• differ in reproductive and organ systems

number of chromosomes

• 46

• same number in men and women

• differ between xx and xy(men)

• half of chromosomes come from sperm and half come from egg

  • sperm determines sex

  • egg is always x

what is a chromosome

• dna is packages into structures called chromosomes, which are kept in the nucleus of our cells

what is a gene

• a segment of dna

• set of instructions to build a protein

• proteins have a job

Insulin

• INS gene

  • instruction to make insulin protein

• made by cells in the pancreas or the digestive system

• releases when food is eaten and insulin tells the cells to take in sugar from the blood

keratin

• KRT gene

  • instructions to make keratin proteins

• these are found in hair, nails and skin

  • structural components

  • makes nails hard

  • skin is a barrier

  • hair growth

SYR gene

• Instruction to make the protein called testis determining factor

• gene only found on the y gene

when is sex defined

• around 6-8 weeks of fetal development

• reproductive organs are bipotential until this point

sex v. gender

• sex

  • 2 sexes

  • chromosomes

  • reproductive anatomy

  • hormones

• gender

  • genetic sex

  • social influences

    • external expression and social perception

gender identity

• internal sense and may not align with genetic sex assigned at birth

• very specific to the individual

examples of homeostasis

sweating when running on a hot day triggers a thirst response

• heart beating faster, breathing increase in order to pump blood to muscles to replenish

nervous system

components

• brain

• spinal cord

• nerves

functions

• communication in the body

• senses

• movement

• cognition

• reflexes

• Nerves that extend out from spinal cord and brain

  -work together for essentially everything in the body

  -communication within the body that regulates the senses

  -allows skeletal muscle movement

  -cognition=learning, memory, language-->higher order functioning

  -reflexes=tough something hot, your body reacts

endocrine system

• components

  • endocrine glands

• functions

  • regulate body functions through hormones

• homeostasis

  • regulates body functions

• hormones=proteins

  • each gland regulates the body through making hormones

• pth and calcitonin

  • regulate bone density

• growth hormone

  • regulates growth

• adrenal gland

  • fight or flight response

  • regulate adrenaline 

integumentary system

• components

  • skin

  • hair 

  • nails

• functions

  • barrier to outside environment

  • touch

  • Absorption of sunlight to produce vitamin D

Skeletal system

• components

  • bones

    • parts

      • collagen for flexibility

      • minerals for rigidity

    • exercise for bone health

      • weight-bearing and strength training to build and maintain density

        • loss of density = osteoporosis

      • constantly  built and broke down through life

        • bone cells do both—oppose each other

• functions

  • structural support

  • protection of organs

  • movement

    • with muscles

  • storage of minerals

  • storage of fat

  • makes blood

    • red blood cells carry oxygen through the body

      • important for energy

    • these cells die and must be replaced

      • bone marrow will make more

    • white blood cells

      • made in bone marrow

      • part of immune system

male v. female skeletal system

• bone density is greater in males

• females bone grow faster and stop growing earlier than males

  • earlier mensuration begins the earlier bones stop growing

• female pelvis is wilder for childbirth

• female femur angles inward

• male brow bone ridges and jaw = more prominent

• male bones are taller on average

muscular system

• components and functions

  • cardiac muscles

    • heart contractions

  • smooth muscles

    • stretching and contracting

      • digestion

  • Skeletal muscles

    • movement

      • Muscle mass is greater in males

Cardiovascular system

• components

  • heart

  • blood vessels

    • Coronary blood vessels

      • bring oxygen and nutrients to and remove waste from the heart

  • blood

• functions

  • delivers oxygen, nutrients and hormones to cells

  • removes waste from cells

• cholesterol or blood clot can cause death of heart tissue that can cause a heart attack

  • women are protected from this due to estrogen

    • menopause stops results in loss of estrogen

      • heart attacks present different in women

whole body

• heart pumps the blood

• blood vessels distribute blood to body

• all cells need energy to do their jobs, sugar will be circulated through blood

• hormones are released in the endocrine glands and will travel through blood vessels to the designated area

• blood picks up co2 that is made and brings it to the lungs to allow you to breath is out

• your body cannot tolerate excess waste for an extended period of time 

lymphatic/immune system

• components

  • lymphatic vessels

  • lymph nodes

    • swell when fighting an infection

  • lymph fluid

  • immune cells

• functions

  • fluid balance

  • fight infections

• two systems work together

  • lymphatic system is a vessel that carries lymph, this is where white blood cells travel

  • immune system fight the infection but travel through the lymphatic system

respiratory system

• components

  • nasal cavity

  • pharynx

  • larynx

  • trachea

  • lungs

• function

  • move oxygen in 

  • move carbon dioxide out

  • smell

digestive system

• components

  • mouth

  • esophagus

  • stomach

  • intestines

  • liver

  • gall bladder

  • pancreas

• functions

  • digestion and absorption of nutrients

• one tube that goes from mouth, all the way down

• take in nutrients your body needs to survive and fuel cells 

urinary system

• components

  • kidneys

    • bilateral

    • responsible for removal of waste

  • ureters

    • connect kidney to bladder

  • bladder

    • stores waste

  • urethra

    • exit

    • short in women= more prone to UTI

• functions

  • removes waste through urine

  • balance fluids and electrolyes

contraception

• prevention of pregnancy

• prevent the sperm from reaching the egg

  • can be done by targeting hormones or anatomy

changes in vaginal canal

• extends when women is aroused

  • normal

    • 2-5 inches

  • aroused

    • 5 - 8 inches

considerations when choosing a contraceptive method

• safety

  • smokers have higher risk of blood clots when using hormonal method

• effectiveness

  • amount of risk

• lifestyle

  • partner cooperation

• consistency

• cost

• reversibility

• protection from STI

  • condoms and complete abstinence only

• medical condition or medication interactions

theoretical v. use effectiveness

• Percentages can be misleading because theoretical effectiveness versus use effectiveness

  • Theoretical is how effective it should be when used perfectly

  • Use effectiveness is effectiveness with average use, more real

continuous and periodic abstinence

• cont.

  • avoiding intercourse

  • prevents STI

• periodic

  • fertility awareness

    • abstain from sex during fertile times

      • ovulation timing

      • egg is viable for 72 hours

      • sperm is viable for 72-96 hours

  • 24% pregnancies/yr

withdrawal

• penis is withdrawn before ejaculation

  • avoid sperm entering vagina

• first few drops of ejaculate contain most concentrated sperm

• pre-ejaculatory fluid may contain sperm

• 22% pregnancies/ yr

spermicides

• chemical inserted into the vagina near cervix

  • often not inserted high enough up

• block movement/kill sperm

• 28% pregnancy per year

  • when the only contraception

  • often used as a secondary method

• need to sit for 20-30 minutes before intercourse

  • only last a few hours

condoms

• 18-21 % failure rate

  • because

    • slipping

    • breaking

    • not being on right

    • rolling

    • leaking

      • all equal loss of physical barrier

• Physical barrier

  • prevent STI

Diaphragms/ cervical cap

• 12 % failure rate

• unique to each person

  • fitted by medical professional

• use with spermicide

• removed 6 hours after intercourse

sponges

• 12-24 % failure rate per year

• similar to cervical cap

• has spermicide in it

• does not need to be fitted

oral contraceptive

• the pill

  • 1. combined 

    • estrogen and progesterone

      • estrogen inhibits release of GnRH/LH/FSH

        • prevents egg development and ovulation

        • progestin thicken cervical mucus

        • progestin decreases thickness of endometrium

  • 2. mini-pill

    • progesterone only

      • thicken cervical mucus

      • Decrease thickness of endometrium

      • can inhibit ovulation but not as consistent as combo pill

      • mothers must take this one bc combo pill will prohibit milk production

  • Menstruation occurs when taking placebo week

  • all are synthetic hormones

    • works because when there are too much of a hormone the body will stop making them

    • Constant hormones when taken at certain time

      • most effective when take at the same time everyday

  • 9% failure rate every year

    • user error and fluctuation

• side effects

  • blood clots

  • stroke

  • heart attack

  • high blood pressure

  • weight gain

  • migraines

  • gall stones

  • inflammation of gall bladder

implant

• synthetic progesterone implanted in arm

  • slowly releases

• Thicken cervical mucus

• decrease thickness of endometrium

• effective 1-7 year

• 1% failure rate

• does not inhibit ovulation

injectable

• synthetic progesterone

  • injected in arm or hip

• thicken cervical mucus

• decrease thickness of endometrium

• effective for 3 months

• 6% failure rate

  • user

    • not staying on top of three month time span

  • injection

    • may not be distributed equally over the three months

patch

• synthetic estrogen and progesterone

• patch on skin

• acts like combo pill

• replaced every week

• 9% failure rate

vaginal ring

• synthetic estrogen and progesterone

• ring encircles the cervix

• acts like combo pill

• in place for 3 weeks, taken out for one

• 9% failure rate

IUD

• hormonal

  • releases progesterone

  • thickens cervical mucus

  • inhibits thickening of endometrium

  • block sperm movement

  • may inhibit ovulation

  • 2-3 effective

• copper 

  • non hormonal

  • releases copper

    • kills sperm

  • block sperm movement

  • effective for 12 years

• less than 1% failure rate

• acts as a partial barrier because of shape

male-gel application

• hormonal

• nesterone

  • testosterone and progestin

• gel applied daily on shoulder and upper arms

• inhibits production of sperm

  • still not at 0

• in clinical trial

male—pill

• non—hormonal

• Blocks sperm production

• in clinical trial

surgical sterilization

• tubal ligation

  • cuts fallopian tube

• less than 1% failure rate per year

• non—reverable

• makes it so the egg can’t get into the fallopian tube

• menstruation can still occur because ovaries are still intact

surgical sterilization—male

• vasectomy

• less that 1% failure rate per year

• much less invasive than women

• blocks sperm from coming out

• cuts vas deferens

reversible vasectomy

• in clinical trail

• gel is injected to the vas deferns

  • blocks sperm passage

  • last two years

emergency contraception

• plan b

• progesterone pill

  • inhibits ovulation when near that point in the cycle

  • changes thickness of lining

• if taken within 72 hours = 89% effective

  • w/in 24 hours= percentage in the 90s

• will not impact pregnancy if egg is already fertilized

• is not an abortion pill but is still controversial

abortion

• Pregnancy termination

• overturn of Roe v. Wade gave rights to the states regarding abortion

• Indiana

  • banned with few exceptions

    • rape

    • incest

    • mothers health

    • fetus not expected to survive pregnancy

  • Challenging to get bc proof and may not occur in timely manner

medical abortion

• two pills

  • mifepristone

    • progesterone receptor blocker

      • even if fertizled egg is there, it can’t bind to anything and the lining will begin to break down

    • fetus is expelled with lining

  • prostaglandin

    • causes uterine contractions 

    • expel contents of uterus

• 97% effective when taken within first 9 weeks

  • very early in pregnancy

contraceptive vaccines

• vaccine stimulated the immune system to target sperm or reproductive hormones

• anti-hCG vaccine

  • required for embryo implantation and growth

• targets embryo—post fertilization===controversial

• in-development, not yet in clinical trial

Comstock act

• federal law the prohibits mailing obscene/dangerous items

  • contraceptives and abortion pills are deemed obscene

    • iffy because it is not always enforced

surgical abortion

• surgical

• cervix is dilated and the fetus is removed from the uterus

  • scraped out along with uterine linig

• very controversial 

what is female genital mutilation

Female genital mutilation is the partial or total removal of the external female genitalia. It can also be any injury to the female genital organs without medical reason. 

1. List 2 reasons why FGM is a violation of the human rights of girls and women?

1. It is an act that further discriminates the sexes and promotes inequality between men and women. 

2. It violates a person right to medical autonomy

1. What part(s) of the female genitalia are targeted in FGM?

• Clitoral glans and clitoral hood

• Labia minor

• Vaginal opening(making it more narrow)

1. Are there any reported health benefits to FGM? 

No