Sexual reproduction; process in which male sex cells and female sex cells join.

Important for manual therapists; stress and emotions affect menstruation, fertility, and pregnancy.

Common structures and physiology

• primary reproductive organs: gonads produce gametes (Sex cells)

  • In males, the testes produce sperm

  • In females, the ovaries produce eggs

• Genitalia: male and female external sex organs

• Accessory organs: ducts, chambers, glands that secrete fluids that protect, transport, or facilitate movement and joining of gametes

• Hormones control processes

Male reproductive system: scrotum and testes

• testes within the scrotom produce male gametes (sperm)

  • Also secrete testosterone for development of reproductive organs and secondary sex characteristic

• Sperm are produces in the seminiferous tubules

• Leading cells produce testosterone

• Figure 16-2

Male reproductive system: Accessory organs

• from testes, sperm pass through series of ducts;

  • Epididymis

  • Vas deferents

  • Ejaculatory duct

  • Urethra

• Seminal vesicles, bulbourethral glands, and prostate produce and secrete fluids to make semen

• Semen nourishes sperm and assists its movement

Male reproductive system : penis

• urethra: passageway for both urine and semen

• Root: attaches penis to pelvis

• Shaft: body of penis

• Glans penis: head of penis

• Prepuce: foreskin

• Corpus spongiosum: bulk of internal make up of penis, its the erectile tissue that fills wit blood (think sponge absorbing blood)

• During sexual arousal, parasympathetic stimulation leads to engorging erectile tissue with blood (erection)

• During manual therapy erection may occur as relaxation response rather than sexual arousal

Female reproductive system

• designed to conceive, carry, and nouris developing fetus and deliver offspring

• Mammary glands: accessory reproductive organs

  • Produce milk after childbirth

  • Milk production stimulated by prolactin and oxytocin

    • Prolactin- pro=for; lact=milk -> stimulates milk production

    • Oxytocin- needed for milk to be released/ “letdown”

Female reproductive system : ovaries

• the ovaries produce female gametes (ova)

  • Ova held in follicles

  • Ovulation: the release of ovum

• Ovaries also secrete estrogen and progesterone

  • For development of reproductive organs and secondary sex characteristics

  • Control reproductive cycle

  • Prepare uterus for childbirth

Female reproductive system: female genitalia

• external female sex organs collectively called the vulva

• Perineum: region between mons pubis and anus

• Labia surround vaginal and urethral orifices, protecting these from micro-organisms. Labia majora become the scrotum in males

• Clitoris: small bud of highly sensitive tissue engorges with blood during sexual arousal, analogous to the male penis

• Figure 16-4

Female reproductive system: Fallopian tubes, uterus, and vagina

• Fallopian tubes (oviducts) carry ova from ovaries to uterus, site of fertilization

• Fertilized ovum implants in uterus

  • Uterus lined with endometrium

  • In childbirth uterus contracts to move fetus through birth canal, oxytocin stimulates his process

• Vagina: muscular tube connecting uterus with exterior environment

• Figure 16-5

Pathology alert: endometriosis

• endometriosis: condition of endometrial cells growing outside the uterus in peritoneal cavity

  • Cells stimulate inflammatory response

  • Fibrous scar tissue forms

  • May be asymptomatic or cause pain and infertility

• Manual therapy often indicated for relaxation and stress reduction

• Manipulation of abdominal soft tissues contraindicated

Female reproductive system: menstrual cycle

• average cycle: 28 days, divided into 3 phases

• Menses: onset of menstruation (sloughing of uterine lining) for 4 to 5 days on average

• Proliferative phase: days 6 to 14, increased levels of estrogen, thickening of endometrium

• Secretion phase: days 15 to 28, begins with ovulation and ends with onset of menses

• Figure 16-6

Pathology alert: common menstrual disorders

• dysmenorrhea: painful menstruation

  • Pain and gastrointestinal symptoms can be severe

  • Can be sign of underlying pathology

  • Manual therapy indicated for pain and stress

  • Abdominal work contraindicated during menstruation

• Amenorrhea: absence of menstruation

  • Common along female athletes and dancers

  • May be caused by emotions or stress

Pregnancy and childbirth

• fertilization (conception): joining of egg and sperm; occurs in Fallopian tube. First new cell is called a zygote

• Fertilization can occur with intercourse 24 hours before to 3-4 days after ovulation

• Gestation period: from conception to birth, or the prenatal period

Fertilization and implantation

• fertilization depends on number of sperm and their health and motility

• Fertilization occurs in Fallopian tube

• Zygote (fertilized egg) passes through Fallopian tube as it develops into blastocyst (balls of cells)

• Blastocyst implants in endometrial lining of uterus (implantation)

• Blastocyst produces a hormone, human chorionic gonadotrophin (hCG) that is detected in pregnancy tests

• Figure 16-7

Pregnancy

• prenatal period: 38 to 40 weeks

• At week 3 blastocyst becomes embryo, at week 9 fetus

• Surrounded by amniotic sac which contains amniotic fluid (protects embryo and fetus)

• Attached to placenta by umbilical cord: connects mother and babies circulatory systems)

• Blood flow through placenta provides oxygen and nutrients

• Figure 16-9

• Maternal changes:

  • Increased blood and fluid volumes (increase blood pressure)

  • Increased blood pressure and kidney function

  • Increased heart and respiratory rates to meet the loads needed by mom and baby

  • Morning sickness due to increased levels of reproductive hormones needed to maintain the pregnancy

• Effects of growing fetus:

  • Pressure on bladder

  • Center of gravity changes, strain on lumbar spine

  • Compression of intestines (constipation)

  • Esophagus_ increase chance of reflux (heartburn)

  • Pelvis- joints become for mobile due to the hormone relaxin

  • Skin of abdomen- stretch marks may occur due to damage of connective tissue

• Figure 16-8

• Important for manual therapies:

  • Physician or midwife clearance needed

  • Screening for high-risk conditions

    • Under 16 or over 35

    • Mother with diabetes or heart disease

    • History of miscarriages or abortions

    • Pregnancy. W/twins, triplets etc.

• Important for manual therapies:

  • Modifications in positioning and bolstering techniques

    • Side lying

    • Semireclining

    • Seated

    • Need assistance on and off table

• Special cautions and contraindications

  • Watch for excessive swelling and varicose veins

    • Avoid any deep abdominal work

    • Deep lower extremity work is contraindicated in 3rd trimester due to increased risk of blood clots

(Side lying = laterally recumbent)

Childbirth

• labor : behind with regular contractions of uterus and rupturing of amniotic sac

• 3 stages of birth process:

  • Cervical dilation

  • Delivery of fetus

  • Expulsion of afterbirth (placenta and fetal membranes)

Aging and the reproductive system: female

• puberty:

  • Sexual reproduction becomes possible

  • Marked by menarche, the first menstrual period

• Menopause:

  • Occurs between ages of 45 and 55

  • Hormonal changes and cessation of menses

  • Symptoms manageable or severe; hot flashes, night sweats, mood swings, etc.

  • Increased risk of osteoporosis (bones become brittle)

Aging and the reproductive system: male

• changes begin between ages of 50 and 60 years

  • Decreased desire for sexual activity - from low testosterone

  • Smaller numbers of viable sperm - decreased testosterone

  • Decreased mass and strength of skeletal muscles- decreased testosterone

  • Enlargement of prostate gland (effects on urination) - benign prostatic hypertrophy (BPH)