(16) reproductive system

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)