(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)

\