maternal and child

Human Sexuality Concepts

  • Definition of Sexuality:
      - Encompasses complex behaviors, attitudes, emotions, and preferences related to sexual self and eroticism.
      - Described as a fundamental and dynamic aspect of life.

  • Role of Nurses:
      - Serve as resource persons regarding human sexuality, particularly for individuals aged 15 to 44 (the age of reproductive capability).

Definitions Related to Sexuality

  • Gender Identity:
      - Sense of femininity and masculinity, typically developed around ages 2 to 4 years.

  • Role Identity:
      - Attitudes and behaviors that differentiate various roles.

  • Sex:
      - Refers to biological male or female status, along with specific sexual activities such as sexual intercourse.

  • Sexuality:
      - Represents the behavioral identity of being male or female, subject to lifelong dynamic changes.

Sexual Anatomy and Physiology

  • Female Reproductive System - External:
      - Vulva (Pudenda):
        - Mons pubis (mountain of Venus): A fatty pad over the pubis symphysis, covered by skin and pubic hair after puberty.
      - Stages of Pubic Hair Development (Tanner’s Scale):
        - Stage 1: Pre-adolescence; no pubic hair, only fine body hair.
        - Stage 2: Ages 11-12; sparse, long, pigmented curls along labia.
        - Stage 3: Ages 12-13; hairs are darker, curlier, and develop along the pubis.
        - Stage 4: Ages 13-14; hair assumes an adult appearance but is less thick, does not appear on the upper thigh.
        - Stage 5: Sexual maturity; hair appears on the inner aspect of the thighs.
      - Labia Majora:
        - Larger folds from perineum to pubis symphysis.
      - Labia Minora (Nymphae):
        - Soft, thin folds between the labia majora.
      - Clitoris:
        - Pea-shaped erectile tissue with sensitive nerve endings, the main site of sexual arousal in females.
      - Fourchet:
        - Tapers posteriorly of the labia majora, sensitive for episiotomy, may tear during pregnancy.
      - Vestibule:
        - Almond-shaped area containing hymen, vaginal orifice, and Bartholin’s glands.
      - Urinary Meatus:
        - Small opening of the urethra, site for urination.
      - Skene’s Gland (Paraurethral Gland):
        - Two mucus-secreting glands contributing to lubrication.
      - Hymen:
        - Membranous tissue partially covering the vaginal orifice.
      - Vaginal Orifice:
        - External opening of the vagina.
      - Bartholin’s Gland:
        - Secretes alkaline substance neutralizing vaginal acidity.
      - Doderleins Bacillus:
        - Maintains vaginal acidity.
      - Perineum:
        - Muscular area between the lower vagina and anus.
      - Internal Vagina:
        - Female organ for ovulation and menstruation passageway; about 3-4 inches or 8-10 cm long, lined with rugae permitting considerable stretching.

Uterine Anatomy and Physiology

  • Uterus:
      - Hollow muscular organ, varies in weight, size, and shape, responsible for menstruation.
      - Size: Approximately 1 x 2 x 3 inches.
      - Shape: Pear-shaped when non-pregnant, changes to ovoid when pregnant.
      - Weight Changes:
        - Non-pregnant: 50-60 g
        - Pregnant: 1000 g
        - 4th stage of labor: 1000 g
        - 2 weeks postpartum: 500 g
        - 3 weeks postpartum: 300 g
        - 5-6 weeks postpartum: 50-60 g.
      - Parts of Uterus:
        - Fundus: Upper cylindrical layer.
        - Corpus/Body: Upper triangular layer.
        - Cervix: Lower cylindrical layer.
        - Isthmus: Lower uterine segment during pregnancy.
      - Composition:
        - Composed of three main muscle layers allowing expansion.
        - Endometrium: Inner layer lining the uterus, responsible for menstruation and sloughing during menstrual cycle.

Female Pathophysiology

  • Endometriosis:
      - Abnormal growth of endometrial tissue outside the uterus, most commonly found in ovaries.
      - Symptoms include dysmenorrhea and low back pain.
      - Diagnostic exams include biopsy and laparoscopy. Treatment options:
        - Lupron (luprolide): Inhibits FSH and LH.
        - Danazol (Danacrine): Preferred for stopping ovulation and menstruation.

Male Reproductive System - External

  • Penis:
      - Male organ for copulation and urination.
      - Composed of a shaft with three cylindrical layers: 2 corpora cavernosa and 1 corpus spongiosum.
      - Glans Penis:
        - The sensitive tip of the penis, similar to the clitoris.

  • Scrotum:
      - Pouch hanging below the penis, divided into two sacs by a medial septum, each containing a testis.
      - Requires a temperature 2 degrees Celsius lower than body temperature for continuous sperm production.

Male Reproductive Physiology

  • Spermatogenesis:
      - Process of sperm maturation located in seminiferous tubules.
      - Travels through epididymis (6 m for maturation) and vas deferens onward to seminal vesicles (producing fructose) and prostate gland.

  • Hormonal Control:
      - Hypothalamus: Releases GnRH (Gonadotropin-Releasing Hormone).
      - Anterior Pituitary Gland (APG): Releases FSH (Follicle Stimulating Hormone - maturation of sperm) and LH (Luteinizing Hormone - testosterone production).
      - Leydig Cells: Produce testosterone.

Basic Knowledge on Genetics and Obstetrics

  • DNA (Deoxyribonucleic Acid): Carries genetic code.

  • Chromosomes: Threadlike structures of hereditary material.

  • Normal Ejaculated Sperm Volume: 3-5 cc (approximately 1 teaspoon).

  • Fertilization Viability:
      - Ovum is viable for fertilization within 24-36 hours post ovulation.
      - Sperm viability is 48-72 hours.

  • Gametogenesis: Differentiation processes of male (spermatogenesis) and female (oogenesis) sex cells.
      - At 30 weeks AOG: 6 million immature oocytes at birth, down to 300-400 by puberty, reaching 4-124 by age 46.

Menstrual Cycle Characteristics

  • Average Menstrual Cycle Duration: 28 days.

  • Average Menstrual Period: 5 days.

  • Normal Blood Loss: 50 cc (approximately ¼ cup).

  • Fibrinolysis: Prevents clot formation during menstruation.

  • Related Terminologies:
      - Menarche: First menstruation.
      - Dysmenorrhea: Painful menstruation.
      - Metrorrhagia: Intermenstrual bleeding.
      - Menorrhagia: Excessive menstrual bleeding.
      - Amenorrhea: Absence of menstruation.
      - Menopause: Cessation of menstruation, average age 51.

  • Tofu: Contains isoflavones, plant-derived estrogen influences.

Hormonal Regulating Functions

  • Estrogen Functions:
      - Induces secondary sexual characteristics in females, inhibits FSH production, promotes myometrial hypertrophy, enhances breast ductal structures, stimulates osteoblastic activity for height increase, induces vaginal lubrication, and retains sodium leading to increased sexual desire.

  • Progesterone Functions:
      - Prepares the endometrium for implantation, inhibiting uterine contractility, regulating GI motility, increasing renal permeability, assisting mammary gland development, and contributing to mood swings.

Phases of the Menstrual Cycle

  • Four phases:
      1. Proliferative Phase: Estrogen levels rise, stimulating the hypothalamus to release GnRH/FSHRF, promoting follicle growth and estrogen secretion.
      2. Secretory Phase: After ovulation, high progesterone sustains the endometrium; corpus luteum degenerates without fertilization.
      3. Ischemic Phase: Without implantation, estrogen and progesterone levels fall, resulting in uterine shedding.
      4. Menses: Shedding of the endometrium occurs if no fertilization takes place.

Stages of Human Sexual Response

  • Initial Response:
      - Vasocongestion: Constriction of blood vessels.
      - Myotonia: Increased muscle tension.

  • Excitement Phase: Heightened muscle tension with varying duration based on stimuli.

  • Plateau Phase: Sustained tension nearing orgasm lasting between 30 seconds and 30 minutes.

  • Orgasm: Involuntary release of sexual tension, distinguishing physiologic and psychological release experienced in 2-3 seconds.

  • Resolution: Return to baseline physiological state; males experience a refractory period lasting 10-15 minutes.

Fertilization and Fetal Growth Stages

  • Fertilization Process:
      - Capacitation leads to sperm's ability to penetrate and fertilize the ovum (Zygote).

  • Stages of Fetal Growth:
      1. Pre-Embryonic Stage:
         - Zygote (Fertilized ovum): Travels for 3-4 days to the uterine cavity, forms a morula.
         - Morula: A multicellular stage (16-50 cells).
         - Blastocyst: Forming cavity becomes embryo; trophoblast develops into placenta.
         - Implantation: Occurs 7-10 days post-fertilization.
         - Symptoms: Slight pain and vaginal spotting.
      2. Embryonic Stage:
         - Lasts from fertilization to 14 days.
         - Embryo (15th day - 2 months): Development of vital organs.
      3. Fetal Stage:
         - Starts from 2 months onward toward birth.

  • Chorionic Villi: First identifiable layer protecting the fetus.

  • Amniotic Fluid Functions: Provides cushioning for the fetus, maintains temperature, facilitates musculoskeletal development, prevents umbilical cord compression.