Reproductive System

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Reproductive System
2015-04-29 16:49:01
Anatomy Physiology

Quiz of 4/17
Show Answers:

  1. Function of the reproductive system
    to produce offspring- new individuals of the species where you pass down genetic info from the mother and fater
  2. Organization of organs of reproductive system
    • Certain organs in males and females are homologous (ex- penis and clitoris)
    • Primary Sex organs and Secondary sex organs
  3. How do reproductive structures develop?
    • they develop from sexually indifferent structures in the embryo (unisex structures- depending on genetics/hormones will develop into male or female)
    • this is true for external and internal genetilia
  4. Differentiation
  5. Primary sex organs
    • called gonads
    • the organs making the sex cells (gametes or germ cells) and hormones (mostly steroids)
    • Female gonads: ovaries- make ova or eggs
    • Male gonads- testes- make spermatozoa (sperm)
  6. Secondary sex organs
    • accessory sex structures
    • all structures that are not the gonads
  7. Location of testes
    • in the scrotum, which is outside of the body at a cooler temperature (needed for fertility of sperm)
    • in the embryo, the testes are initially inside the abdominal pelvic cavity and it descends into the scrotum
  8. cryptochidism
    • testes do not descend 
    • this is the main risk for testicular cancer (most common reproductive cancer of men 15-35 yrs)
    • highly curable by surgical removal of cancerous testis (orchiectomy) and possible radiation or chemotherapy
    • the person could still be fertile if he has another good testis
  9. Functions of testes
    • spermatogenesis
    • hormone production
  10. Spermatogenesis
    synthesis of the sperm in the semineferous tubules of the testes
  11. myoid cells
    smooth muscle-like cells outside the semineferous tubules and when they contract they push sperm out the lumen (opening) into a network of tubules called the rete testis and then to the epididymus
  12. Hormone production
    • most are steroids made from cholesterol
    • main type made: androgen- male sex hormone
    • --> the main type of androgen made is testosterone- made in interstitial cells (leydig cells) between seminiferous tubules
  13. Spermatic chord
    • comes from each testis and goes through the openings called the inguinal canals going into the body cavity
    • contains the vas deferens (tube with sperm), artery, vein, nerve from testis, and connective tissue
  14. Epiddiymus
    • attached on one side to the testis and the other to the vas or ductus deferens 
    • has a series of tubules
  15. functions of the epididymus
    • stores sperm
    • it is where the sperm become motile and mature (fertile)
    • in ejaculation, the sperm comes from the epididymus- the smooth muscle of the epididymus contracts and pushes sperm out
    • if no ejaculation, this is also where the sperm die by phagocytosis
  16. Ejaculation
    release of sperm at orgasm
  17. Semen
    seminal fluid- contains sperm and secretions of 3 types of glands
  18. Vas deferens
    • a tube with smooth muscle
    • the sperm pass through it
    • connects to the urethra
    • in ejaculation, the muscle contracts and the semen moves by perisalsis
  19. ampula
    • widened part of the vas deferens
    • joins with the tube/duct from the seminal vesicle to form the ejaculatory duct (very short) which empties into the urethra which passes through the prostate gland
  20. Vasectomy
    • a type of voluntary sterilization
    • about 50% reversable, but shouldn't be used as birth control
    • you block the vas deferens on both sides so you do not have sperm in the semen
    • cut through the scrotum and either cut, tie (ligate) or clip or cauterize (electrical zap) so the path is blocked
    • the man ejaculates normally semen without sperm, preventing fertilization
    • hormones still produced as normal, bc they go into the blood
    • sperm eventually get degraded
  21. what makes the majority of the semen
    accessory glands
  22. Seminal vessicles- contribution to the semen
    • make about 60% of the volume out
    • they produce an alkaline fluid bc it has to counteract acid that the sperm encounter
  23. What pH and conditions do sperm need?
    • 7.0
    • they have very little cytoplasm so they need nutrients- fructose, ascorbic acid- vitamin C
  24. prostaglandins
    • hormone like regulators, they stimulate a variety of body functions
    • released into the semen (not blood here) and affect the woman if intercourse in 2 ways to help sperm reach egg
  25. 2 ways prostaglandins change woman
    • 1. decreases viscosity of the mucous in a woman's cervix- allows sperm to swim through the narrow cervix easier
    • 2. stimulate reverse peristalsis of the woman's reproductive organs to move sperm up
  26. Prostate gland
    • only 1- surrounds the urethra (part of the urethra it surrounds is the prosthetic urethra)
    • several ducts empty its secretions into the urethra
    • makes 1/3 of semen's volume
  27. describe the secretions of the prostate gland
    • slightly acidic
    • contain nutrients like citrate (used in Kreb cycle)
    • contain a # of enzymes that increase sperm motility
    • contain substances that supress the woman's immune system to prevent an allergic reaction to sperm
    • relaxin
    • PSA
  28. Relaxin
    • acts as a hormone and a hormone like substance
    • has effects right in the body- stimulates growth of prostate
    • in semen, it enhances sperm motility
  29. PSA
    • prostate specific antigen
    • secreted into the blood by prostate
    • if level in blood is >.04 ng/mL, there is an increased risk of prostate cancer but can be high PSA and no cancer or low PSA and cancer
  30. Prostate cancer
    • the most common male reproductive cancer 
    • occurs at older ages
    • if men have a high fat/calorie diet, there is increased risk
    • doctor does a digital rectum exam to feel the prostate for abnormalities
  31. prostate cancer treatment
    • surgery to remove the prostate 
    • must be careful not to cut nerves0 if they do he may not be able to have an erection
    • radiation
  32. Benign Prostatic Hyperplasia
    • an enlarged prostate
    • common in older men
    • symptoms- frequent urination
    • treatment- drugs to shrink it, surgery, balloon to widen urethra, microwave technology to shrink
  33. Bulbourethral Glands
    • Cowper's glands
    • very small
    • each has a duct emptying into urethra
    • clear but thick mucous alkaline secretion
  34. Ejaculate
    • 5mL of material (1 tsp)
    • in this: 250-400 million sperm
    • pH: 7.2-7.6
  35. Penis (external structure)
    • the erectile organ
    • needed for copulation
    • includes: shaft (length of penis), glans penis (widened tip), prepuce (foreskin over the top- not in circumsized),
  36. perineum
    area behind the penis to the anus
  37. Penis structure (internal)
    • urethra runs the length
    • 3 areas of erectile tissue
  38. 3 areas of penile erectile tissue
    • 2 dorsal corpora cavernosa
    • 1 corpus spongeosum (inner, right around the urethra)
    • they contain spongy connective tissue with vascular spaces
  39. Erection
    • on sexual excitement, the penis fills with blood and is rigid (due to parasymp. NS- CNS emotions can stimulate parasymp NS for erection)
    • --> reflex- nitric oxide relaxes smooth muscle of blood vessels so you have dilation and they fill with blood
    • after orgasm, blood flows out and penis becomes flacid
  40. Male sexual response
    • penis stimulated for orgasm and ejaculation
    • coitus- intercourse
    • orgasm
  41. Erectile dysfunction medication works
    meds like viagra and cialis work by increaseing nitric oxide
  42. Male behavior before orgasm
    • increased muscle tension
    • increased heart rate
    • possibly increased blood pressure
  43. male at orgasm
    • epididymus glands and ducts contract- release secretions
    • rhythmic contraction of penis- release semen, sense of pleasure
    • at ejaculation- constriction of the internal sphincter of the bladder preventing urination at the same time and prevents backup of semen
  44. male after orgasm
    • relaxation and decrease blood flow in penis
    • blood vessels constricted
    • most men have a latent (refractory) period when the body is unresponsive to sexual stimulation (mins-hrs, happens w/ age)
  45. Erectile dysfunction
    • inability of a man to attain/sustain an erection
    • causes: phsychological (<20%); physiological- more common, increase with age (problems with blood flow in the body- ex diabetes or high bp or cholesterol)
    • high bp meds or depression meds can cause it
    • prostate surgery with cut nerves will cause
    • alcohol, cigs, weed, cocaine can cause
  46. Testosterone
    • steroid hormone made from cholesterol (so are estrogen and progest)
    • for some effects it must be converted to dihydrotestosterone (external genetalia and secondary sex characteristic development)
    • must be converted to estrogen for calcium deposit in bone for growth
  47. Effects of testosterone in the body
    • stimulates development in utero- in pregnancy development of internal and external reproductive structures of fetus
    • stimulates spermatogenesis
    • stimulates growth and development and functioning of all male secondary sex structures (pubic axillary facial and body hair, enlarged larynx, deeper voice, thicker oily skin)
    • stimulates increased metabolic rate
    • influences behavior
  48. Testosterone in growth
    • it is an anabolic (synthesis) steroid- increases body growth
    • somatic effects: increase in bone growth and density 
    • late in puberty T-->E for calcification 
    • increase in skeletal muscle growth and muscle mass
  49. Testosterone effect on behavior
    • has an effect on labido (sexual desire)
    • affects limbic system of brain, specifically the amygdala
  50. Feedback effects of T
    body maintains homeostasis of T level and sperm by negative feedback
  51. Testosterone and sperm production
    • Hypothalaums secretes gonadotrophin releasing hormone which goes through portal blood to ant. pituitary
    • causes ant. pituitary to release follicle stimulating hormone and leutinizing hormone
    • seminiferous tubules make sperm and androgen binding proteins
    • interstitial cells make testosterone
  52. Androgen binding proteins
    • made in sustenticular cells of semi tubes
    • testosterone made from the interstitial cells travels to the semi tubes to bind to them. they keep T in the semi tubes to stimulate sperm production
  53. FSH
    • released by anterior pituitary
    • affects testes
    • stimulates semitubules to make androgen binding protein and sperm
  54. LH
    • made by anterior pituitary
    • affects testes
    • stimulates interstitial cells to make testosterone
  55. too much sperm
    • FSH also stimulates inhibin when sperm levels too high
    • inhibin stimulates shut off of FSH via A. Pituitary and shut off of gonadotrophin releasing horome from hypothalamus
  56. too much testosterone
    • high level stimulates A. Pituitary to shut off of LH secretion
    • also stimulates hypothalamus to stop production of gonadotrophin releasing hormone
    • You always make T and sperm until level is high enough to signal shut off
  57. Abuse of anabolic steroids
    • T taken to build muscle
    • negative feedback increases causing less FSH and LH and Gonad. releasing hormone and less sperm production
    • can cause smaller reproductive organ size and infertility
    • teens can have early bone calcification stopping growth
    • T converted to E so possible gynecomastia (breast development)
    • females can develop masculine traits, can stop menstrual cycle and possible infertility
  58. Roid Rage
    • T abuse effect on brain
    • raised blood pressure and cholestorol
    • liver damage
  59. Internal genetalia of female reproductive system
    • ovaries
    • fallopean tubes
    • uterus
  60. Ovaries
    • the gonads- make the ova (eggs)- released at ovulation as oocyte (immature)
    • makes estrogens- mainly estradiol )also estriol and estrone)
    • suspended by 3 types of ligaments in pelvic cavity
    • contain follicles of various stages of maturation
  61. When does the mature egg form
    after the sperm enters it
  62. 3 ligaments that suspend the uterus in the pelvic cavity
    • Broad ligament
    • Suspensory Ligament
    • Ovarian ligament
  63. follicle
    • the unit with the developing egg with cells around it
    • earliest is the least mature (premoridal) 
    • then primary (1 layer of follicle cells)
    • then secondary (more than one layer)
    • then theca folliculi layer develops over follicle cells forming tertiary (vesicular or graafian) with fluid filled antrum
    • oocyte then released at ovulation
  64. Before and after ovulation (hormones)
    • before: follicle cells and theca folliculi make estrogen and a little progestrone (estrogen dominates)
    • after: corpus luteum forms and makes mostly progesterone and some estrogen
  65. Fallopean tubes
    • uterine tubes or ova ducts
    • narrow
    • if there is a STD like chlamydia or gonnorhea it can block them (STIs can also spread tot eh ovary and pelvic cavity-pelivc inflammatory disesase- causes infertility)
  66. Fallopean tube functions
    • 1. receive the oocyte at ovulation: the fimbrii beat to move the egg
    • 2. fertilization: takes place in the ampula of the fallopian tube
    • 3. passageway: of the oocyte or zygote if fertilization on the way to the uterus (zygote multiplies by mitosis in here to form embryo)
  67. Ectopic pregnancy
    • normally the embryo implants in the endometrium of the uterus
    • in this you have implantation somewhere else, such as in the fallopian tube or peritineal cavity and there isnt enough blood in either to maintain the pregnancy
    • fallopian tubes too narrow so there is a danger of bursting/misscarriage
    • embryo must be removed- creates scar tissue
  68. Uterus
    thick with a lot of smooth muscle
  69. Cervix
    • bottom narrow part of uterus
    • has cervical glands that secrete a thick mucous that comes out as vaginal discharge
    • thickness is working as protection against infection
    • at ovulation secretions become thin to allow sperm passage
  70. Wall of the uterus
    • endometrium
    • myometrium
    • perimetrium
  71. menses
    menstrual flow
  72. endometrium
    lining- each month it thickens to prepare for pregnancy b/c its key function is implantation of the embryoif no pregnancy, the superficial layers of endometrium will slough off to form menses
  73. myometrium
    • thick muscle
    • contracts for birth
  74. perimetrium
    a serous membrane on the outside of the organ
  75. Cervical cancer
    • most common reproductive cancer of women 30-50 years
    • slow growing and easily treatable if caught early
    • treatment varies according to extent
    • major risk factor- having Human papiloma virus
  76. HPV
    • specific strains are risk factors for cervical cancer
    • HPV vaccine available for boys and girls- should get it before being sexual active
    • in boys- vaccine prevents HPV- risk factor for anal penile and throat cancer
    • multiple sex partners = more risk
    • not sexually active= very low risk
  77. Diagnosis of HPV infection type + precancer or cancer
    • cells taken by pap smear- vaginal and cervical cells
    • HPV can cause genital warts that can be seen- not always
  78. Hysterectomy
    • removal of the uterus
    • radical if uterus along with top of cervix, ovaries and fallopian tubes
  79. Ophorectomy
    removal of ovaries
  80. Vagina
    • a thin walled tube shape with smooth muscle
    • has rugae folds that can expand for intercourse/birth
    • Epithelial cells line it and have glycogen and normal bacteria that convert it to lactic acid making vagina slightly acidic- protects from infection
    • adolescents more at risk for infection bc this process not developed so vagina is more alkaline
  81. Vagina Functions
    • 1. It's the birth canal
    • 2. Passageway for the egg at ovulation to leav the body (happens 2 weeks before menses- its only 1 cell so unnoticed)
    • 3. Passageway for the menses
    • 4. The female copulatory organ (not erectile organ)
  82. Hymen
    • part of the mucosa that forms a partial partition near the vaginal opening
    • often rips at first intercourse causing bleeding- not always though (could rip by development, physical activity, or may just stretch)
  83. External genetalia of female
    • Vulva
    • Clitoris
    • Pereneum
    • Breasts
  84. Vulva
    • all structures in the vaginal area- also called the pudendum
    • contains mons pubis, labia major and labia menora
  85. mons pubis
    • fatty area with pubic hair over pubic bones
    • protects vaginal area
  86. labia majora
    • outer folds
    • have pubic hair
    • protect vaginal area
  87. labia menora
    • inner folds
    • no pubic hair
  88. vestibule
    • the area within the labia
    • vestibular glands produce a lubrication for the vagina on sexual stimulation
  89. Clitoris
    • the erectile organ of the female
    • stimulated for an orgasm
    • has cavernous tissue that engorges with blood on stimulation
  90. perenum
    area from bottom of mons pubis to anus
  91. Breasts
    • function in lactation (synthesis and release of milk)
    • inside there are 15+ lobes of mammary gland tissue (alveoli)
    • from each lobe there is a lactiferous duct- part of the duct under the areola has a widened part called the lactiferous sinus then the duct opens at the nipple
  92. Nipple
    • has about 15 openings 
    • when a woman breastfeeds- infant puts the nipple and part of the areola in the mouth allowing for efficient release of milk
    • breastfeeding decreases risk of breast and ovarian cancer
  93. Breast development
    • at puberty: most development is fat and some ducts
    • In pregnancy: bigger development of ducts and glandular tissue; breasts gain 1lb
  94. Breast cancer
    • most common reproductive cancer in women
    • primarily cancer of the ducts
    • risk factors: early menses/late menopause; no/late pregnancy; no breastfeeding; family history; hormone replacement therapy (getting estrogen after menopause)
    • 5-10% involves BRCA1+2 genes- women under 50 with this have 80% risk of breast cancer
  95. Breast cancer diagnosis
    • self breast exams monthly- after menses (breasts often lumpy during period); if post menopausal any time
    • mamograms after age 40- xray
  96. Breast cancer treatment
    • surgery w/ or w/o chemo/radiation
    • lumpectomy- removal of the area around the lump and the lump
    • mastectomy- removal of breast and possibly lymph nodes
    • radial mastectomy (rare) also removes some chest muscle- no real advantage
    • tomoxifen- an antiestrogen drug- decreases chance of reoccurance in other breast (b cancer often related to estrogen)
  97. Female sexual response
    • clitoris engorged with blood increased blood flow in vaginal organs
    • breasts become engorged with erect nipples 
    • increased heart rate, muscle tension + possible bp
    • increased secretion of vestibular glands that lubricate vagina
    • at orgasm: rhythmic contraction of vagina and uterus followed by blood flow out of vaginal area and relaxation and sense of pleasure
    • no refractory period
  98. Female libido
    • not necessarily linked to estrogen
    • major factor is an androgen (male sex hormone) from the adrenal cortex- hydroepiandrosterone
  99. Hormone changes women
    • at puberty: increase of estrogen and progesterone followed by clinical changes in menstrual cycle
    • at pregnancy: increased estrogen and progesterone bc placenta makes much more of these hormones than the ovaries
  100. In the ovaries before and after ovulation
    • before: follicle cells are source of hormones- they make estrogen and very little progesterone
    • estrogen will dominate progesterone in its effects
    • after: corpus luteum makes mostly progesterone but still significant Estrogen, but P dominates
  101. Estrogen Effects in the body
    • 1. Effects on the fetus
    • 2. Effects on the ovaries
    • 3. Stimulates growth, development and functioning of secondary female sex structures at puberty
    • 4. Lowers blood cholestorol during menstrual years
    • 5. Cyclic changes in menstruation
    • 6. Effects on birth
    • 7. Feedback
  102. Estrogen effects on fetus
    • if there is no Y chromosome there will automatically be female development
    • estrogen needed for maturation of organs at puberty, esp if Turner's syndrome (X_)
  103. Estrogen effects on ovaries
    • Estrogen stimulates follicle development 
    • stimulates oogenesis (egg development) and ovulation (release of oocyte)
  104. Estrogen effects on growth, development and functioning of secondary sex structures at puberty
    • Increase of body subcutaneous fat- contributes to breast development (duct development occurs as well)
    • hips, widening of the pelvis
    • pubic and axillary hair
    • growth spurt at puberty (girls reach adult height first)
  105. Estrogen on blood cholesterol
    • gives decreased heart disease risk by lowering cholesterol during menstrual years
    • young women have lower risk but after menopause they have same risk as men
  106. Estrogen effect on cyclic changes
    dominates before ovulation so it causes thickening of endometrium of uterus; causes thinner cervical secretions for sperm access
  107. Estrogen during birth
    at beginning of labor estrogen stimulates contraction of the uterus
  108. Estrogen and feedback
    positive and neg feedback in the menstrual cycle
  109. Progesterone
    • promotes gestation (length of pregnancy)
    • gets the body ready for pregnancy and maintaining pregnancy
  110. Progesterone body effects
    • 1. Small amount made before ovulation is significant in stimulating ovulation
    • 2. Cyclic changes- dominates after ovulation
    • 3. Inhibits uterine contraction during pregnancy- vital to keeping fetus implanted (end of pregnancy- bodys sensitivity to hormones changes)
    • 4. Feedback- negative
  111. Cyclic change effects of progesterone
    • breasts: increase fluid (in pregnancy- causes gland development of breasts)
    • uterus: maximizes blood and nutrients in endometrium in case there is implantation
    • thickens cervical secretions: protection
    • slight increase in basal body temp: early in the AM.. related to increased metabolic rate in pregnancy
  112. Menstrual cycle
    • a montly rythem
    • from menarchy (First period) to menopause (cycle stops)
    • doesnt happen in pregnancy or lactation
  113. Ovulation
    • woman is most fertile during this
    • happens about 2 weeks after the first day of menses, but can vary
    • egg can live ~24hrs and comes out 2 weeks before the next menses
  114. How long can sperm live?
    up to 5 days
  115. Regulation of hormones in female menstrual cycle:
    • Hypothalamus makes gonadotrophin releasing hormone which stimulates the anterior pituitary gland to make both FSH and LH
    • FSH stimulates ovulation and stimulates follicle cells of the ovaries to make most E and some P which enter the blood and have body effects (BEFORE OVULATION)
    • ---> the E+P made also stimulate ovulation
    • LH stimulates development of the corpus luteum; also stimulates ovaries to make E and more P (AFTER OVULATION)
    • LH also stimulates ovulation
    • see flow chart
  116. Positive feedback loop (menstrual cycle)
    the E released into the blood before ovulation stimulates positive feedback for the hypothalamus to make more gonadotropin releasing hormone and stimulates Anterior pituitary gland to make more FSH and LH
  117. Negative feedback loop (menstrual cycle)
    The P and E made AFTER OVULATION along with inhibin stimulates the hypothalamus to stop making GRH and the anterior pituitary gland to stop making FSH and LH when levels are high
  118. Phases of the menstrual cycle
    • follicular phase
    • leuteal phase
  119. Follicular phase
    • 1st 2 weeks of menstrual cycle
    • follicle is making the E and P hormones
  120. Leuteal phase
    • corpus leuteum is making the hormones
    • last two weeks of the cycle
  121. what happens as the corpus leuteum involutes (curls up)
    • there is a drop in E and P
    • small but constant increase in FSH, which may last through the menses
    • no negative feedback because E and P are low
  122. What does an increase of FSH stimulate
    • follicle development- 1 follicle matures rapidly
    • ovulation
    • follicle cells to make E and P
  123. Maturing follicle
    • has increased E synthesis from cholesterol
    • in other follicle cells- some P accumulates in follicular fluid
  124. FSH and LH before ovulation
    • there is an increase in E before the extreme release of gonadotropins (LH and FSH)
    • feedback on hypothalamus and ant pituitary gland stimulates sharp peak in FSH and mainly LH before ovulation
  125. Preovulatory small rise in P
    • after gonadotropins start but before ovulation
    • P stimulates collagenase-like enzyme that ruptures the collagen in the follicular wall to release the oocyte from the follicle
    • LH and prostaglandins stimulate plasmin (proteolytic enzyme) that breaks down protein and the follicular wall
    • ovulation is due to the coordination of LH, FSH, E and P (all needed for egg release)
  126. Order of hormone secretions needed for ovulation to occur correctly
    • E
    • P
    • FSH
    • LH
  127. Immediately post ovulation
    • follicle has degenerated so low steroids in the blood because its not making them anymore
    • follicle fills with luteal cells  and multiplies rapidly due to large peak in LH before ovulation
  128. When E and P are high...
    • high levels in blood inhibits gonadotropins by feedback inhibition, especially at hypothalamus
    • when E+P are high, FSH and LH are low
  129. If not pregnant...
    • corpus luteum degenerates bc low LH to form corpus albicans
    • there is a drop in E and P as corpus leuteum degenerates
    • low E and P means no negative feedback so increase in FSH which causes new follicle to mature
  130. What is true about the endometrium when E and P are high?
    it is as fully developed as possilbe
  131. What happens when there are no steroids to stimulate the secretory endometrium
    • it is not maintained
    • there is constriction of arterioles, slow circulation and the blood pools
    • blood pools come together to form one mass
    • the superficial (functional) layer of endometrium (makes up 2/3 of it) sloughs off in the menses with leukocytes and mucus (the basal layer remains)
    • discharge of menses 3-7 days (20-200mL)
  132. Menstrual cramps
    prostaglandins stimulate uterine contraction causing dysmenorrhea (menstrual cramps) and menses release
  133. Menopause
    • a time when there is no ovulation and no menses, the ovaries age, happens around age 50
    • a gradual process over the course of years
    • declared menopause after 1 year of no period 
    • drop in E and P bc ovaries are aging and cant make them- causes FSH and LH to increase bc no neg feeback
  134. Climacteric
    the gradual decline of ovarian function
  135. What are the symptoms that may occur during menopause
    • vaginal thinning and dryness- lubrication needed
    • decreased elasticity of skin
    • increased risk of osteoperosis
    • increased risk of cardiovascular disease (no E to lower cholesterol)
    • temporary vasomotor instability (hot flashes and night sweats)
    • change in hypothalamus in temp regulation for a while
    • sense of heat comes from chest
  136. Andropause
    • men aging
    • testes age but not the same as menopause
    • differences from women menopause: testosterone declines slower and later than E in women; and sperm is continuously made eggs arent
  137. Menopause treatments
    • calcium and vitamin D in diet 
    • maintaining exercise
    • possible medication (these 3 decrease risk of osteoperosis)
    • Hormone Replacement therapy
  138. Hormone replacement therapy
    • estrogen and progesterone given (if you dont give P side effects of E are more significant)
    • effects include: decrease hotflashes, decreased risk of osteoperosis, decreased vaginal thinning, decreased skin issues
  139. bad side effects of hormone replacement therapy
    • increased cardiovascular problem risk: abnormal blood clots, heart attack, strokes
    • increased risk of breast and uterine cancer
  140. Pregnancy
    • the period from fertilization to birth (partuition)
    • after birth the term is post partum
  141. Conceptus
    the developing organism
  142. Embryo
    • first 2 months of pregnancy the developing organism is the embryo
    • after the first 2 months its called the fetus
  143. Human gestation period
    • 38 weeks
    • 40 weeks if you count from last menses
  144. Fertilization
    • fusion of gametes
    • takes place in the fallopian tube
    • when sperm and egg unite they form the zygote (fertilized egg)
  145. Capacitation
    a process that sperm undergo after entering the womans body- necessary for the full motility and fertility of sperm
  146. Acrosome
    • cap of the sperm
    • has enzymes that digest holes in the zona pellucica (membrane around the egg)
    • ---> after this happens, calcium is released from the endoplasmic reticulum of the oocyte and this calcium prevents any other sperm from entering
  147. After fertilization
    • zygote forms and moves down the fallopian tubes to the uterus (it divides by mitosis on the way) and forms a ball of cells called a morula
    • the morula will then hollow out to form a blastocyst
    • takes 3-4 days for blastocyst to pass into the uterus and about 1 week after fertilization you have implantation in the endometrium (finishes after about 12 days)
  148. Blastocyst
    • the inner cell mass of the blastocyst goes to form the embyonic disc which forms the embryo
    • the trophoblast forms the placenta
  149. amnion
    the inner membrane with amniotic fluid
  150. Chorion
    • outer membrane, has villi
    • chronic villi in endometrium form placenta (the placenta from the chronic villi is part fetal and part maternal- fetal and part of endometrium where implantation is maternal part)
    • fetal and maternal blood are side by side but not mixed
  151. Umbillical cord
    • there are umbillical arteries and an umbilical vein in it
    • arteries go from fetus to placenta and vein goes from placenta to fetus
    • fetus gets O2 and nutrients from the placenta (which gets them from mom) and gets rid of Co2 and wastes to the placenta and then to mom who will excrete them
  152. Placenta
    • The nutritive, respiratory and excretory organ of the fetus
    • also an endocrine gland
    • drugs and viruses from mom can also o to the placenta and to the fetus
  153. Teratogen
    • a substance that can cause malformations (birth defects) in the fetus
    • a teratogenic substance will be will be most dangerous when organs are forming (during organogenesis)
    • --->fetal nervous system develops early so drugs at first trimester can be very dangerous
    • ex: alcohol- can cause fetal alcohol syndrom, happens early- can affect fetal brain
  154. Gastrulation
    the formation of the 3 germ layers in the embryo and these germ layers will form the various tissues and organs of the body
  155. Reproductive organ development internally If Y chromosome
    • start with sexually indifferent structures
    • gonadoridges will become gonads (for both M and F)
    • 2 sets of ducts: mullarian ducts and wolffian ducts (for both M and F at first)
    • if Y chrom: SRY gene- stimulates at 7 wks gestation for development of male structures
    • wolffian ducts become male secondary internal structures (vas def, prost, etc)
    • mullarian ducts degenerate
  156. Reproductive organ development internally if 2 X chromosomes
    • still gonadoridges become female gonads
    • no Y chromosome so at 8 wks gestation gonads form ovaries
    • mullarian ducts form internal secondary female structures (fall tubes, uterus, etc)
    • woffian ducts degenerate
  157. Reproductive organ development: external structures
    sexually indifferent structures at first: genital tubercle (in male develops into penis and female develops into clitoris); labioscrotal folds (male becomes scrotum and female becomes labia mejora);urethral fold (male- will close around the urethra in the penis giving it urinary and reproductive function; forms labia menora in female giving seperate openings for 2 systems)
  158. Hormones of the early placenta
    • very early placenta first makes human choreonic gonadotropin: starts right after implantation
    • stimulates maitenance of corpus leuteum in moms ovary (acts like LH)
    • keeps the corpus luteum making E and P (needed for keeping endometrium developed and P needed for prevention of uterine contraction)
    • essential for keeping embryo implanted
    • directlyaffects mothers ovary
    • presence of this hormore in urine used for preg test
    • prevents miscarriage
  159. Hormones of placenta after fist trimester (2-3 mo)
    • placenta makes way more E and P than ovaries
    • E important for growth of uterus and fats and ducts of breasts
    • E causes uterine contraction by P dominates and inhibits it
    • E causes breast gland development
    • Human Placental Lactogen also made
    • Relaxin made
    • Human choreonic thyrotropin made
  160. Human placental lactogen
    • stimulates breast development, changes moms metabolism
    • fetus concentrates glucose from the mother and there is a shift in the mother to use more fat for energy
    • ---> if this process is not efficient mother can develop gestational (during preg) diabetes- after birth mom is not diabetic but mom has increased risk of developing type II diabetes later in life
  161. Relaxin
    relaxes pelvic ligaments and the pubic symphysis (makes flexibility for birth)
  162. Human choreonic thyrotropin
    acts like thyroid hormone to increase metabolic rate of mother to synthesize tissues
  163. Physiological changes in pregnancy
    • increased metabolic rate
    • increased efficiency of nutrient absorption
    • 50% increase in blood volume
    • healthy weight gain (25-35lbs) (fetus is ~7lbs and also there is placenta, fluid, breasts, etc)
    • "Morning Sickness"- usually in first tri, can vary from a little nausea to vommiting, related to transition of hormones in 1st tri; happens with empty stomach, eating can cure it
  164. Pregnancy induced hypertension
    • happens in about 10% of pregs
    • usually mild (preeclampsia)- more severe case is eclampsia
    • the body doesnt regulate bp efficiently
    • increased bp, weight gain (from fluid), edema
    • protein present in urine
    • in most severe situation there is danger that mother can have convulsions and die (if late in preg and dangerous a c section may be done to save mom and baby)
  165. Cesarean section
    • surgery- cut into abdomen in uterus
    • can be done with anestethia or epidural (spinal-in meningies over dura mater and gives pain relief)
    • other options in birth include local injections that last less time
  166. Pregnancy induced hypertension maitenence
    • need a balanced diet with plenty of protein 
    • avoid excess salt to prevent edema
  167. Other possible pregnancy changes
    • as fetus grows it may put pressure on various organs: ex pushing up to create heartburn
    • kidney excreting maternal and fetal wastes: puts pressure on bladder to cause frequent urination
    • digestive system: decreased contraction of large intestine making things slower (woman needs much fluid and fiber to avoid constipation)
  168. Fetal circulation
    • there are structures to bypass the fetal lungs (act as them)
    • -->ductus arteriosis
    • -->ductus venosus
    • -->foramen ovale (closes)
    • these all become ligaments in the baby
    • respiratory system develops late in preg
  169. Typical Birth (parturition)
    a typical birth is a vaginal delivery: head first
  170. Different positions baby can be in at birth
    • vertex position: head first; typical
    • breach position: buttocks first; doc cant see where the umbillical cord is- C section optional
    • transverse position: sideways baby- C section necessary
  171. Labor
    • a series of events that expel the infant from the uterus (has 3 stages)
    • involves a series of rhythmic uterine contractions
    • --> they start weak and far apart and become closer together and stronger
    • uterine contractions aided by pushing at the right time (voluntary abdominal contraction)
  172. False labor
    braxton hicks contractions- irregular in pattern and are weak
  173. 3 Stages of labor
    • 1. Dilation Stage
    • 2. Expulsion of the Baby- Delivery Stage
    • 3. Placental Stage
  174. Dilation stage of labor
    • starts from the onset of labor until the cervix is fully dilated (widened) to 10 cm
    • cervix then becomes shortened
    • fetal head descends (engagement)
    • --> when head is visible through the vagina- called crowning
    • a mucous plug forms in the cervix in pregnancy and is expelled in this stage
    • at some point in this stage, the water breaks- a rupture of the amniotic sac and release of amni fluid
  175. Expulsion of the baby stage of labor
    • once head is out- baby can start breathing- stimulated by buildup of CO2 in the babys blood
    • when the baby comes out they clamp and cut the umbilical cord
    • if the vaginal opening is not opening you may need an episiotomy
  176. Placental Stage of labor
    release of the afterbirth- the placenta and fetal membranes
  177. Episiotomy
    • cut from the vagina into part of the perenium to enlarge opening
    • not common anymore
    • sewed back up after
    • vag can rip if not done sometimes
  178. Apgar scoring
    • test on newborn that assesses the well being of the newborn on a 10 pt scale
    • measures especially nervous system
  179. Hormones involved in birth
    • 1. + feedback controlled by hormones for stronger and stronger contractions leading up to birth
    • 2. Decreased sensitivity of uterus to P and increased sensitivity to E 
    • 3. E then stimulates mild contraction of uterus (not strong enough for birth tho)
    • 4. Stronger contractions develop by oxytocin
  180. Contractions from estrogen to oxytocin
    estrogen stimulates uterus to produce prostaglandins which help stimulate uterine contraction, dilate the cervix and enhance oxytocin to cause really strong contractions
  181. Oxytocin stimulation
    • stimulated by neuroendocrine reflex
    • once contractions start, nervous impulses are sent to the brain, stimulating the hypothalamus to make oxytocin which travels via neuron to the post pituitary gland which secretes it into the blood
    • some oxytocin produced by fetus and goes from fetus in the blood to placenta into the mom and stimulates more prostaglandins from her uterus  (minor)
    • oxytocin stimulates strong tetanic contractions of the uterus- this is vital
  182. Induced labor
    • if with oxytocin naturally contractions are not strong enough, they may need to induce labor by giving an IV of synthetic oxytocin called pitocin
    • other places like England give prostaglandins through vagina
  183. Lactation
    • the synthesis and release of milk from the mammary glands of the breast
    • In order to happen, you need
    • 1. Breast development
    • 2. Milk synthesis
    • 3. Milk release
  184. Breasts in lactation
    myoepithelial cells are around the gland cells and they contract to expell milk into the ducts
  185. Breast development (needed for lactation)
    first estrogen, then progesterone then human placental lactogen
  186. Milk synthesis (needed for lactation)
    • happens in mammary glands
    • stimulated by prolactin (made in ant. pituitary gland and is stimulated by prolactin releasing hormone from hyp)
  187. Milk release from breasts (needed for lactation)
    • also called milk letdown or ejection
    • stimulated by oxytocin (made in hypothalamus and travels to post pituitary via neurons)
    • oxytocin also causes uterine contraction during lactation to return the uterus to pre-pregnancy size faster than if she didn't breastfeed
  188. Breastfeeding reflex
    • its a neuroendocrine reflex
    • stimulus: baby nursing on breast
    • nervous impulses go to brain and hypothalamus makes prolactin releasing hormone and oxytocin
    • --> prolactin rel. hormone goes to ant. pituitary which makes prolactin then which is secreted into the blood and will synthesize milk in the glandular cells (alveoli) of the breast to be released at next feeding
    • --> the oxytocin goes to post. pituitary which secretes it into the blood where it stimulates contraction of myoepithilial cells squeezing the milk from the gland cells into the lactiferous ducts; also stimulates release of milk already in breasts 
    • see pic
  189. What must a woman do to continue breastfeeding?
    • she must keep nursing to stimulate the hormones
    • when she stops breastfeeding she'll stop making hormones and milk will dry up
  190. Food for a baby
    • when a baby is born, breast milk is the only food needed for 6months
    • once baby reaches 6mo it must start on solid food- breast feeding occurs less and less so gradual decrease
    • if baby has formula instead of breastmilk, baby must start solid food at 4 months (not as much nutrients)
    • --> may need formula bc drugs and viruses such as HIV can pass into the breastmilk
  191. Colostrum
    • first fluid released by the breasts after birth
    • does not have same composition as mature milk (which takes about a week to develop)
    • very rich in antibodies from mother- important in passive immunity
  192. mature milk
    also has antibodies along with antiviral and antibacterial proteins which help with baby's passive immunity
  193. What are the different contraceptive methods
    • Natural Family Planning (symptothermal Method)
    • Barrior Methods
    • Intrauterine Device
    • Surgery
    • Methods with hormones
    • Breast Feed
    • Coitus interuptus
  194. Methods of birth control that prevent fertilization
    • Symptothermal Method
    • Barrier methods
    • Surgery
    • Mini-Pill (progesterone)
    • Depo-Provera (progesterone injection)
    • Implanon (capsule with Progesterone under skin)
    • Coitus interuputs
  195. Methods of Birth control that prevent implantation
    • Intrauterine device: device inserted by clinition implanted in uterus- sterile but causes inflammatory body response making endometrium non implantable
    • Morning after pill: high dose specific oral contr. taken up to 3 days after- prevents implantation if already fertilization
  196. Methods of birth control that prevent ovulation
    • The pill
    • Depo-provera
    • Implanon
    • Morning after pill
    • Breast feeding
  197. Symptothermal Method
    • abstain from sex when woman is fertile
    • prevents fertilization
    • uses symptoms/body changes to know when ovulation occurs (more accurate than rhythem method- assuming 14 days after period)
    • look for inc. breast development, inc basal body temp, thick mucous
  198. Barrier methods
    • Best used with spremicide (nonoxynol-9) to increase effectiveness and reduce risk of STDs
    • Condom: Sheath over penis; latex decreases risk STDs
    • Diaphragm: A round rubber w/ rim given by RX to fit a womans body- inserted thru vag + covers cervix
    • Cervical Cap: smaller than diaphragm- also covers cervix (used in Europe)
    • Female Condom: sheath inserted into vag
    • Sponge: like a diaphragm, not as efficient bc 1 size fits all
    • Foams, jellies, film: physical barrier with spermacide
  199. Surgeries
    • Vasectomy: cut/block the vas def to block sperm path; hormones unaffected- semen produced without sperm- prevents fertilization
    • Tubal Sterilization: laposcopic sergery to cut/block fallopian tubes to block egg path; hormones unaffected, prevents fertilization
  200. Methods with hormones
    • The pill: oral combined E+P (much less lvl than in preg tho)- Prevents usual LH/FSH peaks from pituitary gland; prevents ovulation
    • Transdermal Patch/Vaginal Ring: work like pill
    • Mini Pill- P only, prevents fert.
    • Depo-Provera: P injection; prevents fert and ovulation for 3 months
    • Norplant: progesterone capsules implanted under skin- removed from market bc side effects
    • Implanon: new norplant (prevents ovulation or fertilization)
    • Morning After Pill: Specific oral contraceptive (high dose)- prevents ovulation or implantation if already fertilization
  201. Breastfeeding (contraceptive)
    hormone prolactin inhibits ovulation for limited amount of time
  202. Coitus interuptus
    • Withdrawal of penis from the vagina
    • ejaculation outside of the women
    • not very effective as first drops of semen are the most concentrated in sperm
    • prevents fertilizatoin
  203. If a couple has had unprotected sex there are other options to prevent pregnancy
    • Morning after pill
    • Mifeprisone: prescribed- effective up to 7wks after; antiprogesterone medication along with prostaglandins induces the menses so if implantation, the embryo will come out
    • Traditional abortion: legal for up to 24 wks; Dilation and curattage- dilate the cervix, scrape the endometrium to remove conseptus