This document provides an overview of the female reproductive system and gynecological health topics. It describes the external and internal genitalia and breasts. It discusses the menstrual cycle, common disorders like PMS and endometriosis, and medical procedures like pelvic exams and pap smears. It also covers topics like menopause, sexual response, and how aging affects the sexual response cycle.

1. Chapter Eight Examining Gynecological Issues

2. External and Internal Genitalia Mons Pubis Labia Majora Labia Minora Clitoris Urethral Opening Vaginal Opening Perineum Vagina Cervix Uterus Fallopian Tubes Ovaries

3. Female Reproductive System

4. Breast Tissue The function of breasts are as follows: Contain mammary glands for new-born nourishment Sex organ for arousal Each breast contains 15-25 clusters called lobes which connect to the nipple The nipple (erectile tissue) are effected by temperature, sexual stimulation, and lactation Breast size is determined by the following: Genetics Amount of fat and glandular tissue Nearly 70% of women experience benign breast changes during the menstrual cycle, 85-90% of lumps are benign See Figure 8.1

5. Preventive Measures See Figure 8.2

6. Menstruation Menarche is the first menstrual cycle for young girls The average age of onset are 12.8 years Genetics, socioeconomic conditions, nutritional status, obesity, and exercise can affect menarche 6 primary hormones are involved in regulating the reproductive system: Gonadotropin-releasing hormone (GnRH) Follicle-stimulating hormone (FSH) Luteinizing hormones (LH) Estrogen Progesterone Testosterone

7. Luteal Secretion

8. Phases of the Menstrual Cycle Follicular (proliferatative) phase lasts 10-14 days and is considered the most variable part of the cycle Ovulatory phase is when the largest follicle bursts, releasing a mature egg into the fallopian tubes Luteal phase causes the secretion of progesterone, preparing for implantation of the fertilized egg Menstruation phase occurs when estrogen and progesterone levels drop, allowing sloughing off of the endometrium

9. Menstrual Cycle Breakdown of the endometrial lining and discharge of tissue (menses)

10. Pelvic Examinations Pelvic exams include a visual screening to ensure that the reproductive organs look normal in size, shape, and location Exams should be conducted annually for 3 consecutive years until your health provider decides otherwise A speculum is inserted into the vagina to observe for internal organ normalcy A pap test and bimanual exam (physical check of the ovaries and uterus), followed by a rectal exam is common procedure for pelvic exams

11. Pelvic Exam

12. Pap test A pap test consists of taking a sample of cells from the cervical area (squamous epithelium) The primary purpose is to prevent invasive squamous cell carcinoma from occurring The area is where 90% of all cervical cancers begin A brush or thin-prep is used to scrape cells from the cervix and smeared onto a slide Another sample is taken from the endocervical canal Both slides are taken to the lab for analysis

13. Menstrual Disorders Endometriosis occurs when the lining of the endometrium fragments and lodges in other parts of the body Dysmenorrhea describes painful menstrual cramps, believed to be a normal response to uterine contractions resulting from increased prostaglandin production Amenorrhea is the absence of a menstrual cycle Primary amenorrhea: significant physical disorder affecting young girls Secondary amenorrhea: due to pregnancy or the onset of menopause Polycystic Ovarian Syndrome occurs when the ovaries produce excessive amounts of male hormones and small cysts develop

14. Premenstrual Syndrome PMS is a disorder with an array of physical and psychological symptoms associated with the luteal phase of menstruation Most symptoms taper off with menstruation, although some women continue to experience symptoms throughout their period Researchers believe that the cyclical trigger are due to normal ovarian function The best approach to dealing with PMS is to alleviate them through non-invasive strategies such as: Biofeedback Exercise Nutritional changes Vitamin/mineral supplementation Relaxation techniques Reducing salt, caffeine, and refined sugars Premenstrual Dysphoric Disorder (PMDD) is a severe Form of PMS that can occur one week prior to menses

15. Other Medical Concerns Female Athlete Triad Uterine Fibroids Hysterectomy Toxic Shock Syndrome (TSS)

16. Menopause American women (1.25 million annually) experience the normal cessation of their menstrual cycle Occurs normally between the ages of 40-58 years and most women experience this by age 50 The 4 stages of menopause are: Premenopause : periods are beginning to become irregular Perimenopause : period of time (3-7 yrs.) before and after the last menstrual period during which the cycle becomes erratic and hot flashes begin Menopause: results from normal aging of the ovaries, when estrogen levels fall and menstruation has ceased for 1 yr. Postmenopause : Menstruation has ceased for over 1 yr.

17. Hormone Replacement Therapy (HRT) The risks of using combined estrogen and progestin have been surprising based upon the findings of the National Heart, Lung and Blood Institute Study findings show that the increases in the following: 41% increase in strokes 29% increase in CHD events 100% increase in blood clots 26% increase in breast cancer Given the recent findings, women are exploring more natural strategies such as: Exercise Nutritional products Reducing stress Wearing comfortable clothing

18. Human Sexual Response Cycle Masters and Johnson determined that the Human Sexual Response Cycle includes 4 predictable phases: Excitement Plateau Orgasm Resolution See Figure 8.4

19. External Genitals and Sexual Response

20. Vaginal and Uterus Response

21. Breast Response

22. Where is the “G-Spot”?

23. Orgasm Rhythmic contractions (3-15) of uterine walls, the first 3-6 are most intense Most anorgasmic experiences have psychological and sociological roots or can be caused by a lack of proper technique Most women need continuous clitoral stimulation to experience an orgasm Orgasm can be achieved with adequate stimulation, whether through masturbation or intercourse

24. Aging and Sexual Response Physiologically, the excitement phase takes longer for the vagina to lubricate The orgasmic phase is shorter in duration and contractions may be less intense The resolution phase has been found to take longer While sexual desires continue throughout the lifespan, a woman’s perceptions of relationship qualities provide a strong indicator of the level of sexual desire she attains during the aging process

25. Chapter Eight Examining Gynecological Issues