2254 New info for final

End of week 16

(100 gm, 15 cm/ 4 oz., 6 in) *fingerprints set -scalp hair appears -blood formation is active in spleen -bronchioles are in the lungs -cerebral lobes of the brain are delineated -fetus suck thumb (14 wks), -swallows, protrudes upper lip,has a grasp reflex, smiles, somersault

End of 28 weeks

(1100 gm, 32-38 cm/1½-2#, 12-14 in) CNS mature enough to provide some regulatory function *skin - "old man/old woman" -appearance minimal sq tissue present -eyelids open et close, pupils can react to light -brain cells are very rapidly developing -heavy protein storage at this time -Pupils react to light

End of 32 weeks

(18-2100 gm, 38-42 cm/4#, 16 in) -increased sq fat (for temp regulation) -fully developed bones but soft et flexible -heavy storage of iron, calcium, et phosphorus -permanent teeth primordia are indicated -taste differentiation is present -testes descending to scrotum

End of 12 weeks

(19-30 gm, 8 cm / ½ oz., 3 in) @10 weeks moves actively - not felt by mother -fingers et nails begin to appear -blood is forming in marrow -palate fusion is complete -intestines are in abdomen, not umbilical cord -kidneys begin to secrete urine -sex is recognizable bronchi are developing in the lungs

End of 36 weeks

(22-2900 gm, 48 cm/6#, 19 in) -Increased sq fat -rounded body appearance -lanugo is beginning to be shed -nails extend to end of fingers et toes -continues to increase brain cell development -continues to increase storage of minerals et vitamins

Fetus - end of week 8

(2gm, 3 cm) weighs < a book of matches, 1 inch long -has human appearance -small intestine is within umbilical cord -bladder et urethra separates from rectum -1st indication of bone formation -main blood vessels have formed -palate et upper lip are forming -brain begins to differentiate

End of 20 weeks

(300gm, 26 cm/ 6-8oz, 10 in) *vernix is present et lanugo appears on the body *fetal activity patterns are well established *eyelashes et eyebrows are forming sebaceous glands present dentine et enamel are forming -increased use of protein for growth

End of 40 weeks

(32-3600 gm, 48-52 cm/7-7½#, 19-21 in) -skin is pink or light brown, et smooth -testes - @ least to the inguinal canal et usually descended to scrotum -lanugo is on upper arms et shoulders mostly -vernix is only in the skin creases et body folds -single, silky strands of hair on head -myelination of brain begins

End of 24 weeks

(600 gm, 32 cm/ 1-1½ #, 12-14 in) -skin is red et wrinkled brown fat is beginning to form -begins to make surfactant which is necessary for gas exchange -begins primitive respiratory like movements -testes at the inguinal ring -nostrils open -begins to store iron

Cervical cap advantages

*82-90% effective *Alternative for women who cannot wear diaphragm-no pressure on urethra *Does not need repeated doses of spermicide *May be inserted up to 12 hrs. before intercourse

male condom advantages

*85-89% effective, if used properly *Provides some STD protection *Relatively cheap, less than $1 each *Easily accessible

diaphragm advantages

*85-97% effective *No side effects *increases comfort & self-knowledge *Spermicide may prevent some STDs, infections *Cost: $35 to $160

Injection advantage and disadvantage

*Advantage: only needed every 12 weeks *Disadvantage: No STI protection, several mos. For return of fertility

Cervical cap disadvantages

*Increased failure rate than others *May damage cervix *Cannot fit up to 6% of women

female condom disadvantages

*May disturb spontaneity *May decrease some sensations *Possible allergy to latex

male condom disadvantages

*May disturb spontaneity *New one for each intercourse *May decrease some sensations *Possible allergy to latex

Vaginal spermicides disadvantages

*Messy *Irritation of vaginal tissue *May increase yeast infections *Unpleasant taste, scent *Decreases spontaneity

Methods based on the menstrual cycle

*Mucus method: cyclical changes in cervical mucus *Calendar method: calendar estimate of fertility; do not use if cycles are <27 or > 35 days; must track cycles for at lest 8 cycles. In one yr, 9% of couples who use the method correctly will conceive. *Basal body-temp. method (BBT) : slight changes in basal body temp. @ ovulation; measured immediately after awakening and before any physical activity; ovulation causes an increase of one-half to one degree Fahrenheit

Transdermal

*Ortho Evra - Skin patch containing estrogen-progestin Change weekly x 3 weeks * Vaginal Ring - Nuva Ring - etonogestrel/ethinyl estradiol; Once a month (for 3 weeks) 98.8% effective ADVANTAGES *less hormone *no daily pill DISADVANTAGES *skin irritation *NO STD protection

Oral contraceptives:

*combination or multiphasic pill: contains estrogen & progestin; inhibits ovulation, thickens cervical mucus, & makes uterine lining less receptive to implantation * progestin only; thickens cervical mucus, makes uterine lining less receptive to implantation, may inhibit ovulation

diaphragm disadvantages

*higher failure rate than others *Messier *Poor fit increases problems *Allergy to spermicide *decreases spontaneity

New directions for contraception in women

*implants, especially biodegradable *progestin cream that is absorbed through the skin *immunocontraceptives, vaccine that stimulates the immune system to shut off functions required for pg.

*NS/CST - nipple stimulation-contraction stress test (or OCT - Oxycontin)

*negative - NO late deceleration, NO variable decelerations with 3 acceptable contractions in a 10 minute period. FAVORABLE *positive - persistent late deceleration with at least ½ of the contractions. UNFAVORABLE *Unsatisfactory - less than 3 contractions in a 10 minute period, poor tracing.

Vaginal spermicides advantages

*~85% effective *Little cost *No doctor *No dangerous side effects *Provides extra lubrication

diaphragm

- Latex, rubber or plastic dome with flexible rubber-covered steel spring rim; - Mechanical barrier keeps sperm out of cervix/uterus; Fitted by Dr. who teaches female how to insert & check proper placement; - Place spermicide around rim -Stays in for 6-8 hrs.

Inguinal Hernia

- Tube of peritoneum extends into scrotum and does not constrict or atrophy 1. Stimuli - familial (ages 5-7) or straining (older) 2. Management - outpatient surgery at young age 90% male

Hydrocele

- bulge in inguinal or scrotal area - no change with straining 1. stimuli - peritoneal fluid in scrotum 2. management - usually resolved before 1 year old

Amniotic fluid - functions:

- cushion to protect against injury (shock absorber) - helps control fetal body temperature - prevents adherence of fetal membranes - allows freedom of fetal movement - source of fetal oral fluid - swallows 400 ml/24 hours - excretion - collection system for fetus

60 million women in U.S. of childbearing age (15-44) 64% use contraception

-3 million women who need contraceptives are not using it and account for ½ of the 3 million unintended pregnancies that occur annually - The other ½ result from contraceptive failure assoc with incorrect or inconsistent use

Dx of breast issues

-95% BSE detected by female -breast palpation by practioner - mammogram - controversy, advantages, soft tissue x-ray, recommendations -ultrasounds-distinguish fluid-filled cyst/solid mass, primary location for surgery -MRI -FNA (fine needle aspiration)

Endometriosis management

-Based on severity and desire for childbearing a. Analgesics and/or prostaglandin inhibitors b. Hormonal therapy-oral contraceptives, Danazol, Synarel c. Surgery-cauterize or lasering of endometrial implants, adhesions

Vaginal spermicides

-Chemical agents that inactivate sperm. -Many forms: creams, jellies, foam, film, & suppositories. -Should be used with diaphragm or cervical cap; not to be used alone

PCOS Management

-Dependant on symptom concern of patient -Lifestyle modifications & manage of presenting symptoms are the focus -Oral contraceptives -Spironolactone, an antiandrogen -GnRH -Ovulation-inducing meds -Metformin

Withdrawal before ejaculation

-Difficult to judge when to withdraw -Can cause anxiety which may decrease pleasure - Preejaculatory secretions from Cowper's gland may carry sperm -Postejaculatory sperm on vulva may travel into vagina/uterus -unreliable and NOT A BIRTH CONTROL METHOD

Nexplanon

-Flexible plastic rod (matchstick size) that is implanted in the arm in the office. -Progestin only, time-release over 3 years

New directions for contraception in men

-Hormonal: pills, injections, implanted -Testosterone; testosterone/GnrH; androgen/progestin combo & receptor modulator -GnRH (gonadotrophin -releasing hormone) inhibitor may decrease the number and motility of sperm * chemical treatment that produce similar effects to surgical castration *requires daily injections *drop in testosterone *leads to possible erectile difficulty *results in loss of weight of the testes, epididymides, and sex-associated tissues *testosterone-derivative & progestine-related drugs may decrease sperm count *weekly injections; possible implant *drugs that would inhibit ejaculation but not orgasm - Nofertyl (Brazilian developed pill) destroys male sperm without loss of erection *potential 10-15% irreversible infertility

Why is family planning important for women?

-Improved health -Have lower rates of induced abortions -Fewer unwanted pregnancies and births -Have the opportunity to get more education and to find jobs, which improves life-style

Amniotic fluid facts and make-up

-Increases to 33 weeks and then decreases until the 40th week -slightly alkaline pH 7 to 7.25 -composition: albumin, lecithin, fat, sphingomeyelin, fructose, enzymes, lanugo -amount: 500 to 1000 ml. @ birth, volume constantly changes

Legality of birth control for minors

-Most states allow dispensing of contraception to minors without parental consent -Controversy re: TV ads for condoms, government funded contraceptive services for minors without parental notification

1st trimester

-Period of remarkable growth and organogenisis by the end of the 2nd wk 3 germ layers have formed, from which the body organs and systems will develop.

Contemporary family planning issues:

-Planning for unwanted children -Population growth -Wide diversity of views among religious leaders

Embryo - end of week 4

-already grown 10 thousand times -heart beating by 24 days -liver is large -primary lung buds appear -rudimentary gut et kidney exist -nerve groove is closed anteriorly to form brain et posteriorly to form spinal cord

Tx of breast issues: fibrocysts

-analgesics or anti-inflammatory medications -Danazol (danocrine) or Tamoxifen [infertility] -oral contraceptives (controversial) -Needle aspiration -Local heat -Dietary changes: decrease sodium and caffeine while increasing Vit E and B6

Ovulation

-as follicle presents to surface, the cortex of ovary ruptures which leads to ovulation -ovum carried away by the antral fluid -the ovum has no power of movement itself -The rest of the follicles in the ovary begin to degenerate

How to share BC responsibility

-ask about BC before intercourse -read & discuss options together -attend a class or clinic together -share expenses -help each other with various methods

Dx Leiomyoma

-based on behaviors -abdominal and pelvic exam -ultrasound -laparoscopy

Tx of breast issues: fibroadenomas

-biopsy- (incisional or excisional) -depending on age can be filled with a thick yellow serous fluid or dark brown -cover with dressing -rest and keep shoulder still

*There are three (3) parts to the decidua: ___________ __________, _________ ____________ and ____________ ________.

-decidua capsularis -decidua basalis -decidua vera (parietalis)

Benefits of shared BC responsibility

-decreases "surprise pregnancy" -reduces stress & increases trust

Polycystic Ovary Syndrome (PCOS) - stimuli

-endocrine imbalance results in increased levels of estrogen, testosterone, and Luteinizing hormone and decreased secretion of FSH -Can be transmitted as an X-linked dominant or autosomal dominant trait (Stein-Leventhal syndrome)

Benign breast changes - (2)

-fibroadenoma -fibrocystic

Transportation of ovum

-fimbria of fallopian tubes are brought closer to ovaries, fan out and increase in contractions helps massage ovarian surface to facilitate ovulation (d/t increased estrogen levels) -ovum captured & rapidly conducted by contraction & cilia to outer 1/3 of tube (ampulla)

Umbilical Cord

-grows as fetus grows (5 in. - > 4 ft.) -carries up to 300 quarts of fluid/day -resists knotting et tends to straighten self out if it becomes tangled as baby moves -1 large vein and 2 small arteries -Wharton's Jelly (special connective tissue), plus increases blood volume pulsating through vessels prevent compression of umbilical cord et ensure nourishment

Breast - Fibroadenoma stiumli

-hormonal imbalances (increased estrogen and decreased progesterone) -impaired ductal drainage -possibly methylxanthines -breast hypertrophy -most common in women in 20s and 30s (20-50) -solid and usually only one or two

Leiomyoma management

-hormone supplementation -surgery: myomectomy vs. hysterectomy

Management of ovarian cysts

-mild analgesics -hormone therapy (oral contraceptives) -laparoscopy/laparotomy -"shell out" the tube. Now some laser treatment

Breast - fibrocystic

-most common benign change -fluid-filled -usually multiple

Adolescent sexual education

-must be educated about masturbation, first base, first intercourse, contraception, teen pregnancy - other options and implications

Dx of cysts

-pelvic exam -ultrasound -R/O pregnancy -lapatoscopy

Stimuli influencing maturation

-quality of sperm/ovum -adequacy of uterine environment (most vulnerable 1st months) -drug, virus, radiation -maternal nutrition -maternal hyperthermia (sauna) -substance abuse

Cervical cap

-thimble-shaped latex or plastic cup -works like diaphragm -fitted by Dr. -filled with spermicide and pressed onto cervix -stays in for 6-24 hrs.

Pregnancy: subjective behaviors

1. Amenorrhea - "spotting" 2. Nausea/vomiting 3. Breast sensitivity - in primigravida 4. Urinary frequency & urgency 5. Lassitude & fatigue 6. Constipation 7. Quickening

Kaplan's Tri-Phase Model

1. Desire 2. Excitement 3. Orgasm

4 phases of sexual response model - Master's and Johnson

1. Excitement 2. Plateau 3. Orgasm 4. Resolution

Dysmenorrhea management:

1. Hormonal therapy: -oral contraceptives -progesterone -estrogen 2. Prostaglandin inhibitors/ analgesics

Pregnancy: objective behaviors

1. Hyperpigmentation: chloasma (mask), linea nigra, striae 2. Breast changes: prominent veins, erect nipples, enlargement, hyper-pigmentation, colostrum

Uterus - abnormal (ineffective) pap results

1. Pap smear classifications (1-5, or CIN 1-3) 2. Frequency of pap smears

PCOS Risks (3)

1. Type II DM, 2. nonalcoholic fatty liver disease, 3. cardiovascular disease

Corpus luteum

1. after ovulation, the ruptured follicle collapses and becomes filled with partially clotted fluid and then develops into Corpus Luteum under the effects of LH 2. It produces estrogen and progesterone leading changes in uterine endometrium and prepare to receive fertilized ovum 3. This continues for ~ 8-10 days after ovulation and will degenerate unless HCG present (from placenta)

Ovarian cysts - types (3):

1. follicle 2. corpus lutein 3. endometrial

Premenstrual Syndrome (PMS)

1. hormonal imbalances - increased prolactin and decreased estrogen - increased estrogen and decreased progesterone 2. nutritional alterations - low magnesium - low BS - low B6 - high Na - high CHO -increased stress - increased prostaglandin levels -variation in endorphin

Follicular development 1. Granulosa cells proliferate and secrete _________ 2. _______ collects within the _____. The fluid filled space is called _________. 3. matured _______ presents on the surface of the _______.

1. progesterone 2. fluid, follicle, antrum 3. follicle, ovary

Phimosis stimuli and management

1. stimuli congenital, edema, inflammation, fibrosis 2. management circumcision or slit is done

Physical changes - sperm (conception)

1st - physiological - capacitation; removal or protective coating around the sperm head. 2nd - structural - acrosome rxn [HYALURONIDASE enzyme] -The changes allow the sperm's head et neck to penetrate the zona pellucida layer of ovum

Females have _________ (amount) at birth and only ______ mature and are released at ovulation during reproductive years. They begin development around day __ to __.

2 million, 400-500, 8-10

Antepartal - DFMC - pattern over time

30" 3x/day, OK with 5/6 movements /30" lie on L side, palpate abdomen until 10 movements felt (20" - 2°)

Endometriosis assoc risk factors

30-40 years genetic/familial late childbearing or infertility frequent D/C's

Antepartal - Ultrasonography

4 weeks, 20 weeks -assessment of fetus (CRL, #, etc), uterus, placenta -adjunct to testing (AFP, amnio, percutaneous umbilical blood sample - PUBS)

Ovarian cysts characteristics

70-80% are benign Occur most in late adolescence up to age 40 Often transient

in-utero sex is differentiated at approximately ________ weeks

8

Gay and lesbian adolescents

80% hetero and 10% homo and 10% unsure approximately in middle/HS - much of the research is negative and not represantative

Fetus

9 weeks - devoted to refining and perfecting

Differentiation of zygote takes place at __ to ___

@ about 10 to14 days, along with embryonic membrane 3 germ layers et development of structures

Hormone-based contraceptives- what to watch out for (possible complications)

A abdominal pain C chest pain, SOB H H/A E eye problems: blurred vision, flashing lights S severe leg pain

female condom

A sheath that fits inside vagina during intercourse with closed ring at the top, open ring at vaginal opening

male condom

A sheath that fits over erect penis; forms mechanical barrier to keep sperm out of vagina; lubricated latex works best

prostate

A walnut-sized structure that is located below the urinary bladder in front of the rectum. This gland contributes additional fluid to the ejaculate which also help to nourish the sperm. The urethra runs through the center of the prostate gland.

Pregnancy: probable behaviors

A. Subjective behaviors Same as with presumptive behaviors B. Objective behaviors 1. Uterine enlargement 2. Palpation of fetal outline

female condom advantages

Advantages: *85-89% effective, if used properly *Provides some STD protection *Relatively cheap

IUD Advantages

Advantages: *Highly effective *Convenient *Increases spontaneity *Ok for women who breast feed

Sterilization male - advantages and disadvantages

Advantages: *cheaper & safer than female surgery; often an out of pocket expense Disadvantages: *10-20 post operative ejaculations *prostate cancer? *see Female

Sterilization female - advantages and disadvantages

Advantages: *most effective of all methods *Increases spontaneity *convenient Disadvantages: *pain during & after the procedure *rare surgical problems

Oral contraceptives advantages and disadvantages

Advantages: *Increased spontaneity *Reversible *Very effective *may decrease dysmenorrhea, PMS s/s, & some other conditions Disadvantages: *No STD protection *Estrogen-related side effects *Spotting

Nexplanon advantages and disadvantages

Advantages: *Less hormone, but constancy s effectiveness (99.9%) *No daily pill *OK w/breastfeeding Disadvantages: *High initial cost *May be hard to remove *Same as mini pill

Methods based on the menstrual cycle - advantages and disadvantages

Advantages: *No side effects *free/cost of a class/BBT thermometer *Increases comfort & self-knowledge *Increases non-coital activities *helps to plan a wanted baby *acceptable to most religions Disadvantages: *Decreases spontaneity *Requires lots of motivation *Lots of record-keeping *Cycles can be disrupted or irregular *Most unreliable method

Conception - critical factors

All systems "GO" for fertilization: 1. ovum: transport after ovulation, lifespan - fertile x ~ 24 hours and occasionally longer, up to ~ 72 hours 2. sperm: amount 2-400 mill/ml, motility, morphology, lifespan, healthy x ~ 24 hours and can survive up to ~ 72 hours -sperm deposited in or near vagina during sexual intercourse ( or heavy petting) -proceed through cervix by flagellar movement of tail & assisted by contractions of uterus

Breastfeeding

Amenorrhea is common for a brief period after birth while breastfeeding and about 80 % ovulate before first period. UNRELIABLE

1915: Margaret Sanger's illegal clinic & contraceptive information (Sep 14, 1879 - Sep 6, 1966)

American sex educator, nurse, and birth control activist. Sanger opened the first birth control clinic in the United States and established Planned Parenthood. Sanger's efforts contributed to the landmark US Supreme Court case which legalized contraception in the US.

Vaginal opening

An introitus is thus an entrance, one that goes into a canal or hollow organ such as the vagina

Zona Pellucida

An outer membrane of the egg. This structure helps the sperm to enter the egg through its hard outer layers. The egg wall hardens with age - the reason that an egg does not fertilize.

Remember that teen pregnancy is usually indicative of?

Another need that they are trying to meet. BC must be given our with a full education.

Emergency Contraception hormonal

Birth control pills taken within 72 hours of unprotected intercourse; works like combination pill Advantages: *Backup for rape or other unplanned event Disadvantages: *Nausea or vomiting *Unknown long-term effects *cycle irregularities

Cowper's gland

Bulbourethral gland, also called Cowper's Gland, either of two pea-shaped glands in the male, located beneath the prostate gland at the beginning of the internal portion of the penis; they add fluids to semen during the process of ejaculation. - alkaline fluid for sperm.

Masterbation

By definition, masturbation is self-stimulation of the genitals. It is done by both boys and girls and is normal behavior. Just how common is masturbation during the various stages of childhood? Up to the age of five or six years, masturbation is quite common. Young children are very curious about their bodies and find masturbation pleasurable and comforting. Youngsters also are curious about the differences between girls and boys, and thus in the preschool and kindergarten years they may occasionally explore each other's body, including their genitals.

Choosing a Birth Control Method

Consider effectiveness *Failure rates reported for each method *Influenced by human error *Backup methods increase effectiveness *Consider cost *ease of use *reversible * side effects *acceptable to both *consider non coital methods of sexual intimacy ("outercourse") *Kissing *Touching

Contraception hx

Contraception has been around at least since recorded history. Comstock laws in 1873 restricted contraceptive information. The ban on contraceptives was declared unconstitutional by the courts in 1936, remaining portions of the law continue to be enforced today on.

epididymis

Develop sperm - The epididymis is a long, coiled tube that stores sperm and transports it from the testes. It appears as a curved structure on the posterior (back) margin of each testis. It is comprised of three sections. These are the head, body, and tail

Uterus

Development/menstral/reproduction - Functions of the uterus include nurturing the fertilized ovum that develops into the fetus and holding it till the baby is mature enough for birth. The fertilized ovum gets implanted into the endometrium and derives nourishment from blood vessels which develop exclusively for this purpose.

IUD Disadvantages

Disadvantages: *Initial cost *Increased PID risk *Discomfort *Risk of miscarriage *2-20% expelled in 1st yr. *Rarely punctures womb

Sponge

Disposable cap saturated with spermicidal foam when activated with tap water.

*Three germ layers are: KNOW WHAT DEVELOPS FROM EACH LAYER

Ectoderm Mesoderm Endoderm

Embryo

Embryo - embryonic - 3-8 weeks all principle organs are being established ** MOST vulnerable to teratogens

During the follicular phase increasing levels of ______ and _____ stimulate development of a mature _______ which is also sensitive to ______.

FSH estrogen follicle LH

*female secondary sex characteristics

Growth spurt, breast development, hair growth, menstruation, feel awkward, embarrassed, insecure

Paragard IUD

Hormone free T-shaped piece of soft, flexible plastic wrapped w/natural copper, affects sperm motility & viability; inserted in uterus in the office; good for 10 yrs.

Epididymitis

Inflammation of the epididymus 1. Stimuli - can be caused by aggressive palpation or infection (STIs like clamydia or gonnerhea). 2. Management: analgesics, antibiotics, scrotal support, cold

Emergency Contraception IUD

Inserted up to 7 days after unprotected intercourse; works same as regular use of IUD Advantages: *Failure <1% *Backup for rape or other unplanned event Disadvantages: *See IUD

Surgical Removal of Embryo - late

Instillation of drugs Hypertonic Saline; Prostaglandins Hysterotomy

Uterine souffle or bruit - pulse

It has a whooshing sound and is not a fetal heartbeat

*decidua basalis

Located directly beneath the blastocyst -maternal portion of placenta developed from this. It has large blood vessels.

Bartholin's gland

Lubrication - AKA greater vestibular glands Two pea sized compound racemose glands located slightly posterior and to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina and are homologous to bulbourethral glands in males.

Skene's gland

Lubrication - lesser vestibular glands, periurethral glands, paraurethral glands, female prostate) are glands located on the anterior wall of the vagina, around the lower end of the urethra.

Conception, sexual differentiation is determined by the _______.

Male - X or Y added to X (males have x or y and females have x)

Surgical Removal of Embryo - early

Menstrual extraction Suction Curettage-Dilation & Curettage (D & C) Dilation & Evacuation (D & E)

Prostatitis

Most common cause male UTI. *Types: acute [bacteria] or chronic [can start during the upper 40s to 50s] *Stimuli: E.Coli, klebsiella, chlamydia *Diagnosis: urine culture, cystoscopy [scope through penis or rectum], rectal exam *Management: antibiotics for 6 weeks, stool softeners, pain meds

Layers of the ovum (4) and all layers are held together by * ______ _____.

Nucleus Cytoplasm Zona Pellucida Corona Radiata HYALURONIC ACID

Dysmenorrhea secondary: onset and stimuli

Onset: after age 20 Stimuli: -endometriosis -uterine fibroids -I.U.D. -P.I.D., -cervical stenosis -uterine displacement

Dysmenorrhea primary: onset and stimuli

Onset: with ovulation, 1-3 yrs after menarche Stimuli: -Prostaglandins E & F -Hormonal imbalances: increased estrogen -nutrition alterations

Hypospadias / Epispadias

Opening to the urethra is not ar the tip. It either has a dorsal or a ventral opening. 1. Stimuli - congenital, ↓ testosterone (low in early gestation) 2. Management - surgery after one year

cervix

Opening/lubrication - It is the lower most part of the uterus and is made up of strong muscles. The function of the cervix is to allow flow of menstrual blood from the uterus into the vagina, and direct the sperms into the uterus during intercourse. The opening of the cervical canal is normally very narrow.

*decidua capsularis

Overlies the blastocyst/trophoblast

Intrauterine devices - what to watch for (complications)

P no period or late A abdominal pain I Increase temp., fever, chills N nasty discharge, foul smelling S spotting, bleeding, heavy periods, clots

parental influences: inoculation boosters, self-esteem, self-worth,

Parents can give gentle reminders about what is appropriate and adolescents will also tend to make better choices if confident (re drugs, alcohol, and sex).

vas deferens

Passageway - Long, muscular tube that travels from the epididymis into the pelvic cavity, to just behind the bladder. Transports mature sperm to the urethra, the tube that carries urine or sperm to outside of the body, in preparation for ejaculation.

Fallopian tubes

Passageway - The uterine tubes, also known as oviducts or Fallopian tubes, are the female structures that transport the ova from the ovary to the uterus each month. In the presence of sperm and fertilization, the uterine tubes transport the fertilized egg to the uterus for implantation.

urethra

Passageway - Tube that carries urine from the bladder to outside of the body. In males, it has the additional function of ejaculating semen when the man reaches orgasm. When the penis is erect during sex, the flow of urine is blocked , allowing only semen to be ejaculated at orgasm.

Vagina

Passageway/lubrication - The inner lining of the vagina is made of non-keratinized stratified squamous epithelial tissue. This tissue provides protection from friction to the underlying layers of the vagina. Watery secretions produced by the vaginal epithelium lubricate the vagina and have an acidic pH to prevent the growth of bacteria and yeast. The acidic pH also makes the vagina an inhospitable environment for sperm, which has resulted in males producing alkaline seminal fluid to neutralize the acid and improve the survival of sperm.

Clitoris

Pleasure - Small projection of erectile tissue in the vulva of the female reproductive system. It contains thousands of nerve endings that make it an extremely sensitive. Touch stimulation of the nerve endings in the clitoris produces sensations of sexual pleasure. It is structurally and functionally homologous to the penis of the male reproductive system, except that the clitoris does not contain the urethra and plays no role in urination.

Endometrial Cycle - physiology

Prepares for pregnancy (receive/nourish zygote) -1st thickens, becomes succulent (rich, velvety cushion of new blood vessels et tissue) -after ovulation, continues to develop d/t progesterone secreted by corpus luteum

Ovaries

Product ova/hormones - The ovaries have two main reproductive functions in the body. They produce oocytes (eggs) for fertilization and they produce the reproductive hormones, estrogen and progesterone.

*NST-nonstress test

Reactive - 2 accelerations ( 15 BPM x 15 sec.) with fetal movement in a 10-20 min. window (FAVORABLE) Nonreactive - less than acceptable accelerations with fetal movement, after 40 minutes (UNFAVORABLE) Unsatisfactory - poor quality tracing, repeat same day

seminal vesicles

Secretion/motility - Sac-like pouches that attach to the vas deferens near the base of the bladder. They produce a sugar-rich fluid that provides sperm with a source of energy to help them move. This fluid of the makes up most of the volume of a man's ejaculate.

Mirena IUD

Soft flexible device that is inserted into the uterus in the office. Progestin only; good for 5 yrs.

Douching

Sperm reach uterus in 1-2 minutes and douching may speed sperm along; irritates vaginal tissue. VERY INEFFECTIVE

Positive fetal behaviors

Subjective: none Objective: 1. Auscultation of fetal heartbeat 2. Palpation of fetal movements 3. Ultrasound

Perineum

The area between the anus and the scrotum or vulva

Corona Radiata

The corona radiata surrounds an egg and consists of two or three layers of cells from the follicle (secretes estrogen). They are attached to the zona pellucida - the outer protective layer of the egg - and their main purpose is to supply vital proteins to the cell.

Cytoplasm

The cytoplasm is a gel-like substance that holds all the cell's other internal structures, called organelles. It is in the cytoplasm that all the cell's activities take place to keep it alive and functioning properly.

Nucleus

The nucleus is the heart of the egg cell; it contains most of the genetic material in the form of chromosomes. This is where the genes are situated and contains half the number of chromosomes as a normal cell (23 each).

ejaculatory duct

These are formed by the fusion of the vas deferens and the seminal vesicles (see below). The ejaculatory ducts empty into the urethra.

Embryonic/fetal membranes 1. 2. 3.

These begin before implantation 1. chorion - outer membrane 2. amnion - inner membrane 3. amniotic cavity - space between amnion et embryo The amnion expands as embryo grows until contacts chorion. Amniotic fluid is secreted from amnion, then, later from maternal plasma et fetal unit.

Testicular torsion

Twisted spermatic cord 1. Stimuli - can be caused by a congenital abnormality of the covering of the testes, but usually trauma. 2. Management -EMERGENGY. Must have SURGERY within 4-6 hours or the testicle will die. -Salvage rate is 90% -If it occurs prenatally there is no testicular viability

1965 birth control ruling

U.S. Supreme Court ruling: states could not prohibit use of contraception by married couples: extended to single people in 1972

Funic souffle

Umbilical cord

braxton hicks

Uterine contractions that can increase at 28 weeks

Management of abnormal pap results

a. Colposcopy b. Biopsy c. Conization d. Cryotherapy or "cryocone" e. Laser therapy

Second: there are three different portions of the OVARIAN cycle. a. ___________ phase b. __________ c. __________ phase

a. Follicular b. Ovulation c. Luteal

Premenstrual Syndrome (PMS) Dx

a. Hormonal supplementation (progesterone) b. Oral contraceptives c. Prostaglandin inhibitors

Third: the endometrial cycle (uterine) there are four phases. a. ___________ phase (days 1 to 5) b. ___________ phase (days 5-14) estrogen is increased c. ___________ phase (day 15-28/3 days b4 menstrual) d. ___________ phase (3 days b4 menstrual until menstruation) - blood supply blocked and necrosis developes.

a. Menstrual b. Proliferative c. Secretory d. Ischemic

First: two things happen during the PITUITARY (hypothalamic) cycle. a. the ___________ secretes ______ b. ______ stimulates the anterior pituitary to secrete _____ and ______

a. hypothalamus, GnRH b. GnRH, FSH, LH

psycho-social development in adolescense

although physically mature, still learning how to handle gender/social roles and sexual scripts

Sex determination

at conception since it is due to the genetic make up of the sperm that gets through.

genitourinary organs 7-8 week embryo

beginning to differentiate sexually at 7-8 weeks

Uterus - Leiomyoma

benign fibroid tumors caused by hormonal imbalance (increased estrogen) -Smooth muscle tumors of the uterus are often multiple. -Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus.

gender assignment happens at _________.

birth - role expectations

Contraception vs. birth control

birth control to prevent or end pregnancy: - contraception (the prevention of fertilization of the ovum by sperm cells) - contragestion (preventing the fertilized egg from implantation - morning-after-pill) - chemical or surgical induction of abortion of the developing embryo/fetus

Endometrial cysts are ______ _______ and caused by ____________.

blood filled endometriosis

Pregnancy: genital/cervix changes: Chadwicks

blue cervix, vulva, vagina

3 stages of intrauterine development

cellular multiplication, cellular differentiation, development and maturation

Sexuality in mid/late adulthood -males

changed in body shape no counter to menopause more gradual and at older ages than females: decreased potency, testosterone, volume of semen, sensitivity of penis, sexual activity, firmness of erection enlarged prostate

Sexuality in mid/late adulthood - females

changes in body type climacteric responses: (the change) hot flashes, vaginal lubrication change, urinary problems, skin and hair changes, osteoporosis, increased of heart disease, irritability/anxiety, will disappear in 5 years, menopause at 45-55

Phimosis

constriction of foreskin which leads to prevention retraction

During the Luteal phase the remaining ruptured follicle collapses and develops into the ________ __________ under the effects of _____. It secretes _______ and __________. This continues for ______ to _____ days after ovulation and will degenerate unless ___ is present.

corpus luteum LH estrogen, progesterone 8,10 HCG

sensual pleasure - touch

cutaneous phase - at birth touching is important foundation for further growth nonverbal communication gender roles - toys

After implantation the endometrium is referred to as __________.

decidua

Sexuality in adulthood: values and types of relationships

delayed first marriage, being single, abstinence standard, cohabitation

During ovulation changes in ________ and ________ and a surge of _____ leads to ovulation.

estrogen progesterone LH

Pregnancy: genital/cervix changes: McDonald's

flexion of fundus into cx

Paraphimosis

foreskin retracted above the glans leading to edema and severe pain.

Placentation (implantation)

forms @ place of attachment to uterine wall a. layers - trophoblast divides into 2 layers (maternal & fetal) - side of placenta b. cotyledons - as pg. progresses 3rd layer of connective Mesoderm develops forming cotyledon (15-20 segments) - a complex vascular system through which exchange of gases et nutrients occurs [Ctyledons are sections of placental chunks that are a redundant system. It is about 8" diameter and weighs 1 lb.]

Physical changes during puberty: secondary sex characteristics begin at what ages?

girls @ 9 to 14 boys @ 11-14

*male secondary sex characteristics

growth spurt, hand, foot and muscle mass growth, scrotal development, ejaculation. [some males develop breast tissue and it will regress in 1-2 years]

Cephalocaudal

head to tail

General to specific

head, trunk, arms, legs to eyebrows, nails, fingerprints, etc

Variations is sexuality (7)

heterosexual homosexual bisexaul transsexual transvestite multiple partners sexually active teens

Endometriosis dignosis

history abdominal and pelvic exam laparoscopy

Scrotum

holds testicles/temperature regulation - It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature.

Menstrual cycle is made up of a sequence of interlocking cycles that are influenced by _________. 1. The __________ cycle 2. The __________ cycle 3. The __________ cycle

hormones 1. pituitary (or hypothalamic) 2. ovarian 3. endometrial

Cellular multiplication begins at conception and then ____________.

implantation

Follicle cysts are caused by ________ _____________.

increased estrogen

Corpus luteum cysts are caused by __________ __________ in _________ women.

increased estrogen ovulating

Laboratory tests (& OTC tests)

increased hcg 6-8 days after

*decidua vera (parietalis)

lines the rest of the uterine cavity

Endometriosis stimuli

menstrual reflux transport through lymph or blood transplantation at time of surgery

Proximal to distal

midline to limbs

genitourinary organs 7-8 week fetus

more differentiation

Fertilization

occurs when ovum reaches the ampulla of the fallopian tube, usually, et 1 sperm penetrates the ovum's nucleus instantly the ovum becomes impenetrable to other sperm and development begins.

Endometriosis sites

ovaries tubes ligaments colon bladder vagina cervix surgical incision

Injections - Inhibits _______ example: ________________

ovulation Depo-Provera (IM progestin q12 weeks)

Penis

passageway/sensation - The penis functions as both a reproductive organ and an excretory organ. As a reproductive organ, the penis becomes erect during sexual intercourse in order to deliver semen more effectively into the vagina. Semen travels through the urethra to the tip of the penis where it is ejaculated out of the body.

G-spot

pleasure/sensation - The G-spot, also called the Gräfenberg spot. Characterized as an erogenous area of the vagina that, when stimulated, may lead to strong sexual arousal, powerful orgasms and potential female ejaculation.[1] It is typically reported to be located 5-8 cm (2-3 in) up the front (anterior) vaginal wall between the vaginal opening and the urethra and is a sensitive area that may be part of the female prostate.

Zygote

pre-embryonic - 0-3 weeks

testes

produce sperm/hormones - The primary functions of the testes are to produce sperm (spermatogenesis) and to produce androgens, primarily testosterone. Both functions of the testicle are influenced by gonadotropic hormones produced by the anterior pituitary. Luteinizing hormone (LH) results in testosterone release.

Labia majora

protection/sensation - The function of the labia majora is to enclose and protect the other external reproductive organs.

Labia minora

protection/sensation - The labia minora are a pair of thin cutaneous folds that form part of the vulva, or external female genitalia. They function as protective structures that surround the clitoris, urinary orifice, and vaginal orifice.

Mons Pubis

protection/sensation - The mons pubis is a rounded mound of fatty tissue that covers the pubic bone. During puberty, it becomes covered with hair. The mons pubis contains oil-secreting (sebaceous) glands that release substances that are involved in sexual attraction (pheromones).

geturouniary organs in a 5-6 week week old embryo

sexually indifferent stage

Pregnancy: genital/cervix changes: Goodell's

soft cervix

Pregnancy: genital/cervix changes: Ladin's

soft mid-uterus

Curiosity

toddlerhood, three years old, curious about how their bodies work or self calm and pleasurable feeling (sex play)

Sterilization female

tubal ligation: blocks sperm from traveling down Fallopian tube to egg (Permanent: 70% reversal success rate) trans-cervical: "Essure" coil placed in each Fallopian tube, failure rate <1%

Cryptorchidism

undescended testes-often retractile 1. Stimuli-premature, genetic hernia 2. Dx-palpation, U.S., laparoscopy, "milk" retractile 3. Mgnt-hormone therapy, surgery (orchiopexy between 1-3 y/o as out-patient)

Sterilization male

vasectomy: cutting & closing of vas deferens prevents sperm from being ejaculated with semen Permanent: 50% pregnancy rate after reversal

peer influences are ____ _________.

very important - video "she probably wants it"