Chapter 5: Female Sexual

Anatomy
 Chapter 5 Outline

• The Female Sexual and Reproductive

System
– External Sex Organs
– Internal Sex Organs
– Other Sex Organs
• The Female Maturation Cycle
– Female Puberty
– Menstruation
– Menopause
 Chapter 5 Outline (Cont.)

• Female Reproductive and Sexual Health

– Gynecological Health Concerns
– Cancer of the Female Reproductive
Organs
 The Female Sexual and
Reproductive System

• External Sex Organs

• Internal Sex Organs
• Other Sex Organs
 External Sex Organs

• Vulva/Pudendum – entire female region of

external sex organs
• Mons Veneris – protective, fatty cushion over
the pubic bone; covered with pubic hair
• Labia Majora – outer lips; tissue folds from
mons to perineum surrounding the rest of the
female genitals; engorge with blood if excited
– Outer: covered with pubic hair; pigmented
– Inner: hairless; oil glands
 External Sex Organs (Cont.)

• Labia Minora – inner lips; pink tissue folds

between vestibule and labia majora; no hair;
many oil glands; darken if sexually aroused
• Clitoris – small cylindrical erectile tissue
beneath the prepuce; rich in blood supply and
nerve endings; solely to provide sexual
pleasure, primarily via indirect stimulation
– Circumcision
– Infibulation
 External Sex Organs (Cont.)

• Vestibule – region between the labia minora;

urethral and vaginal openings, Bartholin’s
glands ducts
• Urethral Meatus – between clitoris and vagina
• Introitus
 External Sex Organs (Cont.)

• Hymen – layer of tissue covering the introitus

at birth, typically with an opening; great
variation in size and form; may tear and bleed
during first intercourse; other activities can
cause its degeneration; hymen-plasty
• Bartholin’s Glands – ducts empty into the
vestibule; may produce a genital scent, but
don’t produce enough lubrication for sex
• Perineum – between anus and vagina
Figure 5.1 The external genital structures of the mature female.
 Internal Sex Organs

• Vagina – 4 inch, thin-walled accordion-like

tube from the introitus to the cervix, tilted
back; organ of intercourse and canal for
menses and babies; lubricant secreted from
vaginal wall openings when engorged; first
1/3 contains many nerve endings, inner 2/3
has little nerves
 Internal Sex Organs (Cont.)

• Grafenberg Spot (G-spot) – dime to quarter

sized spot in the lower third of anterior
vaginal wall (2-3 inches up), just past the
pubic bone; sensitive area; controversy
– Female ejaculation – powerful orgasms
and expulsion of fluid (up to 4 ounces) due
to stimulation of the G-spot in some
women; may be Skene’s glands fluid or
urine
 Internal Sex Organs (Cont.)

• Uterus – 1-inch thick walls, hollow, muscular

organ between the bladder and rectum;
monthly cycle of change; menstruation,
protects fetus, contractions to expel menses
and fetus; 3 inches long, 2 inches wide
– 3 uterine wall layers:
• Perimetrium
• Myometrium
• Endometrium
 Internal Sex Organs (Cont.)

• Cervix – at bottom of the uterus; doughnut-

shaped; secretes mucus to help or impede
sperm, depending on the monthly cycle
– Os – opening leading into the uterus
 Internal Sex Organs (Cont.)

• Fallopian Tubes (oviducts) – two 4-inch long

trumpet shaped tubes that extend from the
sides of the uterus and curve up to and
around the ovaries
– Ampulla – typical site of fertilization
– Infundibulum – has fimbriae surrounding
the ovaries to collect an egg upon release
• Ovaries – form of an almond shell; contain
250,000 ova each; produce estrogen
Figure 5.3 The female internal reproductive system (side view).
Figure 5.4 The female internal reproductive system (front view).
 Other Sex Organs

• Breasts (mammary glands) – modified sweat

glands that produce milk; fatty tissue, 15 to 20
lobes, and milk-producing glands (alveoli)
Alveoli→Secondary tubules→Mammary
ducts→Lactifierous sinuses→nipple
– Nipple, areola
• Sucking stimulates pituitary gland to release
prolactin (begin milk synthesis) and oxytocin
(release of milk)
Figure 5.5 The female breast.
 Other Sex Organs (Cont.)

• Skin, lips, ears, back of knee, armpit, base of

neck, anus, brain
• Any area can be arousing depending on the
type of stimulation and the perceptions of the
recipient
 The Female Maturation Cycle

• Female Puberty
• Menstruation
• Menopause
 Female Puberty

• Begins anywhere from 8 to 15 years of age

• Earlier onset of menstruation may be due to
being overweight; can vary with race
• Puberty lasts about 3 to 5 years
• Begins when pituitary gland initiates release
of FSH and LH, which increases the ovaries
production of estrogen
• Increased size of Fallopian tubes, uterus,
vagina, breasts, buttocks, thighs
 Female Puberty (Cont.)

• Pelvis widens
• Pubic hair grows
• During puberty (usually 11 or 12 years),
ovulation commences
• Menarche occurs during this time as well,
although it may be a few months before or
after ovulation begins
Figure 5.6 Prevalence of obesity in children at age 9, by mother’s age at menarche
(Ong et al., 2007).
 Menstruation

• Menstruation – uterine lining is shed if no

pregnancy; tissue and blood exit the introitus
• Menstrual cycle – lasts about 24 to 35 days,
average is 28 days
• Menstrual cycle has four phases:
– Follicular phase
– Ovulation phase
– Luteal phase
– Menstrual phase
 Menstruation (Cont.)

• Follicular phase – begins after menstruation

ends; lasts 6-13 days; ovarian follicles begin
to ripen; estrogen promotes development of
endometrium to 2-5 millimeters thick
• Ovulation phase – around day 14, an ovum is
released due to FSH and LH that have
ripened primary follicles; one follicle matures
completely (secondary follicle) and ruptures,
releasing the egg to be caught by the fimbriae
 Menstruation (Cont.)

• Luteal phase – corpus luteum forms on the

ovary where the secondary follicle ruptured; it
secretes progesterone and estrogen for 10-
12 days to further develop the endometrium
to 4-6 millimeters thick; without fertilization,
the progesterone and estrogen levels signal
to the hypothalamus to decrease LH and the
corpus luteum deteriorates and estrogen and
progesterone drop significantly
 Menstruation

• Menstrual phase – endometrial buildup is

expelled through uterine contractions for 3-7
days; volume of menses is about 2-4
tablespoons of fluid
• Negative Feedback Loop
Figure 5.7 The ovarian and menstrual cycles.
Figure 5.8 The cycle of female hormones.
 Variations in Menstruation

• Amenorrhea – absence of menstruation

– Primary amenorrhea – never begins
menstruation; physical, health, emotional
causes
– Secondary amenorrhea – menses cease
before reaching menopause; pregnancy,
lifestyle, emotional, physical causes
• Menorrhagia – excessive menses; oral
contraceptives can help control
 Variations in Menstruation (Cont.)

• Dysfunctional uterine bleeding (DUB) –

bleeding for long periods, or intermittent
bleeding; hormonal, lifestyle, physical causes
• Dysmenorrhea – painful menstruation;
caused by inflammations, constipation,
psychological stress; recommend medication,
relaxation, yoga, massage, and stress relief
 Variations in Menstruation (Cont.)

• Premenstrual Syndrome (PMS) – physical or

emotional symptoms that occur during the
last few weeks of the menstrual cycle
• Premenstrual Dysphoric Disorder (PMDD) –
mood, behavioral, somatic, and cognitive
symptoms; medication (SSRIs) and lifestyle
changes provide relief
 Variations in Menstruation (Cont.)

• Risk factors for PMS and PMDD: history of

depression, sexual abuse, PTSD, smoking,
ethnicity
 Menstrual Manipulation and
Suppression

• Women can experience up to 450 periods

• Ways to stem growth of the endometrium:
– Continuous birth control pills
– Progesterone intrauterine devices
– Injections
• Can relieve many physical symptoms related
to menstruation
• Some see menses as indicating health
• No medical basis to avoid sex during a period
The Diva Cup is a silicone menstrual cup that can be used as an alternative to menstrual
products, such as tampons.
 Menopause

• A woman’s final menstrual period

• Climacteric – period of decreased estrogen
production and menstruation stops; 40-58
years, average 51 years
• Typically have irregular cycles, rather than a
sudden stop
• Sexual glands decrease in size
• Secondary sex characteristics change
 Menopause (Cont.)

• Hormonal changes – hot flashes, headaches,

sleep disturbances
• Sexual complaints
• Menopause can be induced by surgically
removing the ovaries; doctors try to keep at
least one in if surgery is necessary
 Menopause (Cont.)

• Hormone replacement therapy – was a

standard treatment, but there are a lot of
health risks and not typically used today
• Nutritional, vitamin, and herbal remedies are
commonly used today
 Female Reproductive and Sexual
Health

• Gynecological Health Concerns

• Cancer of the Female Reproductive Organs
 Female Reproductive and Sexual
Health (Cont.)

• Genital self-exams are recommended for

women to be familiar with their genitals and
any possible abnormalities
• Routine gynecological examinations
recommended once menstruating
– Medical history and checkup
– Pelvic examination (internal and external)
– Breast examination
– Pap smear – cervical swab
 Gynecological Health Concerns

• Endometriosis: endometrial cells begin to migrate to places

other than the uterus.

• Toxic Shock Syndrome

• Polycystic ovarian syndrome (PCOS) is an
endocrine disorder; causes cyst formation on the ovaries during
puberty, which causes estrogen levels to decrease and androgen levels
(including testosterone) to increase.

• Uterine Fibroids: noncancerous growths that occur in the

myometrium layer of the uterus.

• Vulvodynia: chronic vulval pain and soreness

• Vaginal Infections
 Endometriosis

• Endometrial cells deposit outside of the

uterus
• Will engorge/weaken with the menstrual cycle
• Symptoms: painful periods, lower abdominal
or pelvic pain, pain on defecation, pain during
intercourse
• Typically childless women between 25 and 40
• Cause is unknown
• Treatment: hormones, surgery, laser therapy
 Toxic Shock Syndrome

• Caused by prolonged use of a single tampon

which creates a buildup and subsequent
infection of bacteria
• Symptoms: fever, diarrhea, vomiting, sore
throat, muscle ache, rash,
• May cause: dizziness, respiratory distress,
kidney failure, heart failure, death
• Avoid by changing tampons regularly, using
less absorbent tampons, using sanitary pads
 Uterine Fibroids

• Hard tissue masses in the uterus; size range

• Affect 20-40% (maybe 77%) of women over
35 years
• Symptoms: pelvic pain and pressure, heavy
cramping, heavy or prolonged bleeding,
constipation, frequent urination, painful sex
• Treatment: hormones, drugs, laser therapy,
surgery, cryotherapy
 Vulvodynia

• Chronic pain and soreness of the vulva

• Symptoms: vaginal burning, itching, rawness,
stinging, stabbing of vagina/vulva
• The pain may be intermittent or constant
• Cause is unknown
• Treatment: biofeedback, drugs, dietary
changes, nerve blocks, surgery, pelvic floor
muscle strengthening
 Infections

• Non-sexually transmitted infections can occur

– Bartholin’s glands
– Urinary tract
• May be due to poor hygiene practices and/or
frequent intercourse
• Treated by draining infected gland (if
necessary) and use of antibiotics
• Douches change the vaginal pH level and
can increase risk of infection
 Cancer of the Female Reproductive
Organs

• Breast
• Uterine
• Cervical
• Endometrial
• Ovarian
 Breast Cancer

• Worldwide, the most common cancer

• One in 7 American women will develop it
• Risk factors: fat intake, aging, early
menarche, prolonged estrogen, inactive
lifestyle, alcohol consumption, genetics
• Breastfeeding, early pregnancy reduces risk
• Early detection is critical: breast self-
examinations, gynecological checkups,
mammography
Breast self-examination.
 Breast Cancer

• Symptoms: breast lump, breast pain, nipple

discharge, puckering of skin, change in nipple
shape
• If untreated, the cancer will spread to other
parts of the body
• Treatment: partial/modified mastectomy,
radical mastectomy, lumpectomy, radiation,
chemotherapy
 Cervical Cancer

• 1 in 130 American women

• Pap smear is used for detection; should be
screened every year by 21 years of age
• High cure rates
• Risk factors: early intercourse, many sexual
partners, teenage mothers, cervicitis, genital
viral infections, extended oral contraceptive
use
• Treatment: surgery, radiation, hysterectomy
 Endometrial Cancer

• Symptoms: abnormal bleeding, spotting

• Detection most successful with dilation and
curettage
• Treatment: surgery, radiation, hormones,
chemotherapy
• Over 90% survival rate
• Oral contraceptives decrease risk
 Ovarian Cancer

• Less common than breast, uterine cancers

• Most deadly
• Symptoms: few early signs, ovarian cyst,
slight abdominal discomfort, appetite loss,
indigestion, abdominal swelling, nausea,
vomiting
• Risk factors: childlessness, early menopause,
high-fat diet, higher SES, lactose-intolerant,
use talc powder on the vulva
 Ovarian Cancer (Cont.)

• Decreased risk with having children and

using birth control pills, tubal ligation
• Detection techniques: blood tests, pelvic
exams, ultrasound
• Unfortunately, most diagnosed after cancer
has spread beyond the ovary because of the
lack of early warning signs
• Treatment: remove ovaries, radiation,
chemotherapy