GWS 103 Week 2 Lecture & Reading Notes
GWS 103 Week 2 Lecture & Reading Notes GWS 103
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This 24 page Class Notes was uploaded by alexrinehart on Sunday February 7, 2016. The Class Notes belongs to GWS 103 at University of Wisconsin - Madison taught by Araceli Alonso in Spring 2016. Since its upload, it has received 293 views. For similar materials see Women & Their Bodies in Health and Disease in Women and Gender studies at University of Wisconsin - Madison.
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Date Created: 02/07/16
GWS 103 Reading for 1/25 Notes BW "Reproductive Anatomy" p. 51-68 o Intro The female reproductive system and the male reproductive system actually both have a majority of the components internal. People like to say that the female system is hard to understand because everything is internal, but obviously this argument does not hold up. Andreas Vesalius was one of the first Europeans to publish accurate information on the female internal anatomy. "De Humani Coporis Fabrica" Misconceptions about the female reproductive system have shaped research and social policies and attitudes. Dr. Helen O'Connell did research about the nerves that are connected to the clitoris. Her dissections revealed that the internal portions of the clitoris are actually much larger than thought. Homologous Structures Female Male Ovary Testicle Uterus Prostatic Utricle Skene's Gland or Prostate Female Prostate Bartholin's Bulbourethral Gland Gland or Cowper's Gland Labia Majora Scrotum Labia Minora Spongy Urethra Clitoris Penis Glans of the Glans of the Penis Clitoris Clitoral Hood Foreskin of the Penis o Ovaries Ovaries are the female gonads They produce both gametes and hormones Testicles fulfill a homologous role in males 3 cm long by 1-1.5 cm wide by 1 cm thick Almond size The gamete in females is called the ovum, or commonly referred to as eggs. The male gamete is sperm. They are suspended in the pelvic cavity "Attached to the peritoneal covering over the back of the uterus by connective tissue called the mesovarium" "Attached to the uterus by the ovarian ligament" "Attached to the lateral body wall by the suspensory ligament of the ovary." Their position can change over time. The internal surface is covered with germinal epithelium. A flattened layer of protective cells The cortex is the area where the ova develop. The medulla is a region in the cortex where there are many large blood vessels, lymphatic vessels, and nerves. The stroma gives the ovaries their shape. o Oviducts or Fallopian Tubes The fallopian Tubes are also known as the oviducts or the uterine tubes. 2 The fallopian tubes and the ovaries can be referred to as the adnexa because they are next to the uterus. Four sections of the fallopian tube: The interstitial or uterine portion are the shortest and narrowest portion compared to the rest. It lies completely within the muscle of the uterus. "The isthmus is the straight section with a thick muscular wall and a narrow lumen. " This is the usual site of tubal ligation, or known as getting the tubes tied. The ampulla is .5 of the entire length of the tube. It is thin-walled with a lining with a lot of folds. The infundibulum, nearest to the ovary, is trumpet shaped and has fimbriae that wave back and forth to attrach ovum inot the opening, or ostium of the tube. The ovarian fimbria is longer, and closer to the ovary. The tube is lined with ciliated epithelial tissue that secretes a fluid to provide an environment needed for the movement, fertilization, and survival of the ovum/egg. Once the ovum reaches the ampullary-ishtmus junction, transit is delayed for 30 hours, and this is called the "tube-locking mechanism" or the "isthmic block." If sperm is present, fertilization can occur here. Once fertilized the embryo will move to the uterus and implant in the uterine lining. This is called implantation. Ectopic or tubal pregnancy is where the egg is fertilized and implants in the tube. The embryo cannot develop here, and if left untreated it will rupture the tube. o Uterus 3 The uterus is a hollow muscular organ that houses the developing fetus during gestation. Layers: Outer layer, the perimetrium, is epithelial and connective tissues. Middle layer, the myometrium, is the thickest. Smooth muscle responsible for contractions of labor. Inner layer, the endometrium, can be divided into the rapidly dividing basal layer and the thick functional layer. Layer that sheds during menstration The embryo implants in the functional layer and is maintained until delivery. There is an upper expanded portion of the uterus called the body, or fundus, and a lower constricted portion called the neck, or cervix. The cervix projects into the vagina and has an opening, the external os. 76mm long, 51mm wide at the fundus, 25mm thick at its thickest point, and the walls are about 13mm thick. 57 grams to 907 grams when pregnant. Can shrink back to normal size within 6 weeks after delivery. o Position of the uterus Between the rectum and the bladder Varies Depending on posture, how full the bladder and rectum are, and how many pregnancies. Typical - inclined forward When the bladder is distended, the backward movement of the uterus is called retroversion When the rectum is distended, the forward movement is called anteversion Marked anteversion is called acute flexion. Marked retroversion is called retroflexion. 4 "tipped" uterus if remains The uterus is normally anteverted and anteflexed. o Cervix Lower part of the uterus that projects into the vagina and is circumferentially attached to it Divides the uterus into an upper or supravaginal part and a lower of vaginal portion The vaginal part is called the portio vaginalis Directed downward and backward The opening of the cervix is called the external os and the opening of the uterine cavity is the internal os. o Cervical mucus The endocervical glands secrete mucus. Usually the mucus is thick and not hospitable to sperm that may try to pass through it while going to the uterus and fallopian tubes. During ovulation the mucus is thinner and less viscous. Easier for sperm to pass through o Vagina The vagina is a muscular tube that passes upward to the uterus at a 45-degree angle from the vulva The walls collapse against each other when empty The cervix projects into the upper vagina Can feel organs through the fornices / walls o The vaginal lining The lining is called the vaginal epithelium Very protective o Vaginal discharge Acidic with a pH of about 4.5 Vaginal bacteria break down the stored sugars in the cells and form lactic acid Lower pH Normally discharge is clear and contains fluid from the capillaries in the walls o Vaginal lubrication 5 Sexual stimulation produces more vaginal discharge o Nerves of the vagina Sensory neurons facilitate the perception of sensations in the vagina, and autonomic neurons regulate blood flow to the vaginal walls and to the tissues surrounding the vagina. Pressure sensations are detected by nerve receptors in the rectum or bladder. o Female prostate Glands and ducts that create secretions that are expelled by the urethra and contribute to the lubrication of the vulva. Paraurethral or skene's glands o The G-Spot Ernst Graadenberg described a "zone of erogenous feeling located along the anterior vaginal wall." Vaginal organisms connected to varying thickness of the walls o The vulva External genitalia Mons pubis anteriorly, the perineum posteriorly, and the labia minora and majora laterally. The clitoris and vestibule are also considered to be a part of the vulva. Protects the urethral and vaginal openings o Clitoris Erectile tissue that can fill up with blood and swell during sexual excitement More sensory receptors in the clitoris than any other part of the body Consists of two crura, or roots: A shaft which is also called the body Glans o Vestibule The area enclosed by the labia minora Opening into the vestibule are the urethra from the bladder, the vagina, and the two ducts of the 6 Bartholin's glands, which are also called the greater vestibular glands. o Hymen Around the vaginal opening there is a small membrane called the hymen Highly variable The intact hymen is not proof of virginity and ruptured doesn’t mean that intercourse has occurred. Imperforate hymen is when it completely covers the opening The menstrual blood will not drain Hematocolpos Septate hymen is when a band of extra tissue stretches across the opening and makes it appear that there are two openings o Mons Pubis Mons veneris too The cushion of fatty tissue and skin that lies over the pubic symphysis and is covered with hair after puberty o Labia majora Two longitudinal folds off skin the narrow to enclose the vulvar cleft and meet posteriorly in the perineum Protect the inner parts of the vulva o Labia minora Inner folds of skin that enclose the urethral opening and the vagina Nymphae o Pelvic Floor: Support of the Pelvic Organs The uterus, fallopian tubes, ovaries, bladder, and rectum are connected to each other and to the walls of the pelvic cavity by ligaments and folds of the peritoneum. WH "Kegel Exercise" p 500-501 o Literally just having you do Kegel exercises and tells you how to feel your PC muscles 7 o Says that having strong PC muscles helps with sexual enjoyment WH "Made to Order Vaginas" p 204-205 o "vaginoplasty" is a surgical procedure that involves cutting or burning the vaginal wall Supposed to help rejuvenate sensation but it is completely unproven o Vaginal tightness is not connected to sexual pleasure o Unfortunately, these doctors that promote the surgery are not chastised WH "The truth about your clitoris" p 454-456 o Like an iceberg, tip is visible on and its larger mass is under the surface. o The visible tip is the glans or head of the organ o The structure forms a dense pyramid of tissue, with a well supplied nerve and vascular network. o The g-spot is about a knuckle-length in and from one and a half to three inches inside WH "How to stop female genital mutilation" p 205-207 o Removal of all or most of the clitoris, all of part of the labia minora or both. o People are sometimes sent out of the country to have it done. o People who are working with survivors don’t know enough about the effects of the procedure. WH "Cultural Practice or Reconstructive Surgery" p 193- 203 o If the penis is too small, doctors will remove the male genitalia so they can be raised as females, and if the clitoris is too large they will make it smaller. o Emotional and mental harm 8 GWS 103 Lecture Notes 1/25 Sex: Biological differences (dimorphism) between reproductive bodies o Sex is not limited by two categories-male, female Gender: social and cultural constructions, meanings attached to biological sex o Gender is not limited by two categories-women, man An individual's assigned sex and gender may not align (transgender, intersex) A man isn't always male, and a woman isn't always female. Both sex and gender are cultural social constructs. Humans decide who is male or female, and where the categories of male and female end. o Not all women have vulvas o Not all people with vulvas identify as women o Not all women menstruate o Not all women lactate Consider using terms that refer to behaviors or anatomical features like "female assigned people" or "people with vulvas," "people who give birth," etc. Female-identified external and internal organs o External organs Vulva: all the external female genitalia collectively Mons verenis (mons pubis) Pad of fatty tissue that covers the pubic bone The fat protects the pubic bone Before puberty: flat and no hair Labia Majora … fix Clitoral hood (prepuce) Covers the tip of the clitoris Clitoris Most sensitive organ (8,000 nerve endings) Several parts: Glans of the clitoris (tip) Clitoral hood Corpus cavernosum Bulbs of the vestibule The crus (crura) Wishbone shaped About 4 inches long on average Rediscovered in the 1990s after being erased from the books in the 1940s Labia minora Thin stretches of tissue within the labia majora Book: Femalia - pictures of many different sizes, shapes, and colors of the labia minora Vestibule: space inside the labia minora (clitoris, urethral opening, and the vaginal opening) Urethral opening Opening to the urethra just below the clitoris Introitus (vaginal opening) Opening to the vagina, bellow the urethral opening Hymen: membrane that partially covers the vaginal opening No function Looked at the "hymenshop" website Fascination in the world with "virginity" What is virginity if people are having all sorts of sexual activity? Perineum Starts at the bottom of the vulva extending to the anus, includes superficial and deep structures 2 Anus o Surgical alterations of the external sexual organs: Hymenoplasty: surgery to reconstruct the hymen and fake "virginity" Labiaplasty: reduction of labia minora o Surgical alterations of the internal sexual organs: Vaginoplasty: "rejuvenation" or tightening of vaginal muscles Decrease in the size of vaginal muscles; more friction during intercourse Vaginal rejuvenation, designer vaginoplasty, and designer vaginas. The ACOG warns about the procedure if not medically indicated, questioning its safety and effectiveness. Biggest risks: infection, altered sensation, dyspareunia (painful contractions of the vagina), adhesions and scarring. o How different are these procedures from female genital cutting? "All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other non-therapeutic reasons." WHO o How different is FGC from intersex operations? o Internal organs Vagina: extends from the introitus to the cervix (3 inches) Surrounded by a tough layer that is full of the good bacteria Epithelium Tissue composed of cells that line the vaginal service Urethra: passage that connects the urethral opening with the bladder Behind the vagina 3 4 GWS 103 Reading for 1/27 Notes BW "Gynecological Exam" p 68-74 o Introduction Physical exam looking for infections, abnormal changes in the reproductive system, and a Pap smear to screen for cervical cancer. Internal exam can identify uterine fibroids and other irregularities. Cervical, ovarian, and endometrial cancers have few noticeable symptoms during the early stages. STIs can also be asymptomatic. Exams can be a time to talk about reproductive questions and birth control questions. o External examination Laying in lithotomy position Feet in stirrups, her buttocks close to the end of the table, and a sheet is draped like a tent over her knees and the upper part of her body. o This position straightens the curvature in the lumbar region of the spine and relaxes the ab muscles. The procedure includes palpations of the abdomen, inspection of the external genitals, and speculum examination of the vagina and cervix, including cell smears for lab tests. Examines all external and internal and looks for infections, warts, cysts, etc. o Internal examination A speculum is used to separate and hold apart the vaginal walls to examine the cervix and the inside of the vagina. When done it is moved to check the area under the blades. A digital examination is performed with the insertion of the middle and index finger into the vagina. o The Male Reproductive Tract Intro Adapted for the purpose of producing large numbers of sperm and then transporting the sperm into the female's reproductive tract so that the sperm can fertilize the egg. Testes Are the male gonads that produce gametes and hormones, mainly testosterone. Testis or testicles 4-5 cm long and 2.5 cm in diameter Suspended in the scrotum o A loose pouch of of skin divided by a septum into a right and left half o Homologous to the right and left labia majora o Skin wrinkling and contraction in response to cold temp. o Relaxes to change the proximity of them to the body in order to reg. temp. Originated in the abdominal cavity in birth just like in the female They move to the cooler scrotal sacs because cooler temp. is required for the development of sperm 1%-5% of male babies, one or both testes do not descend and remain in the body cavity. o Cryptorchidism 2 o Usually corrects itself during childhood If not, surgery. Spermatogenesis is the production of sperm and occurs with in the seminiferous tubules inside the testes. Male Accessory Genital Ducts Transports the sperm from the testes to the penis and then outside the body Includes the epididymis, vas deferens, and urethra. Mature sperm move to the epididymis o 20 ft long coiled tube o Storage site o 6 weeks, either ejaculate or phagocytosis Through vas defrense to leave the body Vas defrense are also called the ductus deferens Male Accessory glands Contribute fluid to combine with the sperm to create semen The seminal vesicles are located at the base of the bladder, produce a viscous, alkaline fluid rich in fructose that provides a direct source of energy for the sperm. The prostate is a single gland that surrounds the urethra as it leaves the bladder. Hypertrophy is the growth of the prostate that usually happens around age 50 where the prostate will cause urinary obstruction. Penis The external genitalia in the male is made up of the penis and scrotum. 3 The penis is the organ for copulation and also serves as the outlet for urine. Attached root, a body or shaft, and a glans. Thin skin with no hairs except near the root. Prepuce is foreskin o Circumcision Two corpora cavernosa and one corpus spongiosum surround the urethra and are able to fill with blood to create an erection Ejaculation Is the release of semen from the male reproductive tract BW p 118-128 "Reproductive Tract Infections" o Intro The normal flora are normally benign microbes that live on the skin, in the digestive tract, and in the reproductive tract. Counter pathogens o Which cause disease STIs in the reproductive tract o Competition between normal flora and pathogens Normal flora protects the body by secreting chemicals that limit the growth of the pathogens and by competing by nutrients and space. The secretions and shed cells in the vagina provide a nutrient rich environment for both normal flora and pathogens. Gynecological infections fall under two categories Caused by overgrowth of irritation by normal flora Caused by pathogens that are usually sexually transmitted 4 Vaginitis, or vaginal inflammation, is a result of anything that disrupts the balance of normal vaginal flora. Hormonal changes pH changes Antibiotics Physical irritation to the mucus membranes of the reproductive tract Symptoms of infections: Vulva irritation Discolored and excessive vaginal discharge Discomfort in the pelvic cavity o Pelvic Inflammatory Disease Infection of the upper reproductive tract PID More likely when a woman has untreated STIs Lower abdominal tenderness and pain, usually above the pubic bone. UTI infection symptoms. Fever, nausea, vomiting, malaise. o Factors influencing gynecological infections Many different things can play a role in a woman's susceptibility to infection Genetics, behavior, STIs Penicillin was the first thing used to treat infection But only bacterial Viral can be avoided with anti viral meds The misuse of antibiotics has created antibiotic-resistant strains. o Preventing transmission of gynecological infections Infections are spread by close skin to skin contact and bodily fluids STIs can spread via oral sex as well Syphilis, chlamydia, AIDS, HPV, hepatitis, herpes, and gonorrhea. 5 o Barriers and biocides Condoms can help reduce chance of infection Microbicides are topical treatments applied to the vagina to prevent infections with STIs Terameprocol prevents transmission of several sexually transmitted viruses o Teens at high risk for STI 48% of high school students have had sex at least once and 39% didn't use a condom 7.1% had sex before age 13 Many are unable or unwilling to access reproductive health services o Expedited Partner Therapy (EPT) Is often used to provide prompt treatment to all of the individuals involved (STI treatment) Recommended for gonorrhea and chlamydia o Infections caused by normal flora Imbalance or misplacement of the normal flora can result in uncomfortable, painful, and potentially dangerous infections Most common while sexually active UTIs, vaginitis, and pelvic inflammatory disease o Vaginitis Inflammation and infection of the vagina Itching and inflammation of the vulva and the vaginal opening and abnormal discharge Pain during sex, pain during urination, local swelling. o Yeast Infections - vulvovaginal candidiasis VVC, fungus infection, and yeast infection are all names for vaginitis caused by members of the fungal genus Candida Candida is normal flora but can become imbalanced Intense itching of the vulva, burning sensations, and changes in vaginal discharge. 6 o Trichomonas vaginitis A parasitic protist, a single-celled animal that moves by means of four flagella. Most common Asymptomatic o Bacterial vaginosis BV A watery, whitish discharge that smells like stale fish is a classic symptom o Urinary Tract Infections - UTIs Urethral and bladder infections Upper urinary tract infections in the kidneys can be very very serious o Toxic Shock Syndrome TSS Extreme symptoms Usually by tampon use but can also be transmitted in other ways WH p 24-27. The gynecologic exam and the training of medical students. "An Opportunity for Health Education." o Being respectful and making the patient feel comfortable during an exam is extremely important WH p 20-24. How to Tell Your Doctor a Thing or Two. o Patients are now questioning their doctors. Some doctors think this is good, and some expect to be listened to and are hostile. The questioning patient gets well quicker than the patient that just listens to everything o Taking responsibility for one's own healthcare o Money and the American way are changing the patient-doctor relationships American way is like moving around o The rise of medical-consumer groups to protect patients 7 WH p 27-36. "Cadavers, Dolls, and Prostitutes. 'Medical Pedagogy and the Pelvic Rehearsal.'" o Primary fears for the first pelvic exam: Hurting the patient Being judged inept The inability to recognize pathology Sexual arousal Finding the examination unpleasant The disturbance of the doctor-patient relationship o GTAS Gynecological teaching assistants WH p 37-38. "Spreading My Legs for Womankind." o Pelvic educators are important to teach medical students how to make their patients comfortable WH p 38-40. "Take a good look" o The Feminist Women's Health Centers were founded in 1971 by a group of LA women who wanted to know about their bodies and reproductive health. o Self examinations 8 GWS 103 Week 1 Lecture Notes 1/27 Cervix: the opening to the uterus. It varies in diameter from 1 to 3 mm. o The texture of the mucus on the cervix changes with menstruation and ovulation. o The feeling of the cervix is like a nose but during ovulation it is soft. Parts of the cervix: o Internal os The opening from the cervix to the uterus o External os The opening from the cervix to the vagina o Endocervical canal Passage from the internal to the external os SHOW- Cervix during ovulation o Soft, High, Open, Wet G-Spot is the area between the vagina and the urethra, also called urethral sponge. o Can be found by inserting a finger inside the vagina and touch the front wall, a third to half the way up the vagina, not as high up as the cervix o Stimulation may lead to orgasm and ejaculation or it may not Uterus: Major muscular hormone-responsive reproductive sex organ (3 organs) o Size and weight change with pregnancy o Essential in sexual response by directing blood to the pelvis and external genitalia o Fertilized egg is nourished to develop until birth Endometrium: Inner lining of the uterus. o Grows and changes during the menstrual cycle to receive a fertilized egg. Ovaries: Pair of almond-shaped glands which lie on either side of the uterus. o Two main functions: Produce estrogen and progesterone Produce mature ova (eggs) Fallopian tubes: extend from the uterus to the ovaries (3 inches) o It is so thin so the egg has to move out of the fallopian tubes fast otherwise if the egg grows, the tube will burst. o Where fertilization of the ovum (egg) occurs o The larger end is divided into finger-like projections called Fimbria. Pubococcygeus muscles (PC muscles): Pelvic floor muscles that support the walls of the urethra, vagina, and rectum. o How to find PC muscles? By stopping urination, the muscles you feel are the muscles. DO NOT continuously do this. It's bad for the bladder. o How to exercise the muscles? Kegel exercises Improve orgasm Strengthen the pelvic floor Can restore muscle tone after giving birth Prevent urinary/stool incontinence Prevent genital prolapse (uterus, bladder, rectum) Common affections of internal/external organs: o Yeast infection (candidiasis, thrush) Lactobacilli (lactic acid bacteria), coexist with a yeast fungus/Candid albicans. Thrush refers to yeast infection in the mouth. The balance can be altered when: The number of lactobacilli decreases Acidity of the vagina decreases Yeast begin to multiply Causes of the lack of balance: Weakened or underdeveloped immune system Metabolic illnesses such as diabetes (type 2) 2 Wearing wet swimwear for long periods of time Anti-bacterial antibiotics Pregnancy Oral contraceptives Diet HRT (menopause) Infertility treatments Symptoms: Minimal complications (redness, itching, and discomfort) Severe itching, burning, soreness, vaginal irritation (vaginitis) Whitish/whitish-gray cottage cheese-like discharge (curd-like appearance) Treatment: Topical antifungals (Nystatin, monistat 1-2- 3) "Home remedies" Plain unsweetened yogurt with active cultures (internally and externally). No sugar! Three tablespoons vinegar in one liter (quart) of boiled cooled water. Soak a piece of clean cotton and insert into the vagina for three nights, remove in the morning. o Honeymoon cystitis Urinary lower tract infection Cause: Irritation and bruising from frequent and prolonged vaginal sexual intercourse Inflammation of the urethra- urethritis (bladder not involved). Symptoms: Burning Painful urination and urge to urinate frequently Cloudy and bloody urine 3 Pain above the pubic bone Treatment: Antibiotics, anti-inflammatory medication Gynecological/pelvic exam o Complete physical exam of the female pelvic organs by a health professional to evaluate external and internal organs, visually and manually. o Straight, lesbian, bisexual, married, single, sexually active or not, the pelvic exam is an important preventative procedure. o Important reasons to have a pelvic exam: Unexplained pain in the lower belly Vaginal discharge that is different, uncommon No menstrual periods by age 15 or 16 Vaginal bleeding that lasts more than 10 days Missed period Bad menstrual cramps o Main instruments: Speculum A light Cotton swab Cervical brush 4
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