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ORGAN REPRODUKSI

Dr. Bernhard Arianto Purba, M.Kes., AIFO

Textbooks

Guyton, A.C & Hall, J.E. 2006. Textbook of Medical


Physiology. The 11th edition. Philadelphia: ElsevierSaunders: 996-1010, 1011-1026.
Brooks, G.A. & Fahey, T.D. 1985. Exercise Physiology.
Human Bioenergetics and Sts Aplications. New York : Mac
Millan Publishing Company: 122-143.
Foss, M.L. & Keteyian, S.J. 1998. Foxs Physiological Basis
for Exercise and Sport. 4th ed. New York : W.B. Saunders
Company: 471-491.
Astrand, P.O. and Rodahl, K. 1986. Textbook of Work
Pysiology, Physiological Bases of Exercise. New York :
McGrawHill.
Braunwald, Pauci, et al.2008. Harrison's PRINCIPLES OF
INTERNAL MEDICINE. Seventeenth Edition. New York :
McGrawHill: Chapter 340-343.
Kronenberg, and Melmed. 2008. WILLIAMS TEXTBOOK OF
ENDOCRINOLOGY . The 11th edition . Philadelphia:
Elsevier-Saunders: 783-836.

Reproductive
Functions of the Male

Male Sexual Anatomy


External male genitals:
Penis
Scrotum

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Internal male genitals:


Testes
Epididymides
Ductus (vas) deferens
Urethra
Seminal vesicles
Prostrate gland
Cowpers gland

Functions: Urination and


Copulation

Penis

The Penis
Penis: consists of internal root, external shaft, & glans.
Root: the portion of the penis that extends internally into
the pelvic cavity.
Shaft: the length of the penis between the glans and
the body.
Glans: the head of the penis; has many nerve endings.
Cavernous bodies: the structures in the shaft of the
penis that engorge with blood during sexual arousal.
Spongy body: a cylinder that forms a bulb at the base of
the penis, extends up into the penile shaft, and forms
the penile glans. Also engorge with blood during
arousal.
Foreskin: a covering of skin over the penile glans.

Internal structure of the penis: top view


(between glans and the body)

(internal, in
pelvic cavity)

Male Sexual Anatomy (cont.)

(head of the
penis; lots of
nerve endings)

(expands
to form
the glans)

(engorge with blood


during arousal)

Genital Anatomy

Genital Anatomy
Two paired corpora cavernosa (erectile bodies) and a single corpus
spongiosum surrounding the urethra, all encased within Bucks
fascia

The erectile tissue is comprised of a network of vascular sinusoids


surrounded by trabecular smooth muscle.

Vascular Supply
The blood supply to the penis is
derived from the pudendal artery
which branches from the internal
iliac (hypogastric) artery.
Cavernosal arteries course through the
center of each corporal body and
give rise to multiple helicine arteries
which open into the lacunar spaces.

External penile structures


Corona: the rim of the penile
glans
Frenulum: thin strip of skin
connecting the glans to the
shaft on the underside of the
penis
Both are highly sensitive
areas to the touch

The two areas on the penis that harbor a high concentration of


sensitive nerve endings.

Circumcision
Circumcision: surgical removal of the foreskin
of the penis.

Circumcision

Functions: Transport urine &


semen

Bladder

Urethra

Function: Maintain
temperature of testes approx.
0
3 C below normal body temp.
Muscle:
Cremaster
Dartos

Scrotum

Scrotum and testes


Scrotum (or scrotal sac):
Pouch of skin that encloses the testes
2 chambers inside scrotum; each contains one testis

Two layers: skin layer and muscle layer (tunica dartos)


Testes are suspended in the sacs by the spermatic cord
which carries sperm out of the testes in the vas deferens
Normally hangs loosely from body wall
cremasteric muscles pull testes closer to body in cold temperatures
to produce viable sperm, the testes must be at the right temperature,
and these muscles allow testes to be raised or lowered to control the
temperature

Spermatic cord

A cord attached to the testis inside the scrotum that


contains the vas deferens, blood vessels, nerves, and
muscle fibers

Scrotum and testes (external)

Spermatic cord
(inside)

The spermatic cord can be located by palpating the scrotal sac above either testicle
with thumb and forefinger.

Internal structures of the scrotum


(contains vas deferens,
blood vessels, nerves,
and cremasteric muscle)

(sperm-carrying tube)

(muscle fibers that control


the position of the testis
in the scrotal sac)

(where sperm mature and


are stored temporarily)

This illustration shows portions of the scrotum cut away to reveal the cremasteric
muscle, spermatic cord, vas deferens, and a testis within the scrotal sac.

Function: Produce sperm and


testosterone

Testis

Internal structures: the Testes


Two functions:
1) Secrete male hormones
2) Produce sperm: testes must hang below
for them to be at the proper temperature
production.

body
for sperm

Asymmetry is typical: More commonly, the


testis hangs lower than the right testis b/c the
spermatic cord is usually longer than the right.

Development

left
left

testis

Form inside the abdominal cavity and during fetal


development migrate to the scrotum.
cryptorchidism: undescended testis
Affects 3-4% of male infants and 30% of premature male infants.
May resolve on its own or may require surgery.

Function: Produce Sperm

Seminiferous Tubules

Testis

Testis Cross Section

Interstitial Cells
Produce Testosterone

Testis

Function: Sperm storage and


maturation

Epididymis

Function: Transport sperm to


urethra

Vas
Deferens

Vas Deferens

Function: Produce 60% of alkaline


semen including fructose to provide
energy for sperm, and PG-Fibrinogen.

Seminal
Vesicles
Ejaculatory Duct

Function: Produces up to 1/3 of the


semen & includes nutrients &
enzymes to activate sperm.

Prostate

Function: Secretes mucous &


alkaline buffers to neutralize acidic
conditions of urethra.

Cowpers
Gland

The reproductive functions of the male


can be divided into three major
subdivisions:
(1) spermatogenesis,which means simply
the formation of sperm;
(2) performance of the male sexual act;
and
(3) regulation of male reproductive
functions by the various hormones.

Physiologic Anatomy of the


Male Sexual Organs
The testis is composed of up to 900 coiled
seminiferous tubules, each averaging more than
one half meter long, in which the sperm are
formed.
The sperm then empty into the epididymis,
another coiled tube about 6 meters long. The
epididymis leads into the vas deferens, which
enlarges into the ampulla of the vas deferens
immediately before the vas enters the body of the
prostate gland.
Two seminal vesicles, one located on each side
of the prostate, empty into the prostatic end of
the ampulla, and the contents from both the
ampulla and the seminal vesicles pass into an
ejaculatory duct leading through the body of the
prostate gland and then emptying into the
internal urethra.

Prostatic ducts, too, empty from the prostate


gland into the ejaculatory duct and from there
into the prostatic urethra.
Finally, the urethra is the last connecting link
from the testis to the exterior. The urethra is
supplied with mucus derived from a large number
of minute urethral glands located along its entire
extent and even more so from bilateral
bulbourethral glands (Cowpers glands) located
near the origin of the urethra.

Function of the Seminal Vesicles


Each seminal vesicle is a tortuous, loculated tube lined with
a secretory epithelium that secretes a mucoid material
containing an abundance of fructose, citric acid, and other
nutrient substances, as well as large quantities of
prostaglandins and fibrinogen.
During the process of emission and ejaculation, each
seminal vesicle empties its contents into the ejaculatory
duct shortly after the vas deferens empties the sperm. This
adds greatly to the bulk of the ejaculated semen, and the
fructose and other substances in the seminal fluid are of
considerable nutrient value for the ejaculated sperm until
one of the sperm fertilizes the ovum.
Prostaglandins are believed to aid fertilization in two ways:
(1) by reacting with the female cervical mucus to make it
more receptive to sperm movement and (2) by possibly
causing backward, reverse peristaltic contractions in the
uterus and fallopian tubes to move the ejaculated sperm
toward the ovaries (a few sperm reach the upper ends of
the fallopian tubes within 5 minutes).

Function of the Prostate Gland

secretes a thin, milky fluid that contains calcium, citrate


ion, phosphate ion, a clotting enzyme, and a profibrinolysin
During emission, the capsule of the prostate gland
contracts simultaneously with the contractions of the vas
deferens so that the thin, milky fluid of the prostate gland
adds further to the bulk of the semen.
A slightly alkaline characteristic of the prostatic fluid may
be quite important for successful fertilization of the ovum,
because the fluid of the vas deferens is relatively acidic
owing to the presence of citric acid and metabolic end
products of the sperm and, consequently, helps to inhibit
sperm fertility.

Also, the vaginal secretions of the female are acidic (pH of


3.5 to 4.0). Sperm do not become optimally motile until the
pH of the surrounding fluids rises to about 6.0 to 6.5.
Consequently, it is probable that the slightly alkaline
prostatic fluid helps to neutralize the acidity of the other
seminal fluids during ejaculation, and thus enhances the
motility and fertility of the sperm.

Semen
ejaculated during the male sexual activity
composed of the fluid and sperm from the vas deferens (about 10
per cent of the total), fluid from the seminal vesicles (almost 60
per cent), fluid from the prostate gland (about 30 per cent), and
small amounts from the mucous glands, especially the
bulbourethral glands.
bulk of the semen is seminal vesicle fluid, which is the last to be
ejaculated and serves to wash the sperm through the ejaculatory
duct and urethra.
average pH of the combined semen is about 7.5, the alkaline
prostatic fluid having more than neutralized the mild acidity of the
other portions of the semen.
The prostatic fluid gives the semen a milky appearance, and fluid
from the seminal vesicles and mucous glands gives the semen a
mucoid consistency.

A clotting enzyme from the prostatic fluid causes the


fibrinogen of the seminal vesicle fluid to form a weak fibrin
coagulum that holds the semen in the deeper regions of the
vagina where the uterine cervix lies. The coagulum then
dissolves during the next 15 to 30 minutes because of lysis
by fibrinolysin formed from the prostatic profibrinolysin. In
the early minutes after ejaculation, the sperm remain
relatively immobile, possibly because of the viscosity of the
coagulum.
As the coagulum dissolves, the sperm simultaneously
become highly motile.
Once they are ejaculated in the semen, their maximal life
span is only 24 to 48 hours at body temperature.
At lowered temperatures, however, semen can be stored
for several weeks, and when frozen at temperatures below 100C, sperm have been preserved for years.

Effect of Temperature on
Spermatogenesis
Increase temperature of the testis can prevent
spermatogenesis by causing degeneration of
most cells of the seminiferous tubules besides
the spermatogonia. in these patients is unlikely to
be successful.
The reason the testes are located in the dangling
scrotum is to maintain the temperature of these
glands below the internal temperature of the
body, although usually only about 2C below the
internal temperature.
Thus, the scrotum theoretically acts as a cooling
mechanism for the testes (but a controlled
cooling), without which spermatogenesis might
be deficient during hot weather.

How does
the male
apparatus
work?

.
Male Sexual Act
Neuronal Stimulus for Performance of the Male Sexual Act
glans penis
The most important source of sensory nerve signals for
initiating the male sexual act
contains an especially sensitive sensory end-organ system
that transmits into the central nervous system that special
modality of sensation called sexual sensation.
The slippery massaging action of intercourse on the glans
stimulates the sensory end-organs, and the sexual signals
in turn pass through the pudendal nerve, then through the
sacral plexus into the sacral portion of the spinal cord, and
finally up the cord to undefined areas of the brain.
Impulses may also enter the spinal cord from areas
adjacent to the penis to aid in stimulating the sexual act.

Sexual sensations can even originate in


internal structures, such as in areas of the
urethra,
bladder,
prostate,
seminal
vesicles, testes, and vas deferens.
Mild infection and inflammation of these
sexual organs sometimes cause almost
continual sexual desire, and some
aphrodisiac drugs, such as cantharidin,
increase sexual desire by irritating the
bladder and urethral mucosa, inducing
inflammation and vascular congestion.

Psychic Element of Male Sexual


Stimulation
Simply thinking sexual thoughts or
even dreaming that the act of
intercourse is being performed can
initiate the male act, culminating in
ejaculation.
Nocturnal emissions during dreams
occur in many males during some
stages of sexual life, especially
during the teens.

Nocturnal Emissions

Integration of the Male Sexual Act in


the Spinal Cord
brain function is probably not necessary for its
per-formance because appropriate genital
stimulation can cause ejaculation in some
animals and occasionally in humans after their
spinal cords have been cut above the lumbar
region.
The male sexual act results from inherent reflex
mechanisms integrated in the sacral and lumbar
spinal cord, and these mechanisms can be
initiated by either psychic stimulation from the
brain or actual sexual stimulation from the sex
organs, but usually it is a combination of both.

Stages of the Male Sexual Act


1. Penile ErectionRole of the Parasympathetic Nerves.
first effect of male sexual stimulation, and the degree of erection
is proportional to the degree of stimulation, whether psychic or
physical.
caused by parasympathetic impulses that pass from the sacral
portion of the spinal cord through the pelvic nerves to the penis.
These parasympathetic nerve fibers, release nitric oxide and/or
vasoactive intestinal peptide in addition to acetyl-choline. The
nitric oxide especially relaxes the arteries of the penis, as well as
relaxes the trabecular meshwork of smooth muscle fibers in the
erectile tissue of the corpora cavernosa and corpus spongiosum
in the shaft of the penis.
This erectile tissue consists of large cavernous sinusoids, which
are normally relatively empty of blood but become dilated
tremendously when arterial blood flows rapidly into them under
pressure while the venous outflow is partially occluded.
Also, the erectile bodies, especially the two corpora cavernosa,
are surrounded by strong fibrous coats; therefore, high pressure
within the sinusoids causes ballooning of the erectile tissue to
such an extent that the penis becomes hard and elongated. This is
the phenomenon of erection.

SEXUAL RESPONSE PATHWAYS

Erection
flaccid

erect

Mechanism of Erection

Blood flow increases secondary to vasodilatation of the cavernosal arteries

Relaxation of smooth muscle dilates the lacunar spaces causing engorgement

Increased intracorporal pressure expands the trabecular wall against the tunica albuginea

Compression of the subtunical veins along with a reduction of venous blood flow results in elevated
pressures in the lacunar spaces, veno-occlusive mechanism

Fully erect - arterial pressure 80-100mm/Hg


Flaccid penis - arterial pressure 20mm/Hg

Viagra Pills
Erectile dysfunction (ED), a form of impotence, is the inability to attain an erection when
desired. What is missing? In two words, nitric oxide

In healthy males can cause temporary impotence :


Psychological factors (20%),
alcohol, or
certain drugs antihypertensives, antihistamines, antidepressants, the antiulcer drug
cimetidine, and some appetite suppressants and cold remedies

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

chronic condition
the result of hormonal (DM, Cushings
disease, hypothyroidism, and
elevated levels of prolactin) ,
Vascular (arteriosclerosis, injury to
penile blood vessels, or varicose
veins in the penis, which create
venous leaks that allow blood to leave
the penis prematurely), or
nervous system problems (stroke,
multiple sclerosis, tumors, physical
trauma, or damage to penile nerves
during surgery or radiation therapy)

Lubrication, a Parasympathetic
Function
The parasympathetic impulses cause the urethral
glands and the bulbourethral glands to secrete
mucus. This mucus flows through the urethra
during intercourse to aid in the lubrication during
coitus
However, most of the lubrication of coitus is
provided by the female sexual organs rather than
by the male.
Without satisfactory lubrication, the male sexual
act is seldom successful because unlubricated
intercourse causes grating, painful sensations
that inhibit rather than excite sexual sensations.

Emission and EjaculationFunction of the


Sympathetic
Nerves.
Culmination of the male sexual act.
When the sexual stimulus becomes extremely intense, the
reflex centers of the spinal cord begin to emit sympathetic
impulses that leave the cord at T-12 to L-2 and pass to the
genital organs through the hypogastric and pelvic
sympathetic nerve plexuses to initiate emission, the
forerunner of ejaculation.
Emission
begins with contraction of the vas deferens and the ampulla
to cause expulsion of sperm into the internal urethra.
Then, contractions of the muscu-lar coat of the prostate
gland followed by contraction of the seminal vesicles expel
prostatic and seminal fluid also into the urethra, forcing the
sperm forward.
All these fluids mix in the internal urethra with mucus
already secreted by the bulbourethral glands to form the
semen.

Ejaculation
The filling of the internal urethra with semen elicits sensory
signals that are transmitted through the pudendal nerves to the
sacral regions of the cord,giving the feeling of sudden fullness in
the internal genital organs
Also, these sensory signals further excite rhythmical contraction
of the internal genital organs and cause contraction of the
ischiocavernosus and bulbocavernosus muscles that compress
the bases of the penile erectile tissue. These effects together
cause rhythmical, wavelike increases in pressure in both the
erectile tissue of the penis and the genital ducts and urethra,
which ejaculate the semen from the urethra to the exterior
rhythmical contractions of the pelvic muscles and even of some of
the muscles of the body trunk cause thrusting movements of the
pelvis and penis, which also help propel the semen into the
deepest recesses of the vagina and perhaps even slightly into the
cervix of the uterus.
This entire period of emission and ejaculation is called the male
orgasm.
At its termination, the male sexual excitement disappears almost
entirely within 1 to 2 minutes and erection ceases, a process
called resolution.

Human Sexual Response


Stages of sexual response
Excitement/arousal
Plateau
Orgasm
Resolution

Changes in the Genitals

Male
Sexual
Response

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Erection of Male

Male
Sexual
Response

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Ejaculation
How fast does it
leave the body?
How far can it go?
How much is
released?
Is it really released
as a stream?
Muscle
contractions are
0.8 seconds apart

Can you stop ejaculation?


Sure! Just
press here

Male Response Cycle

Men, Sexuality, and Art

Man Posing

The Wrestlers

Lucian Freud, 1985

The original: 350 B.C.

David

Dionysus

Michelangelo 1504

Praxiteles circa 350 B.C.

Marsyas

(Photograph)

George Platt Lyness, 1953

Male
Anatomy

Eros 3
Oil on canvas
Thomas

The Penis
Whats
normal?

Is size really important?

My penis is too
small!

Two out of
three men
think that
their penis
is too small,
even
though it is
average
size. Why?

The Size of Penis

A humans
penis is 4-6
inches long
when erect
(3-5 inches
otherwise).

Penis Enlargement
Some men go for the stretch

(gelking) with weights


attached

Penis Enlargement
This is the after photo
Fat injection

Cutting the ligaments

Male Genital Health Concerns When


Enlargement
it is possible for penis to have a negative reaction to

some vaginal secretions resulting in a condition similar


to eczema
some sex toys (gadgets) are hazardous to the penis, e.g.,
cock rings that help maintain an erection can destroy
tissue in the penis if left on too long, and text says they
should never be used
NEVER masturbate with vacuum cleaner type devices

Whos problem is it?


You or your
partners? If
it is yours,
you might
need therapy,
or surgery,
or..

Buy a penis
extension

Masturbation
The good thing about masturbation is that you don't
have to dress up for it. Truman Capote

Bonobo apes do it; humans do it


Use your hands, or

Purchase
some
help!

Can you
break an
erection?

Youre darn right!

Peyronies Disease
Affects 1 out of 100 men
Usually after age 40
Cause is unknown

What happens as men age?

How many orgasms does a male


have each year?
Age 20: 104
Age 30: 121
Age 40: 84
Age 50: 52
Age 60: 35
Age 70: 22
Age 80: Whos
counting????

What happens with age?


The

angle of the dangle changes

Age
Age
Age
Age
Age
It

20:
30:
40:
50:
70:

+10 degrees
+20 degrees
+1 degree
-1 degree
-25 degrees

gets smaller (20-25%)


Refractory period changes

Erectile Dysfunction
Defined as the inability to maintain or achieve an
erection for satisfactory sexual intercourse.
May include physiologic, organic, or mixed causes

Prevalence of Erectile Dysfunction among men 40-70


yrs is approximately 52% (minimal 17.2%, moderate
25.2%, and complete 9.6%)
Probability of Erectile Dysfunction increases with age
and typically associated with other medical
conditions

Massachusetts Male Aging Study:

Feldman HA, et al. J Urol. 1994;151:54-61.

Physiological Causes of Erectile Dysfunction


Hypertension
Depression
Anemia

PVD
Drug abuse

Vascular surgery
Smoking

CAD

Endothelial dysfunction
ED

Alcohol abuse

Hypogonadism
Peyronies disease

Trauma/surgery to
pelvis or spine

Endocrine Disorders

Hyperlipidemia
Benet AE, Melman A. Urol Clin North Am. 1995;22:699-709

Physiologic Indicators of ED
Atherosclerosis in narrow
penile arteries may manifest
as ED before becoming
apparent in other arteries.

Detecting atherosclerosis in
1 set of blood vessels
increases the chance of
finding it in other vessels.

Risk Factors: Similar between Heart Disease


and Erectile Dysfunction

Risk factors very similar

smoking
dyslipidemia
hypertension
diabetes
obesity
lack of exercise/sex

Both are vascular conditions

Medications Associated With ED

Estrogens
Antiandrogens
H2-receptor blockers
Anticholinergics
Ketoconazole
Marijuana
Alcohol
Antihypertensives
Narcotics

-blockers
Psychotropics
Cigarettes
Cocaine
Spironolactone
Lipid-lowering agents
NSAIDs
Cytotoxic drugs
Diuretics

Benet AE, Melman A. Urol Clin North Am. 1995;22:699-709

Treatment of Erectile Dysfunction


Non Invasive Therapy:

Psychotherapy

Oral PDE-5 Inhibitors

Invasive Therapy:

M.U.S.E (meatal urethral


suppository for erection)

Alprostadil cavernosal injection

Penile revascularization

Penile prosthesis malleable or


inflatable

Vacuum Erection device


Testosterone supplementation

Psychosocial Counseling :
First-Line Therapy

Useful as monotherapy or as adjunctive


treatment and may include:

Communication training for couples

Anxiety reduction/desensitization

Cognitive-behavioral interventions

Sexual stimulation techniques

Rosen RC. Urol Clin North Am. 2001;28:269-278.

Vacuum Erection Device

Cylindrical vacuum pump placed over the penis.


Air is drawn from the cylinder, causing blood to
flow into the penis
Occlusive ring is placed around the penile base
to maintain the erection
Maximum duration of use: 20-30 minutes
Complications include penile pain, penile
bruising, hematoma

Testosterone Supplementation

Not indicated in men with normal testosterone


levels
Indications include: libido, energy, muscle
strength, erectile dysfunction, and osteoporosis
Literature now controversial in regards to
testosterone supplemation in men with
increased PSA and even diagnosed prostate
cancer

Alprostadil Delivery

MUSE (Medicated Urethral System


for Erection)

Erection begins 5-20 minutes after


administration
Must use a condom barrier
Side effects: burning of genitals or urethra,
urethral bleeding, priapism, hypotension

Intracavernosal Injections

Trimix/Bimix: refers to mixture containing 2 or


2 of the following agents: papaverine,
phentolamine, alprostadil
Side effects: pain, penile fibrosis, priapism
Patient must be taught in office and observed
when initiating treatment of either MUSE or
injection therapy

Penile Prosthesis: Realistic Expectations ?

Placement of Penile Prosthesis

Type 5 Phosphodiesterase (PDE5)


Inhibitors

Viagra (Sildenafil) Tabs: 25, 50, 100 mg.

Levitra (Vardenafil) Tabs: 2.5, 5, 10, 20 mg.

Cialis (Tadalafil) Tabs: 5, 10, 20 mg.

Clinical Benefits of PDE5 Inhibitor Therapy

Can be taken orally

Well tolerated by most patients

High success rate when used appropriately

Effects of drug are reversed once drug is discontinued

Results in natural erection

Long term data suggests certain class of medications


can be used with continued success

Lowering of Ca++
Smooth muscle relaxation

PI Data: High Fat Meal

Viagrawhen taken
with a high fat meal,
the rate of absorbtion
is reduced, and mean
delay in Tmax of 60
minutes

Levitraas with Viagra,


high fat meal affects
absorbtion, 4 hour effect
(same as Viagra)

Cialis No effect on
Cmax or Tmax, 36
hour effect

PI Data: Side Effect Profile


Sildenafil

Vardenafil

Tadalafil

Headache 16%

Headache 15%

Headache 15%

Flushing 10%

Flushing 11%

Flushing 3%

Dyspepsia 7%

Dyspepsia 4%

Dyspepsia 10%

Nasal congestion 4%

Nasal congestion 9%

Nasal Congestion 3%

Blue vision 3%

Blue vision <2%

Back pain 6%
Myalgia 3%
Limb pain 3%

Excellent PDE5 Selectivity


PDE6retina (1:10)
PDE1vasculature,
heart, brain (1:80)
PDE3heart (1:4600)

PDE11heart, pituitary,
testes (1:780)
PDE5penis (1:1)

Gbekor E, et al. Poster presented at: European Association of Urology; February 23-26, 2002; Birmingham, United Kingdom.

Reproductive
Functions of the Female

Mosby items and derived items 2006 by Mosby, Inc.

Female
Anatomy
and
Physiology
Female Nude Interior No 5
Jim Read

Mosby items and derived items 2006 by Mosby, Inc.

Seated Nude
Bronze
Jean Doyle
Mosby items and derived items 2006 by Mosby, Inc.

Twisted Female Nude Torso


Thomas Hart Benton

Pensamiento

"Awakening"
Oil on Canvas 2005
Audrey Shwidkiy
Mosby items and derived items 2006 by Mosby, Inc.

DIFFERENTIATION OF SEX ORGANS

HOMOLOGOUS STRUCTURES - ADULT

EXTERNAL STRUCTURES: THE VULVA


Mons pubis
Clitoris
Labia majora
Labia minora

MONS PUBIS

Latin for pubic mound

The pad of fatty tissue


Pubic hair
Sensitive to stimulation

EXTERNAL STRUCTURES: THE VULVA


EXTERNAL FEMALE GENITAL STRUCTURES

TOUR OF THE VULVA


CLITORIS: GLANS CLITORIS
Clitoris:

- Highly sensitive structure of the female


external genitals.
- Is the only organ in the human body
whose only function is pleasure.
- Consists of:
- glans
- shaft: has small spongy structures
that engorge with blood during
sexual arousal.
- internal crura (roots)
- Covered by clitoral hood
- Stimulation of clitoris is the most
common way that most women
achieve orgasm.
- External part of the clitoris has
about the same # of nerve
endings as the head of the penis.

CLITORIS ANATOMY

CLITORIS
Erectile internal structure
Two 3.5 long branches called crura
Crura contain two corpora cavernosa: hollow
chambers that fill with blood and swell during
arousal
Orgasmic
Enlarges initially, then retracts beneath hood just
before and during orgasm
Follows same pattern with repeated orgasms,
though swelling is less pronounced

COMPARATIVE ANATOMY:
CLITORIS AND PENIS

LABIA MAJORA
Two folds of spongy flesh extending from the mons
pubis toward the perineum
May have hair present
Contain a significant concentration of nerve endings

LABIA MINORA
Small folds within the labia majora that meet above
the clitoris to form the clitoral hood
Significant variation in appearance
Contain a significant concentration of nerve endings
Swell during sexual arousal
Enclose the vestibule

Tour of the Vulva


Labia minora (inner lips):

- Located within outer lips and may protrude between them.


- Hairless folds of skin that join at the prepuce (clitoral hood) and
extend down past urinary and vaginal openings
- Contain sweat glands, blood vessels, and nerve endings.
- Vary considerably in size, shape, and color; become darker in
color during pregnancy.

VESTIBULE, LABIA MINORA, MAJORA

BARTHOLINS (VESTIBULAR) AND


SKENES GLANDS

GLANDS
Lesser Vestibular (Paraurethral, Skene's) Male
Homolog = prostate located on the upper wall of the
vagina, around the lower end of the urethra.
They drain into the urethra and near the
urethral opening Function - mucus production
to aid lubrication during intercourse
Greater Vestibular (Bartholin's) Male Homolog =
bulbourethral glands located slightly below and to the
left and right of the opening of the vagina. They
secrete mucus to provide lubrication, especially
when the woman is sexually aroused

INTERNAL STRUCTURES
Vagina
Cervix
Uterus
Fallopian tubes
Ovaries

INTERNAL STRUCTURES

FUNCTION: RECEIVES PENIS & SEMEN AND SERVES


AS BIRTH CANAL & PASSAGE FOR MENSTRUAL
FLOW.

Vagina

VAGINA

Two reproductive functions:


Encompasses penis during coitus (vaginal
intercourse)
Birth canal
3 to 5 inches in length
Introitus: the lower third of the vagina
The majority vaginal nerve endings
Hymen: thin membrane that partially covers introitus
Grafenberg Spot (G-spot)
An erotically sensitive area on front wall of the
vagina mid-way between pubic bone and cervix
Female ejaculation
HLED 403 Human Sexuality

HYMEN

Photograph
of
imperforate
hymen

Transverse Vaginal Septum

FUNCTION: PROVIDES PASSAGEWAY FOR SPERM,


RECEIVES BLASTOCYST, RETAINS & NOURISHES
FETUS & EXPELLS FETUS AT TERM.

Uterus

FEMALE INFERTILITY
Uterine

muscle

tumor
Benign

(>95%)

25-30%

of women

NORMAL SHAPE OF UTERUS

FIBROID UTERUS

FEMALE INFERTILITY - UTERUS

Mullerian

defects (congenital)

Absent uterus
Bicornuate/septate

MULLERIAN DEFECT

FUNCTION: CERVICAL MUCOSA SECRETES MUCOUS


BLOCKING CERVICAL CANAL ENTRANCE TO UTERUS.
Dilates to 10 cm opening during labor
& birth

Cervix

NORMAL CERVIX; CANCEROUS CERVIX

PAP SMEAR SCREEN


PAP screening has reduced incidence of cervical
cancer (SCC) from leading cancer killer of women
(50 years ago) to eighth leading cause today
PAP screen successful because

Koilocytes and dysplasia are detectable


Most cervical cancer is preceded by these
precancerous changes

CERVICAL INTRAEPITHELIAL
NEOPLASIA

Spectrum of cervical intraepithelial neoplasia (CIN):


normal squamous epithelium for comparison

FUNCTION: UTERINE LINING IN WHICH


IMPLANTATION OCCURS.

Endometrium

FUNCTION: MUSCULAR CONTRACTIONS.

Myometrium

ENDOMETRIAL PHASE

Dysmenorrhea More commonly referred to as cramps,


is painful menstruation caused by abnormal uterine contractility

Dysmenorrheic women produce more prostaglandins


in the endometrium and menstrual fluids than those without
dysmenorrhea.
Cyclooxygenase inhibitors such as aspirin, naproxen or ibuprofen
prevent the formation of prostaglandins and relieve the
symptoms of dysmenorrhea.

Dysmenorrhea

Mechanism of Pain

FUNCTIONS OF COX
COX-1

COX-2

CONSITUTIVELY EXPRESSED

INDUCIBLE

HOUSEKEEPING FUNCTIONS

INFLAMMATORY AND

PRESENT IN EVERY ORGAN

NEOPLATIC SITES ALSO

STOMACH, INTESTINE,
KIDNEY PLATLETS,
VASCULAR ENDOTHELIUM

PRESENT IN KIDNEY,
UTERUS. OVARY
BRAIN, SMALL

INTESTINE

COX-1:
Constitutive
Homeostatic
Protection of gastric
mucosa
Platelet activation
Renal functions
Macrophage
differentiation

COX-2:
Regulated
Pathologic

Information
Pain
Fever
Dysregulated
proliferation

Tissue Repair
Physiologic
Reproduction
Renal functions
Other (see text)

Development
kidney

COX-2 INHIBITORS Celecoxib (Celebrex),


are a new class of drugs
that selectively inhibit cyclooxygenase 2.
COX-2 maintains prostaglandin production
predominately in inflamed tissue and joints.

PGE2

http://elfstrom.com/arthritis/nsaids/actions.html
Copyright 1997 David Elfstrom

COX-1 maintains prostaglandin synthesis


in the stomach, kidneys, and platelets.
selective inhibition of COX-2,
avoids all adverse GI events from COX-1 inhibition
Also COX-2 does not inhibit platelet aggregation,
which is beneficial in patients when bleeding is a concern.

FUNCTION: PASSAGEWAY FOR OOCYTE AND


SITE OF FERTILIZATION.

Uterine
Tubes

BLOCKED TUBES CAUSE INFERTILITY

THE JOURNEY OF OVUM

FUNCTION: PRODUCE OOCYTES & THE


HORMONES ESTROGEN AND PROGESTERONE.

Ovaries

FUNCTION: SWEEP OVARIAN SURFACE TO


DRAW OOCYTE INTO OVARIAN TUBE.

Fimbriae

OTHER STRUCTURES
Urethra: tube through which urine passes
Urethral opening
Perineum: area between genitals and anus
Pelvic floor

FEMALE PERINEUM AND


MUSCULATURE

OTHER STRUCTURES

Anus: opening of rectum

Contains two sphincters (circular muscles that open and


close like valves)
Dense supply of nerve endings
The lining of the rectum is fragile
In anal sex play, care must be taken not to rupture the delicate
tissues
Condom and Lubrication

MAMMARY GLANDS [ BREASTS]

Present in both sexes - normally only functional in


females
Developmentally they are derived from sweat glands
Contained within a rounded skin-covered breast anterior
to the pectoral muscles of the thorax
Slightly below center of each breast is a ring of
pigmented skin, the areola - this surrounds a central
protruding nipple
Internally - they consist of 15 to 25 lobes that radiate
around and open at the nipple
Each lobe is composed of smaller lobules- these contain
alveoli that produce milk when a women is lactating
non-pregnant women - glandular structure is
undeveloped - hence breast size is largely due to the
amount of fat deposits

BREASTS

Reproductive function of female breasts is to nourish


offspring through lactation
Composed of fatty tissue and 15-25 lobes that radiate
around a central nipple
Areola: the ring of darkened skin around nipple
Nipples erect in response to stimulation, cold, or sexual
arousal
Women differ in the breast stimulation they find
pleasurable

THE FEMALE BREAST

BREASTS

Whats
normal?
What are they
made of?

SEXUAL RESPONSE MODELS

Masters and Johnson

Kaplan

Loulan

FEMALE SEXUAL RESPONSE MODEL

Masters and Johnson 4 Phase Model:

excitement
plateau
orgasm
resolution

FEMALE SEXUAL RESPONSE MODEL

Kaplans Tri-Phasic Model

Desire
Excitement
Orgasm

FEMALE SEXUAL RESPONSE MODEL

Loulans Sexual Response Model:

Incorporates biological and affective dimensions


Willingness
Desire
Excitement
Engorgement
Orgasm
Pleasure

DESIRE: MIND OR MATTER?

A complex interaction between

The neural system sensory input


Hormones

Occurs throughout many parts of the body


Sexual Satisfaction Research

EXPERIENCING SEXUAL AROUSAL


Clitoris swells
Breathing and heart rate
increase
Nipples become erect,
breasts may enlarge
Uterus elevates

HLED 403 Human Sexuality

Vasocongestion
Myotonia
Vaginal Sweating
Tenting
Labia may enlarge or
flatten and separate
Sex flush

SEXUAL RESPONSE PATHWAYS

ORGASM

As excitement increases
Clitoris retracts beneath clitoral hood
Vaginal opening decreases by about 1/3
Orgasmic platform

Continued stimulation brings orgasm:


Rhythmic contractions
Pleasure

STAGES OF
SEXUAL
RESPONSE:
WOMEN

FEMALE
SEXUAL
RESPONSE

FEMALE
SEXUAL
RESPONSE

Is the G-Spot real?

G-Spot

Ejaculation in Women
It refers to the expulsion of noticeable amounts of clear
fluid or the emission of liquid by human females
from the paraurethral ducts and/or urethra (through
the genitals) during orgasm.
It is also known colloquially as squirting or gushing
or dribbling
Most women ejaculate, although they are variations in
the quantity of the emitted liquid

With great force --- gushing or squirting --6% frequent and 13% infrequent
With little force --- dribble -- 55-60%
Almost-dry orgasm --- don't have any glandular
tissue can't produce anything to ejaculate or
very scarce secretion or the ejection takes
the retrograde direction towards the
bladder, as occurs in the retrograde
ejaculation of some men

Source Of Fluids Expulsed By Females During Orgasm


1-Urethral ejaculate ---Female prostate fluid --Female ejaculation !!!
2-Excess vaginal secretions ?? ---- vaginal
ejaculation fluid--- leukorrhea --- vaginal
lubrication
( 1- 4 ml in 24 hour )
which lubricates the vaginal walls and oozes out during sexual
arousal. ,
it contains vaginal secretions from walls of the vagina..
its function is partly self-cleansing, partly lubrication and partly
protection from infection.

3-Poor bladder control ?? --- urination


Although urine and female ejaculation
are both passed through the urethra,
urine originates in the bladder and
ejaculation originates in the Skene's
glands. However, since the Skene's
glands are the size of a pea, it's
unlikely that women who ejaculate
more than a teaspoon of fluid are
ejecting pure ejaculation. It's far more
likely that the small amount of fluid
from her Skene's glands is mixed with
some urine, producing the larger
quantity

BREAST CHANGES

Female Response Cycle

What happens as women age?


Im scared to
find out

Thinning of vaginal
lining
Increased time for
arousal and
lubrication
Fewer muscle
contractions with
orgasm
Resolution at about
the same rate

Objectives
Define sexual identity, and discuss the major
components of sexual identity, including biology, gender
identity, gender roles, and sexual orientation.
Identify major features and functions of sexual anatomy
and physiology.

Discuss the options available for the expression of ones


sexuality.
Classify sexual dysfunctions, and describe major
disorders.

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Your Sexual Identity


Sexual identity the recognition and acknowledgement
of oneself as a sexual being; is determined by a complex
interaction of genetic, physiological, environmental, and
social factors

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Sexual Orientation
Heterosexual
Homosexual
Bisexual
Transsexual

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Options for Sexual Expression

Celibacy
Autoerotic behaviors
Sexual fantasies
Masturbation
Kissing and erotic touching
Manual stimulation
Oral-genital stimulation
Vaginal intercourse
Anal intercourse

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Variant Sexual Behavior


Group Sex
Transvestism
Fetishism
Exhibitionism

Voyeurism
Sadomasochism
Pedophilia
Autoerotic asphyxiation

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Difficulties That Can Hinder Sexual Function


Sexual desire disorders
Sexual arousal disorders
Orgasm disorders
Sexual performance anxiety

Sexual pain disorders

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Prevalence of Sexual Problems in Men and Women

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Drugs and Sex


Alcohol
Date rape drugs

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Do men and
women have
much in
common?
After the Temptation
Kelly Borsheim
Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Intersex

(formerly true hermaphroditism)

Copyright 2006 Pearson Education, Inc., publishing as Benjamin Cummings

Breast cancer screening


Breast exams: early detection is best b/c
treatments work better on early stage cancers
self-exam following menstruation
routine healthcare provider exams

Breast cancer screening, (cont.)

Mammography: X-ray of the breast

Can detect breast lump before it can be felt manually.


Recommended yearly for women over 50
Sometimes recommended for women between 40-50,
though mammograms are less effective in women
under 50 b/c the breast tissue is more dense.
Can miss tumors- better screening methods are needed.

Breast health
Breast lumps: 3 types
cysts (fluid-filled sacs, benign)
fibroadenomas (solid, round, benign tumors)
malignant tumor (tumor made up of cancer cells)

Breast cancer
Incidence: 1 in 9 women in North America; 190,000 new
diagnoses each year.
Kills 40,000 women in U.S. each year and 370,000
women worldwide each year.
In North America, one woman dies of breast cancer
approximately every 12 minutes.

Breast cancer
Early detection increases survival b/c cancer
is usually found at an earlier stage.
The 5-year survival rate is lower for minority
women than for white women, most likely due
to differences in access to preventive health
care.
Percentage of cancer
diagnosed at this stage

Survival Rate
at 5 years (%)

Local (confined to breast)

60

98

Regional (spread to lymph nodes)

31

76

Distant (spread to other organs)

16

Stage of cancer

Breast cancer: risk factors


Risk rises with age
Growing evidence indicates that synthetic chemicals
found in plastics, pesticides, detergents, and
cosmetics can increase the risk of breast cancer

Axillary Cording

Painful Drain Site

Trunkal Cording

Bilateral Mastectomy with TRAM reconstruction, Chemotherapy, No radiation