Human Sexuality

A.Concepts
1. A person’s sexuality encompasses the complex
behaviors, attitudes emotions and preferences
that are related to sexual self and eroticism.
2. Sex – basic and dynamic aspect of life
3. During reproductive years, the nurse performs
as resource person on human sexuality.
A.Definitions related to sexuality:

o Gender identity – sense of femininity or

masculinity
- 2-4 yrs/3 yrs gender identity develops.
o Role identity – attitudes, behaviors and
attributes that differentiate roles
 
A.Definitions related to sexuality:

o Sex – biologic male or female status.

Sometimes referred to a specific sexual
behavior such as sexual intercourse.

o Sexuality - behavior of being boy or girl, male

or female man/ woman. Entity life long
dynamic change. developed at the
moment of conception
ANATOMY & PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
Male Reproductive
Anatomy
 Penis - Specialized
erectile tissue
 Scrotum (muscular sac
holding testes)
 Secretory gland
 Semen
 ANATOMY & PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
 Male Reproductive
Anatomy
 
 Penis - Specialized erectile
tissue
 Parts: 1. glans penis
2. shaft
 Urethra: passageway for
sperm, urine
 Corpora cavernosa (2)
 Corpora spongiosum (1)
› when engorged with blood causes
penis to enlarge and become firm)
ANATOMY & PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
Male Reproductive
Anatomy
 Scrotum (muscular sac
holding testes)
› Testes/testis
› Epididymis
› Ductus (Vas) Deferens
 ANATOMY & PHYSIOLOGY OF THE MALE
REPRODUCTIVE SYSTEM
Male Reproductive Anatomy
 Scrotum (muscular sac
holding testes)
› Testes/testis
 Seminiferous tubules
 Sertoli cells: sperm development,
blood-testis barrier
 Leydig Cells: secrete testosterone
› Epididymis
 Receives sperm from testis , Sperm
mature in epididymus
› Ductus (Vas) Deferens
 Transports sperm from epididymis
into pelvic cavity , Stores sperm
 Secretory Glands
› Seminal vesicle , Prostrate
gland , secretes 1/3 of the
volume of sperm
› Prostate gland – produces a
highly alkalotic substance
which contains high levels
of acid phosphatase and
serves as a vehicle for the
spermatozoa
› Bulbourethral (Cowper's)
gland , secrete a sticky
alkaline fluid which
lubricates the penile
urethra and vaginal acidity.
 Semen – male ejaculate
composed of spermatozoa
and seminal plasma, 2.5 – 4
cc, normal sperm count 100
M per ml
  
 Sperm Development is Promoted by the Same
Pituitary Hormones Used in Females to Control the
Menstrual Cycle
 Testis is organized into seminiferous tubules:
› Tubules are lined by Sertoli cells
› Leydig cells found between tubules
 Tight junctions between Sertoli cells form a barrier
which may prevent immune cells from entering and
attacking sperm (blood testis barrier)
 FSH stimulates the Sertoli cells to develop sperm
 LH stimulates the Leydig (interstitial) cells to
produce testosterone
 Production of Mature Sperm Requires About
60 days
 Stages in sperm production from germ cells:
› Meiosis to produce haploid cells
› Loss of most of cytoplasm
› Development of flagellum
› Formation of acrosomal tip (aids penetration of egg)
 These events take place in the seminiferous
tubules, epididymis and vas deferens
 Sperm are stored in the vas deferens
Three Glands Add Supporting Secretions to
the Sperm Suspension
The vas deferens empties into the
ejculatory duct at the level of the
prostrate gland
 In this region are 3 glands that add
secretions to the semen
› Seminal vesicle ( 60 % of fluid)
› Prostrate gland ( 30 % of fluid) 
› Bulbourethral (Cowper's) gland ( 5 % of
fluid)
› testes ( 5 % of fluid)

 Fluids from these glands:

› Make the semen more alkaline
(promotes sperm mobility)
› Add other substances which are
believed to promote fertilization
(fructose , prostaglandins, zinc, ascorbic
acid, etc..)
 
Vas Deferens: (ductus deferens) A tube
1. Vasectomy: Go in on either side of the vas deferens and tie off and cut
– Sperm can now no longer get from the epididymis to the urethra –
This can be reversed
Seminal Vesicles: Contributes 60% to the volume of the semen and
create a nutrient rich secretion
1. Nutrients: Fructose, prostaglandins, and fibrinogen
Prostate: Located where the urethra comes out of the bladder
 produces a thin, milky secretion that is quite alkaline
 make the semen alkaline
 (The vagina is an acidic environment so that microbial growth is
retarded but this environment is not good for the motility and life of
the sperm)
 Since the sperm are alkaline, they can survive in the vagina
 produces enzyme that create fibrinogen into fibrin – This helps to
form a clot at the time of ejaculation so that the semen is trapped in
the vagina
 All secretions contribute to the semen – Men who’ve had a vasectomy
can still produce an ejaculate but it is sperm free
Erection of the Penis is Requires
Specialized Vascular Tissue
Parasympathetic reflex
(sacral region)
 Erection of penis is
necessary to deliver sperm
into vagina during
intercourse
 Erection is analogous to
blowing up a balloon:
arterioles dilate and allow
special vascular chambers to
fill with blood
 Erectile tissue:
› Corpora cavernosa (2)
› Corpus spongiosum
Ejaculation is a Spinal Reflex
(Sympathetic System)
 Sperm suspended in semen are delivered to the
female by ejaculation
 About 4 mL, containing 300,000,000 sperm
 Ejaculation is a reflex of the sympathetic nervous
system, originating from the lumbar spinal cord
 Erection and ejaculation involve different branches of
the autonomic nervous system: an example where
they work together instead of opposing each other
 Ejaculation is caused by rhythmic contractions of
bulbocavernosus muscle
 Clitoris
 2 to 3 cm in length.
 It is homologous with the penis and is an erectile organ.
 The clitoris, like the penis, it will enlarge upon tactile stimulation, but it does not lengthen significantly.
 It is highly sensitive and very important in the sexual arousal of a female.
  
 Peri-urethral (Skene’s gland)
 Vulvo-urethral gland – secrete mucus to lubricate the vaginal orifice during sexual arousal
  
 B. External genitalia
 Vagina
› Receives penis in intercourse , Birth canal
› pH is acidic which is maintained by lactic acid producing Doderlein bacilli
  
 Cervix
 is the lower third portion of the uterus which forms the neck of the uterus that opens into the vagina.
 narrow opening of the cervix is called the os. which allows menstrual blood to flow out, and widens during labor to
allow the passage of the fetus through the vagina during childbirth.
  
 REPRODUCTION (FEMALE
 
SYSTEM
 A. External Genitalia 
 Mons pubis - the fatty tissue that
covers inferior of the symphisis
pubis
 becomes covered with
coarse pubic hairs during puberty,
which also
decrease after menopause

 Labia Majora
› are two symmetrical folds of
skin, which provide protection
for the urethral and vaginal
orifices
 REPRODUCTION (FEMALE SYSTEM
 
 Labia Minora
›are thin, delicate folds of fat-free
hairless skin.
›contain a core of spongy tissue with
many small blood vessels but no fat.
›contains many sensory nerve endings.
›Sebaceous and sweat glands open on
both of their surfaces.
›They meet just superior to the
clitoris to form a fold of skin called
the prepuce (clitoral hood).
 Clitoris
 2 to 3 cm in length.
 homologous with the penis and is
an erectile organ.
 like the penis, it will enlarge upon
tactile stimulation, but it does not
lengthen significantly.
 highly sensitive and very important
in the sexual arousal of a female.
 
 Peri-urethral (Skene’s gland)
 Vulvo-urethral gland – secrete
mucus to lubricate the vaginal
orifice during sexual arousal
  
 B. External genitalia
 Vagina
› Receives penis in intercourse ,
Birth canal
› pH is acidic which is maintained by
lactic acid producing Doderlein
bacilli
 
 
 Peri-urethral (Skene’s
gland)
 beside urethra
 Vulvo-urethral
gland(bartholins gland)
 – secrete mucus to
lubricate the vaginal
orifice during
sexual arousal
 
 Vagina
› Receives penis in
intercourse , Birth
canal
› pH is acidic which is
maintained by lactic
acid producing
Doderlein bacilli
 
 
 
 Cervix
 is the lower third
portion of the uterus
which forms the neck
of the uterus that
opens into the vagina.
 narrow opening of the
cervix is called the os.
which allows
menstrual blood to
flow out, and widens
during labor to allow
the passage of the
fetus through the
vagina during
childbirth.
  
Uterus (womb):
 hollow, thick-walled, pear-shaped
muscular organ located between the
bladder and the rectum (in non-pregnant
women).
 It is 7 to 8 cm long, 5 to 7 cm wide, and
2 to 3 cm thick.
 The uterus normally projects
superoanteriorly over the urinary
bladder.
 During pregnancy, the uterus enlarges
greatly to accommodate the embryo and
later the fetus.
 Muscular composition:
 Endomyometrium
 Myometrium
 Perimetrium

 Parts:
 Fundus
 Body
 Cervix

 
 
Oviducts (Fallopian
tubes)
 Deliver eggs to uterus
 These are 10 cm long and 1
cm in diameter.
 The uterine tubes allow
communication between the
peritoneal cavity and the
exterior of the body.
 
Oviducts (Fallopian
tubes)
 The uterine tubes carry
oocytes from the ovaries and
sperm cells from the uterus to
the fertilisation site in the
ampulla of the uterine tube.

 The uterine tube also conveys

the dividing zygote to the
uterine cavity.
 
 The uterine tube is
divided into 4 parts:
 I
 Is
 A
 In
 F 
 Ovaries: follicles, corpus luteum
 Produce eggs, hormones ( estrogen
and progesterone)
 In nulliparae (women who have not
borne children), the ovaries are oval,
almond-shaped, pinkish-white glands
about 3 cm long, 1.5 cm wide, and 1
cm thick.
  
 Mammary glands
› Secrete milk
 Bony Pelvis Structure:
› Supports reproductive organs , Wide
and shallow: allows easier birth
› False pelvis
› True Pelvis – is of paramount
importance as its size and shape must
be adequate for normal delivery. Divide
into inlet, pelvic cavity and pelvic
outlet
 Female Gametes Mature in the Ovary in a Monthly
Menstrual Cycle
 When the human female reaches maturity (puberty) a
monthly cycle (about 28 days) begins during which 5-20
eggs mature and one is released into the Fallopian tube
 At the same time the uterine lining develops to receive
the egg if it is fertilized
 The beginning of menstruation (menarche) is at about
about 13 years of age (it depends upon body weight and
has been getting earlier in the U.S.)
 At menopause (about 50 years of age) cyclic release of
egg cells stops
 THE MENSTRUAL CYCLE
 Menstruation
 is the periodic discharge of blood, mucus, and epithelial cells from the
uterus. I
 t usually occurs at monthly intervals throughout the reproductive
period, except during pregnancy and lactation, when it is usually
suppressed.
  
 The menstrual cycle is controlled
 by the cyclic activity of follicle stimulating hormone (FSH) and LH
from the anterior pituitary and progesterone and estrogen from the
ovaries.
 FSH acts upon the ovary to stimulate the maturation of a follicle, and
during this development, the follicular cells secrete increasing
amounts of estrogen
 Hormonal interaction of the female cycle are as follows:
 Days 1-5.
 the menses phase.
 A lack of signal from a fertilized egg influences the drop in estrogen and progesterone
production.
 A drop in progesterone results in the sloughing off of the thick endometrial lining
which is the menstrual flow. This occurs for 3 to 5 days.
  
 Days 6-14. T
 the proliferative phase.
 A drop in progesterone and estrogen stimulates the release of FSH from the anterior
pituitary. FSH stimulates the maturation of an ovum with graafian follicle
 . Near the end of this phase, the release of LH increases causing a sudden burst like
release of the ovum, which is known as ovulation.
  
 Days 15-28.
 the secretory phase.
 High levels of LH cause the empty graafian follicle to develop into the corpus luteum.
The corpus luteum releases progesterone, which increases the endometrial blood
supply.
 Endometrial glands secrete nutrients into the uterine cavity, helping to prepare the
lining for the arrival of the fertilized egg. If the egg is fertilized, the embryo produces
human chorionic gonadotropin (HCG).
 Thehuman chorionic gonadotropin signals the corpus luteum to continue to supply
progesterone to maintain the uterine lining. Continuous levels of progesterone prevent
the release of FSH and ovulation ceases.
 The length of the menstrual cycle is highly variable. It may be as short as 21 days or as
long as 39 days.
 Only one interval is fairly constant in all females, the time from ovulation to the
beginning of menses, which is almost always 14-15 days.
 The menstrual cycle usually ends when or before a woman reaches her fifties. This is
known as menopause.
 In Sexual Intercourse Large Numbers of Sperm are Deposited in the Vagina
 An average ejaculate contains about 300,000,000 sperm
 About 20% of them are non-functional
 The alkaline semen neutralizes the acidic solutions of the vagina
 Residence in female causes surface reactions to head of sperm (capacitation) which
give it the ability to penetrate an egg
  
 To Fertilize an Egg a Sperm Must Undergo a Long, Hazardous Journey
 Successful fertilization occurs in the fimbria of the Fallopian tube, close to the ovary
 Sperm take several hours to travel this distance and in the attempt most of them die or
become hopelessly lost
 At the entrance to the Fallopian tube only 300,000 sperm are left and only 100 or so
make it to the upper end of this tube
 The sperm must then fight its way through the layers of cells surrounding the egg,
using enzymes from its acrosomal tip
 Only a single sperm will be successful
 PRINCIPLES OF FERTILIZATION
(CONCEPTION)
 Fertilization refers to the joining together of the
ovum (egg) and sperm cells.
 The ovum originates in the graafian follicle within
the ovary.
 The sperm cell originates in the testes. The
microscopic union of sperm and ovum increase in
size more than 20 billion times from conception to
birth. See figure 2-2 for union of sperm and ovum.
 Fertilization Causes Rapid Changes Leading to Zygote
Formation
 When 1 sperm penetrates an egg reactions take place on the
surface of the egg that block penetration by other sperm; this is
necessary because polyspermy is lethal
 The egg cell nucleus is triggered into finishing meiotic division,
finally producing a haploid nucleus
 The sperm loses its tail and its nucleus swells
 The 2 haploid nuclei, from the sperm and egg, fuse to form a
single nucleus
  
 As the Zygote Moves Down the Fallopian Tube
its Cells Divide to Form a Blastocyst
 The new zygote starts to divide by mitosis (about
once every 20 hours)
› Single Cell -> Morula (berry-shaped) -> Blastocyst
(hollow sphere)
 Movement along tube is caused by cilia which
sweep the zygote along
  
 SEX DETERMINATION
 Chromosomes
 are small, threadlike structures within each cell that contain genes, which carry genetic instructions.
 These genes control the physical and chemical traits inherited by children from their parents.
 The inherited traits are color of the eyes, sex, height, and skin color.
  
 The female has 23 pairs of chromosomes.
 The pair of chromosomes that determined her sex are named "XX."
 The ovum carries one chromosome from each of the female's pairs (23 chromosomes). The ovum can
only carry an "X" sex chromosome.
  
 The male has 23 pairs of chromosomes.
 The pair of chromosomes that determined his sex are named "XY."
 The sperm carries one chromosome from each of the male's pairs (23 chromosomes).
 The sperm can carry either an "X" or a "Y" sex chromosome.
  
 If the ovum is fertilized by a sperm carrying
 an "X" chromosome, the child is a girl.
 If the ovum is fertilized by a sperm carrying
 a "Y" chromosome, the child is a boy.
 The sperm of the father always determines the
child's sex
  
 Implantation Occurs About 7 Days After Fertilization
 For the first 7 days the embryo has been using food materials
originally stored in the egg cell
 Now it imbeds itself into the uterine lining so that it can be
nourished by the mother
 Elaborate connections are made between embryonic and maternal
tissue, forming the placenta
 Functions of placenta:
› supplies maternal food and oxygen to embryo
› removes embryonic waste products to mother
› becomes an endocrine organ, producing many hormones
  
 The Placenta Begins Taking Over Some of the
Hormone Secretion Required for Pregnancy
 At about 7 days blastocyst cells produce human
chorionic gonadotropin (hCG)
 hCG replaces LH, stimulating the corpus luteum to
continue producing progesterone
 hCH is the basis of the pregnancy test
 Later in fetal development the placenta takes over the
production of progesterone
 Also produces estrogen and several other hormones that
promote growth
 AMNION
 This is the smooth, slippery, glistening innermost membrane that lines the amniotic space.
 It is filled with fluid and is often called the "bag of water."
 The fetus floats and moves in the amniotic cavity. At full term, this cavity normally contains 500 cc to
1000 cc of fluid (water).
 This fluid provides many functions for the fetus.
 The amnion usually ruptures just before birth. The amnion functions to:
 (1) Protect the fetus from direct trauma by distributing and equalizing any impact the mother may
receive.
 (2) Separate the fetus from the fetal membranes.
 (3) Allow freedom of fetal movement and permits musculoskeletal development.
 (4) Facilitate symmetric growth and development of the fetus.
 (5) Protect the fetus from the loss of heat and maintains a relative, constant fetal body temperature.
 (6) Serve as a source of oral fluid for the fetus.
 (7) Act as an excretion and collection system.
  
 CHORION
 This is the outer membrane.
 It forms a large portion of the connective tissue thickness of the placenta on its fetal side.
 It is the structure in and through which the major branching umbilical vessels travel on the surface
of the placenta.
  
  
  
 MULTI-FETAL PREGNANCIES
 Multi-fetal pregnancy is a pregnancy involving two or more fetuses.
 Twin fetuses may originate several ways (see figure 2-11).
  
› Identical twins (monozygotic) originate from the same ovum and are always of the same sex. They share a
single placenta.
› Fraternal twins (dizygotic) originates from two separate ova and sperm and may be of different sexes. They
each have their own placenta.
 Figure 2-11. Development of twin fetuses.
 FETAL GROWTH AND DEVELOPMENT
 Growth refers to an increase in size.
 Development is the continuous process by which an individual
changes from one life phase to another.
 These phases includes the prenatal period and the postnatal period.
 Fetal maturation takes place in an orderly and predictable pattern.
The physicians refer to the age of a pregnancy as lunar months.
› The lunar months corresponds to the usual length of the menstrual
cycle, in this respect, it is easier to calculate.
› A lunar month is a period of four weeks (28 days) and a trimester is a
time period of 3 months.
 . First Trimester.
 During the first three months of pregnancy, the product of conception grows from the just-visible speck to
the fertilized ovum to a lively embryo. A
 t the end of the first trimester, the following changes have or are occurring:
 (1) All organs are formed.
 (2) The fetus becomes less vulnerable to the effects of most drugs, most infections, and radiation.
 (3) Facial features are forming and the fetus becomes human in appearance.
 (4) External sex organs are visible, but positive sex identification is difficult.
 (5) Well-defined neck, nail beds beginning, and tooth buds form.
 (6) Rudimentary kidneys excrete small amounts of urine into the amniotic sac.
 (7) There is movement but just not strong enough to be felt.
 (8) The fetus is about 2.9 inches long and weighs about 14 grams.
  
 Second Trimester.
 During these months (4th, 5th, and 6th) the fetus grows fast.
 At the end of the second trimester, the fetus:
 (1) Fetal heart tone (FHT) can be heard with a stethoscope.
 (2) Skin is wrinkled, translucent, and appears pink.
 (3) Sex is obvious.
 (4) Looks like a miniature baby.
 (5) Skeleton is calcified.
 (6) Birth survival is possible, but the fetus is seriously at risk.
  
 Third Trimester.
 At the end of the third trimester (7th, 8th, and 9th
month), the fetus:
 (1) Skin is whitish pink.
 (2) Hair in single strands.
 (3) Testes are in the scrotum, if a male child.
 (4) Bones of the skull are firmer, comes closer at the
suture lines.
 (5) Lightening occurs.
 (6) Fetus is about 20 inches long and weighs about
3300 grams.
 DEFINITIONS
 Gravida
 A pregnant woman. This refers to any pregnancy regardless of duration.
 Para
 A woman who has delivered a viable young (not necessarily living at birth). Para is used with numerals to designate the number of pregnancies that
have resulted in the birth of a viable offspring (see para 3-3).
 Nulligravida
 A woman who has never been pregnant.
 Nullipara
 A woman who has not delivered a child who reached viability.
 Primigravida
 A woman pregnant for the first time.
 Primipara.
 A woman who has delivered one child after the age of viability
 Multigravida
 A woman who has been pregnant more than once.
 Multipara
 A woman who has delivered two or more fetuses past the age of viability. It does not matter whether they are born dead or alive.
 Grandmultipara.
 A woman who has had six or more births past the age of viability.
 Viability
 Refers to the capability of a fetus to survive outside the uterus after the earliest gestational age (approximately 22 to 23 weeks gestation).
 In utero
 Refers to within the uterus.
  
 What Is Naegele's Rule?
  
 A German physician named Franz Carl Naegele [1777-1851]
 was the first person to scientifically study and write about estimating due dates
 He developed a rule, now called Naegele's Rule, for estimating a pregnant woman's due
date. 
 Naegele's rule states that the due date can be found by taking the first day of a
woman's last menstrual period, subtracting three months, adding one week and
adjusting the year if necessary. 
 For example, if a woman's last menstrual period was April 14th, 2008 then her due date
by Naegele's rule would be January 21st, 2009, i.e.:
 April 14, 2008
 - 3 months + 7 days + 1
 ---------------------------------------------
 = January 21, 2009
