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The woman is concerned about the long-term effects of birth control pills…

- - - - ovaries
        
        female gonads, produce female gametes (ova) and the sex hormones,esrtogens and progestogen
        
        estrogen include estradiol, estrone, and estriol, but estradiol is the most abundant and is responsible for estrogenic effects in human.
      - internal genitalia
        
        ovaries
        
        immature eggs develop in follicles in the ovaries
        
        held in place by the ovarian ligament anchors the ovary medically ti the uterus:the suspensory ligament anchors it laterally to pelvic Wal:and mesovarium
        
        mesiovaium is apart of the broad ligaments peritoneal fold that "tents" over the uterus and supports the uterine tubes, uterus,and vagina.
        
        these are served by ovarian arteries, branches of the abdominal aorta, and by the ovarian branch of the uterine arteries. the ovarian blood vessels reach the ovaries by travelingthrough suspensory ligaments. and mesovaria.
        
        tunica albuginea surround ovary
        
        outer cortex,which houses the forming gametes
        
        ovarian follicles in here
        
        each follicle consist of oocyte
        
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        inner medulla containing the largest blood vessels and nerves.
        
        ovarian follicles- embedded in the highly vacular connective tissue of the ovary cortex are many tiny sac like structures
        
        duct system
        
        uterus tubes
        
        fallopian tubes or oviducts,form the initial part of the female duct system.they receive the ovulated oocyte and are the site where fertilisation happens .
        
        3 regions
        
        ampulla
        
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        isthmus
        
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        infundibulum
        
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        uterus
        
        lies in the pelvic cavity, anterior to the rectum and poster superior to the bladder.
        
        it is holow, thick-walled, muscular organ that receives, retains, and nourishes a fertilised ovum.
        
        size
        
        before children is the size of a pear, but usually is larger in a women who has given birth
        
        portions of the uterus
        
        body
        
        major portion
        
        funds
        
        round entrance of of uterine tubes
        
        cervix
        
        cervical canal, empty into the vagina via the external os and connects with the cavity of the uterine body via internal os.
        
        supports the uterus
        
        mesometrium- lateral support
        
        cardinal(transverse cervical)ligaments- inferiorly, they extend from the cervix and superior vagina to the lateral walls of the pelvis
        
        utersacral ligaments-secure the uterus to the sacrum posteriorly
        
        round ligaments- run through the inguinal canals to anchor in the subcutaneous tissue of the libra major.
        
        uterus wall
        
        composed of 3 layers
        
        perimetrium
        
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        myometrium
        
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        endometrium
        
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        vagina
        
        is a thin walled tube that lies between tha bladder and the rectum. it extends from urethra parallels its course anteriorly. passage way for birth canal and menstrual flow
        
        receives the penis, which makes it the organ of copulation.
        
        consist of three coats
        
        outer fibroelastic adventitia
        
        smooth muscularis
        
        inner mucosa marked by transversals ridges or urge, which stimulates the penis during inter course.
        
        mucosa is to stand up to friction
        
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        PH of a women's normally quite acidic
        
        the acidity helps vagina keep healthy and free of infection, but also hostile to sperm.
        
        it tends tube alkaline in adolescents,predisposing sexually transmitted infection.
        
        women who have never participated in sex, the mucosa near the distal vaginal orifice forms an incomplete partition called hymen.
      - external genitalia
        
        mons pubis
        
        is a fatty, rounded area overlying the pubic symphysis. after puberty, pubic hair covers the skin of this area.
        
        hair-covered fatty skinfolds,libia majora
        
        libia minora- two thin, hair skin folds, homologous to the spongy urethra.
        
        enclosed a recess -which contains the external openings of the urethra and vagina.
        
        flanking the vaginal opening are the pea sized greater vestibular glands
        
        these erelease mucus into the vestibule and help it keep it moist and lubricated,facilitated intercourse.
        
        labia
        
        clitoris
        
        a small, protruding structure composed largely of erectile tissue, which is homologous to the penis of the male
        
        glans of the clitoris.
        
        exposed portion.
        
        its hooded by the skin called prepuce of clitoris.
        
        has large nerve endings sensitive to the touch, it becomes swollen with blood and erect during tactile stimulation, contributing to a females sexual arousal
    - - the process by which female gametes are produced in the ovary
        
        oogonia(diploid stem cells)
        
        divide by mitosis to produce
        
        primary oocytes
        
        undergo meiosis 1 to produce
        
        secondary oocytes
        
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    - - ovarian cycle lasts 28 days. It is subdivided into two phases:
        
        Follicle phase
        
        he selection of the mature follicle. This phase ends with ovulation. Estradiol is the steering hormone. Normally, it lasts 14 days, but this can vary considerably!
        
        Luteal phase:
        
        progesteron production by the "yellow body" (= corpus luteum) and lasts 14 days (relatively constant)
      - Steps
        
        1.Stimulus Gonadotropin releasing hormone (GnRH) is released by the hypothalamus.
        
        Target Location=Anterior pituitary gland
        
        Result-Stimulates the release of follicle stimulating hormone (FSH). This starts the follicular phase.
        
        2.Stimulus-FSH is released from the anterior pituitary gland into blood.
        
        Target Location-Ovary
        
        Result-Stimulates follicle development in the ovaries. As follicles mature, they start releasing estrogen and inhibin into blood.
        
        3.Stimulus-Estrogen concentrations increase in blood.
        Inhibin concentrations increase in blood.
        
        Target Location-Hypothalamus Uterus
        Anterior pituitary gland
        
        Result-Causes increase in GnRH production.Causes endometrium to develop and regenerate. This starts the proliferative phase.Inhibits further release of FSH.
        
        Stimulus-Increased GnRH production.
        
        Target Location-Anterior pituitary gland
        
        Result-Stimulates the release of luteinizing hormone (LH) into blood.
        
        5.Stimulus-Sudden increase in LH in blood.
        
        Target Location-Ovaries
        
        Result-Causes ovulation to occur at day 14 of the cycle.
        Promotes formation of corpus luteum from the follicle. The corpus luteum produces progesterone and some estrogen. This starts the luteal phase.
        
        6.Stimulus-Progesterone and estrogen concentrations in blood increases.
        
        Target Location-Uterus
        Hypothalamus
        
        Result-Causes endometrium to thicken further and produce secretions. This starts the secretory phase.
        Decreases production of GnRH
        
        7.Stimulus-Decreased GnRH
        
        Target Location-anterior pituitary gland
        
        Result-Decreases the release of LH
        
        8.Stimulus-Decrease of LH in blood.
        
        Target Location-Ovaries
        
        Result-Corpus luteum begins to degenerate – progesterone and estrogen decreases.
        
        9.Stimulus-Progesterone and estrogen concentrations in blood decreases.
        
        Target Location-Hypothalamus Uterus
        
        Result-Begins production of GnRH. Starts the cycle all over again.
        Endometrium is shed. This starts menstruation.
  - - - corpulatory organs
        
        penis
        
        make up the external genitilia of the Male
        
        glans penis
        
        consist of an attached root and a free body that extends tip
        
        prepuce
        
        tissue
        
        spongy urethra
        
        three long cylindrical bodies of erect tissue
        
        erect tissue during erection gets filled up with blood, causing the penis to enlarge
      - gonads
        
        testes
        
        each testis is 4 cm long by 2.5 sm wide surrounded by two tunics.
        
        tunica vaginalis derived from an out pocketing of the peritoneum
        
        tunica albuginea
        
        fibrous capsule of the testis
        
        seminiferous tubules
        
        are sperm sites where sperm is made
        
        each lobule converge to form a straight tubule that conveys sperm into the rete testis
        
        from the rate testis, sperms leave the testes through efferent ductules and enters the epididymis
        
        epididymis - hugs external testis surface posteriorly.immature sperm passes through, where it is stored until ejactulation
        
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        spermatic cord
        
        testicular arteries
        
        branch from the abdominal aorta superior pelvis , supply the testes
        
        testicular veins
        
        drain the testes arise from a network Called the pampiniform venous plexus
        
        surrounds the portion of Esch testicular artery within the scrotum like a climbing vine.
        
        scrotum
        
        function: thermal regulator for testes
        
        2 muscles help maintain a fairly constant intrascroptal temp.
        
        dartos muscle
        
        a layer of smooth muscle in the superficial fascia, wrinkles the scrotal skin
        
        cremaster muscle
        
        bands of skeletal muscle that arise from the internal oblique muscles of the trunk, elevate the testes.
      - gametes
        
        sperm (haploid)
      - accessory ducts
        
        epididymis
        
        it where sperm mature
        
        it head contains efferent ductules that empty into the duct of the epididymis
        
        highly coiled duct that completes the head and forms all of the body and tail of this organ
        
        sperm is ejaculated from here not the testes
        
        when male ejaculates, smooth muscle in the ducts of the epididymis contracts, expelling sperm into the next segment of the duct system, the ductus deferens
        
        ductus deferens
        
        transports sperm during ejaculation, from the epididymis, it runs(as part of the spermatic cord)
        
        extends and turns into ampulla of the ductus deferens and then joins with the duct of the seminal gland to form the short ejaculatory duct
        
        ejaculartory duct
        
        empties into the urethra
        
        urethra transports both urinary and reprodcutive
      - accessory sex glands
        
        prostate
        
        made up of 20 to 30 compound tubloalveolar glands embedded in mass of muscle and dense connective tissue.
        
        during ejactulation, prosthetic smooth muscle contracts , squeezing the prosthetic secretion into protetatic urethra via several ducts.
        
        it realises a milky, slightly acidic fluid that contains citrate and several enzymes including prostate specific antigen
        
        bulb-urethra
        
        pea size ,inferior to the post In the urogenital diaphram
        
        produces a thick, clear mucus, some of which drains into the spongy urethra where it neutralise traces of acidic urine.
        
        this mucus lubricates the glans penis when a man becomes sexually excited
        
        seminal glands
        
        70%of semen vol. it is a secretory psuedostratified columnar epithelium. stored with in the mucosa honey comb of blind alleys is yellowish viscous alkaline fluid containing
        
        fructose sugar, critic acid, coagulating enzyme, prostaglandins and other substances that increase sperm or fertilisation.
        
        semen
        
        milky white, somewhat sticky mixture of accessory gland secretions and sperm. the accessory gland secretions provide a transport medium and nutrients .
        
        they contain chemicals that protect and activate the sperm and facilitate the movement
        
        mature sperm cells are streamlined cellular "torpedoes" containing little cytoplasm or stored nutrients
        
        catabolism of fructose in seminal gland secretions provides nearly all the fuel needed for sperm atp synthesis .
        
        substance it contains
        
        prostaglandins
        
        causes viscosity of mucus guarding the entry of the uterus to decrease , they also stimulate reverse peristalsis in the uterus, facilitating sperm movement through the female reproductive.
        
        the hormone relaxin and certain enzymes in semen enhance sperm motility.
        
        ATP provides energy
        
        certain ingredients suppress the immune response in female reproductive tract.
        
        antibiotic chemicals destroy some bacteria
        
        it PH is alkaline (7.2-8.0) which helps neutralise the acid environment of males urethra and female vagina.
    - - sexual response includes erection and ejactulation
        
        1.erection of the penis, which allows it to penetrate the females vagina
        
        under parasympathetic
        
        when a man is not sexually aroused, arterioles supplying the erectile tissue are constricted and the penis it flaccid.
        
        however, sexual excitement triggers a parasympathetic reflex that promotes release of nitric oxide.
        
        no relaxes smooth muscle in the penile blood vessels walls, dilating the arterioles, and the erectile bodies fill with blood.
        
        enlargement and stiffening of the penis,results from engorgement of the erectile bodies with blood.
        
        corpora cavernosa
        
        expansion of this tissue compresses their drainage vein, retarding blood outflow and maintaining engorgement.
        
        corpora spongiosum
        
        expands as well but not as much.
        
        its job is to keep urethra open during ejaculation.
        
        stimules that cause an erection
        
        tactile stimulation
        
        erotic sights
        
        sounds and smells
        
        how the CNS responds
        
        by activating parasympathetic neutrons that innervate the internal pudendal arteries serving the penis
        
        erection sometimes is induced by emotional or high mental activity
        
        emotions and thoughts can also inhibit erection, causing vasoconstriction and returning the penis to its flaccid state.
        
        ejaculation, which expels semen into the vagina
        
        under sympathetic
        
        its the propulsion of semen from the male duct system.
        
        when impulses provoking erection reach a critical level, a spinal reflex is initiated,and a missive discharge of nerve impulses occurs over the sympathetic nerves serving the genital organs .
        
        results in
        
        the ductus deferent,prostate, and seminal glands contract, emptying contents into the prostatic urethra. and at the same time, the bladder internal sphincter muscle constricts preventing expulsion of urine or reflux of semen into bladder.
        
        semen in the urethra triggers a spinal reflex through somatic motor neurons. the bulbosponisiosus muscle of the penis indergoe a rapid series of contraction, propelling semen fro m urethra at a speed of 500cm/s(11mi/h).
        
        theses rhythmic contractions are accompanied by intense pleasure or climax ,orgasm.
        
        ejaculation is quickly followed by resolution, a period of muscular and psychological relaxation.
        
        sympathetic nerve fibres constricts the internal puedendal arteries, reducing blood flow into the penis, and activates small muscles that squeeze the cavernous bodies,forcing blood out and back to normal.
        
        latent period which is when a man can no longer achieve a orgasm
      - spermatogenesis: sequence of events that leads to formation.
        
        when does it start?
        
        begins at puberty, around the age of 14 years old and continues throughout life.
        
        definition
        
        is the process of forming male gamers. it occurs in the seminiferous tulles of the testes and is the hallmark of sexual maturity.
        
        histology
        
        sustenocytes are large, columnar cells. they act as supporting cells and play several roles in sperm formation.
        
        spermatogenic cells are cells tha give rise to sperm. they are found enveloped by the sustentocytes and can be seen at very different stages of cell division
        
        hyoid cells are smooth like cells that surround each seminiferous tubule in three to five layers. by contractions rhythmically, myoid help to squeeze sperm and testicular fluids through the tubes out the testes
        
        interstitial endocrine cells, also called leading cells, lie in the soft connective tissue surrounding semi. these sells produce androgens, and small amounts of estrogens, which secret in the surrounding interstitial fluid.
        
        spermatogenesis; events
        
        mitosis of spermatogonia: forming spermatocytes
        
        spermatogonia -outermost tubule cells, which are in direct contact with the epithelial basal lamina
        
        divide more or less continuously by mitosis and , until puberty, and their daughter cells become spermatogonia.
        
        begins during puberty, and from the on, each mitotic division of a spermatogonium results in two distinctive daughter cells
        
        type A daughter cell remains at the basal lamina to maintain the pool of dividing cells.
        
        type B daughter cell gets pushed toward the lumen. where it becomes a primary spermatocyte destined to produce 4 sperm.
        
        meiosis: spermatocytes to spermatids
        
        primary spermatocyte undergors meiosis 1,forming 2 smaller haploid cells called secondary spermatocytes
        
        2nd spermatocyte goes onto meiosis 2, which results in daughter cell called spermatids - which are small round cells, with large spherical nuclei, seen closer to the lumen of the tubule
        
        spermatogenesis :spermatids to sperm
        
        spermatid must undergo a process called spermatogenesis, during which elongates, sheds its excess cytoplasmic baggage, and forms a tail.
        
        each sperm has a head,midpiece,and a tail, which correspond roughly to genetic,metabolic,and locomotor regions,
        
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        the role of the sustentocyte
        
        descendants of the same spermatogenonium remain closely attached to one another by cytoplasmic bridges
        
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        bound to each other by tight junctions, which divide the seminiferous tubule into two compartments
        
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        tight junctions between the sustentocutes from the blood testis barrier
        
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      - the function of the male reproductive is regulated by
        
        hypothalamus
        
        releases GnRH ,which reaches the anterior pituitary via the hypophyseal portal veins.
        
        anterior pituitary
        
        the GnRH causes anterior pituitary gonadotropic cells to release FSH and LH.
        
        FSH stimulates spermatogenesis by causing sustentocytes to release
        
        LH stimulates interstitial endocrine cells to secede testosterone, which is essential for spermatogenesis
        
        testicular hormones
        
        testosterone effects other body sites
        
        negative feedback by testosterone inhibits FSH and LH release from the anterior pit. and GnRH release from the hypothalamus.
        
        inhabitation released by sustentocytes feeds back on the anterior pituitary, decreasing FSH release.
  - - - male and female condoms
      - cervical cap
      - diaphragm
      - contraceptive sponge
    - - birth control pills
      - vaginal ring
      - skin patch
      - contraceptive injection
      - These are considered short-acting methods because you have to remember to use them on a daily, weekly or monthly basis.
    - - copper IUD
      - hormonal IUD (Mirena, Skyla, Kyleena)
      - contraceptive implant (Nexplanon)
      - These are considered long-acting methods because they last for three to 10 years after insertion — depending on the device — or until you decide to have the device removed.
    - - This is a permanent method of birth control. Examples include tubal ligation for women and vasectomy for men.
    - - These methods focus on knowing which days of the month you are able to get pregnant (fertile), often based on basal body temperature and cervical mucus. To avoid getting pregnant, you do not have sex on or around the days you are fertile, or you use a barrier method of birth control.
    - - Birth control methods may:
        
        Prevent sperm from reaching the egg
        
        Inactivate or damage sperm
        
        Prevent an egg from being released each month
        
        Alter the lining of the uterus so that a fertilized egg doesn't attach to it
        
        Thicken cervical mucus so that sperm can't easily pass through it
    - - Consider your tolerance for the possible side effects associated with a particular birth control method. Some methods pose more side effects — some potentially serious — than others. Talk to your doctor about your medical history and how it might affect your choice of birth control.
    - - Male and female condoms are the only methods of birth control that offer reliable protection from sexually transmitted infections. Unless you are in a mutually monogamous relationship and have been tested for sexually transmitted infections, use a new condom every time you have sex in addition to any other method of birth control you use.
- - - - A thin, transparent, flexible ring that you insert into the vagina yourself, the vaginal ring releases the same hormones as those in combination oral contraceptives, blocking ovulation and altering the uterine lining to prevent fertilization and implantation. You leave the ring in for three weeks, followed by a week off. Each vaginal ring is effective for one month.
    - - Like the pill, the vaginal ring often makes periods more regular and may lessen cramps – both of which can be important for women approaching menopause.
        On the downside, it can increase vaginal discharge. Side effects are similar to those of combination oral contraceptives.
    - - good choice for older nonsmoking women who have no underlying health problems. if you smoke or have a health condition that could be affected by estrogen – such as a history of breast cancer, migraine headaches or blood clots – the vaginal ring isn’t for you. Women who are obese or have high blood pressure should also avoid the ring.
  - - - T-shaped device is placed inside a woman’s uterus, it changes the uterine environment in ways that prevent sperm from reaching an egg or stop a fertilized egg from implanting.
        Two types of IUDs are available in the U.S.: ParaGard, which is hormone-free, and Mirena, Liletta and Skyla, which contain progestin. Both kinds must be inserted and removed by a doctor.
    - - : IUDs can often stay in place for years at a time. ParaGard, which contains copper, may increase menstrual bleeding and cramping.
        Hormonal IUDs can lighten or eliminate monthly periods, and may be especially appealing to women with heavy bleeding problems. However, they may cause acne or ovarian cysts in some women.
    - - The IUD is an effective birth control method for most women, especially if they don’t want to take medication daily. It can be good for many women in their 40s and 50s, including those who are obese
  - - - also known as having your tubes tied -- is a kind of surgery that will keep you from ever getting pregnant.In a tubal ligation, your fallopian tubes are cut or blocked. That way, the eggs released by your ovaries each cycle can’t make their way to your uterus, where they might be fertilized by sperm.
    - - It’s permanent. This is a big plus if you don’t want to have children or you don’t wish to have any more.
        
        It works. Only about 1 in 200 women get pregnant after a tubal ligation. That’s less than 1%.
        
        It doesn’t affect your hormones. It won’t change your periods or bring on menopause. And it doesn't cause the side effects that birth control pills do, like mood swings, weight gain, or headaches, or the ones sometimes caused by IUDs, like cramps, heavier periods, or spotting.
        
        It doesn’t affect your hormones. It won’t change your periods or bring on menopause. And it doesn't cause the side effects that birth control pills do, like mood swings, weight gain, or headaches, or the ones sometimes caused by IUDs, like cramps, heavier periods, or spotting.
        
        It may lower your chances of ovarian cancer. Scientists aren't sure exactly why this happens, but research has shown that tubal ligation can greatly lower a woman's odds of this type of cancer.