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A healthy, happily married couple in their early 40's has sought your…

- - - - cervical caps
      - male &female condoms
      - diaphragms
      - spermicides
    - - pill
        
        daily pill
        
        emit estrogen and progestin to prevent prgnancy
        
        stop ovulation
        
        thickens cervical mucus preventing sperm from reaching the egg
        
        potential side effects
        
        breakthrough bleeding
        
        possible weight gain or fluid retention
        
        nausea
        
        mood changes
        
        morning after pill
        
        progesterone-like
        
        interfere with normal hormonal signals enough to prevent fertilization or implantation
        
        potential side effects
        
        nausea
        
        bleeding between periods, or heavier period
        
        fatigue
        
        abdominal pain, cramps
        
        emergency contraceptive
        
        must be taken within 3-5 days
      - IUD
        
        release progestin
        
        thickens the cervical mucus
        
        thins the uterine lining
        
        can stop ovulation
        
        potential side effects
        
        pelvic pain
        
        acne
        
        mood changes
        
        nausea
        
        copper
        
        release copper ions
        
        toxic to sperm
        
        potential side effects
        
        increased bleeding during menstruation
        
        cramping
      - patches
        
        hormones are absorbed from the patch
        
        thickens the cervical mucus
        
        changes the lining of the uterus to prevent implantation
        
        prevents eggs from being releases from ovaries
        
        potential side effects
        
        skin irritation
        
        headaches
        
        increased risk for blood clots, high BP, stroke, liver disease, etc.
        
        breakthrough bleeding or spotting
      - vaginal ring
        
        release estrogen and progestin
        
        prevents ovaries from releasing eggs
        
        potential side effects
        
        nausea
        
        cervical pain
        
        weight gain
      - inplants
        
        release progestin over a course of 5 years
        
        thicken the cervical mucus denying entry to sperm
        
        decrease frequency of ovulation
        
        makes the endometrium inhospitable to implantation
        
        potential side effects
        
        mood changes
        
        blood clot formation
        
        changes in menstrual periods
        
        serious depresion
      - injections
        
        progestin
        
        prevents ovulation
        
        makes cervical mucus thicker
        
        potential side effects
        
        changes in mood
        
        thinning of bones
        
        irregular bleeding
        
        weight gain
    - - coitus interruptus
        
        withdrawal of penis just before ejaculation
      - rhythm
        
        avoiding intercourse during periods of ovulation and fertility
        
        ovulation can be detected by recording daily basal temperatures
        
        records must be accurate
      - abstinence
        
        no form of sexual contact
  - - - cutting or cauterizing the uterine tubes
    - - cutting or cauterizing the ductus deferentes
      - sperm still produced but can no longer reach the body exterior
- - - - although it is 100% accurate
      - not realistic for a married couple
    - - still leave a potential risk of pregnancy
    - - still leaves a potential risk of pregnancy
        
        sperm can still be release pre-ejaculation
  - - - will prevent pregnancy since the couple is sure they no longer want children
      - if they decide they fear they want to change their minds
        
        they can try reversing
        
        or the can freeze her eggs for a later time
        
        if she can no longer carry a child they can discuss serrogacy
    - - contains no hormones
        
        It does prevent pregnancy
        
        if they decide the still want kids, it would be the easiest for returned fertility
        
        last up to 12 years
        
        one of the most effective birth controls
    - - will prevent pregnancy since the couple is sure they no longer want kids
      - if they decide they want to change their minds
        
        they can try to reverse the procedure
        
        they can freeze samples of sperm for a later time if they decide they still want kids later on
- - - - structures
        
        organs
        
        ovaries
        
        produce ova (gametes)
        
        produce sex hormones
        
        estrogen
        
        estrone
        
        estriol
        
        estradiol
        
        2 more items...
        
        progesterone
        
        accessory ducts
        
        transport or serve the needs reproductive cells and fetus
        
        uterine tubes
        
        has 3 parts
        
        ampulla
        
        where fertilization usually occurs
        
        isthmus
        
        empties into the superlateral regions of the uterus
        
        infundibulum
        
        vagina
        
        provides a passage way for...
        
        delivery of a baby
        
        menstruation
        
        uterus
        
        receives, retains and nourishes a fertilized ovum
        
        cervix
        
        cavity of the cervix, AKA cervical canal
        
        empties into vagina
        
        uterine wall
        
        has 3 parts
        
        myometrium
        
        1 more item...
        
        endometrium
        
        2 more items...
        
        perimetrium
        
        vascular supply
        
        changes depending on the cycle
      - cycles
        
        uterine
        
        AKA "menstrual cycle"
        
        "menarche": first menstrual cycle
        
        occurs during puberty
        
        implantation must occur 6-7 days after ovulation
        
        events
        
        Proliferative phase
        
        Days 5-14
        
        "Preovulatory"
        
        endometrium rebuilds itself
        
        due to rising blood levels of estrogen
        
        1 more item...
        
        basal layer of endometrium generates a new functional layer
        
        by day 14
        
        ovulation occurs
        
        Secretory Phase
        
        Days 15-28
        
        "Postovulatorty"
        
        this phase is the most constant "timewise"
        
        endometrium prepares for an embryo to implant
        
        endometrial glands enlarge, coil, and begin secreting nutrients into the uterine cavity
        
        1 more item...
        
        progesterone levels rise
        
        cervical mucus becomes viscous
        
        1 more item...
        
        Menstrual phase
        
        Days 0-4
        
        uterus sheds
        
        except for the deepest part
        
        thick, hormone dependent functional layer of the endometrium detaches from the uterine wall
        
        2 more items...
        
        ovarian hormones are at their lowest point
        
        by day 4
        
        growing ovarian follicles start to produce more estrogen
        
        ovarian
        
        hormone interactions
        
        negative feedback
        
        inhibit gonadotropin release
        
        due to riseof estogen in the plasma
        
        neg. feedback on hypothalamus & anterior pituitary
        
        GnRH
        
        stimulates FSH &LH secretion
        
        positive feedback
        
        stimulates gonadotropin release
        
        when estrogen reaches a critical blood concentration...
        
        pos. feedback on the hypothalamus and anterior pituitary
        
        Anterior pituitary gonadotropins
        
        FSH
        
        Follicle stimulating hormone
        
        LH
        
        Luteinizing hormone
        
        stimulate follicles to grow, mature, and secrete sex hormones
        
        LH surge
        
        triggers ovulation
        
        triggers formation of the corpus luteum
        
        rouses the primary cycle of the mature vesicular follicle from its resting rate
        
        Negative feedback pt.2
        
        inhibits LH & FSH release
        
        due to rising levels of progesterone and estrogen
    - - structures
        
        organs
        
        testes
        
        produce sperm
        
        sperm is delivered out the body through the duct system
        
        is viable and cant be produced at core body temperature
        
        lie withing the scrotum
        
        scrotum is affected by temperature changes
        
        pulls close to the body when its cold
        
        1 more item...
        
        pulls away from the body when its hot
        
        muscles that help maintain a constant instrascrotal temperature
        
        2 more items...
        
        testicular arteries
        
        supply the testis
        
        ducts
        
        ductus deferens
        
        transports sperm during ejaculation
        
        smooth muscles create peristaltic waves that squeeze sperm
        
        ejaculatory duct
        
        epididymus
        
        where sperm mature
        
        can store sperm for several months
        
        this is where sperm is ejaculated
        
        urethra
        
        where sperm is expelled
        
        transports urine and semen
        
        accessory sex glands
        
        empty their secretions into the ducts during ejaculation
  - - - structures
        
        main organ
        
        ovaries
        
        female gonad
        
        almond shaped
        
        held by ligaments in the peritoneal cavity
        
        suspensory ligament
        
        achors it laterally to the pelvic wall
        
        mesovarium
        
        suspends it between uterus and pelvic wall
        
        part of the broad ligament
        
        ovarian ligament
        
        anchors ovary medially to uterus
        
        broad ligament
        
        peritoneal fold
        
        tents over uterus
        
        supports uterine tubes, uterus, and vagina
        
        2 of them
        
        in pelvic cavity
        
        accessory ducts
        
        uterus
        
        AKA "womb"
        
        anterior to rectum & posterosuperior to the bladder
        
        hollow,thick walled, muscular organ
        
        parts of the uterus
        
        body
        
        major portion
        
        fundus
        
        rounded region
        
        superior to the entrance of the uterine tubes
        
        cervix
        
        narrow neck
        
        projects into the vagina inferiorly
        
        size and shape
        
        inverted pear in those who have never been pregnant
        
        larger in women who have given birth
        
        uterine wall
        
        3 layers
        
        myometrium
        
        2 more items...
        
        endometrium
        
        2 more items...
        
        perimetrium
        
        1 more item...
        
        vagina
        
        thin walled tube
        
        lies between the bladder and rectum
        
        extends from cervix to body exterior
        
        uterine tubes
        
        AKA fallopian tubes
        
        form initial part of female duct system
        
        has 3 parts
        
        ampulla
        
        wide
        
        forms half the length of the uterine tube
        
        isthmus
        
        forms a narrow medial third of the tube
        
        infundibulum
        
        funnel shaped region
        
        uterine tube opening
        
        ciliated with fimbriae
        
        external genitalia
        
        vulva
        
        includes
        
        mons pubis
        
        labia majora
        
        labia minora
        
        clitoris
    - - structures
        
        organs
        
        testes
        
        lie within the scrotum
        
        scrotum is...
        
        sac of skin and superficial fascia that hangs outside the abdominopelvic cavity
        
        divided by a midline septum
        
        muscles that help maintain a constant intrascrotal temperature
        
        2 more items...
        
        characteristics
        
        2 of them
        
        approx. 4 cm long by 2.5 cm wide
        
        surrounded by 2 tunics
        
        tunica vaginalis
        
        1 more item...
        
        tunica albuginea
        
        1 more item...
        
        septa
        
        divide testis into 250 wedge-shaped lobules
        
        1 more item...
        
        testicular arteries
        
        branch into the abdomino aorta superior to the pelvis
        
        testicular veins
        
        accessory sex glands
        
        prostate
        
        bulbo-urethral glands
        
        seminal glands
        
        ducts
        
        ductus deferens
        
        mucosa is pseudo stratified epithelium
        
        thick muscular layer
        
        ejaculatory duct
        
        epididymis
        
        comma shaped
        
        urethra
        
        terminal point of the male duct sytem
        
        regions
        
        intermediate part of urethra
        
        spongy urethra
        
        75% of urethral length
        
        runs throught the penis and opens to the outside
        
        prostatic urethra
        
        surrounded by the prostate