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Healthy 40 year-old married couple seeking advice on contraceptive…

- - - - hypothalamus release gonadotropin-releasing hormone (GnRH)
        
        stimulate release of follicle-stimulating hormone (FSH)
        
        levels vary in cyclical pattern
        
        produce monthly sequence of events
        
        Ovarian Cycle
        
        3 Phases in 28 days
        
        3 more items...
    - - cease cycling for 1 year
        
        normal onset ages 45 to 55
        
        no more ovarian follicles remain
        
        follicle maturation stops
        
        significant amounts of progesterone and estrogen no longer secreted
        
        uterine lining no longer growing
    - - cyclical changes in endometrial lining
        
        influenced by estrogen and progesterone
        
        based on 28 day uterine cycle
        
        3 Phases
        
        Proliferative Phase
        
        days 6-14
        
        1 more item...
        
        Secretory Phase
        
        days 15-28
        
        1 more item...
        
        Menstrual Phase
        
        days 1-5
        
        1 more item...
  - - - Testes
        
        Epididymis
        
        Ductus (vas) Deferens
        
        Ampulla of Ductus Deferens
        
        Ejaculatory Duct
        
        Urethra
        
        2 more items...
        
        contraction
        
        1 more item...
        
        contracts
        
        forces sperm forward
        
        transports sperm from testes to urethra
        
        first portion of duct system
        
        site for sperm maturation
        
        Seminiferous Tubule
        
        sperm cell production
      - ACCESSORY GLANDS
        
        Seminal Glands
        
        Prostate
        
        Bulbo-urethral Glands
        
        clear, alkaline mucus
        
        lubricate tip of penis for copulation
        
        1 more item...
        
        secretion
        
        milky, slightly acidic
        
        contain citric acid, enzymes, prostate-specific antigen
        
        1 more item...
        
        secretion is largest contribution to semen volume
        
        alkaline secretion
        
        containing fructose and citric acid
        
        nourish sperm
        
        1 more item...
    - - EXTERNAL GENITALIA
        
        VULVA
        
        Clitoris
        
        small mass of erectile tissue
        
        homologous to the penis
        
        External Urethral Orifice
        
        Outlet for urinary system
        
        no reproductive function
        
        Labia Minora
        
        two smaller folds medial to labia majora
        
        no hair or adipose
        
        many sebaceous glands
        
        Prepuce of The Clitoris
        
        skin fold formed by union of labia minora
        
        serve to hood the clitoris
        
        Labia Majora
        
        two elongated hair-covered skin folds
        
        contain sebaceous glands, apocrine glands and adipose
        
        homologous to the scrotum
        
        Hymen
        
        thin fold of vascular mucous membrane
        
        partially cover the vaginal opening
        
        Mons Pubis
        
        rounded fatty eminence
        
        cushion pubic symphysis
        
        covered with coarse pubic hair after puberty
        
        Greater Vestibular Glands
        
        pea-sized mucus secreting glands
        
        lubricate distal end of vagina during coitus
        
        homologous to bulbo-urethral glands in males
      - ACCESSORY STRUCTURES
        
        Uterosacral Ligaments
        
        secure inferior uterus to sacrum, posteriorly
        
        Cardinal Ligaments
        
        laterally connect cervix and vagina to pelvic wall
        
        Round Ligaments
        
        anchors uterus
        
        anterior pelvic wall
        
        by descending through mesometrium and inguinal canal
        
        attach to skin of labia majora
        
        Mesosalpinx
        
        portion of broad ligament
        
        anchors uterine tube
        
        Mesometrium
        
        portion of broad ligament
        
        laterally supports uterus
        
        Mesovarium
        
        posterior fold of broad ligament
        
        supports ovaries
        
        Broad Ligament
        
        fold of peritoneum
        
        drapes over superior uterus
        
        enclose uterus and uterine tubes
        
        anchors them to lateral body walls
        
        Suspensory Ligaments
        
        lateral continuation of broad ligament
        
        attaches ovaries to lateral pelvic wall
        
        Ovarian Ligaments
        
        medially anchors ovaries to uterus
        
        enclosed within broad ligament
      - INTERNAL GENITALIA
        
        Vagina
        
        Ovaries
        
        Uterus
        
        Cervix
        
        Fundus
        
        2 more items...
        
        allow menstrual flow of blood
        
        1 more item...
        
        where offsprings are conceived
        
        serves as site for gestation before birth
        
        site of egg cell production
        
        serves as copulatory organ
        
        birth canal
        
        passage of menstrual flow
  - - - prevent sperm from reaching uterine tubes
        
        condoms, spermicidal gels, diaphragms
    - - flexible plastic structures
        
        inserted into uterus
        
        copper or synthetic progesterone
        
        help prevent implantation
    - - pulling out before ejaculation
        
        high failure rate
    - - Estrogen/Progesteron Patches
        
        prevent LH spike and ovulation
    - - avoiding sex during ovulation period
    - - taken within 72 hours of unprotected intercourse
        
        inhibit ovulation
    - - 100% way of preventing pregnancy
    - - surgically uterine tubes and tying off ends
        
        prevents sperm from reaching uterus
    - - outpatient procedure
        
        ductus deferens cut
        
        segment removed
        
        ends tied
        
        sperm unable to leave testes
- - - - couple might not have enough time to take care of another child
    - - weight gain
        
        emotional instability
        
        breast swelling or tenderness
        
        nausea, upset stomach
    - - may be able to afford surgical methods
        
        possibly could not afford to have another child
    - - married
        
        acceptable with other partner
        
        knowing they'll be spending the rest of their lives with each other
        
        mutual decision
- - - - less invasive
        
        temporary and reversible
    - - predictable
        
        being able to enjoy sex more often
    - - easiest method in my opinion
        
        costly, but no side effects
        
        in case of infidelity
        
        preventative measure for STD transmission
  - - - high failure rate
    - - costly depending on how frequent couple engages in sexual intercourse
    - - what's a marriage if you can't frequently have sex?
        
        does not always happen
    - - Vasectomy & Tubal Ligation
        
        permanent
        
        irreversible