Showing posts with label Reproductive Medicine. Show all posts
Showing posts with label Reproductive Medicine. Show all posts

11 June 2009

Human Reproduction and Development



Human Reproduction and Development

Human Gonads
* Primary sexual organs where genes are packaged into gametes
o Male - testes
o Female - ovaries
* Secrete sex hormones
o Regulate secondary sexual traits

Male Reproductive System
vas deferens
epididymis
testis
penis
seminal vesicle
prostate gland
bulbourethral gland
urethra
bladder
scrotum

Semen = Sperm + Secretions
* Secretions from epididymis aid sperm maturation
* Seminal vesicle secretes fructose and prostaglandins
* Prostate-gland secretions buffer pH in the acidic vagina
* Bulbourethral gland secretes mucus

Prostate Cancer
* Second leading cause of death in American men
* Detection

Testicular Cancer
* About 5,000 U.S. cases per year
* Can be detected by self exam

Spermatogenesis
* Spermatogonium (2n) divides by mitosis to form primary spermatocyte (2n)
* Meiosis produces haploid spermatids
* Spermatids mature to become sperm

Other Testicular Cells
* Sertoli cells
* Leydig cells

Male Hormonal Control
Hypothalamus
Anterior Pituitary
GnRH
LH
FSH
Sertoli Cells
Leydig Cells
Testes
Testosterone
Inhibin
Formation and Development of Sperm
Female Reproductive Organs
vagina
uterus
oviduct
ovary
vagina
clitoris
oviduct
ovary
uterus
Menstrual Cycle
* The fertile period for a human female occurs on a cyclic basis
* Menstrual cycle lasts about 28 days
* Follicular phase and luteal phase

Oocytes Arrested in Meiosis I
* Girl is born with primary oocytes already in ovaries
* Each oocyte has entered meiosis I and stopped
* Meiosis resumes, one oocyte at a time, with the first menstrual cycle

Menarche to Menopause
* First menstruation, or menarche, usually occurs between ages 10-16
* Menstrual cycles continue until menopause, in a woman’s late 40s or early 50s

Ovarian Cycle
secondary oocyte
antrum
primordial follicle
corpus luteum
first polar body
* Follicle grows and matures
* Ovulation occurs
* Corpus luteum forms
Female Hormonal Control
Hypothalamus
Anterior pituitary
GnRH
LH
FSH
Ovary
Estrogen
Progesterone,
estrogens
follicle growth,
oocyte maturation
Rising estrogen stimulates surge in LH
Corpus luteum
Cycle Overview
hypothalamus
anterior pituitary
FSH
LH
FSH
LH
estrogens
FOLLICULAR PHASE
LUTEAL PHASE
menstruation
ovulation
estrogens
progesterone
Fertilization
Pregnancy
Early Divisions
Blastocyst Forms
Implantation Begins
blastocoel
inner cell mass
trophoblast
Uterine cavity
Human Chorionic Gonadotropin (hCG)
Extraembryonic Membranes
yolk sac
chorionic cavity
chorionic villi
chorion
amniotic cavity
connecting stalk
Gastrulation - Day 15
Vertebrate Body Plan Emerges
The Placenta
Embryonic Period
Fetal Period
Fetal Nutrition
Teratogens
Birth (Labor)
Lactation
Stages of Human Development - Prenatal
* Zygote - Single cell
* Morula - Solid ball of cells
* Blastocyst - Ball with fluid-filled cavity
* Embryo - 2 weeks to 8 weeks
* Fetus - 9 weeks to birth
Stages of Human Development - Postnatal
* Newborn - First 2 weeks after birth
* Infant - 2 weeks to 15 months
* Child – To 10-12 years
* Pubescent - At puberty
* Adolescent - Puberty to maturation
* Adult
* Old age
Birth Control Options
Prevent fertilization
Prevent ovulation
Block implantation
AIDS
AIDS Test
Safer Sex
Bacterial STDs
Pelvic Inflammatory Disease (PID)
Viral STDs
Abortion

Human Reproduction and Development.ppt

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Introduction to the Male Half of Reproductive Biology



Introduction to the Male Half of Reproductive Biology
By:Genevieve Griffiths
University Of Delaware

Why Study Sperm Biology?
* One in six couples are infertile.
* In 40 per cent of cases the problem lies exclusively with the male, known as Male Factor Infertility.
* One in 25 males have a low sperm count, and one in 35 are sterile.
* With appropriate treatment, many couples struggling with male factor infertility are able to conceive.

Sexual Reproduction
* Occurs when two gametes (sperm + egg, 1N or ½ genome) combine genetic material (DNA) to form a zygote (embryo, 2N or 1 genome)
* Recombination permits genetic flexibility within a population (can lead to evolution)
* Offspring have characteristics from both parents as well as those unique from parents
* Sperm production is known as spermatogenesis
* Five mitotic divisions produce 16 primary spermatocytes from a single cell
* Two meiotic divisions produce 64 spermatids

Spermatogenesis
* Mitosis (2N (46 chromosomes) to 2N) must occur to create many cells from a single cell
* Meiosis (2N to 1N (23 chromosomes)) must occur to divide DNA in half

After meiosis, sperm dramatically change shape
Testes and Epididymis
* Spermatogeneis occurs in the seminiferous tubules of the testes
* Sperm maturation occurs in the epididymis

Immature Sperm
Mature Sperm
Mammalian Fertilization
cumulus
cells
zona
pellucida
Egg
Mammalian Fertilization
cumulus
cells
Oocyte

Introduction to the Male Half of Reproductive Biology.ppt

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Male Female Reproductive System



Male Female Reproductive System

Male Reproduction -Testis
* Compartments
Testicular cell types
* Germ cells - spermatogenesis
Molecular Structure of LH and FSH
Spermatogonium
Resting cell and 3 active cells
Mitotic divisions
Type B spermatogonia
1o spermatocytes
Meiosis I
2o spermatocytes
spermatids
Mitotic divisions
Meiosis II
Spermatogenesis
spermatozoa
Sperm Maturation vs Capacitation
Sperm vs Seminal Plasma vs Semen
Somatic cells
Sertoli cell function
Major Actions of Testosterone
Androgens
Actions of androgens and metabolites
* Estrogens
Relative abundance of steroids in males and females
Major Components of the Reproductive Female System
GnRH pulse generator
Progesterone Effects on the Pulse Generator
Effects of Estradiol on the Pulse Generator
Ovarian Cell Types
Germ Cells
Stages of Follicular development
Ovulation
Corpus Luteum formation
Ovarian Cycle
Human Menstrual Cycle
Maternal Recognition of Pregnancy
Physiological effects of ovarian steroids
* Estrogens
* Progesterone
Sexual Differentiation
Duct Development
MIH
testosterone
External Genitalia
Response to dihydrotestosterone
Brain
Sexual Differentiation of the Hypothalamus

Male Female Reproductive System.ppt

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REPRODUCTIVE SYSTEM



REPRODUCTIVE SYSTEM

REPRODUCTIVE SYSTEM: Design
* Not for Homeostasis; Instead to Perpetuate the Species
* Sexual Reproduction Results in Genetic Variability
* Internal Fertilization & Gestation
* One Offspring per Pregnancy is Typical

REPRODUCTIVE SYSTEM: Functions
* Production & Support of Gametes
* Formation, Transport & Delivery of Sperm
* Formation & Transport of Ova
* Protect & Support Developing Embryo, and Nourish Fetus
* Deliver the Fetus

REPRODUCTIVE SYSTEM: Overview of Anatomy
* Reproductive Organs
* Associated Ducts
* Accessory Glands
* External Genitalia

MALE ANATOMY: TESTES
* From the Greek for “witness” (e.g., testify)
* Essential organs of reproduction in the male (Male Gonad)
* Site of sperm production
* Suspended in scrotum by spermatic cord
* Oval, ~4.5 cm long, 10.5 - 14 gms

MALE ANATOMY: SCROTUM
* Pouch of skin and fascia evaginated from anterior abdominal wall
* Subdivided into two lateral compartments, indicated by Raphe (Ridge)
* Houses testes, keeps them cool (93F)
* Cremaster muscle brings testes closer to body
* Dartos muscle causes wrinkling

MALE ANATOMY: TESTES
* Develop initially in abdominal cavity (retroperitoneally)
* Descend into scrotum
* Seminiferous tubules: Sites of sperm production
* Interstitial Cells: Secrete Testosterone
* Efferent ductules: Carry sperm from testes
* Epididymis:

MALE ANATOMY: SPERMATIC CORD
* Contains structures passing to and from testes
* Coverings derived from abdominal wall
* Contents include:
o Vas deferens
o Spermatic artery and vein
o Spermatic nerve
o Lymph vessel

MALE ANATOMY: VAS (DUCTUS) DEFERENS
* Carries sperm from epididymis to seminal vesicle
* Passes through inguinal canal into body cavity
* Crosses surface of urinary bladder
* Joins with duct of seminal vesicle to form the ejaculatory duct
* Vasectomy

MALE ACCESSORY GLANDS: SEMINAL VESICLES
* Paired structures posterior to urinary bladder
* Secrete ~60% of seminal fluid
* Fluid is sugary, alkaline
* Rich in carbohydrates, Vitamin C

MALE ACCESSORY GLANDS : PROSTATE GLAND
* Located inferior to urinary bladder, anterior to rectum
* Surrounds prostatic urethra
* Secretes ~25% of seminal fluid
* Enzymes to Liquify Semen

MALE ACCESSORY GLANDS : BULBOURETHRAL GLANDS
* Also called Cowper’s glands
* Lateral to membranous urethra
* Secrete a drop of alkaline mucus
o Cleans, lubricates urethra

MALE ANATOMY: PENIS

* Male copulatory organ
* Functions to introduce sperm into female
* Consists of three erectile bodies
o Two corpora cavernosa
o One corpus spongiosum

MALE ANATOMY: PENIS
* Corpus spongiosum
* Corpora cavernosa
* Prepuce (foreskin):

MALE PHYSIOLOGY: SPERMATOGENESIS
o Occurs in seminiferous tubules
o Spermatogonia divide mitotically
o One Spermatocyte eventually gives rise to Four Sperm via meiosis
o Y Sperm are Smaller, Faster, Prefer Alkaline Environment
o X Sperm are Larger, Stronger, Prefer Acidic Environment


MALE SEXUAL RESPONSE
* Erection
o Arteries dilate, increasing blood in spongy tissue
o Constricts veins, causes erection
* Ejaculation (expulsion)
o Semen passes through urethra
o Contractions of urethra & penile musculature


MALE HORMONAL CONTROLS
* Gonadotropic Hormones
* Testosterone (Male Sex Hormone)

FEMALE ANATOMY: OVARY
* Female Gonad
* All ova arrested at prophase I at birth
* Paired, oval, almond sized
* Supported by ligaments

FEMALE ANATOMY: UTERINE (Fallopian) TUBES
* Site of Fertilization
* Paired, ~10 cm long
* Attach to uterus, one on each side
* Transport via Cilia & Peristalsis

FEMALE ANATOMY: UTERUS
* Usually unpaired; hollow, muscular, pear-shaped organ
* Receives uterine tubes, empties into vagina
* Site of Implantation & Development
* Supported by ligaments
* Uterine wall has three layers

FEMALE ANATOMY: UTERUS
* Fundus: Arches above entry of uterine tubes
* Body: Large triangular lumen
* Isthmus: Narrowed region
* Cervix:

FEMALE ANATOMY: VAGINA
* Functions:
* Located between urethra and rectum
* Lined with stratified squamous E.T.
* Acidic environment (Resident Bacteria)
* Fornix: Circular recess around cervix; upper portion of vagina
* Hymen:
* Bartholin’s glands:

FEMALE ANATOMY: VULVA (External Genitalia)
* Mons pubis: Fatty mound
* Labia majora: Outer Folds of skin, Homologous to scrotum
* Labia minora: Inner folds, Encircle clitoris, forming prepuce
* Clitoris: Homologous to penis, corpora cavernosa

FEMALE ANATOMY: CLITORIS
* Foreskin or Prepuce
* Function – Sexual Pleasure
* Orgasm controlled by Sympathetic Division of ANS

FEMALE ANATOMY: BREASTS
* Structurally – Integument
* Functionally – Reproductive

HORMONAL CONTROL: ADULT FEMALE
* Four hormones involved:

THE OVARIAN CYCLE
* Includes:

FOLLICLE DEVELOPMENT
* Up to 20 follicles begin maturation process monthly
* Only one secondary follicle reaches maturity
* Others undergo atresia (degradation)
* Controlled primarily by FSH
* Causes follicle cells to secrete estrogen


OVULATION
* Caused by LH surge
* Day 14 (28-day cycle)
* Expels ovum into abdominal cavity
* Fimbriae on uterine tube sway vigorously, produce a current
* Fimbriae scratch Graafian follicle, rupture it, pull ovum into tube

FORMATION OF CORPUS LUTEUM
* Ruptured Graafian follicle becomes corpus luteum
* Corpus luteum secretes estrogen, progesterone
* Maintains endometrial lining during pregnancy

THE UTERINE CYCLE

* Proliferative phase
o Follows Menstruation
o Estrogen from follicle stimulates proliferation of endometrium
* Secretory phase
o Follows Ovulation
o Progesterone from corpus luteum stimulates secretion by endometrium
* Menstrual phase

REPRODUCTIVE SYSTEM.ppt

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27 May 2009

Infertility



Infertility
By:Stephanie R. Fugate D.O.
Dewitt Army Community Hospital
Department of OB/GYN

Objectives
* Define primary and secondary infertility
* Describe the causes of infertility
* Diagnosis and management of infertility

Requirements for Conception
* Production of healthy egg and sperm
* Unblocked tubes that allow sperm to reach the egg
* The sperms ability to penetrate and fertilize the egg
* Implantation of the embryo into the uterus
* Finally a healthy pregnancy

Infertility
* The inability to conceive following unprotected sexual intercourse
o 1 year (age < 35) or 6 months (age >35)
o Affects 15% of reproductive couples
+ 6.1 million couples
o Men and women equally affected
* Reproductive age for women
* With the proper treatment 85% of infertile couples can expect to have a child
* Health problems develop
* SAB
* Primary infertility
* Secondary infertility

Conception rates for fertile couples
Age and Pregnancy
Pregnancy
Age and related miscarriage
Causes for infertility

* Male
o ETOH
o Drugs
o Tobacco
o Health problems
o Radiation/Chemotherapy
o Age
o Enviromental factors
* Female
o Age
o Stress
o Poor diet
o Athletic training
o Over/underweight
o Tobacco
o ETOH
o STD’s
o Health problems

* Anovulation (10-20%)
* Anatomic defects of the female genital tract (30%)
* Abnormal spermatogenesis (40%)
* Unexplained (10%-20%)

Evaluation of the Infertile couple
* History and Physical exam
* Semen analysis
* Thyroid and prolactin evaluation
* Determination of ovulation
o Basal body temperature record
o Serum progesterone
o Ovarian reserve testing
* Hysterosalpingogram

Abnormalities of Spermatogenesis
Male Factor
Semen Analysis (SA)
* Obtained by masturbation
* Provides immediate information
o Quantity
o Quality
o Density of the sperm
* Abstain from coitus 2 to 3 days
* Collect all the ejaculate
* Analyze within 1 hour
* A normal semen analysis excludes male factor 90% of the time
* Morphology
* Motility

Normal Values for SA
Volume
Sperm Concentration
Motility
Viscosity
Morphology
pH
WBC

Causes for male infertility
Abnormal Semen Analysis
* Azospermia
* Oligospermia
* Abnormal volume

Evaluation of Abnormal SA
* Repeat semen analysis in 30 days
* Physical examination
o Testicular size
o Varicocele
* Laboratory tests
o Testosterone level
o FSH (spermatogenesis- Sertoli cells)
o LH (testosterone- Leydig cells)
* Referral to urology

Evaluation of Ovulation
Menstruation
* Ovulation occurs 13-14 times per year
* Menstrual cycles on average are Q 28 days with ovulation around day 14
* Luteal phase
* Progesterone causes
* Involution of the corpus luteum causes a fall in progesterone and the onset of menses
Menstrual Cycle
Ovulation

* A history of regular menstruation suggests regular ovulation
* The majority of ovulatory women experience
o fullness of the breasts
o decreased vaginal secretions
o abdominal bloating
* Absence of PMS symptoms may suggest anovulation
o mild peripheral edema
o slight weight gain
o depression

Diagnostic studies to confirm Ovulation
* Basal body temperature
o Inexpensive
o Accurate
* Endometrial biopsy
o Expensive
o Static information
* Serum progesterone
o After ovulation rises
o Can be measured
* Urinary ovulation-detection kits
o Measures changes in urinary LH
o Predicts ovulation but does not confirm it

Basal Body Temperature
* Excellent screening tool for ovulation
o Biphasic shift occurs in 90% of ovulating women
* Temperature
o drops at the time of menses
o rises two days after the lutenizing hormone (LH) surge
* Ovum released one day prior to the first rise
* Temperature elevation of more than 16 days suggests pregnancy

Serum Progesterone
* Progesterone starts rising with the LH surge
o drawn between day 21-24
* Mid-luteal phase
o >10 ng/ml suggests ovulation

Anovulation Symptoms Evaluation
* Irregular menstrual cycles
* Amenorrhea
* Hirsuitism
* Acne
* Galactorrhea
* Increased vaginal secretions
* Follicle stimulating hormone
* Lutenizing hormone
* Thyroid stimulating hormone
* Prolactin
* Androstenedione
* Total testosterone
* DHEAS
* Order the appropriate tests based on the clinical indications

Anatomic Disorders of the Female Genital Tract
Sperm transport, Fertilization, & Implantation
* The female genital tract is not just a conduit
o facilitates sperm transport
o cervical mucus traps the coagulated ejaculate
o the fallopian tube picks up the egg
* Fertilization must occur in the proximal portion of the tube
o the fertilized oocyte cleaves and forms a zygote
o enters the endometrial cavity at 3 to 5 days
* Implants into the secretory endometrium for growth and development

Acquired Disorders
* Acute salpingitis
* Intrauterine scarring
* Endometriosis, scarring from surgery, tumors of the uterus and ovary
* Trauma

Congenital Anatomic Abnormalities
Hysterosalpingogram
* An X-ray that evaluates the internal female genital tract
* Performed between the 7th and 11th day of the cycle
* Diagnostic accuracy of 70%

Hysterosalpingogram
* The endometrial cavity
* Fallopian tubes
* Dye should spill promptly

Unexplained infertility
Treatment of the Infertile Couple
Inadequate Spermatogenesis
Clomid
Superovulatory Medications
Anatomic Abnormalities
Assisted Reproductive Technologies (ART)
Emotional Impact
Conclusion
Test Question Case
Causes for Abnormal SA
* No sperm
o Klinefelter’s syndrome
o Sertoli only syndrome
o Ductal obstruction
o Hypogonadotropic-hypogonadism
* Few sperm
o Genetic disorder
o Endocrinopathies
o Varicocele
o Exogenous (e.g., Heat)
Abnormal Count
* Abnormal Morphology
o Varicocele
o Stress
o Infection (mumps)
* Abnormal Motility
o Immunologic factors
o Infection
o Defect in sperm structure
o Poor liquefaction
o Varicocele
* Abnormal Volume
o No ejaculate
+ Ductal obstruction
+ Retrograde ejaculation
+ Ejaculatory failure
+ Hypogonadism
o Low Volume
+ Obstruction of ducts
+ Absence of vas deferens
+ Absence of seminal vesicle
+ Partial retrograde ejaculation
+ Infection

Infertility.ppt

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24 May 2009

Sexual organs



Sexual organs
* Genitalia
* Reproductive tracts
* Glandular systems
* Nervous system

Women
* Genitalia
o Vulva
o Clitoris
o Vagina
* Reproductive tracts
o Ovaries
o Fallopian tubes
o Uterus
The vulva
* Mons pubis or mons veneris
* Labia majora
* Labia minora
* Prepuce or clitoral hood
* Bartholin’s glands
* Vaginal opening
* Skene’s glands
* Introitus or vestibule; vestibular bulbs
* Pubococcygeal muscles and Kegel exercises: close to 1 cm diameter
o Vaginismus and dyspareunia
* Perineum and episiotomy

The clitoris
* Glans
* Shaft
* Smegma
* Circumcision, clitoridectomy (excision), Pharaonic circumcision, and infibulation
* Urethra, between clitoris and vagina

The vagina
* Hymen or maidenhead
* Mucosal lining: Lubrication
* Nerve endings: Outer 1/3 of vagina
* Grafenberg spot

Vaginal health
* Self-examination with mirror, flashlight
* Do not douche or use vaginal deodorants
* Wash vulva daily, but do not scrub
o Insist that a sexual partner is also freshly clean
* Wear all-cotton panties
o Especially if taking antibiotics or perspiring
* Normal signs:
o A creamy discharge, clear to white in color
o Odor from sweet to musky, varies with hormones, medication, perspiration
* Limit tampon use: TSS, ulceration
o Avoid superabsorbent types
o Four-hour limit; no overnight use
* Change panty liners frequently
* Warning signs of vaginitis:
o Yellow or green discharge, clumps in discharge
o Foul odor
o Irritation, itching, or burning
o Urgent need to urinate

Reproductive tract
* Uterus
o Fundus and body: Perimetrium, myometrium, and endometrium: Endometriosis
o Cervix and Os
* Ovaries: Hormones and ova
o Ovarian ligaments
o Follicles and oocytes
* Fallopian tubes
* Hysterectomy

Fallopian tubes
* Fimbriae collect ova
* Infundibulum and ciliary movement
* Fertilization
* Ectopic pregnancy

Menstruation
* Menarche
* Dysmenorrhea
* Oligomenorrhea, amenorrhea, and menorrhagia
* Attitudes toward menstruation
* Sexual activity during menses: Safer sex
* PMS/PMDD: Does it exist?

The menstrual cycle
* 1. Menstrual phase, 5 days (variable)
* 2. Proliferative phase, 9- 11 days
o FSH --> Estrogen --> Endometrial growth
* 3. Ovulation, 14 days before menses
* 4. Secretory or luteal phase, 14 days
o LH --> Progesterone --> Preparation for implantation
Menopause
* Clemacteric, perimenopause, and menopause
* Decreased responsiveness of ovaries to pituitary hormones
* Perimenopausal symptoms
o Flashes, flushes, and sleep problems
o Dizziness, pains, and paresthesias
o Vaginal dryness, impaired cognition
* HRT/ERT
HRT/ERT: Increased risk of health problems counter obvious benefits
* Breast cancer:
o Estrogen alone: 15% increased risk; Estrogen + progestin: 58%; Estrogen + testosterone: 77% (all compared to no HRT) (Tamimi et al, 2006)
o The Women’s health Initiative study (2002) reported 26% increase in estrogen + progestin group—from 30/10,000 to 38/10,000

Other health risks of HRT
* Contrary to predictions, a 29% increased risk of heart attack (37/10,000 vs 30/10,000)
* 41% increased risk of stroke (29/10,000 vs. 21/10,000)
* Blood clot risk more than doubles (34/10,000 vs 16/10,000)
* Risk of ovarian cancer triples in women using estrogen for 20 or more years (NCI, 2002)
* Estrogen + progestin HRT impairs hearing (Frisina et al, 2006)

The gynecological examination
* Medical and sexual history
* External examination
* Speculum examination
* Pap smear
* Palpation
* Recto-vaginal examination
* Breast examination
o Breast self-examination
Breasts

* Secondary sex characteristics and self-esteem: Breasts vs. menstruation
* Mammary glands and ducts
* Adipose tissue
* Nipples and areolas
o Respond to stimulation: Temperature, arousal
o May be involuted
* Sensitivity varies with menstrual cycle

Sexual organs.ppt

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22 May 2009

Intra Cytoplasmic Sperm Injection (ICSI) Procedure



Intra Cytoplasmic Sperm Injection (ICSI) Procedure
Intracytoplasmic Sperm Injection procedure

The indications for ICSI and a video of the process

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Chinese Fertilty Massage video



Chinese Fertilty Massage video

Massage techniques for blocked fallopian tubes, endometriosis, female fertility and fibroids.

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Infertility - Advances in Treatment video(Part 2)



Infertility - Advances in Treatment video(Part 2)

Overview:
Infertility affects thousands of couples. In this interview, Dr. Howard McClamrock discusses advances in understanding and treating infertility.

Part Two:
How in-vitro fertilization works
Who can benefit most
Egg retrieval
Pre-implantation testing
Intracytoplasmic sperm injection
GIFT and ZIFT procedures
Acupuncture and IVF
Frozen eggs

Guest:
Dr. Howard McClamrock, director of the Center for Assisted Reproductive Technologies at the University of Maryland Medical Center. Dr. McClamrock is also an associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.

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Dealing with infertility Video



Dealing with infertility Video

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13 May 2009

Herbal Alternatives For Erectile Dysfunction video



Herbal Alternatives For Erectile Dysfunction

Most men are extremely bothered by erectile dysfunction. Herbal treatment has been found to be one of the safest and efficacious ways to deal with it. With the number of herbal medicines in the market that promise harder erections and improvement in sexual performance, it can be quite confusing which one really delivers results.

Traditional Chinese medicine and Western medicine each have its own merits. The former considers a problem from an overall point of view and is comparatively circumspect, while the latter proceeds from a microscopic point of view and excels in objectivity, reliability, and convincing power. If treatment can be carried out in a mutually complementary way by combining traditional Chinese medicine and Western medicine to cure diseases, that will no doubt yield the best result.

No matter whether traditional Chinese medicine or Western medicine is concerned, the object of study is man's health and the diseases that affect it, and the purpose of the study is how to maintain and enhance the health of the human body and to defeat or resolve the diseases that do harm to it.



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Erectile Dysfunction Treatment



Erectile Dysfunction Treatment - Penile Prosthesis, Dr. Herb Riemenschneider


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Urinary Incontinence and Erectile Dysfunction video



Urinary Incontinence and Erectile Dysfunction video

This is a short clip by Dr. Herb Riemenschneider of Riverside Urology in Columbus, Ohio about Urinary Incontinence and Erectile Dysfunction. Contact his office via the website and ask for a free DVD of the full length presentation.

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12 May 2009

Female Reproductive System



Female Reproductive System

Adolescence
* Puberty
* Burst of hormones activate maturation of the gonads: ovaries
* Begins: 8-13 yrs of age
* Abnormally early = precocious puberty
* Delayed =Primary Amenorrhea

Function of Female Reproductive System
* Produce sex hormones
* Produce functioning gamates [ova]
* Support & protect developing embryo

General Physical Changes
* Axillary & pubic hair growth
* Changes in body conformation [widening of hips, development of breasts]
* Onset of first menstrual period [menarche]
* Mental changes

THE EMOTIONAL HEALTH OF ADOLESCENT GIRLS A CONCERN
Major Organs
* Ovaries [ gonads]
* Uterine tubes [ fallopian tubes]
* Uterus
* Vagina
* Accessory glands
* External genitalia
* Breasts

During Oogenesis
During Spermatogenesis & Mitosis
oogenesis
fallopian tubes [uterine tubes]
uterus
endometrium
Uterine arteries
* Arcuate arteries - encircle endometrium
* Radial arteries – connect arcuate to straight
* Straight arteries – deliver blood to basilar zone
* Spiral arteries – deliver blood to functional zone

The Cervix
The Vagina
External genetalia
Mammary Glands [ breasts]
glands

Female Reproductive System.ppt

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Male Reproductive System



Male Reproductive System
presentation lecture from: Evergreen University

Adolescence
* Puberty
* Burst of hormones activate maturation of the gonads: testes
* Begins: 9 – 14 yrs of age
* Abnormally early = precocious puberty
* Delayed = eunuchoidism

General Physical Changes
* Enlargement of the external and internal genitalia
* Voice changes
* Hair growth
* Mental changes
* Changes in body conformation and skin
* Sebaceous gland secretions thicken/increase acne

External Genitalia
* Gonads = testes undescended by birth= cryptorchidsim
* Scrotum
* Penis
Testes
* Each testis is an oval structure about 5 cm long and 3 cm in diameter
* Covered by: tunica albuginea
* Located in the scrotum
* There are about 250 lobules in each testis. Each contains 1 to 4 -seminiferous tubules that converge to form a single straight tubule, which leads into the rete testis.
* Short efferent ducts exit the testes.
* Interstitial cells (cells of Leydig), which produce male sex hormones, are located between the seminiferous tubules within a lobule.

scrotum
* consists of skin and subcutaneous tissue
* A vertical septum, of subcutaneous tissue in the center divides it into two parts, each containing one testis.
* Smooth muscle fibers, called the dartos muscle, in the subcutaneous tissue contract to give the scrotum its wrinkled appearance. When these fibers are relaxed, the scrotum is smooth.
* the cremaster muscle, consists of skeletal muscle fibers and controls the position of the scrotum and testes. When it is cold or a man is sexually aroused, this muscle contracts to pull the testes closer to the body for warmth.

Epididymis
* a long tube (about 6 meters) located along the superior and posterior margins of the testes.
* Sperm that leave the testes are immature and incapable of fertilizing ova. They complete their maturation process and become fertile as they move through the epididymis. Mature sperm are stored in the lower portion, or tail, of the epididymis

spermatic cord
* contains the proximal ductus deferens, testicular artery and veins, lymph vessels, testicular nerve, cremaster muscle and a connective tissue covering.

Duct System
* Sperm cells pass through a series of ducts to reach the outside of the body. After they leave the testes, the sperm passes through the epididymis, ductus deferens, ejaculatory duct, and urethra.

Ductus Deferens [vas deferens]

* a fibromuscular tube that is continuous with the epididymis.
* enters the abdominopelvic cavity through the inguinal canal and passes along the lateral pelvic wall, behind bladder & toward the prostate gland. Just before it reaches the prostate gland, each ductus deferens enlarges to form an ampulla.
* Sperm are stored in the proximal portion of the ductus deferens, near the epididymis

Ejaculatory Duct
* Each ductus deferens, at the ampulla, joins the duct from the adjacent seminal vesicle (one of the accessory glands) to form a short ejaculatory duct.
* Each ejaculatory duct passes through the prostate gland and empties into the urethra.

Urethra
* extends from the urinary bladder to the external urethral orifice at the tip of the penis.
* It is a passageway for sperm and fluids from the reproductive system and urine from the urinary system.
* divided into three regions: The prostatic urethra, the membranous urethra & the penile urethra (also called spongy urethra or cavernous urethra)

accessory glands
* are the seminal vesicles, prostate gland, and the bulbourethral glands. These glands secrete fluids that enter the urethra.

Seminal Vesicles
* glands posterior to the urinary bladder.
* Each has a short duct that joins with the ductus deferens at the ampulla to form an ejaculatory duct, which then empties into the urethra.
* The fluid is viscous and contains fructose, prostaglandins and proteins.

Prostate
* a firm, dense structure about the size of a walnut that is located just inferior to the urinary bladder.
* encircles the urethra as it leaves the urinary bladder.
* Numerous short ducts from the prostate gland empty into the prostatic urethra. The secretions of the prostate are thin, milky colored, and alkaline. They function to enhance the motility of the sperm.

Bulbourethral Glands
* small, about the size of a pea, and located near the base of the penis. A short duct from each enters the proximal end of the penile urethra.
* In response to sexual stimulation, the bulbourethral glands secrete an alkaline mucus-like fluid

Seminal Fluid or Semen
* a slightly alkaline mixture of sperm cells and secretions from the accessory glands.
* Secretions from the seminal vesicles make up about 60 percent of the volume of the semen, with most of the remainder coming from the prostate gland. The sperm and secretions from the bulbourethral gland contribute only a small volume.
* The volume of semen in a single ejaculation may vary from 1.5 to 6.0 ml. There are between 50 to 150 million sperm per milliliter of semen. Sperm counts below 10 to 20 million per milliliter usually present fertility problems.

penis
* is a cylindrical pendant organ located anterior to the scrotum and functions to transfer sperm to the vagina.
* consists of three columns of erectile tissue that are wrapped in connective tissue and covered with skin. The two dorsal columns are the corpora cavernosa. The single, midline ventral column surrounds the urethra and is called the corpus spongiosum.
* 3 parts: a root, body (shaft), and glans penis.
* The root of the penis attaches it to the pubic arch
* the body is the visible, pendant portion.
* The corpus spongiosum expands at the distal end to form the glans penis.
* The urethra, which extends throughout the length of the corpus spongiosum, opens through the external urethral orifice at the tip of the glans penis. A loose fold of skin, called the prepuce, or foreskin, covers the glans penis.

Erection

* Involves increase in length, width & firmness
* Changes in blood supply: arterioles dilate, veins constrict
* The spongy erectile tissue fills with blood
* Erectile Dysfunction [ED] also known as impotence

Hormones
* Follicle-stimulating hormone (FSH) stimulates spermatogenesis
* Interstitial Cell Stimulating Hormone (ICSH) stimulates the production of testosterone
* testosterone stimulates the development of male secondary sex characteristics & spermatogenesis.

Spermatogenesis
* Sperm are produced within the seminiferous tubules.
* Interspersed within the tubules are large cells which are the sustentacular cells (Sertoli's cells), which support and nourish the other cells.
* Early in embryonic development, primordial germ cells enter the testes and differentiate into spermatogonia
* Spermatogonia are diploid cells, each with 46 chromosomes (23 pairs) located around the periphery of the seminiferous tubules.
* At puberty, hormones stimulate these cells to begin dividing by mitosis. Some remain at the periphery as spermatogonia.
* Others become primary spermatocytes. Because they are produced by mitosis, primary spermatocytes, like spermatogonia, are diploid and have 46 chromosomes.
* Each primary spermatocytes goes through the first meiotic division, meiosis I, to produce two secondary spermatocytes, each with 23 chromosomes (haploid). Just prior to this division, the genetic material is replicated
* During meiosis I, one chromosome, goes to each secondary spermatocyte. In the second meiotic division, meiosis II, each secondary spermatocyte divides to produce two spermatids. There is no replication of genetic material in this division, but a single-stranded chromatid goes to each cell.
* As a result of the two meiotic divisions, each primary spermatocyte produces four spermatids.
* each spermatid has 23 chromosomes (haploid), one from each pair in the original primary spermatocyte.

* The final step in the development the spermatids formed from spermatogenesis become mature spermatozoa, or sperm.
* The mature sperm cell has a head, midpiece, and tail. The head, also called the nuclear region, contains the 23 chromosomes surrounded by a nuclear membrane. The tip of the head is covered by an acrosome, which contains enzymes that help the sperm penetrate the female gamete. The midpiece, metabolic region, contains mitochondria that provide adenosine triphosphate (ATP). The tail, locomotor region, uses a typical flagellum for locomotion.

Male Reproductive System.ppt

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Puberty



Puberty
Presentation by:Angela Bauer-Dantoin, Ph.D.
Associate Professor, Human Biology and Women's Studies
University of Wisconsin Green Bay

* defined as transition period between sexually immature child to sexually mature, fertile adult
* involves growth and maturation of many tissues
* timing has much individual variability
* sequence of events doesn’t vary
* timing differs between the sexes:
o growth spurt begins ~2 yrs earlier in females
o females become fertile ~1 yr earlier than males

Typical sequence of pubertal events Females vs. Males
Ovarian changes during childhood
Testicular changes during childhood
* at birth, seminiferous tubules contain only Sertoli cells and spermatogonia
* Leydig cells are present at birth; disappear by 6 months of age
* Leydig cells reappear at 9-10 yrs. > spermatogenesis begins
* mature sperm not produced until 14-15th yr.
* spermatogenesis depends on descent of testes into scrotum
* body temperature prevents spermatogenesis
* descent >months 7-9 of gestation
* under influence of testosterone
* testes “guided” by gubernaculum (cord attached to testes, scrotum)

Cryptorchidism
* in 3-4% of newborn males, testes haven’t descended
* consequences:
o germ cells killed by normal body temperature
o increased incidence of testicular cancer
* usually corrected with surgery or gonadotropins / GnRH by 2 yrs

Hormonal changes at puberty
* in young children, LH and FSH levels insufficient to initiate gonadal function
* between 9-12 yrs., blood levels of LH, FSH increase
* amplitude of pulses increases, especially during sleep
* high levels of LH, FSH initiate gonadal development
* GH secretion from pituitary also increases
* TSH (thyroid stimulating hormone) secretion from pituitary increases in both sexes:
o increases metabolic rate
o promotes tissue growth

Female hormonal changes
* surge of LH release initiates 1st ovarian cycle
* usually not sufficient to cause ovulation during 1st cycle
* brain and endocrine systems mature soon thereafter
* estrogen levels in blood increase, due to growing follicles
* estrogen induces secondary sex characteristics:
o growth of pelvis
o deposit of subcutaneous fat
o growth of internal reprod. organs, external genitalia
* androgen release by adrenal glands increases > growth of pubic hair, lowering of voice, growth of bone, increased secretion from sebaceous glands

Male hormonal changes
* LH and FSH release increases ~10 yrs. of age
* spermatogenesis; androgen secretion
* adrenals also secrete androgens
* androgens initiate growth of sex accessory structures (e.g. prostate), male secondary sex characteristics (facial hair, growth of larynx)
* androgens causes retention of minerals in body to support bone and muscle growth
* Sertoli cells also secrete some estrogen

Gonadostat hypothesis

* “Prepubertally, steroid hormone feedback operates at a very low setpoint; at puberty, set point increases.”
* if setpoint is raised at puberty, then LH and FSH levels would increase
* evidence: smaller amount of estrogen needed to lower gonadotropin levels in children (vs. adult women)
* evidence against hypothesis: in children without gonads, increase in LH, FSH levels occurs at normal age
* conclusion: even though puberty involves a change in setpoint, it is not the driving force for puberty

Hypothalamic Maturation Hypothesis

* “Activation of reproductive system at puberty is due to maturation of hypothalamus”.
* assume GnRH is driving force for puberty
* supporting evidence:
* in monkeys and humans, secretion of GnRH increases at puberty in absence of gonads
* give immature monkey GnRH > will show ovulatory cycles with estrogen, LH surges
* females with Turner’s Syndrome (XO) show normal LH, FSH onset
* tumors secreting GnRH can cause precocious puberty

Timing of puberty
* trend toward earlier puberty exists within W.
Europe and USA
* examination of lifestyle changes may give clues regarding mechanisms inducing onset
* 2 possible contributing factors: photoperiod and nutrition

Photoperiod
* refers to daylength (amount of light to which a person is exposed / day)
* electricity allows us to artificially extend daylength
* typically, we see only 8 hrs of darkness / day
* simulates summer photoperiod (“long days”)
* evidence against photoperiod hypothesis:
o intensity of domestic light not sufficient to affect neural mechanisms regulating GnRH secretion
o little evidence that photoperiod regulates human reproductive activity
Nutrition

* “Critical body weight must be attained before activation of the reproductive system”.
* even though age of menarche is decreasing, the average body weight of menarche remains the same
* earlier puberty due to improvement of nutrition, living conditions, healthcare?
* evidence supporting hypothesis:
o obese girls go through early menarche
o malnutrition is associated with delayed menarche
o primary amenorrhea common in lean female athletes
o “bodyfat” setpoint very noticeable in girls with fluctuating body weight due to anorexia nervosa

Puberty.ppt

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Puberty



Puberty
Presentation lecture by:Dr. Penny Frohlich
Hormones & Puberty

* Hypothalamus stimulates pituitary gland
o growth hormone which causes growth spurt
o ovaries and testes release gonadotrophins (sex hormones)
+ males: testosterone
+ females: estrogen and progesterone

Hormones & Puberty
* hormones stimulate
o growth of primary sexual characteristics (genital)
o growth of secondary sexual characteristics (non-genital)
o precursors to adult sexuality

Sex Differences in Puberty

* Growth spurt begins
o 10.5 years in girls
o 12.5 years in boys
o girls taller than boys between ages 11-13 years
* full adult height
o 17 years old in girls
o 21 years old in boys

Sex Differences in Puberty
* Menarche: first menstrual cycle
o typically occurs by age 12-13
o initially may involve anovulatory, irregular cycles
* Spermarche: first ejaculation
o typically occurs by age 15
o initial period of sterility

Sex Differences in Puberty
* Puberty marks an increased incidence of internalizing disorders in girls compared to boys (Haward & Sanborn, 2002; Kessler, 2003)
* Due to hormones? Environmental variables? Pregnancy?
* Is depression adaptive? (Nesse, 2000)

Precocious and Delayed Puberty
* Girls who enter puberty early more likely to have teen pregnancy
* girls who have teen pregnancy, more likely to have daughters with teen pregnancy

Precocious and Delayed Puberty
* Vandenbergh Effect
o male present --> earlier onset of puberty
o females only --> later onset of puberty
o may be a way of regulating population density

Precocious and Delayed Puberty
* Stable species – unchanging predictable environments, live long lives in large populations, large bodied, lavish lots of parental attention on few offspring – reach puberty later
* Opportunistic species – unstable unpredictable ecosystems – conditions good, everyone begins mating or pollinating --> conditions favorable, reach puberty rapidly

Precocious and Delayed Puberty
* Absent Father Theory:
o girls abandoned by their father behave like females from opportunistic species and reach puberty earlier (Draper, Belsky, & Harpending).
o process may be caused by pheromones
* Strategies for reproductive success
1) early pubertal development, low investment in offspring
2) later pubertal development, high investment in offspring
* Evidence in support:
o females with absent father reached puberty earlier (Surbey, 1988, 1990)
o females with greater emotional distance from parents reached puberty earlier (Sternberg, 1988)
o females with greater stress in parental relationship reached puberty earlier
Correlation does not equal causation!!!
* Absent father predicts early puberty:
o stress tends to delay menarche
o postpuberty stress inhibits ovulation
* Absent father predicts early puberty
o absent father may lead to lower SES
o lower SES may lead to problems associated with early menarche
* Absent father predicts early puberty
o Wamala et al. (1997)
+ 300 Swedish women ages 30-65
+ examined reproductive history, weight, SES
+ Findings: SES and obesity associated with higher number of children and earlier menarche
* Absent father predicts early puberty
o when the father is absent, mother may have poorer prenatal care (diet, rest, etc)
o Koziel & Jankowska (2002)
+ 1060 Polish girls aged 13.5 to 14.5 years
+ collected BMI and weight data
+ Findings: BMI and birthweight affected onset of menarche

* Early puberty predicts absent father:
o Mother’s genetics predicts earlier puberty
o Girls with early puberty get attention from males earlier - more likely to get pregnant?
o Girls likely to inherit onset of puberty from mother
* Third variable predicts absent father and early puberty:
o variant of x-linked androgen receptor that:
+ predisposes father to unstable relationships
+ causes early puberty in female offspring who inherit
o Comings et al. (2002): significant association between this gene and the following characteristics:
+ aggression and impulsivity
+ increased number of sexual partners
+ sexual compulsivity
+ paternal divorce
+ father absence
+ early menarche in females

* Early puberty, early spermarche

Hormones & Puberty.ppt

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04 May 2009

Sexual and Gender Identity Disorders



Sexual and Gender Identity Disorders

* Nothing improves with age
* Sex has no calories
* Sex takes up the least amount of time and causes the most amount of trouble
* There is no remedy for sex but more sex
* Never sleep with anyone crazier than yourself

Murphy's Law About Sex

* Sex is dirty only if it is done right
* Sex is hereditary. If your parents never had it, chances are you won’t either
* Don’t do it if you can’t keep it up
* Sex is like a box of chocolates, you never know what your going to get

What is Normal Sex

* Multiple Partners
* Mostly Heterosexual
* Mostly Monogamous
* Condom Use Has Increased
* Over 50% College Women Still Practice Unprotected Sex
* Older Populations are Still Active

Gender Differences in Sexual Behavior

* Masturbation
o Males > Females (Primates Too!)
* Causal Premarital Sex
o Males > Females
* No Gender Differences in
o Attitudes About Homosexuality, Sexual Satisfaction, Masturbation
* Big Gap in Views About Sex
o Females (Love); Males (Arousal)
* Are You Born
o Straight
o Homosexual
o Bisexual?
* Nature vs. Nurture

The Development of Sexual Orientation

* Homosexuality
o Runs in Families
o More Common in Monozygotic Twins
o Prenatal Exposure to Hormones
* The Biological Basis Argument
o Promoted by the Media, but Narrow
o The Link is Not That Strong
* Inherit Sexual Predispositions

The Nature of Sexual Arousal and Function

Plateau
Orgasm
Resolution
Arousal - Excitement
Desire Phase
Normal Functioning
Where Problems Arise
* Gender Identity Disorders
* Sexual Dysfunctions
* Paraphilias

Main Classes of Disorders Overview of Sexual and Gender Identity Disorders
Features of Gender Identity Disorders
* Man or Woman?
* Trapped in the Body of the Wrong Sex
* Transexualism
* Transgendered
* Rare

The Nature of Gender Identity Disorders
* Goal is Not Sexual
* No Physical Abnormalities
* Independent of Sexual Arousal Patters
* May be Attracted to People With Desired Identity

The Causes of Gender Identity Disorders

* No Specific Biological Link
* Probably Learned Early in Life

The Treatment of Gender Identity Disorders

* Sex Reassignment Surgery
* Costs $25 - 30,000
* Double $ for Female to Male
* Female-to-Male Adjust Better
* Psychosocial Treatment
* Gender Identity Disorders
* Sexual Dysfunctions
* Paraphilias

Main Classes of Disorders
Overview of Sexual and Gender Identity Disorders
Features of Sexual Dysfunctions

Plateau
Orgasm
Resolution
Arousal - Excitement
Desire Phase
Where Problems Arise
Hypoactive Sexual Desire Disorder
* No Interest in Any Sex Activity
* Common Presenting Problem
* How Much Sex Is Enough?
* Anything Sexual Evokes Fear, Disgust, or Panic
* 10% Males Have Panic Attacks

Sexual Aversion Disorder
The Nature of Sexual Arousal Disorders

Male Erectile Disorder
* Problem is NOT Desire, but Arousal
* Males: “Impotence”
Maintaining /Achieving Erection
* Females: “Frigidity”
Maintain / Achieve Lubrication

Female Sexual Arousal Disorder
Inhibited Orgasm

* Adequate Arousal and Desire
* BUT Unable to Achieve Orgasm
* Common in Females; Rare in Males
Only 50% Women Experience Regular Orgasms During Intercourse
* Ejaculation Occurs Too Quickly
* Hard to Define “Too Quickly”
* Problem Occurs in About 37% Males
* Perception of Lack of Control Over Orgasm in the Chief Complaint

Premature Ejaculation
Dyspareunia

* Intercourse Associated With Pain
* Rule out Medical Causes of Pain
* Rare Condition in Males
* More Common in Women
Vaginismus “Unhappily Mated as Bedfellows”

Let's Test
Your Sexual IQ
How Often Do Married Couples
Do it (i.e., Have Sex)?
Assessment of Sexual Behavior and Dysfunction
Interviews

* How Would You Describe Your Current Interest in Sex?
* Do You Have Sexual Fantasies?
* How Often Do You Masturbate?
* Medications can Disrupt Sexual Functioning
* Check Vascular Functioning
* Check Hormonal Levels
Thorough Medical Evaluation
* Listen to Audiovisual Erotic Material
* Measure Arousal Directly
* Penile Strain Gauge
* Vaginal Plethysmograph

Thorough Medical Evaluation Psychophysiological Assessment

The Causes of Sexual Dysfunctions
Biological Contributions

* Diabetes and Kidney Disease
* Cardiovascular Diseases
* Chronic Illness
* Prescription Medications
* Using Alcohol and Other Drugs
* More Than Performance Anxiety
* Performance Anxiety Involves
Arousal, Cognition, and Negative Affect
* The Role of Distraction
* Arousal Level is Underestimated
* Learn That Sexuality is Negative
* Traumatic Sexual Experiences
* Poor Interpersonal Relationship
* Inaccurate Beliefs and Myths

Psychological Contributions
Social and Cultural Contributions
Treatment of Sexual Dysfunctions
Providing Education About Sex
* Eliminate Performance Anxiety
Sensate Focus / Nondemand Pleasuring
* Gradual Process of Building Intimacy
* Several Other Available Treatments
* Many Treatments Work!

Psychosocial Treatments
Medical Treatments
Main Classes of Disorders
An Overview
Fetishism
* “The Flasher”
o Expose Genitals to Unsuspecting Strangers
o Element of Risk is Important
o Not Harmless (Many Rape / Molest)

Exhibitionism
* “The Peeping Tom”
o Watching Unsuspecting Strangers Naked or Undressing
Voyeurism
* “Cross Dresser”
o Sexual Arousal by Dressing in Clothes of the Opposite Sex
o Most are Male Heterosexuals
o Most are Married

Transvestic Fetishism
Sexual Sadism and Masochism
* Pedophilia
o Sexual Attraction to Children
o More Aroused to Young Children



Pedophilia and Incest
* Incest
o Children Related to Perpetrator
o May be Aroused to Adults
Other Forms of Paraphilia

* Frotteurism -- Rubbing
* Necrophilia -- Corpses
* Klismaphilia -- Enemas
* Coprophilia -- Feces
* Zoophilia -- Animals
* Scatologia -- Obscene Calls

Psychosocial Contributions

* Inability to Develop Adequate Relationships
* Early “Unusual” Sexual Experiences
* Person’s Early Sexual Fantasies
* Excessive Sex Drive & Suppression
* Specific Causes are Still Unclear

Psychosocial Treatments

* Suppression
o Paradoxically Backfires
* Covert Sensitization
* Orgasmic Reconditioning
* Relapse Prevention
* Treatment Works!


Drug Treatments

* Anti-Androgen
o Cyproterone Acetate
o Reduces Testosterone Levels
* Eliminates Sexual Desire / Fantasy
* Use for Sex Offenders
* Only a Temporary Solution

Sexual and Gender Identity Disorders.ppt

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03 May 2009

Orgasm in the Male



Orgasm in the Male
Presentation by: Dr.Li Ming Shun

Frequency of Sex with a Partner:
18-24 yr old Males
Frequency of Masturbation:
Total Population
Masturbation: Males 18-24
* Interesting data: 85 % of men living with a sexual partner masturbated in the previous year. 80% of men with advanced degrees masturbated in the previous year.
“Phallic Fallacies”
* The larger the penis, the more effective the male partner in coital connection with the female. May be valid for anal sex with male partner (b/c of location of prostate)
* Little relation of size erect to size flaccid
* No relation of skeletal stature to penis size

Male Sexual Response Cycle
Variant Arousal in Males
* Too much arousal:
o Priapism
o Premature ejaculation
* Too little arousal:
o Impotence (“ED”)

Priapus: God of Fertility and Gardening
Priapism
* Non-sexual origin
* Usually due to blood vessel pathology or nerve disorders.

Premature Ejaculation

* Male inability to control ejaculation for a sufficient length of time during intravaginal containment to satisfy his partner at least 50% of the time.
* Not a “stopwatch” definition
* Usually psychological in origin
* Treated by “training”
Impotence

* Inability to achieve an erection even with effective sexual stimulation
* Psychological basis
* Physiological basis
Primary Impotence

* Never able to have or maintain a functional erection
* Most often psycho-social basis
* Rarely physiological basis
Secondary Impotence

* History of adequate erections
* Psycho-social basis
o Fear of failure
o Lack of interest
* Physiological basis
o Cardiovascular pathology (e.g., diabetes; arteriosclerosis)
o Nerve damage (injury, stroke)
o Medications

Test for erections during REM sleep
Agents that affect erections
* Viagra: vasodilation (promotes erections)
* Poppers: vasodilation; also relaxation of vagina and anal sphincter
* Alcohol: blocks vasodilation (no NO)
* Nicotine: vasoconstriction
* Ecstasy: decreased libido and agression

The Little Blue Pill
Vasodilation and Constriction
Viagra inhibits Phospho-di-esterase type 5 (PDE5)
PDE5 is only in the penis
“Classical” Popper [for heart attacks]
Rush, Ram, Thrust, Rock Hard, Hix, TNT, Liquid Gold
Chemistry of Nitro-compounds
Subjective Reports of Orgasm
M&J

* Stage I: Sensation of ejaculatory inevitability; 2-3 seconds; “feeling the ejaculation is coming.”
* Stage II: Contractile sensation followed by a specific appreciation of fluid volume as it is expelled along the lengthened and distended penile urethra

Objective Reports of Orgasm
M&J
* Stage I: Rhythmic contractions of accessory organs (epididymis, vas deferens, seminal vesicles, prostate); collection of fluid in the prostatic part of the urethra
* Stage II: Relaxation of external sphincter of bladder; fluid flows into distended bulb and penile urethra; regular contractions of penile urethra and penile muscles forcefully expels semen from penis (12-24 inches); 3-4 major regular contractions (0.8 sec) and several more irregular minor contractions.

Involuntary Myotonia in Orgasm
Brain metabolic scans during penile stimulation
Two main areas are activated
One area is deactivated
Male Brain during Orgasm

* Simulation
* Inject tracer
* Measure signal during orgasm at 10 sec intervals
* Map location of signal (increased blood flow)

Brain activation during ejaculation
Ejaculation signal minus Stimulation signal
Male Brain during Orgasm

* Several parts of the brain known to be involved in reward behavior (e.g. heroin pleasure) were activated (meso-diencephalic junction; cerebellum)
* One part was de-activated (amydala/entorhinal cortex) (these parts are activated during fear)
* Very beginnings of study of brain/mind/sex

Relational Male Anatomy
Multiple Orgasm in Males

* “Many males below the age of 30, but relatively few thereafter, have the ability to ejaculate frequently and are subject to only very short refractory periods during the resolution phase.” One of their subjects could ejaculate 3 times in 10 minutes from the onset of stimulatory activity.
* Not quite the same as in the female.. Where the orgasms originate from the plateau phase rather than the resolution phase as in the male.

Does volume of ejaculate matter?
* Subjective reports (M&J, etc.) say yes.
* First orgasm is most intense
* After a period of continence, the orgasm is reported to more intense, and the volume of the ejaculate is highest (on average)
* Very little scientific study

Circumcision and Orgasm
* Can the uncircumcised male exercise ejaculatory control more effectively than the circumcised male?.... The exposed glans in the circumcised male is assumed to be more sensitive.
* M&J found in controlled neurological testing that there was no difference in sensitivity of the glans in either case

A G-spot for the Male?
* The prostate is sensitive to sexual stimulation
* Located adjacent to rectum; surrounds urethra
* Urethra can be erogenous zone for males

Vibrators
Prostate/Anal Stimulation
Questions to think about
* Why do humans have orgasms?
* Why do the French call orgasms “La petite mort” ?
* Can males have orgasms without ejaculation?
* What are the variables that can effect orgasmic satisfaction? Same for males and females?

Orgasm in the Male.ppt

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