Sex Differences and Defects

1. Sex Differences and Defects Menstruation Circumcision Disorders of the Male Sex Organs Disorders of the Female Sex Organs Sexual Dysfunctions and Therapies Hormones

2. Menstruation • The sexual and reproductive lives of a woman are interwoven with menstruation. Defined: The sloughing off of built-up uterine lining that recurs in non pregnant women from menarche to menopause. • Menstruation is just one part of a woman’s menstrual cycle.

3. Menstruation Defined: The time from the beginning of one menstrual period to the beginning of the next (typically 28 days) • Every month from her first menstrual cycle (menarche) as a preteen or teenager to her last (menopause) in her 40’s or 50’s, a woman’s uterine lining prepares for the fertilization of an egg cell. • A woman who has two pregnancies will average about 500 menstrual cycles in her lifetime. • Menstrual fluid is a mix of blood, mucus, and cells from the endometrium (the lining of the uterus) • If fertilization does not occur, the uterine lining sheds off and is discharged as menstrual flow.

4. Menstruation I. Menarche • The initial onset of menstruation in life and signals the beginning of puberty. • Average age at menarche is about 12 years

5. Menstruation II. Length and Frequency of the Menstrual cycle • Measured from the first day of menstrual flow to the day before the next flow begins. • Length ranges from 24 to 42 days with an average of 28 days • Some women’s cycles are regular as clockwork while for others the lengths of the cycles vary widely. • A woman’s period may arrive a few days earlier or later than usual for a number of reasons • Travel to a different time zone, sleep deprivation, stress, or changes in diet and exercise can delay or accelerate menstruation. • Sometimes the flow is heavy and sometimes it is very light

6. Menstruation Include segment on women and shared menstrual cycles in dormitory housing.

7. Circumcision: Male • Defined: Surgical removal of the prepuce or foreskin of the penis • One of the oldest surgical procedures known to humans • For more than 3,000 years, Jewish families have been circumcising their newborn males on the eighth day after birth as a sign of their covenant with God. • Most Jewish and Muslim families routinely choose to have their sons circumcised

8. Circumcision: Male • National Center for Health Statistics estimates that about 60% of all male infants born in the United States are circumcised. • Sharp contrast with other Western societies, in which circumcision is much less common Medical value: • Subject to heated debate • Uncircumcised boys have four times the risk of getting urinary tract infections in their first year, the risk is still only 1 in 100 • Studies suggest that circumcised men have a reduced risk of contracting HIV and spreading the disease

9. Circumcision: Male • Some argue against routine circumcision, stating that the foreskin may serve an important but as yet unknown function. • Others oppose what they see as an unnecessary, traumatic surgical procedure that poses possible complications including hemorrhage, infections, mutilation, shock, psychological trauma, and even death in rare cases.

10. Circumcision: Male Historically: • The only surgical procedure that is routinely performed without first administering analgesia or anesthesia • Was thought that newborns did not feel pain and that the risks involved in using anesthesia on infants were too high to justify its uses • However, during circumcision boys were noted to be agitated, cry intensely, and have changes in facial expressing indicating the procedure was indeed painful • Many physicians now use a local analgesic or a dorsal penile nerve block, a form of local anesthesia, to reduce circumcision pain and stress response

11. Circumcision: Female Defined: Ritual excision of the vulva • Misnomer: The vulva is not a foreskin • More correctly referred to as Female Genital Mutilation • This would be better compared with a complete removal of all the sexually sensitive skin on the male penis which is far more drastic than male circumcision.

12. Disorders of the Male Sex Organs Prostate Cancer: Second only to skin cancer as a leading cancer killer among American men. • One in six American men will develop prostate cancer in their lifetime • More than 80% of men with prostate cancer are over the age of 65 Prostatitis: Inflammation of the prostate gland, common disorder that may occur in men of any age.

13. Disorders of the Male Sex Organs Benign Prostatic Hyperplasia (BPH): Noncancerous enlargement of the prostate. • Happens naturally with ageing. • As the prostate enlarges, the surrounding capsule stops it from expanding, causing the gland to press against the urethra. • This can cause irritation of the bladder and thus the bladder begins to contract even with small amounts of urine, which causes frequent urination. Testicular Cancer: Cancer of the testis • Can be discovered as a small lump before the cancer spreads • Relatively few men routinely perform self-examination

14. Disorders of the Male Sex Organs Testicular Torsion: Occurs when a testis is rotated, twisting the spermatic cord. • May cut off blood flow to the testicles and surrounding structures • Results in permanent damage to the affected testis Epididymitis: Inflammation of the epididymis • Infection is the most common causal factor • Can cause severe fever if it makes it to the whole testicle

15. Disorders of the Male Sex Organs Penile Cancer: Cancer cells are found on the skin and in the tissues of the penis. • Very rare: Accounts for less than ½ percent of all malignancies in the United States. • Occurs in men over the age of 50 Peyronie’s Disease: Characterized by a bending or curving of the erect penis. • Many researchers believe it is caused by damage to the erectile bodies; when one of these bodies is stretched or bent during an erection the damage can result in a thickened, inelastic scar on the outside of the erectile tissue, usually on the topside of the penis.

16. Disorders of the Female Sexual Organs Endometriosis: Condition in which endometrial tissue grows in pelvic regions outside the uterus. • Non-life-threatening condition • Typically the tissue growth occurs in the pelvic area • 10 to 20% of women during their reproductive years • 15-50% among infertile women Endometrial Cancer: Cancer originating in the lining of the uterus. Nearly all of these life-threatening cancers occur in the form of adenocarcinomas (tumors of glandular cells) • Most common malignancy of the female reproductive organs • Abnormal bleeding from the uterus is the primary symptom of endometrial cancer • 90% of patients diagnosed with endometrial cancer complain of post-menopausal bleeding or irregular vaginal bleeding

17. Disorders of the Female Sexual Organs Uterine Fibroids: Balls of solid tissue that can grow inside the uterus, within the uterine wall, or outside the uterine wall. • Can range in size from a grain of rice to a basketball • Frequently occur in groups or clumps which tend to enlarge and distort the uterus • Affects up to 25% of women over the age of 30 • African American women are three to nine times more likely to be affected by uterine fibroids than white women. • Almost always benign becoming cancerous in less than 1% of the cases • Benign: Noncancerous; does not invade nearby tissue or spread to other parts of the body Cervical Cancer: Cancer of the lower portion of the uterus, begins in the lining of the cervix and does not form suddenly.

18. Disorders of the Female Sexual Organs Ovarian Cysts: Balloonlike swellings of fluid contained within an envelope of ovarian tissue • Most are harmless and will go away without any treatment • Functional ovarian cyst: most common type of ovarian cyst Ovarian Cancer: Most common ovarian cancer in women age 55-80 is adenocarcinoma (cancer that develops in the lining of the inner surface) • Malignant ovarian tumors in women under age 30 will usually be germ cell tumors which can be some of the most aggressive cancers known

19. Disorders of the Female Sexual Organs Vulvar Cancer: Cancer of the vulva is a malignancy that can occur on any part of the female external reproductive system but most often affects the inner edges of the labia majora or the labia minora. • Less often vulvar cancer occurs on the clitoris or the Bartholin’s glands. • Over 90% of cancers of the vulva are squamous cell carcinomas, a type of skin cancer that occurs in squamous cells, the main cell type of the skin • Second most common type of vulvar cancer (4%) is melanoma, the deadliest type of skin cancer

20. Disorders of the Female Sexual Organs Vaginitis: Inflammation of the vagina, typically caused by bacteria or yeast infection Breast cancer: Breast cancer represents 30% of all female cancers, affecting approximately 110 women per 100,000 • It is not the cancer of the breast that is fatal • If untreated, the cancer may metastasize or spread to other vital body parts such as the brain, bone, or lungs