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The Reproductive System. A. Introduction . Why be concerned about reproduction in old people? . Integral to maintaining self-esteem Expression of love Aging changes have emotional and psychological impact.

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slide1

The Reproductive System

A. Introduction

Why be concerned about reproduction in old people?

Integral to maintaining self-esteem

Expression of love

Aging changes have emotional and psychological impact

2. Many elderly are concerned about their sexuality and need/want sexual relationships

slide2

The Reproductive System

B. Review of structure and function

Overview

Primary function of reproductive organs is continuation of the species

Gametes (sperm and ova) are produced by the gonads

External genitalia provide the mechanism by which male sperm are introduced into the female reproductive system

The female system provides the environment that supports development

2. Gonads also produce the sex hormones

Male = androgens (testosterone)

Female = progesterone and estrogens

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The Reproductive System

B. Review of structure and function

3. Male reproductive system

Testes in scrotum to regulate temperature

Ducts

Seminiferous tubules 

Ductus epididymis 

Ductus (vas) deferens 

Ejaculatory duct  Urethra

c. Glands

Bulbourethral glands

Seminal vesicles

Prostate gland

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The Reproductive System

B. Review of structure and function

3. Male reproductive system

  • Semen
  • Penis

Erectile tissue

Erection

f. Hormones

Interstitial cell stimulating hormone (ICSH)

Follicle stimulating hormone (FSH)

Testosterone

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The Reproductive System

B. Review of structure and function

4. Female reproductive system

Organs

Ovaries

Oviducts

Uterus

Vagina and external genitalia

b. Hormones

Follicle stimulating hormone (FSH)

Luteinizing hormone (LH)

Estrogens

Progesterone

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The Reproductive System

B. Review of structure and function

4. Female reproductive system

c. Ovarian cycle

Follicular phase

Initiated by FSH

Results in estrogen secretion

ii. Ovulation

Initiated by LH

Results in corpus luteum formation

  • Luteal phase – estrogens and progesterone secretion
  • Corpus luteum begins to die at day 12; dead at day 14
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The Reproductive System

B. Review of structure and function

4. Female reproductive system

FSH

LH

Menstrual cycle

Proliferative phase

estrogen

Initiated by estrogen

Rebuilds endometrium

progesterone

ii. Secretory phase

proliferative

secretory

Initiated by estrogen and progesterone

Endometrium prepares for implantation

iii. Menstrual phase

Lack of estrogen and progesterone

Removes endometrium

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The Reproductive System

C. Age-related changes

  • Changes in men

Testicular changes

Decrease in size and firmness

Very slow decline in testosterone secretion

Decrease in sperm number and motility (30% reduction by age 60)

b. Prostate gland changes

Atrophy begins at ~50, reducing secretory capacity

Muscle fibers replaced by connective tissue

Volume and force of expulsion therefore decreased

Enlarges around urethra; may make making urination difficult

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The Reproductive System

C. Age-related changes

  • Changes in men

c. Seminal vesicle changes

Decrease in size and storage capacity

Muscle fiber replacement with connective tissue

  • Bulbourethral gland changes
  • Penile changes

Some atrophy and tends to become smaller

Erectile tissue becomes more rigid, less elastic after ~55, resulting in decreased ability to attain erection

f. Changes in sexual ability can lead to depression, mood swings, and general feelings of uneasiness

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The Reproductive System

C. Age-related changes

2. Changes in women

Ovarian changes

First to occur as follicles are depleted

Decreasing estrogen and progesterone levels lead to degenerative changes in uterus and vagina

b. Menopause

Begins with cessation of the menstrual cycle

Remaining follicles become unresponsive to FSH and LH, generally occurring in the 40 – 50s

Adrenal glands become primary source of estrogen

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The Reproductive System

C. Age-related changes

2. Changes in women

c. Menopausal symptoms

Hot flashes, sweating, red patches on face and chest

Episodes of depression or irritability, headaches, insomnia

Most women experience mild versions of all these

d. Postmenopausal changes

Progressive ovarian atrophy and formation of fibrous tissue

Loss of reproductive cyclical changes

Decrease in uterine wall thickness; muscle replaced with connective tissue

Atrophy of the endometrium and uterine tubes

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The Reproductive System

C. Age-related changes

2. Changes in women

d. Postmenopausal symptoms

v. Vaginal changes

Narrower and shorter, thinner and less elastic walls

Vestibular glands atrophy and secrete less, leading to a dry vagina and painful intercourse

Vaginal environment becomes less acidic, leading to increased bacterial and yeast infections

vi. Testosterone levels don’t decrease greatly, so sexuality and enjoyment of sex does not diminish greatly

vii. Other changes – fact accumulation in wrists, thighs, butt; skin thins and sags; hair thins and coarsens; external genitalia atrophy; glandular breast tissue replaced with fat

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The Reproductive System

D. Age-related dysfunctions

  • Cancer

Prostatic cancer very prevalent in older men

Incidence of ovarian, uterine, cervical, and breast cancers increase dramatically after menopause

Increase in cancer with age again points out need for regular exams

  • Atrophic vaginitis
  • Prolapse of the uterus

Ligament weakness allows uterus to drop through cervical canal and protrude into the vagina

Previous births may contribute to occurrence

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The Reproductive System

D. Age-related dysfunctions

4. Impotence

Most common and disturbing dysfunction in males

Failure to attain and/or maintain an erection

Progressively more frequent as men age (25% at age 65, 55% at age 75, 75% at age 80

Numerous causes

Numerous treatments

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The Reproductive System

D. Age-related dysfunctions

5. Diminished sexual functioning

Most common complaint is decreased ability to function sexually

Elderly persons frequently without a partner

Time to respond to sexual stimulation increases

Time to orgasm increases

Orgasms decrease in intensity and duration

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The Reproductive System

E. Take home messages

  • Sexual interest and activity continue well into old age
  • Changes in reproductive organs affect sexual function
  • Males – gradual decline in testosterone with accompanying changes in organs
  • Females – loss of follicles leads to decreased estrogen and progesterone, culminating with menopause in the 40 – 50s; loss of estrogen has multiple effects

end