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The Reproductive System. Chapter 16. ___________________- primary sex organs - ie . Testes and ovaries _______________________--sex cells produced by gonads as well as gonads secrete sex hormones _______________________________-remaining reproductive structures

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___________________-primary sex organs-ie. Testes and ovaries

  • _______________________--sex cells produced by gonads as well as gonads secrete sex hormones
  • _______________________________-remaining reproductive structures
  • Joint purpose of Reproductive system is produce offspring---via sperm in males and ___________ in females

Accessory reproductive organs





Anatomy of Male Reproductive System

  • Testes have exocrine-sperm producing- function and endocrine-testosterone producing
  • Accessory structures in delivery of sperm to exterior or to female

Tunica albuginea

  • Plum shaped---4 cm –sized surrounded by fibrous connective tissue capsule-_____________________________-“white coat”
  • Extensions of capsule extend into testes and divide into wedge-shaped ______________________each containing 1-4 _____________________________-sperm producing portion


Seminiferous tubules


Seminiferous tubules empty into another set of tubules---____________________on each side of testis-sperm travel from rete to enter 1st part of duct system-____________________-hugging external testis

  • In soft tissue around seminiferous tubules are -__________________-that produce androgens-esp. testosterone---thus different tissue process sperm and then hormones

Rete testis


Interstitial cells


DUCT SYSTEM-inc.edididymis,ducusdeferns, and urethra

  • A.___________________________-highly coiled tube-~6 m-capping superior testis and extends posterolaterally-temporary storage for immature sperm entering from testis
  • Takes sperm about _____________days to travel epididymis,maturing along the way...and become motile
  • During ejaculation,epididymis contracts to expel ___________into--_________________________________



Sperm….ductus deferens


. Ductus Deferens(= vas deferens)-extends upward from epididymis through inguinal canal,to pelvic cavity and arches over superior bladder…enclosed w/ blood vessels and nerves and connective tissue sheath-______________________ and it travels up through inguinal canal

Spermatic cord


Loops medially over ureter and goes down posterior bladder-expands as ampulla and empties into _________________--this passes through prostate gland and merges w/ urethra

  • Main function of ductus deferens is to _________________________
  • At ejaculation smooth muscle squeeze sperm forward by ___________________

Propel live sperm from storage-epididymis and distal vas deferns

Ejaculatory duct



A __________________________________is a contraceptive procedure that ligates-“ties-off” ducusdeferns in part that lies in scrotum---sperm are still produced-but don’t reach body exterior and are phagocytized-rendering male sterile


  • From base bladder to tip of penis-terminal feature of male system-carries urine and sperm-however both never travel @ same time---bladder sphincter constricts @ ejaculation preventing this
  • 3 regions: 1) ______________-surrounded by prostrate
  • 2)_____________-from prostatic urethra to penis and 3)__________-runs length of penis

Prostatic urethra

Membranous urethra

Spongy (penile)urethra

accessory glands and semen

-inc. paired seminal vesicles,singleprostate,bulbourethral glands and semen

  • A.____________________@ base of bladder make ~60% of seminal fluid-secretion rich in _________________which nourish and activate sperm
  • Each of its duct joins vas deferens on same side to form __________----thus sperm and seminal fluid enter urethra during ejaculation

Fructose, vitamin C, proglastins…

Seminal vesicles

Ejaculatory duct

prostate single doughnut shaped gland encircles prostatic urethra below bladder
Prostate-single doughnut –shaped gland-encircles prostatic urethra below bladder
  • Its glandular , milky secretion helps activate sperm---during ejaculation-fluid enters urethra through several small ducts
  • Since near rectum,can be palpitated rectally

Older men suffer hypertrophy of gland, strangling urethra-making urination difficult and increases risk of bladder infections-________________ and kidney damage

  • Treatments include :surgery,drugs or microwaves to shrink prostate,insertion of small balloon to push prostate away from urethra,incineration w/low energy radiation
  • ___________________-inflammation of prostate-common
  • _______________-most prevalent cancer in men-slow growing,usually



Prostatic cancer


C. _______________________-tiny pea-sized glands posterior to prostate, produce thick,clearmucus draining into penile urethra----is 1st secretion to pass upon sexual arousal ---functions in cleansing urethra of acidic urine and is a sexual lubricant

Bulbourethral glands


D. Semen-milky white, somewhat sticky mixture of sperm and gland secretions ;transport medium for nutrients and chemicals that protect and aid in movement of sperm

  • Sperm have little cytoplasm or stored nutrients so __________________ is energy fuel
  • pH ~ 7.2-7.6 helps neutralize acidic vagina(3.5-4.0)-protecting sperm(sperm are sluggish in acidic environment)
  • ________________-antibiotic chemical destroying certain bacteria
  • Hormone_______________-………………………….




semen cont d
Semen cont’d
  • Enzymes to enhance sperm motility
  • Substances to inhibit female reproductive immune response
  • Male infertility---causes include obstruction of duct system, hormone imbalance , environmental estrogens ,pesticides, too much alcohol….often _________________is checked to analyze sperm count, motility, and morphology,semen volume ,pH, fructose amount…sperm count should not be below 20 million /mL

Semen analysis

external genitalia ie scrotum and penis
EXTERNAL GENITALIA-ie. Scrotum and penis
  • Scrotum-divided sac of skin outside abdominal cavity, normally hangs loosely, rendering testes temperature below body temp.( @ ~ 5.4 degrees lower)-necessary for healthy sperm production ,changes in scrotal surface area help maintain temp—example -wrinkles as pulls toward body during external cold temp’s
  • Penis-delivers sperm-consists of shaft ,glans penis tip and prepuce or foreskin-loose skin covering-often removed at circumcision/Internally-spongy urethra SURROUNDED by 3 elongated areas of _______________________that fill w/ blood during arousal-causing rigid erection

Erectile tissue

male reproductive functions
Male Reproductive Functions
  • Spermatogenesis=sperm production-begins @ puberty and is lifelong
  • Millions/day
  • _________________primitive stem cells @ periphery of each seminiferous tubule/rapid mitotic division to build stem cell line….from birth to puberty


spermatogeneisis cont d

Follicle-stimulating hormone

Spermatogeneisis cont’d
  • @ puberty _______________________(FSH) is secreted in increasing amounts by ant. Pituitary gland…from here on out ,each division produces 1 stem cell-type A daughter ---which remains @ tubule periphery to maintain stem population…and 2nd,type B daughter-pushed toward tubule lumen to become primary spermatocyte and will undergo MEIOSIS
  • Gametes @ this stage are called _______-made by meiosis and have ½ genetic material (2n in humans=23 x 2)
  • As meiosis occurs ,primary,thensecondary spermatocytes pushed toward tubule of lumen
  • Spermatids NOT functional sperm-nonmotile and excess cellular baggage


spermatogenesis cont d
Spermatogenesis cont’d
  • During last stage-_______________-excess cytoplasm sloughed off and now have _________________________,equipped w/high metabolism and motility
  • Sperm head has DNA---essentailly nucleus
  • Anterior to head is ______________made by golgi and similar to large lysosome---which breaks down @ membrane and releases to help sperm penetrate follicle of egg

Mature sperm compacted into 3 regions-head,midpiece and tail


spermatogenesis cont d1
Spermatogenesis cont’d
  • Filaments make long tail from centriloes in midpiece w/mitochondria wrapped around for necessary ATP
  • All of spermatogenesis-from primary spermatocyte to release of immature sperm takes 64-72 days
  • Sperm in lumen nonmotile and can’t fertilize….moved by peristalsis from tubules into epididymis---there further maturation and increased motility
  • Things that can alter sperm formation:________________-

Some antibiotics,radiation,lead,somepesticides,marijuana,tobacco, excessive alcohol

testosterone production
Testosterone production
  • produced by intersitial cells
  • @ puberty FSH prods sperm production and ________________(LH) is also released by anterior pituitary on from here on out testosterone is produced continuosly,rising levels responsible for secondary sexual characteristics:___________________-testosterone not produced and secondary sex characteristics not produced_____________….castration will cause this or malfunction of interstitial cells…also cause sterility

Deeping voice,increased hair all over most of body-esp. axillary and pubic;skeletal muscle enlargement-more muscle mass;increased bone growth and density of bone

Luteinizing hormone

Sexual infantilism

female reproductive anatomy
  • function in producing gametes(ova) and nurture/protect developing fetus
  • _____________________primary reproductive organs-both exocrine and endocrine in nature



Ovarian follicles

Follicle cells

  • Shape of almonds but about twice as large
  • Internally __________________-each consisting of an immature egg-oocyte-surrounded by 1 or more layers called __________
  • As developing egg matures follicle enlarges and produces fluid filled antrum-At this point follicle is called vesicular or _________________follicle,which is mature and ready to released during ____________________.
  • After ovulation,ruptured follicle is transformed into ___________________--“yellow body”,which degenerates

Graafian follicle


Corpus luteum


Ovarian follicle

Follicle cells

ovaries cont d
Ovaries cont’d

Ovarian ligaments

  • Ovulation ~ every 28 days….in older women ovaries are scarred and pitted from release of many eggs
  • Ovaries secured to lateral pelvis by _________________and medially by ______________and in between held by fold of peritoneum-broad ligament

Suspensory ligaments

duct system uterine tube uterus and vagina
DUCT SYSTEM-uterine tube,uterus and vagina
  • Fallopian(uterine) tubes—internal duct system
  • receive ovulated oocyte and provide fertilization site
  • each about 4” long,extends medially from ovary to empty in superior uterus
  • enclosed and supported by broad ligament
fallopian tubes cont d
Fallopian tubes cont’d
  • little or no contact between fallopian tubes and ovaries-instead contact @ distal end is by funnel-shaped ____________________that has fingerlike projections-fimbriae that surround ovary-- WHICH create fluidlike current that carries oocyte into fallopian tube---to thus journey to uterus
  • At this point is where many potential eggs are lost in peritoneal cavity
  • Cilia and peristalsis move oocyte along to uterus-taking about 3-4 days,but egg is viable ~24 hrs. after ovulation,sofertilization is usually in fallopian tube
  • To reach oocyte,sperm must swim up through vagina and uterus to fallopian tubes---swimming against a downward beat of Cilia!


fallopian tubes cont d1
Fallopian tubes cont’d

Pelvic inflammatory disease

  • Because fallopian tubes and ovaries are not physically continuous,this makes this area vulnerable to infection,such as bacteriaof Gonorrhea…maybe causing __________________which can cause scarring and closing of tubes
uterus located in pelvis between bladder and rectum
Uterus-located in pelvis between bladder and rectum
  • Hallow/functions to receive,retain,and nourish a fertilized egg
  • About the size and shape of a pear in women who haven’t been pregnant
  • Suspended by broad ligament and anchored by round and uterosacral ligaments
  • _________________=main portion
  • _________________-superior,rounded region above fallopian tube entrance



uterus cont d
Uterus cont’d
  • ______________-narrow outlet into vagina below
  • Wall is thick w/3 layers:1)inner mucosa-________________-At implantation-fertilized egg burrows here/This layer sloughs off during ________________-menstruation every 28 days-- if not fertilized
  • 2)______________-interlacing bundles of smooth muscle making bulky middle layer-contracts during labor 3) perimetrium-outer serous layer(visceral peritoneum






__________________________________-common in women 30-50-risks factors inc. cervical inflammation,STDs,multiplepregnancies,promiscuity/detected w/Pap smear/slow growing ,usually

Cervical cancer


Vagina-thin-walled tube 3-4”long/between bladder and rectum from cervix to body exterior=birth canal./also organ of copulation

  • Distally partially enclosed by __________mucosa-which is very vascular and bleeds when ruptured


external genitalia vulva
External genitalia=vulva
  • monspubis-fatty,rounded area overlying pubic symphysis-hair after puberty
  • laterally are 2 skin folds w/hair-labia majora (encloses vestibule which houses external urethra opening and vagina)and l.minora
  • ______________ surround vagina and secretes for distal vagina
  • Clitoris-small protrusion that is corresponding to penis w/erectile tissue but no reproductive duct
  • ___________________-between ant. labial folds,anus and ischialtuberosities

Greater vestibular glands


female reproductive functions and cycles
  • Females’ reproductive ability begins at puberty and ends around 50’s(menopause)
  • In developing female fetus,_________-female stem cells multiply rapidly to increase their numbers,then daughter cells-primary oocytes-push into ovary connective tissue and primary follicle forms around them
  • By birth,oogonia cease to exist and a lifetime supply of primary oocytes are in place---waiting 10-14 years to undergo MEIOSIS!
  • @ puberty , ant. Pituitary produces_________FSH-stimulates a small # of primary follicles to grow and mature each month and then ovulation occurs monthly….constituting the _________cycle


Follicle-stimulating hormone


oogenesis and ovarian cycle cont d
Oogenesis and ovarian cycle cont’d
  • @ puberty ~ 250,000 oocytes remain w/ a small # activated each month….appx 500 of the 250,000 ova are released in the limited # of years of fertility
  • The FSH prods the follicle to enlarge ,accumulating fluid in central antrum/Primary oocyte replicates chromosomes and MEIOSIS occurs-producing 1 ________________and polar body
  • Follicle development to the point of rupture takes about 14 days with ___ovulation________________ occurring at just about this time
  • Ovulation occurs at the response to _luteinizing hormone__LH
  • Secondary oocyte is still surrounded by follicle cell capsule now called_coronaradiata(“radiating crown”)…abdominal pain can accompany this-mittelschmerz

Secondary oocyte


1 developing follicle dominates each month/mature follicles not ovulated are overripe and deteriorate

  • Besides triggering ovulation each month,LHaso causes ruptured follicle to turn into corpus luteum(Both c.luteum and maturing follicle produce hormones)
  • If ovulated, secondary oocyte is penetrated by sperm in fallopian tube,THEN oocyte undergoes_________________________________making another polar body and ovum

2nd meiotic division


….its 23 chromosomes are combined w/23 of sperm in fertilized egg

  • If not fertilized, deteriorates
  • Polar bodies deteriorate
  • Sperm v. egg:-sperm relies mostly on surrounding for nutrients,while—egg larger and______________________-stocked w/ nutrients


uterine menstrual cycle
Uterine (Menstrual) Cycle
  • receptive to implantation only briefly---~ 7 days after ovulation
  • events of _____________________ are cyclic changes that endometrium goes through monthly in response to ovarian hormone changes
  • Anterior pituitary ____________________ hormones FSH and LH regulate Ovarian estrogen and progesterone
  • Typically cycle is 28 days w/ovulation occurring midway

Menstrual cycle


menstrual cycle cont d
Menstrual cycle cont’d
  • 3 stages:
  • 1)______________________--superficial functional layer of thick endometrium is sloughed off-accompanied by 3-5 days bleeding---passing out vagina as menstrual flow/average blood loss 50-150mL(1/4-1/2 cup)….By day 5 ovarian follicles begin to produce estrogen
  • 2)__________________---is stimulated by estrogen levels to cause basal layer of endometrium to regenerate ,glands form w/in and endometrial blood supply increases…endometrium restores to velvety,thick and well vascularized—ovulation @ end of this phase in response to LH

Days 1-5-Menstrual phase

Days 6-14-Proliferative phase

menstrual cycle cont d1
Menstrual cycle cont’d
  • 3)______________________-progestrone levels have risen(by corpus luteum) and act on estrogen charged endometrium and increase blood supply more/also increasing size of endometrial glands and begin supplying nutrients into uterine cavity to sustain an embryo until implanted

Days 15-28-Secretory phase


If fertilization does occur,embryo produces hormone similar to LH-causes ______________________________

  • If fertilization does NOT occur,c. luteum degenerates and LH levels drop…This causes vessels supplying endometrium to go into spasms and kink—causing endometrial cells-deprived of O2 –to die ….setting stage for next menses
  • Cycle can vary from 21-40 days ,but time of ovulation is usually @ 14-15 days

Corpus luteum to cont. producing its hormones

hormone production by ovaries
  • Begin @ puberty
  • Follicle cells of growing follicles produce_______________________-causing the appearance of secondary sex characteristics :enlargement of fallopian tubes, vagina and external genitalia ;development of breasts ;axillary and pubic hair ;increased fat in hips and breasts and in general; Widening and lightening of pelvis; Onset of menses
  • Estrogen also has metabolic effects---ex-maintaing blood cholesterol(high HDL) and help Ca2+ uptake



Other ovarian hormone is ______________________________made by c.luteum as long as LH is present in blood…stopping 10-14 days after ovulation/helps establish menses w/estrogen,but does NOT contribute to secondary sex traits…plays a role in pregnancy by inhibiting contraction of endometrium and prepares_____________________(source of progesterone in pregnancy is placenta)

For lactation


mammary glands
Mammary glands
  • In both sexes ,but has normal functions in female---being important only once reproduction is accomplished—stimulated to increase size by estrogen
  • Are actually modified sweat glands and part of integument ,in that sense….and anterior to pectoral muscles
  • ________________-center pigmented area w/protruding nipple
  • Internally has 15-25 lobes radiating around nipple/lobes are padded and separated by connective tissue and fat
  • Within each lobe are smaller _________________ w/clusters of alveolar glands that _______________-produce milk into lactiferous ducts opening via the nipple to the outside





______________________-2nd most common cause of death in American women---1 in 8 developing this condition….~10% hereditary and half traced to BRCA 1 and 2 gene/80% of women w/ gene contract cancer---other risk factors inc. early menses,latemenopause,estrogen replacement therapy….Breast cancer is signaled by change in skin texture ,puckering and nipple leakage…can be detected by self examination and by ___________________-X-rays that reveal tumors too small to feel(<1 cm.)

Breast cancer


accomplishing fertilization
  • Sperm must reach secondary oocyte-viable 12-24 hours after leaving ovary/sperm viable ~ 24-48 hrs….Therfore, intercourse must occur no more than 2 days before ovulation and no later than 24 hrs. after ovulation---when oocyte is appx. 1/3 way down fallopian tube
  • Sperm attracted to oocyte by “homing device” chemicals—locating oocyte
  • Sperm take __hours to reach fallopian tube,however many leak out or are destroyed by vagina’s acidity---only a few hundred –few thousand make it to area of egg’s location
  • When sperm reach oocyte,cell surface hyraluronidaseenzymes break down “cement” holding follicle cells of corona radiate around oocyte



Once path cleared through corona,1000’s sperm undergo_______________________where acrosome membrane break down-releasing enzymes to lyse through oocyte membrane….then a single sperm can make contact w/oocyte membrane receptors---pulling head(nucleus) of sperm pulled into oocyte cytoplasm….****sperm reaching this point after acrosomal reactions have started are the more likely to fertilize

  • After a sperm has reached oocyte,2nd meiosis occurs---making ovum and polar body
  • Changes in fertilized egg preventing other sperm entry
  • _________________occurs @ moment genetic material of sperm combines w/ that of ovum to make________________-fertilized egg

Acrosomal reaction



events of embryonic and fetal development
  • Rapid MITOTIC division as zygote goes down fallopian tube-________________,w/daughter cells becoming smaller and smaller—large # of cells will be building block of embryo-until 9th week
  • By time embryo reaches uterus(3 days after ovulation)=_________________-ball of 16 cells looking like a raspberry…Since uterus not totally prepared for embryo yet, embryo floats in uterine cavity---using uterine secretions for nutreints @ this time---Unattached,continues to develop to ~ 100 cells---It then hallows out to form_________orchorionic vesicle





@ this same time ,it is secreting a hormone called______________________(hCG)-this prods c.luteum of ovary continue hormone production(otherwise,endometrium would shed)

  • Pregnancy tests usually detect______________levels
  • Blastocyst also has __________________-forming large fluid-filled sphere and also an inner cell mass-small cell cluster to one side
  • By day 7 after ovulation,blastocystattahes to endometrium,eroding away some of lining and envelops into thick mucosa

Human chorionic gonadotropin




During this time the primary germ layers are forming from inner mass:

  • ______________________gives rise to nervous system and epidermis
  • ______________________forms mucosa and associated glands
  • __________________________gives rises to basically everything else





By day 14 after ovulation,implantation is complete and mucosa grown over embryo…The ______________of the blastocyst develops projections called chorionic villi,combining w/uterus to produce __________________________




Once placenta has formed,embryonic body is surrounded by_____________________________-fluid –filled sac and attaches w/blood vessel stalk-_____________________________________

  • By 3rdweek,placenta delivers nutrients and O2 to and removes wastes from embryonic blood---all through ____________________________
  • By end of 2ndmonth,placeta becomes endocrine organ producing estrogen,progesterone,and other hormones to maintain pregnancy…c.luteum becomes inactive


Umbilical cord

Placental barrier


By week 8--all organ systems laid down in some form and looks human

  • Week 9—Now called__________-now growth and organ specialization are major activities
  • As fetus,grows from ~ 3cm. and 1g to 36 cm(14”),~4kg(6-10 lbs.)…at birth ~ 22”
  • 270 days-10th lunar month-full term


effects of pregnancy on mother
  • ___________________________-period from conception to birth
  • Anatomical changes-
  • Uterus goes from fist sized to eventually nearing level of xiphoid process-thorax widens as organs press on diaphragm
  • Center of gravity changes sometimes causing lordosois---thus backaches
  • Placental hormone____________________causes pelvic ligaments and pubic symphsis to relax,widen and become more flexible
  • Good nutrition necessary—needing only about 300 calories extra/day
  • Substances that can cross placental barriers are alcohol,nicotine,many drugs and maternal infections
  • _________________ termination of pregnancy by loss of fetus---spontaneous abortion is a miscarriage





Physiological Changes

  • GI system-morning sickness usually first trimester,as mother adjusts to elevated estrogens;heartburn because of displaced esophagus and displaced stomach;constipation –because GI motility decreased
  • Urinary system-kidneys now need to dispose of fetal metabolic wastes,producing MORE urine;also uterus compresses bladder---frequent urination-Ie. stress incontinence
  • Respiratory System-nasal mucosa responds to estrogen by swelling and congested,maybe nosebleeds ;respiratory rate increases but residual volume declines causing_______________-difficult breathing in later stages
  • Cardiovascular system-Total body water rises and blood volume increases 25-40%---helping in safeguarding from blood loss effects during labor;BP and pulse increase and raise cardiac output 20-40%;venous return from lower limbs may be impaired---maybe causing varicose veins




  • Usually w/in 15 days of calculated due date (280 days from last menstrual period)
  • _________________-series of events that expel infant from uterus
  • Initiation of labor
  • Estrogen has reached highest levels causing myometrium to form much ________________receptors-to be receptive to that hormone
  • AND interfering with progesterone’s quieting influence on uterine muscle—causing weak uterine contractions---called _________________contractions—often producing false labor


Braxton-Hicks contractions



Then ,cells of fetus produce oxytocin and this stimulates placenta to release _______________________stimulating more frequent and powerful contractions

  • Mom’s hypothalamus activated by emotional and physical stress---signals oxytocin release by posterior pituitary gland ---rhythmic ,expulsive contractions-TRUE LABOR…positive feedback mechanism now w/hypothalamus,strengthening contractions
  • Anything that interferes w/oxytocin or proglastins can hinder onset of labor….example--antiproglastin drugs such as aspirin and ibuprofen


stages of labor
Stages of Labor
  • 1st-_____________________________from time of true contractions until full-10 cm-dilation of cervix….contractions move from upper uterus to vagina,becoming more vigorous and softening cervix and thinning….amnion ruptures-“water –breaking”-----usually 6-12 hours or MORE!!!

Dilation stage


2nd-Expulsion stage-full dilation to delivery…urge increases to push 20 min -50 min.---sometimes 2 hrs

  • Infant should be head first-Vertex position-skull as a wedge to dilate cervix…after head,rest of body comes out more easily…umbilical cord clamped off
  • _______________-buttocks-first
  • _________________-during a difficult 2nd stage,O2 delivery inadequate leading to cerebral palsy or epilepsy….often a C-section done to prevent these
  • 3rd-____________________-w/in 15 min.placenta usually expelled---placenta and other fetal membranes constitute ____________________

Placental stage




developmental aspects
  • Gonads from 8th week and then accessory structures and external genitalia….all depends on presence or absence of testosterone
  • If genetic male fails to produce testosterone-female accessory structures form and external genitalia…
  • --If genetic female exposed to testosterone-male accessory ducts and glands as well as penis and scrotum….both cases are pseudohermaphrodites----a true hermaphrodite possesses ovaries and testes-rare case
  • XO female appears normal but lacks ovaries/YO males perish
  • __________________narrowing of foreskin of penis and misplaced urethral openings
  • _______________________-failure of full descent of testes




_______________=period ~11-13---taking another 2 years for dependable ovulation

  • Most common problem in females are infection-sometimes caused by STD’s
  • Male inflammatory conditions include _______________________,maybe following STD transmission
  • ______________-inflammation of testes….maybe following STD or mumps
  • Neoplasms a danger in both genders
  • Women reach peak reproductive abilities @ late 20’s,estrogen declines eventually producing________________-producing a ceasing of menses—irritability and mood changes can accompany
  • Dangers can accompany HRT
  • Its all downhill…! 
  • Puberty @ 10-15 yrs.