Pregnancies must be planned, wanted, supported, and monitored.
- Planned: Number of children, Spacing (at least three to five years, five years for C.S.), and Timing (>17, <36 y.o.).
- Timing may be during average maternal age, and after the attainment of acceptable weight (for overweight or underweight women), etc.
- The recommended number of children is 2 to 3.
- Monitored: a facility-based prenatal checkup by trained and professional staff.
- According to WHO, there must be at least four prenatal checkups during pregnancy, one before the fourth month, one on the sixth month, one on the eighth month, then once on the final month of pregnancy (one every trimester + final month).
- For a private doctor, at least once a month for the first six months, then twice a month for the next two months, and weekly for the final month for a total of 14 prenatal visits (NCLEX standard).
Male Reproductive Anatomy
External Anatomy
- Penis: the organ used during copulation. It is made of multiple ligaments, the corpora cavernosa and corpus spongeosum. When erect, it averages 4 to 5 inches.
- Corpora Cavernosa
- Corpus Spongeosum: “sponge”, capable of retaining large amounts of blood to maintain an erection. This expends into the glans penis, the counterpart of the glans clitoris. This ends in the urethral meatus, the opening at the end of the urethra.
- Erections are rooted from sexual stimulation, where the penile artery dilate while the penile vein constricts, trapping blood in the penis to allow for voluminous expansion of the shaft and glans.
- Scrotum: the external covering of the testicles. The testes sit outside of the body, and are highly sensitive to temperature changes. A change in 1°C could initiate sperm death. This sack regulates testicle temperature.
Internal Anatomy
- Testicles: the male sex gland/gonad, producing male sex cells/gamete, spermatozoa, through spermatogenesis.
- Testosterone, the male sex hormone, is also produced by the testicles.
- Specifically, production of gametes occurs within the seminiferous tubules within the testes.
- Nourishment for the seminiferous tubules, specially through fructose, is supplied by Leydiq’s cells.
- Epididymis: the storage and maturation of the spermatozoa coming from the testicles. This process takes 64 to 75 days, where they make their way to the ampulla through the vas deferens. Prior to reaching the vas deferens, this also produces 5% of the total seminal fluid used to lubricate sperm.
- Vas Deferens: a long connecting tube between the epididymis and ampulla.
- Ampulla: storage for the mature sperm cells.
- Seminal Vesicle: the secondary producer of seminal fluid at 30% of the total volume.
- Ejaculatory Duct: the meeting place of the ampulla and seminal vesicle.
- Urinary Bladder: the storage space for urine excreted by the body connected to the urethra through the ureter.
- Prostate Gland: the main producer of seminal fluid at 60% of the total volume.
- Cowper’s/Bulbourethral Gland: a contributor to seminal fluid (5%).
- Urethra: normally 5 to 9 inches. This serves two functionsー elimination (urination) and reproduction (ejaculation).
Sperm Analysis
Normally, 3 to 5 mL (one teaspoon) is expulsed during one ejaculation.
- Per mL, a normal sperm count is 20 to 150 million sperm cells. In a single ejaculation, sperm count reaches at least 400 million.
- Lifespan: 3 to 5 days, averaging 72 hours within the fallopian tubes.
- Sperm pH: normally 7 to 8, which contrasts with the acidity of the vaginal canal. This alkaline is supplied by the prostate gland and bulbourethral gland.
Fertility Medication
Clomid is a medication used to increase sperm counts.
Only 30% of sperm cells have the correct morphology. 50% have the correct mobility. 50% are viable.
- Androsperm: containing the Y sex chromosome. Faster-moving, small-headed, long-tailed. Less alkaline, more susceptible to damage by acid.
- Gynosperm: containing the X sex chromosome. Slow-moving, large-headed, short-tailed. More alkalinic than androsperm.
- Morphology may include abnormalities such as abnormal head sizes, multiple tails, split tails, multiple heads, etc. These constitute 70% of sperm cells. Only 30% (~120 million) are viable for fertilization.
- Motility: only half of the sperm are actually able to move.
Vasectomy
Cutting of the vas deferens to prevent transfer of sperm cells from the epididymis to the ampulla. The man will still be able to gain an erection, and to ejaculate semen-free seminal fluid.
Female Reproductive Anatomy
External Anatomy
Collectively, the external genitalia of the female is called the vulva.
- Mons Pubis and Mons Veneris protects the symphysis pubis.
- Labia Majora and Labia Majora: the folds of skin that surround the vestibule and vagina.
- Vestibule: the space in between the labia.
- Glans Clitoris: the female counterpart of the glans penis, the seat of sexual excitement.
- Urethral Meatus: the external opening of the urethra.
- Skene’s Gland: two glands located on either side of the urethra which helps lubricates the vagina during sex, and protects against infection.
- Vaginal Opening
- Bartholin’s Gland: lubricates the vagina.
- Fourchette: frenulum; a thin fold of skin at the back of the vulva at the bottom of the vaginal opening designed to stretch during vaginal intercourse and childbirth.
Internal Anatomy
- Urethra: the single-purpose stoma for the excretion of urine. In women, it is around 3 to 4 inches in length.
- Vaginal Canal: the organ of copulation that receives the penis during sex, and serves as the birth canal and passageway of menstrual discharge.
- Naturally acidic, at 4 to 5 pH due to lactic acid produced by duoderleine bacilli, the normal flora of the canal.
- This canal is normally 3 to 4 inches when unstimulated, with rugae allowing it to expand and stretch when stimulated.
- Cervical Canal: non-acidic environment bridging the uterus and vagina.
- Fallopian Tubes: the ciliated pathway where sperm await an ovum.
- Fimbrae: the hand-like structure with projections that receive the ovaries’ ovum.
- Ovaries: the female equivalent of testicles. These are responsible for the production of oocytes during ovulation and the female hormones estrogen and progesterone.
- Uterus: a highly muscular pear-shaped organ often 3 inches long, 2 inches wide, and 1 inch thick weighing at 50 to 60 grams when non-pregnant. It is the site of implantation where the products of conception eventually grow.
- In pregnancy, the uterus weighs at least 500 grams.
- It is composed of three layers: the perimetrium (outermost), myometrium, and endometrium.
- It can be divided into four parts: the fundus (uppermost part), cervix (collar/mouth), isthmus (lower uterine segment), and corpus (body of the uterus)
- The uterus aids in labor and delivery through uterine contractions.
- Contraction rates may be defined as duration (length of contraction), interval (gap between contractions), and frequency (time between the start of two contractions).
- Contractions may be promoted by oxytocic drugs or inhibited by tocolytic drugs.
- Oxytocic: syntocinon, pitocin, oxytocin, methergine
- Tocolytic: duvadilon, bricanyl (Terbutaline), dactylob, yutopar
Stages of Sexual Intercourse
- Arousal/Excitement
- Plateau
- Orgasm: women are able to obtain multiple orgasms.
- Resolution:
Implantation and Fertilization
- Corona radiata: the outer shell of the female sex cell, which is tough and requires thinning by enzymes secreted by sperm cells.
- Zona pellucida: an inner shell of the female sex cell. When sperm meet this layer, their enzymes soften rather than dissolves. Once a single sperm cell is able to penetrate this layer, the zona pellucida hardens, preventing more sperm from entering. This is the actual act of fertilization.
- Zygote: the combination of male and female sex cells.
- Cleavage: where rapid cell division occurs, and where multiple pregnancy may occur.
Practice Questions
Q: It will take how many days for the sperm to grow and mature in the epididymis? A: 64 to 75 days
Q: Can precum cause pregnancy? A: Yes.
Q: Is coitus interruptus a reliable source of contraception? A: No. It holds a 20% failure rate based on the individual. In fact, it is among the most common causes of teenage pregnancy.
Q: When does the doctor cut for an episiotomy? C: Increment, Acme, Decrement A: Acme
Q: Is anesthesia used during an episiotomy? A: No. Natural anesthesia is produced during labor.
Q: Where are contractions originating within the uterus? A: From the myometrium of the fundus in the upper uterine segment.
Q: Which of the following may be considered as a presumptive sign of pregnancy? C: Goodell’s Sign, Hegar’s Sign, Chadwick’s Sign A: Chadwick’s Sign
Q: When is methergine given, and how? C: Through IV Push, After Placental Delivery C: Through IV Instillation, Before Placental Delivery C: IM, Before Placental Delivery C: IM, After Placental Delivery A: After the placenta has been delivered to avoid retention of the placenta due to the potent effect of methergine. Methergine is given IM.
Q: If the doctor can still save the pregnancy, which medicine is prepared? C: Oxytocic, Tocolytic A: Tocolytic allows for more time before birth.
Q: If the doctor can no longer save the pregnancy, which medicine is prepared? C: Oxytocic, Tocolytic A: Oxytocic aids in the removal of all products of conception.
Q: What drug is prepared for preterm labor that can still be stopped? What drug is going to be prepared? A: Tocolytic
Q: What drug is prepared for preterm labor that can still be stopped? What drug is going to be prepared? A: Oxytocic
Q: The woman is expecting a threatened abortion. What drug is going to be prepared? A: Tocolytic
Q: The woman experienced abruptio placenta. Which drug is contraindicated? A: Oxytocics will further increase contractions.
Q: A woman’s fetus is experiencing distress. Which drug is contraindicated? A: Oxytocics will induce vasoconstriction, further reducing oxygenation.