اختالالت عمل جىسی آم زش مطا ري

Transcription

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2 اختالالت عمل جىسی آم زش مطا ري

3 ذف کلی درس : آضىایی با اختالالت عمل جىسی آم زش مىاسب در ایه م ارد ا ذاف کلی جلسات : ( ج ت ر جلس یک ذف ) آضىایی با فاز ای مختلف سیکل پاسخ جىسی آضىایی با ع املی ماوىذ سه دار بیماری ا... تأثیر آو ا بر مسائل جىسی آضىایی با مسائل جىسی در د ران و زادی و پایی خردسالی پیص از مذرس د ران مذرس آضىایی با مسائل جىسی درد ران بل غ و ج اوی آضىایی با فعالیت ای جىسی تغییرات آن در د ران بارداری ضیرد ی آضىآ آضىایی با ک ىسالی تأثیر آن بر مسائل جىسی آضىایی با بیماری ای مختلف تأثیر آن ا بر مسائل جىسی آضىایی با اختالالت عمل جىسی طریق مقابل با آن

4 Anatomy of the male reproductive system Testis Scrotum Penis Seminal vessicles, prostate gland, bulbourethral glands Epididymis, vas deferens, urethra

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7 TESTES Primary reproductive organs or gonads Production of sperm Suspended outside the body cavity by scrotum

8 PENIS Deposits sperm in female Erectile tissue (vascular) Erection results from gorging tissue with blood Erection is a parasympathetic spinal reflex to tactile and other stimulation enhanced by sympathetic inhibition

9 Provide the bulk of the semen, a mixture of secretions, sperm and mucous Fructose and prostaglandins from seminal vessicles Alkalinity and clotting enzymes from prostate Lubricant for intercourse from bulbourethral glands

10 Epididymus, vas deferens, urethra: ejaculation Route of exit of sperm Ductus deferns stores sperm During emmission phase of ejaculation sperm are emptied into urethra by sympathetically induced contractions Motor neuron induced contractions of skeletal muscles at base of penis expell the semen during expulsion phase of ejaculation Ejaculation is a part of orgasm

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12 vagina uterus cervix clitoris labia ovaries oviducts

13 Vagina Entrance to uterus Place where penis inserts to deposit sperm Muscular, expansible tube

14 Uterus maintains fetus during pregnancy musculature contracts to expel fetus at birth

15 lowest portion of the uterus projects into vagina cervical canal serves as pathway for sperm during sexual intercourse Passage-way for delivery of baby from uterus

16 erectile tissue analogous to penis in male sensitive and erotic at fold of labia minora

17 link ovaries to uterus fallopian or uterine tubes pick up ova at ovulation site for fertilization

18 درمان اختالالت عملکرد جنسی دکتر آذر دکتر نوحی اختالالت جنسی دکتر جهانفر میترا موالیی نژاد بیماریهای زنان نواک

19 Sexual intercourse Coitus or copulation At some point penis is inserted into vagina Sexual response cycle

20 Phases of sexual cycle Masters and Johnson have relabeled these phases as: Excitement Plateau Orgasm Resolution

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22 Excitement can be initiated physically (tactile stimuli)and/or psychologically clitoris, surrounding perineal area and penis are primary areas for this other sensitive areas may contribute if stimulated, breasts, testicles, etc. erection of penis and clitoris result (clitoris is a homologue of the penis) lubrication from vaginal capillaries, glands at opening of vagina and penis prepare for intercourse

23 1. EXCITEMENT

24 How does the penis become erect?

25 The human penis is composed of three cylinders of spongy tissue. There are two corpora cavernosa which are located on the top side of the penis. The third cylinder is called the corpus spongiosum. The corpus spongiosum connects with the head (glans) of the penis, and the urethra (water channel) runs through the corpus spongiosum.

26 During sexual excitement the arteries dilate to rush flow of blood into the penis to create an erection. The veins are believed to contain valves to slow down the exit of blood from the penis

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29 1.Excitement Some general observations Sexual excitement may mount rather unexpectedly and quickly, particularly in younger men, but it may also build up gradually over a longer period of time. In fact, some individuals deliberately distract themselves repeatedly, in order to prolong and savor their experience of becoming aroused.

30 1. EXCITEMENT The Penis Mounting sexual excitement produces an obvious change in the penis. ادم Tumescence: The three spongy bodies inside the penis (the two corpora cavernosa and the corpus spongiosum) become tumescent, i.e. they are filled with blood and thus cause the penis to rise and stiffen. Therefore, the most obvious sign of sexual excitement in the male is the erection of his penis.

31 1. EXCITEMENT The Scrotum At the same time, the smooth muscles of the scrotum contract, its tissue thickens, and the testicles are pulled upward toward the abdomen by the contracting spermatic cords. Muscular Tension, Pulse Rate and Blood Pressure As sexual excitement increases, there is a corresponding increase in muscular tension. At the same time, the pulse rate and blood pressure rise.

32 1. EXCITEMENT The sex flush A number of men also experience what is known as a sex flush, i.e., a red rash that usually begins in the area of the lower abdomen and then spreads to the neck and face or even to the shoulders, arms, and thighs. The sex flush may start only late in the excitement phase and is more likely to appear in the plateau phase. In many cases, however, there is no sex flush at all. Erection of Nipples Not all males experience an erection of their nipples. In some men, it may be brought about by a direct stimulation of the breasts. When nipple erection occurs, it usually appears toward the end of the excitement phase or during the plateau phase and then lasts through the other phases.

33 2. PLATEAU

34 2. Plateau Some general observations The plateau phase is actually nothing more than the continuation of the excitement phase. The word "plateau" is meant to indicate that a certain even level of excitement has been reached which is then maintained for a while before orgasm occurs.

35 2. Plateau Penis and Testicles During the plateau phase, the now erect penis does not undergo any new major changes. However, the testicles swell noticeably and are pulled close to the abdomen. The Bulbo-urethral (Cowper's) Glands The bulbo-urethral (Cowper's) glands secrete a few drops of a clear liquid which may appear at the tip of the penis. (Such a drop may contain some stray sperm cells. This fact should be remembered by couples who want to avoid pregnancy.)

36 2. PLATEAU Sex Flush The sex flush may now appear for the first time or, if it had been visible before, grow more obvious. Not all men show a sex flush, and that some show it only occasionally. Muscular Tension, Pulse Rate and Blood Pressure With increasing sexual stimulation, the entire body experiences an increase in muscular tension, both voluntary and involuntary. At the same time, the pulse rate and blood pressure continue to rise, and breathing becomes faster. Erection of Nipples The same is true for the erection of the nipples. However, if the nipples should become erect during the plateau phase, they will remain so through the other phases

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38 3. Orgasm Some general observations Orgasm (lustful excitement) is the sudden release of muscular and nervous tension at the climax of sexual excitement. The experience represents the most intense physical pleasure of which human beings are capable and is basically the same for males and females. An orgasm lasts only a few seconds and is felt very much like a short seizure or rather a quick succession of convulsions which involve the whole body and soon lead to complete relaxation.

39 3. Orgasm In males, orgasm begins with involuntary rhythmic contractions of the genital ducts and accessory organs (vasa deferentia, seminal vesicles, prostate gland), the urethra, the muscles at the base of the penis and finally the penis itself. The first three or four forceful contractions recur within less than a second, then, as they become weaker, at longer intervals.

40 3. Orgasm In sexually mature males, orgasm is usually accompanied by the ejaculation (throwing out) of semen: As a result of the orgasmic muscular contractions, the accumulated semen is forced through the urethra to the outside where it emerges in several quick spurts. At times, it may be projected a considerable distance; At other times, it may flow out rather gently. The force of a particular ejaculation is not related to a man's strength or virility.

41 How much semen is ejaculated? The amount of semen ejaculated during one orgasm is usually about a teaspoonful. Repeated ejaculations within a short time produce less and less semen.

42 How does ejaculation (coming) occur? Ejaculation (expulsion of semen from the penis) and orgasm (an intense sensation of pleasure with sexual climax) typically occur together in men but represent distinct physiological events. Ejaculation is a complex process that involves tight coordination of the nervous, muscular, and urogenital systems. Ejaculation itself is divided into two distinct phases, emission and ejection. Both of these processes occur within a matter of seconds.

43 Orgasm without Ejaculation Orgasm and ejaculation are two different processes. While it is true that, in men, there can be no ejaculation without orgasm, there can very well be orgasm without ejaculation.

44 What occurs during the emission phase? *The muscular bladder neck and external urethral sphincter tighten in the innermost portion of the urethra. *fluid from the seminal vesicles and prostate is deposited in this portion of the urethra, where it mixes with sperm that travel through a tube attached to the testicle called the vas deferens. This fluid and sperm mixture is known as semen.

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47 What occurs during the ejection phase? During ejection the external urethral sphincter opens up, permitting semen to pass into the portion of the urethra beyond the prostate. Strong contractions of the bulbospongiosus muscle then force the semen out of the urethral meatus (the hole at the tip of the penis).

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49 3. ORGASM Anal Sphincter During orgasm, the anal sphincter muscles contract at the same intervals as the sex organs. Muscular Tension, Pulse Rate and Blood Pressure It is important to remember that the whole body is involved. There is great muscular tension throughout the body, breathing becomes very fast, and the pulse rate and blood pressure rise even higher than during the plateau phase

50 3.ORGASM

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52 4. Resolution Some general observations After orgasm the sex organs (and with them the whole body) need a relatively short time to return to their former, unexcited state. The length of this so-called resolution phase is directly proportionate to that of the excitement phase

53 4. RESOLUTION The Penis The most visible physiological change during this period is the loss of penile erection which proceeds in two stages: The major loss occurs immediately after orgasm. the penis still retains some firmness which may persist for some time, especially if the excitement and plateau phases were extended. On the other hand, nonsexual activities or distractions can complete the loss of erection rather rapidly.

54 4. RESOLUTION Muscular Tension, Pulse Rate and Blood Pressure The muscular tension in the body subsides. Breathing, pulse rate, and blood pressure revert to normal.

55 4. RESOLUTION Sex Flush and Nipple Erection The sex flush mentioned earlier disappears quickly. In contrast, the erection of the nipples, remains visible for some time. Some men perspire immediately after orgasm, although even then this reaction usually remains restricted to the palms of their hands and the soles of their feet.

56 5. REFRACTORY PERIOD After orgasm, there is a period in which males do not respond to new sexual stimulation, This so-called refractory period may be rather short in young males, but usually becomes longer with advancing age

57 5. REFRACTORY PERIOD Immediately following orgasm males experience a socalled refractory period. During this period, which extends well into the resolution phase, the individual cannot respond to any additional or new sexual stimulation, i.e., he is incapable of having another erection and another orgasm. The refractory period may be very short in some individuals, especially while they are young, but it usually becomes longer with advancing age. There may also be such a refractory period in females, although many women can experience several orgasms in rapid succession

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62 sexual response sexual response cycle in women cycle in women sexual response cycle in women

63 What physical changes occur during the sexual response cycle in women?

64 Cross section of the female pelvis showing internal and external organs of the genitalia and neighboring organs

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67 In modern times, the sexual response cycle was first analyzed and described by Albert Moll, who also proposed its division into four major phases: 1. the onset of voluptuousness, 2. the equable voluptuous sensation, 3. the voluptuous acme, and 4. the sudden decline (A. Moll, The Sexual Life of the Child, 1909). Wilhelm Reich, in a later book, offered a different description: 1. mechanical tension, 2. bio-electric charge, 3. bio-electric discharge, and 4. mechanical relaxation. (W. Reich, The Function of the Orgasm [1927] 1942). More recently, Masters and Johnson have relabeled these phases as 1. excitement, 2. plateau, 3. orgasm, and 4. resolution. In addition, they have introduced the concept of a fifth phase, the refractory period.

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69 1. EXCITEMENT

70 1.Excitement Some general observations Not only men but also women can become sexually aroused very suddenly, and some of them may experience one or more orgasms within a few minutes. As a matter of fact, there are women who reach orgasm fifteen to thirty seconds after they begin sexual intercourse. It seems, however, that during the first stages of arousal women are more easily distracted than men and depend more on continued direct physical stimulation. For this reason, many females seem to need a longer time to reach orgasm during coitus than their male partners, whose excitement is often sustained and increased by psychological factors. In general, females are less easily stimulated by mere sights and sounds, or by erotic fantasies and anticipations. On the other hand, when the average woman is able to concentrate on her preferred method of stimulation (during masturbation, for instance), she achieves orgasm just as quickly as the average man

71 The Vagina Mounting sexual excitement produces two major changes in the vagina: 1- An engorgement with blood, i.e. tumescence 2- A widening of the inner two thirds of the vaginal barrel, i.e. a tenting effect.

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73 1- Tumescence The first and most obvious sign of sexual excitement and tumescence is the lubrication of the vagina. In response to effective stimulation, the vaginal walls begin to secrete a clear fluid which soon provides a moist coating for the entire vagina in preparation for coitus. Without such lubrication, the insertion of a penis into a vagina could be painful for both partners. (The corresponding sign of tumescence in males is the erection of the penis. In short, as the penis becomes ready to enter the vagina, the vagina becomes ready to receive it).

74 2-Tenting effect With continued arousal, the inner two thirds of the vagina increase in both length and width, creating a tenting or ballooning effect. (In its unexcited state, the vagina is a collapsed tube, i.e., its walls are touching). At the same time, there is a vaginal color change from the usual red to a deep purple that becomes even darker during the following phases.

75 The Major Lips A woman's major lips respond differently, depending on whether she has given birth to children or not. If she has not given birth, sexual excitement will cause her major lips to flatten out and expose the vaginal opening. The major lips of a woman who has given birth, on the other hand, are rather large and now grow even larger as a result of engorgement. Nevertheless, they also expose the vaginal opening.

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77 2-Tenting effect The Minor Lips The minor lips swell considerably in all women and also change their color to a progressively deeper red. The clitoris increases in size as its erectile tissue becomes filled with blood. This increase is usually most noticeable in the diameter of the clitoral shaft. The Uterus&breasts The uterus also begins to swell and is pulled upward into the abdomen, thus contributing to the lengthening of the vagina mentioned above. During sexual excitement, the nipples of the breasts become erect and maintain this erection throughout the other phases. However, since the dark area around each nipple, and, indeed the whole breast, soon also becomes engorged and swollen, the nipple erection itself gradually appears less conspicuous.

78 Muscle contractions and sex flush Mounting sexual tension further produces voluntary and involuntary muscular contractions in various parts of the body as well as a rise in pulse rate and blood pressure. Most women also show a so called sex flush, i.e., a red rash which begins in the stomach area and then spreads to the breasts and neck. This rash lasts through the orgasmic phase.

79 1. EXCITEMENT

80 2. Plateau Some general observations The plateau phase is nothing more than the continuation of the excitement phase. The word "plateau" is meant to indicate that a certain even level of excitement has been reached which is then maintained for a while before orgasm occurs.

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82 The Vagina: Orgasmic Platform There is only a slight increase in length and width of the inner two thirds of the vagina. Outer one-third becomes congested with blood. As a result, this part of the vagina, which might have widened somewhat during the excitement phase, now narrows by about 33 percent. This congested and tightening outer third of the vagina has been named the''orgasmic platform" by Masters and Johnson.

83 The Major and Minor Lips While the major lips show no further changes during the plateau phase, the minor lips continue to darken in color, especially in women who have given birth. This marked color change is a sign that orgasm is approaching.

84 The Clitoris The clitoris retracts under the clitoral hood or foreskin, and thus becomes inaccessible to direct stimulation by the woman or her sexual partner. (In the past, it was not always understood that this retraction of the clitoris indicates an increase, not decrease, of sexual excitement). With mounting sexual excitement, the glans of the clitoris retracts under its hood.

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86 2. Plateau The Greater Vestibular (Bartholin's) Glands The greater vestibular (Bartholin's) glands (which correspond to the bulbourethral [Cowper's] glands in the male) may secrete a small amount of fluid during the plateau phase or late in the excitement phase. Uterus and Breasts The uterus is pulled further upward into the abdomen and further increases in size. The breasts also reach their greatest expansion during the plateau phase. Sex Flush and Increasing Muscular Tension The sex flush, if indeed it should have occurred, may now become more intense and cover a wider area. Voluntary and involuntary muscular tension greatly increases throughout the body. The pulse rate and blood pressure rise, and breathing becomes faster.

87 2. PLATEAU

88 2. PLATEAU

89 3. Orgasm Some general observations Orgasm (lustful excitement) is the sudden release of muscular and nervous tension at the climax of sexual excitement. The experience represents the most intense physical pleasure of which human beings are capable and is basically the same for females and males. An orgasm lasts only a few moments and is felt very much like a seizure or rather a series of convulsions which involve the whole body and soon lead to complete relaxation.

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91 The Vagina In females, orgasm begins with strong, rhythmic contractions of the outer onethird of the vagina, which Masters and Johnson call the orgasmic platform. These contractions, which may number from three to fifteen, first recur within less than a second, then, as they become weaker, at longer intervals.

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93 3. Orgasm Uterus and Anal Sphincter Almost at the same time, the uterus begins to contract. However, the uterine contractions are irregular. They start at the top, working their way down, not unlike the contractions during the first stage of labor. The sphincter muscles of the rectum may also contract a few times at the same intervals as the orgasmic platform. Muscular Tension, Pulse Rate and Blood Pressure In general, there is great muscular tension, not only in the entire pelvic area, but also in other parts of the body, such as the neck, arms, hands, legs, and feet. The pulse rate and blood pressure rise slightly even beyond the level reached during the plateau phase, and breathing is very fast. The intensity of all of these physical reactions depends, of course, on the degree and duration of sexual tension. Possible Patterns Masters and Johnson found only one sexual response pattern in males. However, in females, they discovered some possible variations

94 Ejaculation? In sexually mature males, orgasm is accompanied by the ejaculation of semen. Women do not produce semen, and, as a rule, do not ejaculate. However, there are exceptions: In some women certain paraurethral glands (i.e. glands next to the urethra) have developed to a point where they produce an prostate-like fluid which can be expelled through the urethra during the muscular contractions of orgasm. In these cases, many researchers speak of a female prostate and female ejaculation.

95 4. Resolution Some general observations After orgasm, the sex organs (and with them the whole body) need some time to return to their unexcited state. The Vagina During the so-called resolution phase, the congestion in the outer one-third of the vagina (the orgasmic platform) disappears quickly. The Clitoris The clitoris reemerges from under the clitoral hood. The Major and Minor Lips The major and minor lips again assume their former shape and size. The Uterus The uterus also shrinks back to its usual size, and, as it descends from its elevated position in the abdomen, the tenting or ballooning effect in the inner two thirds of the vagina is eliminated.

96 4. Resolution The Sex Flush The sex flush mentioned earlier vanishes. The Breasts The nipples of the breasts and the breasts themselves slowly return to their normal state. With the release of muscular tension, the pulse rate and blood pressure decrease, and breathing becomes normal again. No "Refractory Period It should be noted at this point that, unlike men, many women do not seem to have a "refractory period," i.e. a rest period in which they cannot respond to additional stimulation. At any rate, if they do have one, it is not as obvious. In many cases continued or repeated stimulation can bring a woman to a second and third orgasm immediately following the first one. Indeed, many women are capable of having many orgasms in quick succession. Obviously, in this case, the resolution phase as described here does not begin until after the last of these orgasms.

97 4. RESOLUTION

98 4. RESOLUTION

99 5. REFRACTORY PERIOD There is some evidence that females may also experience a so-called refractory period, i.e. a time after orgasm in which they do not respond to renewed sexual stimulation. However, this phenomenon is not always easily noticed, since many females are capable of several orgasms in quick succession.

100 5. REFRACTORY PERIOD

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