# Sexual Education

## November 2nd, 2020

-   So, gynecologist Dr. Gregory Moore is giving a guest lecture about sexuality - so, be prepared for that
    -   "We're pretty much surrounded by sex - you can't check something out at the grocery store without seeing something sexual on a magazine"
        -   "Hooking up" refers to 2 people getting together to do something sexual...but it turns out that people don't agree on what it means! 36% think it means intercourse, 17% think it just means making out, and others think it's something in-between
    -   For this class, SEX refers to intimate activity that could result in a pregnancy or sexually transmitted infections

-   So, let's talk about some physiology
    -   HORMONES are chemical messengers in your body, the big ones involved in sex are ESTROGEN (hormone responsible for secondary female sex characteristics - "things you're not born with, like breasts"), PROGESTERONE (responsible for development of endometrial tissues in the uterus), and TESTOSTERONE (responsible for primary and secondary male sex characteristics, like hair on chin, Adam's apple, etc.)
    -   The female reproductive system has...
        -   2 "X" chromosomes
        -   Ovaries (glands that produce ova and female hormones)
        -   Fallopian tubes (structure where the ripe egg is released and fertilized)
        -   Uterus (where the fertilized egg lands and develops into a child)
        -   Cervix (neck of the uterus that opens into the vagina)
        -   Vagina (passage between the cervix and external sex organs)
            -   The VULVA is the outside portion of this; technically, the vagina ONLY refers to the internal passage
        -   Clitoris (a dense nerve network that's important in female arousal)
        -   The female reproductive system is controlled by 4 primary hormones: LM and FSH (follicle stimulating hormone) are produced by the pituitary gland,
            -   OVULATION is the release of mature or ripe ovums, or eggs
                -   In a period, there'll be vaginal bleeding for 5-6 days with estrogen at a fairly low level, a spike in estrogen, the egg is released, estrogen goes down and progesterone goes up (followed shortly by estrogen) to stabilize the uterine lining, and then the progesterone
                -   This whole cycle takes ~28 days
                -   The cycles of this MENSTRUATION period include the PROLIFERATIVE STAGE (before the egg is released), SECRETORY PHASE (after egg released), and MENSTRUAL PHASE (during the egg's release):
                    -   Days ~1-5 and ~19-28, which is relatively safe for unprotected intercourse
                    -   Days 6-8 is when deposited sperm may remain viable when the egg is released
                    -   Day 9-13 is when sperm has a high chance of remaining viable on the egg if unprotected sex should occur
                    -   Day 14 is when the egg is released, along with the lining of the uterus (which comes out as "blood")
                    -   Days 15-16 have a high chance of the egg still receiving sperm and becoming fertilized, and 17-18 have a lesser chance of the egg still being viable
            -   MENOPAUSE is the cessation of the female menstrual cycle, when the female body runs out of its millions of eggs; it usually occurs between ages 45 and 55
                -   This can result in decreased estrogen levels, vaginal dryness, "hot flashes" (the skin actually rises in temperature), and bone loss
                -   Most menopause symptoms disappear after a year, but in some cases can persist for a long time; some women treat this with hormone replacement theory, but this has some risks (like blood clotting)
        -   Fertilization occurs when the egg makes contact with sperm; it then begins dividing into multiple cells within 24 hours, by day 4 it's divided many times
        -   Speaking more about what females go through during puberty:
            -   The MENARCHE is the onset of the first menstrual period in women, which normally happens between ages 10 and 18; during this time, secondary sexual characteristics like underarm hair growth, breast growth, etc. occur
            -   OVULATION is the phase of the menstrual period when the ovarian walls rupture and release a mature egg
        -   Menstrual problems are fairly common, and can take many forms
            -   Premenstrual syndrome occurs in 85% of women, but generally with mild symptoms (mild headache, bloating, etc.)
            -   Premenstrual dysphoric disorder is SEVERE symptoms like depression, suicidal thoughts, migraines, etc., and is rare
            -   Dysmenorrhea is pain during the menstrual period; this is fairly common, but usually mild (the kind of pain Advil would take care of)
            -   Toxic Shock Syndrome usually comes from improper use of tampons, and is where a toxic bacteria builds up in the vagina and can cause poisoning ("so tampons need to be removed before sleeping")
    -   Now, for the male reproductive system...
        -   The TESTES are the glands that produce sperm and testosterone
        -   The SCROTUM is the sack that protects the testes
        -   The VAS DEFERENS receives sperm from the testes and provides routes for the movement of sperm
        -   SEMINAL VESICLES secrete nutrients to keep the sperm alive
        -   The BULBOURETHRAL GLANDS (or "Cowper's Glands") secrete a lubricating substance that helps sperm pass through the urethra
        -   The PROSTATE GLAND secretes an alkaline substance that cancels out the vagina's medium (as the vagina is usually acidic, < 4.7 ph)
        -   GLANS PENIS is the head of the penis and a dense network of nerves, which is important in male arousal
            -   "Women are more prone to get bladder infections because the urethra in men is much longer; bacteria live in the bladder, not as much in the urethra"
        -   While it can happen to women too, men are subject to HERNIAS (i.e. bulging out of the internal part of these organs, since men already have them outside)

-   So, let's talk about pregnancy
    -   At the split-second, within a millisecond of sperm coming into contact with the ovum, the egg wall changes to not allow any other sperm cells inside, at which point fertilization begins
    -   The FIRST TRIMESTER of pregnancy lasts 12-13 weeks; until week 8 or 9, the baby is called an embryo before becoming a FETUS
    -   The SECOND TRIMESTER lasts weeks 12-26, when the fetus is 2 to 2.5 pounds
    -   The THIRD TRIMESTER is weeks 27-40, when the fetus weighs 7 to 8 pounds (growing to a normal birth rate)
        -   In the weeks before birth, contractions begin, causing the cervix to thin and moving the baby lower in the womb; when the amniotic sack bursts, it releases water through the cervix; active LABOR (the 1st stage of birth) then begins, with contractions becoming more frequent and intense, the cervix opening widening, and
            -   Then "transition" (the 2nd and most painful part of birth) begins, with the woman feeling an urge to push the baby through the birth canal; "Crowning" is when the baby's head is visible externally (the baby usually comes out head first)
            -   In the 3rd stage of birth, the placenta (baby's nutrient source)detaches, comes out of the womb, and is also pushed out
    -   Pregnancies are usually straightforward, but complications can occur
        -   ECTOPIC PREGNANCY is when the fertilized egg implants somewhere besides the uterus/womb (usually the fallopian tube, but sometimes the abdomen)
            -   Usually such eggs die, but occasionally it finds a place to implant and can damage the body or cause internal bleeding; this is a leading cause of death in pregnancy
        -   BREECH BIRTH is when the baby isn't born head-first (e.g. feet or buttocks first); these babies are usually delivered via C-section
        -   MISCARRIAGE (or "unintentional abortion" in medical terms) is when a child dies while developing, for whatever reason; this happens almost always in the first half of pregnancy
        -   STILLBIRTH is when the baby is born, but has died during birth or late in the 2nd+ trimester (usually due to strangling via the umbilical cord, or the cord being cut off - as that's the baby's source of oxygen)
        -   Placental complications, like PLACENTA PREVIA (placenta blocking the exit of the cervix, keeping the baby in) or PLACENTA ABRUPTION (placenta separates from the uterine wall before birth)
        -   PREECLAMPSIA is a mysterious condition where the blood pressure swells before birth; by itself it's normal, but in severe cases of ECLAMPSIA, this can cause death or coma

-   So, if you want to avoid getting pregnant, you use CONTRACEPTIVES - "plenty of these exist, so if you don't want to get pregnant, you shouldn't ever"
    -   There are HORMONE METHODS that use hormones to suppress the menstrual cycle in the first place
        -   Birth control pills use hormones to suppress ovulation or thicken cervical mucus, restricting sperm movement
        - Contraceptive implants are administered under the skin via shots, last 3 months, and emit progesterone to suppress ovulation
        -   Vaginal rings also emit estrogen/progesterone into the vaginal wall directly
        -   Contraceptive skin patches do the same thing, but as a bandage
    -   BARRIER METHODS try to keep the egg from coming in contact with semen via a physical barrier
        -   Condoms cover the male penis, diaphragms cover the female entrance to the uterus
            -   These are often coated in sperm-killing spermicides
        -   "These have the issue of having to remember to use them, and using them properly"
        -   Intrauterine devices that are put inside the uterus are HIGHLY effective, and can last for multiple years and be removed at any time
    -   Surgical methods like VASECTOMY (cutting off the fallopian tubes) are very effective, but permanent
    -   NATURAL METHODS are like recording your ovulation cycle and only having sex when you're not ovulating
    -   There's, finally, emergency contraception "morning after" pills - these have to be taken within 72 hours after unprotected intercourse to be effected
        -   PlanB is the less effective over-the-counter version that stops ~70% of pregnancies, Ella stops ~85% of pregnancies and works slightly longer; both have mild side effects like dizziness, abdominal pain, fatigue, headache, etc.
        -   These work ONLY after conception but before the "pregnancy is established" (before it reaches the uterus)
        -   Copper IUDs are actually the most effective emergency contraceptive (works up to 5-10 days later), as copper ions kill sperm and impair their function, as well as inhibiting ovulation - "people have known for centuries that objects placed in the uterus prevent pregnancy"
    -   Condoms, however, are really the ONLY thing that'll prevent STDs and STIs, but misusing them is common

-   So, any loss of pregnancy is medically known as an abortion, but colloquially abortion refers to voluntary abortions
    -   This was legalized in the U.S. in 1973 in the Roe v. Wade case; states can't give the husband veto power, but may require notice to be given to parents of a minor, and medicaid funding cannot be used for the procedure
        -   Later-term or "partial" abortions are uncommon, and illegal in all 50 states
        -   Statistically, 64% of abortions are done in the first 8 weeks, 27% in weeks 9-13, and 7% in weeks 14-20 - all in the 1st or 2nd trimester
    -   During the 1st trimester, this can be done using drugs; the 2nd trimester usually requires surgery (instruments inside the uterus)
    -   Abortion is, of course, controversial ethically - is it okay if the woman has a chance of high death from the pregnancy? If the fetus is guaranteed to die upon birth? If it's a pregnancy from sexual assault?
        -   ...I notice none of these hypotheticals are against abortion

-   Well, that's the first half - see you for the second!