5.

2 The Reproductive System

Overview
The human reproductive system consists of functional male and female reproductive organ systems.

Primary Functions:

• Produce and deposit sperm in males and egg cells in females

• Enable internal fertilization through sexual intercourse

• Facilitate the fertilization of the ovum (egg) when sperm enters the uterus and fallopian tubes

5.2.1 Human Reproductive System (Male and Female)

The Male Reproductive System

The male reproductive system contains:

• External organs: Penis, testes, and scrotum

• Internal parts: Prostate gland, vas deferens, and urethra

Functions:

• Produce sperm (male gametes)

• Produce male sex hormones

• Produce other components of semen

1. The Penis The penis is the male copulatory organ containing:

• Soft, spongy tissue

• Muscles

• Fibrous tissue

• Veins and arteries

• Urethra

Functions: Urinary and sexual functions

Sexual Function Stages:

Erection:

• Occurs when there is increased blood flow into the corpus cavernosa and corpus spongiosum

• Arteries supplying erectile tissues dilate (widen), causing the penis to engorge (fill) with blood

Ejaculation:

• Expulsion of semen from the penis

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2. Urethra The urethra is a tube connecting the urinary bladder to the urinary meatus for urine
removal.

In males, it serves dual purposes:

• Passage of urine from the bladder to outside the body (urination)

• Expulsion of sperm during ejaculation

3. The Scrotum The scrotum is a sack of thick skin that:

• Protects the testes

• Controls temperature for suitable sperm creation

Contains:

• Seminal vesicles

• Vas deferens

• Testicles (testes)

• Prostate gland

4. Testes Testes are oval pair bodies found in the scrotum with two primary functions:

1. Production of testosterone (male sex hormones)

2. Production of sperm (spermatogenesis)

The Female Reproductive System

The female reproductive system includes:

• Ovaries

• Fallopian tubes

• Uterus

• Vagina

• Accessory glands

• External genital organs

Functions:

• Produce gametes called eggs

• Secrete sex hormones (such as estrogen)

• Provide a site for fertilization

External Reproductive Organs Labia Majora:

• “Large lips” that enclose and protect other external reproductive organs

• Hair growth occurs during puberty

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 • Contain sweat and oil-secreting glands

Clitoris:

• Small, sensitive protrusion where the two labia minora meet

• Comparable to the penis in males

• Covered by a fold of skin called the prepuce (similar to foreskin)

• Very sensitive to stimulation and can become erect

Labia Minora:

• “Small lips” with various sizes and shapes

• Lie just inside the labia majora

• Surround openings to the vagina and urethra

• Very delicate skin that can become easily irritated and swollen

Bartholin’s Glands:

• Located next to the vaginal opening on each side

• Produce fluid (mucus) secretion

Internal Reproductive Organs Vagina:

• Canal joining the cervix to the outside of the body

• Also known as the birth canal

Uterus (Womb):

• Hollow, pear-shaped organ that houses a developing fetus

• Divided into two parts:

• Cervix: Lower part that opens into the vagina

• Corpus: Main body of the uterus that expands to hold a developing baby

• A canal through the cervix allows sperm to enter and menstrual blood to exit

Ovaries:

• Small, oval-shaped glands located on either side of the uterus

• Produce eggs and hormones

Fallopian Tubes:

• Narrow tubes attached to the upper part of the uterus

• Serve as pathways for ova (egg cells) to travel from ovaries to uterus

• Fertilization normally occurs in the fallopian tubes

• The fertilized egg moves to the uterus where it implants into the uterine lining

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5.2.2 Gametogenesis
Gametogenesis is a process where a haploid daughter cell (n) is formed from a diploid mother cell (2n)
through meiosis.

Two Types:

• Spermatogenesis: Produces spermatozoa in males

• Oogenesis: Produces ova in females

Spermatogenesis

Spermatogenesis is the process by which haploid (n) spermatozoa develop from germ cells in the seminif-
erous tubules of the testis.

Additional Function: Testes produce the male hormone called androgen (testicular hormone).

Process:

1. Germinal epithelium lines the seminiferous tubules

2. Primordial germ cells (PGCs) are cuboidal cells in the lining

3. Sertoli cells are tall somatic cells that help nourish developing sperm (also called nurse cells)

Stages of Development:

1. At sexual maturity, undifferentiated PGCs divide several times by mitosis to produce sperm mother
cells or spermatogonia

2. Spermatogonia are diploid cells that:

• Go through mitotic division

• Generate primary spermatocytes

3. Primary spermatocytes undergo meiosis to form two haploid cells called secondary sperma-
tocytes (each with 23 chromosomes)

4. Second meiotic division occurs in secondary spermatocytes, resulting in production of four equal
and haploid spermatids

5. Spermiogenesis: Spermatids are transformed into spermatozoa (sperm)

6. Maturation takes place in the epididymis where sperm is secreted in the form of semen during
puberty

Oogenesis

Oogenesis is the development of female egg cells found in the outermost layers of the ovaries.

Process:

• Begins with germ cell oogonium

• Ends with one to two million cells in embryogenesis

• Oogenesis arrests division as it develops in the follicle

• Gives rise to a haploid (n) cell oocyte and a smaller polar body

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Phases of the Menstrual Cycle
The menstrual cycle is the process of discharge of blood and other materials through the vagina every
month from puberty to menopause (excluding pregnancy).

Key Points:

• If the ovum is not fertilized, the uterine lining is released, resulting in menstruation

• Duration averages about 28 days

• Can range from 20 to 45 days in different women

Phases (Events) of Menstrual Cycles

1. The Follicular Phase

• Anterior pituitary produces and secretes follicle-stimulating hormone (FSH)

• FSH stimulates estrogen production
• Negative feedback prevents growth of other follicles

2. The Ovulation Phase

• Occurs midway through the cycle (days 12-14)

• Estrogen stimulates the anterior pituitary to secrete luteinizing hormone (LH)
• Positive feedback causes surge in LH
• Release of an egg (secondary oocyte) occurs

3. The Luteal Phase

• Ruptured follicle develops into a slowly degenerating corpus luteum

• Corpus luteum secretes:
– High levels of progesterone
– Lower levels of estrogen
• Both hormones act on the uterus to thicken the endometrial lining in preparation for pregnancy
• Inhibit secretion of FSH and LH to prevent follicle development

4. The Menstruation Phase

• If fertilization occurs:
– Embryo develops and implants in the endometrium
– Embryo releases hormones to sustain the corpus luteum
• If fertilization fails:
– Corpus luteum degenerates
– Estrogen and progesterone levels drop
– Forms corpus albicans after two weeks
– Endometrium is not maintained
– Uterine lining is eliminated from the body as menstrual blood

Feedbacks to Menstrual Cycle

Estrogen Hormone:

• Promotes secretion and ovulation

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 • During days 12-14, estrogen provides positive feedback to hypothalamus and pituitary gland

• Accelerates production leading to ovulation

Progesterone:

• Involved in menstrual cycle

• Promotes gestation (carrying of fetus)

• Maintains the endometrium of the uterus

Uterus:

• Walls dilate by contracting and stretching until birth of baby

Table 5.6: Menstrual Cycle

Positive and Negative Feedbacks to Control the Menstrual Cycle

A feedback mechanism is a physiological regulation system that works to return the body to its normal
internal state (homeostasis).

Positive Feedback:

• End products of an action cause more of that action to occur

• In menstrual cycle: Days 12-14 when estrogen stimulates hypothalamus to release Gonadotropin
Releasing Hormones (GnRH)

• GnRH stimulates anterior pituitary to secrete Luteinizing Hormone (LH) and Follicle Stim-
ulating Hormone (FSH)

1. Luteinizing Hormone (LH)

LH is a gonadotrophic hormone regulating function of testes in men and ovaries in women.

In Men:

• Stimulates cells in testes to produce testosterone

• Supports sperm production

In Women:

• Stimulates ovarian follicles to produce female sex hormone estradiol

• Around day 14, surge in LH causes ovarian follicle to rupture and release mature oocyte (egg) —
ovulation

• Remnants of ovarian follicle form corpus luteum to produce progesterone required for early preg-
nancy

• Rise of LH levels is negative feedback; too much LH indicates infertility

2. Follicle Stimulating Hormone (FSH)

FSH plays a role in sexual development and reproduction, affecting ovaries and testicles.

Function:

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 • Released at beginning of each cycle

• Stimulates ovaries to grow follicles and eggs for ovulation

• Progesterone maintains uterine lining/thickness

Process:

• Rise in FSH stimulates follicle growth in ovary

• Produces increasing amounts of estradiol

• Reduces release of gonadotrophin hormone as negative feedback

• During follicular phase, FSH stimulates follicular growth leading to ovulation

• Ruptured follicle forms corpus luteum producing high progesterone (luteal phase)

• At end of cycle, corpus luteum breaks down, progesterone decreases, next cycle begins

Negative Feedback Outcome:

• Biochemical pathway turns off

• Egg fails to fertilize

• Corpus luteum dies

• Progesterone levels drop

• Uterine lining breaks down

• Menstruation occurs

Summary:

• Positive feedback leads to ovulation

• Negative feedback leads to menstruation

5.2.3 Fertilization and Pregnancy

1. Fertilization

Fertilization is the union of human egg and sperm cells in the ampulla of the fallopian tube to produce
a zygote.

Process:

• 23 sets of chromosomes from spermatozoon fuse with 23 sets from egg cell

• Fertilized egg (zygote) divides repeatedly as it moves down fallopian tube to uterus

• About 6 days after fertilization, embryo attaches to uterine lining (usually near top)

• This process is called implantation, completed within 9-10 days

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2. Pregnancy

Pregnancy (gestation period) is the period in which the fetus develops inside a woman’s womb or uterus.

Duration: About 40 weeks (280 days) from last menstrual period to delivery

Multiple Pregnancy: A pregnancy with more than one fetus (twin or triplet)

5.2.4 Mechanism of Action of Contraceptives

Contraception refers to the intentional process of preventing pregnancy through:

• Hormonal drugs

• Devices

• Sexual practices

• Chemicals

• Surgical procedures

Categories

Barrier Contraceptives: Devices providing physical barrier between sperm and egg.

Examples:

• Male condom

• Female condom

• Diaphragm

• Cervical cap

Diaphragm

• Small, soft silicon dome placed inside vagina

• Stops sperm from entering uterus
• Forms physical barrier between sperm and egg

Chemical Barriers or Spermicides

• Sperm-killing substances
• Available as: foams, creams, gels, films, or suppositories
• Often used with mechanical barriers

Oral Contraceptive Pills

• Combined hormonal pills with estrogen and progesterone

• Type of birth control taken orally by women

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Contraceptive Implant

• Small flexible plastic rod placed under skin in upper arm

• Lasts for three years
• Releases hormone progesterone into bloodstream to prevent pregnancy

Contraceptive Injection

• Contains synthetic version of hormone progesterone (DEPO Provera)

• Brand name for medroxyprogesterone acetate
• Prevents body from producing its own hormones and releasing eggs from ovaries

Contraceptive Ring (Vaginal Ring)

• Releases continuous dose of hormones estrogen and progesterone into bloodstream

Sterilization

• Permanent method of contraception

• For women: tubal ligation — prevents egg from traveling through fallopian tubes and blocks
sperm
• For men: vasectomy — blocks or cuts each vas deferens tube, keeping sperm out of semen; sperm
cells stay in testicles and are absorbed by body

5.2.5 Causes of Infertility in Humans

Infertility is the inability of a person to reproduce by natural means.

Female Infertility

Inability to get pregnant (conceive) after unprotected sex.

Causes:

1. Ovulatory Problems:
• Manifested by sparse or absent menstrual periods
2. Thyroid Problems:
• Prevents ovulation (both overactive and underactive)
3. Pelvic Surgery Complications:
• Fallopian tube damage and scarring
• Cut ovaries
4. Cervical Mucus Problems:
• Harder mucus prevents sperm from swimming into vagina
5. Fibroids:
• Non-cancerous growths in or around womb affect fertility
6. Endometriosis:
• Growths in womb lining (endometrium) block ovaries
7. Pelvic Inflammatory Diseases:
• Cause infections of upper female genital tract
8. Medicines and Drugs:

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 • Side effects cause infertility

Infertility in Men

Production of low, abnormal, and dysfunctional sperm and blockages preventing adequate delivery of
sperm.

Contributing Factors:

• Chronic health problems

• Illnesses

• Injuries

• Inherited disorders

• Hormonal imbalances

• Dilated veins around testicle

• Conditions blocking passage of sperm

Symptoms of Male Infertility:

1. Immotile sperm (harder to swim to egg)

2. Discomfort, pain, swelling, or lump in testicle area

3. Surgery of groin, testicle, prostate, penis, or scrotum

4. Lower sperm count (fewer than 15 million sperm per milliliter or total count less than 39 million
per ejaculate)

Risk Factors:

• Smoking tobacco

• Using alcohol and drugs

• Being overweight

• Exposure to toxins

• Repeated past or present STD infections

• Overheating and trauma to testicles

Major Sexually Transmitted Infections (STIs) in Ethiopia

Sexually Transmitted Infections (STIs) are communicable diseases primarily transmitted through
sexual contact from a sick person to a healthy person.

Statistics: More than 20 types of STIs spread through unprotected sexual intercourse.

Major Causative Agents: Bacteria, viruses, and parasites

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Types of Sexually Transmitted Infections and Preventions

Bacterial Infections A. Bacterial Vaginosis

• Type of vaginal inflammation caused by overgrowth of bacteria naturally found in vagina

• Causative agent: Bacterial vaginosis

• Transmission: Sexual contact

• Symptoms:

• Vaginal discharge (thin, gray, white, or green)

• Foul-smelling or fishy vaginal odor

• Vaginal itching and burning during urination

• Prevention/Treatment: Protective sexual contact and medical treatments

• Prevalence in Ethiopia: 2.8–19.4%

B. Chlamydia

• Common STI caused by bacteria Chlamydia trachomatis

• Spreads through sexual contact when vaginal fluid or semen containing bacteria travels from one
person to another

C. Syphilis

• Life-threatening disease affecting brain, nervous system, eyes, heart, and other organs

• Develops through four stages of symptoms

• Causative agent: Treponema pallidum

• Transmission: Sexual contact

• Symptoms:

• Sores around genitals, anus, rectum, or mouth (last 3-6 weeks)

• Non-itchy rash of rough, brownish or red spots on palms and soles

• Lesions in mucous membranes (mouth, vagina, or anus)

D. Gonorrhea

• Infectious disease caused by bacterium Neisseria gonorrhea

• Highly contagious; can lead to life-threatening complications

• Transmission: Touches of infected body area; thrives in warm, moist parts (vagina, penis, mouth,
rectum, eye)

• Symptoms: Painful urination and abnormal discharge from penis or vagina

• Prevention/Treatment: Protective sexual contact and medical treatments

E. Chancroid

• Curable STI caused by bacterial species Haemophilus ducreyi

• Highly contagious, painful necrotizing genital ulcer accompanied by inguinal lymphadenopathy

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Viral Infections A. Genital Herpes

• STI caused by two types of herpes simplex virus (HSV): HSV-1 and HSV-2

HSV-1 (Human Simplex Virus 1):

• Affects the mouth

• Spreads through saliva or herpes-related sore around mouth

HSV-2 (Human Simplex Virus 2):

• Affects genital, anal, and mouth areas

• Transmitted through sexual intercourse

B. Genital Warts

• STI caused by human papilloma virus (HPV)

• Can cause pain, discomfort, and itching

• HPV is a group of viruses affecting skin, mucous membranes, throat, cervix, anus, and mouth

• Increases risk of cervical and throat cancer

• Spreads through sex

C. Molluscum Contagiosum

• Contagious viral skin infection caused by pox virus

• Affects both adults and children

• Causative agent: Molluscum contagiosum virus

• Transmission: Skin-to-skin contact

• Symptoms: Small round bumps and indents on skin that disappear soon

• Prevention/Treatment: Protective self-hygiene

D. Human Immunodeficiency Virus (HIV)

• Virus attacking human immune system cells that fight infections

• Makes person vulnerable to other infections and diseases

• Without treatment, advances in stages, gradually destroying immune system

• Eventually causes Acquired Immunodeficiency Syndrome (AIDS)

• Belongs to class of viruses known as retroviruses

• Attacks CD4 helper cells (T cells) and organelles (ribosome, Golgi apparatus, endoplasmic reticu-
lum)

Three Stages of HIV Infection:

1. Acute HIV Infection (Earliest Stage):

• 2 to 4 weeks after infection
• Flu-like symptoms: fever, headache, rash

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 • HIV multiplies rapidly and spreads throughout body
• Virus attacks and destroys CD4 cells
2. Chronic HIV Infection (Second Stage):
• 1 to 7 years
• Also called asymptomatic HIV infection or clinical latency
• HIV continues to multiply
• Usually advances to AIDS
3. AIDS (Final Stage):
• 10 years and above
• Most severe stage
• HIV severely damages immune system
• Body cannot fight off opportunistic infections (tuberculosis, tumors)
• CD4 count fewer than 200 cells/mm³
• Without treatment, survival about 3 years
• Healthy immune system CD4 counts: 500-1600 cells/mm³

E. Hepatitis B

• Viral infection attacking liver

• Causes both acute and chronic liver diseases

• Virus remains in semen, blood, and other bodily fluids

• Can develop liver cancer, cirrhosis, and hepatocellular carcinoma causing liver failure and death

• Vaccines prevent hepatitis B effectively

WHO Statistics (2019):

• 296 million people living with chronic hepatitis B

• 1.5 million new infections each year

• 820,000 deaths from cirrhosis and hepatocellular carcinoma

Causative agent: Viruses

Transmission:

• Sexual contact with infected persons

• Use of non-sterile injections

• Blood and bodily fluids

Symptoms:

• Yellowing of skin and eyes (jaundice)

• Dark urine

• Extreme fatigue

• Nausea and vomiting

• Abdominal pain

Prevention/Treatment:

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 • Protective sexual contact

• Safe from contact with bodily fluids or contaminations

Parasites A. Crabs (Pubic Lice)

• Pubic lice attaching to pubic hair

• Sometimes affect hair in armpits, beard, eyelashes, or eyebrows

• Spread during close physical and sexual contact

• Transmitted via shared towels

B. Trichomoniasis

• Common STI caused by parasite Trichomonas vaginalis

• Causative agent: Trichomonas vaginalis

• Transmission: Sexual contact

Symptoms in Women:

• Large amount of thin, often foul-smelling discharge (clear, white, gray, yellow, or green)

• Genital redness, burning, and itching

• Pain with urination or sex

• Discomfort over lower stomach area

Symptoms in Men:

• Itching or irritation inside penis

• Burning with urination or after ejaculation

• Discharge from penis

Prevention/Treatment: Protective sexual contact and medical treatments

C. Scabies

• Contagious skin disease developing due to a mite

• Spreads through direct skin-to-skin contact

5.3 Harmful Traditional Practices

Harmful traditional practices affect reproductive health:

1. Early Marriage:
• Forcing underage girls to marry based on cultural norms
• Perpetuates poverty
2. Kidnapping/Abduction:
• Abducting girls to make them wives unwillingly
3. Gender-Based Violence:

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 • Any form of unwanted sexual contact (sexual abuse or harassment)
4. Female Genital Mutilation (FGM):
• Partial or total removal of external female genital organs

5.4 Family Planning

Family planning is the ability to:

• Anticipate and attain desired number of children

• Control spacing and timing of births

• Access materials for individuals and couples to establish a family

5.4.2 Family Planning Actions

The family calendar includes:

• Prevention of unwanted pregnancy

• Safe family from STIs, counseling plans, and fertility management

• Adequate resources for couples to prevent unwanted pregnancy

• Waiting at least 6 months after miscarriage or abortion

• Adoption as another option to build a family

• Birth control and assisted reproductive technology

• Adjustment of family plan calendar to natural menstrual cycle

5.4.3 Family Planning Services

• Pregnancy testing and counseling

• Pregnancy-achieving services (preconception health)
• Basic counseling on infertility
• Counseling on sexually transmitted diseases
• Breast and pelvic examinations
• Breast and cervical cancer screening

Effects of Alcohol Use, Chewing Khat, Cannabis, and Other Drug Uses on
STIs Transmission and Unwanted Pregnancy
5.5.1 Effects of Alcohol Use

Heavy alcohol use affects human lifestyles. Normal blood alcohol limit for euphoria is 0.1%, but increased
intake damages body functions.

Negative Effects:

Acute Effects:

• Higher concentration of blood alcohol (0.25-0.30%) causes sleepiness and confusion

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Chronic Effects:

• Prolonged excessive intake increases dementia (poor nutritional status)

• Damages brain (vitamin deficiencies) and liver (causing cirrhosis)

• Heavy drinking causes J-shaped legs, colorectal and colon cancer

Statistics:

• Alcoholic drinks cause 6.2% of males’ and 1.1% of females’ deaths globally

5.5.2 Effects of Chewing Khat

Khat is a shrubby plant (Catha edulis) chewed as recreational stimulant and psychoactive drug.

Mechanism:

• Stimulates central nervous system

• Leaves contain stimulant drug called cathinone

Negative Effects:

1. Hypertension, stomatitis, esophagitis, gastritis, and constipation

2. Acute coronary syndrome (coronary artery spasm) and myocardial infarction

3. Metabolic disorders, diabetes mellitus, hepatitis, and liver cirrhosis

4. Impotency or loss of sexual drive/libido among male users

5.5.3 Effects of Drug Use

Drugs are biochemical components mostly extracted from plant species. Some affect body and brain
intermittently; others have long-lasting consequences and permanent health hazards.

1. Marijuana

• Prepared from dried leaves and flowers of Cannabis sativa plant

• Stronger than other forms; high potency strains known as sinsemilla or hashish

Harms:

• Brain

• Breathing system

• Heart

• Child development

• Muscular system coordination

2. Cocaine

• Addictive stimulant drug made from leaves of coca plant (Erythroxylum coca) native to South
America

Harms:

• Cardiovascular system

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 • Breathing system

• Gastrointestinal system

• Nervous system

3. Heroin

• Very addictive drug made from morphine

• Psychoactive substance from resin of opium poppy seedpod

4. Inhalants

• Chemicals found in ordinary household or workplace products

• Inhaled on purpose to get high

General Side Effects of Drugs

• Increasing risk of illness and infection

• Heart conditions (abnormal heart rates, heart attacks, collapsed veins, blood vessel infections from
injected drugs)
• Nausea and abdominal pain leading to appetite changes and weight loss
• Seizures, stroke, mental confusion, and brain damage
• Problems with memory, attention, and decision-making

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