{"id":4955,"date":"2019-06-24T16:28:20","date_gmt":"2019-06-24T16:28:20","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/chapter\/13-6-joints-3\/"},"modified":"2023-11-30T18:57:29","modified_gmt":"2023-11-30T18:57:29","slug":"13-6-joints-3","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/chapter\/13-6-joints-3\/","title":{"raw":"11.6\u00a0Joints","rendered":"11.6\u00a0Joints"},"content":{"raw":"&nbsp;\r\n\r\n[caption id=\"attachment_4083\" align=\"aligncenter\" width=\"345\"]<img class=\"wp-image-4083\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/woman-in-black-tank-top-and-black-shorts-lying-on-floor-e1606261742472-2.jpg\" alt=\"A female gymnast performing a backbend with one leg extended up to the ceiling.\" width=\"345\" height=\"500\" \/> <em>Figure 11.6.1 That's quite a stretch!<\/em>[\/caption]\r\n\r\n<div>\r\n<h1>Double Jointed?<\/h1>\r\n<\/div>\r\nIs this woman double jointed? No, there is actually no such thing \u2014 at least as far as humans are concerned. However, some people, like the woman pictured in Figure 11.6.1, are much more flexible than others, generally because they have looser ligaments. Physicians call this condition joint hypermobility. Regardless of what it\u2019s called, the feats of people with highly mobile joints can be quite impressive.\r\n<div>\r\n<h1>What Are Joints?<\/h1>\r\n<\/div>\r\n[pb_glossary id=\"3949\"]<strong>Joints<\/strong>\u00a0[\/pb_glossary]are locations at which\u00a0bones\u00a0of the skeleton connect with one another. A joint is also called an articulation. The majority of joints are structured in such a way that they allow movement. However, not all joints allow movement. Of joints that\u00a0<em>do<\/em>\u00a0allow movement, the extent and direction of the movements they allow also vary.\r\n<div>\r\n<h1>Classification\u00a0of Joints<\/h1>\r\n<\/div>\r\nJoints can be classified structurally or functionally. The structural\u00a0classification\u00a0of joints depends on the manner in which the\u00a0bones\u00a0connect to each other. The functional classification of joints depends on the nature of the movement the joints allow. There is significant overlap between the two types of classifications, because function depends largely on structure.\r\n<h2>Structural Classification of Joints<\/h2>\r\nThe structural classification of joints is based on the type of tissue that binds the\u00a0bones\u00a0to each other at the joint. There are three types of joints in the structural classification: fibrous, cartilaginous, and synovial joints.\r\n<ol>\r\n \t<li><strong>[pb_glossary id=\"4084\"]Fibrous joints[\/pb_glossary]<\/strong> are joints in which bones are joined by dense connective tissue that is rich in collagen fibres. These joints are also called sutures. The joints between bones of the cranium are fibrous joints.<\/li>\r\n \t<li><strong>[pb_glossary id=\"4085\"]Cartilaginous joints[\/pb_glossary]<\/strong>\u00a0are joints in which bones are joined by cartilage. The joints between most of the vertebrae in the spine are cartilaginous joints.<\/li>\r\n \t<li><strong>[pb_glossary id=\"4086\"]Synovial joints[\/pb_glossary]<\/strong> are characterized by a fluid-filled space (called a synovial cavity) between the bones of the joints. You can see a drawing of a typical synovial joint in Figure 11.6.2. The cavity is enclosed by a membrane and filled with a fluid (called synovial fluid) that provides extra cushioning to the ends of the bones. Cartilage covers the articulating surfaces of the two bones, but the bones are actually held together by ligaments. The knee is a synovial joint.<\/li>\r\n<\/ol>\r\n[caption id=\"attachment_4087\" align=\"aligncenter\" width=\"483\"]<img class=\"wp-image-4087\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Synovial_Joints-2.jpg\" alt=\"11.6.2 Synovial Joint\" width=\"483\" height=\"535\" \/> <em>Figure 11.6.2 A typical synovial joint is represented by this diagram.<\/em>[\/caption]\r\n<h2>Functional Classification of Joints<\/h2>\r\nThe functional classification of joints is based on the type and degree of movement that they allow. There are three types of joints in the functional classification: immovable, partly movable, and movable joints.\r\n<ol>\r\n \t<li><strong>[pb_glossary id=\"4088\"]Immovable joints[\/pb_glossary]<\/strong>\u00a0allow little or no movement at the joint. Most immovable joints are fibrous joints. Besides the bones of the cranium, immovable joints include joints between the tibia and fibula in the lower leg, and between the radius and ulna in the lower arm.<\/li>\r\n \t<li><strong>[pb_glossary id=\"4090\"]Partly movable joints[\/pb_glossary]<\/strong>\u00a0permit slight movement. Most partly movable joints are cartilaginous joints. Besides the joints between vertebrae, they include the joints between the ribs and sternum (breast bone).<\/li>\r\n \t<li><strong>[pb_glossary id=\"5641\"]Movable joints[\/pb_glossary]<\/strong>\u00a0allow bones to move freely. All movable joints are synovial joints. Besides the knee, they include the shoulder, hip, and elbow. Movable joints are the most common type of joints in the body.<\/li>\r\n<\/ol>\r\n<h2>Types of Movable Joints<\/h2>\r\nMovable joints can be classified further according to the type of movement they allow. There are six classes of movable joints: pivot, hinge, saddle, plane, condyloid, and ball-and-socket joints. An example of each class \u2014 as well as the type of movement it allows \u2014 is shown in Figure 11.6.3.\r\n<div>\r\n\r\n[caption id=\"attachment_4099\" align=\"aligncenter\" width=\"985\"]<img class=\"wp-image-4099 \" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Types_of_Synovial_Joints-2.jpg\" alt=\"11.6.3 Types of Synovial Joints\" width=\"985\" height=\"1174\" \/> <em>Figure 11.6.3 This diagram shows the six classes of movable joints in the human body. All of these joints are synovial joints.<\/em>[\/caption]\r\n\r\n<\/div>\r\n<ul>\r\n \t<li style=\"margin-top: 0px;\">A\u00a0<strong>[pb_glossary id=\"4093\"]ball-and-socket joint[\/pb_glossary]<\/strong> allows the greatest range of movement of any movable joint. It allows forward and backward motion, as well as upward and downward movement. It also allows rotation in a circle. The hip and shoulder are the only two ball-and-socket joints in the human body.<\/li>\r\n \t<li>A\u00a0<strong>[pb_glossary id=\"4094\"]pivot joint[\/pb_glossary]<\/strong>\u00a0allows one bone to rotate around another. An example of a pivot joint is the joint between the first two vertebrae in the spine. This joint allows the head to rotate from left to right and back again.<\/li>\r\n \t<li>A\u00a0<strong>[pb_glossary id=\"4096\"]hinge joint[\/pb_glossary]<\/strong>\u00a0allows back and forth movement like the hinge of a door. An example of a hinge joint is the elbow. This joint allows the arm to bend back and forth.<\/li>\r\n \t<li>A\u00a0<strong>[pb_glossary id=\"4098\"]saddle joint[\/pb_glossary]<\/strong>\u00a0allows two different types of movement. An example of a saddle joint is the joint between the first metacarpal bone in the hand and one of the carpal bones in the wrist. This joint allows the thumb to move toward and away from the index finger, and also to cross over the palm toward the little finger.<\/li>\r\n \t<li>A\u00a0<strong>[pb_glossary id=\"4100\"]plane joint[\/pb_glossary]<\/strong>\u00a0(also called a gliding joint) allows two bones\u00a0to\u00a0glide over one another. The joints between the tarsals in the ankles and between the carpals in the wrists are mainly gliding joints. In the wrist, this type of joint allows the hand to bend upward at the wrist, and also to wave from side to side while the lower arm is held steady.<\/li>\r\n \t<li>A\u00a0<strong>[pb_glossary id=\"5483\"]condyloid joint[\/pb_glossary]<\/strong>\u00a0is one in which an oval-shaped head on one bone moves in an elliptical cavity in another bone, allowing movement in all directions, except rotation around an axis. The joint between the radius in the lower arm and carpal bones of the wrist is a condyloid joint, as is the joint at the\u00a0base\u00a0of the index finger.<\/li>\r\n<\/ul>\r\n<div>\r\n<h1>Feature: My\u00a0Human Body<\/h1>\r\n<\/div>\r\nOf all the parts of the\u00a0skeletal system, the joints are generally the most fragile and subject to damage. If the cartilage that cushions bones at joints wears away, it does not grow back. Eventually, all of the cartilage may wear away. This causes [pb_glossary id=\"4102\"]osteoarthritis[\/pb_glossary], which can be both painful and debilitating. In serious cases of <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/osteoarthritis\/symptoms-causes\/syc-20351925\">osteoarthritis<\/a>, people may lose the ability to climb stairs, walk long distances, perform routine daily activities, or participate in activities they love, such as gardening or playing sports. If you protect your joints, you can reduce your chances of joint damage, pain, and disability. If you already have joint damage, it is equally important to protect your joints and limit further damage. Follow these five tips:\r\n<ol>\r\n \t<li><strong>Maintain a normal, healthy<\/strong><strong>\u00a0<\/strong>weight<strong>.<\/strong>\u00a0The\u00a0more you weigh, the more force you exert on your joints. When you walk, each knee has to bear a force equal to as much as\u00a0<em>six times<\/em>\u00a0your body\u00a0weight. If a person weighs 200 pounds, each knee bears more than half a ton of weight with every step. Seven in ten knee replacement surgeries for osteoarthritis can be attributed to\u00a0obesity.<\/li>\r\n \t<li><strong>Avoid too much high-impact<\/strong><strong>\u00a0<\/strong>exercise<strong>.<\/strong>\u00a0Examples of high-impact activities include volleyball, basketball, and tennis. These activities generally involve running or jumping on hard surfaces, which puts tremendous stress on weight-bearing joints, especially the knees. Replace some or all of your high-impact activities with low-impact activities, such as biking, swimming, yoga, or lifting light weights.<\/li>\r\n \t<li><strong>Reduce your risk of injury.<\/strong>\u00a0Don\u2019t be a weekend warrior, sitting at a desk all week and then crowding all your physical activity into two days. Get involved in a regular, daily\u00a0exercise\u00a0routine that keeps your body fit and your\u00a0muscles\u00a0toned. Building up muscles will make your joints more stable, allowing stress to spread across them. Be sure to do some stretching every day to keep the muscles around joints flexible and less prone to injury.<\/li>\r\n \t<li><strong>Distribute work over your body, and use your largest, strongest joints.<\/strong>\u00a0Use your shoulder, elbow, and wrist to lift heavy objects \u2014 not just your fingers. Hold small items in the palm of your hand, rather than by the fingers. Carry heavy items in a backpack, rather than in your hands. Hold weighty objects close to your body, instead of at arms\u2019 length. Lift with your hips and knees, not your back.<\/li>\r\n \t<li><strong>Respect pain.<\/strong>\u00a0If it hurts, stop doing it. Take a break from the activity \u2014 at least until the pain stops. Try to use joints only to the point of mild fatigue, not pain.<\/li>\r\n<\/ol>\r\n<div>\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">\r\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Summary<\/span><\/h1>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ul>\r\n \t<li>[pb_glossary id=\"3949\"]Joints[\/pb_glossary]\u00a0are\u00a0spots\u00a0at which [pb_glossary id=\"5913\"]bones[\/pb_glossary]\u00a0of the skeleton connect with one another. A joint is also called an articulation.<\/li>\r\n \t<li>Joints can be classified structurally or functionally, and there is significant overlap between the two types of classifications.<\/li>\r\n \t<li>The structural classification of joints depends on the type of tissue that binds the bones to each other at the joint. There are three types of joints in the structural classification: [pb_glossary id=\"4084\"]fibrous[\/pb_glossary], [pb_glossary id=\"4085\"]cartilaginous[\/pb_glossary], and [pb_glossary id=\"4086\"]synovial joints[\/pb_glossary].<\/li>\r\n \t<li>The functional classification of joints is based on the type and degree of movement that they allow. There are three types of joints in the functional classification: [pb_glossary id=\"4088\"]immovable[\/pb_glossary], [pb_glossary id=\"4090\"]partly movable[\/pb_glossary], and [pb_glossary id=\"5641\"]movable joints[\/pb_glossary].<\/li>\r\n \t<li>Movable joints can be classified further according to the type of movement they allow. There are six classes of movable joints: [pb_glossary id=\"4094\"]pivot[\/pb_glossary], [pb_glossary id=\"4096\"]hinge[\/pb_glossary], [pb_glossary id=\"4098\"]saddle[\/pb_glossary], [pb_glossary id=\"4100\"]plane[\/pb_glossary], [pb_glossary id=\"5483\"]condyloid[\/pb_glossary], and [pb_glossary id=\"4093\"]ball-and-socket joints[\/pb_glossary].<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Review Questions<\/span><\/h1>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<ol>\r\n \t<li>What are joints?<\/li>\r\n \t<li>What are two ways that joints are commonly classified?<\/li>\r\n \t<li>[h5p id=\"597\"]<\/li>\r\n \t<li>How are joints classified structurally?<\/li>\r\n \t<li>Describe the functional classification of joints.<\/li>\r\n \t<li>How are movable joints classified?<\/li>\r\n \t<li>Name the six classes of movable joints. Describe how they move and give an example of each.<\/li>\r\n \t<li>Which specific type of moveable joint do you think your knee joint is? Explain your reasoning.<\/li>\r\n \t<li>Explain the difference between cartilage in a cartilaginous joint and cartilage in a synovial joint.<\/li>\r\n \t<li>Why are fibrous joints immovable?<\/li>\r\n \t<li>What is the function of synovial fluid?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Explore More<\/span><\/h1>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nhttps:\/\/www.youtube.com\/watch?v=IjiKUmfaZr4\r\n<p style=\"text-align: center;\">Why do your knuckles pop? - Eleanor Nelsen, TED-Ed, 2015.<\/p>\r\nhttps:\/\/www.youtube.com\/watch?v=FWsBm3hr3B0\r\n<p style=\"text-align: center;\">Why haven\u2019t we cured arthritis? - Kaitlyn Sadtler and Heather J. Faust, TED-Ed, 2019.<\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n\r\n<\/div>\r\n<h2>Attributions<\/h2>\r\n<strong>Figure 11.6.1<\/strong>\r\n\r\n<a href=\"https:\/\/pixabay.com\/de\/photos\/sport-gymnastik-fitness-frau-3994082\/\" rel=\"cc:attributionURL\">Tags: Sports Gymnastics Fitness Woman Preparation<\/a> by <a href=\"https:\/\/pixabay.com\/de\/users\/nastya_gepp-3773230\/\">nastya_gepp<\/a> on <a href=\"http:\/\/pixabay.com\">Pixabay<\/a> is used under the <a href=\"https:\/\/pixabay.com\/de\/service\/license\/\">Pixabay License<\/a> (https:\/\/pixabay.com\/de\/service\/license\/).\r\n\r\n<strong>Figure 11.6.2<\/strong>\r\n\r\n<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:907_Synovial_Joints.jpg\" rel=\"cc:attributionURL\">Synovial_Joints<\/a> by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" rel=\"license\">CC BY 3.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n\r\n<strong>Figure 11.6.3<\/strong>\r\n\r\n<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:909_Types_of_Synovial_Joints.jpg\" rel=\"cc:attributionURL\">Types_of_Synovial_Joints<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" rel=\"license\">CC BY 3.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\r\n<h2>References<\/h2>\r\n<p class=\"hanging-indent\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). <span class=\"os-title-label\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">9.8<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"30020\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">Synovial joints<\/span><\/span> [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 9.4). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints<\/p>\r\n<p class=\"hanging-indent\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 9.10 Types of synovial joints [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 9.4). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints<\/p>\r\n<p class=\"hanging-indent\">Mayo Clinic Staff. (n.d.). Osteoarthritis [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/osteoarthritis\/symptoms-causes\/syc-20351925<\/p>\r\n<p class=\"hanging-indent\">TED-Ed. (2015, May 5). Why do your knuckles pop? - Eleanor Nelsen. YouTube. https:\/\/www.youtube.com\/watch?v=IjiKUmfaZr4<\/p>\r\n<p class=\"hanging-indent\">TED-Ed. (2019, November 7). Why haven\u2019t we cured arthritis? - Kaitlyn Sadtler and Heather J. Faust. YouTube. https:\/\/www.youtube.com\/watch?v=FWsBm3hr3B0<\/p>\r\n&nbsp;","rendered":"<p>&nbsp;<\/p>\n<figure id=\"attachment_4083\" aria-describedby=\"caption-attachment-4083\" style=\"width: 345px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4083\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/woman-in-black-tank-top-and-black-shorts-lying-on-floor-e1606261742472-2.jpg\" alt=\"A female gymnast performing a backbend with one leg extended up to the ceiling.\" width=\"345\" height=\"500\" \/><figcaption id=\"caption-attachment-4083\" class=\"wp-caption-text\"><em>Figure 11.6.1 That&#8217;s quite a stretch!<\/em><\/figcaption><\/figure>\n<div>\n<h1>Double Jointed?<\/h1>\n<\/div>\n<p>Is this woman double jointed? No, there is actually no such thing \u2014 at least as far as humans are concerned. However, some people, like the woman pictured in Figure 11.6.1, are much more flexible than others, generally because they have looser ligaments. Physicians call this condition joint hypermobility. Regardless of what it\u2019s called, the feats of people with highly mobile joints can be quite impressive.<\/p>\n<div>\n<h1>What Are Joints?<\/h1>\n<\/div>\n<p><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3949\"><strong>Joints<\/strong>\u00a0<\/a>are locations at which\u00a0bones\u00a0of the skeleton connect with one another. A joint is also called an articulation. The majority of joints are structured in such a way that they allow movement. However, not all joints allow movement. Of joints that\u00a0<em>do<\/em>\u00a0allow movement, the extent and direction of the movements they allow also vary.<\/p>\n<div>\n<h1>Classification\u00a0of Joints<\/h1>\n<\/div>\n<p>Joints can be classified structurally or functionally. The structural\u00a0classification\u00a0of joints depends on the manner in which the\u00a0bones\u00a0connect to each other. The functional classification of joints depends on the nature of the movement the joints allow. There is significant overlap between the two types of classifications, because function depends largely on structure.<\/p>\n<h2>Structural Classification of Joints<\/h2>\n<p>The structural classification of joints is based on the type of tissue that binds the\u00a0bones\u00a0to each other at the joint. There are three types of joints in the structural classification: fibrous, cartilaginous, and synovial joints.<\/p>\n<ol>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4084\">Fibrous joints<\/a><\/strong> are joints in which bones are joined by dense connective tissue that is rich in collagen fibres. These joints are also called sutures. The joints between bones of the cranium are fibrous joints.<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4085\">Cartilaginous joints<\/a><\/strong>\u00a0are joints in which bones are joined by cartilage. The joints between most of the vertebrae in the spine are cartilaginous joints.<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4086\">Synovial joints<\/a><\/strong> are characterized by a fluid-filled space (called a synovial cavity) between the bones of the joints. You can see a drawing of a typical synovial joint in Figure 11.6.2. The cavity is enclosed by a membrane and filled with a fluid (called synovial fluid) that provides extra cushioning to the ends of the bones. Cartilage covers the articulating surfaces of the two bones, but the bones are actually held together by ligaments. The knee is a synovial joint.<\/li>\n<\/ol>\n<figure id=\"attachment_4087\" aria-describedby=\"caption-attachment-4087\" style=\"width: 483px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4087\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Synovial_Joints-2.jpg\" alt=\"11.6.2 Synovial Joint\" width=\"483\" height=\"535\" \/><figcaption id=\"caption-attachment-4087\" class=\"wp-caption-text\"><em>Figure 11.6.2 A typical synovial joint is represented by this diagram.<\/em><\/figcaption><\/figure>\n<h2>Functional Classification of Joints<\/h2>\n<p>The functional classification of joints is based on the type and degree of movement that they allow. There are three types of joints in the functional classification: immovable, partly movable, and movable joints.<\/p>\n<ol>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4088\">Immovable joints<\/a><\/strong>\u00a0allow little or no movement at the joint. Most immovable joints are fibrous joints. Besides the bones of the cranium, immovable joints include joints between the tibia and fibula in the lower leg, and between the radius and ulna in the lower arm.<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4090\">Partly movable joints<\/a><\/strong>\u00a0permit slight movement. Most partly movable joints are cartilaginous joints. Besides the joints between vertebrae, they include the joints between the ribs and sternum (breast bone).<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5641\">Movable joints<\/a><\/strong>\u00a0allow bones to move freely. All movable joints are synovial joints. Besides the knee, they include the shoulder, hip, and elbow. Movable joints are the most common type of joints in the body.<\/li>\n<\/ol>\n<h2>Types of Movable Joints<\/h2>\n<p>Movable joints can be classified further according to the type of movement they allow. There are six classes of movable joints: pivot, hinge, saddle, plane, condyloid, and ball-and-socket joints. An example of each class \u2014 as well as the type of movement it allows \u2014 is shown in Figure 11.6.3.<\/p>\n<div>\n<figure id=\"attachment_4099\" aria-describedby=\"caption-attachment-4099\" style=\"width: 985px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4099\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Types_of_Synovial_Joints-2.jpg\" alt=\"11.6.3 Types of Synovial Joints\" width=\"985\" height=\"1174\" \/><figcaption id=\"caption-attachment-4099\" class=\"wp-caption-text\"><em>Figure 11.6.3 This diagram shows the six classes of movable joints in the human body. All of these joints are synovial joints.<\/em><\/figcaption><\/figure>\n<\/div>\n<ul>\n<li style=\"margin-top: 0px;\">A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4093\">ball-and-socket joint<\/a><\/strong> allows the greatest range of movement of any movable joint. It allows forward and backward motion, as well as upward and downward movement. It also allows rotation in a circle. The hip and shoulder are the only two ball-and-socket joints in the human body.<\/li>\n<li>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4094\">pivot joint<\/a><\/strong>\u00a0allows one bone to rotate around another. An example of a pivot joint is the joint between the first two vertebrae in the spine. This joint allows the head to rotate from left to right and back again.<\/li>\n<li>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4096\">hinge joint<\/a><\/strong>\u00a0allows back and forth movement like the hinge of a door. An example of a hinge joint is the elbow. This joint allows the arm to bend back and forth.<\/li>\n<li>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4098\">saddle joint<\/a><\/strong>\u00a0allows two different types of movement. An example of a saddle joint is the joint between the first metacarpal bone in the hand and one of the carpal bones in the wrist. This joint allows the thumb to move toward and away from the index finger, and also to cross over the palm toward the little finger.<\/li>\n<li>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4100\">plane joint<\/a><\/strong>\u00a0(also called a gliding joint) allows two bones\u00a0to\u00a0glide over one another. The joints between the tarsals in the ankles and between the carpals in the wrists are mainly gliding joints. In the wrist, this type of joint allows the hand to bend upward at the wrist, and also to wave from side to side while the lower arm is held steady.<\/li>\n<li>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5483\">condyloid joint<\/a><\/strong>\u00a0is one in which an oval-shaped head on one bone moves in an elliptical cavity in another bone, allowing movement in all directions, except rotation around an axis. The joint between the radius in the lower arm and carpal bones of the wrist is a condyloid joint, as is the joint at the\u00a0base\u00a0of the index finger.<\/li>\n<\/ul>\n<div>\n<h1>Feature: My\u00a0Human Body<\/h1>\n<\/div>\n<p>Of all the parts of the\u00a0skeletal system, the joints are generally the most fragile and subject to damage. If the cartilage that cushions bones at joints wears away, it does not grow back. Eventually, all of the cartilage may wear away. This causes <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4102\">osteoarthritis<\/a>, which can be both painful and debilitating. In serious cases of <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/osteoarthritis\/symptoms-causes\/syc-20351925\">osteoarthritis<\/a>, people may lose the ability to climb stairs, walk long distances, perform routine daily activities, or participate in activities they love, such as gardening or playing sports. If you protect your joints, you can reduce your chances of joint damage, pain, and disability. If you already have joint damage, it is equally important to protect your joints and limit further damage. Follow these five tips:<\/p>\n<ol>\n<li><strong>Maintain a normal, healthy<\/strong><strong>\u00a0<\/strong>weight<strong>.<\/strong>\u00a0The\u00a0more you weigh, the more force you exert on your joints. When you walk, each knee has to bear a force equal to as much as\u00a0<em>six times<\/em>\u00a0your body\u00a0weight. If a person weighs 200 pounds, each knee bears more than half a ton of weight with every step. Seven in ten knee replacement surgeries for osteoarthritis can be attributed to\u00a0obesity.<\/li>\n<li><strong>Avoid too much high-impact<\/strong><strong>\u00a0<\/strong>exercise<strong>.<\/strong>\u00a0Examples of high-impact activities include volleyball, basketball, and tennis. These activities generally involve running or jumping on hard surfaces, which puts tremendous stress on weight-bearing joints, especially the knees. Replace some or all of your high-impact activities with low-impact activities, such as biking, swimming, yoga, or lifting light weights.<\/li>\n<li><strong>Reduce your risk of injury.<\/strong>\u00a0Don\u2019t be a weekend warrior, sitting at a desk all week and then crowding all your physical activity into two days. Get involved in a regular, daily\u00a0exercise\u00a0routine that keeps your body fit and your\u00a0muscles\u00a0toned. Building up muscles will make your joints more stable, allowing stress to spread across them. Be sure to do some stretching every day to keep the muscles around joints flexible and less prone to injury.<\/li>\n<li><strong>Distribute work over your body, and use your largest, strongest joints.<\/strong>\u00a0Use your shoulder, elbow, and wrist to lift heavy objects \u2014 not just your fingers. Hold small items in the palm of your hand, rather than by the fingers. Carry heavy items in a backpack, rather than in your hands. Hold weighty objects close to your body, instead of at arms\u2019 length. Lift with your hips and knees, not your back.<\/li>\n<li><strong>Respect pain.<\/strong>\u00a0If it hurts, stop doing it. Take a break from the activity \u2014 at least until the pain stops. Try to use joints only to the point of mild fatigue, not pain.<\/li>\n<\/ol>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3949\">Joints<\/a>\u00a0are\u00a0spots\u00a0at which <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5913\">bones<\/a>\u00a0of the skeleton connect with one another. A joint is also called an articulation.<\/li>\n<li>Joints can be classified structurally or functionally, and there is significant overlap between the two types of classifications.<\/li>\n<li>The structural classification of joints depends on the type of tissue that binds the bones to each other at the joint. There are three types of joints in the structural classification: <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4084\">fibrous<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4085\">cartilaginous<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4086\">synovial joints<\/a>.<\/li>\n<li>The functional classification of joints is based on the type and degree of movement that they allow. There are three types of joints in the functional classification: <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4088\">immovable<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4090\">partly movable<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5641\">movable joints<\/a>.<\/li>\n<li>Movable joints can be classified further according to the type of movement they allow. There are six classes of movable joints: <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4094\">pivot<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4096\">hinge<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4098\">saddle<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4100\">plane<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5483\">condyloid<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4093\">ball-and-socket joints<\/a>.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>What are joints?<\/li>\n<li>What are two ways that joints are commonly classified?<\/li>\n<li>\n<div id=\"h5p-597\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-597\" class=\"h5p-iframe\" data-content-id=\"597\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"11.6 Quiz\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>How are joints classified structurally?<\/li>\n<li>Describe the functional classification of joints.<\/li>\n<li>How are movable joints classified?<\/li>\n<li>Name the six classes of movable joints. Describe how they move and give an example of each.<\/li>\n<li>Which specific type of moveable joint do you think your knee joint is? Explain your reasoning.<\/li>\n<li>Explain the difference between cartilage in a cartilaginous joint and cartilage in a synovial joint.<\/li>\n<li>Why are fibrous joints immovable?<\/li>\n<li>What is the function of synovial fluid?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff;\">11.6 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Why do your knuckles pop? - Eleanor Nelsen\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/IjiKUmfaZr4?feature=oembed&#38;rel=0&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: center;\">Why do your knuckles pop? &#8211; Eleanor Nelsen, TED-Ed, 2015.<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Why haven\u2019t we cured arthritis? - Kaitlyn Sadtler and Heather J. Faust\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/FWsBm3hr3B0?feature=oembed&#38;rel=0&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: center;\">Why haven\u2019t we cured arthritis? &#8211; Kaitlyn Sadtler and Heather J. Faust, TED-Ed, 2019.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 11.6.1<\/strong><\/p>\n<p><a href=\"https:\/\/pixabay.com\/de\/photos\/sport-gymnastik-fitness-frau-3994082\/\" rel=\"cc:attributionURL\">Tags: Sports Gymnastics Fitness Woman Preparation<\/a> by <a href=\"https:\/\/pixabay.com\/de\/users\/nastya_gepp-3773230\/\">nastya_gepp<\/a> on <a href=\"http:\/\/pixabay.com\">Pixabay<\/a> is used under the <a href=\"https:\/\/pixabay.com\/de\/service\/license\/\">Pixabay License<\/a> (https:\/\/pixabay.com\/de\/service\/license\/).<\/p>\n<p><strong>Figure 11.6.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:907_Synovial_Joints.jpg\" rel=\"cc:attributionURL\">Synovial_Joints<\/a> by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" rel=\"license\">CC BY 3.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 11.6.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:909_Types_of_Synovial_Joints.jpg\" rel=\"cc:attributionURL\">Types_of_Synovial_Joints<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\/deed.en\" rel=\"license\">CC BY 3.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). <span class=\"os-title-label\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">9.8<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"30020\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text\" data-timestamp=\"1596567079410\" data-highlight-id=\"7e7717cd-fb93-47e2-a575-7a15a0811909\" data-highlighted=\"true\">Synovial joints<\/span><\/span> [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 9.4). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints<\/p>\n<p class=\"hanging-indent\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 9.10 Types of synovial joints [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 9.4). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/9-4-synovial-joints<\/p>\n<p class=\"hanging-indent\">Mayo Clinic Staff. (n.d.). Osteoarthritis [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/osteoarthritis\/symptoms-causes\/syc-20351925<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, May 5). Why do your knuckles pop? &#8211; Eleanor Nelsen. YouTube. https:\/\/www.youtube.com\/watch?v=IjiKUmfaZr4<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2019, November 7). Why haven\u2019t we cured arthritis? &#8211; Kaitlyn Sadtler and Heather J. Faust. YouTube. https:\/\/www.youtube.com\/watch?v=FWsBm3hr3B0<\/p>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_4955_3949\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_3949\"><div tabindex=\"-1\"><p>A nervous system cell that provides support for neurons and helps them transmit nerve impulses.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4084\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4084\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4736\" aria-describedby=\"caption-attachment-4736\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4736\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Steak-and-Kidney-Pie-by-Charles-Haynes-on-flickr-1.jpg\" alt=\"16.4.1 Kidney Pie\" width=\"400\" height=\"356\"><figcaption id=\"caption-attachment-4736\" class=\"wp-caption-text\"><em>Figure 16.4.1 Steak and kidney pie!<\/em><\/figcaption><\/figure>\n<div>\n<h1>Kidneys on the Menu<\/h1>\n<\/div>\n<p>Pictured in Figure 16.4.1 is a steak and kidney pie; this savory dish is a British favorite. When kidneys are on a menu, they typically come from sheep, pigs, or cows. In these animals (as in the human animal), kidneys are the main organs of excretion.<\/p>\n<div>\n<h1>Location\u00a0of the Kidneys<\/h1>\n<\/div>\n<p>The two bean-shaped\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2988\">kidneys<\/a><\/strong>\u00a0are located high in the back of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3763\">abdominal cavity<\/a>, one on each side of the spine. Both kidneys sit just below the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4292\">diaphragm<\/a>, the large\u00a0breathing\u00a0muscle that separates the abdominal and thoracic cavities. As you can see in the\u00a0following\u00a0figure, the right kidney is slightly smaller and lower than the left kidney. The right kidney is behind the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2989\">liver<\/a>, and the left kidney is behind the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4497\">spleen<\/a>. The\u00a0location\u00a0of the liver explains why the right kidney is smaller and lower than the left.<\/p>\n<figure id=\"attachment_4737\" aria-describedby=\"caption-attachment-4737\" style=\"width: 455px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4737\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Gray-Kidneys-1.png\" alt=\"16.4.2 Classic Kidney Illustration from Gray's Anatomy\" width=\"455\" height=\"600\"><figcaption id=\"caption-attachment-4737\" class=\"wp-caption-text\"><em>Figure 16.4.2 This classic illustration of the abdominal cavity provides a view of the internal organs from the back of the body. It clearly shows the locations of the right and left kidney, as well as the large blood vessels that connect the kidneys to the body\u2019s main artery (aorta) and vein (inferior vena cava). The ureter exiting each kidney is also shown in the diagram.<\/em><\/figcaption><\/figure>\n<p><span style=\"font-size: 1.602em;font-weight: bold\">Kidney Anatomy<\/span><\/p>\n<p>The shape of each kidney gives it a convex side (curving outward) and a concave side (curving inward). You can see this clearly in the detailed diagram of kidney anatomy shown in Figure 16.4.3. The concave side is where the renal artery enters the kidney, as well as where the renal vein and ureter leave the kidney. This area of the kidney is called the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4739\">hilum<\/a><\/strong>. The entire kidney is surrounded by tough fibrous tissue \u2014 called the\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4740\">renal capsule<\/a><\/strong>\u00a0\u2014 which, in turn, is surrounded by two layers of protective, cushioning fat.<\/p>\n<figure id=\"attachment_4738\" aria-describedby=\"caption-attachment-4738\" style=\"width: 765px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4738\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0592_KidneyAnatomy_01-1.png\" alt=\"16.4.3 Kidney Anatomy\" width=\"765\" height=\"574\"><figcaption id=\"caption-attachment-4738\" class=\"wp-caption-text\"><em>Figure 16.4.3 This diagram shows the location and relative size of the two kidneys, as well as the internal structure of each kidney.<\/em><\/figcaption><\/figure>\n<p>Internally, each kidney is divided into two major layers: the outer <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4741\"><strong>renal cortex<\/strong><\/a> and the inner <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4742\"><strong>renal medulla<\/strong><\/a> (see Figure 16.4.3 above). These layers take the shape of many cone-shaped renal lobules, each containing renal cortex surrounding a portion of medulla called a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4743\"><strong>renal pyramid<\/strong><\/a>. Within the renal pyramids are the structural and functional units of the kidneys, the tiny <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4718\">nephron<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. Between the renal pyramids are projections of cortex called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4744\"><strong>renal columns<\/strong><\/a>. The tip, or papilla, of each pyramid empties urine into a minor calyx (chamber). Several minor calyces empty into a major calyx, and the latter empty into the funnel-shaped cavity called the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4724\">renal pelvis<\/a>, which becomes the ureter as it leaves the kidney.<\/span><\/p>\n<div>\n<h3>Renal\u00a0Circulation<\/h3>\n<\/div>\n<p>The renal circulation is an important part of the kidney\u2019s primary function of filtering waste products from the blood. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2702\">Blood<\/a> is supplied to the kidneys via the renal arteries. The right renal artery supplies the right kidney, and the left renal artery supplies the left kidney. These two arteries branch directly from the aorta, which is the largest artery in the body. Each kidney is only about 11 cm (4.4 in) long, and has a mass of just 150 grams (5.3 oz), yet it receives about ten per cent of the total output of blood from the heart. Blood is filtered through the kidneys every 3 minutes, 24 hours a day, every day of your life.<\/p>\n<p>As indicated in Figure 16.4.4, each renal artery carries blood with waste products into the kidney. Within the kidney, the renal artery branches into increasingly smaller <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4385\">arteries<\/a> that extend through the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4744\">renal columns<\/a> between the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4743\">renal pyramids<\/a>. These arteries, in turn, branch into arterioles that penetrate the renal pyramids. Blood in the arterioles passes through <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4718\">nephrons<\/a>, the structures that actually filter the blood. After blood passes through the nephrons and is filtered, the clean blood moves through a network of venules that converge into small <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4386\">veins<\/a>. Small veins merge into increasingly larger ones, and ultimately into the renal vein, which carries clean blood away from the kidney to the inferior <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4410\">vena cava<\/a>.<\/p>\n<figure id=\"attachment_4745\" aria-describedby=\"caption-attachment-4745\" style=\"width: 683px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4745\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Diagram_showing_how_the_kidneys_work_CRUK_138.svg_-1.png\" alt=\"16.4.4 Kidney and Nephron\" width=\"683\" height=\"719\"><figcaption id=\"caption-attachment-4745\" class=\"wp-caption-text\"><em>Figure 16.4.4 The renal artery and renal vein carry blood to and from the kidney, respectively. As blood passes through a nephron within the kidney, it is filtered. Substances filtered from the blood are eventually collected in a tubule (collecting duct).<\/em><\/figcaption><\/figure>\n<div>\n<h1>Nephron Structure and Function<\/h1>\n<\/div>\n<p>Figure 16.4.4 gives an indication of the complex structure of a nephron. The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4718\">nephron<\/a><\/strong>\u00a0is the basic structural and functional unit of the kidney, and each kidney typically contains at least a million of them. As blood flows through a nephron, many materials are filtered out of the blood, needed materials are returned to the blood, and the remaining materials form urine. Most of the waste products removed from the blood and excreted in urine are byproducts of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3681\">metabolism<\/a>. At least half of the waste is <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4708\">urea<\/a>, a waste product produced by\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3721\">protein<\/a>\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3629\">catabolism<\/a>. Another important waste is <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4709\">uric\u00a0acid<\/a>, produced in\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4727\">nucleic acid<\/a>\u00a0catabolism.<\/p>\n<h2>Components of a Nephron<\/h2>\n<p>Figure 16.4.5 shows in greater detail the components of a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4718\">nephron<\/a>. Each nephron is composed of an initial filtering component that consists of a network of capillaries called the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4747\">glomerulus<\/a><\/strong>\u00a0(plural, glomeruli), which is surrounded by a space within a structure\u00a0called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4748\">glomerular capsule<\/a> <\/strong>(also known as the Bowman's capsule). Extending from glomerular capsule is the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4749\">renal tubule<\/a><\/strong>. The proximal end (nearest glomerular capsule) of the renal tubule is called the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4750\">proximal convoluted (coiled) tubule<\/a><\/strong>. From here, the renal tubule continues as a loop (known as the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4751\"><strong>loop of Henle<\/strong><\/a>) (also known as the loop of the nephron), which in turn becomes the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4752\"><strong>distal convoluted tubule<\/strong><\/a>. The latter finally joins with a collecting duct. As you can see in the diagram, arterioles surround the total length of the renal tubule in a mesh called the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4753\"><strong>peritubular capillary network<\/strong><\/a>.<\/p>\n<figure id=\"attachment_4746\" aria-describedby=\"caption-attachment-4746\" style=\"width: 425px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4746\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blood_Flow_in_the_Nephron-1.jpg\" alt=\"16.4.5 Nephron\" width=\"425\" height=\"600\"><figcaption id=\"caption-attachment-4746\" class=\"wp-caption-text\"><em>Figure 16.4.5 This model of an individual nephron shows each of the structures that are involved in filtering blood, returning needed materials to blood, or excreting wastes that form urine.<\/em><\/figcaption><\/figure>\n<div><\/div>\n<figure id=\"attachment_4754\" aria-describedby=\"caption-attachment-4754\" style=\"width: 257px\" class=\"wp-caption alignright\"><img class=\"size-medium wp-image-4754\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Physiology_of_Nephron-1.png\" alt=\"16.4.6 Urine Formation at the Nephron\" width=\"257\" height=\"300\"><figcaption id=\"caption-attachment-4754\" class=\"wp-caption-text\">Figure 16.4.6 This diagram of a nephron shows the parts of the nephron where different stages of nephron function take place. These stages are filtration, reabsorption, secretion, and excretion.<\/figcaption><\/figure>\n<h2>Function of a Nephron<\/h2>\n<p>The simplified diagram of a nephron in Figure 16.4.6 shows an overview of how the nephron functions. Blood enters the nephron through an arteriole called the afferent arteriole. Next, some of the blood passes through the capillaries of the glomerulus. Any blood that doesn\u2019t pass through the glomerulus \u2014 as well as blood after it passes through the glomerular capillaries \u2014 continues on through an arteriole called the efferent arteriole. The efferent arteriole follows the renal tubule of the nephron, where it continues\u00a0playing a role\u00a0in nephron functioning.<\/p>\n<p>&nbsp;<\/p>\n<h3>Filtration<\/h3>\n<p>As blood from the afferent arteriole flows through the glomerular capillaries, it is under pressure. Because of the pressure, water and solutes are filtered out of the blood and into the space made by glomerular capsule, almost like the water you cook pasta is is filtered out through a strainer. This is the filtration stage of nephron function. The filtered substances \u2014 called <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3379\">filtrate<\/a><\/strong> \u2014 pass into glomerular capsule, and from there into the proximal end of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4749\">renal tubule<\/a>.\u00a0 Anything too large to move through the pores in the glomerulus, such as blood cells, large proteins, etc., stay in the cardiovascular system.\u00a0 At this stage, filtrate (fluid in the nephron) includes water, salts, organic solids (such as nutrients), and waste products of metabolism (such as urea).<\/p>\n<figure id=\"attachment_4756\" aria-describedby=\"caption-attachment-4756\" style=\"width: 403px\" class=\"wp-caption alignright\"><img class=\" wp-image-4756\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Nephron_Secretion_Reabsorption-1.jpg\" alt=\"16.4.7 Nephron Secretion and Reabsorption\" width=\"403\" height=\"769\"><figcaption id=\"caption-attachment-4756\" class=\"wp-caption-text\"><em>Figure 16.4.7 Secretion and reabsorption happen along the length of the renal tubule as the nephron balances blood pH and volume and maintains homeostasis of ions in the blood. Reabsorption is the movement of substance back into the bloodstream and secretion is movement of substances from the blood into the nephron for excretion.<\/em><\/figcaption><\/figure>\n<h3>Reabsorption and Secretion<\/h3>\n<p>As filtrate moves through the renal tubule, some of the substances it contains are reabsorbed from the filtrate back into the blood in the efferent arteriole (via <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4753\">peritubular capillary network<\/a>). This is the reabsorption stage of nephron function and it is about returning \"the good stuff\" back to the blood so that it doesn't exit the body in urine. About two-thirds of the filtered salts and water, and all of the filtered organic solutes (mainly <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3359\">glucose<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3615\">amino acid<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">) are reabsorbed from the filtrate by the blood in the peritubular capillary network. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4757\">Reabsorption<\/a> occurs mainly in the proximal convoluted tubule and the loop of Henle, as seen in Figure 16.4.7.<\/span><\/p>\n<p>At the distal end of the renal tubule, some additional reabsorption generally occurs. This is also the region of the tubule where other substances from the blood are added to the filtrate in the tubule. The addition of other substances to the filtrate from the blood is called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4758\">secretion<\/a><\/strong>. Both reabsorption and secretion (shown in Figure 16.4.7) in the distal convoluted tubule are largely under the control of endocrine hormones that maintain <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3669\">homeostasis<\/a> of water and mineral salts in the blood. These hormones work by controlling what is reabsorbed into the blood from the filtrate and what is secreted from the blood into the filtrate to become urine. For example, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3467\">parathyroid hormone<\/a> causes more calcium to be reabsorbed into the blood and more phosphorus to be secreted into the filtrate.<\/p>\n<h2>Collection of Urine and Excretion<\/h2>\n<figure id=\"attachment_4760\" aria-describedby=\"caption-attachment-4760\" style=\"width: 219px\" class=\"wp-caption alignleft\"><img class=\" wp-image-4760\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Weewee-1.jpg\" alt=\"16.4.8 Urine\" width=\"219\" height=\"478\"><figcaption id=\"caption-attachment-4760\" class=\"wp-caption-text\"><em>Figure 16.4.8 Fresh urine is typically yellow or amber in colour.<\/em><\/figcaption><\/figure>\n<p>By the time the filtrate has passed through the entire renal tubule, it has become the\u00a0liquid\u00a0waste known as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4717\">urine<\/a>. Urine empties from the distal end of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4749\">renal tubule<\/a> into a\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4759\">collecting duct<\/a><\/strong>. From there, the urine flows into increasingly larger collecting ducts. As urine flows through the system of collecting ducts, more water may be reabsorbed from it. This will occur in the presence of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3441\">antidiuretic\u00a0hormone\u00a0<\/a>from the\u00a0posterior\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a>. This\u00a0hormone\u00a0makes the collecting ducts permeable to water, allowing water molecules to pass through them into capillaries by\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3571\">osmosis<\/a>, while preventing the passage of ions or other solutes. As much as 75% of the water may be reabsorbed from urine in the collecting ducts, making the urine more concentrated.<\/p>\n<p>Urine finally exits the largest collecting ducts through the renal papillae. It empties into the renal calyces, and finally into the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4724\">renal pelvis<\/a>. From there, it travels through the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4725\">ureter<\/a> to the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">urinary bladder<\/a> for eventual excretion from the body. An average of roughly 1.5 litres (a little over 6 cups) of urine is excreted each day. Normally, urine is yellow or amber in colour (see <span style=\"font-size: 1em\">Figure 16.4.8<\/span><span style=\"text-align: initial;font-size: 1em\">). The darker the colour, generally speaking, the more concentrated the urine is.<\/span><\/p>\n<p>&nbsp;<\/p>\n<div><span style=\"font-size: 1.602em;font-weight: bold\">Other Functions of the Kidneys<\/span><\/div>\n<p>Besides filtering blood and forming urine for excretion of soluble wastes, the kidneys have several vital functions in maintaining body-wide\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3669\">homeostasis<\/a>. Most of these functions are related to the\u00a0composition\u00a0or volume of urine formed by the kidneys. The kidneys must maintain the proper balance of water and salts in the body, normal\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4480\">blood pressure<\/a>, and the correct range of blood\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4330\">pH<\/a>. Through the processes of absorption and secretion by nephrons, more or less water, salt ions, acids, or bases are returned to the blood or excreted in urine, as needed, to maintain homeostasis.<\/p>\n<h2>Blood Pressure\u00a0Regulation<\/h2>\n<p>The kidneys do not control homeostasis all alone. As indicated above, endocrine hormones are also involved. Consider the regulation of\u00a0blood pressure\u00a0by the kidneys. Blood pressure is the pressure exerted by blood on the walls of the arteries. The regulation of blood pressure is part of a complex system, called the renin-angiotensin-aldosterone system. This system regulates the\u00a0concentration\u00a0of sodium in the blood to control blood pressure.<\/p>\n<figure id=\"attachment_4761\" aria-describedby=\"caption-attachment-4761\" style=\"width: 736px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4761\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Renin_Angiotensin_System-01-1.jpg\" alt=\"16.4.9 Regulation of Blood Pressure\" width=\"736\" height=\"336\"><figcaption id=\"caption-attachment-4761\" class=\"wp-caption-text\"><em>Figure 16.4.9 This diagram summarizes the processes that occur in the regulation of blood pressure by the renin-angiotensin-aldosterone system. The final step on the far right occurs in the nephrons and collecting ducts of the kidneys, where aldosterone stimulates increased reabsorption of sodium and water into the blood.<\/em><\/figcaption><\/figure>\n<p>The renin-angiotensin-aldosterone system is put into play when the\u00a0concentration\u00a0of sodium ions in the blood falls lower than normal. This causes the kidneys to secrete an\u00a0enzyme\u00a0called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4762\">renin<\/a> into the blood. It also causes the liver to secrete a\u00a0protein\u00a0called angiotensinogen. Renin changes angiotensinogen into a proto-hormone\u00a0called\u00a0angiotensin I. This is converted to angiotensin II by an\u00a0enzyme\u00a0(angiotensin-converting enzyme) in lung capillaries.<\/p>\n<p>Angiotensin II is a potent hormone that causes arterioles to constrict. This, in turn, increases blood pressure. Angiotensin II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the kidneys to increase the reabsorption of sodium ions and water from the filtrate into the blood. This returns the\u00a0concentration\u00a0of sodium ions in the blood to normal. The increased water in the blood also increases blood volume and blood pressure.<\/p>\n<h2>Other Kidney Hormones<\/h2>\n<p>Hormones other than renin are also produced and secreted by the kidneys. These include calcitriol and erythropoietin.<\/p>\n<ul>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4763\">Calcitriol<\/a><\/strong>\u00a0is secreted by the kidneys in response to low levels of calcium in the blood. This hormone stimulates uptake of calcium by the intestine, thus raising blood levels of calcium.<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4764\">Erythropoietin<\/a><\/strong> is secreted by the kidneys in response to low levels of oxygen in the blood. This hormone stimulates erythropoiesis, which is the production of\u00a0 <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4398\">erythrocytes<\/a>\u00a0in bone marrow. Extra red blood cells increase the level of oxygen carried in the blood.<\/li>\n<\/ul>\n<div>\n<h1>Feature: Human Biology in the News<\/h1>\n<\/div>\n<p>Kidney failure is a complication of common disorders including <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2771\">diabetes mellitus<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4231\">hypertension<\/a>. It is estimated that approximately 12.5% of Canadians have some form of kidney disease.\u00a0 If the disease is serious, the patient must either receive a donated kidney or have frequent hemodialysis, a medical procedure in which the blood is artificially filtered through a machine. Transplant generally results in better outcomes than hemodialysis, but demand for organs far outstrips the supply. The average time on the organ donation waitlist for a kidney is four years.\u00a0 There are over 3,000 Canadians on the wait list for a kidney transplant and some will die waiting for a kidney to become available.<\/p>\n<p>For the past decade, Dr. William Fissell, a kidney specialist at Vanderbilt University, has been working to create an implantable part-biological and part-artificial kidney. Using microchips like those used in computers, he has produced an artificial kidney small enough to implant in the patient\u2019s body in place of the failed kidney. According to Dr. Fissell, the artificial kidney is \u201c... a bio-hybrid device that can mimic a kidney to remove enough waste products, salt, and water to keep a patient off [hemo]dialysis.\u201d<\/p>\n<p>The filtration system in the artificial kidney consists of a stack of 15 microchips. Tiny pores in the microchips act as a scaffold for the growth of living kidney\u00a0cells\u00a0that can mimic the natural functions of the kidney. The living cells form a membrane to filter the patient\u2019s blood as a biological kidney would, but with less risk of rejection by the patient\u2019s immune system, because they are embedded within the device. The new kidney doesn\u2019t need a power source, because it uses the natural pressure of blood flowing through arteries to push the blood through the filtration system. A major part of the design of the artificial organ was devoted to fine tuning the fluid dynamics so blood flows through the device without clotting.<\/p>\n<p>Because of the potential life-saving benefits of the device, the implantable kidney was given fast-track approval for testing in people by the U.S. Food and Drug Administration. The artificial kidney is expected to be tested in pilot trials by 2018. Dr. Fissell says he has a long list of patients eager to volunteer for the trials.<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.4 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>The two bean-shaped kidneys are located high in the back of the abdominal cavity on either side of the spine. A renal artery connects each kidney with the aorta, and transports unfiltered blood to the kidney. A renal vein connects each kidney with the inferior vena cava and transports filtered blood back to the\u00a0circulation.<\/li>\n<li>The kidney has two main layers involved in the filtration of blood and formation of urine: the outer cortex and inner medulla. At least a million nephrons \u2014 which are the tiny functional units of the kidney \u2014 span the cortex and medulla. The entire kidney is surrounded by a fibrous capsule and protective fat layers.<\/li>\n<li>As blood flows through a nephron, many materials are filtered out of the blood, needed materials are returned to the blood, and the remaining materials are used to form urine.<\/li>\n<li>In each nephron, the glomerulus and surrounding Bowman\u2019s capsule form the unit that filters blood. From Bowman\u2019s capsule, the material filtered from blood (called filtrate) passes through the long renal tubule. As it does, some substances are reabsorbed into the blood, and other substances are secreted from the blood into the filtrate, finally forming urine. The urine empties into collecting ducts, where more water may be reabsorbed.<\/li>\n<li>The kidneys control homeostasis with the help of endocrine hormones.\u00a0The kidneys, for example, are part of the renin-angiotensin-aldosterone system that regulates the concentration of sodium in the blood to control blood pressure. In this system, the\u00a0enzyme\u00a0renin secreted by the kidneys works with hormones from the liver and adrenal gland to stimulate nephrons to reabsorb more sodium and water from urine.<\/li>\n<li>The kidneys also secrete endocrine hormones, including calcitriol \u2014 which helps control the level of calcium in the blood \u2014 and erythropoietin, which stimulates bone marrow to produce red blood\u00a0cells.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.4 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-195\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-195\" class=\"h5p-iframe\" data-content-id=\"195\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Active Transport\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Contrast the renal artery and renal vein.<\/li>\n<li>Identify the functions of a nephron.\u00a0Describe in detail what happens to fluids (blood, filtrate, and urine) as they pass through the parts of a nephron.<\/li>\n<li>Identify two endocrine hormones secreted by the kidneys, along with the functions they control.<\/li>\n<li>Name two regions in the kidney where water is reabsorbed.<\/li>\n<li>Is the blood in the glomerular capillaries more or less filtered than the blood in the peritubular capillaries? Explain your answer.<\/li>\n<li>What do you think would happen if\u00a0blood flow to the kidneys is blocked?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.4 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/FN3MFhYPWWo<\/p>\n<p style=\"text-align: center\">How do your kidneys work? - Emma Bryce, TED-Ed, 2015.<\/p>\n<p>https:\/\/youtu.be\/es-t8lO1KpA<\/p>\n<p style=\"text-align: center\">Urine Formation, Hamada Abass, 2013.<\/p>\n<p>https:\/\/youtu.be\/bX3C201O4MA<\/p>\n<p style=\"text-align: center\">Printing a human kidney - Anthony Atala, TED-Ed, 2013.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 16.4.1<\/strong><\/p>\n<p><a href=\"https:\/\/www.flickr.com\/photos\/haynes\/3403969320\" rel=\"cc:attributionURL\">Steak and Kidney Pie<\/a> by <a class=\"owner-name truncate\" title=\"Go to Charles Haynes's photostream\" href=\"https:\/\/www.flickr.com\/photos\/haynes\/\" data-track=\"attributionNameClick\">Charles Haynes<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/\" rel=\"license\">CC BY-SA 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/) license.<\/p>\n<p><strong>Figure 16.4.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Gray1120.png\" rel=\"cc:attributionURL\">Gray Kidneys<\/a> by\u00a0<a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Vandyke_Carter\">Henry Vandyke Carter<\/a>\u00a0(1831-1897) on Wikimedia Commons is in the \u00a0<a class=\"extiw\" title=\"en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/public_domain). (<a class=\"extiw\" title=\"en:Bartleby.com\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bartleby.com\">Bartleby.com<\/a>:\u00a0<a class=\"external text\" href=\"http:\/\/www.bartleby.com\/107\/\" rel=\"nofollow\">Gray\u2019s Anatomy<\/a>, <a class=\"external text\" href=\"http:\/\/www.bartleby.com\/107\/illus1120.html\" rel=\"nofollow\">Plate 1120<\/a>).<\/p>\n<p><strong>Figure 16.4.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0592_KidneyAnatomy_01.png\" rel=\"cc:attributionURL\">Blausen_0592_KidneyAnatomy_01<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a>\u00a0on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.4.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Diagram_showing_how_the_kidneys_work_CRUK_138.svg\" rel=\"cc:attributionURL\">Diagram_showing_how_the_kidneys_work_CRUK_138.svg<\/a> by <a class=\"external text\" href=\"http:\/\/www.cancerresearchuk.org\/\" rel=\"nofollow\">Cancer Research UK<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\" rel=\"license\">CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.<\/p>\n<p><strong>Figure 16.4.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2611_Blood_Flow_in_the_Nephron.jpg\" rel=\"cc:attributionURL\">Blood_Flow_in_the_Nephron<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-3-gross-anatomy-of-the-kidney\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.4.6<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Physiology_of_Nephron.png\" rel=\"cc:attributionURL\">1024px-Physiology_of_Nephron<\/a> by <a title=\"User:Madhero88\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Madhero88\">Madhero88<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.4.7<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2618_Nephron_Secretion_Reabsorption.jpg\" rel=\"cc:attributionURL\">Nephron_Secretion_Reabsorption<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-6-tubular-reabsorption\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.4.8<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Weewee.JPG\" rel=\"cc:attributionURL\">Urine<\/a> by <a class=\"extiw\" title=\"en:User:Markhamilton\" href=\"https:\/\/en.wikipedia.org\/wiki\/User:Markhamilton\">User:Markhamilton<\/a> at <a class=\"extiw\" title=\"en:Main Page\" href=\"https:\/\/en.wikipedia.org\/wiki\/Main_Page\">English Wikipedia<\/a> on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).<\/p>\n<p><strong>Figure 16.4.9<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2712_Renin_Angiotensin_System-01.jpg\" rel=\"cc:attributionURL\">Renin_Angiotensin_System-01<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/26-3-electrolyte-balance\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text focus\" data-timestamp=\"1597634737557\" data-highlight-id=\"78b92c1f-19a8-4f25-a51f-bbc8324f8001\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text focus\" data-timestamp=\"1597634737557\" data-highlight-id=\"78b92c1f-19a8-4f25-a51f-bbc8324f8001\" data-highlighted=\"true\">25.10<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"4696\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text focus\" data-timestamp=\"1597634737557\" data-highlight-id=\"78b92c1f-19a8-4f25-a51f-bbc8324f8001\" data-highlighted=\"true\">Blood flow in the nephron [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 25.3). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-3-gross-anatomy-of-the-kidney<\/span><\/span><\/p>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text focus\" data-timestamp=\"1597635089440\" data-highlight-id=\"44eee2fb-aa0d-4804-9be2-6a8facf0058f\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text focus\" data-timestamp=\"1597635089440\" data-highlight-id=\"44eee2fb-aa0d-4804-9be2-6a8facf0058f\" data-highlighted=\"true\">25.17<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"26834\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text last focus\" data-timestamp=\"1597635089440\" data-highlight-id=\"44eee2fb-aa0d-4804-9be2-6a8facf0058f\" data-highlighted=\"true\">Locations of secretion and reabsorption in the nephron <span id=\"4696\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text focus\" data-timestamp=\"1597634737557\" data-highlight-id=\"78b92c1f-19a8-4f25-a51f-bbc8324f8001\" data-highlighted=\"true\">[digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 25.6). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-6-tubular-reabsorption<\/span><\/span><\/span><\/span><\/p>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text focus\" data-timestamp=\"1597635408675\" data-highlight-id=\"1dfb4674-6d07-43f5-aeac-06bacc555bc7\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text focus\" data-timestamp=\"1597635408675\" data-highlight-id=\"1dfb4674-6d07-43f5-aeac-06bacc555bc7\" data-highlighted=\"true\">26.14<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"41702\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text focus\" data-timestamp=\"1597635408675\" data-highlight-id=\"1dfb4674-6d07-43f5-aeac-06bacc555bc7\" data-highlighted=\"true\">The renin-angiotensin system <span id=\"26834\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text last focus\" data-timestamp=\"1597635089440\" data-highlight-id=\"44eee2fb-aa0d-4804-9be2-6a8facf0058f\" data-highlighted=\"true\"><span id=\"4696\" class=\"os-title\" data-type=\"title\">[digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 26.3). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/26-3-electrolyte-balance<\/span><\/span><\/span><\/span><\/span><\/p>\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014.\u00a0<i>WikiJournal of Medicine<\/i>\u00a0<b>1<\/b>\u00a0(2).\u00a0DOI:10.15347\/wjm\/2014.010.\u00a0ISSN\u00a02002-4436<\/p>\n<p class=\"hanging-indent\">Hamada Abass. (2013). Urine formation. YouTube. https:\/\/www.youtube.com\/watch?v=es-t8lO1KpA&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, February 9). How do your kidneys work? - Emma Bryce. YouTube. https:\/\/www.youtube.com\/watch?v=FN3MFhYPWWo&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2013, March 15). Printing a human kidney - Anthony Atala. YouTube. https:\/\/www.youtube.com\/watch?v=bX3C201O4MA&amp;feature=youtu.be<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4085\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4085\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4767\" aria-describedby=\"caption-attachment-4767\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4767\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Cliche-1.jpg\" alt=\"16.5.1 Dog peeing on fire hydrant\" width=\"400\" height=\"300\"><figcaption id=\"caption-attachment-4767\" class=\"wp-caption-text\"><em>Figure 16.5.1 Just leaving a message.....<\/em><\/figcaption><\/figure>\n<div>\n<h1>Communicating with Urine<\/h1>\n<\/div>\n<p>Why do dogs pee on fire hydrants? Besides \u201chaving to go,\u201d they are marking their territory with chemicals in their urine called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4768\">pheromone<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. It\u2019s a form of communication, in which they are \u201csaying\u201d with odors that the yard is <\/span><em style=\"text-align: initial;font-size: 1em\">theirs<\/em><span style=\"text-align: initial;font-size: 1em\">\u00a0and other dogs should stay away. In addition to fire hydrants, dogs may urinate on fence posts, trees, car tires, and many other objects. Urination in dogs, as in people, is usually a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3004\">voluntary<\/a> process controlled by the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3823\">brain<\/a>. The process of forming urine \u2014 which occurs in the kidneys \u2014 occurs constantly, and is not under voluntary control. What happens to all the urine that forms in the kidneys? It passes from the kidneys through the other organs of the urinary system, starting with the ureters.<\/span><\/p>\n<div>\n<h1>Ureters<\/h1>\n<\/div>\n<p>As shown in Figure 16.5.2, <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4725\">ureter<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a><\/strong><span style=\"text-align: initial;font-size: 1em\"> are tube-like structures that connect the kidneys with the urinary bladder. They are paired structures, with one ureter for each kidney. In adults, ureters are between 25 and 30 cm (about 10\u201312 in) long and about 3 to 4 mm in diameter.<\/span><\/p>\n<figure id=\"attachment_4769\" aria-describedby=\"caption-attachment-4769\" style=\"width: 446px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4769\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Urinary-System-Male-1.jpg\" alt=\"16.5.2 Urinary System - Ureters\" width=\"446\" height=\"449\"><figcaption id=\"caption-attachment-4769\" class=\"wp-caption-text\"><em>16.5.2 Besides the kidneys, the urinary system includes two ureters, the urinary bladder, and the urethra.<\/em><\/figcaption><\/figure>\n<p>Each ureter arises in the pelvis of a kidney (the renal pelvis in Figure 16.5.3). It then passes down the side of the kidney, and finally enters the back of the bladder. At the entrance to the bladder, the ureters have sphincters that prevent the backflow of urine.<\/p>\n<figure id=\"attachment_4770\" aria-describedby=\"caption-attachment-4770\" style=\"width: 388px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4770\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Adrenal-glands-on-Kidney-by-NCI-Public-Domain-1-1.jpg\" alt=\"16.5.3 Renal Pelvis and Ureter\" width=\"388\" height=\"357\"><figcaption id=\"caption-attachment-4770\" class=\"wp-caption-text\"><em>16.5.3 Urine collects in the renal pelvis, which is continuous with the ureter. The ureter then carries the urine from the kidney to the urinary bladder.<\/em><\/figcaption><\/figure>\n<p>The walls of the ureters are composed of multiple layers of different types of tissues.\u00a0 The innermost layer is a special type of epithelium, called transitional epithelium. Unlike the epithelium lining most organs, transitional epithelium is capable of stretching and does not produce mucus. It lines much of the urinary system, including the renal pelvis, bladder, and much of the urethra, in addition to the ureters. Transitional epithelium allows these organs to stretch and expand as they fill with urine or allow urine to pass through. The next layer of the ureter walls is made up of loose connective tissue containing elastic fibres, nerves, and blood and lymphatic vessels. After this layer are two layers of smooth muscles, an inner circular layer, and an outer longitudinal layer. The smooth muscle layers can contract in waves of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a> to propel urine down the ureters from the kidneys to the urinary bladder. The outermost layer of the ureter walls consists of fibrous tissue.<\/p>\n<div>\n<h1>Urinary Bladder<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">urinary bladder<\/a><\/strong>\u00a0is a hollow, muscular, and stretchy organ that rests on the pelvic floor. It collects and stores <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4717\">urine<\/a> from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2988\">kidney<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0before the urine is eliminated through <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4726\">urination<\/a>. As shown in Figure 16.5.4, urine enters the urinary bladder from the ureters through two ureteral openings on either side of the back wall of the bladder. Urine leaves the bladder through a sphincter called the internal urethral sphincter. When the sphincter relaxes and opens, it allows urine to flow out of the bladder and into the urethra.<\/span><\/p>\n<figure id=\"attachment_4771\" aria-describedby=\"caption-attachment-4771\" style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4771\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/2605_The_Bladder-1.jpg\" alt=\"16.5.4 Urinary Bladder\" width=\"1024\" height=\"627\"><figcaption id=\"caption-attachment-4771\" class=\"wp-caption-text\"><em>Figure 16.5.4 This diagram of the urinary bladder shows (a) a cross-sectional drawing of the entire bladder and (b) a microscopic cross-section of the tissues in the wall of the bladder.<\/em><\/figcaption><\/figure>\n<p>Like the ureters, the bladder is lined with transitional epithelium, which can flatten out and stretch as needed as the bladder fills with urine. The next layer (lamina propria) is a layer of loose connective tissue, nerves, and blood and lymphatic vessels. This is followed by a submucosa layer, which connects the lining of the bladder with the detrusor muscle in the walls of the bladder. The outer covering of the bladder is peritoneum, which is a smooth layer of epithelial cells that lines the abdominal cavity and covers most abdominal organs.<\/p>\n<p>The detrusor muscle in the wall of the bladder is made of smooth muscle fibres controlled by both the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3807\">autonomic<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3014\">somatic<\/a> nervous systems. As the bladder fills, the detrusor muscle automatically relaxes to allow it to hold more urine. When the bladder is about half full, the stretching of the walls triggers the sensation of needing to urinate. When the individual is ready to void, conscious nervous signals cause the detrusor muscle to contract, and the internal urethral sphincter to relax and open. As a result, urine is forcefully expelled out of the bladder and into the urethra.<\/p>\n<div>\n<h1>Urethra<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4732\">urethra<\/a><\/strong> is a tube that connects the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">urinary bladder<\/a> to the external urethral orifice, which is the opening of the urethra on the surface of the body. As shown in Figure 16.5.5, the urethra in males travels through the penis, so it is much longer than the urethra in females. In males, the urethra averages about 20 cm (about 7.8 in) long, whereas in females, it averages only about 4.8 cm (about 1.9 in) long. In males, the urethra carries semen (as well as urine), but in females, it carries only urine.\u00a0 In addition, in males, the urethra passes through the prostate gland (part of the reproductive system) which is absent in women.<\/p>\n<figure id=\"attachment_4772\" aria-describedby=\"caption-attachment-4772\" style=\"width: 512px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4772\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/512px-Male_and_female_urethral_openings.svg_-1.png\" alt=\"16.5.5\" width=\"512\" height=\"355\"><figcaption id=\"caption-attachment-4772\" class=\"wp-caption-text\"><em>Figure 16.5.5 The male pelvis on the left and the female pelvis on the right. Notice how much longer the male urethra is because it travels through the length of the penis to reach the external urethral orifice.<\/em><\/figcaption><\/figure>\n<p>Like the ureters and bladder, the proximal (closer to the bladder) two-thirds of the urethra are lined with transitional epithelium. The distal (farther from the bladder) third of the urethra is lined with mucus-secreting epithelium. The mucus helps protect the epithelium from urine, which is corrosive. Below the epithelium is loose connective tissue, and below that are layers of smooth muscle that are continuous with the muscle layers of the urinary bladder. When the bladder contracts to forcefully expel urine, the smooth muscle of the urethra relaxes to allow the urine to pass through.<\/p>\n<p>In order for urine to leave the body through the external urethral orifice, the external urethral sphincter must relax and open. This sphincter is a striated muscle that is controlled by the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3014\">somatic nervous system<\/a>, so it is under conscious, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3004\">voluntary<\/a> control in most people (exceptions are infants, some elderly people, and patients with certain injuries or disorders). The muscle can be held in a contracted state and hold in the urine until the person is ready to urinate. Following urination, the smooth muscle lining the urethra automatically contracts to re-establish muscle tone, and the individual consciously contracts the external urethral sphincter to close the external urethral opening.<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.5 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4725\">Ureters<\/a>\u00a0are tube-like structures that connect the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2988\">kidneys<\/a>\u00a0with the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">urinary bladder<\/a>. Each ureter arises at the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4724\">renal pelvis<\/a> of a kidney and travels down through the abdomen to the urinary bladder. The walls of the ureter contain <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2982\">smooth muscle<\/a> that can contract to push <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4717\">urine<\/a> through the ureter by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a>. The walls are lined with transitional epithelium that can expand and stretch.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">urinary bladder<\/a> is a hollow, muscular organ that rests on the pelvic floor. It is also lined with transitional epithelium. The function of the bladder is to collect and store urine from the kidneys before the urine is eliminated through urination. Filling of the bladder triggers the sensation of needing to urinate. When a conscious decision to urinate is made, the detrusor muscle in the bladder wall contracts and forces urine out of the bladder and into the urethra.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4732\">urethra<\/a> is a tube that connects the urinary bladder to the external urethral orifice. Somatic nerves control the sphincter at the distal end of the urethra. This allows the opening of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4627\">sphincter<\/a> for urination to be under <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3004\">voluntary<\/a> control.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.5 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>What are ureters?\u00a0 Describe the location of the ureters relative to other urinary tract organs.<\/li>\n<li>Identify layers in the walls of a ureter. How do they contribute to the ureter\u2019s function?<\/li>\n<li>Describe the urinary bladder. What is the function of the urinary bladder?<\/li>\n<li>\n<div id=\"h5p-196\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-196\" class=\"h5p-iframe\" data-content-id=\"196\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Energy Needs of Living Things\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>How does the nervous system control the urinary bladder?<\/li>\n<li>What is the urethra?<\/li>\n<li>How does the nervous system control urination?<\/li>\n<li>Identify the sphincters that are located along the pathway from the ureters to the external urethral orifice.<\/li>\n<li>What are two differences between the male and female urethra?<\/li>\n<li>When the bladder muscle contracts, the smooth muscle in the walls of the urethra _________ .<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.5 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/2Brajdazp1o<\/p>\n<p style=\"text-align: center\">The taboo secret to better health | Molly Winter, TED. 2016.<\/p>\n<p>https:\/\/youtu.be\/dg4_deyHLvQ<\/p>\n<p style=\"text-align: center\">What Happens When You Hold Your Pee? SciShow, 2016.<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 16.5.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cliche.jpg\" rel=\"cc:attributionURL\">Cliche<\/a> by <a class=\"external text\" href=\"https:\/\/www.flickr.com\/people\/27735730@N00\" rel=\"nofollow\">Jackie<\/a> on Wikimedia Common s is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\" rel=\"license\">CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0) license.<\/p>\n<p><strong>Figure 16.5.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:UrinarySystemMale.jpg\" rel=\"cc:attributionURL\">Urinary System Male<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\" rel=\"license\">CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.<\/p>\n<p><strong>Figure 16.5.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Kidney_and_adrenal_gland.jpg\" rel=\"cc:attributionURL\">Adrenal glands on Kidney by NCI Public Domain<\/a>\u00a0by Alan Hoofring (Illustrator) \/<a class=\"extiw\" title=\"en:National Cancer Institute\" href=\"https:\/\/en.wikipedia.org\/wiki\/National_Cancer_Institute\">National Cancer Institute<\/a> (<a href=\"https:\/\/visualsonline.cancer.gov\/details.cfm?imageid=4355\">photo ID 4355<\/a>) on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).<\/p>\n<p><strong>Figure 16.5.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2605_The_Bladder.jpg\" rel=\"cc:attributionURL\">2605_The_Bladder<\/a> by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-2-gross-anatomy-of-urine-transport\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license. <span class=\"os-caption\"><span class=\"search-highlight text last\" data-timestamp=\"1597636975236\" data-highlight-id=\"b46f272f-e324-486a-9b46-6607817bb903\" data-highlighted=\"true\">(Micrograph originally provided by <span class=\"search-highlight first text last\" data-timestamp=\"1597636975280\" data-highlight-id=\"fda2d69c-8a26-4beb-b12b-daf80f2c011d\" data-highlighted=\"true\">the<\/span>\u00a0Regents of\u00a0<span class=\"search-highlight first text last\" data-timestamp=\"1597636975286\" data-highlight-id=\"855d8b77-088b-43c9-81b4-0e0ff4f489e1\" data-highlighted=\"true\">the<\/span> University of Michigan Medical School \u00a9 2012.)<\/span><\/span><\/p>\n<p><strong>Figure 16.5.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Male_and_female_urethral_openings.svg\" rel=\"cc:attributionURL\">512px-Male_and_female_urethral_openings.svg<\/a>\u00a0by <a title=\"User:Andrybak\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Andrybak\">andrybak<\/a> (derivative work) on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\" rel=\"license\">CC BY-SA 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/3.0) license. (Original: <a title=\"File:Male anatomy blank.svg\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Male_anatomy_blank.svg\">Male anatomy blank.svg<\/a>:\u00a0<a class=\"external text\" href=\"http:\/\/www.luckymojo.com\/faqs\/altsex\/penis.html\" rel=\"nofollow\">alt.sex FAQ<\/a>, derivative work:\u00a0<a title=\"User:Tsaitgaist\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Tsaitgaist\">Tsaitgaist<\/a>\u00a0<a title=\"File:Female anatomy with g-spot.svg\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Female_anatomy_with_g-spot.svg\">Female anatomy with g-spot.svg<\/a>:\u00a0<a title=\"User:Tsaitgaist\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Tsaitgaist\">Tsaitgaist<\/a>.)<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text\" data-timestamp=\"1597636975236\" data-highlight-id=\"b46f272f-e324-486a-9b46-6607817bb903\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text\" data-timestamp=\"1597636975236\" data-highlight-id=\"b46f272f-e324-486a-9b46-6607817bb903\" data-highlighted=\"true\">25.4<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"3366\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text\" data-timestamp=\"1597636975236\" data-highlight-id=\"b46f272f-e324-486a-9b46-6607817bb903\" data-highlighted=\"true\">Bladder\u00a0<\/span><\/span><span class=\"os-caption\"><span class=\"search-highlight text last\" data-timestamp=\"1597636975236\" data-highlight-id=\"b46f272f-e324-486a-9b46-6607817bb903\" data-highlighted=\"true\">(a) Anterior cross section of the bladder. (b)\u00a0<span class=\"search-highlight first text last\" data-timestamp=\"1597636975256\" data-highlight-id=\"b7b616c9-437f-4937-a7f5-c1b47387a77e\" data-highlighted=\"true\">The<\/span>\u00a0detrusor muscle of\u00a0<span class=\"search-highlight first text last\" data-timestamp=\"1597636975257\" data-highlight-id=\"31417372-bff6-4d54-941d-580ae31d2bcf\" data-highlighted=\"true\">the bladder<\/span> (source: monkey tissue) LM \u00d7 448 [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 7.3). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/25-2-gross-anatomy-of-urine-transport\u00a0<\/span><\/span><\/p>\n<p class=\"hanging-indent\">SciShow. (2016, January 22). What happens when you hold your pee? YouTube. https:\/\/www.youtube.com\/watch?v=dg4_deyHLvQ&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED. (2016, September 2). The taboo secret to better health | Molly Winter. YouTube. https:\/\/www.youtube.com\/watch?v=2Brajdazp1o&amp;feature=youtu.be<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4086\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4086\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4777\" aria-describedby=\"caption-attachment-4777\" style=\"width: 124px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4777\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/512px-Green_ribbon.svg_-1.png\" alt=\"16.6.1 Green Ribbon\" width=\"124\" height=\"200\"><figcaption id=\"caption-attachment-4777\" class=\"wp-caption-text\"><em>Figure 16.6.1 The green ribbon raises awareness for kidney disorders.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Awareness Ribbon<\/h1>\n<\/div>\n<p>Awareness ribbons are symbols meant to show support or to raise consciousness for a cause. Different colours are associated with different issues, often relating to health problems. The first ribbon to gain familiarity for a health issue was the red ribbon for HIV\/AIDS, created in 1991. The pink ribbon for breast cancer awareness is probably the best known today. Do you know what a green ribbon like the one pictured in Figure 16.6.1 represents? Among several other health problems, a green ribbon is meant to show support or raise awareness for kidney disorders.<\/p>\n<div>\n<h1>Disorders of the\u00a0Kidneys<\/h1>\n<\/div>\n<p>The\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2988\">kidney<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0play such vital roles in eliminating wastes and toxins \u2014 and in maintaining body-wide\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3669\">homeostasis<\/a>\u00a0\u2014 that disorders of the kidneys may be life threatening. Gradual loss of normal kidney function commonly occurs with a number of disorders, including\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2771\">diabetes\u00a0mellitus<\/a> and high\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4480\">blood pressure<\/a>. Other disorders of the kidneys are caused by faulty inherited genes. Loss of kidney function may eventually progress to kidney failure.<\/span><\/p>\n<h2>Diabetic Nephropathy<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4778\">Diabetic nephropathy<\/a><\/strong> is a progressive kidney disease caused by damage to the capillaries in the glomeruli of the kidneys, due to long-standing <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2771\">diabetes mellitus<\/a> (see Figure 16.6.2). It is not fully understood how diabetes leads to damage of glomerular capillaries, but it is thought that high levels of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3359\">glucose<\/a> in the blood are involved. In people with diabetes, <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/diabetic-nephropathy\/symptoms-causes\/syc-20354556\">diabetic nephropathy<\/a> is more likely if blood glucose is poorly controlled. Having high blood pressure, a history of cigarette smoking, and a family history of kidney problems are additional risk factors. Diabetic nephropathy often has no symptoms at first. In fact, it may take up to a decade after kidney damage begins for symptoms to appear. When they do appear, they typically include severe tiredness, headaches, nausea, frequent urination, and itchy skin.<\/p>\n<figure id=\"attachment_4779\" aria-describedby=\"caption-attachment-4779\" style=\"width: 1024px\" class=\"wp-caption alignnone\"><img class=\"size-full wp-image-4779\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Blausen_0310_DiabeticNephropathy-1.png\" alt=\"16.6.2 Diabetic Nephropathy\" width=\"1024\" height=\"768\"><figcaption id=\"caption-attachment-4779\" class=\"wp-caption-text\"><em>Figure 16.6.2 Diabetic nephropathy is characterized by damage to the capillaries in the glomeruli of the kidneys, represented by the lower of the two inset diagrams.<\/em><\/figcaption><\/figure>\n<p>Proteins\u00a0are large molecules that are usually not filtered out of\u00a0blood\u00a0in the glomeruli. When the glomerular capillaries are damaged, it allows proteins (such as albumin) to leak into the filtrate from the blood. As a result, albumin ends up being excreted in the urine. Finding a high level of albumin in the urine is one indicator of diabetic nephropathy and helps to diagnose the disorder. Drugs may be prescribed to reduce\u00a0protein\u00a0levels in the urine. Controlling high blood sugar levels and hypertension (high blood pressure) is also important to help slow kidney damage, as is a reduction of sodium intake.<\/p>\n<h2>Polycystic Kidney Disease<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4780\">Polycystic kidney disease<\/a> (PKD)<\/strong> is a genetic disorder in which multiple abnormal cysts develop and grow in the kidneys. Figure 16.6.3\u00a0shows a pair of kidneys that are riddled with cysts from PKD. In people who inherit <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/polycystic-kidney-disease\/symptoms-causes\/syc-20352820\">PKD<\/a>, the cysts may start to form at any point in life, from infancy through adulthood. Typically, both kidneys are affected. Symptoms of the disorder may include high blood pressure, headaches, abdominal pain, blood in the urine, and excessive urination.<\/p>\n<figure id=\"attachment_4781\" aria-describedby=\"caption-attachment-4781\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4781\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Polycystic_kidneys_gross_pathology_CDC_PHIL-1.png\" alt=\"16.6.3 Polycystic Kidney Disease\" width=\"400\" height=\"271\"><figcaption id=\"caption-attachment-4781\" class=\"wp-caption-text\"><em>Figure 16.6.3 In polycystic kidney disease, the kidneys are injured by the formation of multiple cysts, which may grow to be quite large.<\/em><\/figcaption><\/figure>\n<p>There are two types of PKD. The more common type is caused by an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2112\">autosomal<\/a> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3881\">dominant<\/a> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3357\">allele<\/a>, and the less common type is caused by an autosomal <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2479\">recessive<\/a> allele. Both types together make PKD one of the most common hereditary diseases in Canada, affecting one in every 500 people. There is little or no difference in the rate of occurrence of PKD between genders or ethnic groups. Other than a kidney transplant, there is no known cure for this disease.<\/p>\n<h2>Kidney Failure<\/h2>\n<p>Both diabetic nephropathy and PKD may lead to\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4782\"><strong>kidney<\/strong>\u00a0(or renal)\u00a0<strong>failure<\/strong><\/a>(classified as end-stage kidney disease), in which the kidneys are no longer able to adequately filter metabolic wastes from the blood. Long-term, uncontrolled high blood pressure is another common cause of kidney failure. Symptoms of kidney failure may include nausea, more or less frequent urination, blood in the urine, muscle cramps, anemia, swelling of the extremities, and shortness of breath due to the accumulation of fluid in the lungs. If kidney function drops below the level needed to sustain life, then the only treatment option is kidney transplantation or some means of artificial filtration of the blood, such as by hemodialysis.<\/p>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4783\">Hemodialysis<\/a><\/strong> is a medical procedure in which blood is filtered externally through a machine. You can see how it works in Figure 16.6.4. During dialysis, waste products (such as urea) are removed \u2014 along with excess water \u2014 from the patient\u2019s blood before the blood is returned to the patient. Hemodialysis is typically done on an outpatient basis in a hospital or special dialysis clinic. Less frequently, it is done in the patient\u2019s home. Depending on the patient\u2019s size, among other factors, the blood is filtered for three to four hours roughly three times a week.<\/p>\n<figure id=\"attachment_4784\" aria-describedby=\"caption-attachment-4784\" style=\"width: 1000px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4784\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1000px-Hemodialysis-en.svg_-1.png\" alt=\"16.6.4 Hemodialysis\" width=\"1000\" height=\"862\"><figcaption id=\"caption-attachment-4784\" class=\"wp-caption-text\"><em>Figure 16.6.4 This\u00a0 diagram shows the general process by which blood is filtered externally in the process of hemodialysis.<\/em><\/figcaption><\/figure>\n<h2>Kidney Stones<\/h2>\n<figure id=\"attachment_4787\" aria-describedby=\"caption-attachment-4787\" style=\"width: 203px\" class=\"wp-caption alignleft\"><img class=\"wp-image-4787 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/512px-Kidney_stone_1-e1592690641778-1.jpg\" alt=\"16.6.5 Kidney Stone Real\" width=\"203\" height=\"175\"><figcaption id=\"caption-attachment-4787\" class=\"wp-caption-text\"><em>Figure 16.6.5 A kidney stone is composed of calcium, oxalate and uric acid which have crystallized.<\/em><\/figcaption><\/figure>\n<p>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4785\">kidney stone<\/a><\/strong>, (pictured in Figure 16.6.5) also known as a renal calculus, is a solid crystal that forms in a kidney from minerals in urine (see Figure 16.6.6). The majority of <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/kidney-stones\/symptoms-causes\/syc-20355755\">kidney stones<\/a> consist of crystals of calcium salts. Kidney stones typically leave the body in the urine stream. A small stone may go undetected, because it can pass through the ureters and other urinary tract organs without causing symptoms. A larger stone may cause pain when it passes through the urinary tract. If a kidney stone grows large enough, it may block the ureter. Blockage of a ureter may cause a decrease in kidney function and damage to the kidney.<\/p>\n<figure id=\"attachment_4786\" aria-describedby=\"caption-attachment-4786\" style=\"width: 590px\" class=\"wp-caption alignnone\"><img class=\" wp-image-4786\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0595_KidneyStones-1.png\" alt=\"16.6.5 Kidney Stones\" width=\"590\" height=\"446\"><figcaption id=\"caption-attachment-4786\" class=\"wp-caption-text\"><em>Figure 16.6.6 Kidney stones form in the kidney and may grow large enough to block the ureter.<\/em><\/figcaption><\/figure>\n<p>A kidney stone that causes pain is generally treated with pain medication, such as opiates, until it passes through the urinary tract. A stone that causes a blockage may be treated with lithotripsy. This is a medical procedure in which high-intensity ultrasound pulses are applied externally to cause fragmentation of the stone into pieces small enough to pass easily through the urinary tract. Although lithotripsy is noninvasive, it can cause damage to the kidneys. An alternative treatment for a stone that blocks urine flow is to insert a stent into the ureter to expand it and allow both urine and the stone to pass. In some cases, surgery may be required to physically remove a large stone from the ureter.\u00a0 In minor cases, sometimes drinking apple cider vinegar or lemon juice can break down small kidney stones because of the citric acid these foods contain.<\/p>\n<p>A combination of lifestyle and genetic factors seem to predispose certain people to develop kidneys stones. Risk factors include high consumption of cola soft drinks, eating a diet high in animal\u00a0protein, being overweight, and not drinking enough fluids. Preventive measures are obvious. They include limiting cola consumption, eating less animal protein, losing\u00a0weight, and increasing fluid intake.<\/p>\n<div>\n<h1>Other\u00a0Urinary System\u00a0Disorders<\/h1>\n<\/div>\n<p>Although disorders of the kidneys are generally the most serious\u00a0urinary system\u00a0disorders, problems that affect other organs of the urinary tract are generally more common. They include bladder infections and urinary incontinence.<\/p>\n<h2>Bladder Infection<\/h2>\n<p>A\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4789\">bladder infection<\/a><\/strong>, also called cystitis, is a very common type of urinary tract infection in which the urinary bladder becomes infected by bacteria (typically\u00a0<em>E. coli<\/em>), and rarely by\u00a0fungi. Symptoms of bladder infections may include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. In some cases, there may be blood in the urine. A much less common type of urinary tract infection is\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4790\">pyelonephritis<\/a><\/strong>, in which the kidney becomes infected. If a kidney infection occurs, it is generally because of an untreated bladder infection. Bladder infections are treated mainly with antibiotics.<\/p>\n<p>Risk factors for urinary bladder infections include sexual intercourse, improper toileting technique, diabetes, obesity, and \u2014 most notably \u2014 female sex. Bladder infections are four times more common in women than in men. For women, they are the most common type of bacterial infections, and as many as one in ten women have a bladder infection in any given year. Female anatomy explains the sex difference in the incidence of bladder infections. The urethra is much shorter and closer to the anus in females than in males, so contamination of the urethra and then the bladder with GI tract bacteria is more likely in females than in males. Once the bacteria reach the bladder, they can attach to the bladder wall and form a biofilm that resists the body\u2019s immune response.<\/p>\n<h2>Urinary Incontinence<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4791\">Urinary incontinence<\/a><\/strong>\u00a0is a chronic problem of uncontrolled leakage of urine. It is very common, especially at older ages, and especially in women. Sometimes, urinary incontinence is a sign of another health problem, such as diabetes or\u00a0obesity. Regardless of the underlying cause, the symptoms of urinary incontinence alone may have a large impact on quality of life, frequently causing inconvenience, embarrassment, and distress.<\/p>\n<p>In men, urinary incontinence is most commonly caused by an enlarged prostate gland or treatment for prostate\u00a0cancer. In women, there are two common types of urinary incontinence with different causes: stress incontinence and urge incontinence.<\/p>\n<ul>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4792\">Stress urinary incontinence<\/a><\/strong>\u00a0is caused by loss of support of the urethra, usually due to stretching of pelvic floor\u00a0muscles\u00a0during childbirth. It is characterized by leakage of small amounts of urine with activities that increase abdominal pressure, such as coughing, sneezing, or lifting. Treatment of stress urinary incontinence may include Kegel exercises to strengthen the pelvic muscles. More serious cases may call for surgery to improve support for the bladder.<\/li>\n<li><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4793\">Urge urinary incontinence<\/a><\/strong>\u00a0(commonly called \u201coveractive bladder\u201d) is caused by uncontrolled contractions of the detrusor muscle in the wall of the bladder. This causes the bladder to empty unexpectedly. Urge incontinence is characterized by leakage of large amounts of urine in association with insufficient warning to get to the bathroom in time. Treatment of urge incontinence may include taking a medication to relax the detrusor muscle.<\/li>\n<\/ul>\n<div>\n<h1>Feature: My\u00a0Human Body<\/h1>\n<\/div>\n<p>You probably have had to \u201cdonate\u201d a urine specimen for analysis in conjunction with a medical visit. A thorough medical exam often includes clinical tests for urine. Understanding what your urine\u00a0can\u00a0reveal about your health may help you appreciate the need for such tests.<\/p>\n<p>The most common urine test is called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4794\">urinalysis<\/a><\/strong>. In a routine urinalysis, a urine sample may be analyzed by sight and smell, and with simple urine test strips. If a particular disorder is suspected, urinalysis may be more extensive.\u00a0The urine may be analyzed with specific tests or viewed under a\u00a0microscope\u00a0to identify abnormal substances in the urine. If a bacterial infection is suspected, a sample of urine may be cultured in the lab to see if it grows\u00a0bacteria, and which type of bacteria grow. Knowing the type of bacteria is important for deciding which class of antibiotics is likely to be most effective in treating the infection.<\/p>\n<p>The colour and clarity of urine may be obvious first indicators of disorders or other abnormalities. Normal urine is yellow to amber in colour, and looks clear. If urine is nearly colourless, it could be a sign of excessive fluid intake, or it might be a sign of diabetes. Very dark urine may indicate dehydration, but it could also be caused by taking certain medications or ingesting some other substances. If urine has a reddish tinge, it is often a sign of blood in the urine, which could be due to a urinary tract infection, kidney stone, or even cancer. If urine appears cloudy instead of clear, it could be due to white blood cells in the urine, which may be another sign of a urinary tract infection.<\/p>\n<p>If it is very diluted, normal urine may have virtually no odor. It will have a stronger odor if it is concentrated. Brief changes in the normal odor of urine often occur due to the ingestion of certain foods or medications.\u00a0After eating asparagus, for example, urine may have a peculiar and distinctive odor for several hours. More significant is urine that has a sweet smell, because this may indicate sugar in the urine, which is a sign of diabetes.<\/p>\n<figure id=\"attachment_4795\" aria-describedby=\"caption-attachment-4795\" style=\"width: 312px\" class=\"wp-caption alignleft\"><img class=\"wp-image-4795 \" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Urinalysis-by-Dominic-Alves-on-Flickr-e1592691855487-1.jpg\" alt=\"16.6.7\" width=\"312\" height=\"264\"><figcaption id=\"caption-attachment-4795\" class=\"wp-caption-text\"><em>Figure 16.6.7 Urinalysis strips are a basic diagnostic tool used to determine pathological changes in a patient's urine. A standard urine test strip may comprise up to 10 different chemical pads or reagents which react (change colour) when immersed in, and then removed from, a urine sample. The test can often be read in as little as 60 to 120 seconds after dipping, although certain tests require longer.<\/em><\/figcaption><\/figure>\n<p>Urine test strips (shown in Figure 16.6.7), much like the familiar litmus test strips used to detect acids and bases in chemistry lab, are used to identify abnormal levels of certain components in the urine. For example, urine test strips can detect and quantify the presence of nitrites in urine, which is usually a sign of infection with certain types of bacteria. Urine test strips can also be used to identify proteins such as albumin in urine, which may be a sign of a kidney infection or of kidney failure. Levels of sodium in urine can also be measured with test strips, and higher-than-normal levels may be another indication of kidney failure. In addition, test strips can identify and quantify the presence of white blood cells and blood in a urine specimen, both of which are likely to be a sign of a urinary tract infection or some other urinary system disorder.<\/p>\n<p>Besides the use of urine test strips, other simple urine tests that are often performed include Benedict\u2019s test, which is a test for the presence and quantity of glucose in urine. If the level is high, it likely indicates <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2969\">diabetes<\/a>. The test is so simple that it may even be done by the patient\u00a0at\u00a0home to monitor how well sugar levels are being controlled. Testing for some other substances in urine requires the patient to collect urine over a 24-hour period. This is the case when testing for the adrenal\u00a0hormone\u00a0cortisol. When urine cortisol levels are higher than normal, it may indicate <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3492\">Cushing\u2019s syndrome<\/a>. When the levels are lower than normal, it may indicate <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3493\">Addison\u2019s disease<\/a>.<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.6 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4778\">Diabetic nephropathy<\/a> is a progressive kidney disease caused by damage to the capillaries in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4747\">glomeruli<\/a> of the kidneys due to long-standing <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2771\">diabetes mellitus<\/a>. Years of capillary damage may occur before symptoms first appear.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4780\">Polycystic kidney disease<\/a> (PKD) is a genetic disorder (autosomal dominant or recessive) in which multiple abnormal cysts grow in the kidneys.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4778\">Diabetic nephropathy<\/a>, PKD, or chronic hypertension may lead to kidney failure, in which the kidneys are no longer able to adequately filter metabolic wastes from the blood. Kidneys may fail to such a degree that kidney transplantation or repeated, frequent <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4783\">hemodialysis<\/a> is needed to support life. In hemodialysis, the patient\u2019s blood is filtered artificially through a\u00a0machine, and then returned to the patient\u2019s\u00a0circulation.<\/li>\n<li>A kidney stone is a solid crystal that forms in a kidney from minerals in urine. A small stone may pass undetected through the ureters and the rest of the urinary tract. A larger stone may cause pain when it passes, or be too large to pass, causing blockage of a ureter. Large kidney stones may be shattered with high-intensity ultrasound into pieces small enough to pass through the urinary tract, or they may be removed surgically.<\/li>\n<li>A bladder infection is generally caused by bacteria that reach the bladder from the GI tract and multiply. Bladder infections are much more common in females than males, because the female urethra is much shorter and closer to the anus. Treatment generally includes antibiotic drugs.<\/li>\n<li>Urinary incontinence is a chronic problem of uncontrolled leakage of urine. It is very common, especially at older ages and in women. In men, urinary incontinence is usually caused by an enlarged prostate gland. In women, it is usually caused by stretching of pelvic floor\u00a0muscles\u00a0during childbirth (stress incontinence) or by an \u201coveractive bladder\u201d that empties without warning (urge incontinence).<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.6 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-197\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-197\" class=\"h5p-iframe\" data-content-id=\"197\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"11.3 Drag and Drop Bone sort\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Define kidney failure.<\/li>\n<li>When kidney function drops below the level needed to sustain life, what are potential treatments for kidney failure?<\/li>\n<li>Describe hemodialysis.<\/li>\n<li>How may a large kidney stone be removed from the body?<\/li>\n<li>How are bladder infections usually treated?<\/li>\n<li>Why are bladder infections much more common in females than in males?<\/li>\n<li>Compare and contrast stress incontinence and urge incontinence.<\/li>\n<li>Why is the presence of a protein(such as albumin) in the urine a cause for concern?<\/li>\n<li>Patients undergoing hemodialysis usually have to do this procedure a few times a week. Why does it need\u00a0to be done so frequently?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">16.6 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/lY2bZjggc08<\/p>\n<p style=\"text-align: center\">Urinary Tract Infections, Animation, Alila Medical Media, 2016.<\/p>\n<div class=\"badge badge-style-type-verified style-scope ytd-badge-supported-renderer\"><\/div>\n<p>https:\/\/youtu.be\/W0GpIMNTPYg<\/p>\n<p style=\"text-align: center\">What causes kidney stones? - Arash Shadman, TED-Ed, 2017.<\/p>\n<p>https:\/\/youtu.be\/wRKhtfbJHdo<\/p>\n<p style=\"text-align: center\">Kegel Exercises Beginners Workout For Women, Michelle Kenway, 2013.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 16.6.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Green_ribbon.svg\" rel=\"cc:attributionURL\">512px-Green_ribbon.svg<\/a> by <a title=\"User:MesserWoland\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:MesserWoland\">MesserWoland<\/a> on Wikimedia Commons is used under a <a href=\"http:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/\" rel=\"license\">CC BY-SA 3.0<\/a> (http:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/) license.<\/p>\n<p><strong>Figure 16.6.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0310_DiabeticNephropathy.png\" rel=\"cc:attributionURL\">1024px-Blausen_0310_DiabeticNephropathy<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong style=\"text-align: initial;font-size: 1em\">Figure 16.6.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Polycystic_kidneys,_gross_pathology_CDC_PHIL.png\" rel=\"cc:attributionURL\">1024px-Polycystic_kidneys,_gross_pathology_CDC_PHIL<\/a> by Dr. Edwin P. Ewing, Jr. \/ <a class=\"extiw\" title=\"w:Centers for Disease Control and Prevention\" href=\"https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention\">CDC<\/a>'s\u00a0<a class=\"external text\" href=\"https:\/\/phil.cdc.gov\/\" rel=\"nofollow\">Public Health Image Library<\/a> (PHIL) <b><a class=\"external text\" href=\"https:\/\/phil.cdc.gov\/Details.aspx?pid=861\" rel=\"nofollow\">#861<\/a><\/b>. on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).<\/p>\n<p><strong>Figure 16.6.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Hemodialysis-en.svg\" rel=\"cc:attributionURL\">1000px-Hemodialysis-en.svg<\/a> by <a href=\"https:\/\/commons.wikimedia.org\/wiki\/User:YassineMrabet\">User:YassineMrabet<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.6.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Kidney_stone_1.jpg\" rel=\"cc:attributionURL\">512px-Kidney_stone_1<\/a> by <a title=\"User:\u041c\u0438\u0445\u0430\u0458\u043b\u043e \u0410\u043d\u0452\u0435\u043b\u043a\u043e\u0432\u0438\u045b\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:%D0%9C%D0%B8%D1%85%D0%B0%D1%98%D0%BB%D0%BE_%D0%90%D0%BD%D1%92%D0%B5%D0%BB%D0%BA%D0%BE%D0%B2%D0%B8%D1%9B\">User:\u041c\u0438\u0445\u0430\u0458\u043b\u043e \u0410\u043d\u0452\u0435\u043b\u043a\u043e\u0432\u0438\u045b<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\" rel=\"license\">CC BY-SA 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/3.0) license.<\/p>\n<p><strong>Figure 16.6.6<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0595_KidneyStones.png\" rel=\"cc:attributionURL\">Blausen_0595_KidneyStones<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 16.6.7<\/strong><\/p>\n<p><a href=\"https:\/\/www.flickr.com\/photos\/dominicspics\/9183250624\" rel=\"cc:attributionURL\">Amanda Cotton \u2013 Urinalysis Test Strips<\/a> by <a class=\"owner-name truncate\" title=\"Go to Dominic Alves's photostream\" href=\"https:\/\/www.flickr.com\/photos\/dominicspics\/\" data-track=\"attributionNameClick\">Dominic Alves<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a\u00a0 <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" rel=\"license\">CC BY 2,0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0\/) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Alila Medical Media. (2016, September 8). Urinary tract infections, animation. YouTube. https:\/\/www.youtube.com\/watch?v=lY2bZjggc08&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. <em>WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\n<p class=\"hanging-indent\">Michelle Kenway. (2013, February 1). Kegel exercises beginners workout for women. YouTube. https:\/\/www.youtube.com\/watch?v=wRKhtfbJHdo&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2017, July 3). What causes kidney stones? - Arash Shadman. YouTube. https:\/\/www.youtube.com\/watch?v=W0GpIMNTPYg&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Updated Canadian expert consensus published to guide optimal management of ADPKD. (2018, December 18). PDK Foundation of Canada. https:\/\/www.endpkd.ca\/canadian_expert_consensus_2018<\/p>\n<p class=\"hanging-indent\">\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4088\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4088\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4803\" aria-describedby=\"caption-attachment-4803\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4803\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Lymph-nodes-1.png\" alt=\"17.1.1 Checking Lymph Nodes\" width=\"400\" height=\"380\"><figcaption id=\"caption-attachment-4803\" class=\"wp-caption-text\"><em>Figure 17.1.1 Health practitioners will often check your lymph nodes for unusual lumps.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Case Study: Defending Your Defenses<\/h1>\n<\/div>\n<figure id=\"attachment_4807\" aria-describedby=\"caption-attachment-4807\" style=\"width: 291px\" class=\"wp-caption alignright\"><img class=\" wp-image-4807\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/mitchell-luo-ymo_yC_N_2o-unsplash-scaled-2.jpg\" alt=\"17.1.2 Hakeem\" width=\"291\" height=\"437\"><figcaption id=\"caption-attachment-4807\" class=\"wp-caption-text\"><em>Figure 17.1.2 Hakeem is concerned about his health - he has been unusually tired, has been losing weight and most recently, found an unexpected lump on the side of his neck.<\/em><\/figcaption><\/figure>\n<p>Twenty-six-year-old Hakeem wasn\u2019t feeling well. He was more tired than usual, dragging through his workdays despite going to bed earlier, and napping on the weekends. He didn\u2019t have much of an appetite, and had started losing weight. When he pressed on the side of his neck, like the doctor is doing in Figure 17.1.1, he noticed an unusual lump.<\/p>\n<p>Hakeem went to his doctor, who performed a physical exam and determined that the lump was a swollen lymph node. Lymph nodes are part of the immune system, and they will often become enlarged when the body is fighting off an infection. Dr. Hayes thinks that the swollen lymph node and fatigue could be signs of a viral or bacterial infection, although he is concerned about Hakeem\u2019s lack of appetite and weight loss. All of those symptoms combined can indicate a type of cancer called lymphoma. An infection, however, is a more likely cause, particularly in a young person like Hakeem. Dr. Hayes prescribes an antibiotic in case Hakeem has a bacterial infection, and advises him to return in a few weeks if his lymph node does not shrink, or if he is not feeling better.<\/p>\n<p>Hakeem returns a few weeks later. He is not feeling better and his lymph node is still enlarged. Dr. Hayes is concerned, and orders a biopsy of the enlarged lymph node. A lymph node biopsy for suspected lymphoma often involves the surgical removal of all or part of a lymph node. This helps to determine whether the tissue contains cancerous cells.<\/p>\n<figure id=\"attachment_4808\" aria-describedby=\"caption-attachment-4808\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4808\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Lymph-node-biopsy-by-US-Army-in-Africa-on-Flickr-1.jpg\" alt=\"17.1.3 Lymph Node Biopsy\" width=\"400\" height=\"314\"><figcaption id=\"caption-attachment-4808\" class=\"wp-caption-text\"><em>Figure 17.1.3 Surgeons performing a lymph node biopsy.<\/em><\/figcaption><\/figure>\n<p>The initial results of the biopsy indicate that Hakeem does have lymphoma. Although lymphoma is more common in older people, young adults and even children can get this disease. There are many types of lymphoma, with the two main types being <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/hodgkins-lymphoma\/symptoms-causes\/syc-20352646\">Hodgkin's lymphoma<\/a> and <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/non-hodgkins-lymphoma\/symptoms-causes\/syc-20375680\">non-Hodgkin's lymphoma<\/a>. Non-Hodgkin lymphoma (NHL), in turn, has many subtypes. The subtype depends on several factors, including which cell types are affected. Some subtypes of NHL, for example, affect immune system cells called B cells, while others affect different immune system cells called T cells.<\/p>\n<p>Dr. Hayes explains to Hakeem that it is important to determine which type of lymphoma he has, in order to choose the best course of treatment. Hakeem\u2019s biopsied tissue will be further examined and tested to see which cell types are affected, as well as which specific cell-surface proteins \u2014 called antigens \u2014 are present. This should help identify his specific type of lymphoma.<\/p>\n<p>As you read this chapter, you will learn about the functions of the immune system, and the specific roles that its cells and organs \u2014 such as B and T cells and lymph nodes \u2014 play in defending the body. At the end of this chapter, you will learn what type of lymphoma Hakeem has and what some of his treatment options are, including treatments that make use of the biochemistry of the immune system to fight cancer with the immune system itself.<\/p>\n<div>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">Chapter Overview: Immune System<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>In this chapter, you will learn about the immune system \u2014 the system that defends the body against infections and other causes of disease, such as cancerous cells. Specifically, you will learn about:<\/p>\n<ul>\n<li>How the immune system identifies normal cells of the body as \u201cself\u201d and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3707\">pathogens<\/a> and damaged cells as \u201cnon-self.\u201d<\/li>\n<li>The two major subsystems of the general immune system: the innate immune system \u2014 which provides a quick, but non-specific response \u2014 and the adaptive immune system, which is slower, but provides a specific response that often results in long-lasting immunity.<\/li>\n<li>The specialized immune system that protects the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3823\">brain<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3010\">spinal cord<\/a>, called the neuroimmune system.<\/li>\n<li>The organs, cells, and responses of the innate immune system, which includes physical barriers (such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3521\">skin<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4571\">mucus<\/a>), chemical and biological barriers, inflammation, activation of the complement system of molecules, and non-specific cellular responses (such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1680\">phagocytosis<\/a>).<\/li>\n<li>The lymphatic system \u2014 which includes white blood cells called lymphocytes, lymphatic vessels (which transport a fluid called lymph), and organs (such as the spleen, tonsils, and lymph nodes) \u2014 and its important role in the adaptive immune system.<\/li>\n<li>Specific cells of the immune system and their functions, including B cells, T cells, plasma cells, and natural killer cells.<\/li>\n<li>How the adaptive immune system can generate specific and often long-lasting immunity against pathogens through the production of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3567\">antibodies<\/a>.<\/li>\n<li>How vaccines work to generate immunity.<\/li>\n<li>How cells in the immune system detect and kill cancerous cells.<\/li>\n<li>Some strategies that pathogens employ to evade the immune system.<\/li>\n<li>Disorders of the immune system, including allergies, autoimmune diseases (such as diabetes and multiple sclerosis), and immunodeficiency resulting from conditions such as HIV infection.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox shaded\">\n<p>As you read the chapter, think about the following questions:<\/p>\n<ol>\n<li>What are the functions of lymph nodes?<\/li>\n<li>What are B and T cells? How do they relate to lymph nodes?<\/li>\n<li>What are cell-surface antigens? How do they relate to the immune system and to cancer?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 17.1.1<\/strong><\/p>\n<p><a href=\"https:\/\/vimeo.com\/271958333\" rel=\"cc:attributionURL\">Lymph nodes\/Is it a Cold or the Flu\u00a0<\/a> by <a href=\"https:\/\/vimeo.com\/leehealth\">Lee Health<\/a> on Vimeo is used under <a href=\"https:\/\/vimeo.com\/terms#licenses\">Vimeo's Terms of Service<\/a> (https:\/\/vimeo.com\/terms#licenses).<\/p>\n<p><strong>Figure 17.1.2<\/strong><\/p>\n<p><a href=\"https:\/\/unsplash.com\/photos\/ymo_yC_N_2o\" rel=\"cc:attributionURL\">mitchell-luo-ymo_yC_N_2o-unsplash<\/a> [photo] by <a class=\"_3XzpS _1ByhS _4kjHg _1O9Y0 _3l__V _1CBrG xLon9\" href=\"https:\/\/unsplash.com\/@mitchel3uo\">Mitchell Luo<\/a> on <a href=\"http:\/\/unsplash.com\">Unsplash<\/a> is used under the <a href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a> (https:\/\/unsplash.com\/license).<\/p>\n<p><strong>Figure 17.1.3<\/strong><\/p>\n<p><a href=\"https:\/\/flic.kr\/p\/qMacvT\" rel=\"cc:attributionURL\">Lymph node biopsy<\/a> by <a class=\"owner-name truncate\" title=\"Go to US Army Africa's photostream\" href=\"https:\/\/www.flickr.com\/photos\/usarmyafrica\/\" data-track=\"attributionNameClick\">US Army Africa<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a\u00a0 <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\" rel=\"license\">CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0\/) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Mayo Clinic Staff. (n.d.). Hodgkin's lymphoma [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/hodgkins-lymphoma\/symptoms-causes\/syc-20352646<\/p>\n<p class=\"hanging-indent\">Mayo Clinic Staff. (n.d.). Non-Hodgkin's lymphoma [online article]. MayoClinic.org. https:\/\/www.mayoclinic.org\/diseases-conditions\/non-hodgkins-lymphoma\/symptoms-causes\/syc-20375680<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4090\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4090\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4840\" aria-describedby=\"caption-attachment-4840\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4840\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/512px-Tonsillitis-1.jpg\" alt=\"17.3.1 Tonsilitis\" width=\"400\" height=\"305\"><figcaption id=\"caption-attachment-4840\" class=\"wp-caption-text\"><em>Figure 17.3.1 Ouch! Tonsillitis can be very painful.\u00a0<\/em><\/figcaption><\/figure>\n<div>\n<h1>Tonsillitis<\/h1>\n<\/div>\n<p>The white patches on either side of the throat in Figure 17.3.1 are signs of tonsillitis. The tonsils are small structures in the throat that are very common sites of infection. The white spots on the tonsils pictured here are evidence of infection. The patches consist of large amounts of dead bacteria, cellular debris, and white blood cells \u2014 in a word: pus. Children with recurrent tonsillitis may have their tonsils removed surgically to eliminate this type of infection. The tonsils are organs of the lymphatic system.<\/p>\n<div>\n<h1>What Is the Lymphatic System?<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2911\">lymphatic system<\/a><\/strong>\u00a0is a collection of organs involved in the production, maturation, and harboring of white\u00a0blood\u00a0cells\u00a0called lymphocytes. It also includes a network of vessels that transport or filter the fluid known as\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4552\">lymph<\/a><\/strong> in which lymphocytes circulate. Figure 17.3.2 shows major lymphatic vessels and other structures that make up the lymphatic system. Besides the tonsils, organs of the lymphatic system include the thymus, the spleen, and hundreds of lymph nodes distributed along the lymphatic vessels.<\/p>\n<figure id=\"attachment_4841\" aria-describedby=\"caption-attachment-4841\" style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4841\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0623_LymphaticSystem_Female-1.png\" alt=\"17.3.2 Lymphatic System\" width=\"1024\" height=\"945\"><figcaption id=\"caption-attachment-4841\" class=\"wp-caption-text\"><em>Figure 17.3.2 The lymphatic system includes organs such as the thymus and spleen, as well as a body-wide network of vessels that transport lymph.<\/em><\/figcaption><\/figure>\n<p>The lymphatic vessels form a transportation network similar in many respects to the\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3743\">blood vessel<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0of the\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3835\">cardiovascular system<\/a>. However, unlike the cardiovascular system, the lymphatic system is not a closed system. Instead, lymphatic vessels carry lymph in a <em>single<\/em> direction \u2014 always toward the upper chest, where the lymph empties from lymphatic vessels into blood vessels.<\/span><\/p>\n<div>\n<h1>Cardiovascular Function of the Lymphatic System<\/h1>\n<\/div>\n<p>The return of lymph to the bloodstream is one of the major functions of the lymphatic system. When blood travels through <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3831\">capillaries<\/a> of the cardiovascular system, it is under pressure, which forces some of the components of blood (such as water, oxygen, and nutrients) through the walls of the capillaries and into the tissue spaces between cells, forming tissue fluid, also called interstitial fluid (see Figure 17.3.3). Interstitial fluid bathes and nourishes cells, and also absorbs their waste products. Much of the water from interstitial fluid is reabsorbed into the capillary blood by osmosis. Most of the remaining fluid is absorbed by tiny lymphatic vessels called lymph capillaries. Once interstitial fluid enters the lymphatic vessels, it is called lymph. Lymph is very similar in composition to blood plasma. Besides water, lymph may contain proteins, waste products, cellular debris, and pathogens. It also contains numerous white blood cells, especially the subset of white blood cells known as lymphocytes. In fact, lymphocytes are the main cellular components of lymph.<\/p>\n<figure id=\"attachment_4842\" aria-describedby=\"caption-attachment-4842\" style=\"width: 482px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4842 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/2201_Anatomy_of_the_Lymphatic_System-1-e1592718747447-1.jpg\" alt=\"17.3.3 Interstitial Fluid\" width=\"482\" height=\"292\"><figcaption id=\"caption-attachment-4842\" class=\"wp-caption-text\"><em>Figure 17.3.3 Fluid and other substances in blood are forced by blood pressure through the walls of capillaries and into the surrounding tissue spaces. Some of the tissue fluid is absorbed by tiny lymphatic vessels, forming lymph. The arrows show the direction of lymph through the\u00a0 lymphatic vessels.<\/em><\/figcaption><\/figure>\n<p>The lymph that enters lymph capillaries in tissues is transported through the lymphatic vessel network to two large lymphatic ducts in the upper chest. From there, the lymph flows into two major veins (called subclavian veins) of the cardiovascular system. Unlike blood, lymph is not pumped through its network of vessels. Instead, lymph moves through lymphatic vessels via a combination of contractions of the vessels themselves and the forces applied to the vessels externally by skeletal muscles, similarly to how blood moves through veins. Lymphatic vessels also contain numerous valves that keep lymph flowing in just one direction, thereby preventing backflow.<\/p>\n<div>\n<h1>Digestive Function of the Lymphatic System<\/h1>\n<\/div>\n<figure id=\"attachment_4843\" aria-describedby=\"caption-attachment-4843\" style=\"width: 253px\" class=\"wp-caption alignright\"><img class=\" wp-image-4843\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1000px-Intestinal_villus_simplified.svg_-1.png\" alt=\"17.3.4 Lacteals\" width=\"253\" height=\"322\"><figcaption id=\"caption-attachment-4843\" class=\"wp-caption-text\"><em>Figure 17.3.4 Vessels called lacteals in the villi lining the small intestine are the main way that fatty acids from digestion are absorbed from the gastrointestinal tract. These nutrients eventually reach the blood circulation after traveling through the network of lymphatic vessels.<\/em><\/figcaption><\/figure>\n<p>Lymphatic vessels called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4607\">lacteal<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\"> (see Figure 17.3.4) are present in the lining of the gastrointestinal tract, mainly in the small intestine. Each tiny <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4543\">villus<\/a> in the lining of the small intestine has an internal bed of capillaries and lacteals. The capillaries absorb most nutrients from the digestion of food into the blood. The lacteals absorb mainly fatty acids from lipid digestion into the lymph, forming a fatty-acid-enriched fluid called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4844\">chyle<\/a>. Vessels of the lymphatic network then transport chyle from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4559\">small intestine<\/a> to the main lymphatic ducts in the chest, from which it drains into the blood circulation. The nutrients in chyle then circulate in the blood to the liver, where they are processed along with the other nutrients that reach the liver directly via the bloodstream.<\/span><\/p>\n<div>\n<h1>Immune Function of the Lymphatic System<\/h1>\n<\/div>\n<p>The primary immune function of the lymphatic system is to protect the body against pathogens and cancerous cells. This function of the lymphatic system is centred on the production, maturation, and circulation of lymphocytes. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4832\">Lymphocyte<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a><\/strong><span style=\"text-align: initial;font-size: 1em\">\u00a0are leukocytes that are involved in the\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4822\">adaptive immune system<\/a>. They are responsible for the recognition of \u2014 and tailored defense against \u2014 specific pathogens or tumor cells. Lymphocytes may also create a lasting memory of pathogens, so they can be attacked quickly and strongly if they ever invade the body again. In this way, lymphocytes bring about long-lasting\u00a0immunity\u00a0to specific pathogens.<\/span><\/p>\n<p>There are two major types of lymphocytes, called B cells and T cells. Both B cells and T cells are involved in the adaptive immune response, but they play different roles.<\/p>\n<h2>Production and Maturation of Lymphocytes<\/h2>\n<p>Like all other types of blood cells (including erythrocytes), both B cells and T cells are produced from stem cells in the red marrow inside bones. After lymphocytes first form, they must go through a complicated maturation process before they are ready to search for pathogens. In this maturation process, they \u201clearn\u201d to distinguish self from non-self. Only those lymphocytes that successfully complete this maturation process go on to actually fight infections by pathogens.<\/p>\n<p>B cells mature in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4021\">bone marrow<\/a>, which is why they are called B cells. After they mature and leave the bone marrow, they travel first to the\u00a0circulatory system\u00a0and then enter the lymphatic system to search for pathogens. T cells, on the other hand, mature in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4829\">thymus<\/a>, which is why they are called T cells. The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4829\">thymus<\/a><\/strong> is illustrated in Figure 17.3.5. It is a small lymphatic organ in the chest that consists of an outer cortex and inner medulla, all surrounded by a fibrous capsule. After maturing in the thymus, T cells enter the rest of the lymphatic system to join B cells in the hunt for pathogens. The bone marrow and thymus are called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4845\">primary lymphoid organ<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0because of their role in the production and\/or maturation of lymphocytes.<\/span><\/p>\n<figure id=\"attachment_4846\" aria-describedby=\"caption-attachment-4846\" style=\"width: 1024px\" class=\"wp-caption alignnone\"><img class=\"size-full wp-image-4846\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/2206_The_Location_Structure_and_Histology_of_the_Thymus-1.jpg\" alt=\"17.3.5 The Thymus\" width=\"1024\" height=\"718\"><figcaption id=\"caption-attachment-4846\" class=\"wp-caption-text\"><em>Figure 17.3.5 The thymus is an important organ of the lymphatic system because it is the location of T cell maturation.<\/em><\/figcaption><\/figure>\n<h2>Lymphocytes in Secondary Lymphoid Organs<\/h2>\n<p>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4830\">tonsil<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4497\">spleen<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4831\">lymph node<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\">\u00a0are referred to as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4847\">secondary lymphoid organs<\/a>. These organs do not produce or mature lymphocytes. Instead, they filter lymph and store lymphocytes. It is in these secondary lymphoid organs that pathogens (or their antigens) activate lymphocytes and initiate adaptive immune responses. Activation leads to\u00a0cloning\u00a0of pathogen-specific lymphocytes, which then circulate between the lymphatic system and the blood, searching for and destroying their specific pathogens by producing antibodies against them.<\/span><\/p>\n<h3>Tonsils<\/h3>\n<p>There are four pairs of human <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4830\">tonsil<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a>.<\/strong><span style=\"text-align: initial;font-size: 1em\"> Three of the four are shown in Figure 17.3.6. The fourth pair, called tubal tonsils, is located at the back of the nasopharynx. The palatine tonsils are the tonsils that are visible on either side of the throat. All four pairs of tonsils encircle a part of the anatomy where the respiratory and gastrointestinal tracts intersect, and where pathogens have ready access to the body. This ring of tonsils is called Waldeyer's ring.<\/span><\/p>\n<figure id=\"attachment_4849\" aria-describedby=\"caption-attachment-4849\" style=\"width: 488px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4849\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Blausen_0861_TonsilsThroat_Anatomy2-1.png\" alt=\"17.3.6 Tonsils\" width=\"488\" height=\"488\"><figcaption id=\"caption-attachment-4849\" class=\"wp-caption-text\"><em>Figure 17.3.6 Three of four pairs of human tonsils are shown in this figure.<\/em><\/figcaption><\/figure>\n<h3>Spleen<\/h3>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4497\">spleen<\/a><\/strong> (Figure 17.3.7) is the largest of the secondary lymphoid organs, and is centrally located in the body. Besides harboring <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4832\">lymphocyte<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0and filtering <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4552\">lymph<\/a>, the spleen also filters <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2702\">blood<\/a>. Most dead or aged erythrocytes are removed from the blood in the red pulp of the spleen. Lymph is filtered in the white pulp of the spleen. In the fetus, the spleen has the additional function of producing red blood cells. This function is taken over by bone marrow after birth.<\/span><\/p>\n<figure id=\"attachment_4850\" aria-describedby=\"caption-attachment-4850\" style=\"width: 544px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4850\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Figure_42_02_14-1.jpg\" alt=\"17.3.7 The Spleen\" width=\"544\" height=\"581\"><figcaption id=\"caption-attachment-4850\" class=\"wp-caption-text\"><em>Figure 17.3.7 The spleen is a secondary lymphoid organ, where pathogens are likely to encounter lymphocytes and trigger an adaptive immune response.<\/em><\/figcaption><\/figure>\n<h3>Lymph Nodes<\/h3>\n<p>Each\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4831\">lymph node<\/a><\/strong> is a small, but organized collection of lymphoid tissue (see Figure 17.3.8) that contains many lymphocytes. Lymph nodes are located at intervals along the lymphatic vessels, and lymph passes through them on its way back to the blood.<\/p>\n<figure id=\"attachment_4851\" aria-describedby=\"caption-attachment-4851\" style=\"width: 465px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-4851\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Illu_lymph_node_structure-1.png\" alt=\"17.3.8 Lymph Node\" width=\"465\" height=\"265\"><figcaption id=\"caption-attachment-4851\" class=\"wp-caption-text\"><em>Figure 17.3.8 Lymph flows through lymph nodes like this one before returning to the blood.<\/em><\/figcaption><\/figure>\n<p>There are at least 500 lymph nodes in the human body. Many of them are clustered at the base of the limbs and in the neck. Figure 17.3.9 shows the major lymph node concentrations, and includes the spleen and the region named Waldeyer\u2019s ring, which consists of the tonsils.<\/p>\n<figure id=\"attachment_4852\" aria-describedby=\"caption-attachment-4852\" style=\"width: 464px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-4852\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1000px-Lymph_node_regions.svg_-1.png\" alt=\"17.3.9 Lymph Node Regions\" width=\"464\" height=\"663\"><figcaption id=\"caption-attachment-4852\" class=\"wp-caption-text\"><em>Figure 17.3.9 In this diagram, lymph node regions are shown for the left side of the body only. The same regions are also found on the right side of the body.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Feature: Myth vs. Reality<\/h1>\n<\/div>\n<p>When lymph nodes become enlarged and tender to the touch, they are obvious signs of immune system activity. Because it is easy to see and feel swollen lymph nodes, they are one way an individual can monitor his or her own health. To be useful in this way, it is important to know the myths and realities about swollen lymph nodes.<\/p>\n<p>&nbsp;<\/p>\n<table class=\"grid\" style=\"border-collapse: collapse;width: 100%;height: 374px\" border=\"0\">\n<tbody>\n<tr style=\"height: 63px\">\n<td style=\"width: 37.9081%;height: 63px\">\n<h2><span style=\"color: #ff0000\">Myth<\/span><\/h2>\n<p>&nbsp;<\/td>\n<td style=\"width: 62.0919%;height: 63px\">\n<h2><span style=\"color: #339966\">Reality<\/span><\/h2>\n<p>&nbsp;<\/td>\n<\/tr>\n<tr style=\"height: 111px\">\n<td style=\"width: 37.9081%;height: 111px\"><em><span style=\"font-size: 16px\">\"You should see a doctor immediately whenever you have swollen lymph nodes.\"<\/span><\/em><\/td>\n<td style=\"width: 62.0919%;height: 111px\"><strong><span style=\"font-size: 16px\">Lymph nodes are constantly filtering lymph, so it is expected that they will change in size with varying amounts of debris or pathogens that may be present. A minor, unnoticed infection may cause swollen lymph nodes that may last for a few weeks. Generally, lymph nodes that return to their normal size within two or three weeks are not a cause for concern.<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 111px\">\n<td style=\"width: 37.9081%;height: 111px\"><em><span style=\"font-size: 16px\">\"Swollen lymph nodes mean you have a bacterial infection.\"<\/span><\/em><\/td>\n<td style=\"width: 62.0919%;height: 111px\"><strong><span style=\"font-size: 16px\">Although an infection is the most common cause of swollen lymph nodes, not\u00a0<\/span><em style=\"font-size: 16px\">all<\/em><span style=\"font-size: 16px\">\u00a0infections are caused by\u00a0bacteria. Mononucleosis, for example, commonly causes swollen lymph nodes, and it is caused by viruses. There are also other causes of swollen lymph nodes besides infections, such as\u00a0cancer\u00a0and certain medications.<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 79px\">\n<td style=\"width: 37.9081%;height: 79px\"><em><span style=\"font-size: 16px\">\"A swollen lymph node means you have cancer.\"<\/span><\/em><\/td>\n<td style=\"width: 62.0919%;height: 79px\"><strong><span style=\"font-size: 16px\">Cancer\u00a0is far less likely to be the cause of a swollen lymph node than is an infection. However, if a lymph node remains swollen longer than a few weeks \u2014 especially in the absence of an apparent infection \u2014 you should have your doctor check it.<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 63px\">\n<td style=\"width: 37.9081%;height: 63px\"><em><span style=\"font-size: 16px\">\"Cancer in a lymph node always originates somewhere else. There is no cancer of the lymph nodes.\"<\/span><\/em><\/td>\n<td style=\"width: 62.0919%;height: 63px\"><strong><span style=\"font-size: 16px\">Cancers do commonly spread from their site of origin to nearby lymph nodes and then to other organs, but cancer may also originate in the lymph nodes. This type of cancer is called lymphoma.<\/span><\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.3 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2911\">lymphatic system<\/a> is a collection of organs involved in the production, maturation, and harboring of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3531\">leukocytes<\/a>\u00a0called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4832\">lymphocytes<\/a>. It also includes a network of vessels that transport or filter the fluid called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4552\">lymph<\/a> in which lymphocytes circulate.<\/li>\n<li>The return of lymph to the bloodstream is one of the functions of the lymphatic system. Lymph flows from tissue spaces \u2014 where it leaks out of blood vessels \u2014 to the subclavian veins in the upper chest, where it is returned to the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3835\">cardiovascular system<\/a>. Lymph is similar in composition to blood <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4395\">plasma<\/a>. Its main cellular components are lymphocytes.<\/li>\n<li>Lymphatic vessels called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4607\">lacteals<\/a>\u00a0are found in villi that line the\u00a0small intestine. Lacteals absorb fatty acids from the digestion of\u00a0lipids\u00a0in the\u00a0digestive system. The fatty acids are then transported through the network of lymphatic vessels to the bloodstream.<\/li>\n<li>The primary immune function of the lymphatic system is\u00a0to protect the body against pathogens and cancerous cells. It is responsible for producing mature lymphocytes and circulating them in lymph. Lymphocytes, which include B cells and T cells, are the subset of white blood cells involved in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4822\">adaptive immune responses<\/a>. They may create a lasting memory of and\u00a0immunity\u00a0to specific pathogens.<\/li>\n<li>All lymphocytes are produced in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4021\">bone marrow<\/a> and then go through a process of maturation in which they \u201clearn\u201d to distinguish self from non-self. B cells mature in the bone marrow, and T cells mature in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4829\">thymus<\/a>. Both the bone marrow and thymus are considered <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4845\">primary lymphatic organs<\/a>.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4847\">Secondary lymphatic organs<\/a>\u00a0include the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4830\">tonsils<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4497\">spleen<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4831\">lymph nodes<\/a>. There are four pairs of tonsils that encircle the throat. The spleen filters blood, as well as lymph. There are hundreds of lymph nodes located in clusters along the lymphatic vessels. All of these secondary organs filter lymph and store lymphocytes, so they are sites where pathogens encounter and activate lymphocytes and initiate adaptive immune responses.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.3 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>What is the lymphatic system?<\/li>\n<li>\n<div id=\"h5p-200\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-200\" class=\"h5p-iframe\" data-content-id=\"200\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Cellular Respiration\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Summarize the immune function of the lymphatic system.<\/li>\n<li>Explain the difference between lymphocyte maturation and lymphocyte activation.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.3 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/RMLPwOiYnII<\/p>\n<p style=\"text-align: center\">What is Lymphoedema or Lymphedema? Compton Care, 2016.<\/p>\n<p>https:\/\/youtu.be\/ah74jT00jBA<\/p>\n<p style=\"text-align: center\">Spleen physiology What does the spleen do in 2 minutes, Simple Nursing, 2015.<\/p>\n<p>https:\/\/youtu.be\/L4KexZZAdyA<\/p>\n<p style=\"text-align: center\">How to check your lymph nodes, University Hospitals Bristol and Weston NHS FT, 2020.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 17.3.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Tonsillitis.jpg\" rel=\"cc:attributionURL\">512px-Tonsillitis<\/a> by <a class=\"extiw\" title=\"wikipedia:User:Michaelbladon\" href=\"https:\/\/en.wikipedia.org\/wiki\/User:Michaelbladon\">Michaelbladon<\/a>\u00a0at\u00a0<a class=\"extiw\" title=\"wikipedia:\" href=\"https:\/\/en.wikipedia.org\/wiki\/\">English Wikipedia<\/a> on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain). \u00a0(Transferred from\u00a0<span class=\"plainlinks\"><a class=\"external text\" href=\"https:\/\/en.wikipedia.org\/\">en.wikipedia<\/a><\/span> to Commons by <a class=\"mw-userlink\" title=\"User:Kauczuk\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Kauczuk\">Kauczuk<\/a>)<\/p>\n<p><strong>Figure 17.3.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0623_LymphaticSystem_Female.png\" rel=\"cc:attributionURL\">Blausen_0623_LymphaticSystem_Female<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a>\u00a0 on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 17.3.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2201_Anatomy_of_the_Lymphatic_System.jpg\" rel=\"cc:attributionURL\">2201_Anatomy_of_the_Lymphatic_System<\/a> (cropped)\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/21-1-anatomy-of-the-lymphatic-and-immune-systems\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 17.3.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Intestinal_villus_simplified.svg\" rel=\"cc:attributionURL\">1000px-Intestinal_villus_simplified.svg<\/a> by <a title=\"User:Snow93\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Snow93\">Snow93<\/a> on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain).<\/p>\n<p><strong>Figure 17.3.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:2206_The_Location_Structure_and_Histology_of_the_Thymus.jpg\" rel=\"cc:attributionURL\">2206_The_Location_Structure_and_Histology_of_the_Thymus<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/21-1-anatomy-of-the-lymphatic-and-immune-systems\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 17.3.6<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0861_Tonsils%26Throat_Anatomy2.png\" rel=\"cc:attributionURL\">Blausen_0861_Tonsils&amp;Throat_Anatomy2<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a>\u00a0 on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 17.3.7<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_42_02_14.jpg\" rel=\"cc:attributionURL\">Figure_42_02_14<\/a>\u00a0by <a href=\"https:\/\/cnx.org\/contents\/GFy_h8cu@10.8:etZobsU-@6\/Adaptive-Immune-Response\">CNX OpenStax<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" rel=\"license\">CC BY 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/4.0) license.<\/p>\n<p><strong>Figure 17.3.8<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Illu_lymph_node_structure.png\" rel=\"cc:attributionURL\">Illu_lymph_node_structure<\/a> by <a href=\"https:\/\/training.seer.cancer.gov\/anatomy\/lymphatic\/components\/nodes.html\">NCI\/ SEER<\/a> Training on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain). (Archives: https:\/\/web.archive.org\/web\/20070311015818\/http:\/\/training.seer.cancer.gov\/module_anatomy\/unit8_2_lymph_compo1_nodes.html)<\/p>\n<p><strong>Figure 17.3.9<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Lymph_node_regions.svg\" rel=\"cc:attributionURL\">1000px-Lymph_node_regions.svg<\/a> by <a title=\"User:Fred the Oyster\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Fred_the_Oyster\">Fred the Oyster<\/a> (derivative work) on Wikimedia Commons is in the <a href=\"https:\/\/en.wikipedia.org\/wiki\/Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/Public_domain). (Original by <a href=\"https:\/\/training.seer.cancer.gov\/lymphoma\/anatomy\/lymph-nodes.html\">NCI\/ SEER<\/a> Training)<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text focus\" data-timestamp=\"1597689412024\" data-highlight-id=\"765c359c-d30b-4bbe-839d-a71c956f03e0\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><\/span><span class=\"os-number\"><span class=\"search-highlight text focus\" data-timestamp=\"1597689412024\" data-highlight-id=\"765c359c-d30b-4bbe-839d-a71c956f03e0\" data-highlighted=\"true\">21.2<\/span><\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"93337\" class=\"os-title\" data-type=\"title\"><span class=\"search-highlight text focus\" data-timestamp=\"1597689412024\" data-highlight-id=\"765c359c-d30b-4bbe-839d-a71c956f03e0\" data-highlighted=\"true\">Anatomy of the lymphatic system<\/span><\/span><span class=\"os-divider\">\u00a0<\/span>[digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 21.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/21-1-anatomy-of-the-lymphatic-and-immune-systems<\/p>\n<p class=\"hanging-indent\"><span class=\"os-title-label\"><span class=\"search-highlight text focus\" data-timestamp=\"1597689412024\" data-highlight-id=\"765c359c-d30b-4bbe-839d-a71c956f03e0\" data-highlighted=\"true\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<span class=\"os-number\">21.7<\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"32303\" class=\"os-title\" data-type=\"title\">Location, structure, and histology of the thymus<\/span> <\/span>[digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 21.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/21-1-anatomy-of-the-lymphatic-and-immune-systems<\/span><\/p>\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014\".\u00a0<em>WikiJournal of Medicine\u00a01\u00a0<\/em>(2).\u00a0DOI:10.15347\/wjm\/2014.010.\u00a0ISSN\u00a02002-4436<\/p>\n<p class=\"hanging-indent\">Compton Care. (2016, March 7). What is lymphoedema or lymphedema? YouTube. https:\/\/www.youtube.com\/watch?v=RMLPwOiYnII&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">OpenStax. (2016, May 27) Figure 14. The spleen is similar to a lymph node but is much larger and filters blood instead of lymph [digital image]. In <em>Open Stax, Biology<\/em> (Section 42.2). OpenStax CNX.\u00a0 https:\/\/cnx.org\/contents\/GFy_h8cu@10.8:etZobsU-@6\/Adaptive-Immune-Response<\/p>\n<p class=\"hanging-indent\">Simple Nursing. (2015, June 28). Spleen physiology What does the spleen do in 2 minutes. YouTube. https:\/\/www.youtube.com\/watch?v=ah74jT00jBA&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">University Hospitals Bristol and Weston NHS FT. (2020, May 13). How to check your lymph nodes. YouTube. https:\/\/www.youtube.com\/watch?v=L4KexZZAdyA&amp;feature=youtu.be<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_5641\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_5641\"><div tabindex=\"-1\"><p>A joint in which the opposing bony surfaces are covered with a layer of hyaline cartilage or fibrocartilage and in which some degree of free movement is possible.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4093\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4093\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_4998\" aria-describedby=\"caption-attachment-4998\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-4998\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Oedema-1.jpg\" alt=\"17.6.1 Allergies\" width=\"400\" height=\"243\"><figcaption id=\"caption-attachment-4998\" class=\"wp-caption-text\"><em>Figure 17.6.1 Oh m-eye!<\/em><\/figcaption><\/figure>\n<div>\n<h1>Allergy Eyes<\/h1>\n<\/div>\n<p>Eyes that are red, watery, and itchy are typical of an allergic reaction known as allergic rhinitis. Commonly called hay fever, allergic rhinitis is an immune system reaction, typically to the pollen of certain plants. Your immune system usually protects you from pathogens and keeps you well. However, like any other body system, the immune system itself can develop problems. Sometimes, it responds to harmless foreign substances as though they were pathogens. This is the basis of allergies like hay fever.<\/p>\n<div>\n<h1>Allergies<\/h1>\n<\/div>\n<p>An\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4877\">allergy<\/a><\/strong>\u00a0is a disorder in which the immune system makes an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4860\">inflammatory response<\/a> to a harmless <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2704\">antigen<\/a>. It occurs when the immune system is hypersensitive to an antigen in the environment that causes little or no response in most people. Allergies are strongly familial. Allergic parents are more likely to have allergic children, and those children\u2019s allergies are likely to be more severe, which is evidence that there is a heritable tendency to develop allergies. Allergies are more common in children than adults, because many children outgrow their allergies by adulthood.<\/p>\n<h2>Allergens<\/h2>\n<p>Any antigen that causes an allergy is called an\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4999\">allergen<\/a>.<\/strong> Common allergens are plant pollens, dust mites, mold, specific foods (such as peanuts or shellfish), insect stings, and certain common medications (such as aspirin and penicillin). Allergens may be inhaled or ingested, or they may come into contact with the skin or eyes. Symptoms vary depending on the type of exposure, and the severity of the immune system response. Some of the most common causes of allergies are shown in Figure 17.6.2: latex, pollen, dust mites, pet dander, insect stings and various foods. Inhaling pollen may cause symptoms of allergic rhinitis, such as sneezing and red itchy eyes. Insect stings may cause an itchy rash. This type of allergy is called contact dermatitis.<\/p>\n<div>\n<div id=\"h5p-203\">\n<div class=\"h5p-content\" data-content-id=\"203\"><\/div>\n<\/div>\n<p><em>Figure 17.6.2 Common allergens include latex, pollen, dust mites, pet dander, insect stings, and foods.<\/em><\/p>\n<\/div>\n<h2>Prevalence of Allergies<\/h2>\n<p>There has been a significant increase in the prevalence of allergies over the past several decades, especially in the rich nations of the world, where allergies are now very common disorders. In the developed countries, about 20% of people have or have had hay fever, another 20% have had contact dermatitis, and about 6% have food allergies. In the poorer nations of the world, on the other hand, allergies of all types are much less common.<\/p>\n<p>One explanation for the rise in allergies in the developed world is the hygiene hypothesis. According to this hypothesis, people in developed countries live in relatively sterile environments because of hygienic practices and sanitation systems. As a result, people in these countries are exposed to fewer pathogens than their immune system evolved to cope with. To compensate, their immune system \u201ckeeps busy\u201d by attacking harmless antigens in allergic responses.<\/p>\n<h2>How Allergies Occur<\/h2>\n<p>The diagram in Figure 17.6.3 shows how an allergic reaction occurs. At the first exposure to an allergen, B cells are activated to form plasma cells that produce large amounts of antibodies to the allergen. These antibodies attach to leukocytes called mast cells. Subsequently, every time the person encounters the allergen again, the mast cells are already primed and ready to deal with it. The primed mast cells immediately release cytokines and histamines, which in turn cause inflammation and recruitment of leukocytes, among other responses. These responses are responsible for the signs and symptoms of allergies.<\/p>\n<figure id=\"attachment_5000\" aria-describedby=\"caption-attachment-5000\" style=\"width: 341px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5000\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/512px-Mast_cells-1.jpg\" alt=\"17.3 Allergic Reaction Pathway\" width=\"341\" height=\"612\"><figcaption id=\"caption-attachment-5000\" class=\"wp-caption-text\"><em>Figure 17.6.3 This diagram shows how the adaptive immune system is activated by an otherwise harmless antigen on ragweed pollen, responding to the allergen as though it was a pathogen.<\/em><\/figcaption><\/figure>\n<h2>Treating Allergies<\/h2>\n<p>The symptoms of allergies can range from mild to life-threatening. Mild allergy symptoms are often treated with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3377\"><strong>antihistamine<span style=\"font-size: 1em\">s<\/span><\/strong><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. These are drugs that reduce or eliminate the effects of the histamines that produce allergy symptoms.<\/span><\/p>\n<h3>Treating Anaphylaxis<\/h3>\n<p>The most severe allergic reaction is a systemic reaction called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5002\">anaphylaxis<\/a>.<\/strong> This is a life-threatening response caused by a massive release of histamines. Many of the signs and symptoms of anaphylaxis are shown in Figure 17.6.4. Some of them include a drop in blood pressure, changes in heart rate, shortness of breath, and swelling of the tongue and throat, which may threaten the patient with suffocation unless emergency treatment is given. People who have had anaphylactic reactions may carry an epinephrine autoinjector (widely known by its brand name EpiPen\u00ae) so they can inject themselves with epinephrine if they start to experience an anaphylactic response. The epinephrine helps control the immune reaction until medical care can be provided. Epinephrine constricts blood vessels to increase blood pressure, relaxes smooth muscles in the lungs to reduce wheezing and improve breathing, modulates heart rate, and works to reduce swelling that may otherwise block the airways.<\/p>\n<figure id=\"attachment_5003\" aria-describedby=\"caption-attachment-5003\" style=\"width: 745px\" class=\"wp-caption alignnone\"><img class=\" wp-image-5003\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Signs_and_symptoms_of_anaphylaxis-1.png\" alt=\"17.6.4 Signs and Symptoms of Anaphylaxis\" width=\"745\" height=\"627\"><figcaption id=\"caption-attachment-5003\" class=\"wp-caption-text\"><em>Figure 17.6.4 Anaphylaxis is a rapid, systemic reaction to allergens that may lead to life-threatening symptoms.<\/em><\/figcaption><\/figure>\n<h3>Immunotherapy for Allergies<\/h3>\n<figure id=\"attachment_5005\" aria-describedby=\"caption-attachment-5005\" style=\"width: 303px\" class=\"wp-caption alignleft\"><img class=\" wp-image-5005\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Allergy-Tests-1.jpg\" alt=\"17.6.5 Allergy Tests\" width=\"303\" height=\"378\"><figcaption id=\"caption-attachment-5005\" class=\"wp-caption-text\"><em>Figure 17.6.5 Skin testing for common allergens is one way to identify the cause(s) of a patient\u2019s allergic symptoms.<\/em><\/figcaption><\/figure>\n<p>Another way to treat allergies is called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5004\">immunotherapy<\/a>,<\/strong>\u00a0commonly called \u201callergy shots.\u201d This approach may actually\u00a0<em>cure<\/em> specific allergies, at least for several years if not permanently. It may be particularly beneficial for allergens that are difficult or impossible to avoid (such as pollen). First, however, patients must be tested to identify the specific allergens that are causing their allergies. As shown in Figure 17.6.5, this may involve scratching tiny amounts of common allergens into the skin, and then observing whether there is a localized reaction to any of them. Each allergen is applied in a different numbered location on the skin, so if there is a reaction \u2014 such as redness or swelling \u2014 the responsible allergens can be identified. Then, through periodic injections (usually weekly or monthly), patients are gradually exposed to larger and larger amounts of the allergens. Over time, generally from months to years, the immune system becomes desensitized to the allergens. This method of treating allergies is often effective for allergies to pollen or insect stings, but its usefulness for allergies to food is unclear.<\/p>\n<p><span style=\"font-size: 1.602em;font-weight: bold\">Autoimmune Diseases<\/span><\/p>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5006\">Autoimmune diseases<\/a><\/strong>\u00a0occur when the immune system fails to recognize the body\u2019s own molecules as self. As a result, instead of ignoring the body\u2019s healthy cells, it attacks them, causing damage to tissues and\u00a0altering\u00a0organ growth and function. Most often, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3447\">B cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0are at fault for autoimmune responses. They are generally the cells that lose tolerance for self. Why does this occur? Some autoimmune diseases are thought to be caused by exposure to <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3707\">pathogen<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\">\u00a0that have antigens similar to the body\u2019s own molecules. After this exposure, the immune system responds to body cells as though they were pathogens, as well.<\/span><\/p>\n<p>Certain individuals are genetically susceptible to developing autoimmune diseases. These individuals are also more likely to develop more than one such disease. Gender is a risk factor for autoimmunity \u2014 females are much more likely than males to develop autoimmune diseases. This is likely due, in part, to gender differences in sex hormones.<\/p>\n<p>At a population level, autoimmune diseases are less common where infectious diseases are more common. The hygiene hypothesis has been proposed to explain the inverse relationship between infectious and autoimmune diseases, as well as the prevalence of allergies. According to the hypothesis, without infectious diseases to \u201ckeep it busy,\u201d the immune system may attack the body\u2019s own cells instead.<\/p>\n<h2>Common Autoimmune Diseases<\/h2>\n<p>An estimated 15 million or more people worldwide have one or more autoimmune diseases. Two of the most common autoimmune diseases are <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3507\">type I diabetes<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5007\">multiple sclerosis<\/a>. In terms of the specific body cells that are attacked by the immune system, both are localized diseases. In the case of type I diabetes, the immune system attacks and destroys <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2590\">insulin<\/a>-secreting islet cells in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3197\">pancreas<\/a>. In the case of multiple sclerosis, the immune system attacks and destroys the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3028\">myelin sheath<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0that normally insulate the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3809\">axon<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\">\u00a0of <\/span><span style=\"font-size: 1em;text-align: initial\"><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2984\">neuron<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0and allow rapid transmission of nerve impulses.<\/span><\/p>\n<p>Some relatively common autoimmune diseases are systemic \u2014 or body-wide \u2014 diseases. They include <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5008\">rheumatoid arthritis<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5009\">systemic lupus erythematosus<\/a> (SLE). In these diseases, the immune system may attack and injure many tissues and organs. For example, as you can see in Figure 17.6.6, symptoms of SLE may involve the muscular, skeletal, integumentary, respiratory, and cardiovascular systems.<\/p>\n<figure id=\"attachment_5010\" aria-describedby=\"caption-attachment-5010\" style=\"width: 549px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5010\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Symptoms_of_SLE-1.png\" alt=\"Figure 17.6.6 Symptoms of Lupus\" width=\"549\" height=\"687\"><figcaption id=\"caption-attachment-5010\" class=\"wp-caption-text\"><em>Figure 17.6.6 Systemic lupus erythematosus is an autoimmune disease that may cause symptoms of body-wide tissue damage.<\/em><\/figcaption><\/figure>\n<h2>Treatment for Autoimmune Diseases<\/h2>\n<p>None of these common autoimmune diseases can be cured, although all of them have treatments that may help relieve symptoms and prevent some of the long-term damage they may cause. Traditional treatments for autoimmune diseases include immunosuppressive drugs to block the immune response, as well as anti-inflammatory drugs to quell inflammation. Hormone replacement may be another option.\u00a0Type I diabetes, for example, is treated with injections of the hormone insulin, because islet cells in the pancreas can no longer secrete it.<\/p>\n<div>\n<h1>Immunodeficiency<\/h1>\n<\/div>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5011\">Immunodeficiency<\/a><\/strong>\u00a0occurs when the immune system is not working properly, generally because one or more components of the immune system are inactive. As a result, the immune system may be unable to fight off pathogens or cancers that a normal immune system would be able to resist. Immunodeficiency may occur for a variety of reasons.<\/p>\n<h2>Causes of Immunodeficiency<\/h2>\n<p>Dozens of rare genetic diseases can result in a defective immune system. This type of immunodeficiency is called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5012\">primary immunodeficiency<\/a><\/strong>. One is born with one of these diseases, rather than acquiring it after birth. Probably the best known of these primary immunodeficiency diseases is <a href=\"https:\/\/www.niaid.nih.gov\/diseases-conditions\/severe-combined-immunodeficiency-scid\">severe combined immunodeficiency<\/a> (SCID). It is also known as \u201cbubble boy disease,\u201d because people with this disorder are extremely vulnerable to infectious diseases, and some of them have become well known for living inside a bubble that provides a sterile environment. SCID is most often caused by an X-linked <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2479\">recessive<\/a> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2381\">mutation<\/a> that interferes with normal B cell and T cell production.<\/p>\n<p>Other types of immunodeficiency are not present at birth, but are acquired due to experiences or exposures that occur after birth. Acquired immunodeficiency is called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5013\">secondary immunodeficiency<\/a><\/strong>\u00a0because it is secondary to some other event or exposure. Secondary immunodeficiency may occur for a number of different reasons:<\/p>\n<ul>\n<li style=\"margin-top: 0px\"><strong>Some pathogens attack and destroy immune system cells.<\/strong>\u00a0An example is the virus known as HIV, which attacks and destroys T cells.<\/li>\n<li><strong>The immune system naturally becomes less effective as people get older.<\/strong>\u00a0This age-related decline \u2014 called immunosenescence \u2014 generally begins around the age of 50 and worsens with increasing age. Immunosenescence is\u00a0the reason\u00a0older people are generally more susceptible to disease than younger people.<\/li>\n<li><strong>The immune system may be damaged by another disorder, such as obesity, alcoholism, or the abuse of other drugs.<\/strong><\/li>\n<li><strong>In developing countries, malnutrition is the most common cause of immune system damage and immunodeficiency.<\/strong>\u00a0Inadequate protein intake is especially damaging to the immune system. It can lead to impaired complement system activity, phagocyte malfunction, and lower-than-normal production of antibodies and cytokines.<\/li>\n<li><strong>Certain medications can suppress the immune system.<\/strong>\u00a0This is the intended effect of immunosuppressant drugs given to people with transplanted organs so they do not reject them. In many cases, however, immunosuppression is an unwanted side effect of drugs used to treat other disorders.<\/li>\n<\/ul>\n<div>\n<h1>Focus on HIV<\/h1>\n<\/div>\n<p><strong>Human immunodeficiency virus (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4501\">HIV<\/a>)<\/strong> is the most common cause of immunodeficiency in the world today. HIV infections of human hosts are a relatively recent phenomenon. Scientists think that the virus originally infected monkeys, but then jumped to human populations. most likely from a bite, probably sometime during the early to mid-1900s. This most likely occurred in West Africa, but the virus soon spread around the world. HIV was first identified by medical researchers in 1981. Since then, HIV has killed almost 40 million people worldwide, and its economic toll has also been enormous. The hardest hit countries are in Africa, where the virus has infected human populations the longest, and medications to control the virus are least available.\u00a0 In 2016, over 63,000 Canadians were living with HIV.<\/p>\n<h2>HIV Transmission<\/h2>\n<p>HIV is transmitted through direct contact of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3538\">mucous membrane<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\"> or body fluids such as blood, semen, or breast milk. As shown in Figure 17.6.7, transmission of the virus can occur through sexual contact or the use of contaminated hypodermic needles. It can also be transmitted from an infected mother\u2019s blood during late pregnancy or childbirth, or through breast milk after birth. In the past, HIV was also transmitted occasionally through blood transfusions. Because donated blood is now screened for HIV, the virus is no longer transmitted this way.<\/span><\/p>\n<figure id=\"attachment_5014\" aria-describedby=\"caption-attachment-5014\" style=\"width: 500px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5014\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/HIV-transmission-1.jpg\" alt=\"17.6.7 HIV Transmission\" width=\"500\" height=\"351\"><figcaption id=\"caption-attachment-5014\" class=\"wp-caption-text\"><em>Figure 17.6.7 HIV may be transmitted in all of the ways shown here: through sexual activities, from mother to child (in utero, during childbirth, through breastmilk), and by sharing needles.<\/em><\/figcaption><\/figure>\n<h2>HIV and the Immune System<\/h2>\n<p>HIV infects and destroys <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3445\">helper T cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">, the type of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4832\">lymphocyte<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\"> that regulate the immune response. This process is illustrated in the diagram in Figure 17.6.8. The virus injects its own DNA into a helper T cell and uses the T cell\u2019s \u201cmachinery\u201d to make copies of itself. In the process, the helper T cell is destroyed, and the virus copies go on to infect other helper T cells. HIV is able to evade the immune system and keep destroying helper T cells by mutating frequently so its surface antigens keep changing, and by using the host cell\u2019s membrane to hide its own antigens.<\/span><\/p>\n<figure id=\"attachment_5015\" aria-describedby=\"caption-attachment-5015\" style=\"width: 500px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5015\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/HIV-life-cycle-1.jpg\" alt=\"17.6.8 HIV and Helper T Cells\" width=\"500\" height=\"467\"><figcaption id=\"caption-attachment-5015\" class=\"wp-caption-text\"><em>Figure 17.6.8 This diagram shows how HIV infects and destroys helper T cells.<\/em><\/figcaption><\/figure>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5016\">Acquired immunodeficiency syndrome<\/a> (AIDS)<\/strong> may result from years of damage to the immune system by HIV. It occurs when helper T cells fall to a very low level and opportunistic diseases occur. Opportunistic diseases are infections and tumors that are rare, except in people with a damaged immune system. The diseases take advantage of the \u201copportunity\u201d presented by people whose immune system cannot fight back. Opportunistic diseases are usually the direct cause of death for people with AIDS.<\/p>\n<h2>Treating HIV\/AIDS<\/h2>\n<p>For patients who have access to HIV medications, infection with the virus is no longer the death sentence\u00a0that it once was. By 1995, combinations of drugs called \u201chighly active antiretroviral therapy\u201d were developed. For some patients, these drugs can reduce the amount of virus they are carrying to undetectable levels. However, some\u00a0level\u00a0of virus always hides in the body\u2019s immune cells, and it will multiply again if a patient stops taking the medications. Researchers are trying to develop drugs to kill these hidden viruses, as well. If their efforts are successful, it could end AIDS.<\/p>\n<div>\n<h1>Feature: Human Biology in the News<\/h1>\n<\/div>\n<p>EpiPens\u00ae and their sole manufacturer (pharmaceutical company Mylan) were featured in headlines in 2016, but not for a good reason. The media\u00a0outburst\u00a0was triggered by a drastic price hike in EpiPens\u00ae \u2014 and Mylan\u2019s apparent greed.<\/p>\n<figure id=\"attachment_5017\" aria-describedby=\"caption-attachment-5017\" style=\"width: 290px\" class=\"wp-caption alignleft\"><img class=\"wp-image-5017\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Epipen-by-Stock-Catalog-on-flickr-e1592884964782-1.jpg\" alt=\"17.6.9 Epipens\" width=\"290\" height=\"375\"><figcaption id=\"caption-attachment-5017\" class=\"wp-caption-text\"><em>Figure 17.6.9 An Epipen\u00ae is a hypodermic device that administers a dose of epinephrine, used for the emergency treatment of an acute allergic reaction.<\/em><\/figcaption><\/figure>\n<p>EpiPens\u00ae are auto-injectable syringes preloaded with a measured dose of epinephrine, a drug that can rapidly stop a life-threatening anaphylactic response to an allergen. Using the device is easy and does not require any special training. The injector just needs to be jammed against the thigh, which can be done through clothing or on bare skin. Each year, doctors write millions of prescriptions for EpiPens\u00ae. Many people with severe allergies always carry two of the devices with them, just in case they experience anaphylaxis, although most of them never need to use them. Other people with severe allergies have literally had their lives saved multiple times by EpiPens\u00ae when they had anaphylactic reactions. Even when the devices haven\u2019t been used, they must be replaced each year due to expiration of the epinephrine.<\/p>\n<p>You might think that EpiPens\u00ae would be relatively inexpensive, given their life-saving potential. As recently as 2009, a two-pack of EpiPens\u00ae cost about $100. However, in just seven years, the cost of the same two-pack of EpiPens\u00ae skyrocketed by an incredible 400%! By 2016, the cost was $600 or more. Mylan apparently raised the price for the sole purpose of increasing profits. The company also raised prices significantly on many other drugs. The price hike in EpiPens\u00ae alone was certainly profitable. In 2015, the sale of EpiPens\u00ae earned Mylan $1 billion. Mylan\u2019s CEO took home almost $19 million the same year, which was an increase of more than 600% over her prior salary.<\/p>\n<p>News coverage of the price hike in EpiPens\u00ae began in the summer of 2016 after a price increase in May of that year. Both private citizens and elected officials expressed outrage over the price increase, especially when coupled with the gluttonous profits of the company and its CEO. By late August, Mylan responded to the backlash by offering discount coupons for EpiPens\u00ae. A few days later, the company promised to introduce a cheaper, generic version of the device. Analysts quickly determined that selling a generic version would allow Mylan to make more money on the product than reducing the price of the name-brand device, which they still declined to do. By September of 2016, Mylan was being investigated for antitrust violations\u00a0related\u00a0to sales of EpiPens\u00ae to public schools in New York City.<\/p>\n<p>The Mylan\/EpiPen\u00ae story may still be making the news. But whatever its outcome, the story has already added fuel to public and private debates about important ethical issues\u00a0\u2014\u00a0issues such as the excessive costs of life-saving drugs and the huge profits of big pharma. What is the most recent news on EpiPens\u00ae and Mylan? If you are interested, you can check the headlines online to find out. What are your views on the ethical issues they raise?<\/p>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.6 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>An <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4877\">allergy<\/a> is a disorder in which the immune system makes an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4860\">inflammatory response<\/a> to a harmless antigen. Any <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2704\">antigen<\/a> that causes allergies is called an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4999\">allergen<\/a>. Common allergens include pollen, dust mites, mold, specific foods (such as peanuts), insect stings, and certain medications (such as aspirin).<\/li>\n<li>The prevalence of allergies has been increasing for decades, especially in developed countries, where they are much more common than in developing countries. The hygiene hypothesis posits that this has occurred because humans evolved to cope with more pathogens than we now typically face in our relatively sterile environments in developed countries. As a result, the immune system \u201ckeeps busy\u201d by attacking harmless antigens.<\/li>\n<li>Allergies occur when <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3447\">B cells<\/a>\u00a0are first activated to produce large amounts of antibodies to an otherwise harmless allergen, and the antibodies attach to <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4881\">mast cells<\/a>. On subsequent exposures to the allergen, the mast cells immediately release <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4865\">cytokines<\/a>\u00a0and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4879\">histamines<\/a>\u00a0that cause inflammation.<\/li>\n<li>Mild allergy symptoms are frequently treated with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3377\">antihistamines<\/a>\u00a0that counter histamines and reduce allergy symptoms. A severe systemic allergic reaction, called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5002\">anaphylaxis<\/a>, is a medical emergency that is usually treated with injections of epinephrine. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5004\">Immunotherapy<\/a> for allergies involves injecting increasing amounts of allergens to desensitize the immune system to them.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5006\">Autoimmune diseases<\/a> occur when the immune system fails to recognize the body\u2019s own molecules as self and attacks them, causing damage to tissues and organs. A family history of autoimmunity and female gender are risk factors for autoimmune diseases.<\/li>\n<li>In some autoimmune diseases, such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3507\">type I diabetes<\/a>, the immune system attacks and damages specific body cells. In other autoimmune diseases, such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5009\">systemic lupus erythematosus<\/a>, many different tissues and organs may be attacked and injured. Autoimmune diseases generally cannot be cured, but their symptoms can often be managed with drugs or other treatments.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5011\">Immunodeficiency<\/a> occurs when the immune system is not working properly, generally because one or more of its components are inactive. As a result, the immune system is unable to fight off pathogens or cancers that a normal immune system would be able to resist.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5012\">Primary immunodeficiency<\/a> is present at birth and caused by rare genetic diseases. An example is severe combined immunodeficiency. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5013\">Secondary immunodeficiency<\/a> occurs because of some event or exposure experienced after birth. Possible causes include aging, certain medications, infections with pathogens, and other disorders, such as obesity or malnutrition.<\/li>\n<li>The most common cause of immunodeficiency in the world today is human immunodeficiency virus (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4501\">HIV<\/a>), which infects and destroys helper T cells. HIV is transmitted through mucous membranes or body fluids. The virus may eventually lead to such low levels of helper T cells that opportunistic infections occur. When this happens, the patient is diagnosed with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5016\">acquired immunodeficiency syndrome<\/a> (AIDS). Medications can control the multiplication of HIV in the human body \u2014 but they don't eliminate the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4283\">virus<\/a> completely.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.6 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-204\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-204\" class=\"h5p-iframe\" data-content-id=\"204\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Fermentation\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>How does immunotherapy for allergies work?<\/li>\n<li>What are autoimmune diseases?<\/li>\n<li>Identify two risk factors for autoimmune diseases.<\/li>\n<li>Autoimmune diseases may be specific to particular tissues, or they may be systemic. Give an example of each type of autoimmune disease.<\/li>\n<li>What is immunodeficiency? Compare and contrast primary and secondary immunodeficiency. Give an example of each.<\/li>\n<li>What is the most common cause of immunodeficiency in the world today? How does this affect the immune system?<\/li>\n<li>Distinguish between HIV and AIDS.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.6 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/-q7Fz7NIMWM<\/p>\n<p style=\"text-align: center\">Why do people have seasonal allergies? - Eleanor Nelsen, TED-Ed, 2016.<\/p>\n<p>https:\/\/youtu.be\/0TipTogQT3E<\/p>\n<p style=\"text-align: center\">Why it\u2019s so hard to cure HIV\/AIDS - Janet Iwasa, TED-Ed, 2015.<\/p>\n<p>https:\/\/youtu.be\/pJa6KVLwl9U<\/p>\n<p style=\"text-align: center\">The Boy in the Bubble | Retro Report | The New York Times, 2015.<\/p>\n<p>https:\/\/youtu.be\/Mjr9h_QmdeM<\/p>\n<p style=\"text-align: center\">Why Are Peanut Allergies Becoming So Common? Seeker, 2014.<\/p>\n<p>https:\/\/youtu.be\/RiMSmDBvgto<\/p>\n<p style=\"text-align: center\">What Are Tonsil Stones? | Gross Science, 2015.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<h2>Attributions<\/h2>\n<p><strong>Figure 17.6.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Oedema.JPG\" rel=\"cc:attributionURL\">Oedema<\/a> by <a class=\"new\" title=\"User:Championswimmer (page does not exist)\" href=\"https:\/\/commons.wikimedia.org\/w\/index.php?title=User:Championswimmer&amp;action=edit&amp;redlink=1\">Championswimmer<\/a> on Wikimedia Commons is in the <a class=\"extiw\" title=\"w:en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/en:public_domain).<\/p>\n<p><strong>Figure 17.6.2<\/strong><\/p>\n<ul>\n<li><a href=\"http:\/\/pngimg.com\/download\/81708\">Medical (latex) gloves<\/a> from pngimg.com is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/\">CC BY-NC 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/) license.<\/li>\n<li><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:House_dust_mites_(5247996458).jpg\">House dust mites (5247996458)<\/a> by <a class=\"external text\" href=\"https:\/\/www.flickr.com\/people\/9082612@N05\" rel=\"nofollow\">Gilles San Martin<\/a> from Namur, Belgium on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/deed.en\">CC BY-SA 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/2.0\/deed.en) license.<\/li>\n<li><a href=\"https:\/\/www.flickr.com\/photos\/krayker\/4312985916\/\">\u00a0Honey bee macro<\/a> by <a class=\"owner-name truncate no-outline\" title=\"Go to Karunakar Rayker's photostream\" href=\"https:\/\/www.flickr.com\/photos\/krayker\/\" data-track=\"attributionNameClick\">Karunakar Rayker<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a<a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\"> CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0\/) license.<\/li>\n<li><a href=\"https:\/\/www.pexels.com\/photo\/brown-nuts-on-white-surface-4202959\/\">Peanuts<\/a> by <a href=\"https:\/\/www.pexels.com\/@karolina-grabowska\">Karolina Grabowska<\/a> on <a href=\"http:\/\/pexels.com\">Pexels<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/\">CC0 1.0<\/a> Universal Public Domain Dedication license (https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/).<\/li>\n<li><a href=\"https:\/\/pxhere.com\/en\/photo\/1597775\">Photo of dog and grey cat<\/a> by <a class=\"profile-link\" href=\"https:\/\/pxhere.com\/en\/photographer\/2204651\">ERC4N51<\/a> on pxhere is used under a <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/\">CC0 1.0<\/a> Universal Public Domain Dedication license (https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/).<\/li>\n<li><a href=\"https:\/\/pixabay.com\/photos\/pollen-allergy-spring-nature-4845841\/\">Tags: Pollen Allergy Spring<\/a>\u00a0by <a class=\"hover_opacity\" href=\"https:\/\/pixabay.com\/users\/Castagnari53-15149183\/\">Castagnari53<\/a> on <a href=\"http:\/\/pixabay.com\">Pixabay<\/a>, is used under the <a href=\"https:\/\/pixabay.com\/service\/license\/\">Pixabay License<\/a> (https:\/\/pixabay.com\/service\/license\/).<\/li>\n<\/ul>\n<p><strong>Figure 17.6.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Mast_cells.jpg\" rel=\"cc:attributionURL\">512px-Mast_cells<\/a> by <a href=\"https:\/\/scholarworks.iupui.edu\/bitstream\/handle\/1805\/748\/Understanding%20the%20immune%20system.pdf?sequence=1&amp;isAllowed=y\">National Institute of Allergy and Infectious Diseases (U.S.) &amp; National Cancer Institute<\/a> (p.29) is in\u00a0the <a class=\"extiw\" title=\"w:en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/en:public_domain).<\/p>\n<p><strong>Figure 17.6.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Signs_and_symptoms_of_anaphylaxis.png\" rel=\"cc:attributionURL\">Signs_and_symptoms_of_anaphylaxis<\/a> by <a title=\"User:Mikael H\u00e4ggstr\u00f6m\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Mikael_H%C3%A4ggstr%C3%B6m\">Mikael H\u00e4ggstr\u00f6m<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/\">CC0 1.0<\/a> Universal Public Domain Dedication license (https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/).<\/p>\n<p><strong style=\"text-align: initial;font-size: 1em\"><br \/>\nFigure 17.6.5<\/strong><\/p>\n<p><a href=\"https:\/\/flic.kr\/p\/5XtivM\" rel=\"cc:attributionURL\">Allergy Tests<\/a> by <a class=\"owner-name truncate\" title=\"Go to Dan Pupius's photostream\" href=\"https:\/\/www.flickr.com\/photos\/dpup\/\" data-track=\"attributionNameClick\">Dan Pupius<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/2.0\/\" rel=\"license\">CC BY-NC-SA 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc-sa\/2.0\/) license.<\/p>\n<p><strong>Figure 17.6.6<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Symptoms_of_SLE.png\" rel=\"cc:attributionURL\">1024px-Symptoms_of_SLE<\/a> by <a class=\"extiw\" title=\"en:User:Mikael H\u00e4ggstr\u00f6m\" href=\"https:\/\/en.wikipedia.org\/wiki\/User:Mikael_H%C3%A4ggstr%C3%B6m\">Mikael H\u00e4ggstr\u00f6m<\/a> on Wikimedia Commons\u00a0is used under a <a href=\"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/\">CC0 1.0<\/a> Universal Public Domain Dedication license (https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/).<\/p>\n<p><strong>Figure 17.6.7<\/strong><\/p>\n<p><a href=\"https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/\" rel=\"cc:attributionURL\">HIV transmission<\/a>\u00a0by <a href=\"https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/\">CK-12 Foundation<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\">CC BY NC 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/) license.<\/p>\n<div><img src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/logo_ck12.png\" alt=\"\"> <span style=\"font-size: 1em\">\u00a9<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/\">CK-12 Foundation<\/a> <span style=\"font-size: 1em\">Licensed under\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\"><img class=\"alignnone size-full wp-image-8217\" title=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\" src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/icon_licence.png\" alt=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\"><\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/terms-of-use\/?_ga=2.264717007.1988667202.1598996862-1392032960.1592870652\">Terms of Use<\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/attribution\/\">Attribution<\/a><\/div>\n<p><strong>Figure 17.6.8<\/strong><\/p>\n<p><a href=\"https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/\" rel=\"cc:attributionURL\">HIV life cycle<\/a> by <a href=\"https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/\">CK-12 Foundation<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\">CC BY NC 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/) license.<\/p>\n<p><img src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/logo_ck12.png\" alt=\"\"> <span style=\"font-size: 1em\">\u00a9<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/\">CK-12 Foundation<\/a> <span style=\"font-size: 1em\">Licensed under\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\"><img class=\"alignnone size-full wp-image-8217\" title=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\" src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/icon_licence.png\" alt=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\"><\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/terms-of-use\/?_ga=2.264717007.1988667202.1598996862-1392032960.1592870652\">Terms of Use<\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/attribution\/\">Attribution<\/a><\/p>\n<p><strong>Figure 17.6.9<\/strong><\/p>\n<p><a href=\"https:\/\/flic.kr\/p\/23Ju8FC\" rel=\"cc:attributionURL\">Epipen by Stock Catalog on flickr<\/a> by <a class=\"owner-name truncate\" title=\"Go to Stock Catalog's photostream\" href=\"https:\/\/www.flickr.com\/photos\/stockcatalog\/\" data-track=\"attributionNameClick\">Stock Catalog<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\/\">CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0\/) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Brainard, J\/ CK-12 Foundation. (2016). Figure 8 HIV may be transmitted in all of the ways shown here [digital image]. In <em>CK-12 College Human Biology<\/em> (Section 19.6) [online Flexbook]. CK12.org. https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/<\/p>\n<p class=\"hanging-indent\">Brainard, J\/ CK-12 Foundation. (2016). Figure 9 This diagram shows how HIV infects and destroys helper T cells [digital image]. In <em>CK-12 College Human Biology<\/em> (Section 19.6) [online Flexbook]. CK12.org. https:\/\/www.ck12.org\/book\/ck-12-human-biology\/section\/19.6\/<\/p>\n<p class=\"hanging-indent\">CBS News. (2016, August 16). Rising cost of potentially life-saving EpiPen puts pinch on families [online article]. CBS Interactive Inc. https:\/\/www.cbsnews.com\/news\/allergy-medication-epipen-epinephrine-rising-costs-impact-on-families\/<\/p>\n<p class=\"hanging-indent\">Gross Science. (2015, June 29). What are tonsil stones? | Gross Science. YouTube. https:\/\/www.youtube.com\/watch?v=RiMSmDBvgto&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">H\u00e4ggstr\u00f6m, M. (2014). Medical gallery of Mikael H\u00e4ggstr\u00f6m 2014.\u00a0<i>WikiJournal of Medicine<\/i>\u00a0<b>1<\/b>\u00a0(2).\u00a0DOI:10.15347\/wjm\/2014.008.\u00a0ISSN\u00a02002-4436<\/p>\n<p class=\"hanging-indent\">National Institute of Allergy and Infectious Diseases (NIAID). (n.d.). Severe combined immunodeficiency (SCID) [online article]. National Institute of Health (NIH). https:\/\/www.niaid.nih.gov\/diseases-conditions\/severe-combined-immunodeficiency-scid<\/p>\n<p class=\"hanging-indent\">National Institute of Allergy and Infectious Diseases (U.S.) &amp; National Cancer Institute (U.S.). (2003, September). Understanding the immune system and how it works [NIH Publication No. 03-5423]. <em>Scholar Works<\/em> - \u00a0Indiana University. https:\/\/scholarworks.iupui.edu\/handle\/1805\/748<\/p>\n<p class=\"hanging-indent\">[The] New York Times. (2015, December 15). The boy in the bubble | Retro Report | The New York Times. YouTube. https:\/\/www.youtube.com\/watch?v=pJa6KVLwl9U&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Seeker. (2014, October 3). Why are peanut allergies becoming so common? YouTube. https:\/\/www.youtube.com\/watch?v=Mjr9h_QmdeM&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Summary: Estimates of HIV incidence, prevalence, and Canada's progress on meeting the 90-90-90 HIV targets 2016. (2018, July). Public Health Agency of Canada. https:\/\/www.canada.ca\/content\/dam\/phac-aspc\/documents\/services\/publications\/diseases-conditions\/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90\/pub-eng.pdf<\/p>\n<p class=\"hanging-indent\">Swetlitz, I., Silverman, E. (2016, August 25). Mylan may have violated antitrust law in its EpiPen sales to schools, legal experts say [online article]. STATNews.com. https:\/\/www.statnews.com\/2016\/08\/25\/mylan-antitrust-epipen-schools\/<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2016, May 26). Why do people have seasonal allergies? - Eleanor Nelsen. YouTube.\u00a0 https:\/\/www.youtube.com\/watch?v=-q7Fz7NIMWM&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, March 16). Why it\u2019s so hard to cure HIV\/AIDS - Janet Iwasa, https:\/\/www.youtube.com\/watch?v=0TipTogQT3E&amp;feature=youtu.be<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4094\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4094\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_5024\" aria-describedby=\"caption-attachment-5024\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5024\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Cycling-to-Beat-Blood-Cancer-1.jpg\" alt=\"17.7.1 Cycling to Beat Blood Cancer\" width=\"400\" height=\"267\"><figcaption id=\"caption-attachment-5024\" class=\"wp-caption-text\"><em>Figure 17.7.1 Be Unstoppable for Leukemia and Lymphoma Research.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Case Study Conclusion: Defending Your Defenses<\/h1>\n<\/div>\n<p>These people are participating in a bike ride to raise funds for leukemia and lymphoma research (Figure 17.7.1). Leukemia and lymphoma are blood cancers. In 2020,\u00a0 approximately 6,900 Canadians will be diagnosed with leukemia and 3,000 will die from this cancer. Lymphoma is the most common type of blood cancer. As a lymphoma patient, Hakeem, who you learned about in the beginning of this chapter, may eventually benefit from research funded by a bike ride like this one.<\/p>\n<p>What type of blood cell is affected in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5026\">lymphoma<\/a>? As the name implies, lymphoma is a cancer that affects lymphocytes, which are a type of leukocyte. As you have learned in this chapter, there are different types of lymphocytes, including the B and T cells of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4822\">adaptive immune system<\/a>. Different types of lymphoma affect different types of lymphocytes in different ways. It is important to correctly identify the type of lymphoma, so that patients can be treated appropriately.<\/p>\n<p>You may recall that one of Hakeem\u2019s symptoms was a swollen <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4831\">lymph node<\/a>, and he was diagnosed with lymphoma after a biopsy of that lymph node. Swollen lymph nodes are a common symptom of lymphoma. As you have learned, lymph nodes are distributed throughout the body along lymphatic vessels, as part of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2911\">lymphatic system<\/a>. The lymph nodes filter <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4552\">lymph<\/a> and store lymphocytes. Therefore, they play an important role in fighting infections. Because of this, they will often swell in response to an infection. In Hakeem\u2019s case, the swelling and other symptoms did not improve after several weeks and a course of antibiotics, which caused Dr. Hayes to suspect lymphoma instead. The biopsy showed that Hakeem did indeed have cancerous lymphocytes in his lymph nodes.<\/p>\n<p>But which type of lymphocytes were affected? Lymphoma most commonly affects B or T lymphocytes. The two major types of lymphoma are called Hodgkin (HL) or non-Hodgkin lymphoma (NHL). NHL is more common than HL. In 2020, the Canadian Cancer Society estimates 10,400 Canadians will be diagnosed with non-Hodgkin lymphoma, whereas 1,000 will be diagnosed with Hodgkin lymphoma. While HL is one distinct type of lymphoma, NHL has about 60 different subtypes, depending on which specific cells are affected and how.<\/p>\n<p>Hakeem was diagnosed with a type of NHL called diffuse large B-cell lymphoma (DLBCL) \u2014 the most common type of NHL. This type of lymphoma affects <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3447\">B cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\"> and causes them to appear large under the microscope. In addition to Hakeem\u2019s symptoms of fatigue, swollen lymph nodes, loss of appetite, and weight loss, common symptoms of this type of lymphoma include fever and night sweats. It is an aggressive and fast-growing type of lymphoma that is fatal if not treated. The good news is that with early detection and proper treatment, about 70% of patients with DLBCL can be cured.<\/span><\/p>\n<figure id=\"attachment_5028\" aria-describedby=\"caption-attachment-5028\" style=\"width: 299px\" class=\"wp-caption alignright\"><img class=\" wp-image-5028\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/antigen-stain-1.jpg\" alt=\"17.7.2 Antigen stain\" width=\"299\" height=\"267\"><figcaption id=\"caption-attachment-5028\" class=\"wp-caption-text\">Figure 17.7.2 A lab technician can apply stains that target specific antigens to help identify which type of lymphoma is present.<\/figcaption><\/figure>\n<p>How do physicians determine the specific type of lymphoma? Tissue obtained from a biopsy can be examined under a microscope to observe physical changes (such as abnormal cell size or shape) that are characteristic of a particular subtype of lymphoma. Additionally, tests can be performed on the tissue to determine which cell-surface antigens are present. Recall that antigens are molecules that bind to specific antibodies. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3567\">Antibodies<\/a> can be produced in the laboratory and labeled with compounds that can be identified by their colour under a microscope. When these antibodies are applied to a tissue sample, this colour will appear wherever the antigen is present, because it binds to the antibody. This technique was used in the photomicrograph in Figure 17.7.2 to identify the presence of a cell-surface antigen (shown as reddish-brown) in a sample of skin cells. This technique, called immunohistochemistry, is also commonly used to identify antigens in tissue samples from lymphoma patients.<\/p>\n<p>Why would identifying cell-surface antigens be important in diagnosing and treating lymphoma? As you have learned, the immune system uses antigens present on the surface of cells or pathogens to distinguish between self and non-self, and to launch adaptive immune responses. Cells that become cancerous often change their cell-surface antigens. This is one way that the immune system can identify and destroy them. Also, different cell types in the body can sometimes be identified by the presence of specific cell-surface antigens. Knowing the types of cell-surface antigens present in a tissue sample can help physicians identify which cells are cancerous, and possibly the specific subtype of cancer. Knowing this information can be helpful in choosing more tailored and effective treatments.<\/p>\n<p>One treatment for NHL is, in fact, the use of medications made from antibodies that bind to cell-surface antigens present on cells affected by the specific subtype of NHL. This is called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5004\">immunotherapy<\/a>. These drugs can directly bind to and kill the cancerous cells. For patients with DLBCL like Hakeem, immunotherapy is often used in conjunction with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5029\">chemotherapy<\/a> and radiation as a course of treatment. Although Hakeem has a difficult road ahead, he and his medical team are optimistic that \u2014 given the high success rate when DLBCL is caught and treated early \u2014 he may be cured. More research into how the immune system functions may lead to even better treatments for lymphoma \u2014 and other types of cancers \u2014 in the future.<\/p>\n<div>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">Chapter 17 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>In this chapter, you learned about the immune system. Specifically, you learned that:<\/p>\n<ul>\n<li>Any agent that can cause disease is called a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3707\">pathogen<\/a>. Most human pathogens are <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3683\">microorganisms<\/a>, such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2588\">bacteria<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4283\">viruses<\/a>. The immune system is the\u00a0body\u00a0system that defends the human host from pathogens and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3513\">cancerous<\/a>\u00a0cells.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4820\">innate immune system<\/a> is a subset of the immune system that provides very quick, but non-specific responses to pathogens. It includes multiple types of barriers to pathogens, leukocytes that phagocytize pathogens, and several other general responses.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4822\">adaptive immune system<\/a> is a subset of the immune system that provides specific responses tailored to particular pathogens. It takes longer to put into effect, but it may lead to <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4884\">immunity<\/a> to the pathogens.<\/li>\n<li>Both innate and adaptive immune responses depend on the ability of the immune system to distinguish between self and non-self molecules. Most body cells have <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4825\">major histocompatibility complex (MHC)<\/a> proteins that identify them as self. Pathogens, infected cells, and tumor cells have non-self proteins called antigens that the immune system recognizes as foreign.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2704\">Antigens<\/a>\u00a0are proteins that bind to specific receptors on immune system cells and elicit an adaptive immune response. Some immune cells (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3447\">B cells<\/a>) respond to foreign antigens by producing antibodies that bind with antigens and target pathogens for destruction.<\/li>\n<li>An important role of the immune system is tumor surveillance. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4893\">Killer T cells<\/a>\u00a0of the adaptive immune system find and destroy tumor cells, which they can identify from their abnormal antigens.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4833\">neuroimmune system<\/a> that protects the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3841\">central nervous system<\/a> is thought to be distinct from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4834\">peripheral immune system<\/a> that protects the rest of the human body. The blood-brain and blood-spinal cord barriers are one type of protection of the neuroimmune system. Neuroglia also play a role in this system, for example, by carrying out <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1680\">phagocytosis<\/a>.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2911\">lymphatic system<\/a> is a human organ system that is a vital part of the adaptive immune system. It consists of several organs and a system of vessels that transport or filter the fluid called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4552\">lymph<\/a>. The main immune function of the lymphatic system is to produce, mature, harbor, and circulate white blood cells called lymphocytes, which are the main cells in the adaptive immune system, and are circulated in lymph.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>The return of lymph to the bloodstream is one of the functions of the lymphatic system. Lymph flows from tissue spaces, where it leaks out of blood vessels, to major veins in the upper chest. It is then returned to the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3835\">cardiovascular system<\/a>. Lymph is similar in composition to blood <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4395\">plasma<\/a>. Its main cellular components are lymphocytes.<\/li>\n<li>Lymphatic vessels called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4607\">lacteals<\/a>\u00a0are found in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4543\">villi<\/a> that line the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4559\">small intestine<\/a>. Lacteals absorb fatty acids from the digestion of lipids in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3877\">digestive system<\/a>. The fatty acids are then transported through the network of lymphatic vessels to the bloodstream.<\/li>\n<li>Lymphocytes, which include <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3447\">B cells<\/a>\u00a0and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4892\">T cells<\/a>, are the subset of leukocytes involved in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4822\">adaptive immune responses<\/a>. They may create a lasting memory of and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4884\">immunity<\/a> to specific pathogens.<\/li>\n<li>All lymphocytes are produced in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4021\">bone marrow<\/a> and then go through a process of maturation, in which they \u201clearn\u201d to distinguish self from non-self. B cells mature in the bone marrow, and T cells mature in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4829\">thymus<\/a>. Both the bone marrow and thymus are considered <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4845\">primary lymphatic organs<\/a>.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4847\">Secondary lymphatic organs<\/a> include the tonsils, spleen, and lymph nodes. There are four pairs of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4830\">tonsils<\/a>\u00a0that encircle the throat. The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4497\">spleen<\/a> filters blood, as well as lymph. There are hundreds of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4831\">lymph nodes<\/a>\u00a0located in clusters along the lymphatic vessels. All of these secondary organs filter lymph and store lymphocytes, so they are sites where pathogens encounter and activate lymphocytes and initiate adaptive immune responses.<\/li>\n<\/ul>\n<\/li>\n<li>Unlike the adaptive immune system, the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4820\">innate immune system<\/a> does not confer immunity. The innate immune system includes surface barriers, inflammation, the complement system, and a variety of cellular responses.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>The body\u2019s first line of defense consists of three different types of barriers that keep most pathogens out of body tissues. The types of barriers are mechanical, chemical, and biological barriers.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4857\">Mechanical barriers<\/a>\u00a0\u2014\u00a0which include the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3521\">skin<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3538\">mucous membranes<\/a>, and fluids (such as tears and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4717\">urine<\/a>) \u2014 physically block pathogens from entering the body.<\/li>\n<li>Chemical barriers\u00a0\u2014\u00a0such as enzymes in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4711\">sweat<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4595\">saliva<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4885\">semen<\/a>\u00a0\u2014\u00a0kill pathogens on body surfaces.<\/li>\n<li>Biological barriers are harmless bacteria that use up food and space so pathogenic bacteria cannot colonize the body.<\/li>\n<\/ul>\n<\/li>\n<li>If pathogens breach the protective barriers, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4860\">inflammation<\/a> occurs. This creates a physical barrier against the spread of infection and repairs tissue damage. Inflammation is triggered by chemicals (such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4865\">cytokines<\/a>\u00a0and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4879\">histamines<\/a>), and it causes swelling, redness, and warmth.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4868\">complement system<\/a> is a complex biochemical mechanism that helps <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3567\">antibodies<\/a> kill pathogens. Once activated, the complement system consists of more than two dozen proteins that lead to disruption of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3529\">cell membrane<\/a> of pathogens and bursting of the cells.<\/li>\n<li>Cellular responses of the innate immune system involve various types of leukocytes (white blood cells). For example, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3453\">neutrophils<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4340\">macrophages<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4875\">dendritic cells<\/a>\u00a0phagocytize pathogens. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3481\">Basophils<\/a>\u00a0and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4881\">mast cells<\/a>\u00a0release chemicals that trigger inflammation. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3423\">Natural killer cells<\/a>\u00a0destroy cancerous or virus-infected cells, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3437\">eosinophils<\/a>\u00a0kill parasites.<\/li>\n<li>Many pathogens have evolved mechanisms that help them evade the innate immune system. For example, some pathogens form a protective capsule around themselves, and some mimic host cells so the immune system does not recognize them as foreign.<\/li>\n<\/ul>\n<\/li>\n<li>The main cells of the adaptive immune system are <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4832\">lymphocytes<\/a>. There are two major types of lymphocytes: T cells and B cells. Both types must be activated by foreign antigens to become functioning immune cells.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Most activated T cells become either <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4893\">killer T cells<\/a>\u00a0or <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3445\">helper T cells<\/a>. Killer T cells destroy cells that are infected with pathogens or are cancerous. Helper T cells manage immune responses by releasing cytokines that control other types of leukocytes.<\/li>\n<li>Activated B cells form <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4902\">plasma cell<\/a>s that secrete antibodies, which bind to specific antigens on pathogens or infected cells. The antibody-antigen complexes generally lead to the destruction of the cells, for example, by attracting phagocytes or triggering the complement system.<\/li>\n<\/ul>\n<\/li>\n<li>After an adaptive immune response occurs, long-lasting <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4904\">memory B cells and memory T cells<\/a> may remain to confer <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4884\">immunity<\/a> to the specific pathogen that caused the adaptive immune response. These memory cells are ready to activate an immediate response if they are exposed to the same antigen again in the future.<\/li>\n<li>Immunity may be active or passive.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4906\">Active immunity<\/a> occurs when the immune system has been presented with antigens that elicit an adaptive immune response. This may occur naturally as the result of an infection, or artificially as the result of immunization. Active immunity may last for years or even for life.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4910\">Passive immunity<\/a> occurs without an adaptive immune response by the transfer of antibodies or activated T cells. This may occur naturally between a mother and her fetus or her nursing infant, or it may occur artificially by injection. Passive immunity lasts only as long as the antibodies or activated T cells remain alive in the body, generally just weeks or months.<\/li>\n<\/ul>\n<\/li>\n<li>Many pathogens have evolved mechanisms to evade the adaptive immune system. For example, human immunodeficiency virus (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4501\">HIV<\/a>) evades the adaptive immune system by frequently changing its antigens and by forming its outer envelope from the host\u2019s cell membrane.<\/li>\n<li>An <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4877\">allergy<\/a> is a disorder in which the immune system makes an inflammatory response to a harmless antigen. Any antigen that causes allergies is called an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4999\">allergen<\/a>. Common allergens include pollen, dust mites, mold, specific foods (such as peanuts), insect stings, and certain medications (such as aspirin).<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>The prevalence of allergies has been increasing for decades, especially in developed countries, where they are much more common than in developing countries. The hygiene hypothesis posits that this has occurred because humans evolved to cope with more pathogens than we now typically face in our relatively sterile environments in developed countries. As a result, the immune system \u201ckeeps busy\u201d by attacking harmless antigens.<\/li>\n<li>Allergies occur when B cells are first activated to produce large amounts of antibodies to an otherwise harmless allergen, and the antibodies attach to mast cells. On subsequent exposures to the allergen, the mast cells immediately release cytokines and histamines that cause inflammation.<\/li>\n<li>Mild allergy symptoms are frequently treated with antihistamines that counter histamines and reduce allergy symptoms. A severe systemic allergic reaction, called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5002\">anaphylaxis<\/a>, is a medical emergency that is usually treated with injections of epinephrine. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5004\">Immunotherapy<\/a> for allergies involves injecting increasing amounts of allergens to desensitize the immune system to them.<\/li>\n<\/ul>\n<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5006\">Autoimmune diseases<\/a>\u00a0occur when the immune system fails to recognize the body\u2019s own molecules as self and attacks them, causing damage to tissues and organs. A family history of autoimmunity and female gender are risk factors for autoimmune diseases.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>In some autoimmune diseases, such as type I diabetes, the immune system attacks and damages specific body cells. In other autoimmune diseases, such as systemic lupus erythematosus, many different tissues and organs may be attacked and injured. Autoimmune diseases generally cannot be cured, but their symptoms can often be managed with drugs or other treatments.<\/li>\n<\/ul>\n<\/li>\n<li>Immunodeficiency occurs when the immune system is not working properly, generally because one or more of its components are inactive. As a result, the immune system is unable to fight off pathogens or cancers that a normal immune system would be able to resist.<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5012\">Primary immunodeficiency<\/a> is present at birth and caused by rare genetic diseases. An example is severe combined immunodeficiency. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5013\">Secondary immunodeficiency<\/a> occurs because of some event or exposure experienced after birth. Possible causes include substance abuse, obesity, and malnutrition, among others.<\/li>\n<li>The most common cause of immunodeficiency in the world today is human immunodeficiency virus (HIV), which infects and destroys helper T cells. HIV is transmitted through mucous membranes or body fluids. The virus may eventually lead to such low levels of helper T cells that opportunistic infections occur. When this happens, the patient is diagnosed with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5016\">acquired immunodeficiency syndrome<\/a> (AIDS). Medications can control the multiplication of HIV in the human body, but\u00a0it can't\u00a0eliminate the virus completely.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Up to this point, this book has covered body systems that carry out processes within individuals, such as the digestive, muscular, and immune systems. Read the next chapter to learn about the body system that allows humans to produce new individuals \u2014 the reproductive system.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">Chapter 17 Review<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-205\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-205\" class=\"h5p-iframe\" data-content-id=\"205\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"11.6 Quiz\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Compare and contrast a pathogen and an allergen.<\/li>\n<li>Describe three ways in which pathogens can enter the body.<\/li>\n<li>The complement system involves the activation of several proteins to kill pathogens. Why do you think this is considered part of the innate immune system, instead of the adaptive immune system?<\/li>\n<li>Why are innate immune responses generally faster than adaptive immune responses?<\/li>\n<li>Explain how an autoimmune disease could be triggered by a pathogen.<\/li>\n<li>What is an opportunistic infection?\u00a0Name two diseases or conditions that could result in opportunistic infections. Explain your answer.<\/li>\n<li>Which cell type in the immune system can be considered an \u201cantibody factory?\"<\/li>\n<li>Besides foreign pathogens, what is one thing that the immune system protects the body against?<\/li>\n<li>What cell type in the immune system is infected and killed by HIV?<\/li>\n<li>Name two types of cells that produce cytokines in the immune system.\u00a0What are two functions of cytokines in the immune system?<\/li>\n<li>Many pathogens evade the immune system by altering their outer surface in some way. Based on what you know about the functioning of the immune system, why is this often a successful approach?<\/li>\n<li>What is \u201cmissing self?\" How does this condition arise?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">17.7 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/Z3B-AaqjyjE<\/p>\n<p style=\"text-align: center\">What is leukemia? - Danilo Allegra and Dania Puggioni, TED-Ed, 2015.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 17.7.1<\/strong><\/p>\n<p><a href=\"https:\/\/flic.kr\/p\/eQCQyD\" rel=\"cc:attributionURL\">Cycling to Beat Blood Cancer<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/leukaemia_research\/\">Blood Cancer UK<\/a> (Formerly Bloodwise) on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\">CC BY-NC-ND 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/) license.<\/p>\n<p><strong>Figure 17.7.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Langerhans_Cells_in_Normal_Epidermis,_CD1a_Immunostain_(4435883030).jpg\" rel=\"cc:attributionURL\">antigen stain<\/a> by <a class=\"external text\" href=\"https:\/\/www.flickr.com\/people\/78147607@N00\" rel=\"nofollow\">Ed Uthman<\/a> from Houston, TX, USA on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\" rel=\"license\">CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https:\/\/www.cancer.ca:443\/en\/cancer-information\/cancer-type\/hodgkin-lymphoma\/statistics\/?region=on<\/p>\n<p class=\"hanging-indent\">Non-Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https:\/\/www.cancer.ca:443\/en\/cancer-information\/cancer-type\/non-hodgkin-lymphoma\/statistics\/?region=on<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, April 30). What is leukemia? - Danilo Allegra and Dania Puggioni. YouTube. https:\/\/www.youtube.com\/watch?v=Z3B-AaqjyjE&amp;feature=youtu.be<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4096\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4096\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_5194\" aria-describedby=\"caption-attachment-5194\" style=\"width: 334px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5194\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Sperm-20051108-1.jpg\" alt=\"18.4.1 Sperm\" width=\"334\" height=\"330\"><figcaption id=\"caption-attachment-5194\" class=\"wp-caption-text\"><em>Figure 18.4.1 Sperm-ho!<\/em><\/figcaption><\/figure>\n<div>\n<h1>Colourful Sperm<\/h1>\n<\/div>\n<p>This false-colour image (Figure 18.4.1) shows real human sperm. The tiny gametes are obviously greatly magnified in the picture, because they are actually the smallest of all human cells. In fact, human sperm cells are small, even when compared with sperm cells of other animals. Mice sperm are about <em>twice<\/em> the length of human sperm! Human\u00a0sperm may be small in size, but in a normal, healthy man, huge numbers of them are usually released during each ejaculation. There may be hundreds of millions of sperm cells in a single teaspoon of semen. Producing sperm is one of the major\u00a0functions of the male reproductive system.<\/p>\n<div>\n<figure id=\"attachment_5195\" aria-describedby=\"caption-attachment-5195\" style=\"width: 356px\" class=\"wp-caption alignright\"><img class=\" wp-image-5195\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Sperm-Anatomy-1.png\" alt=\"18.4.2 Sperm Anatomy\" width=\"356\" height=\"516\"><figcaption id=\"caption-attachment-5195\" class=\"wp-caption-text\"><em>Figure 18.4.2 Each normal mature sperm cell has the structures labeled in this image.<\/em><\/figcaption><\/figure>\n<h1>Sperm Anatomy<\/h1>\n<\/div>\n<p>A mature sperm cell has several structures that help it reach and penetrate an egg. These are labeled in the drawing of a sperm shown in Figure 18.4.2.<\/p>\n<ul>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5196\">head<\/a><\/strong>\u00a0is the part of the sperm that contains the\u00a0nucleus\u00a0\u2014 and not much else. The nucleus, in turn, contains tightly coiled\u00a0DNA\u00a0that is the male parent\u2019s contribution to the genetic makeup of a zygote (if one forms). Each sperm is a haploid cell, containing half the chromosomal complement of a normal, diploid body cell.<\/li>\n<li>The front of the head is an area called the\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5197\">acrosome<\/a><\/strong>. The acrosome contains enzymes that help the sperm penetrate an ovum (if it reaches one).<\/li>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5198\">midpiece<\/a><\/strong>\u00a0is the part of the sperm between the head and the flagellum. The midpiece is packed with\u00a0mitochondria\u00a0that produce the\u00a0energy\u00a0needed to move the flagellum.<\/li>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3515\">flagellum<\/a><\/strong> (also called the tail) can rotate like a propeller, allowing the sperm to \u201cswim\u201d through the female reproductive tract to reach an ovum if one is present.<\/li>\n<\/ul>\n<div>\n<h1>Spermatogenesis<\/h1>\n<\/div>\n<p>The process of producing sperm is known as\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">spermatogenesis<\/a>. <\/strong>Spermatogenesis normally starts when a male reaches <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5155\">puberty<\/a>, and it usually continues uninterrupted until death, although a decrease in sperm production generally occurs at older ages. A young, healthy male may produce hundreds of millions of sperm a day! Only about half of these, however, are likely to become viable, mature sperm.<\/p>\n<h2>Where Sperm Are Produced<\/h2>\n<p>Spermatogenesis occurs in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5160\">seminiferous tubules<\/a> in the testes. Spermatogenesis requires high concentrations of testosterone. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3409\">Testosterone<\/a> is secreted by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5171\">Leydig\u00a0cells<\/a>, which are adjacent to the seminiferous tubules in the testes.<\/p>\n<p>Sperm production in the seminiferous tubules is very sensitive to temperature. This may be the most important reason the testes are located outside the body in the scrotum. The temperature inside the scrotum is generally about 2 degrees Celsius cooler than core body temperature. This lower temperature is optimal for spermatogenesis. The scrotum regulates its internal temperature as needed by contractions of the smooth muscles lining the scrotum. When the temperature inside the scrotum becomes too low, the scrotal muscles contract. The contraction of the muscles pulls the scrotum higher against the body, where the temperature is warmer. The opposite occurs when the temperature inside the scrotum becomes too high.<\/p>\n<h2>Events of Spermatogenesis<\/h2>\n<figure id=\"attachment_5200\" aria-describedby=\"caption-attachment-5200\" style=\"width: 256px\" class=\"wp-caption alignright\"><img class=\"size-full wp-image-5200\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Spermatogenesis-1.jpg\" alt=\"18.4.3 Spermatogenesis\" width=\"256\" height=\"594\"><figcaption id=\"caption-attachment-5200\" class=\"wp-caption-text\"><em>Figure 18.4.3 Spermatogenesis includes one mitotic division and two meiotic divisions.<\/em><\/figcaption><\/figure>\n<p>Figure 18.4.3 summarizes the main cellular events that occur in the process of spermatogenesis. The process begins with a diploid stem cell called a <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5199\">spermatogonium<\/a><\/strong>\u00a0(plural, spermatogonia), and involves several cell divisions. The entire process takes at least ten weeks to complete, including maturation in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5090\">epididymis<\/a>.<\/p>\n<ol>\n<li>A spermatogonium undergoes\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1987\">mitosis<\/a>\u00a0to produce two <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2103\">diploid<\/a> cells called primary spermatocytes. One of the primary spermatocytes goes on to produce <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a>. The other replenishes the reserve of spermatogonia.<\/li>\n<li>The primary spermatocyte undergoes\u00a0meiosis\u00a0I to produce two haploid daughter cells called secondary spermatocytes.<\/li>\n<li>The secondary spermatocytes rapidly undergo\u00a0meiosis\u00a0II to produce a total of four <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2484\">haploid<\/a> daughter cells called spermatids.<\/li>\n<li>The spermatids begin to form a tail, and their\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_277\">DNA<\/a>\u00a0becomes highly condensed. Unnecessary cytoplasm and\u00a0organelles\u00a0are removed from the cells, and they form a head, midpiece, and flagellum. The resulting cells are sperm (spermatozoa).<\/li>\n<\/ol>\n<div><\/div>\n<p>As shown in Figure 18.4.4, the events of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">spermatogenesis<\/a> begin near the wall of the seminiferous tubule \u2014 where spermatogonia are located \u2014 and continue inward toward the lumen of the tubule. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5169\">Sertoli cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0extend from the wall of the seminiferous tubule inward toward the lumen, so they are in contact with developing sperm at all stages of spermatogenesis. Sertoli cells play several roles in spermatogenesis:<\/span><\/p>\n<ul>\n<li>They secrete\u00a0endocrine <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3569\">hormones<\/a>\u00a0that help regulate spermatogenesis.<\/li>\n<li>They secrete substances that initiate\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2486\">meiosis<\/a>.<\/li>\n<li>They concentrate testosterone (from <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5171\">Leydig cells<\/a>), which is needed at high levels to maintain spermatogenesis.<\/li>\n<li>They <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1680\">phagocytize<\/a> the extra cytoplasm that is shed from developing sperm cells.<\/li>\n<li>They secrete testicular fluid that helps carry sperm into the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5090\">epididymis<\/a>.<\/li>\n<li>They maintain a blood-testis barrier, so immune system cells cannot reach and attack the sperm.<\/li>\n<\/ul>\n<figure id=\"attachment_5201\" aria-describedby=\"caption-attachment-5201\" style=\"width: 900px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5201\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Testis-cross-section-2-1.jpg\" alt=\"18.4.4 Testis Structure\" width=\"900\" height=\"511\"><figcaption id=\"caption-attachment-5201\" class=\"wp-caption-text\"><em>Figure 18.4.4 Cross-section of a testis and seminiferous tubules.<\/em><\/figcaption><\/figure>\n<h2>Maturation in the Epididymis<\/h2>\n<p>Although the sperm produced in the testes have tails, they are not yet motile (able to \u201cswim\u201d). The non-motile sperm are transported to the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5090\">epididymis<\/a> in testicular fluid that is secreted by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5169\">Sertoli cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0with the help of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristaltic contractions<\/a>. In the epididymis, the sperm gain motility, so they are capable of swimming up the female genital tract and reaching an ovum. The mature sperm are stored in the epididymis until ejaculation occurs.<\/span><\/p>\n<div>\n<h1>Ejaculation<\/h1>\n<\/div>\n<p>Sperm are released from the body during\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5150\">ejaculation<\/a>,<\/strong>\u00a0which typically occurs during orgasm. Hundreds of millions of mature sperm \u2014 contained within a small amount of thick, whitish fluid called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4885\">semen<\/a>\u00a0\u2014\u00a0are propelled from the penis during a normal ejaculation.<\/p>\n<h2>How Ejaculation Occurs<\/h2>\n<p>Ejaculation occurs when <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a> of the muscle layers of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5095\"><em>vas deferens<\/em><\/a> and other accessory structures propel sperm from the epididymes, where mature sperm are stored. The muscle contractions force the sperm through the <em>vas deferens<\/em> and the ejaculatory ducts, and then out of the penis through the urethra. Due to the peristaltic action of the\u00a0muscles, the ejaculation occurs in a series of spurts.<\/p>\n<h2>The Role of Semen<\/h2>\n<p>As sperm travel through the ejaculatory ducts during ejaculation, they mix with secretions from the seminal vesicles, prostate gland, and bulbourethral glands to form semen (see Figure 18.4.5 ). The average amount of semen per ejaculate is about 3.7 mL, which is a little less than a teaspoonful. Most of this volume of semen consists of glandular secretions, with the hundreds of millions of sperm cells actually contributing relatively little to the total volume.<\/p>\n<figure id=\"attachment_5202\" aria-describedby=\"caption-attachment-5202\" style=\"width: 389px\" class=\"wp-caption alignleft\"><img class=\" wp-image-5202\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Human_semen_in_a_petri_dish-1.jpg\" alt=\"18.4.5\" width=\"389\" height=\"292\"><figcaption id=\"caption-attachment-5202\" class=\"wp-caption-text\"><em>Figure 18.4.5 This petri dish shows normal human semen in a typical ejaculate.<\/em><\/figcaption><\/figure>\n<p>The secretions in semen are important for the survival and motility of sperm. They provide a medium through which sperm can swim. They also include sperm-sustaining substances, such as high concentrations of the sugar fructose, which is the main source of\u00a0energy\u00a0for sperm. In addition, semen contains many alkaline substances that help neutralize the acidic environment in the female vagina. This protects the\u00a0DNA\u00a0in sperm from being denatured by\u00a0acid, and prolongs the life of sperm in the female reproductive tract.<\/p>\n<div>\n<h1>Erection<\/h1>\n<\/div>\n<p>Besides providing a way for sperm to leave the body, the main role of the penis in\u00a0reproduction\u00a0is\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5203\">intromission<\/a>,<\/strong>\u00a0or depositing sperm in the vagina of the female reproductive tract. Intromission depends on the ability of the penis to become stiff and erect, a state referred to as an\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5204\">erection<\/a>.<\/strong>\u00a0The human penis, unlike that of most other mammals, contains no erectile bone. Instead, in order to reach its erect state, it relies entirely on engorgement with\u00a0blood\u00a0of its columns of spongy tissue. During sexual arousal, the arteries that supply blood to the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5091\">penis<\/a> dilate, allowing more blood to fill the spongy tissue. The now-engorged spongy tissue presses against and constricts the veins that carry blood away from the penis. As a result, more blood enters than leaves the penis, until a constant erectile size is achieved.<\/p>\n<p>In addition to sperm, the penis also transports urine out of the body. These two functions cannot occur simultaneously. During an erection, the sphincters that prevent urine from leaving the bladder are controlled by centres in the brain so they cannot relax and allow urine to enter the urethra.<\/p>\n<div>\n<h1>Testosterone Production<\/h1>\n<\/div>\n<p>The final major function of the male reproductive system is the production of the male sex\u00a0hormone\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3409\">testosterone<\/a>. In mature males, this occurs mainly in the testes. Testosterone production is under the control of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5205\">luteinizing hormone<\/a> (LH) from the\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a>. LH stimulates <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5171\">Leydig cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3486\">testes<\/a> to secrete testosterone.<\/span><\/p>\n<p>Testosterone is important for male sexual\u00a0development\u00a0at\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5155\">puberty<\/a>. It stimulates maturation of the\u00a0male reproductive organs, as well as the development of secondary male sex characteristics (such as facial hair). Testosterone is also needed in mature males for normal <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">spermatogenesis<\/a> to be maintained in the testes. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5206\">Follicle stimulating\u00a0hormone<\/a>\u00a0(FSH) from the\u00a0pituitary gland\u00a0is also needed for spermatogenesis to occur, in part because it helps <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5169\">Sertoli cell<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0in the testes concentrate testosterone to high enough levels to maintain sperm production. Testosterone is also needed for proper functioning of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5096\">prostate gland<\/a>. In addition, testosterone plays a role in <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5204\">erection<\/a>, allowing sperm\u00a0to\u00a0be deposited within the female reproductive tract.<\/span><\/p>\n<div>\n<h1>Feature: My\u00a0Human Body<\/h1>\n<\/div>\n<figure id=\"attachment_5207\" aria-describedby=\"caption-attachment-5207\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5207\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Laptop-by-logan-weaver-b76PEyeIptQ-unsplash-scaled-2.jpg\" alt=\"18.4.6 Laptop and Sperm Production\" width=\"400\" height=\"267\"><figcaption id=\"caption-attachment-5207\" class=\"wp-caption-text\"><em>Figure 18.4.6 The heat emitted by a laptop could decrease sperm production.<\/em><\/figcaption><\/figure>\n<p>If you\u2019re a man and you use a laptop computer on your lap for long periods of time, you may be decreasing your fertility. The reason? A laptop computer generates considerable\u00a0heat, and its proximity to the scrotum during typical use results in a significant rise in\u00a0temperature\u00a0inside the scrotum. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">Spermatogenesis<\/a> is very sensitive to high temperatures, so it may be adversely affected by laptop computer use. If you want to avoid the potentially fertility-depressing effect of laptop computer use, you might want to consider using your laptop computer on a table or other surface rather than on your lap \u2014 at least when you log on for long computer sessions. Other activities that raise scrotal temperature and have the potential to reduce spermatogenesis including soaking in hot tubs, wearing tight clothing, and biking. Although the effects of short-term scrotal heating on fertility seem to be temporary, years of such heat exposure may cause irreversible effects on sperm production.<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.4 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>Parts of a mature sperm include the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5196\">head<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5197\">acrosome<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5198\">midpiece<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3515\">flagellum<\/a>. The process of producing sperm is called spermatogenesis. This normally starts during\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5155\">puberty<\/a>, and continues uninterrupted until death.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">Spermatogenesis<\/a> occurs in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5160\">seminiferous tubules<\/a> in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3486\">testes<\/a>, and requires high concentrations of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3409\">testosterone<\/a>. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5169\">Sertoli cells<\/a>\u00a0in the testes play many roles in spermatogenesis, including concentrating testosterone under the influence of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5206\">follicle stimulating\u00a0hormone<\/a>\u00a0from the\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a>.<\/li>\n<li>Spermatogenesis begins with a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2103\">diploid<\/a> stem cell called a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5199\">spermatogonium<\/a>, which undergoes\u00a0mitosis\u00a0to produce a primary spermatocyte. The primary spermatocyte undergoes meiosis I to produce <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2484\">haploid<\/a> secondary spermatocytes, and these cells in turn undergo meiosis II to produce spermatids. After the spermatids grow a tail and undergo other changes, they become <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a>.<\/li>\n<li>Before sperm are able to \u201cswim,\u201d they must mature in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5090\">epididymis<\/a>. The mature sperm are then stored in the epididymis until <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5150\">ejaculation<\/a> occurs.<\/li>\n<li>Ejaculation is the process in which <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4885\">semen<\/a> is propelled by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a> in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5095\"><em>vas deferens<\/em><\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5174\">ejaculatory ducts<\/a>\u00a0from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4732\">urethra<\/a> in the penis. Semen is a whitish fluid that contains sperm and secretions from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5097\">seminal vesicles<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5096\">prostate gland<\/a>, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5183\">bulbourethral glands<\/a>. These alkaline secretions are important for sperm survival and motility.<\/li>\n<li>Besides ejaculating sperm, another reproductive role of the penis is <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5203\">intromission<\/a>, which is depositing sperm in the female <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a>. This requires the penis to become stiff and erect, a state referred to as an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5204\">erection<\/a>. Erection usually occurs with sexual arousal as the columns of spongy tissue inside the penis become engorged with\u00a0blood.<\/li>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5171\">Leydig cells<\/a>\u00a0in the testes secrete testosterone under the control of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5205\">luteinizing hormone<\/a> (LH) from the pituitary gland. Testosterone is needed for male sexual\u00a0development\u00a0at puberty, and to maintain normal spermatogenesis after puberty. It also plays a role in prostate function and\u00a0penis's ability\u00a0to become erect.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.4 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>&nbsp;<\/p>\n<ol>\n<li>\n<div id=\"h5p-209\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-209\" class=\"h5p-iframe\" data-content-id=\"209\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"4.13 Review Questions\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Compare and contrast the terms: erection, ejaculation, and intromission.<\/li>\n<li>Describe semen and its components.<\/li>\n<li>Explain how erection occurs.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.4 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/gNHSTa0Yct4<\/p>\n<p style=\"text-align: center\">How You're Destroying Your Sperm! Seeker, 2014.<\/p>\n<p>https:\/\/youtu.be\/krSMZDsjLuU<\/p>\n<p style=\"text-align: center\">Human Physiology - Reproduction: Spermatogenesis, Janux, 2015.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 18.4.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Sperm-20051108.jpg\" rel=\"cc:attributionURL\">Sperm-20051108<\/a> by <a class=\"external text\" href=\"https:\/\/www.flickr.com\/people\/93087247@N00\" rel=\"nofollow\">Gilberto Santa Rosa<\/a>\u00a0from\u00a0<a class=\"extiw\" title=\"w:Rio de Janeiro\" href=\"https:\/\/en.wikipedia.org\/wiki\/Rio_de_Janeiro\">Rio de Janeiro<\/a>,\u00a0<a class=\"extiw\" title=\"w:Brazil\" href=\"https:\/\/en.wikipedia.org\/wiki\/Brazil\">Brazil<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\" rel=\"license\">CC BY 2.0<\/a>\u00a0(https:\/\/creativecommons.org\/licenses\/by\/2.0) license.<\/p>\n<p><strong>Figure 18.4.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Sperm_Anatomy.png\" rel=\"cc:attributionURL\">Sperm Anatomy<\/a> by <a title=\"User:Christinelmiller\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Christinelmiller\">Christinelmiller<\/a> on Wikimedia Commons is used under a \u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"license\">CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.<\/p>\n<p><strong>Figure 18.4.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_28_01_04.jpg\" rel=\"cc:attributionURL\">Spermatogenesis<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-1-anatomy-and-physiology-of-the-male-reproductive-system\">OpenStax College<\/a> is used and adapted by Christine Miller under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 18.4.4<\/strong><\/p>\n<p><a href=\"https:\/\/www.ck12.org\/book\/ck-12-college-human-biology\/section\/20.4\/\" rel=\"cc:attributionURL\">Testis-cross-section<\/a>\u00a0by <a href=\"https:\/\/www.ck12.org\/book\/ck-12-college-human-biology\/section\/20.4\/\">CK-12 Foundation<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\">CC BY-NC 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/) license.<\/p>\n<div><img src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/logo_ck12.png\" alt=\"\"> <span style=\"font-size: 1em\">\u00a9<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/\">CK-12 Foundation<\/a> <span style=\"font-size: 1em\">Licensed under\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/\"><img class=\"alignnone size-full wp-image-8217\" title=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\" src=\"https:\/\/www.ck12info.org\/wp-content\/uploads\/2016\/05\/icon_licence.png\" alt=\"CK-12 Foundation is licensed under Creative Commons AttributionNonCommercial 3.0 Unported (CC BY-NC 3.0)\"><\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/terms-of-use\/?_ga=2.264717007.1988667202.1598996862-1392032960.1592870652\">Terms of Use<\/a><span style=\"font-size: 1em\">\u00a0\u2022\u00a0<\/span><a style=\"font-size: 1em\" href=\"http:\/\/www.ck12.org\/about\/attribution\/\">Attribution<\/a><\/div>\n<p><strong>Figure 18.4.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Human_semen_in_a_petri_dish.jpg\" rel=\"cc:attributionURL\">Human_semen_in_a_petri_dish<\/a> by <a title=\"User:Digitalkil\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Digitalkil\">Digitalkil<\/a> on Wikimedia Commons is in the <a class=\"extiw\" title=\"w:en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/en:public_domain).<\/p>\n<p><strong>Figure 18.4.6<\/strong><\/p>\n<p><a href=\"https:\/\/unsplash.com\/photos\/b76PEyeIptQ\" rel=\"cc:attributionURL\">Laptop by logan-weaver-b76PEyeIptQ-unsplash<\/a> [photo] by <a class=\"_3XzpS _1ByhS _4kjHg _1O9Y0 _3l__V _1CBrG xLon9\" href=\"https:\/\/unsplash.com\/@lgnwvr\">LOGAN WEAVER<\/a> on <a href=\"http:\/\/unsplash.com\">Unsplash<\/a> is used under the <a href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a> (https:\/\/unsplash.com\/license).<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\"><span class=\"os-title-label\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><span class=\"os-number\">27.5<\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"81306\" class=\"os-title\" data-type=\"title\">Spermatogenesis [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 27.1). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-1-anatomy-and-physiology-of-the-male-reproductive-system<\/span><\/p>\n<p class=\"hanging-indent\">Brainard, J\/ CK-12 Foundation. (2016). <span id=\"81306\" class=\"os-title\" data-type=\"title\">F<\/span>igure 4 Cross-section of a testis and seminiferous tubules [digital image]. In <em>CK-12 College Human Biology<\/em> (Section 20.4) [online Flexbook]. CK12.org. https:\/\/www.ck12.org\/book\/ck-12-college-human-biology\/section\/20.4\/<\/p>\n<p class=\"hanging-indent\">Janux. (2015, January 10). Human physiology - Reproduction: spermatogenesis. YouTube. https:\/\/www.youtube.com\/watch?v=krSMZDsjLuU&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Seeker. (2014, June 16). How you're destroying your sperm! YouTube. https:\/\/www.youtube.com\/watch?v=gNHSTa0Yct4&amp;feature=youtu.be<\/p>\n<p>&nbsp;<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4098\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4098\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_5234\" aria-describedby=\"caption-attachment-5234\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5234\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/1024px-Cattien_stone_yoni-1.png\" alt=\"18.6.1\" width=\"400\" height=\"302\"><figcaption id=\"caption-attachment-5234\" class=\"wp-caption-text\"><em>Figure 18.6.1 Yep, that's a vagina.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Fertility Symbol<\/h1>\n<\/div>\n<p>The geometric design on the ancient stone carving in Figure 18.6.1 represents a powerful symbol of female fertility: the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a>. The symbol is called <em>yoni<\/em> in Hindu, and it reflects the value placed by Hindu culture on the ability of females to give birth. The vagina is one of several organs in the\u00a0female reproductive system.<\/p>\n<div>\n<h1>Female Reproductive Organs<\/h1>\n<\/div>\n<p>The female reproductive system is made up of internal and external organs that function to produce haploid female gametes called ova (or oocytes), secrete female sex hormones (such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a>), and carry and give birth to a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5086\">fetus<\/a>. The internal female reproductive organs include the vagina, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviduct<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a>. The external organs \u2014 collectively called the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5152\">vulva<\/a> \u2014 include the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5153\">clitoris<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5154\">labia<\/a>.<\/span><\/p>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a><\/strong> is an elastic, muscular canal leading from its opening in the vulva to the neck of the uterus, called the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5235\">cervix<\/a>. It is about 7.5 cm (about 3 in) long at the front, and about 9 cm (3.5 in) long at the back. The vagina accommodates the penis and is the site where <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a> are usually ejaculated during sexual intercourse. In the context of pregnancy and natural (vaginal) childbirth, the vagina is referred to as the birth canal. In addition, it channels the flow of menstrual blood from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>.<\/p>\n<h2>Structure of the Vagina<\/h2>\n<p>Muscles and ligaments support the vagina within the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2992\">pelvic cavity<\/a>. The vagina itself is made up of several layers of fibrous and muscular tissues and lined with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3538\">mucous membrane<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">. Folds in the mucosa provide the vagina with extra surface area so it can stretch in both length and width during intercourse or childbirth. The elasticity of the vagina and the extra mucosa allow it to stretch to many times its normal diameter in order to deliver a baby.<\/span><\/p>\n<h2>Bacteria\u00a0and\u00a0pH\u00a0in the Vagina<\/h2>\n<p>A healthy <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a> is home to many <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3727\">symbiotic<\/a>\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2588\">bacteria<\/a> that help prevent pathogens (such as yeast) from colonizing the vagina. The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4330\">pH<\/a> in the vagina is normally between 3.8 and 4.5, and this acidity also helps keep pathogenic microorganisms from colonizing it. The vagina constantly sheds its epithelium, so it is considered self-cleaning. As a consequence, there is no need for douching to clean it. Physicians actually discourage the practice, as it may upset the normal bacterial and pH balance in the vagina, although washing the vulva with a mild soap is good practice.<\/p>\n<div>\n<h1>Uterus<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a><\/strong> (commonly called the womb) is a pear-shaped, muscular organ that is about 7.6 cm (about 3 in) long. It is located above the vagina and behind the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4731\">bladder<\/a> in the centre of the pelvis. The position of the uterus in the pelvis is stabilized by several ligaments and bands of supportive tissue. The uterus is where a fetus develops during gestation, and the organ provides mechanical protection and support for the developing offspring. Contractions of the muscular wall of the uterus are responsible for pushing the fetus out of the uterus during childbirth.<\/p>\n<figure id=\"attachment_5240\" aria-describedby=\"caption-attachment-5240\" style=\"width: 368px\" class=\"wp-caption alignright\"><img class=\" wp-image-5240\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1000px-Gray1167.svg_-1.png\" alt=\"18.6.2 Uterus and Vagina\" width=\"368\" height=\"400\"><figcaption id=\"caption-attachment-5240\" class=\"wp-caption-text\"><em>Figure 18.6.2 The cervix of the uterus opens into the vagina. The body of the uterus lies above the cervix.<\/em><\/figcaption><\/figure>\n<h2>Parts of the Uterus<\/h2>\n<p>As shown in Figure 18.6.2, the lower end of the uterus forms the <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5235\">cervix<\/a>,<\/strong> which is also called the neck of the uterus. The cervix is about 2.5 cm (almost 1 in) long and protrudes downward into the vagina. A small canal runs the length of the cervix, connecting the uterine cavity with the lumen of the vagina. This allows semen deposited in the vagina to enter the uterus, and a baby to pass from the uterus into the vagina during birth. Glands in the cervix secrete mucus that varies in water content and thickness, so it can function either as a barrier to keep <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3683\">microorganism<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0out of the uterus during\u00a0pregnancy, or as a transport medium to help\u00a0sperm\u00a0enter the uterus around the time of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a>. The rest of the uterus above the cervix is called the body of the uterus. The upper end of the uterus is connected with the two <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviduct<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\">.<\/span><\/p>\n<h2>Tissues of the Uterus<\/h2>\n<p>As indicated in Figure 18.6.3, the uterus consists of three tissue layers, called the endometrium, myometrium, and perimetrium.<\/p>\n<ul>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a><\/strong> is the innermost tissue layer of the uterus. It consists of epithelial tissue, including mucous membranes. This layer thickens during each menstrual cycle and, unless an egg is fertilized, sloughs off during the following menstrual period. If an ovum is fertilized, the thickened endometrium is maintained by hormones and provides nourishment to the embryo. As gestation progresses, the endometrium develops into the maternal portion of the placenta.<\/li>\n<li>The <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5242\">placenta<\/a><\/strong>\u00a0is a temporary organ that consists of a mass of maternal and fetal\u00a0blood vessels\u00a0through which the mother\u2019s and fetus\u2019s\u00a0blood\u00a0exchange substances.<\/li>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5243\">myometrium<\/a><\/strong>\u00a0is the middle layer of the uterus. It consists mostly of a thick layer of smooth muscle tissue. Powerful contractions of the smooth muscle allow the uterus to contract and expel an infant during childbirth.<\/li>\n<li>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5244\">perimetrium<\/a><\/strong>\u00a0is the outermost layer of the uterus. It covers\u00a0the\u00a0outer surface of the uterus. This layer actually consists of two layers of epithelium that secrete fluid into the space between them. The fluid allows for small movements of the uterus within the pelvis, without\u00a0causing it to rub\u00a0against other organs.<\/li>\n<\/ul>\n<figure id=\"attachment_5245\" aria-describedby=\"caption-attachment-5245\" style=\"width: 380px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5245 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Uterine_anatomy.-e1593113913396-1.jpg\" alt=\"18.6.3 Layers of the Uterus\" width=\"380\" height=\"260\"><figcaption id=\"caption-attachment-5245\" class=\"wp-caption-text\"><em>Figure 18.6.3 The thick walls of the uterus are composed of layers of tissues known as endometrium, myometrium, and perimetrium (not shown in this image).<\/em><\/figcaption><\/figure>\n<div>\n<p><span style=\"font-size: 1.424em\">Oviducts<\/span><\/p>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviduct<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a><\/strong><span style=\"text-align: initial;font-size: 1em\"> (often referred to as Fallopian tubes) are two thin tubes that lie between the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a> and the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>. The oviducts are not attached to the ovaries, but their broad upper ends \u2014 called infundibula \u2014 lie very close to the ovaries. The infundibula also have fringe-like extensions called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5247\">fimbriae<\/a> that move in a waving motion to help guide eggs from the ovaries into the oviducts. The lower ends of the oviducts are attached to the upper part of the body of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a> on either side of the body. They open into the uterus.<\/span><\/p>\n<p>The oviducts are made up of multiple tissue layers. The innermost layer consists of mucosal epithelium. The epithelium is covered with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1597\">cilia<\/a>, which can move in a sweeping motion to help ova move through the tube from the ovary to the uterus. In between the ciliated cells of the epithelium are cells that secrete a fluid called tubular fluid. This fluid contains nutrients for sperm, ova, and zygotes. The secretions in tubular fluid also remove certain molecules from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3397\">plasma membrane<\/a> of sperm so they are better able to penetrate an egg. Other layers of the oviducts consist of connective tissue and smooth muscle. Contractions of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2982\">smooth muscle<\/a> allow <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a> to help move eggs through the tubes.<\/p>\n<div>\n<h1>Ovaries<\/h1>\n<\/div>\n<p>Like the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3486\">testes<\/a> in males, the\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a><\/strong>\u00a0in females are <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3408\">gonad<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0that produce <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3931\">gamete<\/span><span style=\"font-size: 1em\">s<\/span><span style=\"font-size: 1em;text-align: initial\"><\/a><\/span><span style=\"font-size: 1em;text-align: initial\"> and secrete sex <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3569\">hormones<\/a>. The gametes produced by the ovaries are called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5099\">ova<\/a>, or oocytes. The main sex hormone secreted by the ovaries is <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a>. The position of the paired ovaries relative to the other reproductive system organs is shown in Figure 18.6.4. Each ovary lies along one side of the uterus and is about 4 cm (a little more than 1.5 in) long. Fibrous ligaments attach one end of each ovary to its nearby oviduct and the other and to its side of the uterus. These ligaments keep the ovaries in place within the pelvis.<\/span><\/p>\n<figure id=\"attachment_5251\" aria-describedby=\"caption-attachment-5251\" style=\"width: 689px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5251 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Sites_of_tubo_ovarian_abscess-e1593120204450-1.png\" alt=\"18.6.4 Placement of the Ovaries\" width=\"689\" height=\"482\"><figcaption id=\"caption-attachment-5251\" class=\"wp-caption-text\"><em>Figure 18.6.4 The placement of the two ovaries within the pelvis allows eggs from each ovary to enter a Fallopian tube and travel to the uterus.<\/em><\/figcaption><\/figure>\n<h2>Ovarian Follicles<\/h2>\n<p>The ovary consists of two main layers, called the ovarian medulla (the inner layer) and the ovarian cortex (the outer layer). The ovary also contains\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3743\">blood<\/a>\u00a0and lymphatic vessels. The ovarian cortex consists primarily of the functional units of the ovaries, which are called\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">ovarian follicle<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a>.<\/strong><span style=\"text-align: initial;font-size: 1em\"> The follicles are nests of epithelial cells, within each of which is an ovum. The photomicrograph in Figure 18.6.5 shows an ovarian follicle and the developing ovum inside it. If an ovum and follicle complete maturation, the follicle ruptures and the ovum is released from the ovary. This event is called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a>.<\/span><\/p>\n<figure id=\"attachment_5254\" aria-describedby=\"caption-attachment-5254\" style=\"width: 800px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5254\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Ovarian_follicle-1.png\" alt=\"18.6.4 Ovarian Follicle\" width=\"800\" height=\"480\"><figcaption id=\"caption-attachment-5254\" class=\"wp-caption-text\"><em>Figure 18.6.5 An ovum within its nest of follicular cells inside an ovary.<\/em><\/figcaption><\/figure>\n<h2>Ova in the Ovaries<\/h2>\n<p>Whereas the male <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3486\">testes<\/a> produce sperm continuously after\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5155\">puberty<\/a>, the female ovary already contains all the ova it will ever produce by the time a female is born. At birth, a baby girl\u2019s <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a> contain at least a million eggs, each of which is contained within a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">follicle<\/a>. Only about 500 of these eggs will eventually mature and be ovulated. This process starts at puberty and typically continues at monthly intervals until <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5255\">menopause<\/a> occurs around age 52. The remaining eggs never mature, and their number declines as the woman ages. By menopause, a woman\u2019s reserve of eggs is nearly depleted, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a> no longer occurs.<\/p>\n<div>\n<h1>Vulva<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5152\">vulva<\/a><\/strong> is a general term for all of the external female reproductive organs. The vulva includes the clitoris, labia, and external openings for the urethra and vagina.<\/p>\n<h2>Labia<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5154\">labia<\/a><\/strong> (singular, labium) refer to the \u201clips\u201d of the vulva, which are folds of tissue that contain and protect the other, more delicate structures of the vulva (as shown in Figure 18.6.6). There are two pairs of labia: the outer and larger labia majora, and the inner and smaller labia minora. The labia minora contain numerous sebaceous glands. These glands release secretions that help lubricate the labia and vulvar area.<\/p>\n<figure id=\"attachment_5256\" aria-describedby=\"caption-attachment-5256\" style=\"width: 361px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5256\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/HumanVulva-NewText-PhiloViv-1.jpg\" alt=\"18.6.5 Vulva Labeled\" width=\"361\" height=\"256\"><figcaption id=\"caption-attachment-5256\" class=\"wp-caption-text\"><em>Figure 18.6.6 The vulva includes the external features of the female reproductive system including the labia, clitoris and clitoral hood, and the openings from the urethra and to the vagina.<\/em><\/figcaption><\/figure>\n<h2>Clitoris<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5153\">clitoris<\/a>,<\/strong>\u00a0is located at the front of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5152\">vulva<\/a> where the labia minora meet. The visible portion of the clitoris is called the glans clitoris. It is roughly the size and shape of a pea. It is highly sensitive, because it contains many nerve endings. A hood of tissue called the clitoral hood (shown in Figure 18.6.5 above), or prepuce, normally covers and protects the clitoris. The clitoris is the homologue to the male penis, and they both contain spongy tissue.\u00a0\u00a0<span style=\"font-size: 1em\">Stimulation of the glans clitoris during sexual activity generally results in sexual arousal in females, and may lead to orgasm.<\/span><span style=\"font-size: 1em\"> The glans clitoris is the only part of the overall clitoris visible externally, but this spongy tissue extends down either side of the openings to the urethra and vagina, as seen in Figure 18.6.7.<\/span><\/p>\n<figure id=\"attachment_5257\" aria-describedby=\"caption-attachment-5257\" style=\"width: 729px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5257\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Vulva-1.jpg\" alt=\"18.6.6 Clitoris\" width=\"729\" height=\"428\"><figcaption id=\"caption-attachment-5257\" class=\"wp-caption-text\"><em>Figure 18.6.7 While the glans clitoris is the only externally visible part of the clitoris, this spongy tissue extends dorsally into the corpus cavernosum, which flanks the left and right sides of the opening to the vagina.<\/em><\/figcaption><\/figure>\n<h2>Other Vulvar Structures<\/h2>\n<p>The area between the two labia minora is called the vestibule of the vulva. Both the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4732\">urethra<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a> have openings to the outside of the body in the vestibule. As you can see in Figure 18.6.7 above, the urethral opening (or meatus) is located just in front of, and is much smaller than, the vaginal opening. Both openings are protected by the labia. Two glands \u2014 called Bartholin\u2019s glands \u2014 open on either side of the vaginal opening. These glands secrete mucus and a vaginal and vulvar lubricant.<\/p>\n<div>\n<h1>Breasts<\/h1>\n<\/div>\n<figure id=\"attachment_5258\" aria-describedby=\"caption-attachment-5258\" style=\"width: 350px\" class=\"wp-caption alignright\"><img class=\"size-full wp-image-5258\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Breast-Diagram-2.gif\" alt=\"18.6.7 Breasts\" width=\"350\" height=\"274\"><figcaption id=\"caption-attachment-5258\" class=\"wp-caption-text\"><em>Figure 18.6.8 The breasts are not really reproductive organs, but they play a reproductive role as mammary glands that can produce milk to feed an infant.<\/em><\/figcaption><\/figure>\n<p>The breasts are not directly involved in\u00a0reproduction, but because they contain\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3432\">mammary gland<\/strong><strong style=\"font-size: 1em\">s<\/strong><strong style=\"text-align: initial;font-size: 1em\"><\/a>,<\/strong><span style=\"text-align: initial;font-size: 1em\"> they can provide nourishment to an infant after birth. The breasts overlay major muscles in the chest from which they project outward in a conical shape. The two main types of tissues in the breast are adipose (fat) tissue and glandular tissue that produces milk. As shown in Figure 18.6.8, each mature breast contains many lobules, where milk is produced and stored during pregnancy. During breastfeeding (or lactation), the milk drains into ducts and sacs, which in turn converge at the nipple. Milk exits the breast through the nipple in response to the suckling action of an infant and is regulated by a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2962\">positive feedback loop<\/a>. The nipple is surrounded by a more darkly pigmented area called the areola. The areola contains glands that secrete an oily fluid, which lubricates and protects the nipple during breastfeeding.<\/span><\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.6 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>The\u00a0female reproductive system\u00a0is made up of internal and external organs that function to produce <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2484\">haploid<\/a> female <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3931\">gametes<\/a> called ova, secrete female sex hormones (such as <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a>), and carry and give birth to a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5086\">fetus<\/a>.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a> is an elastic, muscular canal that can accommodate the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5091\">penis<\/a>. It is also where sperm are usually ejaculated during <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5149\">sexual intercourse<\/a>. The vagina is the birth canal, and it channels the flow of menstrual blood from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>. A healthy vagina has a balance of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3727\">symbiotic<\/a> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2588\">bacteria<\/a> and an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3599\">acidic<\/a> <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4330\">pH<\/a>.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a> is a muscular organ above the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a> where a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5086\">fetus<\/a> develops. Its muscular walls contract to push out the fetus during childbirth. The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5235\">cervix<\/a> is the neck of the uterus that extends down into the vagina. It contains a canal connecting the vagina and uterus for sperm, or for an infant to pass through. The innermost layer of the uterus \u2014 the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a> \u2014 thickens each month in preparation for an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5262\">embryo<\/a>, but is shed in the following menstrual period if\u00a0fertilization does not occur.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviducts<\/a>\u00a0extend from the uterus to the ovaries. Waving <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5247\">fimbriae<\/a> at the ovary ends of the oviducts guide ovulated eggs into the tubes where <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3917\">fertilization<\/a> may occur as the ova travel to the uterus. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_1597\">Cilia<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2890\">peristalsis<\/a> help ova move through the tubes. Tubular fluid helps nourish sperm as they swim up the tubes toward ova.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a> are <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3408\">gonads<\/a> that produce ova and secrete sex hormones, including <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a>. Nests of cells called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">follicles<\/a> in the ovarian cortex are the functional units of ovaries. Each follicle surrounds an immature ovum. At birth, a baby girl\u2019s ovaries contain at least a million ova, and they will not produce any more during her lifetime. During a woman\u2019s reproductive years, one ova typically matures and is ovulated each month.<\/li>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5152\">vulva<\/a> is a general term for external female reproductive organs. The vulva includes the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5153\">clitoris<\/a>, two pairs of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5154\">labia<\/a>, and openings for the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4732\">urethra<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5143\">vagina<\/a>. Secretions from mucosal glands near the vaginal opening lubricate the vulva.<\/li>\n<li>The breasts are not technically reproductive organs, but their <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3432\">mammary glands<\/a> produce milk to feed an infant after birth. Milk drains through ducts and sacs, and out through the nipple when a\u00a0 baby sucks during breastfeeding.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.6 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-211\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-211\" class=\"h5p-iframe\" data-content-id=\"211\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Mitosis and Cytokinesis True\/False\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>State the general functions of the female reproductive system.<\/li>\n<li>Describe the vagina and its reproductive functions.<\/li>\n<li>Outline the structure and basic functions of the uterus.<\/li>\n<li>What is the endometrium? How does it change during the monthly cycle?<\/li>\n<li>Why are breasts included in discussions of reproduction, if they are not organs of the female reproductive system?<\/li>\n<li>What is the function of the folds in the mucous membrane lining of the vagina?<\/li>\n<li>What are two ways in which the female reproductive system protects itself from pathogens?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.6 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/SkB4gG8ke7Q<\/p>\n<p style=\"text-align: center\">The uncomplicated truth about women's sexuality | Sarah Barmak, TED, 2019.<\/p>\n<p>https:\/\/youtu.be\/9rs2gNchQig<\/p>\n<p style=\"text-align: center\">Human Physiology - Functional Anatomy of the Female Reproductive System, Janux, 2015.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<div id=\"content\" class=\"site-content\">\n<section class=\"standard post-956 chapter type-chapter status-publish hentry focusable\" data-type=\"chapter\">\n<h2>Attributes<\/h2>\n<p><strong>Figure 18.6.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Cattien_stone_yoni.png\" rel=\"cc:attributionURL\">1024px-Cattien_stone_yoni<\/a> by <a title=\"User:Binh Giang\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Binh_Giang\">Binh Giang<\/a> on Wikimedia Commons is in the \u00a0<a class=\"extiw\" title=\"w:en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/en:public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/en:public_domain).<\/p>\n<p><strong>Figure 18.6.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Gray1167.svg\" rel=\"cc:attributionURL\">1000px-Gray1167.svg<\/a> by <a href=\"https:\/\/en.wikipedia.org\/wiki\/Henry_Vandyke_Carter\">Henry Vandyke Carter<\/a>\u00a0(1831-1897) on Wikimedia Commons is in the \u00a0<a class=\"extiw\" title=\"en:public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/public_domain\">public domain<\/a>\u00a0(https:\/\/en.wikipedia.org\/wiki\/public_domain). (<a class=\"extiw\" title=\"en:Bartleby.com\" href=\"https:\/\/en.wikipedia.org\/wiki\/Bartleby.com\">Bartleby.com<\/a>:\u00a0<a class=\"external text\" href=\"http:\/\/www.bartleby.com\/107\/\" rel=\"nofollow\">Gray\u2019s Anatomy<\/a>, <a class=\"external text\" href=\"http:\/\/www.bartleby.com\/107\/illus1167.html\" rel=\"nofollow\">Plate 1167<\/a>).<\/p>\n<p><strong>Figure 18.6.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Uterine_anatomy..jpg\" rel=\"cc:attributionURL\">Uterine_anatomy.<\/a> from <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK27042\/bin\/Teixeira01.jpg\">Uterine Stem cells<\/a> by <a href=\"http:\/\/www.stembook.org\">The Stem Cell Research Community, StemBook<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 18.6.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Sites_of_tubo_ovarian_abscess.PNG\" rel=\"cc:attributionURL\">Sites_of_tubo_ovarian_abscess<\/a> by <a title=\"User:Bfpage\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Bfpage\">Bfpage<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\" rel=\"license\">CC BY-SA 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.<\/p>\n<p><strong>Figure 18.6.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Ovarian_follicle.png\" rel=\"cc:attributionURL\">Ovarian_follicle<\/a> by <a title=\"User:TiagoLubiana\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:TiagoLubiana\">TiagoLubiana<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" rel=\"license\">CC BY 4.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/4.0) license.<\/p>\n<p><strong style=\"text-align: initial;font-size: 1em\"><br \/>\nFigure 18.6.6<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:HumanVulva-NewText-PhiloViv.jpg#file\" rel=\"cc:attributionURL\">HumanVulva-NewText-PhiloViv<\/a> by <a title=\"User:Amphis\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Amphis\">Amphis<\/a> (edited) on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en\" rel=\"license\">CC BY-SA 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.en) license. (<span style=\"text-align: initial;font-size: 1em\">Original \u00a0<a class=\"extiw\" title=\"en:Image:HumanVulva-NoText-PhiloVivero.jpg\" href=\"https:\/\/en.wikipedia.org\/wiki\/Image:HumanVulva-NoText-PhiloVivero.jpg\">en:Image:HumanVulva-NoText-PhiloVivero.jpg<\/a> by <\/span><a class=\"extiw\" style=\"text-align: initial;font-size: 1em\" title=\"en:user:PhiloVivero\" href=\"https:\/\/en.wikipedia.org\/wiki\/user:PhiloVivero\">en:user:PhiloVivero<\/a>)<\/p>\n<p><strong>Figure 18.6.7<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_28_02_02.jpg\" rel=\"cc:attributionURL\">Vulva<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system\">OpenStax College<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 18.6.8<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Breast-Diagram.gif\" rel=\"cc:attributionURL\">Breast-Diagram<\/a> by <a href=\"https:\/\/www.womenshealth.gov\/cancer\/breast-cancer\">Women's Health<\/a> (NCI\/ NIH) on Wikimedia Commons is in the <a class=\"extiw\" title=\"w:en:Public domain\" href=\"https:\/\/en.wikipedia.org\/wiki\/en:Public_domain\">public domain<\/a> (https:\/\/en.wikipedia.org\/wiki\/en:Public_domain).<\/p>\n<p>&nbsp;<\/p>\n<div class=\"media-atttributions\">\n<p><span style=\"font-size: 1.424em;font-weight: bold;color: #333333\">References<\/span><\/p>\n<\/div>\n<\/section>\n<\/div>\n<p class=\"hanging-indent\"><span class=\"os-title-label\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure\u00a0<\/span><span class=\"os-number\">27.10<\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"33336\" class=\"os-title\" data-type=\"title\">The vulva [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/span><\/p>\n<p class=\"hanging-indent\">Janux. (2015, January 10). Human physiology - Functional anatomy of the female reproductive system. YouTube. https:\/\/www.youtube.com\/watch?v=9rs2gNchQig&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">TED. (2019, March 22). The uncomplicated truth about women's sexuality | Sarah Barmak. YouTube.\u00a0 https:\/\/www.youtube.com\/watch?v=SkB4gG8ke7Q&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">Teixeira, J., Rueda, B.R., and Pru, J.K. (September 30, 2008). Figure 1 Uterine anatomy. In <em>Uterine Stem Cells<\/em> (StemBook, ed.). The Stem Cell Research Community, StemBook, doi\/10.3824\/stembook.1.16.1, http:\/\/www.stembook.org<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4100\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4100\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<figure id=\"attachment_5295\" aria-describedby=\"caption-attachment-5295\" style=\"width: 400px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5295\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/WaterforPeople_Uganda-1.jpg\" alt=\"18.8.1 Menstruation Awareness\" width=\"400\" height=\"300\"><figcaption id=\"caption-attachment-5295\" class=\"wp-caption-text\"><em>Figure 18.8.1 It's healthy to talk about menstruation.<\/em><\/figcaption><\/figure>\n<div>\n<h1>Taboo Topic<\/h1>\n<\/div>\n<p>The banner in Figure 18.8.1 was carried in a 2014 march in Uganda as part of the celebration of Menstrual Hygiene Day. Menstrual Hygiene Day is an awareness day on May 28 of each year that aims to raise awareness worldwide about menstruation and menstrual hygiene. Maintaining good menstrual hygiene is difficult in developing countries like Uganda because of taboos on discussing menstruation and lack of availability of menstrual hygiene products. Poor menstrual hygiene, in turn, can lead to embarrassment, degradation, and reproductive health problems in females. May 28 was chosen as Menstrual Hygiene Day because of its symbolism. May is the fifth month of the year, and most women average five days of menstrual bleeding each month. The 28th day was chosen because the menstrual cycle averages about 28 days.<\/p>\n<div>\n<h1>What Is the Menstrual Cycle?<\/h1>\n<\/div>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5293\">menstrual cycle<\/a><\/strong> refers to natural changes that occur in the female reproductive system each month during the reproductive years. The cycle is necessary for the production of ova and the preparation of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a> for <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5280\">pregnancy<\/a>. It involves changes in both the ovaries and the uterus, and is controlled by pituitary and ovarian hormones. Day 1 of the cycle is the first day of the menstrual period,\u00a0when bleeding from the uterus begins as the built-up <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a> lining the uterus is shed. The endometrium builds up again during the remainder of the cycle, only to be shed again during the beginning of the next cycle if\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5280\">pregnancy<\/a>\u00a0does not occur. In the ovaries, the menstrual cycle includes the\u00a0development\u00a0of a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">follicle<\/a>, ovulation of a secondary oocyte, and then degeneration of the follicle if pregnancy does not occur. Both uterine and ovarian changes during the menstrual cycle are generally divided into three phases, although the phases are not the same in the two organs.<\/p>\n<h2>Menarche and Menopause<\/h2>\n<p>The female reproductive years are delineated by the start and stop of the menstrual cycle. The first menstrual period usually occurs around 12 or 13 years of age, an event that is known as\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5300\">menarche<\/a>.<\/strong>\u00a0There is considerable variation among individuals in the age at menarche. It may occasionally occur as early as eight years of age or as late as 16 years of age and still be considered normal. The average age is generally later in the developing world, and earlier in the developed world. This variation is thought to be largely attributable to nutritional differences.<\/p>\n<p>The cessation of menstrual cycles at the end of a woman\u2019s reproductive years is termed\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5255\">menopause<\/a>.<\/strong>\u00a0The average age of menopause is 52 years, but it may occur normally at any age between about 45 and 55 years of age. The age of menopause varies due to a variety of biological and environmental factors.\u00a0It\u00a0may occur earlier as a result of certain illnesses or medical treatments.<\/p>\n<h2>Variation in the Menstrual Cycle<\/h2>\n<p>The length of the menstrual cycle \u2014 as well as its phases \u2014 may vary considerably, not only among different women, but also from month to month for a given woman. The average length of time between the first day of one menstrual period and the first day of the next menstrual period is 28 days, but it may range from 21 days to 45 days. Cycles are considered regular when a woman\u2019s longest and shortest cycles differ by less than eight days. The menstrual period itself is usually about five days long, but it may vary in length from about two days to seven days.<\/p>\n<div>\n<h1>Ovarian Cycle<\/h1>\n<\/div>\n<p>The events of the menstrual cycle that take place in the ovaries make up the\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5301\">ovarian cycle<\/a>.<\/strong> It consists of changes that occur in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">follicles<\/a> of one of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a>. The ovarian cycle is divided into the following three phases: follicular phase, ovulation, and luteal phase. These phases are illustrated in Figure 18.8.2.<\/p>\n<figure id=\"attachment_5302\" aria-describedby=\"caption-attachment-5302\" style=\"width: 919px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5302 \" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Ovarian-Cycle-e1593185427416-1.png\" alt=\"18.8.2 Ovarian Cycle\" width=\"919\" height=\"473\"><figcaption id=\"caption-attachment-5302\" class=\"wp-caption-text\"><em>Figure 18.8.2 The phases and days of the ovarian cycle are shown in this diagram. The ovarian cycle depicted in the diagram represents a cycle in which fertilization does not occur so the corpus luteum degenerates during the luteal phase.<\/em><\/figcaption><\/figure>\n<h2>Follicular Phase<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5303\">follicular phase<\/a><\/strong>\u00a0is the first phase of the ovarian cycle. It generally lasts about 12 to 14 days for a 28-day menstrual cycle. During this phase, several <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">ovarian follicle<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\"> are stimulated to begin maturing, but usually only one \u2014 called the Graafian follicle \u2014 matures completely so it is ready to release an egg. The other maturing follicles stop growing and disintegrate. Follicular development occurs because of a rise in the blood level of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5206\">follicle stimulating hormone<\/a> (FSH), which is secreted by the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a>. The maturing follicle releases <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a>, the level of which rises throughout the follicular phase. You can see these and other changes in hormone levels that occur during the menstrual cycle in the following chart.<\/span><\/p>\n<figure id=\"attachment_5304\" aria-describedby=\"caption-attachment-5304\" style=\"width: 724px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5304 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Figure_43_04_04-e1593185848433-1.png\" alt=\"18.8.3 Pituitary and Ovarian Hormones\" width=\"724\" height=\"457\"><figcaption id=\"caption-attachment-5304\" class=\"wp-caption-text\"><em>Figure 18.8.3 FSH and estrogen increase during the first half of the menstrual cycle. LH surges shortly before ovulation occurs due to the rise in estrogen.<\/em><\/figcaption><\/figure>\n<h2>Ovulation<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">Ovulation<\/a><\/strong>\u00a0is the second phase of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5301\">ovarian cycle<\/a>. It usually occurs around day 14 of a 28-day menstrual cycle. During this phase, the Graafian follicle ruptures and releases its ovum. Ovulation is stimulated by a sudden rise in the blood level of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5205\">luteinizing hormone<\/a> (LH) from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a>. This is called the LH surge. You can see the LH surge in the top hormone graph in Figure 18.8.3. The LH surge generally starts around day 12 of the cycle and lasts for a day or two. The surge in LH is triggered by a continued rise in estrogen from the maturing follicle in the ovary. During the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5303\">follicular phase<\/a>, the rising estrogen level actually suppresses LH secretion by the pituitary gland. However, by the time the follicular phase is nearing its end, the level of estrogen reaches a threshold level above which this effect is reversed, and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a> stimulates the release of a large amount of LH. The surge in LH matures the ovum and weakens the wall of the follicle, causing the fully developed follicle to release its secondary <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5274\">oocyte<\/a>.<\/p>\n<h2>Luteal Phase<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5305\">luteal phase<\/a><\/strong>\u00a0is the third and final phase of the ovarian cycle. It typically lasts about 14 days in a 28-day menstrual cycle. At the beginning of the luteal phase, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5206\">FSH<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5306\">LH<\/a> cause the Graafian follicle that ovulated the egg to transform into a structure called a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5277\">corpus luteum<\/a>. The corpus luteum secretes <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3411\">progesterone<\/a>, which in turn suppresses FSH and LH production by the pituitary gland and stimulates the continued buildup of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a> in the uterus. How this phase ends depends on whether or not the ovum has been fertilized.<\/p>\n<ul>\n<li>If\u00a0fertilization\u00a0has not occurred, the falling levels of FSH and LH during the luteal phase cause the corpus luteum to atrophy, so its production of progesterone declines. Without a high level of progesterone to maintain it, the endometrium starts to break down. By the end of the luteal phase, the endometrium can no longer be maintained, and the next menstrual cycle begins with the shedding of the endometrium (menses).<\/li>\n<li>If\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3917\">fertilization<\/a>\u00a0has occurred so a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2471\">zygote<\/a> forms and then divides to become a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5279\">blastocyst<\/a>, the outer layer of the blastocyst produces a\u00a0hormone\u00a0called <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5307\">human chorionic gonadotropin<\/a> (HCG). This hormone is very similar to LH and preserves the corpus luteum. The corpus luteum can then continue to secrete progesterone to maintain the new pregnancy.<\/li>\n<\/ul>\n<div>\n<h1>Uterine Cycle<\/h1>\n<\/div>\n<p>The events of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5293\">menstrual cycle<\/a> that take place in the uterus make up the\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5308\">uterine cycle<\/a><\/strong>. This cycle consists of changes that occur mainly in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a>, which is the layer of tissue that lines the uterus. The uterine cycle is divided into the following three phases: menstruation, proliferative phase, and secretory phase. These phases are illustrated in Figure 18.8.4.<\/p>\n<figure id=\"attachment_5309\" aria-describedby=\"caption-attachment-5309\" style=\"width: 488px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5309 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/Ovarian-and-menstrual-cycle-e1593188761715-1.jpg\" alt=\"18.8.4 Uterine cycle\" width=\"488\" height=\"206\"><figcaption id=\"caption-attachment-5309\" class=\"wp-caption-text\"><em>Figure 18.8.4 The uterine cycle begins with menstruation, which starts on day 1 of the cycle. The relative thickness of the endometrium in each phase is indicated in pink.<\/em><\/figcaption><\/figure>\n<h2>Menstruation<\/h2>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5310\">Menstruation<\/a><\/strong> (also called menstrual period or menses) is the first phase of the uterine cycle. It occurs if <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3917\">fertilization<\/a> has not taken place during the preceding menstrual cycle. During menstruation, the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a> of the uterus, which has built up during the preceding cycle, degenerates and is shed from the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>, flowing through an opening in the cervix, and out through the external opening of the vagina. The average loss of blood during menstruation is about 35 mL (about 1 oz or 2 tablespoons). The flow of blood is often accompanied by uterine cramps, which may be severe in some women.<\/p>\n<h2>Proliferative Phase<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5311\">proliferative phase<\/a><\/strong>\u00a0is the second phase of the uterine cycle. During this phase, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a> secreted by\u00a0cells\u00a0of the maturing <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">ovarian follicle<\/a> causes the lining of the uterus to grow, or proliferate. Estrogen also stimulates the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5235\">cervix<\/a> of the uterus to secrete larger amounts of thinner mucus that can help\u00a0<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a>\u00a0swim through the cervix and into the uterus, making fertilization more likely.<\/p>\n<h2>Secretory Phase<\/h2>\n<p>The\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5312\">secretory phase<\/a><\/strong>\u00a0is the third and final phase of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5308\">uterine cycle<\/a>. During this phase, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3411\">progesterone<\/a> produced by the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5277\">corpus luteum<\/a> in the ovary stimulates further changes in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5241\">endometrium<\/a> so it is more receptive to implantation of a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5279\">blastocyst<\/a>. For example, progesterone increases blood flow to the uterus and promotes uterine secretions. It also decreases the contractility of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2982\">smooth muscle<\/a> tissue in the uterine wall.<\/p>\n<p>&nbsp;<\/p>\n<h1>Bringing it All Together<\/h1>\n<p>It is important to note that the pituitary gland, the ovaries and the uterus are all responsible for parts of the ovarian and uterine cycles.\u00a0 The pituitary hormones, LH and FSH affect the ovarian cycle and its hormones.\u00a0 The ovarian hormones, estrogen and progesterone affect the uterine cycle and also feedback on the pituitary gland.\u00a0 Look at Figure 18.8.5 and look at what is happening on different days of the cycle in each of the sets of hormones, the ovarian cycle and the uterine cycle.<\/p>\n<figure id=\"attachment_5313\" aria-describedby=\"caption-attachment-5313\" style=\"width: 1000px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5313\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1000px-MenstrualCycle2_en.svg_-1.png\" alt=\"18.8.8 Overview of ovarian and uterine cycle\" width=\"1000\" height=\"977\"><figcaption id=\"caption-attachment-5313\" class=\"wp-caption-text\"><em>Figure 18.8.5 The pituitary gland, ovarian cycle and uterine cycle are all interrelated in their regulation and participation in the monthly reproductive cycles of women.<\/em><\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.8 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li>The <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5293\">menstrual cycle<\/a> refers to natural changes that occur in the female reproductive system each month during the reproductive years, except when a woman is pregnant. The cycle is necessary for the production of ova and the preparation of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a> for <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5280\">pregnancy<\/a>. It involves changes in both the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a> and uterus, and is controlled by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a> hormones (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5206\">FSH<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5306\">LH<\/a>) and ovarian hormones (<a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3903\">estrogen<\/a> and <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3411\">progesterone<\/a>).<\/li>\n<li>The female reproductive period is delineated by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5300\">menarche<\/a>, or the first menstrual period, which usually occurs around age 12 or 13; and by <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5255\">menopause<\/a>, or the cessation of menstrual periods, which typically occurs around age 52. A typical menstrual cycle averages 28 days in length but may vary normally from 21 to 45 days. The average menstrual period is five days long, but may vary normally from two to seven days. These variations in the menstrual cycle may occur both between women and within individual women from month to month.<\/li>\n<li>The events of the menstrual cycle that take place in the ovaries make up the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5301\">ovarian cycle<\/a>. It includes the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5303\">follicular phase<\/a> (when a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5253\">follicle<\/a> and its ovum mature due to rising levels of FSH), <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a> (when the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5099\">ovum<\/a> is released from the ovary due to a rise in estrogen and a surge in LH), and the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5305\">luteal phase<\/a> (when the follicle is transformed into a structure called a corpus luteum that secretes progesterone). In a 28-day menstrual cycle, the follicular and luteal phases typically average about two weeks in length, with ovulation generally occurring around day 14 of the cycle.<\/li>\n<li>The events of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5293\">menstrual cycle<\/a> that take place in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a> make up the uterine cycle. It includes <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5310\">menstruation<\/a>, which generally occurs on days 1 to 5 of the cycle and involves shedding of endometrial tissue that built up during the preceding cycle; the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5311\">proliferative phase<\/a>, during which the endometrium builds up again until <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a> occurs; and the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5312\">secretory phase<\/a>, which follows ovulation and during which the endometrium secretes substances and undergoes other changes that prepare it to receive an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5262\">embryo<\/a>.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.8 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>\n<div id=\"h5p-213\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-213\" class=\"h5p-iframe\" data-content-id=\"213\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Eukaryote and Prokaryote Drag and Drop\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>What is the menstrual cycle? Why is the menstrual cycle necessary in order for pregnancy to occur?<\/li>\n<li>What organs are involved in the menstrual cycle?<\/li>\n<li>Identify the two major events that mark the beginning and end of the reproductive period in females. When do these events typically occur?<\/li>\n<li>Discuss the average length of the menstrual cycle and menstruation, as well as variations that are considered normal.<\/li>\n<li>If the LH surge did not occur in a menstrual cycle, what do you think would happen? Explain your answer.<\/li>\n<li>Give one reason why FSH and LH levels drop in the luteal phase of the menstrual cycle.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.8 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/cjbgZwgdY7Q<\/p>\n<p style=\"text-align: center\">Why do women have periods? TED-Ed, 2015.<\/p>\n<p>https:\/\/youtu.be\/5B3Abpv0ysM<\/p>\n<p style=\"text-align: center\">Girl's Rite of Passage | National Geographic, 2007.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 18.8.1<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:WaterforPeople_Uganda.jpg\" rel=\"cc:attributionURL\">WaterforPeople_Uganda<\/a> by <a href=\"https:\/\/www.flickr.com\/photos\/gtzecosan\/17511016219\/in\/album-72157626959211983\/\">WaterforPeople_Uganda<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/2.0\" rel=\"license\">CC BY 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/2.0) license.<\/p>\n<p><strong>Figure 18.8.2<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_43_04_04.png%20andhttps:\/\/commons.wikimedia.org\/wiki\/File:MenstrualCycle2_en.svg\" rel=\"cc:attributionURL\">Ovarian Cycle<\/a> by <a href=\"https:\/\/cnx.org\/contents\/GFy_h8cu@10.53:Ha3dnFEx@6\/Hormonal-Control-of-Human-Reproduction\">CNX OpenStax<\/a> on Wikimedia Commons is used and adapted under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" rel=\"license\">CC BY 4.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/4.0) license.<\/p>\n<p><strong>Figure 18.8.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_43_04_04.png\" rel=\"cc:attributionURL\">Figure_43_04_04<\/a>\u00a0by <a href=\"https:\/\/cnx.org\/contents\/GFy_h8cu@10.53:Ha3dnFEx@6\/Hormonal-Control-of-Human-Reproduction\">CNX OpenStax<\/a> on Wikimedia Commons is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\" rel=\"license\">CC BY 4.0 <\/a>(https:\/\/creativecommons.org\/licenses\/by\/4.0) license. (Original: modification of work by Mikael H\u00e4ggstr\u00f6m)<\/p>\n<p><strong>Figure 18.8.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Figure_28_02_07.jpg\" rel=\"cc:attributionURL\">Ovarian and menstrual cycle<\/a>\u00a0by <a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system\">OpenStax College<\/a> on Wikimedia Commons is used under a\u00a0 <a href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.<\/p>\n<p><strong>Figure 18.8.5<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:MenstrualCycle2_en.svg\" rel=\"cc:attributionURL\">1000px-MenstrualCycle2_en.svg<\/a> by <a title=\"User:Isometrik\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:Isometrik\">Isometrik<\/a> on Wikimedia Common is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\" rel=\"license\">CC BY-SA 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-sa\/3.0) license.<\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). <span class=\"os-title-label\">Figure\u00a0<\/span><span class=\"os-number\">27.15<\/span><span class=\"os-divider\">\u00a0<\/span><span id=\"78432\" class=\"os-title\" data-type=\"title\">Hormone levels in ovarian and menstrual cycles<\/span> [digital image].\u00a0 In <em>Anatomy and Physiology<\/em> (Section 27.2). OpenStax. https:\/\/openstax.org\/books\/anatomy-and-physiology\/pages\/27-2-anatomy-and-physiology-of-the-female-reproductive-system<\/p>\n<p class=\"hanging-indent\">National Geographic. (2007, May 31). Girl's rite of passage | National Geographic. YouTube. https:\/\/www.youtube.com\/watch?v=5B3Abpv0ysM&amp;feature=youtu.be<\/p>\n<p class=\"hanging-indent\">OpenStax. (2016, May 27) Figure 4 Rising and falling hormone levels result in progression of the ovarian and menstrual cycles [digital image]. In <em>Open Stax, Biology<\/em> (Section 43.4). OpenStax CNX. https:\/\/cnx.org\/contents\/GFy_h8cu@10.53:Ha3dnFEx@6\/Hormonal-Control-of-Human-Reproduction<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, October 19). Why do women have periods? YouTube.\u00a0 https:\/\/www.youtube.com\/watch?v=cjbgZwgdY7Q&amp;feature=youtu.be<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_5483\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_5483\"><div tabindex=\"-1\"><p>A synovial joint in which an oval-shaped process of one bone fits into a roughly elliptical cavity of the other, allowing movement in two planes.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_4102\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_4102\"><div tabindex=\"-1\"><p>Created by CK-12 Foundation\/Adapted by Christine Miller<\/p>\n<div id=\"h5p-215\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-215\" class=\"h5p-iframe\" data-content-id=\"215\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Cell Biology Multiple Choice\"><\/iframe><\/div>\n<\/div>\n<p><em>Figure 18.10.1 Families all have something in common.<\/em><\/p>\n<div>\n<h1>Family Portrait<\/h1>\n<\/div>\n<p>What do all these families (Figure 18.10.1) have in common?\u00a0 They were born!\u00a0 Every person on this planet was conceived, carried in utero and then born.\u00a0 While families come in all shapes, sizes and styles, we all came into existence in the same way.\u00a0 Virtually all human societies past and present \u2014 value having children. Indeed, for many people, parenthood is an important life goal. Unfortunately, some people are unable to achieve that goal because of infertility.<\/p>\n<div>\n<h1>What Is Infertility?<\/h1>\n<\/div>\n<p><strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4813\">Infertility<\/a><\/strong> is the inability of a sexually mature adult to reproduce by natural means. For scientific and medical purposes, infertility is generally defined as the failure to achieve a successful pregnancy after at least one year of regular, unprotected sexual intercourse. Infertility may be primary or secondary. Primary infertility applies to cases in which an individual has never achieved a successful pregnancy. Secondary infertility applies to cases in which an individual has had at least one successful pregnancy, but fails to achieve another after trying for at least a year. Infertility is a common problem. The government of Canada reported that in 2019, 16% of Canadian couples experience infertility, a number which has doubled since the 1980s. If you look around at the couples you know, that means that almost 1 in 6 of them are having issues with fertility.<\/p>\n<div>\n<h1>Causes of Infertility<\/h1>\n<\/div>\n<p><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5280\">Pregnancy<\/a> is the result of a multi-step process. In order for a normal pregnancy to occur, a woman must release an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5099\">ovum<\/a> from one of her <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a>, the ovum must go through an <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviduct<\/a>, a man\u2019s <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a> must fertilize the ovum as it passes through the oviduct, and then the resulting <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2471\">zygote<\/a> must implant in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>. If there is a problem with any of these steps, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4813\">infertility<\/a> can result.<\/p>\n<p>A couple\u2019s infertility may be due to a problem with either the male or the female partner. As shown in the circle graph below (Figure 18.10.2), about 40% of infertility cases are due to female infertility, and about 30% are due to male infertility. The remaining 30% of cases are due to a combination of male and female problems or unknown causes.<\/p>\n<figure id=\"attachment_5342\" aria-describedby=\"caption-attachment-5342\" style=\"width: 900px\" class=\"wp-caption aligncenter\"><img class=\"wp-image-5342 size-full\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2019\/06\/Causes-of-infertility-in-Canada-1.png\" alt=\"18.10.2 Causes of Infertility\" width=\"900\" height=\"515\"><figcaption id=\"caption-attachment-5342\" class=\"wp-caption-text\"><em>Figure 18.10.2 This graph shows that infertility affects males as often as females, and that the cause of infertility often is unexplained.<\/em><\/figcaption><\/figure>\n<h2>Causes of Male Infertility<\/h2>\n<p>Male infertility occurs when there are no, or too few, <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a>, or when the sperm are not healthy and motile and cannot travel through the female reproductive tract to fertilize an egg. A common cause of inadequate numbers or motility of sperm is varicocele, which is enlargement of blood vessels in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5089\">scrotum<\/a>. This may raise the temperature of the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3486\">testes<\/a> and adversely affect sperm production. In other cases, there is no problem with the sperm, but there is a blockage in the male reproductive tract that prevents the sperm from being ejaculated.<\/p>\n<p>Factors that increase a man\u2019s risk of infertility include heavy alcohol use, drug abuse, cigarette smoking, exposure to environmental toxins (such as pesticides or lead), certain medications, serious diseases (such as kidney disease), and radiation or chemotherapy for cancer. Another risk factor is advancing age. Male fertility normally peaks in the mid-twenties and gradually declines after about age 40, although it may never actually drop to zero.<\/p>\n<h2>Causes of Female Infertility<\/h2>\n<p>Female infertility generally occurs due to one of two problems: failure to produce viable <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5099\">ova<\/a> by the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3487\">ovaries<\/a>, or structural problems in the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5101\">oviduct<span style=\"font-size: 1em\">s<\/span><span style=\"text-align: initial;font-size: 1em\"><\/a><\/span><span style=\"text-align: initial;font-size: 1em\">\u00a0or <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5102\">uterus<\/a>. The most common cause of female infertility is a problem with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a>. Without ovulation, there are no ova to be fertilized. Anovulatory cycles (menstrual cycles in which ovulation does not occur) may be associated with no or irregular menstrual periods, but even regular menstrual periods may be anovulatory for a variety of reasons. The most common cause of anovulatory cycles is <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_3485\"><strong>polycystic ovary syndrome (PCOS)<\/strong><\/a>, which causes hormone imbalances that can interfere with normal ovulation. Another relatively common cause of anovulation is primary ovarian insufficiency. In this condition, the ovaries stop working normally and producing viable eggs at a relatively early age, generally before the age of 40.<\/span><\/p>\n<p>Structural problems with the oviducts or uterus are less common causes of female infertility. The oviducts may be blocked as a result of <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5333\">endometriosis<\/a>. Another possible cause is pelvic inflammatory disease, which occurs when sexually transmitted infections spread to the oviducts or other female reproductive organs (see Figure 18.10.3). The infection may lead to scarring and blockage of the oviducts. If an ovum is produced and the oviducts are functioning \u2014 and a woman has a condition such as uterine fibroids \u2014 implantation in the uterus may not be possible. Uterine fibroids are non-cancerous clumps of tissue and muscle that form on the walls of the uterus.<\/p>\n<figure id=\"attachment_5344\" aria-describedby=\"caption-attachment-5344\" style=\"width: 1024px\" class=\"wp-caption aligncenter\"><img class=\"size-full wp-image-5344\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Blausen_0719_PelvicInflammatoryDisease-1.png\" alt=\"18.10.3 Pelvic inflammatory disease\" width=\"1024\" height=\"768\"><figcaption id=\"caption-attachment-5344\" class=\"wp-caption-text\"><em>Figure 18.10.3 An infection of the Fallopian tubes may cause scarring and blockage of the tubes, so sperm cannot reach eggs for fertilization.<\/em><\/figcaption><\/figure>\n<p>Factors that increase a woman\u2019s risk of infertility include tobacco smoking, excessive use of alcohol, stress, poor diet, strenuous athletic training, and being overweight or underweight. Advanced age is even more problematic for females than males. Female fertility normally peaks in the mid-twenties, and continuously declines after age 30 and until menopause around the age of 52, after which the ovary no longer releases eggs. About 1\/3 of couples in which the woman is over age 35 have fertility problems. In older women, more cycles are likely to be anovulatory, and the eggs may not be as healthy.<\/p>\n<h1>Diagnosing Causes of Infertility<\/h1>\n<p>Diagnosing the cause(s) of a couple\u2019s infertility often requires testing both the man and the woman for potential problems. In men, the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4885\">semen<\/a> is likely to be examined for the number, shape, and motility of sperm. If problems are found with sperm, further studies are likely to be done, such as medical imaging to look for structural problems with the testes or ducts.<\/p>\n<p>In women, the first step is most often determining whether <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5239\">ovulation<\/a> is occurring. This can be done at home by carefully monitoring body temperature (it rises slightly around the time of ovulation) or using a home ovulation test kit, which is available over the counter at most drugstores. Whether or not ovulation is occurring can also be detected with blood tests or ultrasound imaging of the ovaries. If ovulation is occurring normally, then the next step may be an X-ray of the oviducts and uterus to see if there are any blockages or other structural problems. Another approach to examining the female reproductive tract for potential problems is laparoscopy. In this surgical procedure, a tiny camera is inserted into the woman\u2019s abdomen through a small incision. This allows the doctor to directly inspect the reproductive organs.<\/p>\n<div>\n<h1>Treating Infertility<\/h1>\n<\/div>\n<p>Infertility often can be treated successfully. The type of treatment depends on the cause of infertility.<\/p>\n<h2>Treating Male Infertility<\/h2>\n<p>Medical problems that interfere with sperm production may be treated with medications or other interventions that may lead to the resumption of normal sperm production.\u00a0If, for example,\u00a0an infection is interfering with sperm production, then antibiotics that clear up the infection may resolve the problem. If there is a blockage in the male reproductive tract that prevents the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5150\">ejaculation<\/a> of sperm, surgery may be able to remove the blockage. Alternatively, the man\u2019s sperm may be removed from his body and then used for artificial insemination of his partner. In this procedure, the sperm are injected into the woman\u2019s reproductive tract.<\/p>\n<h2>Treating Female Infertility<\/h2>\n<p>In females, it may be possible to correct blocked Fallopian tubes or uterine fibroids with surgery. Ovulation problems, on the other hand, are usually treated with hormones that act either on the <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2938\">pituitary gland<\/a> or on the ovaries. Hormonal treatments that stimulate ovulation often result in more than one egg being ovulated at a time, thus increasing the chances of a woman having twins, triplets, or even higher multiple births. Multiple fetuses are at greater risk of being born too early or having health and developmental problems. The mother is also at greater risk of complications arising during pregnancy. Therefore, the possibility of multiple fetuses should be weighed in making a decision about this type of infertility treatment.<\/p>\n<h2>Assisted Reproductive Technology<\/h2>\n<p>Some cases of infertility are treated with\u00a0<strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5345\">assisted reproductive technology (ART)<\/a><\/strong>. This is a collection of medical procedures in which ova are removed from the woman\u2019s body and sperm are taken from the man\u2019s body to be manipulated in ways that increase the chances of fertilization occurring. The eggs and sperm may be injected into one of the woman\u2019s oviducts for fertilization to take place <em>in vivo<\/em>\u00a0(in the body). More commonly, however, the eggs and sperm are mixed together outside the body so fertilization takes place\u00a0<em>in vitro<\/em> (in a test tube or dish in a lab). The latter approach is illustrated in Figure 18.10.4. With <em>in vitro <\/em>fertilization, the fertilized eggs may be allowed to develop into embryos before being placed in the woman\u2019s uterus.<\/p>\n<figure id=\"attachment_5346\" aria-describedby=\"caption-attachment-5346\" style=\"width: 508px\" class=\"wp-caption aligncenter\"><img class=\" wp-image-5346\" src=\"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-content\/uploads\/sites\/152\/2023\/10\/1024px-Blausen_0060_AssistedReproductiveTechnology-1.png\" alt=\"18.10.4 Assisted Reproductive Technology\" width=\"508\" height=\"381\"><figcaption id=\"caption-attachment-5346\" class=\"wp-caption-text\"><em>Figure 18.10.4 This figure shows one way ART procedures may be used to treat infertility. An egg is removed from the female reproductive tract, injected with sperm from her partner, and allowed to develop into an embryo in the lab. Then, the embryo is placed inside the woman\u2019s uterus for implantation and development during the remainder of gestation.<\/em><\/figcaption><\/figure>\n<p>ART has about a 40% chance of leading to a live birth in women under the age of 35, but only about a 20%t chance of success in women over the age of 35. Some studies have found a higher-than-average risk of birth defects in children produced by ART procedures, but this may be due to the generally higher ages of the parent \u2014 not the technologies used.<\/p>\n<h2>Other Approaches<\/h2>\n<p>Other approaches for certain causes of infertility include the use of a surrogate mother, a gestational carrier, or sperm donation.<\/p>\n<ul>\n<li>A\u00a0<strong>surrogate mother<\/strong>\u00a0is a woman who agrees to become pregnant using the man\u2019s sperm and her own egg. The child, who will be the biological offspring of the surrogate and the male partner, is given up at birth for adoption by the couple. Surrogacy might be selected by women with no eggs or unhealthy eggs.\u00a0A\u00a0woman who carries a mutant gene for a serious genetic disorder might choose this option to ensure that the defective gene is not passed on to the offspring.<\/li>\n<li>A\u00a0<strong>gestational carrier<\/strong>\u00a0is a woman who agrees to receive a transplanted embryo from a couple and carry it to term. The child, who will be the biological offspring of the couple, is given to the parents at birth. A gestational carrier might be used by women who have normal ovulation but no uterus, or who cannot safely carry a fetus to term because of a serious health problem (such as kidney disease or cancer).<\/li>\n<li><strong>Sperm donation<\/strong>\u00a0is the use of sperm from a fertile man (generally through artificial insemination) for cases in which the male partner in a couple is infertile, or in which a woman seeks to become pregnant without a male partner.\u00a0A\u00a0lesbian couple may use donated sperm to enable one of them to become pregnant and have a child.\u00a0Sperm can be obtained from a sperm bank, which buys and stores sperm for artificial insemination, or a male friend or other individual may donate sperm to a specific woman.<\/li>\n<\/ul>\n<div>\n<h1>Social and Ethical Issues Relating to Infertility<\/h1>\n<\/div>\n<p>For people who have a strong desire for children of their own, infertility may lead to deep disappointment and depression. Individuals who are infertile may even feel biologically inadequate. Partners in infertile couples may argue and feel resentment toward each other, and married couples may get divorced because of infertility. Infertility treatments \u2014 especially ART procedures \u2014 are generally time-consuming and expensive. The high cost of the treatments can put them out of financial reach of many couples.<\/p>\n<h2>Ethical Concerns<\/h2>\n<p>Some people question whether the allocation of medical resources to infertility treatments is justified, and whether the resources could be better used in other ways. The status of embryos that are created\u00a0<em>in vitro<\/em>\u00a0and then not used for a pregnancy is another source of debate. Some people oppose their destruction on religious grounds, and couples may sometimes argue about what should be done with their extra embryos. Ethical issues are also raised by procedures that increase the chances of multiple births, because of the medical and developmental risks associated with multiple births.<\/p>\n<h2>Infertility in Developing Countries<\/h2>\n<p>Infertility is an under-appreciated problem in the poorer nations of the world, because of assumptions about overpopulation problems and high birth rates in developing countries. In fact, infertility is at least as great a problem in developing as in developed countries. High rates of health problems and inadequate health care in the poorer nations increase the risk of infertility. At the same time, infertility treatments are usually not available \u2014 or are far too expensive \u2014 for the vast majority of people who may need them. In addition, in many developing countries, the production of children is highly valued. Children may be needed for family income generation and economic security of the elderly. It is not uncommon for infertility to lead to social stigmatization, psychological problems, and abandonment by spouses.<\/p>\n<div>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.10 Summary<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ul>\n<li><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_4813\">Infertility<\/a> is the inability of a sexually mature adult to reproduce by natural means. It is defined scientifically and medically as the failure to achieve a successful pregnancy after at least one year of regular, unprotected sexual intercourse.<\/li>\n<li>About 40% of infertility in couples is due to female infertility, and another 30% is due to male infertility. In the remaining cases, a couple\u2019s infertility is due to problems in both partners, or to unknown causes.<\/li>\n<li>Male infertility occurs when there are no, or too few, healthy, motile <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2506\">sperm<\/a>. This may be caused by problems with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_2507\">spermatogenesis<\/a>, or by blockage of the male reproductive tract that prevents sperm from being ejaculated. Risk factors for male infertility include heavy alcohol use, smoking, certain medications, and advancing age, to name just a few.<\/li>\n<li>Female infertility occurs due to failure to produce viable ova by the ovaries, or structural problems in the oviducts or uterus. Polycystic ovary syndrome (PCOS) is the most common cause of failure to produce viable ova. <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5333\">Endometriosis<\/a> and uterine fibroids are possible causes of structural problems in the oviducts and uterus. Risk factors for female infertility include smoking, stress, poor diet, and older age, among others.<\/li>\n<li>Diagnosing the cause(s) of a couple\u2019s infertility generally requires testing both the man and the woman for potential problems. For men, semen is likely to be examined for adequate numbers of healthy, motile sperm. For women, signs of ovulation are monitored, for example, with an ovulation test kit or ultrasound of the ovaries. For both partners, the reproductive tract may be medically imaged to look for blockages or other abnormalities.<\/li>\n<li>Treatments for infertility depend on the cause. For example, if a medical problem is interfering with sperm production, medication may resolve the underlying problem so sperm production is restored. Blockages in either the male or the female reproductive tract can often be treated surgically. If there are problems with ovulation, hormonal treatments may stimulate ovulation.<\/li>\n<li>Some cases of infertility are treated with <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_4955_5345\">assisted reproductive technology (ART)<\/a>. This is a collection of medical procedures in which ova and sperm are taken from the couple and manipulated in a lab to increase the chances of fertilization occurring and an embryo forming. Other approaches for certain causes of infertility include the use of a surrogate mother, gestational carrier, or sperm donation.<\/li>\n<li>Infertility can negatively impact a couple socially and psychologically, and it may be a major cause of marital friction or even divorce. Infertility treatments may raise ethical issues relating to the costs of the procedures and the status of embryos that are created\u00a0<em>in vitro, <\/em>but not used for pregnancy. Infertility is an under-appreciated problem in developing countries, where birth rates are high and children have high economic \u2014 as well as social \u2014 value. In these countries, poor health care is likely to lead to more problems with infertility and fewer options for treatment.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.10 Review Questions<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<ol>\n<li>What is infertility? How is infertility defined scientifically and medically?<\/li>\n<li>What percentage of infertility in couples is due to male infertility? What percentage is due to female infertility?<\/li>\n<li>Identify causes of and risk factors for male infertility.<\/li>\n<li>Identify causes of and risk factors for female infertility.<\/li>\n<li>How are causes of infertility in couples diagnosed?<\/li>\n<li>How is infertility treated?<\/li>\n<li>Discuss some of the social and ethical issues associated with infertility or its treatment.<\/li>\n<li>Why is infertility an under-appreciated problem in developing countries?<\/li>\n<li>Describe two similarities between causes of male and female infertility.<\/li>\n<li>Explain the difference between males and females in terms of how age affects fertility.<\/li>\n<li>\n<div id=\"h5p-216\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-216\" class=\"h5p-iframe\" data-content-id=\"216\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"12.2 Quiz\"><\/iframe><\/div>\n<\/div>\n<\/li>\n<li>Do you think that taking medication to stimulate ovulation is likely to improve fertility in cases where infertility is due to endometriosis? Explain your answer.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h1 class=\"textbox__title\"><span style=\"color: #ffffff\">18.10 Explore More<\/span><\/h1>\n<\/header>\n<div class=\"textbox__content\">\n<p>https:\/\/youtu.be\/P27waC05Hdk<\/p>\n<p>How <em>in vitro<\/em> fertilization (IVF) works - Nassim Assefi and Brian A. Levine, TED-Ed, 2015<\/p>\n<p>https:\/\/youtu.be\/6BBmMtVfZ4Y<\/p>\n<p style=\"text-align: center\">A journey through infertility -- over terror's edge | Camille Preston | TEDxBeaconStreet, TEDx Talks, 2014.<\/p>\n<p>https:\/\/youtu.be\/iqA8uAjvEdM<\/p>\n<p style=\"text-align: center\">Smoking Marijuana May Lower Sperm Count by 33%, David Pakman Show, 2015.<\/p>\n<p>https:\/\/youtu.be\/V6-v4eF9dyA<\/p>\n<p style=\"text-align: center\">ivf embryo developing over 5 days by fertility Dr Raewyn Teirney, Fertility Specialist Sydney, 2014.<\/p>\n<p>https:\/\/youtu.be\/4Khn_z9FPmU<\/p>\n<p style=\"text-align: center\">Homosexuality: It's about survival - not sex | James O'Keefe | TEDxTallaght, 2016.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<\/div>\n<h2>Attributions<\/h2>\n<p><strong>Figure 18.10.1<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/www.flickr.com\/photos\/bobjagendorf\/9177582651\">Gay Pride Parade NYC 2013 - Happy Family<\/a> by <a class=\"owner-name truncate\" title=\"Go to Bob Jagendorf's photostream\" href=\"https:\/\/www.flickr.com\/photos\/bobjagendorf\/\" data-track=\"attributionNameClick\">Bob Jagendorf<\/a> on <a href=\"http:\/\/flickr.com\">Flickr<\/a> is used under a <a href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/\">CC BY-NC 2.0<\/a> (https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/) license.<\/li>\n<li><a href=\"https:\/\/unsplash.com\/photos\/kf3dLxBql6U\">#beaches #summer #family #blue #water<\/a> by <a class=\"_3XzpS _1ByhS _4kjHg _1O9Y0 _3l__V _1CBrG xLon9\" href=\"https:\/\/unsplash.com\/@theuntangled_\">Jove Duero<\/a> on <a href=\"https:\/\/unsplash.com\/\">Unsplash<\/a> is used under the <a class=\"ICezk _2GAZm _2WvKc\" href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a> (https:\/\/unsplash.com\/license).<\/li>\n<li><a href=\"https:\/\/unsplash.com\/photos\/MOqAfi6GvVU\">Photograph of five men near outdoor<\/a> by <a href=\"https:\/\/unsplash.com\/@dollargill\">Dollar Gill<\/a> on <a style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/\">Unsplash<\/a><span style=\"font-size: 1em\"> is used under the <\/span><a class=\"ICezk _2GAZm _2WvKc\" style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a><span style=\"font-size: 1em\"> (https:\/\/unsplash.com\/license).\u00a0<\/span><\/li>\n<li><a href=\"https:\/\/unsplash.com\/photos\/JYJxLjvIGWY\">Fam\u00edlia<\/a> by <a class=\"_3XzpS _1ByhS _4kjHg _1O9Y0 _3l__V _1CBrG xLon9\" href=\"https:\/\/unsplash.com\/@laerciocavalcanti\">Laercio Cavalcanti<\/a> on <a style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/\">Unsplash<\/a><span style=\"font-size: 1em\"> is used under the <\/span><a class=\"ICezk _2GAZm _2WvKc\" style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a><span style=\"font-size: 1em\"> (https:\/\/unsplash.com\/license).\u00a0<\/span><\/li>\n<li><a href=\"https:\/\/unsplash.com\/photos\/GmDVGjqeVEk\">Happiness \ud83d\ude42<\/a> by <a class=\"_3XzpS _1ByhS _4kjHg _1O9Y0 _3l__V _1CBrG xLon9\" href=\"https:\/\/unsplash.com\/@suicide_chewbacca\">Ashwini Chaudhary<\/a> on <a style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/\">Unsplash<\/a><span style=\"font-size: 1em\"> is used under the <\/span><a class=\"ICezk _2GAZm _2WvKc\" style=\"font-size: 1em\" href=\"https:\/\/unsplash.com\/license\">Unsplash License<\/a><span style=\"font-size: 1em\"> (https:\/\/unsplash.com\/license).\u00a0<\/span><\/li>\n<\/ul>\n<p><strong>Figure 18.10.2<\/strong><\/p>\n<p>Causes of infertility in Canada by Christine Miller is in the <a href=\"https:\/\/creativecommons.org\/publicdomain\/mark\/1.0\/\" rel=\"license\">Public Domain<\/a> (https:\/\/creativecommons.org\/publicdomain\/mark\/1.0\/).<\/p>\n<p><strong>Figure 18.10.3<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0719_PelvicInflammatoryDisease.png\" rel=\"cc:attributionURL\">1024px-Blausen_0719_PelvicInflammatoryDisease<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a><span style=\"text-align: initial;font-size: 1em\"> on Wikimedia Commons is used under a <a style=\"text-align: initial;font-size: 1em\" href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\u00a0<\/span><\/p>\n<p><strong>Figure 18.10.4<\/strong><\/p>\n<p><a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Blausen_0060_AssistedReproductiveTechnology.png\" rel=\"cc:attributionURL\">1024px-Blausen_0060_AssistedReproductiveTechnology<\/a> by <a title=\"User:BruceBlaus\" href=\"https:\/\/commons.wikimedia.org\/wiki\/User:BruceBlaus\">BruceBlaus<\/a><span style=\"text-align: initial;font-size: 1em\"> on Wikimedia Commons is used under a <a style=\"text-align: initial;font-size: 1em\" href=\"https:\/\/creativecommons.org\/licenses\/by\/3.0\" rel=\"license\">CC BY 3.0<\/a> (https:\/\/creativecommons.org\/licenses\/by\/3.0) license.\u00a0<\/span><\/p>\n<h2>References<\/h2>\n<p class=\"hanging-indent\">Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. <em>WikiJournal of Medicine 1<\/em> (2). DOI:10.15347\/wjm\/2014.010. ISSN 2002-4436.<\/p>\n<p class=\"hanging-indent\">David Pakman Show. (2015, September 1). Smoking marijuana may lower sperm count by 33%. YouTube. https:\/\/www.youtube.com\/watch?v=iqA8uAjvEdM<\/p>\n<p class=\"hanging-indent\">Fertility Specialist Sydney. (2014, April 11). ivf embryo developing over 5 days by fertility Dr Raewyn Teirney. YouTube. https:\/\/www.youtube.com\/watch?v=V6-v4eF9dyA&amp;t=5s<\/p>\n<p class=\"hanging-indent\">Public Health Agency of Canada. (2019, May 28). Fertility. Government of Canada. https:\/\/www.canada.ca\/en\/public-health\/services\/fertility\/fertility.html<\/p>\n<p class=\"hanging-indent\">TED-Ed. (2015, May 7). How <em>in vitro<\/em> fertilization (IVF) works - Nassim Assefi and Brian A. Levine.\u00a0 YouTube. https:\/\/www.youtube.com\/watch?v=P27waC05Hdk&amp;t=4s<\/p>\n<p class=\"hanging-indent\">TEDx Talks. (2014, June 26). A journey through infertility -- over terror's edge | Camille Preston | TEDxBeaconStreet. YouTube. https:\/\/www.youtube.com\/watch?v=6BBmMtVfZ4Y&amp;t=2s<\/p>\n<p class=\"hanging-indent\">TEDx Talks. (2016, November 15). Homosexuality: It's about survival - not sex | James O'Keefe | TEDxTallaght. YouTube. https:\/\/www.youtube.com\/watch?v=4Khn_z9FPmU&amp;t=1s<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_4955_5913\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_4955_5913\"><div tabindex=\"-1\"><p>A rigid organ that constitutes part of the vertebrate skeleton in animals.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":32,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[48],"contributor":[],"license":[55],"class_list":["post-4955","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","license-cc-by-nc"],"part":4907,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapters\/4955","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/wp\/v2\/users\/32"}],"version-history":[{"count":4,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapters\/4955\/revisions"}],"predecessor-version":[{"id":6463,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapters\/4955\/revisions\/6463"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/parts\/4907"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapters\/4955\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/wp\/v2\/media?parent=4955"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/pressbooks\/v2\/chapter-type?post=4955"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/wp\/v2\/contributor?post=4955"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/acchumanbio\/wp-json\/wp\/v2\/license?post=4955"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}