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Serum blood tests
(check galactorrhea (milk production), amenorrhea, gynecomastia(enlarged breast tissue))
•FSH
•LH
•Estrogen
•Progesterone
•Testosterone
•hCG to conform pregnancy
•PSA- prostate specific antigen, done annually, leading cause of mortality for men over 50
•-Annually
Menarche
•First menstrual period
•Approx. 9-15 years of age
D&C
•dilation & curettage
•Dilates cervix to allow passes of a curette for endometrial sampling or removal of products of conception
Laparoscopy
•Scope of abdomen to visualize female anatomy
•Used for pathology, ovarian cysts, fibroids, endometriosis, tubal abscess
Estrogen function
•causes thickening & Increased blood flow
•-considered a primary sex hormone; development secondary sex characteristics; regulate menstrual cycle; thickening of endometrial lining
Functions of the uterus
•Incubator
•Contracts
•Passageway
functions of the female reproductive system
•Secretion of hormones
•Production of ova
•Environment for fetal development
Mons pubis
•adipose tissue externally that protects the symphysis pubis
Labia majora
•outer layer of protective covering of the labia minora
Labia minora
•inner labia that have no hair follicles, but contain sebaceous glands
Fourchette
•band of tissue at bottom of labia minora (tears during childbirth)
Clitoris
•female erectile tissue-enlarges with stimulation
Vaginal vestibule
•External urethral opening
•Vaginal opening
•Hymen
•Bartholins Glands
Perineum
area between the vagina & anus
Vagina
•Passageway for menstrual flow & childbirth; ends at cervix; lined with mucous membranes; composed of Rugae
Cervix
•narrow portion at opening of uterus
•2-4 cm in length
•External opening
•Internal opening
Pap smear
•(checking cells on inside of cervix)
Cervical mucus
bacteriostatic, barrier to sperm when non-fertile, free pathway when fertile, formation of operculum (mucus plug) during pregnancy
Uterus
•Shaped like upside down pear
•Muscular organ
•Located between bladder and rectum
•Free moving
•Suspended by ligaments
•Usually tilted forward
Parts of the uterus
•Lower portion (cervix)
•Middle body (corpus)
•Top (fundus)
Layers of the uterus
•Serosal
•Myometrium
•Endometrium (lining that sheds during menstruation)
Fallopian tubes
•Site of fertilization
•connected to uterus
Fimbrae
•finger-like projections at the end of the fallopian tube and cover ovary)-capture oocyte and bring into fallopian tubes
Ovaries
•Upper pelvic cavity
•Almond shaped
•Primary sex organ
Functions of ovaries
primary sex organs, site of egg development, produce estrogen & progesterone
Functions of breasts
•milk producing gland, secondary sex organs
Lobes
•divide into other lobes, end in alveoli
Alveoli
•site of milk production
Ducts
•bring milk to lactiferous sinus under the nipple
External features of breasts
•Nipple
•Montgomery’s tubercles-sebum production
Sites of hormone release for females
•Hypothalamus
•Anterior Pituitary gland
•Ovaries
•Pregnancy related structures
Hormones of the hypothalamus
GnRH
CRH
Thyrotropin releasing hormone
PIF
Function of GnRH
•stimulates release of FSH & LH from anterior pituitary gland
•Released when low progesterone & estrogen
Function of CRH
•minimize immune response during pregnancy
Function of the thyrotropin-releasing hormone
•stimulates release of prolactin from anterior pituitary
Function of PIF
inhibits production and release of prolactin
Hormones secreted by the anterior pituitary
•Adrenocorticotropic Hormone
•Prolactin
•FSH
•LH
Function of adrenocorticotropic hormone
•controls development & function of adrenal cortex; adrenal cortex controls androgen (testosterone) production
Function of prolactin
•Stimulates maturation of mammary glands during pregnancy; milk production; somewhat inhibits LH & FSH production
Function of FSH
•causes maturation of ovarian follicle
Function of LH
•causes rupture of ovarian follicle & ovulation
Hormones secreted by posterior pituitary
Oxytocin
Function of oxytocin
stimulates uterine contractions; release of milk from milk ducts during lactation
Hormones of the ovaries
-Estrogen
-Progesterone
-Testosterone
Function of progesterone
•relaxation of smooth muscle
•-role in menstrual cycle; decreases uterine motility & contractility; prepares uterus; readies breasts for lactation
Function of testosterone
enhances libido; increases energy; boosts immune function; protects osteoporosis
Placental hormones
hCG
prostaglandins
relaxin
hCG
•Produced by trophoblast then placenta
•Function-limits maternal immune response to pregnancy
•Measured to diagnose pregnancy
Prostaglandins
•Not produced by a gland
•Produced as a chemical reaction at the site they are needed
•Function- have an effect on ovulation, fertility & cervical mucus and high levels cause vasoconstriction, can lead to dysmenorrhea
Relaxin
•Produced by corpus luteum during pregnancy
•Function- helps soften & lengthen cervix; promotes uterine relaxation
Menarche
•1st episode of menstrual bleeding (signifies puberty) preceded by increased progesterone and estrogen by ovaries; usually between 12-13 years of age
LH menstrual cycle
•rupture of follicle & ovulation
FSH menstrual cycle
•maturation of follicle
Estrogen menstrual cycle
•building of endometrial lining
Progesterone menstrual cycle
•prepare uterus for pregnancy, relax uterus
Average cycle length
•every 28 days; occurs every 21 to 35 days; lasts 2-8 days
phases of menstrual cycle
• follicular/proliferative phase, secretory/luteal phase and ischemic/menstrual phase
Follicular phase
•Day 6-13
•Ovaries less active=low estrogen & progesterone
•FSH increases=maturing of follicles which
stimulate estrogen production=decreased FSH
(Negative feedback controlled by hypothalmus)
•Estrogen released by follicle as it matures
•Stimulates thickening of endometrial lining
•As estrogen increases FSH decreases
•Drop in FSH signals LH release
Ovulatory phase
-Approximately Day 14
•Surge of LHà rupture of follicle = ovulation
•Ovum lives 24 hrs max
•Ruptured follicle becomes corpus luteus
•Corpus luteum supports egg until placenta takes or egg dies
Luteal phase
•Day 15-21
•Estrogen & Progesterone released from corpus luteum
•Maintains uterine lining
•If no pregnancy corpus luteum degenerates
•Estrogen & Progesterone levels fall
•Leads into pre-menstrual phase
•If one is pregnant=high levels estrogen & progesterone which inhibits LH & FSH so ovulation decreases during pregnancy
Pre-menstrual phase
•Day 22-28
•Corpus luteum has degenerated (only lasts 8days)
•Hormones decrease
•Will lead to lining shedding
•Leads back to menses back to day 1
Ovulation related body changes
•Cervical mucus- due to increased estrogen
•Basal body temperature- increase 24-28 post ovulation
•Mittleschmertz- abdominal pain at time of ovulation
•Midcycle spotting
•All of these used for data in Natural Family Planning
Primary functions of the male reproductive system
•Create, protect & transport sperm
•Deposit sperm in female reproductive system
•Produce male hormones
Penis
•3 columns of erectile tissue covered by thin layer of skin
Prepuce
•foreskin of uncircumcised male
functions of the penis
•micturition; ejection of seminal fluid during intercourse
functions of the scrotum
•houses and protects testes
Scrotum
•Protective pouch suspended between penis and anus
•Darker skin, left testes generally hangs lower than the right
•House and protect the testes
•Allow for temp regulation of testes- must stay approx. 2 degrees below body temp
Cremaster muscle
causes fluctuations in scrotal size
Testes
•pair of male gonads
Functions of testes
•produce sperm (spermatogenesis)- inside Seminiferous tubules & produce male sex hormones (androgens)
Epididymis
•tightly coiled, lays just outside testes
•Storage and maturation of term
Vas defrens
•straight tube
•Connects epididymis to seminal vesicle
Ejactulatory duct
•Urethera
Spermatogenesis
•Process of sperm production
•Begins at puberty
•Stimulated by FSH & LH
Characteristics of sperm and semen
•Slightly alkaline
•2-5 mL at ejaculation
•Approximately 120 million sperm cells/mL
•5 million WBC/mL
•Can survive 72 hours post ejaculation (if ideal conditions)
Fertility
•Related to: number, size, shape, motility
•Sperm production affected by: contact sports, smoking, tight clothing, autoimmune disorders, varicosities in scrotum, or decreased sperm motility
Male Testosterone
•Stimulates enlargement of testes & accessory organs
•Development of secondary sex characteristics
•-Body hair
•-Voice deepening
•-Thickened skin
•-Increased musculature
•-Linear growth
Complete history for reproductive assessment
•Allergies
•Past medical history
•Surgical history
•Psychological history
•Family history
•Sexual history
•Social History- alcohol/tobacco/THC
Steroids in women
•Decrease production of LH and FSH by pituitary
Antihypertensive in women
•Raise prolactin-hampers ovulation
CNS drugs in women
•Raise prolactin-hampers ovulation
Thyroid meds in women
•Interfere with ovulation
Testosterone supplements and steroids in men
Impair sperm production
Long term use of opiates in men
lowers testosterone and sperm production
5 alpha-reductase inhibitors in men (treats BPH)
lowers sperm production
Alpha blockers (treat BPH) in men
interfere with ejaculation
SSRIs in men
lowers sperm motility
Reproductive history in women
•Sores
•Discharge
•Itching
•Pain
•Burning
•Hx of cysts or fibroids
•Hx of pap smears
•Family hx of reproductive cancers
Menstrual history in women
•LMP
•Age of menarche
•Cycle frequency
•Length of cycle
•Heaviness of flow- how many pads/tampons in 24 hr period
•PMS- bloating, headaches, cramps, mood changes
•Bleeding between periods
Pregnancy history in women
history- GTPAL- remember your gravida/para, nulliparous, multiparous, ect.
reproductive history in men
•Sores
•Discharge
•Problems with scrotum or testes
•Lumps, bumps, swelling of scrotum
•Hernias
•Family hx of prostate cancer
Sexual history in men
•Sexually active
•Satisfaction
•Pain with intercourse
•Bleeding with intercourse (female)
•Age of first sexual experiences
•Sexual preferences
•Partners within last 12 mo? Last 2 mo? Lifetime partners
•Current partners
•Contraceptive use
•Hx of STI
•Strategies to prevent STI
Female breast exam
•Various positions-seated with arms down, arms up, lean forward, hands on hips or on back with pillow under should of side examining
•Clavicular & axillae areas
•Pain
•Discharge-from nipple
•Unilateral nipple inversion; asymmetry is normal
•Education- self breast exam
•-Inspection in mirror- first step
•-Palpation
•-Compress nipple
•-Report
Physical assessment of the female reproductive system
•Positioning-lithotomy; cover with drape
•Perineal External Inspection
•-Inflammation
•-Lesions
•-Asymmetry
•-Palpable masses
Internal female reproductive exam
•Void first
•Bimanual exam
•--One hand inside vagina, other on abdomen
•--Palpate uterine size, position, mobility, tenderness
•--Palpate adnexal area (adjacent to uterus)-looking for abnormalities in fallopian tubes & ovaries
•---Normal is not palpable
•Speculum exam
•-Visualize vagina & cervix
•-Warm & lubricate
•-Warn patient before hand & insertion of speculum
Rectovaginal exam
•not routine
•-One finger in vagina, one in rectum
•-Only when are of concern
•-Must change gloves between rectovaginal & bimanual exam to avoid cross contamination
Inspection/palpation of the male reproductive system
•Hair distribution
•Lesions
•Swelling
•Masses
•Undescended testes
•Hernia (palpate push finger from through scrotal sac to inguinal ring)- bulges, bowel sounds in scrotum, have patient bear down
•Compress glans- look for drainage or discharge
•Foreskin- pull back and assess glands if applicable
•Palpate testes to check lumps (thumb & 2 fingers of 1 hand)
Rectal prostate exam
•Externally first- lesions, masses, hemorrhoids
•One finger in rectum towards posterior- feel for consistency, bumps
Mammography
•Screening to detect tumors in the breast
•No deodorant, creams, lotions.