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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.