Reproductive Health Notes

Female Reproductive System

Internal Structures & Sensory Organs

  • Primary internal structures include sensory organs and mammary glands.

Reproductive Cycle

  • Childbearing involves the follicular phase (14-28 days).
  • Luteinizing hormone's role is critical.
  • Luteal phase occurs from day 15 to 28.
  • Sexual development in the fetus occurs around 12 weeks.
  • Puberty ranges from 9 to 17 years old, typically around 12.
  • Menopause is defined as the absence of menstruation for 12 months.

Menstruation & Vaginal Health

  • Normal menstruation lasts 2-8 days; changes should be reported.
  • Normal vaginal discharge is acidic, odorless, and off-white; deviations should be reported.
  • Breast asymmetry is common unless augmentation has occurred.

Contraception

  • Abstinence is a 100% effective method of preventing pregnancy.
  • Natural Family Planning:
    • Involves using a calendar and thermometer to track body temperature.
    • Used to predict fertile periods.
    • Not highly reliable.
    • Favored by some religious groups.
  • Oral Contraceptives:
    • Most popular method.
    • Smoking while on oral contraceptives, especially after age 35, increases the risk of blood clots.
  • Mechanical Barriers:
    • IUDs (Intrauterine Devices).
    • Condoms.
    • Diaphragm.
    • Cervical cap.
    • Vaginal sponge.
  • Spermicides: Chemical substances that kill sperm.
  • Implants: Hormonal contraceptive implants.
  • Permanent Contraception:
    • Tubal ligation for women.
    • Vasectomy for men.
  • Emergency Contraception:
    • Should be taken within 72 hours of intercourse.
    • Not for regular use due to potential cycle disruption.
    • There are limits to how often you can use it.

Menopause

  • Lower Estrogen Levels:
    • Can lead to vaginal dryness, requiring lubrication.
  • Emotional & Physical Changes:
    • Some women feel fine and happy.
    • Others experience negative feelings about aging or a desire for more children.
  • Mood Swings & Hot Flashes:
    • Hormone fluctuations cause mood swings and hot flashes.
  • Support:
    • Family and nursing support is essential.
    • Reassure women that these changes are normal.

Prevention

  • Primary Prevention:
    • No smoking.
    • Avoiding birth control to prevent blood clots (contextual).
  • Secondary Prevention:
    • Annual mammograms.
    • Monthly breast self-exams, a week before menstruation, even post-menopause.
    • ()Vulvar()Vulvar self-examination, involves visually inspecting the vulva for abnormalities.

Diagnostic Procedures

  • Endometrial Biopsy: Taking a sample of the uterine lining for examination.
  • Hysteroscopy: Visual examination of the uterus.
  • Mammogram: Important for breast health.
  • Ultrasound: Used to view the uterus and fallopian tubes.
  • Advanced Imaging: PET scans, MRI, CT scans can be utilized.
  • Biopsy: Most definitive diagnostic tool.
  • Mammograms can be done on any breast tissue (even for transgender individuals).
    • Important to check for any changes (e.g., swollen mosquito bites).
    • Inverted nipples should always be examined.
  • Note: Mammograms can be painful for some.

Sexual Health Assessment

  • Inquire about:
    • Partners, practices, protection from STIs (Sexually Transmitted Infections).
    • Past history of STIs.
    • Prevention of pregnancy.
  • Avoid Assumptions:
    • Do not assume sexual preference or gender identity.
  • Transgender Considerations:
    • Test for the organs they were born with instead of assuming by the gender they identify as.
    • Be sensitive to how you approach them.
    • Use the correct name and pronouns.
  • Information Needed:
    • Infections, pregnancy, menstruation patterns.

Male Reproductive System

Structures & Functions

  • Includes testes, vas deferens, prostate gland, etc.
  • Functions include spermatogenesis.
  • Hormonal control of sperm production.

Age-Related Changes

  • Prostate enlargement.
  • Decreased testosterone.
  • Decreased sperm production (but not motility).
    • An 80-year-old man can still potentially impregnate someone.
  • Decreased volume of ejaculate. Sperm still move.
  • Sexual response lengthens; arousal takes longer.
  • Vascular issues, medical disorders, and medications can impact sexual function (e.g., erectile dysfunction).

Relationship between Urethra and Reproductive System

  • Sperm and urine pass through the urethra.
  • Everything in men exits through one hole.

Contraception

  • Condoms: Reversible contraceptive.
  • Vasectomy: Permanent.
    • Post-procedure: Acetaminophen or ibuprofen for pain.
    • Abstain from intercourse for one week.
    • Use contraception until two negative sperm counts are obtained.
    • Reversal is possible but not always successful.

Health Concerns

  • Younger Men:
    • More prone to STIs and testicular cancer.
  • Older Men:
    • More prone to prostate issues.

Diagnostic Tests

  • Testicular Self-Exam:
    • Best time: Monthly, after a warm bath or shower.
  • Digital Rectal Exam (DRE):
    • Detects lumps and bumps in the prostate.
    • Often, by the time a lump is felt, the prostate cancer is terminal.

Sensitivity and Inclusivity

  • Be sensitive to transgender and gender-diverse individuals.
  • Avoid embarrassing them.
  • Prioritize their safety and health.
  • Use proper names and pronouns.
  • Understand some individuals may have a mix of internal and external sex organs.
  • Do not judge.

Clinical Scenarios

  • Contraception Counseling: Teach methods that do not protect against STIs.
  • Irregular menses reporting.