Reproductive

CHAPTER 55: Reproductive System

PREFACE

  • Terminology Clarification: The terms "male" and "female" are used to describe the anatomical features of sex organs.

  • Gender Identity Note: These terms may not accurately reflect someone's gender identity and are not meant to exclude anyone.

  • Importance in Care: Assessment of a patient’s sex assigned at birth and current inventory of sex organs are crucial for providing appropriate care.

STRUCTURES AND FUNCTIONS OF REPRODUCTIVE SYSTEMS

  • Primary (Essential) Organs:

    • Secrete hormones

    • Produce gametes (ova in females and sperm in males)

    • Female Gonads: Ovaries

    • Male Gonads: Testes

  • Secondary (Accessory) Organs:

    • Transport and nourish ova and sperm

    • Preserve and protect fertilized ova

STRUCTURES AND FUNCTIONS OF MALE REPRODUCTIVE SYSTEM

Major Roles (1 of 7)

  • Production and transportation of sperm.

  • Deposition of sperm in the female reproductive tract.

  • Secretion of hormones.

Anatomical Structures (2 of 7)

  • Key Components:

    • Ureter

    • Seminal vesicle

    • Ejaculatory duct

    • Prostate gland

    • Rectum

    • Cowper's gland

    • Anus

    • Epididymis

    • Testis

    • Scrotum

  • Additional Structures:

    • Bladder

    • Pubic symphysis

    • Ductus deferens

    • Urethra

    • Penis

    • Glans

Testes Description (3 of 7)

  • Structure:

    • Ovoid, smooth, firm organs located within the protective scrotal sac.

  • Functionality:

    • Seminiferous tubules are responsible for spermatozoa formation.

    • Spermatogenesis: The process of sperm production.

    • Interstitial Cells: Located between seminiferous tubules, produce the male sex hormone testosterone.

Ducts Functionality (5 of 7)

  • Role in Sperm Transport:

    • Epididymis: Transports sperm as they mature; exit through ductus deferens.

    • Ejaculatory Duct: Passes downward through the prostate gland, connecting with the urethra.

    • Urethra: Extends from bladder through the prostate, ending in slit-like opening (meatus).

Glands and Semen Production (6 of 7)

  • Major Glands:

    • Seminal Vesicles: Form part of ejaculatory ducts that enter the prostate.

    • Prostate Gland: Lies beneath bladder and is in contact with rectal wall.

    • Cowper’s Glands: Located on each side of the urethra.

  • Function:

    • Secretions from these glands make up most of the fluid in ejaculate and create an alkaline, nutritious medium for sperm.

External Male Genitalia (7 of 7)

  • Components:

    • Penis, which consists of:

    • Shaft: Contains erectile tissue and urethra.

    • Glans: The tip of the penis.

    • Prepuce: Foreskin at the junction of the shaft and glans.

STRUCTURES AND FUNCTIONS OF FEMALE REPRODUCTIVE SYSTEM

Major Roles (1 of 11)

  • Key Functions:

    • Production of ova (eggs).

    • Secretion of hormones.

    • Protection and facilitation of the development of a fetus in a pregnant female.

Ovaries (2 of 11)

  • Function: Responsible for ovulation, which diminishes throughout a woman's life (atresia).

  • Hormonal Secretion: Produces two major reproductive hormones:

    • Estrogen

    • Progesterone

Fallopian Tubes (3 of 11)

  • Role in Reproduction:

    • Transports ovum towards uterus, facilitating fertilization or implantation.

    • Fimbriae: Fingerlike projections at the distal ends of fallopian tubes that help extract mature ovum.

  • Length: Average of 4.8 inches (12 cm).

Additional Pelvic Structures (4 of 11)

  • Anatomical Components:

    • Fallopian Tube

    • Ureter

    • Sacrum

    • Ovaries

    • Body of Uterus

    • Fundus of Uterus

    • Round Ligament

    • Bladder

    • Symphysis Pubis

    • Vagina

    • Vaginal Introitus

    • Uterosacral Ligament

    • Cervix

    • Urethra

    • Rectum

    • Anus

Vagina Description (5 of 11)

  • Structure Characteristics:

    • Tubular structure measuring 3 to 4 inches long.

    • Lined with squamous epithelium.

  • Secretions:

    • Cervical mucus, desquamated epithelium, and a watery secretion during sexual stimulation.

Uterus Structure (6 of 11)

  • Location: Found between bladder and rectum.

  • Anatomical Parts: Consists of:

    • Fundus

    • Body

    • Cervix

  • The Pelvis: Consists of four bones held together by ligaments.

External Female Genitalia (Vulva) (8 of 11)

  • Components:

    • Mons Pubis

    • Labia Majora

    • Labia Minora

    • Vestibule

    • Clitoris

    • Skene’s Glands

    • Bartholin’s Glands

Breasts (10 of 11)

  • Characteristics:

    • Secondary sex characteristics that develop in response to the presence of estrogen and progesterone.

    • Subject to cyclic hormonal changes.

    • Extent: From second to sixth ribs.

    • Tail of Spence: Upper outer quadrant extending into axilla.

    • Areola: Pigmented, dome-shaped center of the breast.

Anatomy of Breasts (11 of 11)

  • Structural Components:

    • Clavicle

    • Intercostal Muscle

    • Fascia of Pectoral Muscles

    • Pectoralis Major Muscle

    • Alveolus

    • Ductule

    • Duct

    • Tail of Spence

    • Lactiferous Duct

    • Pectoralis Major Muscle

    • Lactiferous Sinus

    • Alveoli

    • Areola

    • Nipple Pores

    • Adipose Tissue

    • Nipple

    • Suspensory Ligaments (of Cooper)

NEUROENDOCRINE REGULATION OF REPRODUCTIVE SYSTEM

Hormonal Pathways (1 of 4)

  • GnRH (Gonadotropin-Releasing Hormone): Produced in the hypothalamus.

  • Pituitary Gland Hormones:

    • FSH (Follicle-Stimulating Hormone)

    • LH (Luteinizing Hormone) (female) and LH (or ICSH) (male)

    • Prolactin

  • Functions:

    • Ovarian Change: Involved in ovulation.

    • Sperm Maturation in males and Lactation in females.

FSH and LH Functions (2 of 4)

  • FSH: Stimulates production of ova or sperm.

  • LH: Contributes to maturation of ova or sperm.

  • Role of Progesterone:

    • Regulates menstrual cycle in females.

    • Triggers testosterone production in males.

Progesterone Functions (3 of 4)

  • Maintains a rich vascular state in the uterus: Necessary for the maintenance of the implanted ovum.

  • Involved in bodily changes during pregnancy.

Estrogen and Testosterone Functions (4 of 4)

  • Estrogen:

    • Essential for the development and maintenance of secondary sex characteristics.

    • Involved in proliferative phase of the menstrual cycle and uterine changes in pregnancy.

    • Produced by ovaries in females and adrenal cortices in males.

  • Testosterone:

    • Produced by testes; responsible for the development and maintenance of secondary sex characteristics.

MENSTRUAL CYCLE

Phases Overview (1 of 3)

  • Three Phases:

    • Proliferative or Follicular Phase

    • Secretory or Luteal Phase

    • Menstrual or Ischemic Phase

Hormonal Chart (2 of 3)

  • Key Players:

    • Pituitary Gland

    • Developing Follicles

    • LH and FSH from the Hypothalamus

    • Corpus Luteum

    • Estrogen and Progesterone from the Ovary

  • Cycle Timing:

    • Duration of 28 days with specific processes occurring throughout each segment: Menses, Proliferative Phase, Ovulation, Secretory Phase.

Menopause (3 of 3)

  • Definition: Physiological cessation of menses associated with declining ovarian function.

  • Completion Criterion: Occurs after one year of amenorrhea (absence of menstruation).

SEXUAL RESPONSE

  • Concept Overview:

    • Complex interplay of physical and psychological phenomena.

    • Influenced by variables such as stress and illness.

    • Similar patterns observed for both males and females.

    • Phases of Sexual Response:

    • Excitement

    • Plateau

    • Orgasmic

    • Resolution

MALE SEXUAL RESPONSE

Excitement Phase (1 of 4)

  • Mechanism: Stimulated via sympathetic, parasympathetic, and pudendal nerve endings.

  • Physiological Changes:

    • Large venous sinuses in erectile tissue of penis become congested with blood, resulting in erection.

    • Tautness facilitates vaginal insertion.

Plateau Phase (2 of 4)

  • Characteristics:

    • Erection maintained.

    • Slight increase in vasocongestion leads to minor increase in diameter and testicle size.

    • Glans penis may turn reddish-purple.

Orgasmic Phase (3 of 4)

  • Process:

    • Ejaculation occurs via contraction of musculature propelling sperm outward through the meatus.

    • Orgasm involves a rapid release of vasocongestion and muscular tension through rhythmic contractions, primarily in the penis, prostate gland, and seminal vesicles.

Resolution Phase (4 of 4)

  • Return to Baseline:

    • Involution of the penis with gradual return to its unstimulated, flaccid state.

    • Skin becomes loose again, with sinuses holding a reduced amount of blood.

FEMALE SEXUAL RESPONSE

Excitation Phase (1 of 3)

  • Physiological Changes:

    • Similar to males, the clitoris becomes congested, with increased vaginal lubrication from cervical, Bartholin’s glands, and vaginal wall secretions.

Plateau Phase (2 of 3)

  • Characteristics:

    • Vaginal expansion and elevation of the uterus.

Orgasmic Phase (3 of 3)

  • Mechanism:

    • Slight relaxation of the cervical os and rapid muscular tension release through rhythmic contractions in clitoris, vagina, and uterus.

  • Multiorgasmic Capability: Females can achieve multiple orgasms without having to go through the resolution phase between orgasms.

GERONTOLOGIC CONSIDERATIONS - EFFECTS OF AGING ON REPRODUCTIVE SYSTEMS

Changes in Females (1 of 3)

  • Altered Hormone Production: Declining estrogen production associated with menopause leads to:

    • Decreased circulating estrogen and other sex steroids.

    • Breast and genital atrophy.

    • Reduced bone mass.

    • Increased rate of atherosclerosis.

Changes in Males (2 of 3)

  • Aging Effects: Testosterone levels decline gradually, leading to:

    • Physical, psychological, and sexual manifestations.

    • Increased prostate size.

    • Decreased sperm production, scrotal muscle tone, and size/firmness of testicles.

    • Potential erectile and sexual problems may occur.

Shared Changes (3 of 3)

  • Impacts on Sexual Practices:

    • Gradual change in sexual response.

    • Negative social attitudes toward sexuality in older adults.

  • Nurses' Role: Provide accurate and unbiased information and emphasize the normality of sexual activity.

ASSESSMENT OF REPRODUCTIVE SYSTEM

Subjective Data (1 of 17)

  • Health Information: Many individuals perceive reproduction and sexual issues as intimate and private topics.

  • Professionalism: Maintain a sensitive approach, asking gender-neutral questions and being aware of cultural beliefs. Initiate discussions with less sensitive questions.

Subjective Data - Health History (2 of 17)

  • Include co-morbidities and chronic conditions:

    • Mumps and rubella.

    • Endocrine disorders.

    • Record any allergies.

Subjective Data - Medications (3 of 17)

  • History Collection: Verify full medication history including:

    • Use of herbal products, diet supplements, psychotropic agents, antihypertensives, street drugs, hormonal contraceptives, and hormone therapy.

Subjective Data - Surgical History (4 of 17)

  • Document any surgeries, especially concerning those involving the reproductive system:

    • Record any therapeutic or spontaneous abortions.

Subjective Data - Functional Health Patterns (5 of 17)

  • Health Perception: Patient's assessment of their health and measures taken to maintain it.

Subjective Data - Genetic Risk Alerts (6 of 17)

  • Watch for:

    • Family history of breast, ovarian, uterine, and prostate cancer.

    • Familial tendencies for other disorders.

    • Lifestyle risks associated with smoking.

Subjective Data - Nutritional Assessments (7 of 17)

  • Evaluate dietary adequacy and consider:

    • Anemia risks, eating disorders, and bone health (calcium and vitamin D).

Subjective Data - Elimination Patterns (8 of 17)

  • Understanding gynecologic problems:

    • Women: Issues may include urinary incontinence, UTIs, vaginal infections.

    • Men: Potential issues with urethritis and benign prostatic hyperplasia (BPH).

Subjective Data - Activity-Exercise Patterns (9 of 17)

  • Review amount and intensity of physical activity:

    • Consider links to osteoporosis and conditions associated with lack of weight-bearing exercise, especially in postmenopausal females.

    • Awareness of the female athlete triad and its role in anemia.

Subjective Data - Sleep-Rest Patterns (10 of 17)

  • Evaluate disruptions during:

    • Postpartum periods or due to raising young children.

    • Hot flashes and sweating during perimenopause.

    • Daytime fatigue from poor sleep quality associated with prostate enlargement or hormone therapy.

Subjective Data - Cognitive-Perceptual Patterns (11 of 17)

  • Identify pelvic pain associated with:

    • Pelvic inflammatory disease, ovarian cysts, and endometriosis.

    • Dyspareunia (painful intercourse) that may strain relationships with partners, especially postmenopausal.

Subjective Data - Self-Perception Patterns (12 of 17)

  • Address emotional distress from aging-related changes:

    • Physical changes, such as pendulous breasts, vaginal dryness, and decreases in penis size.

Subjective Data - Role-Relationship Patterns (13 of 17)

  • Explore family dynamics and roles:

    • Changes in recent work-related relationships.

    • New additions to the family may shift existing dynamics.

Subjective Data - Sexual-Reproductive Patterns (14 of 17)

  • Assess changes caused by contraceptive use, pregnancies, births, abortions, and sexual practices:

    • Satisfaction levels regarding sexual activity.

Subjective Data - Coping-Stress Tolerance Patterns (15 of 17)

  • Assess support systems available during stressful life periods:

    • Address etiologies like STIs or mental health issues.

Subjective Data - Value-Belief Patterns (16 of 17)

  • Acknowledge cultural, religious, moral, and ethical values influencing sexual and reproductive functioning:

    • Investment in understanding beliefs regarding sexuality and reproduction.

PHYSICAL ASSESSMENT: MALE

External Genitalia (1 of 4)

  • Objective Data Collection:

    • Inspection and palpation of external genitalia, including:

    • Pubis, penis, and scrotum.

    • Clinical breast examination if there is suspicion of breast cancer or a strong family history.

Pubis Assessment (2 of 4)

  • Characteristics:

    • Assess for coarse and diamond-shaped hair patterns.

    • Absence of hair is not a normal finding.

    • Check for signs of skin irritation or inflammation.

Penis and Scrotum Assessment (3 of 4)

  • Inspection Criteria:

    • Look for lesions, bleeding, or swelling of the penis.

    • Retract foreskin (if present) to inspect glans and meatus; replace afterwards.

    • Examine scrotal sac thoroughly.

Anus Examination (4 of 4)

  • Focus Points:

    • Assess for lesions, swelling, or inflammation in the buttocks and anal sphincter and perineal region.

PHYSICAL ASSESSMENT: FEMALE

Overview (1 of 5)

  • Objective Data Collection: Conduct inspection and palpation of:

    • Breasts and axillae,

    • Abdomen and genitalia,

    • Internal pelvic examination.

Breast Examination (2 of 5)

  • Criteria for Assessment:

    • Investigate various positions:**

    • Evaluate for symmetry, size, shape, color, vascular patterns, dimpling, and unusual lesions.

    • Special attention around Tail of Spence, where most malignancies develop.

    • Palpate around the areolae.

External Genitalia (3 of 5)

  • Procedural Guidelines:

    • Use gloves for inspection and palpation of:

    • Mons pubis

    • Vulva

    • Clitoris

    • Urethral meatus

    • Vaginal orifice

    • Anus

Internal Pelvic Examination (4 of 5)

  • Specialist Procedure: Usually performed by healthcare professionals with advanced training using:

    • Speculum and bimanual technique.

    • Pap specimen is taken while the vagina and cervix are visually observed for irregularities.

Diagnostic Studies: Overview (1 of 7)

  • Types of Studies:

    • Urine and blood studies for ovarian function, syphilis, gonadal function, pregnancy, infertility, menstrual irregularities, causes of amenorrhea, reduced libido/impotence, prostate cancer, testicular cancer/anomalies.

Cultures and Tests (2 of 7)

  • Usefulness:

    • Helps detect syphilitic lesions, vaginal abnormalities, gonorrhea, Chlamydia, trichomoniasis.

Cytologic Studies (3 of 7)

  • Examples: Papanicolaou (Pap) test, nipple discharge test.

Radiologic Studies (4 of 7)

  • Types:

    • Mammography

    • Ultrasound (US) of breasts, pelvis, testes

    • CT Scan of pelvis

    • MRI

Invasive Procedures (5 of 7)

  • Types:

    • Hysteroscopy

    • Hysterosalpingogram

    • Colposcopy

    • Conization

    • Loop electrosurgical excision procedure (LEEP)

    • Culdotomy

Further Invasive Assessments (6 of 7)

  • Additional Procedures Include:

    • Culdoscopy and culdocentesis

    • Laparoscopy

    • Dilation and curettage (D&C)

Fertility Studies (7 of 7)

  • Assessments:

    • Semen analysis

    • Basal body temperature assessment

    • Hysterosalpingogram

    • Serum estradiol, FSH, progesterone

    • Urinary LH

REFLECTION QUESTIONS

  1. Conversations on Human Sexuality: Consider what kind of patients, questions, or topics would be most challenging for discussions on human sexuality.

  2. Personal Comfort in Discussing Sexuality: Think of ways to improve personal comfort level and capacity to address sexuality aspects of nursing care.

  3. Comfortable Environment for Patients: Reflect on strategies to create a supportive space for patients to express personal concerns about reproduction or sexuality.

AUDIENCE RESPONSE QUESTIONS

  1. Reproductive Function Inquiry: When the nurse obtains information related to reproductive function from a female patient, what question should the nurse ask first?

    • Correct Answer: "Tell me about your menstrual periods."

  2. Concerns About Nipple Discharge: For a 58-year-old female patient with concerns about a milky discharge from her nipples, which question is most appropriate?

    • Correct Answer: "Do you take any antidepressants?"

  3. Erectile Dysfunction Causes: In assessing a male patient worried about sexual functioning, which medication might lead to erectile dysfunction?

    • Correct Answer: Propranolol (Inderal).