The Reproductive System

1. The Reproductive System Ana Corona, MSN, FNP-C Nursing Instructor February 2009 Sydney Cancer Center, Adams Anatomy Images, The McGraw-Hill Companies, WebMD Corporation, Mayo Foundation. Foundations of Nursing, 2nd ed. L. White. More reviews: Nurseana.com

2. Functions of the Female Reproductive System Produce ovum, Maintain the fertilized egg, Maintain the embryo Structures: • Ovaries: Have 2 main functions: Ovulation and production of hormones (estrogen & progesterone) • Uterus: is peared shape and measures approx 3 inches. Receives and nurtures embryo during development • Fallopian Tubes: convey ovum to uterus • Fimbrae: fingerlike projections lined by tiny hair like cilia that assist the ovum to travel to the uterus.

3. Vagina: receives sperm & serves as birth canal for the fetusCervix: lower part of the uterusPerimetrium: Outer layer of the uterus Myometrium: middle layer of uterus. MuscleEndometrium: inner layer of the uterus

4. Mons Pubis: Fatty tissue on pubic symphysis. Labia Majora: Protects external genital structures Labia Minora: Protects vaginal and urethral openings Clitoris: Erectile tissue and is richly supplied with nerves Bartholin Glands: small pea-sized glands. Produce a mucoid secretion to lubricate the vagina and vulva. Skene’s Glands: Secrete mucus. Structures of the Female Reproductive System

5. "On the Rag" • Originated sometime between 19th to 20th century. • When a woman was menstruating, she was “on the rag,” • Each woman had a supply of rags for specific use during menstruation. • Layer rags together, use pins to attach the rags to their panties. • Women would wash the rags and hang them out to dry.

6. Menstrual Cycle • Normal cycle length is considered 28 days • varies from female to female • Bleeding as a result of menstruation lasts 2 to 7 days on average • An average loss of 20 to 80mL of blood.   

7. Three Phases during Menstrual Cycle • Proliferative Phase: Preparing for Ovulation - endometrium begins to grow after menstruation. • Secretory Phase: Preparing for Implantation - endometrium is becoming ready for the implantation of a blastocyst. • Menstrual Phase: If no implantation occurs, the endometrium breaks down and is discharged in menstruation.

8. Proliferation Phase: Preparing…. • Proliferation Phase starts in the anterior pituitary gland with the release of FSH (follicle stimulating hormone) • FSH goes to the ovaries and causes the ovarian graafian follicle (OVUM) to develop/mature & ripen. • Follicle begins to mature - releases ESTROGEN • Estrogen causes the uterine lining to thicken in preparation of the ovum (egg) and causes the ovum to ripen and enlarge. • When estrogen levels get high enough they cause the release of LH or luteinizing hormone

9. Secretory Phase: Ovulation • Secretory Phase---extends from the day of ovulation to about 3days before the next menstrual period. • LH causes the release of the ovum or OVULATION • The follicle pops and the ovum comes oozing out causing a crater on the side of the ovary to be formed • The “crater” that is left on the side of the ovary oozes PROGESTERONE. • After ovulation, a large amount of progesterone is produced. • Progesterone causes the uterine lining to thicken in preparation for implantation of a fertilized ovum.

10. Menstrual Phase: NO BABY • No fertilization of the ovum occurs in the fallopian tubes and the ovum deteriorates. • If fertilization and implantation does not occur, progesterone and estrogen levels decrease • The hypothalamus secretes gonadotropin-releasing hormone (GnRH) that stimulates the anterior pituitary to secrete FSH • Menstruation begins which marks the first day of the new menstrual cycle. • Rising levels of FSH trigger the beginning of the next phase, called the proliferative phase

11. The Ovarian Cycle • The normal ovulatory cycle is divided into two phases called the follicular and luteal phases. • Different levels of hormones are released. • Follicular Phase: is initiated from the day bleeding stops and finishes with a midcycle surge of LH. • Luteal Phase: this is initiated with the mid-cycle surge of LH which coincides with ovulation and ends with the first day of onset of the period.

13. Menstrual Disorders • Dysmenorrhea–painful menstruation. • Amenorrhea–absence of menstruation. • Polymenorrhea–menstrual cycles of less than 21 days. • Oligomenorrhea–diminished menstrual flow that is not amenorrhea. • Interventions based on cause of disorder.

14. Primary Absence of menstruation in a woman by the age of 16. Secondary Menstruation has stopped for 3 months in a woman with a history of regular cyclic bleeding, or 6 months in a woman with a history of irregular periods. Amenorrhea Cessation of Menstruation2 Types Primary & Secondary

15. Dysmenorrhea • Severe uterine pain during menstruation. • Pain - sharp, throbbing, dull, burning, shooting • Nausea and vomiting, diarrhea, headache, fainting, and fatigue. • Heavy blood loss, known as menorrhagia. • Release of prostaglandins and other inflammatory mediators in the uterus is thought to be a major factor in primary dysmenorrhea.

16. Metrorrhagia, Menorrhagia • Metrorrhagia: heavy bleeding between periods, or bleeding unrelated to the menstrual period. • Menorrhagia: menstrual bleeding that lasts more than 7 days or bleeding that is much heavier than usual for the individual. • Hormonal imbalance • Chronic medical problems - as thyroid disorders, diabetes, and blood-clotting disorders. • Diagnostic Tests: Laboratory, Pelvic/transvaginal ultrasound • Treatment: Hormonal therapy

17. Premenstrual Syndrome - PMS • PMS often occurs after ovulation. • Over 150 symptoms have been reported that have been related to PMS. • Treatment includes counseling, medications, dietary changes, regular exercise.

18. Climacteric • Menopause • Change of life • Cessation of menstruation • Decreasing level of ovarian hormone production affects women in variety of ways • Depression, hot flashes, insomnia, anxiety • Treatment includes- Hormone Replacement Therapy (HRT) estrogen replacement therapy, Medications: Conjugated equine estrogen/ Premarin, Transderm estrogen system/Estraderm • Controversy – increased risk for endometrial cancer in postmenopausal women • dietary changes, exercise.

19. Papanicolaou test • A Pap smear is an examination under the microscope of cells scraped from the cervix • The Pap smear can detect cancerous or precancerous conditions of the cervix • Cervical Cancer Screening Guidelines

20. Trichomoniasis Vaginalis • Protozoan (parasite) infection • STD • Yellow/gray, greenish vaginal discharge • Itching and burning • Vaginal culture or wet mount • Treatment: Flagyl • Partner tx • Strawberry cervix

21. Candidiasis Vaginitis (yeast) • White thick curdy discharge • Vaginal itching, burning • Vaginal culture, wet mount • Treatment: vaginal creams - Minonazole, Monistat-3, Monistat-7, Nystatin • Oral – diflucan • Prevention: avoid tight fitting clothes. • Antibiotic therapy or hormonal • Yogurt • No douching

22. Chlamydia Trachomatis • STD • Vaginal burning, dysuia • Vaginal discharge or bleeding • Pelvic pain • Dysparunia • Vaginal or urine chlamydia culture • Treatment: azythromycin • Partner treatment

23. Bacterial Vaginosis • Gardnerella vaginalis • Milky thick discharge • Fishy odor • Itching and burning • Vaginal culture or wet mount • Treatment: metronidazole or clindamycin (vaginal gel or pills). • Partner treatment recommended

24. Cervical Cancer • The most preventable gynecological cancer, with regular Pap smears. • Most common signs: abnormal bleeding, odor, pain in lower back, groin, difficulty in voiding, hematuria, rectal bleeding. • Treatment includes varying degrees of surgery, radiation, and palliation

25. (CIS) is pre-malignant cells Abnormal cells remain with in the cervix Have not yet spread to other organs Carcinoma In Situ

26. Colposcopy • Diagnostic procedure to examine and view the cervix and the tissues of the vagina and vulva. • Colposcope allows of enlarged abnormal areas to be visualized • Directed biopsies can be obtained for further pathological examination.

27. Endometrial Cancer • Cancer of the lining of the uterus. • Symptoms do not appear until the cancer is advanced. • Routine Pap smears, pelvic examinations not adequate for early diagnosis. • Treatment: radiation, chemotherapy, and/or surgery.

28. Ovarian Cancer • Originates in epithelial tissue of ovary and does not produce symptoms until it is in an advanced, inoperable stage. • Treatment includes a combination of surgery, radiation, chemotherapy, immunotherapy, and palliation.

29. Growth of endometrial tissue outside the uterus within the pelvic cavity. Cause is unknown Symptoms include low backache, painful intercourse, a feeling of heaviness on the pelvis, and spotting. Treatment: danazol and/or surgical removal of the lesions. Endometriosis

30. The procedure may be performed in the hospital or in a clinic using general or local anesthesia. The vaginal canal is held open by a speculum and the opening to the uterus. The cervical canal is dilated using a metal rod and a curette is then passed through the canal into the uterine cavity. The endometrium is scraped away and the tissue is collected for examination. Dilation and Curettage

31. Benign tumors growing in or on uterus. Symptoms include menorrhagia, increasing pelvic pressure, dysmenorrhea, abdominal enlargement, and constipation. Treatment: periodic reexamination, myomectomy, or hysterectomy. Fibroid Tumors

32. An abnormal connection between an organ, vessel, or intestine and another structure. Result of injury, surgery, infection or inflammation Fistula

33. Urethrocele–downward displacement of the urethra into the vagina. Rectocele–anterior displacement of the rectum into the posterior vaginal wall. Structural disorders of the female reproductive system.

34. Cystocele–downward displacement of the bladder into the anterior vaginal wall. Walls weakens between bladder and vagina Bladder herniates into the vagina. Symptoms: urine leakage, UTI, pressure. Treatment: avoidance of heavy lifting or straining. A pessary device Large cystoceles may require surgery Cystocele

35. Downward displacement of the uterus into the vagina. Factors – multiple vaginal deliveries, large infant, Increasing age, frequent heavy lifting. A number of conditions, constipation, and obesity. Symptoms - Urinary complaints including urinary incontinence frequency, urgency, pain with defecation, constipation, or incontinence, sexual complaints, including pain with intercourse. Dx: Examination, Ultrasound, MRI Tx: kegel exercise, pessaries, surgery Prolapsed uterus

36. Surgical procedure Surgical intervention for both cystocele and rectocele. General or local anesthesia. A speculum is inserted into the vagina to hold it open during the procedure. An incision is made into the vaginal skin. The vaginal skin is separated from the fascia and the defect is folded over and sutured (stitched). Colporrhaphy

37. Transvaginal hydrolaparoscopy or THL) To detect problems such as endometriosis or scar tissue which can both affect fertility. Narrow telescope inserted thru the back of the vagina To check the outside of the uterus, fallopian tubes and ovaries. Saline is instilled into the pelvis. A blue dye instilled to visualize fallopian tube patency No scars Local anaesthesia. Culdoscopy

38. Toxic Shock Syndrome • Toxic shock syndrome (TSS) life-threatening illness. • Staphylococcus aureus enters bloodstream. • Common tampon (super-absorbent) users. • Temp of 102ºF or greater, vomiting, diarrhea, hypotension, flulike symptoms, flat red rash that peels in 1 to 2 weeks. • Treatment: antibiotics, bed rest, and symptomatic treatment.

39. Inflammation of fallopian tubes, ovaries, or both, along with vascular and supporting structures within the pelvis, except the uterus. Symptoms include fever, pelvic pain, foul-smelling vaginal discharge. Treatment: antibiotic therapy, bed rest. Pelvic Inflammatory Disease (PID)

40. Common diagnostic tests used for female clients with symptoms of reproductive system disorders. • Alpha-fetoprotein (AFP): a protein normally produced by the liver and yolk sac of a fetus. • Cultures: vaginal culture, wet mount, gonorrhea, Chlamydia. • Human Chorionic Gonadatropin (HCG): is a hormone produced during pregnancy. Urine and blood.

41. 15 lobes Divide into lobules The alveoli produce milk Milk pass from the alveoli to Lactiferous ducts to Lactiferous sinus where it accumulates. Mammary Glands

42. Mastitis • Breast infection Contributing factors – Alteration in nipple integrity • Delayed emptying of breast milk • Clinical findings – Unilateral breast pain, warmth and redness • Malaise and flu-like symptoms

43. Fibrocystic Breast Disease: • Also called chronic cystic mastitis. • Symptoms include lumps that are single or multiple cysts, frequently fluid-filled. • Aspiration or surgical excision may be indicated. • TX: Danazol (X) • Vitamin E • No caffeine

44. Monthly breast self-exams. Women by age 20. More likely to notice changes -- including masses or lumps -- that could be early signs of cancer. One week after menstruation. Self Breast Exam

45. A special type of X-ray of the breasts. Can show tumors long before they are big enough to be noticed. Are recommended every year or two for women older than 40. Recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease. Mammography

46. Breast Cancer • Key to cure is early detection by physical examination, mammography, breast self-examination. • A painless mass or thickening is the most common presenting symptom. • Treatment: lumpectomy, mastectomy, radiation, chemotherapy, medications.

47. Breast Cancer Stages

48. Breast Cancer • Management: • Chemotherapy • Tamoxifen – reduces risk and recurrence and death • Surgical Procedure • Lumpectomy • Partial mastectomy • Simple mastectomy • Modified radical mastectomy

49. Simple Mastectomy (Total) • A surgical procedure to remove the whole breast that contains cancer. • Some of the lymph nodes under the arm may also be removed for biopsy. • Dotted line shows entire breast is removed. Some lymph nodes under the arm may also be removed.

50. Modified Radical Mastectomy • A surgical procedure to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles. • Dotted line shows entire breast and some lymph nodes are removed. • Part of the chest wall muscle may also be removed.