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.

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. Structures of the Female Reproductive System 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.

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. Amenorrhea Cessation of Menstruation2 Types Primary & Secondary 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.

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

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. Endometriosis 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.

30. Dilation and Curettage 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.

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

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

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

34. Cystocele 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

35. Prolapsed uterus 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

36. Colporrhaphy 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).

37. Culdoscopy 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.

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. Pelvic Inflammatory Disease (PID) 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.

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

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. Self Breast Exam 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.

45. Mammography 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.

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.

51. Lumpectomy and Partial Mastectomy Partial Mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Lumpectomy: A surgical procedure to remove a tumor and a small amount of normal tissue around it. Breast-conserving surgery. Dotted lines show area containing the tumor that is removed and some of the lymph nodes that may be removed.

52. Sentinel lymph node mapping A method of determining whether cancer has spread beyond the primary tumor and into the lymph system. Blue dye is injected into the area around the original cancer site. The dye moves to the first lymph node (sentinel node) that drains close to the cancer site. Forms a map pattern of lymphatic fluid. The map can show where the cancer is likely to spread and which lymph node is most likely to have cancer cells.

53. Functions of the male reproductive system Hormone production Deposit Sperm Spermatogenesis Major Structures: Glans Penis: urination and deposit semen Scrotum: encloses the 2 testes and maintains temperature suitable for sperm production. Testes: Produce sperm. Produce and secrete testosterone.

54. Structures of the male reproductive system. Epididymis: stores maturing sperm Vas Defrens: carries sperm upward from epididymis to the ejaculatory duct. Ejaculatory Duct: During ejaculation, semen passes through the ducts and exits the body via the penis. Spermatic Cord: Cord-like structure formed by the vas deferens and surrounding tissue. Cowper’s Glands: secrete fluid that neutralize urine acidity in urethra prior to passage of semen. Seminal Vesicles: secrete fluid high in fructose to nourish sperm. Prostate Gland: secretes fluid that initiates sperm movement and nutrition. Urethra: passage of urine and semen

55. Cryptorchidism Absence of one or both testes from the scrotum. Failure of the testis to move, or "descend," during fetal development from an abdominal position, through the inguinal canal, into the ipsilateral scrotum. Most testes descend by the first year of life (the majority within three months)

56. Phimosis A condition in which the foreskin is tightly stretched around the head of the penis and cannot be pulled back freely. Can occur naturally. Triggered by an infection under the foreskin or chronic conditions. A very tight foreskin may interfere with urination or sexual function. Prevented by good hygiene. Treatment with certain medicated creams. Circumcision

57. Circumcision Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. Local anesthesia Injected at the base of the penis, in the shaft, or applied as a cream. The foreskin is pushed from the head of the penis and clamped with a metal or plastic ring-like device.

58. Structural Male Disorders Hydrocele–a benign, nontender collection of fluid within the space of the testes and the spermatic cord. Spermatocele–benign nontender cyst of the epididymis or the rete testis. Variocele–dilation of veins of the scrotum. Torsion of the spermatic cord–twisting of the vascular pedicle of the testis.

59. BENIGN PROSTATIC HYPERPLASIA (BPH) Enlargement of prostate gland that occurs with aging. Symptoms related to partial or complete obstruction of the urethra. Treatment includes medications, balloon dilation, urethral stent, thermotherapy, and the transurethral resection (TURP). Symptoms of BPH • Urgency of urination • Frequency of urination • Abdominal straining • Nocturia • Impairment of size and force of stream • Intermittent hesitancy • Incomplete bladder emptying • Terminal dribbling • Dysuria • Eventual renal failure from urinary obstruction

60. A resectoscope inserted through the urethra, for the treatment of BPH. A wire loop cuts away prostate tissue and seals blood vessels with an electric current.

61. The nurse carefully assesses the patient for symptoms of TURP syndrome, including:  dramatic increase in BP full, bounding pulses bradycardia tachypnea confusion agitation temporary blindness Assesses the patency of inflow and outflow tubing, rate of irrigation, and bladder distention by palpation The nurse should hang irrigation solution bags no higher than two to three feet above the level of the patient's bladder. A 0.9% sodium chloride solution is used for irrigation.

62. Prostate Cancer Second leading cause of cancer deaths in men. Early symptoms include dysuria, weak urinary stream, increased frequency. Treatment depends on extent of disease and age of client; includes surgery, radiation, and hormone therapy.

63. Prostate Tests Digital rectal exam: (DRE) is an exam of the rectum. A rectal exam to examine the the prostate for lumps or anything else that seems unusual. Prostate Smear: Smear/Biopsy to examine tissue for disease. Prostate-Specific Antigen (PSA): prostate cancer screen. High PSA level: These include urinary tract infections, benign prostatic hyperplasia (BPH) and prostatitis. normal range <4 ng/ml. Annual >50 yrs.

64. Testicular Cancer Unknown cause, several factors seem to increase risk. Past medical history of undescended testicle(s), abnormal testicular development, Klinefelter's syndrome (a sex chromosome disorder). Small, hard, painless lump is usually first symptom noted. Men should perform a testicular self-examination (TSE) monthly. Treatment includes surgery, chemotherapy, and radiation. 15 – 34 yrs

65. Diagnostic tests used for male clients with symptoms of reproductive system disorders. Semen Analysis: Male fertility test. Measures the amount and quality of a man's semen and sperm. Testicular Self Examination: Examination of the testicles. Monthly during or after a shower while standing. Testicles should feel firm, but not rock hard. >15 yrs

66. Penile Cancer Bacteria harbored in foreskin of uncircumcised male are irritants to glans penis and prepuce, thought to be carcinogenic. HPV causative factor Symptoms: itching/burning on penis, painless, nodular growth on foreskin, fatigue, weight loss. The primary treatment is surgery. TX: Surgical procedure, cryotherapy,radiation therapy Prevention: Circumcision, condom use, smoking cessation.

67. Inflammatory disorders Epididymitis is inflammation of epididymis. Orchitis is inflammation of testes. Prostatitis is inflammation of prostate. Treatment for all includes antibiotics, bed rest, scrotal support, and ice to the area. Impotence: Inability of adult male to have erection firm enough or to maintain it long enough to complete sexual intercourse. Three types: functional, atonic, and anatomic. Treatment: external devices to promote erection, surgery, medications.

68. Infertility

69. Etiology and management of infertility. Inability to produce offspring. Basic infertility workup is initiated when conception has not occurred after 6 to 12 months of unprotected intercourse. The goal of treatment is successful achievement of a pregnancy carried to full term. Medication: Clomid (clomiphene citrate) Pregnyl (human chorionic gonadotropin) Pergonal (menotropins)

70. Compare the following contraceptive methods Prevention of pregnancy. Safety, ease of use, effectiveness, and cost should be considered when choosing a method. Sterilization is considered permanent and effective. Natural method Oral contraceptives Depo-Provera Lunelle Mirena Transdermal patch Vaginal Ring Intrauterine device Barriers Spermicides Sterilization Tubal ligation Vasectomy Independently review the effects of aging on the female and male reproductive system.

71. Vasectomy Male sterilization by surgical excision of the vas deferens. Minor surgical procedure that can be performed in a physician's office in less than half an hour Another method of birth control must be used until a follow-up sperm count test is done 2 months after the vasectomy It takes about 10 to 20 ejaculations for sperm count to be zero.

72. Contraception