DISTURBANCES IN

REPRODUCTION
TOPICS
 ASSESSMENT
1. HISTORY
2. PHYSICAL ASSESSMENT
3. DIAGNOSTIC ASSESSMENT
- WOMEN
- MEN
 COMMON HEALTH PROBLEMS IN REPRODUCTION
1. INFANT AND CHILD
2. ADOLESCENT AND YOUNG ADULT
3. ADULT WOMEN
4. ADULT MEN
 QUICK RECAP OF THE ANATOMY AND
PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM
ANATOMY OF THE FEMALE
REPRODUCTIVE SYSTEM
 Vulva

The external female genitals are collectively

referred to as The Vulva. This consists of the
labia majora and labia minora (while these
names translate as "large" and "small" lips,
often the "minora" can be larger, and
protrude outside the "majora"), mons pubis,
clitoris, opening of the urethra (meatus),
vaginal vestibule, vestibular bulbs, vestibular
glands.
 Labia Majora

-are the outer "lips" of the vulva. They are

pads of loose connective and adipose tissue,
as well as some smooth muscle.
 Labia Minora

-the inner lips of the vulva. They are thin

stretches of tissue within the labia majora
that fold and protect the vagina, urethra,
and clitoris
-There is no pubic hair on the labia minora,
but there are sebaceous glands.

-Both the inner and outer labia are quite

sensitive to touch and pressure
 Clitoris

 visible as the small white oval between the

top of the labia minora and the clitoral hood,
is a small body of spongy tissue that
functions solely for sexual pleasure.

 Urethra

- The opening to the urethra is just below the

clitoris. Although it is not related to sex or
reproduction, it is included in the vulva. The
urethra is actually used for the passage of
urine
 Hymen

 Sometimes it may partially cover the vaginal

orifice. The hymen is usually perforated
during later fetal development.
 A tear to the hymen, medically referred to as
a "transection," can be seen in a small
percentage of women or girls after first
penetration.
 Perineum

- The perineum is the short stretch of skin

starting at the bottom of the vulva and
extending to the anus. It is a diamond shaped
area between the symphysis pubis and the
coccyx. This area forms the floor of the
pelvis and contains the external sex organs
and the anal opening.
INTERNAL GENITALS

 Vagina

- The vagina is a muscular, hollow tube that

extends from the vaginal opening to the
cervix of the uterus.

- is about three to five inches long in a grown

woman. The muscular wall allows the vagina
to expand and contract.
 Cervix

 The cervix (from Latin "neck") is the lower,

narrow portion of the uterus where it joins
with the top end of the vagina.
 It is cylindrical or conical in shape and
protrudes through the upper anterior vaginal
wall.
UTERUS
 the uterus is shaped like an upside-down pear,
with a thick lining and muscular walls.

 it is hollow to allow a blastocyte, or fertilized

egg, to implant and grow. It also allows for the
inner lining of the uterus to build up until a
fertilized egg is implanted, or it is sloughed off
during menses.

 The uterus is only about three inches long and two

inches wide
 The top rim of the uterus is called the fundus and
is a landmark for many doctors to track the
progress of a pregnancy. The uterine cavity refers
to the fundus of the uterus and the body of the
uterus.
FALLOPIAN TUBES
 There are two fallopian tubes, also called the uterine
tubes or the oviducts.

 Each fallopian tube attaches to a side of the uterus and

connects to an ovary.

 The fallopian tubes are about four inches long and about
as wide as a piece of spaghetti.

 Within each tube is a tiny passageway no wider than a

sewing needle.

 At the other end of each fallopian tube is a fringed area

that looks like a funnel. This fringed area, called the
infundibulum, lies close to the ovary, but is not attached.
MAMMARY GLANDS

 The basic components of the mammary gland are the

alveoli (hollow cavities, a few millimetres large) lined
with milk-secreting epithelial cells and surrounded by
myoepithelial cells.

 These alveoli join up to form groups known as lobules,

and each lobule has a lactiferous duct that drains into
openings in the nipple.

 The myoepithelial cells can contract, similar to muscle

cells, and thereby push the milk from the alveoli
through the lactiferous ducts towards the nipple,
where it collects in widenings (sinuses) of the ducts.
STRUCTURE LOCATION & FUNCTION
DESCRIPTION
Breasts Upper chest one on Lactation milk/nutrition
each side containing for newborn.
alveolar cells (milk
production),
myoepithelial cells
(contract to expel
milk), and duct walls
(help with extraction of
milk).
Cervix The lower narrower During childbirth,
portion of the uterus. contractions of the
uterus will dilate the
cervix up to 10 cm in
diameter to allow the
child to pass through.
During orgasm, the
cervix convulses and the
external os dilates
 Clitoris Small erectile organ Sexual excitation,
directly in front of the engorged with blood.
vestibule.
Fallopian tubes Extending upper part of Egg transportation from
the uterus on either ovary to uterus
side. (fertilization usually
takes place here).
Hymen Thin membrane that
partially covers the
vagina in young
females.
Labia majora Outer skin folds that Lubrication during
surround the entrance mating.
to the vagina.
Labia minora Inner skin folds that Lubrication during
surround the entrance mating
to the vagina.
 Provides an
environment for
maturation of oocyte.
Ovaries (female Pelvic region on either
Synthesizes and
gonads) side of the uterus.
secretes sex hormones
(estrogen and
progesterone).
Perineum Short stretch of skin
starting at the bottom
of the vulva and
extending to the anus.
Urethra Pelvic cavity above Passage of urine.
bladder, tilted.
Uterus Center of pelvic cavity. To house and nourish
developing human.
Vagina Canal about 10-8 cm long Receives penis during
going from the cervix to mating. Pathway through a
the outside of the body. woman’s body for the baby
to take during childbirth.
Provides the route for the
menstrual blood (menses)
from the uterus, to leave
the body.
Vulva Surround entrance
to the reproductive
tract.(encompasses
all external
genitalia)
Endometrium The innermost layer Contains glands that
of uterine wall secrete fluids that
bathe the utrine
lining.
Myometrium Smooth muscle in Contracts to help
uterine wall. expel the baby.
ANATOMY OF THE MALE
REPRODUCTIVE SYSTEM
 Testes

- Each testis is about 1 1/2 inches long by 1

inch wide. Testosterone is produced in the
testes which stimulates the production of
sperm as well as give secondary sex
characteristics beginning at puberty.
 Scrotum

 The two testicles are each held in a fleshy sac

called the scrotum. The major function of the
scrotal sac is to keep the testes cooler than
thirty-seven degrees Celsius

 Temperature has to be lower than normal in

order for spermatogenis (sperm production) to
take place.
 Efferent ductules

- The sperm are transported out of the testis and

into the epididymis through a series of efferent
ductules.
 Blood Supply

- The testes receive blood through the

testicular arteries (gonadal artery). Venous
blood is drained by the testicular veins. The
right testicular vein drains directly into the
inferior vena cava. The left testicular vein
drains into the left renal vein.
 Epididymis

- The seminiferous tubules join together to become

the epididymis.

- is a tube that is about 20 feet long that is coiled on

the posterior surface of each testis.

- Within the epididymis the sperm complete their

maturation and their flagella become functional.

-is also a site to store sperm until the next

ejaculation. Smooth muscle in the wall of the
epididymis propels the sperm into the ductus
deferens.
 Ductus Deferens

- The ductus (vas) deferens

- also called sperm duct, or, spermatic
deferens

- extends from the epididymis in the scrotum

on its own side into the abdominal cavity
through the inguinal canal.

- The smooth muscle layer of the ductus

deferens contracts in waves of peristalsis
during ejaculation.
 Seminal Vesicles

- The pair of seminal vesicles are posterior to

the urinary bladder.

- They secrete fructose to provide an energy

source for sperm and alkalinity to enhance
sperm mobility.
 Ejaculatory Ducts

-There are two ejaculatory ducts. Each

receives sperm from the ductus deferens and
the secretions of the seminal vesicle on its
own side.
 Prostate Gland

- The prostate gland is a muscular gland that

surrounds the first inch of the urethra as it
emerges from the bladder.

- The smooth muscle of the prostate gland

contracts during ejaculation to contribute to
the expulsion of semen from the urethra.
 Bulbourethral Glands

 also called Cowper's glands are located below

the prostate gland and empty into the
urethra.

 Penis

- The penis is an external genital organ.

- The distal end of the penis is called the glans

penis and is covered with a fold of skin
called the prepuce or foreskin.
 Urethra

- urethra, which is the last part of the urinary

tract, traverses the corpus spongiosum and its
opening, known as the meatus, lies on the tip of
the glans penis. It is both a passage for urine
and for the ejaculation of semen.
STRUCTURE FUNCTION
Bulbourethral glands Secretion of gelatinous seminal
fluid called pre-ejaculate. This
fluid helps to lubricate the
urethra for spermatozoa to pass
through, and to help flush out
any residual urine or foreign
matter. (< 1% of semen)
Efferent ductules Ducts for sperm to get to
epididymis
Ejaculatory ducts Causes reflex for ejaculation.
During ejaculation, semen passes
through the ducts and exits the
body via the penis.
Epididymis Storage and maturation of
sperm.
Penis Male reproductive organ and also
male organ of urination.
 Stores and secretes a clear,
slightly alkaline fluid constituting
Prostate gland up to one-third of the volume of
semen. Raise vaginal pH.(25-30%
of semen)
Scrotum Regulates temperature at slightly
below body temperature.
Semen -Usually white but can be yellow,
gray or pink (blood stained). After
ejaculation, semen first goes
through a clotting process and then
becomes more liquid.
-Components are sperm, and
"seminal plasma". Seminal plasma is
produced by contributions from the
seminal vesicle, prostate, and
bulbourethral glands.
Seminal vesicles About 65-75% of the seminal fluid
in humans originates from the
seminal vesicles. Contain proteins,
enzymes, fructose, mucus, vitamin
C, flavins, phosphorylcholine and
prostaglandins. High fructose
concentrations provide nutrient
energy for the spermatozoa as
they travel through the female
reproductive system.
Testes Gonads that produce sperm and
male sex hormones.Production of
testosterone by cells of Leydig in
the testicles.
Vas deferens During ejaculation the smooth
muscle in the vas deferens wall
contracts, propelling sperm
forward.
Urethra Tubular structure that receives
urine from bladder and carries it to
outside of the body. Also passage
for sperm.
ASSESSMENT OF THE FEMALE
REPRODUCTIVE SYSTEM
I. History of the Patient
 The history of the female reproductive
system includes data related to the
genitals, the reproductive system, the
breasts and the overall health status of the
woman.

1. Biographical and Demographic Data

 The incidence in some gynecologic cancer is
higher in certain age groups
 Ethnicity may also be a risk
2. Current health: the chief complaint
3. Past Health History
3.1 Childhood and Infectious Diseases
- like rubella that may affect a women’s
childbearing
- maternal rubella during the first
trimester increases fetal risk for congenital
disorders.
- also ask the client about her history of
STDs and STD exposure.
3.2 Major illness and Hospitalization
 ex.: diabetes is associated with increased
maternal and fetal morbidity
 Cardiovascular disease
 Hypothyroidism and hyperthyroidism can
affect the menstrual cycle.
 Urinary tract infections can interfere with
sexual functions
4. MEDICATION
5.Allergies (latex and copper)
6. BREAST HISTORY
 Ask client about breast pain or tenderness
 Ask whether woman has had or currently has
breast lump
 Ask about any nipple discharge
 Ask whether the woman performs a monthly
breast self-examination and the technique used
 Ask whether there is a history of breast cancer
in the client’s blood-related female relatives.
7. Menstrual History
8. Contraceptive History
 Document current contraceptive method
 Duration of use and contraceptive problems

9. Sexual History
10. Sexual History
 Obtain sexual history using a direct approach
and terms the woman understands.
 A nonjudgmental approach is essential
 Be alert of any risk taking behaviors that may
put her at risk of STDs.
11. OBSTRETRIC HISTORY
 Obtain information about the last pregnancy
including the delivery and postpartum period.
 Record any spontaneous or planned abortions.

12. GENITOURINARY HISTORY

 Pelvic infections or STDs.
 Urinary tract infections

13. Reproductive health practices

 Ask about the frequency of gynecological
examinations. If appropriate, ask whether the
client uses protection against STDs. And
unwanted pregnancy.
14. Family Health History
15. Occupation and Environment
 Any exposures to hazards encountered at
work including toxins and radiation that can
affect the reproductive system.
16. Habits
 Smoking together with oral contraceptives
can increase maternal morbidity
 Drugs and alcohol abuse can increase the risk
of STDs.
 PHYSICAL ASSESSMENT
INSPECTION
BREAST AND AXILLA
-symmetrical, full, rounded, smooth in all
positions, without dimpling, retractions or
masses. Faint, even vascular pattern and
striae noted. Nipples everted, areola even.
Axilla without mass.
GENITALIA

 Pubic hair distribution varied with stage of

sexual development
 Labia majora covered with pubic hair in adult
women; may gape open slightly.
 Clitoris midline, smooth, urethral meatus
pink, discharge absent.
 Vaginal orifice clean, without bulges. Vaginal
walls intact, pink and glistening, rugae
present. Discharge, bulges and masses absent.
 Cervix round with OS round or oval in
nulliparus women and slit-like in parous
women; discharge absent.
PALPATION
-palpation of the axilla is usually done while
the client is seated; breast palpation is
facilitated while the client is supine. The
breast should be palpated in both positions.

BREAST AND AXILLA

 Breast firm without masses, lumps. Local
areas of warmth or tenderness. Nipples
without discharges. Axilla smooth and nodes
nonpalpable
The Axillar Lymph Nodes
 Supraclavicular lymph nodes
 Intraclavicular lymph nodes
 Midaxillary (central)
 Pectoral (anterior)
 Subscapular

 Encourage the client to relax her arm, this relaxes

the chest muscles and eases palpation.
 Pectoral midaxillary subscapular brachial
infraclvicular supraclavicular
 The nodes should be nonpalpable, although a
detection of one or two small nontender, mobile
CENTRAL NODES is often an normal finding.
 Breast consistency varies from firm and elastic
in young women to stringy and nodular in older
women.
 If the client reports a mass, begin palpating in
the unaffected breast to have basis for
comparison.
 Pay particular attention to the upper outer
quadrant where most of the glandular tissue is
located and 50% of breast lesions are found.
There should be no mass or local areas of
warmth. Not the characteristics and location
and the position the client is in for the
palpation).
 Palpate the areola and nipple gently. Compress
the nipple using the thumb and index finger .
There should be no discharge. Nipple erection
and wrinkling with manipulation are normal.

GENITALIA
 Pelvic floor masculature firm
 Skene’s gland firm and without discharge and
tenderness.
 Bartholin’s gland without mass and tenderness
 No bulges in vaginal wall
 Uterus anteverted, firm smooth, nontender,
without masses
PELVIC EXAM CONSIDERATIONS
 Women often find pelvic examination embarrassing,
humiliating and anxiety provoking.
 Put the woman at ease during the pelvic
examination.
 Promote comfort by being nonjudgmental, relaxed
and competent.
 Avoid quick movements, because they may cause
the client to tense her muscles.
 Enhance comfort with gentleness. Provide privacy
 Be aware that the client may become sexually
stimulated.
 Some facilities mandate that a female assistant may
be present when an examiner performs pelvic
examination to both comfort the client and
discourage accusations of sexual impropriety.
 COMMON POSITION DURING
PHYSICAL ASSESSMENT
DORSAL RECUMBENT OR LITHOTOMY POSITION
 DIAGNOSTIC TESTS
 Papanicolaou Smear (PAP SMEAR)

CYTOLOG- is examination of the structure, function,

pathology, and chemistry of the cell.
-pap smear is the most common cytologic test in
gynecology.
Named after George Papanicolaou
 It identifies the preinvasive and invasive cervical cancer.
 Cytologic smear of the secretions is examined under a
microscope, early cellular changes may be detected
before disease becomes clinically apparent. The PAP test
is up to 95% accurate in the diagnosis of early cervical
carcinoma, provided of course the correct handling and
sampling.
-Pap smear is usually painless.
 Women who are or have been sexually active
or who have reached 18 years should have
annual PAP test and pelvic examinations.
 After the woman has had three normal
findings, PAP smear may be performed less
often.
 The test aims to detect potentially pre-
cancerous changes (called cervical
intraepithelial neoplasia (CIN) or cervical
dysplasia), which are usually caused by
sexually transmitted human papillomaviruses
(HPVs)
PAP SMEAR
 PREPARATION BEFORE THE
PROCEDURE
 Instruct the woman not to douche, have
intercourse, or use vaginal products 2-3 days
before doing the pelvic exam.
 And in a PAP SMEAR, the woman should not
be menstruating.
 Just before the examination, ask the woman
to empty her bowel and bladder to enhance
comfort and accuracy. If necessary collect a
urine specimen at that time.
Hysteroscopy

 The intrauterine cavity is directly viewed through

an endoscope called hyteroscope.
 After anesthetic agent is administered, the
hysteroscope is passed into the uterus via the
vagina.
 Used for ruling out of organic causes in abnormal
uterine or postmenopausal bleeding, examining
suspected polyps, removing an IUD with a
missing string, evaluating infertility, performing
surgical technique for uterine abnormalities.
Nursing responsibilities

 Explain the procedure to the client and

obtained an informed consent.
 Position the client in a lithotomy position.
 Explain to the client that she will be
experiencing referred shoulder pain if carbon
dioxide is introduced into the pelvic cavity
during the procedure.
Contraindications and
complications
 Contraindicated if the client has acute pelvic
inflammatory disease, recurrent chronic
upper genital tract infection, recent uterine
perforation, or suspected or know cervical
malignancy.
 Complications may include bleeding, uterine
perforation, infection and rarely bowel
injuries. It is also contraindicated in
pregnancy.
hysteroscopy
laparoscopy
 A common diagnostic and therapeutic tool, is a
telescope with illuminated optical system.
 It is inserted into the abdomen through a small
incision in or near the umbilicus to visualize
abdominal and pelvic organs.
 Performed diagnostically for conditions such as
pelvic pain, pelvic masses, infertility, suspected
ectopic pregnancy, and endomitritis.
 Typically, women who had a laparoscopic procedure
can go home 2 to 4 hours after the procedure.
Nursing responsibilities

 Explain the procedure

 Explain the client how she can feel afterward
 Inform the client (NPO post midnight)
 No driving after the procedure
 Take the clients vital signs 15minutes after the
procedure.
 Explain that she may feel mild to moderate bloating
and referred shoulder pain due to the carbon dioxide or
nitrous oxide that was used to distend the abdomen,
separate the organs and allow clear visualization.
Endometrial Biopsy

 An endometrial tissue sample is obtained for

histologic study .
 Tissue may be analyzed for endometrial
cancer, dysfunctional uterine bleeding.
 The biopsy is performed after the bimanual
examination of the uterus.
 The woman may receive NSAIDS, a
paracervical block or both relieve discomfort
due to cramping.
 Assessment of the Male
Reproductive System
 Be sensitive and tactful because many men are
uncomfortable discussing issues associated with these
disorders.
 Discuss lifestyle factors that affect health and
maintenance, such as :
-diet
Exercise
Adequate sleep and rest
Stress management
Smoking cessation
 Provide information about protection against STDs
HISTORY

1. Biographical and Demographic Data

 Age, race and occupation all have health risk
implications.
 Men over age 50 may have benign prostatic
hypertrophy
 Men younger than age 40 who have
manifestation that resembles that of BPH are
more likely to have prostatitis.
 African American men and those over age 40 are
at increased risk for adenocarcinoma of the
prostate.
2. CURRENT HEALT: THE CHIEF COMPLAINT
3. PAST HEALTH HISTORY
Childhood and infectious diseases.
4. MAJOR ILLNESS AND HOSPITALIZATION
-urinary tract infection can interfere with sexual
functioning
Ask the client about previous surgeries
involving the reproductive system.
5. MEDICATION
Some medications prescribed for hypertension
may cause impotence.
Other medications can decrease sperm count.
6. ALLERGIES
Ask the client about any allergies to antibiotics, rubber or
latex.
7. SEXUAL AND REPRODUCTIVE HISTORY
7.1 BREAST HISTORY
-ask about breast pain, masses, skin change and nipple
discharge.
Gynecomastia can occur in obese or older men and as a side
effect of some medication
7.2 SEXUAL HISTORY
Clients pattern of sexual relationship.
Multiple partners that could lead to STDs
Same sex relationship that could increase the risk of HIV.
Does the client have any sexual concerns, such as inability to
attain erection?
7.3 GENITUURINARY HISTORY
Does the client have past problems with
genitourinary infections such as prostatitis?
8.HEALTH PRACTICES
-sexual and reproductive hygiene
Does he protect himself against STDs
9. FAMILY HEALTH HISTORY
Family history of infertility, diabetes and
hypertension.
10. HABITS
- Use of caffeine, alcohol, tobacco, and recreational
drugs including marijuana. These substances may
affect the sperm count, contribute to impotence,
decreased libido.
 PHYSICAL EXAMINATION

 Many men find physical examination of the

reproductive system stressful and
embarrassing.
 Explain each step
 Occasionally, a man will have an erection
during an examination.
INSPECTION
BREAST AND AXILLA
-breast symmetrical, smooth in all positions,
without refractions or masses. Striae absent,
nipples everted and areola absent, axilla even
color without mass or rash.

PENIS
Size and shape vary among individuals
Foreskin may or may not be present
Head of penis slightly rounded without
discharges. Smegma under the foreskin is
present if client is uncircumcised.
Urinary meatus free of discharge.
SCROTUM
-left side hangs lower than the right. Scrotal size
and shape vary normally.
Scrotal skin thin and rugose.
Transillumination shows no masses or areas of
thickness.

INGUINAL AND FEMORAL AREAS

Coarse hair covers symphisis pubis, inner thighs
extending towards the umbilicus.
No bulges over the inguinal area.
PALPATION

BREAST AND AXILLA

Breast firm without masses, lumps and local areas of
warmth, or tenderness.
Nipples even without discharge.
Axilla smooth, nodules non palpable.

PENIS
Masses along the penile shaft and head of the penis
absent.
Firm, nontender
TESTIS
Two testicles present, smooth, oval and similar
in consistency.
Mobile and equal in size. Slight tender with
palpation.

INGUINAL CANAL
- No bulge or mass in inguinal canal either at rest
or at with straining.
 DIAGNOSTIC TESTS

1. LABORATORY STUDIES
a. BLOOD TEST (PROSTATE SPECIFIC ANTIGEN)
 Substance found in the prostatic fluid, aids the
liquifaction of semen.
 PSA serum levels in men without prostate cancer are
very low.
 A level of 4.0 ng/ml or higher maybe normal for men
over 65 years old, with a lower level being normal for
younger men.
 Prostatic massage 48 hours before the assay can cause
elevated PSA.
SEMEN EXAMINATION
To evaluate fertility
One to three samples collected at intervals of
2 to 4 weeks
To collect an adequate sample, the client
should abstain from ejaculation for 2 to 5
days before the test.
Prolonged abstinence may decrease sperm
quality and motility, whereas more frequent
ejaculations reduce sperm concentration and
volume.
RADIOGRAPHY
CT scan and MRI

ULTRASONOGRAPHY
A full bladder may also improve sound
transmission.
A transrectal approach is used in prostatic
ultrasonography.
The rectum must be free of feces.
Help the client in a left lateral Sim’s Position.
Tell the client that some discomfort may be felt
with probe insertion and manipulation.
Once the probe has been removed, there should
be no discomfort.
 PREVENTION OF REPRODUCTIVE PROBLEMS

PRIMARY PREVENTION
Genetic counseling
Immunization against infectious diseases.
Good nutrition
Careful genital hygiene
The use of condoms to prevent STDs
Knowing one’s partners
Avoiding sexual intercourse (oral, anal, genital)
with a person who has genital lesions
SECONDARY PREVENTION
(detecting and treating a problem)
Screening activities, such as SERUM PSA levels
in men over 50 years old and TSE (testicular self-
examination)

TERTIARY PREVENTION
(AVOIDING COMPLICATIONS AND
REHABILITATION)
Health care provided for clients experiencing
acute and chronic disorders.
For example: teaching perineal exercises after a
prostatectomy helps men regain urinary control.