PRESENTATIONS

HEALTH ASSESSMENT AND CLERKSHIP

GROUP 3
TOPIC: FEMALE REPRODUCTIVE SYSTEM
 GROUP MEMBERS:

 Candiru Eunice- VU-BMS-2307-0798-WEE

 Nambirige Maureen-VU-BMS-2307-1053-WEE
 Oluru Josephine-VU-BMS-2307-0347-WEE
 Kabugho Rosette-VU-BMS-2307-0010-WEE
 Mvako Topister-VU-BMS-2307-0820-WEE
 PRESENTATION OUTLINE

 Introduction
 Anatomy, physiology and assessment.
 Stages of development
 Changes in pregnancy and complications
 Abnormal findings and their management
 Conclusions
 References
 Introduction

 The female reproductive system is a complex system responsible

for the production of eggs, the development of embryos, and the
nurturing of offspring.
 It consists of both external and internal structures, and its main
functions include the production of eggs (ova), fertilization,
implantation, and supporting the development of a fetus during
pregnancy.
 Here's an overview of the key components of the female
reproductive system:
 ANATOMY AND PHYSIOLOGY
 External gentalia:
 The structure of external genitalia continues

The external genitalia are called the vulva.

 The mons pubis: Is a round, firm pad of adipose tissue covering the symphysis
pubis. After puberty it is covered with hair in the pattern of an inverted triangle.
 The labia majora: Are two rounded folds of adipose tissue extending from the mons
pubis down and around to the perineum. After puberty hair covers the outer surfaces
of the labia, whereas the inner folds are smooth and moist and contain sebaceous
follicles.
 The labia minora. Are two smaller, darker folds of skin found inside the Labia majora,
these are joined anteriorly at the clitoris where they form a hood, or prepuce,
posteriorly by a transverse fold, the frenulum, or fourchette
 Structure of external genitalia cont.

 The clitoris. Is a small, pea-shaped erectile body, homologous with the male penis
and highly sensitive to tactile stimulation. The labial structures encircle a boat-shaped
space, or cleft, termed the vestibule and within it are numerous openings.
 The urethral meatus. This appears as a dimple 2.5 cms posterior to the clitoris. and
Surrounded by the tiny, multiple Para urethral (Skene) glands. Their ducts are not
visible but open posterior to the urethra at the 5 and 7 o'clock posi irregular edges,
depending on the presentation of the membranous hymen
 Vaginal orifice: The vaginal orifice is posterior to the urethral meatus. It appears either
as a thin median slit or a large opening with irregular edges, depending on the
presentation of the membranous hymen
 Structure of external genitalia cont.

 The hymen
is a thin layer of mucous membrane that stretches across the vaginal lumen, just
inside the external opening. It is normally incomplete to allow for passage of
menstrual flow, and is stretched or completely torn away by sexual intercourse,
insertion of a tampon or childbirth.

 Vestibular (Bartholin) glands

Located on either side and posterior to the vaginal orifice, and secrete a clear
lubricating mucus during intercourse. Their ducts are not visible but open in the
groove between the labia minora and the hymen.
THE FEMALE INTERNAL GENITALIA
 Internal genitalia cont.

Vagina
The vagina is a fibromuscular tube lined with stratified squamous epithelium opening into
the vestibule at its distal end and with the uterine cervix protruding into its proximal end.
 It runs obliquely upwards and backwards at an angle of about 45 degrees between
the bladder in front and the rectum and anus behind. In the adult, the anterior wall is
about 7.5 cm long and the posterior wall about 9 cm long. The difference is due to the
angle of insertion of the cervix through the anterior wall.
 The vaginal wall has three layers: an outer covering of areolar tissue, a middle layer
of smooth muscle and an inner lining of stratified squamous epithelium that forms
ridges or rugae
 It has no secretory glands but the surface is kept moist by cervical secretions.
 Internal gentalia cont.

 Between puberty and the menopause, Lactobacillus acidophilus, a bacterium that

secretes lactic acid is normally present, maintaining the pH of cervical canal between
4.9 and 3.5.
 The acidity inhibits the growth of most other microorganisms that may contaminate
the vagina from the perineum or during sexual intercourse
 Uterus: The Uterus is a pear-shaped, thick-walled, muscular organ. It is flattened
anteroposteriorly, measuring 5.5 to 8 cm long by 3.5 to 4 cm wide and 2 to 2.5 cm
thick.
 It is freely movable, not fixed, and usually tilts forward and superior to the bladder (a
position labeled as ant everted and ante flexed
 And it weighs between 30 and 40 grams. It has 3 main parts:
 Internal genitalia cont.

Fundus: This is the dome-shaped part of the uterus above cervix and
openings of the uterine tubes.
Body: This occupies the upper two-thirds of the uterus. It is pear-shaped,
and narrowest inferiorly at the internal os, where it is continuous with the
cervix.
This is the narrowest portion and is usually about 25 cm long. It protrudes
through the anterior wall of the vagina opening into it at the external os.
Cervix (neck of the uterus): This is the narrowest portion and is usually
about 25 cm long. It protrudes through the anterior wall of the vagina
opening into it at the external os.
 Internal Genitalia cont.

The walls of the uterus are composed of three layers of tissue:

perimetrium, myometrium and endometrium.
Perimetrium:
 The perimetrium can be imagined as a blanket draped over the uterus,
uterine tubes and ovaries from above, so it mainly covers the anterior,
upper and posterior surfaces of the uterus. Anteriorly, it lies over the
fundus and the body, where it is folded on to the upper surface of the
urinary bladder. This fold of peritoneum forms the vesicouterine pouch.
 Posteriorly, the peritoneum covers the fundus, the body and the cervix,
then it folds back on to the rectum to form the rectouterine pouch
 Internal genitalia cont.

 Laterally, only the fundus is covered because the peritoneum forms a double fold with
the uterine tubes in the upper free border. This double fold is the broad Ligament
which at its lateral ends, attaches the uterus to the sides of the cervix.
 Myometrium
This is the thickest layer of tissue in the uterine wall. It is a mass of smooth muscle
fibers interlaced with areolar tissue, blood vessels and nerves.
 Endometrium
 This is columnar epithelium covering a layer of connective tissue containing abundant
mucus secreting tubular glands. It is richly supplied with blood by spiral arteries,
branches of the uterine artery. It is divided into two layers:
 Internal gentalia cont.

 The functional layer

 Is the upper layer and it thickens and becomes rich in blood vessels in the first half of
the menstrual cycle when the ovum is not fertilized and does not implant, t his layer is
shed during menstruation
 The basal layer
 lies next to the myometrium and is not lost during menstruation.
 It is the permanent layer, from which the fresh functional layer is regenerated during
each cycle
 The upper two—thirds of the cervical canal is lined with
a mucous membrane. Lower parts contain the stratified squamous epithelium that
merges with the lining of the vagina itself
 The internal genitalia cont.

 Uterine tubes:
 The uterine (Fallopian) tubes are about 10 cm long and extend from the
sides of the uterus between the body and the fundus.

 They lie in the upper free border of the broad ligament and their trumpet-
shaped lateral ends penetrate the posterior wall, opening into the
peritoneal cavity close to the ovaries.

 The end of each tube has finger-like projections called fimbriae. The
longest of these is the ovarian fimbriae which is in close association with
the ovary.
 Structure of the Uterine tubes

The uterine tubes are covered with peritoneum (broad ligament), have a
middle layer of smooth muscle and are lined with ciliated epithelium. Blood
and nerve supply and lymphatic drainage are as for the uterus.
Ovaries:
 The ovaries are the female gonads and they lie in a shallow fossa on the
lateral walls of the pelvis. They are 25-3.5 cm long, 2 cm wide and 1 cm
thick.
 Each is attached to the upper part of the uterus by the ovarian ligament
and to the back of the broad ligament by a broad band of tissue, the
mesovarium. Blood vessels and nerves pass to the ovary
through the mesovarium.
 Structure of the Ovary

The ovaries have two layers of tissue the medulla and cortex.
 Medulla
This lies in the center and consists of fibrous tissue, blood
vessels and nerves
 Cortex
This surrounds the medulla. It has a framework of connective

tissue (stroma) covered by germinal epithelium. It contains

ovarian follicles in various stages of maturity, each of which
contains an ovum.
 Structure of the ovary cont.
 Before puberty the ovaries are inactive but the stroma already contains
immature (primordial) follicles, which the female has from birth.
 During the childbearing years, about every 28 days, one or more
ovarian follicle matures, ruptures and releases its ovum.
 This is called ovulation and it occurs during the menstrual cycle.
Following ovulation the ruptured follicle develops into the corpus luteum
(yellow body), which in turn will leave a small permanent scar of fibrous
tissue called the corpus albicans (white body) on the surface of the
ovary.
Oogenesis/ ovulation /Ovarian cycle
 Physiology of female reproductive system

 The female reproductive system is a network of organs and structures

that work together to facilitate reproduction.

 Its primary functions include producing eggs (ova), providing a suitable

environment for fertilization and development of the embryo, and
supporting the growth and nourishment of the fetus during pregnancy.
Different organs have different functions as stated below;
 Ovaries: Paired organs located on either side of the uterus.
 It Produce eggs (ova) and female sex hormones (estrogen and
progesterone).
 Physiology cont.

Fallopian tubes:
Tubes that extend from each ovary to the uterus.
Provide a pathway for eggs to travel from the ovaries to the uterus; it is
also the site where fertilization typically occurs.
Uterus:
Muscular organ situated in the pelvic cavity.
Nurtures and houses a fertilized egg during pregnancy. The lining of the
uterus (endometrium) thickens in preparation for implantation.
 Physiology cont.

Cervix:
Located in the Lower portion of the uterus that connects to the vagina and
acts as a passageway between the uterus and vagina; also produces
mucus that changes in consistency during the menstrual cycle.
The vagina
serves as a passageway for menstrual flow, receives the penis during
sexual intercourse, and acts as the birth canal during childbirth.
Labia Majora and Labia Minora:
External folds of skin surrounding the vaginal opening.
Protect and enclose the external genitalia.
 Physiology cont.

 Clitoris: Is small, sensitive organ located at the anterior junction of the labia minora.
It Contains a high concentration of nerve endings and is involved in sexual arousal.
 Mammary glands (Breasts): Paired structures on the chest.
It Produces milk to nourish the newborn after childbirth.
 Skene’s Glands and Bartholin’s Glands:
Skene's glands are near the urethra, and Bartholin's glands are near the vaginal
opening.
They Secrete fluids that contribute to lubrication during sexual activity
 Physiology cont.

 The external genitalia protect the internal reproductive organs and are
involved in sexual arousal and intercourse.
 The menstrual cycle regulates the release of eggs, prepares the uterus for
potential pregnancy, and ensures the proper functioning of the reproductive
system.
 These hormones play key roles in regulating the menstrual cycle, supporting
the development of secondary sexual characteristics, and maintaining
pregnancy.
 Assessment of the female reproductive system

Subjective data
 1.Menstrual history
 2. Obstetric history
 3. Menopause
 4. Patient-centered care
 5. Acute pelvic pain
 6. Vaginal discharge
 7. Sexual activity
 8. Contraceptive use
 9. Sexually transmitted infection (STI) contact
 Assessment of the female reproductive system cont.

 Past history
 History for preadolescent and Adolescents
 Contraceptive use
 Menstrual history

 Questions to ask;
 Date of your last menstrual period? (LMP); to assess the duration.
 Age at first period? Menarche: normal age 12-13 years, delayed onset suggests
endocrine or under weight problem.
 How often are your periods?: normally every 28 days; varies from 18-45 days
amenorrhea.
 How many days does your period last?, duration: average 3-7 days
 Usual amount of flow: light, medium, heavy? How many pads or
tampons do you use each day or hour? To assess heavy menses (menorrhagia).
 Any clotting? Clotting indicates heavy flow or vaginal pooling.
 Any pain or cramps before or during period?
 Menstrual history cont.

 How do you treat it?, Dysmenorrhea responds to ibuprofen because it

works on the uterine smooth muscles.
 Does it interfere with daily activity?
 Any other associated symptoms: such as bloating, breast tenderness,
moodiness?
 Any spotting between periods?
 Obstetric history:

Questions to be asked
 Have you ever been pregnant?
 How many times? (Gravida—Number of pregnancies).
 How many babies have you had? (Para—Number of births).
 Any miscarriage or abortion?
 For each pregnancy describe: duration, any complication, labor and
delivery, baby's sex, birth weight, condition.
 Do you think you may be pregnant now?
 What symptoms have you noticed?
 3. Menopause

Menopause is cessation of menstruation.

Questions to be asked;
 Have your periods slowed down or stopped?
 Any associated symptoms of menopause (e.g., hot flashes, night
sweats, numbness and tingling, headache, palpitations, drenching
sweats, mood swings, vaginal dryness, itching)?
 Any treatment?
 Premenopausal period from ages 40 to 55 years has hormone
 shifts, resulting in vasomotor instability.
 Menopause cont.

 If hormone replacement therapy (HRT), how much? How is it working?

 Any side effects? Like; fluid retention, breast pain, vaginal
bleeding, cardiovascular, and breast cancer risk.
 How do you feel about going through menopause? Although a normal
life stage, reaction varies from acceptance to feelings of loss
 4. Patient centered care

Questions to be asked;
 How often do you have a gynecologic checkup?
The recommended screening for cervical cancer prevention by age:
 No Pap tests if you are under 21 years, regardless of sexual activity.
 Pap test once every 3 years for women ages 21-30 years.
 HPV and Pap “co-testing” every 3 years for women ages 30-65 years.
 Your last Pap test? Results?
Although Pap tests save lives, adolescents and young women
have high rates of HPV infection that their own immune systems can clear.
 Patient centered care cont.

 Delaying Pap testing until age 21 allows the HPV

infections to regress spontaneously in adolescents, avoiding
overtreatment.
 We do recommend yearly screening for chlamydial infection in all
sexually active women under 25 years and in older women with a
new
sex partner, more than one sex partner, or a sex partner with other
Partners, and this is done by testing first-catch urine
 5. Acute pelvic pain

Questions asked;
 Any pain in the lower abdomen or pelvis?
 When did it start? Constant or comes and goes? Associated with
periods? On a scale of 1 to 10, with 10 being the strongest,
 how would you rate your pain?
 Acute pain lasts <3 months. Consider urgent conditions:
pelvic inflammatory disease (PID), appendicitis, ruptured ovarian cysts,
ovarian torsion, which need transvaginal ultrasound imaging.
 6. Vaginal discharges

 Questions asked;
 Any unusual vaginal discharge? Increased in amount?
Normal discharge is small, clear or cloudy, and always nonirritating.
 • Character or color: white, yellow-green, gray, cordlike, foul smelling
Suggests vaginal infection; character of discharge often suggests
causative organism (see Table 27.5, p. 760). Jarvis text book.
 • When did it begin? Acute versus chronic problem.
Some of the abnormal discharges
 Vaginal discharges cont.

 Is the discharge associated with; vaginal itching, rash, pain with

intercourse? Rash is as result of irritation from discharge.
 Dyspareunia occurs with vaginitis of any cause.
 Taking any medications/ contraceptives?; Oral contraceptives increase
glycogen content of vaginal epithelium, providing fertile medium for some
organisms.
Broad-spectrum antibiotics alter balance of normal flora.
 Family history of diabetes? because Diabetes increases glycogen content.
 In which part of your menstrual cycle are you now? Postpartum menses,
and menopause have a more alkaline vaginal pH.
 Vaginal discharges cont.

 Do you do a vaginal douche? How often? because Frequent douching

alters pH.
 Do you Use feminine hygiene spray? because the Spray has risk for
contact of dermatitis.
 Do you wear non ventilating underpants, pantyhose?
 Have you treated the discharge with anything?, any Result?, any Local
irritation
 Past history

 Any other problems in the genital area? Sores or lesions—

 now or in the past? How were they treated? Any abdominal pain?
 Any past surgery on uterus, ovaries, vagina? Assess feelings. Some
fear loss of sexual response after
 hysterectomy, which may affect intimate relationships.
 7. Sexual activities

Questions asked;
Often women have a question about their sexual relationship and how it
affects their health.
 Are you in a relationship involving sex now?
 How are aspects of sex satisfactory to you and your partner?
 Are you Satisfied with the way you and your partner communicate
about sex?
 Satisfied with your ability to respond sexually?
 Sexual activity cont.

 Do you have more than one sexual partner?

 Begin with open-ended question to assess individual needs which
Include appropriate questions as a routine.
 Communicates that; you accept individual's sexual activity and believe
that it is important.
 Have you and your partner discussed having children?
 Contraceptive use:

 Questions asked;
 Currently planning pregnancy or avoiding pregnancy?
 Do you and your partner use a contraceptive?, Which method?, Is it
satisfactory?, Do you have any question about contraceptive methods?,
which method methods have you used in the past? Have you and your
partner discussed having children?
 Assess smoking history, because oral contraceptives together with cigarette
smoking increase the risk for vascular problems.
 Have ever had problem becoming pregnant, because infertility is considered
after 1year of un protected sexual intercourse without conceiving
 STI Contact:

Questions asked;
 Any sexual contact with partner having an STI such as
gonorrhea, herpes, HIV/AIDS, chlamydial infection, venereal warts, and
syphilis?
When? How was it treated? Were there any complications?
 STI can be transmitted during vaginal, oral, and anal sexual contact with an
infected partner.
 Treating patient and the sex partner(s) prevents reinfection and infection of
others.
 Any precautions to reduce risk for STIs? Use condoms at each episode
of sexual intercourse?
 History for preadolescents and Adolescents:

 Assess sexual growth and development and sexual behavior.

 First, ask questions that seem appropriate for girl's age, but norms vary widely
and be sure that your information is more thoughtful and accurate.
 Ask direct, matter-of-fact questions. Avoid sounding judgmental.
 Start with a permission statement: “Often girls your age experience ….” This
conveys that it is normal to think or feel a certain way.
 Try the open-ended question: “When did you …?” rather than “Do you …?” This
is less threatening because it implies that the topic is normal and unexceptional.
 Around age 9 or 10 years, girls start to develop breasts and pubic hair. Have you
ever seen charts and pictures of normal growth patterns for girls? Let us go over
these now.
 History for preadolescent and Adolescent cont.

 Have your periods started? How did you feel? Were you ready or
surprised? Assess attitude of girl and parents. and note inadequate
preparation or distaste.
 To whom in your family do you talk about your body changes and sex
information?
 How do these talks go? Do you think you get enough information?
What about sex education classes at school?
 Is there a teacher, a nurse or doctor, a minister, a counselor to whom
you can talk?
 History for preadolescent and Adolescent cont.

 Often girls your age have questions about sexual intercourse.

 Do you have questions? Are you dating Someone steady?
 Do you and your boyfriend have intercourse? Are you using condoms?
What kind of protection did you use the last time you had sex?
 Has anyone ever talked to you about sexually transmitted infections
such as chlamydia, herpes, gonorrhea, or HIV/AIDS?
 Routine vaccinations include the human papillomavirus (HPV) vaccine
given before girls have sexual intercourse.
 The 2-dose series of Gardasil 9 is recommended for girls and boys 9–
14 years, doses separated by 6–12 months.9
 Objective Data:

Preparations;
 Preparation of equipment's and Assembling of instruments for
examinations like speculum.
Objective data may include inspection and palpation.
 On inspection: view;
 The Clitoris.
 Urethral opening: appears stellate or slit like and is midline.
 Vaginal opening, or introit us: may appear as a narrow vertical slit
or as a larger opening.
 Objective Data cont.

 Perineum: appears smooth. A well-healed episiotomy scar,

midline or Medio lateral, may be present after a vaginal birth.
 Anus has coarse skin of increased pigmentation
On Palpation
 Assess Bartholin glands. Palpate the posterior parts of the labia majora
with your gloved index finger in the vagina and your thumb outside at 5
and 7 o'clock positions.
 Objective Data cont.

Speculum Examination is done.

Select the proper-size speculum.
Further, use lubricant to decrease pain, and may increase compliance in
older women with vaginal atrophy.
 Inspect the Cervix and Its Os: Note the Color. Normally the cervical
mucosa is pink and even.
During the 2nd month of pregnancy it looks blue (Chadwick sign), after
menopause it is pale
 Position. Midline, either anterior or posterior. Projects 1 to 3 cm into the
vagina.
 Objective Data cont.

 Size. Diameter is 2.5 cm (1 inch).

 Os. This is small and round in the nulliparous woman. In the parous woman it
is a horizontal, irregular slit and also may show healed lacerations
 Surface: This is normally smooth, but cervical eversion, or ectropion, may
occur normally after vaginal deliveries.
 The endocervical canal is everted or “rolled out.” It looks like a red, beefy halo
inside the pink cervix surrounding the os.
 Note the cervical secretions. Depending on the day of the menstrual cycle,
secretions may be clear and thin, or thick, opaque, and stringy.
 Objective Data cont.

 Obtain Cervical specimens for Tests and Cultures

 The Pap test screens for cervical cancer
 infectious discharge if present by picking a high vaginal swab.
 DEVELOPMENTAL COMPETENCE

 Objective data cont.

 Infants and Children:
 Infant—Place on examination table.
 Toddler/preschooler—Place on parent's lap.
Frog-leg position—Hips flexed, soles of feet together and up to bottom.
 Preschool child may want to separate her own labia.
 No drapes—The young girl wants to see what you are doing
 Developmental competence cont.

 School-age child—Place on examination table, frog-leg position, no

drapes.
 During childhood a routine screening is limited to inspection of the
external genitalia to determine that the structures are normal
 The newborn's genitalia are somewhat engorged. The labia majora are
swollen, the labia minora are prominent and protrude beyond the labia
majora, the clitoris looks relatively large, and the hymen appears thick.
Because of transient engorgement, the vaginal opening is more difficult
to see
 STAGES OF DEVELOPMENT IN FEMALE
REPRODUCTIVE SYSTEM:

 The female reproductive system derives from four origins: mesoderm,

primordial germ cells, coelomic epithelium, and mesenchyme.
 The uterus forms during Mullerian organogenesis accompanied by the
development of the upper third of the vagina, the cervix, and both
fallopian tubes.
 The development of the female reproductive system begins before birth
and continues through puberty. Here are the key stages of
development
 Stages of development cont.

Gonadal Development (Weeks 4-6).

 Initially, the gonads are undifferentiated in the early embryo. Around the
sixth week of gestation, if the fetus carries two X chromosomes (XX),
the gonads develop into ovaries.
 If the fetus has a Y chromosome (XY), the gonads develop into testes.
 The expression of specific genes guides the undifferentiated gonads
toward forming ovarian tissue.
 Stages cont.

Differentiation of Mullerian Ducts (Weeks 6-10)

 Mullerian ducts, also known as paramesonephric ducts, are bilateral structures that
form parallel to the Wolff an ducts (which develop into male reproductive structures).
 In the absence of anti-Mullerian hormone (AMH) from the testes, the Mullerian ducts
persist and develop into the female reproductive organs.
Paramesonephric Duct Fusion:
 Fusion of the paramesonephric ducts results in the formation of a single uterus. If
fusion is incomplete, it can lead to variations in uterine structure, such as a septate or
Bicornuate uterus.
 Stages cont.

Differentiation of Mullerian Ducts (Weeks 6-10)

 Mullerian ducts, also known as paramesonephric ducts, are bilateral structures that
form parallel to the Wolffian ducts (which develop into male reproductive structures).
 In the absence of anti-Mullerian hormone (AMH) from the testes, the Mullerian ducts
persist and develop into the female reproductive organs.
Paramesonephric Duct Fusion:
 Fusion of the paramesonephric ducts results in the formation of a single uterus. If
fusion is incomplete, it can lead to variations in uterine structure, such as a septate or
Bicornuate uterus.
 Stages cont.

 Embryonic Stage: Weeks 1-5: The gonadal ridges develop on either side of the
urogenital ridge. In females, these gonadal ridges develop into the ovaries.
 Fetal Stage: Weeks 6-22: The primordial germ cells migrate to the developing
ovaries, where they differentiate into oogonia (precursors to eggs). The ovarian
follicles, which contain the eggs, begin to form
 Neonatal Period: Birth to Puberty: At birth, a female typically has all the eggs she will
ever have. However, these eggs are in an immature state (oocytes) and do not
complete development until later in life.
 Childhood: Pre-puberty: The reproductive system remains relatively inactive during
childhood. The ovaries are present, but the reproductive organs are not fully
developed.
 Stages cont.

 Maturation and Readiness for Puberty:

Around Ages 8-14: Puberty marks the onset of reproductive maturity. The hypothalamus
signals the pituitary gland to release hormones that stimulate the ovaries.
This leads to the development of secondary sexual characteristics, such as breast
development and the growth of pubic hair. Menstruation typically begins a couple of
years into puberty.
 Menstrual Cycle:
Menstruation is a monthly process where the lining of the uterus thickens in preparation
for a potential pregnancy. If fertilization does not occur, the lining is shed during
menstruation
 Stages cont.

 Reproductive Years: Late Teens to Late 40s/Early 50s: Women are fertile and
capable of conceiving during this period. Ovulation occurs regularly, usually on a
monthly basis.
 Perimenopause: Late 30s/Early 40s to Menopause: This transitional stage precedes
menopause and involves hormonal fluctuations, leading to changes in menstrual
patterns and the gradual decline of fertility.
 Menopause:
 Late 40s to Early 50s: Menopause is the cessation of menstruation, marking the end
of a woman's reproductive years
 Stages cont.

 Menopause;
 It is defined as the absence of menstrual periods for 12 consecutive
months. Hormonal changes during menopause lead to various physical
and emotional symptoms.
 It's important to note that these stages can vary among individuals, and
the ages mentioned are generalizations.
 The development of the female reproductive system is influenced by
genetic, environmental, and nutritional factors. Additionally, each
woman may experience puberty and menopause at different ages.
 Changes that occur During pregnancy:

Throughout pregnancy, the female reproductive system undergoes significant changes to

support the development and well-being of the growing fetus. Some key changes include
 Uterine expansion
The uterus, a muscular organ, grows in size to accommodate the developing fetus. This
process is essential for providing sufficient space for the baby to grow and mature.
As the uterus expands, it puts pressure on surrounding organs and tissues, which can
contribute to discomfort and changes in posture.
 Vaginal Changes.
Hormonal influences, particularly estrogen, leads to increased blood flow and changes in the
vaginal walls. This increased vascularity contributes to the characteristic bluish tint of the
vaginal mucosa during pregnancy. These changes, along with increased elasticity, help
prepare the birth canal for the passage of the baby during delivery.
 Changes cont.

 Ovarian changes.
Ovulation typically ceases during pregnancy due to the elevated levels of hormones
such as hCG and progesterone. This halting of the menstrual cycle is a natural part of
maintaining the pregnancy and preventing the release of additional eggs.
 Breast Changes.
Hormonal changes, particularly the increase in estrogen and progesterone, stimulate the
growth of mammary glands and result in breast enlargement. The breasts become more
sensitive, and the areolas (the darker area around the nipples) may darken.
These changes prepare the breasts for lactation, the production of breast milk to nourish
the newborn. These intricate and interconnected changes are essential for a successful
pregnancy and the healthy development of the baby.
Changes during pregnancy cont.
 Cervical Changes. As pregnancy progresses, the cervix undergoes a series of
changes in preparation for childbirth.
These changes include softening of the cervix (known as effacement), dilation (opening
of the cervix), and changes in position.
 Placental Development
The placenta is a temporary organ that forms during early pregnancy. It attaches to the
uterine wall and serves as a crucial interface between the mother and the developing
baby.
The placenta allows for the exchange of nutrients, oxygen, and waste products between
the maternal and fetal bloodstreams, providing the necessary support for fetal growth.
hense adaptations facilitate the passage of the baby through the birth canal during labor.
 Changes during pregnancy cont.

 Blood Flow.
The cardiovascular system undergoes changes to meet the increased demands of
pregnancy.
Hormones, such as relaxin, contribute to the dilation of blood vessels, ensuring an
adequate supply of nutrients and oxygen to the developing fetus.
The increased blood flow can also lead to changes in blood pressure.
 Metabolic Changes:
Increased Metabolism: The body's metabolic rate increases to provide energy for fetal
development.
 Complications in reproductive system:

The reproductive system is complex, and various complications can

occur, affecting both male and female reproductive organs. Here are
some common complications:
In Females reproductive system:
Menstrual Disorders:
 Dysmenorrhea: Painful menstruation.
 Menorrhagia: Heavy or prolonged menstrual periods.
 Amenorrhea: Absence of menstruation.
 Complications cont.

Certainly, here are some complications that can affect the female
reproductive system:
 Polycystic Ovary Syndrome (PCOS):
PCOS is a common hormonal disorder among women of reproductive
age. It can cause irregular menstrual cycles, cysts on the ovaries, and
hormonal imbalances, leading to fertility issues.
 Endometriosis:
Endometriosis occurs when the tissue lining the uterus (endometrium)
grows outside the uterus. This can lead to pelvic pain, painful
menstruation, and fertility problems.
 Complications cont.

 . Uterine Fibroids:
Uterine fibroids are noncancerous growths in the uterus that can cause
heavy menstrual bleeding, pelvic pain, and pressure on the bladder or
rectum.
 Complications cont.

 Pelvic Inflammatory Disease (PID):

PID is an infection of the reproductive organs, often caused by sexually
transmitted bacteria. It can lead to inflammation, scarring, and damage to
the fallopian tubes, increasing the risk of infertility
 Ovarian Cysts:
Ovarian cysts are fluid-filled sacs that can form on the ovaries. While
many are harmless and resolve on their own, some may cause pain,
rupture, or interfere with fertility.

The ovarian cyst
 Amenorrhea:
Amenorrhea is the absence of menstruation. It can be caused by factors
such as hormonal imbalances, stress, excessive exercise, or certain
medical conditions.
 Dysmenorrhea:
Dysmenorrhea refers to painful menstruation. It can be primary (common
menstrual cramps) or secondary (caused by an underlying reproductive
health issue).
 Menorrhagia:
Menorrhagia is characterized by abnormally heavy or prolonged
menstrual bleeding. It can be caused by hormonal imbalances, uterine
fibroids, or other conditions.
 Premenstrual Syndrome(PMS) and Premenstrual Dysphoric
Disorder(PMDD):
PMS involves a range of physical and emotional symptoms before
menstruation, while PMDD is a severe form of PMS that can significantly
impact daily functioning.
 Cervical Dysplasia:
Cervical dysplasia is the abnormal growth of cells on the cervix, often
linked to human papillomavirus (HPV) infection. If left untreated, it can
progress to cervical cancer.
The image showing abnormal growth in the cervix
(pre-cancerous lessons).
 Complications cont.

 Gynecological Cancer:
Cancers such as ovarian cancer, uterine cancer, and cervical cancer can
affect the female reproductive system and may require surgery,
chemotherapy, or radiation therapy.
 Ectopic Pregnancy:
An ectopic pregnancy occurs when a fertilized egg implants outside the
uterus, usually in a fallopian tube, or abdominal cavity. It poses a serious
health risk and requires immediate medical attention.
 Possible abnormal things that can occur in
the female reproductive system

These conditions are present at birth and may impact the development
and function of reproductive organs. Here are some examples:
 Turner Syndrome:
This genetic disorder are congenital abnormalities that can affect the
female reproductive system and is characterized by the partial or
complete absence of one of the X chromosomes. It can lead to
underdeveloped ovaries, short stature, and infertility.
 Mullerian Anomalies:
These are abnormalities in the development of the Müllerian ducts, which
give rise to the female reproductive organs. Examples include:
 Septate Uterus: A partition or wall within the uterus.
 Bicornuate Uterus: Uterus with two separate horns.
 Unicornuate Uterus: Uterus that forms only on one side.
 Abnormal things cont.

 Androgen in sensitivity Syndrome (AIS):

AIS is a genetic condition where an individual with XY chromosomes
(typically male) is partially or completely insensitive to androgens (male
hormones). In complete AIS, individuals may have external female
genitalia but no functional uterus or ovaries.
 Congenital Adrenal Hyperplasia (CAH):
CAH is a group of genetic disorders affecting the adrenal glands, leading
to abnormal hormone production. In females, it can cause virilization
(development of male secondary sexual characteristics) and affect the
development of reproductive organs.
 Abnormal things cont.

 Vaginal Agenesis:
This condition involves the incomplete or absent development of the
vagina. It may be associated with Mayer-Rokitansky-Küster-Hauser
(MRKH) syndrome, where the uterus is either absent or underdeveloped.

 Ovarian Dysgenesis:
Ovarian dysgenesis is a condition where the ovaries do not develop
properly. It can result in hormonal imbalances and may lead to primary
amenorrhea and infertility.
 Abnormal things cont.

 Gonadal Dysgenesis:
This condition involves abnormal development of the gonads (ovaries or
testes). It can result in ambiguous genitalia or underdeveloped
reproductive organs.
 Double Uterus (Didelphys Uterus):
In this condition, a woman has two separate uteri, each with its own
cervix. It can be associated with a double or partially double vagina.
 Management:

The management of reproductive complications will depend on the

subjective and objective data collected.
Note: for History of present illness, you can follow the acronym below, P.
Q. R. S
For example;
Subjective data:
Pain Description: Ask the patient to describe the pain, including its
location, intensity, quality (e.g., cramping, sharp), and radiation. Pain
scales, like the Numeric Rating Scale (NRS) or Visual Analog Scale
(VAS), may be used to quantify pain intensity.
 Onset and Duration: Ask about when the pain started, its duration, and
whether there are specific triggers or patterns associated with the pain.
 Aggravating or Alleviating Factors: Explore factors that worsen or
alleviate the pain, such as specific activities, medications, or rest.
 Associated Symptoms: Inquire about other symptoms accompanying
dysmenorrhea, such as nausea, vomiting, diarrhea, headaches, or
dizziness.
 Impact on Daily Activities: Assess how dysmenorrhea affects the
patient's daily life, including work, school, and social activities.
 Management cont.

Objective data:
 Vital Signs: Measure the patient's vital signs, including heart rate,
blood pressure, respiratory rate, and body temperature. These can
provide insights into the physiology of the disease. And manage
accordingly
 Physical Examination: Conduct a pelvic examination to check for
abnormalities, tenderness, or signs of reproductive health issues. And
manage accordingly
 Laboratory Tests: often a clinical diagnosis is obtained after doing
certain laboratory tests like culture and sensitivity, full blood count and
others.
 CONCLUSON

 It's important for individuals experiencing reproductive system

complications to seek medical advice for proper diagnosis and
management. Many conditions can be treated, and early intervention is
often key to preserving reproductive health. Regular gynecological
check-ups, screenings, and a healthy lifestyle contribute to overall
reproductive well-being.
 Summary Checklist: for Female Genitalia Examination

 . Inspect external genitalia.

 2. Palpate labia, Skene and Bartholin glands.
 3. Using vaginal speculum, inspect cervix and vagina.
 4. Obtain specimens for cytologic study.
 5. Perform bimanual examination: cervix, uterus, adnexa
 . 6. Perform rectovaginal examination.
 7. Test stool for occult blood.
 References:

 American Academy of Pediatrics (AAP). Screening for nonviral sexually transmitted

infections in adolescents and young adults. Pediatrics. 2014;134(1):1– 26.
 Anderson S, Must A. Interpreting the continued decline in the average age at menarche:
Results from two nationally representative surveys of U.S. girls studied 10 years apart. J
Pediatr. 2005;147(6):753–760.
 . Banayya Jungari S. Female genital mutilation is a violation of reproductive rights of
women. Health Soc Work. 2016;41(1):25–31.
 Brunham RC, Gottlieb SL, Paavonen J. Pelvic inflammatory disease. N Engl J Med.
2015;372(21):2039.
 Centers for Disease Control and Prevention (CDC). Chlamydial infections.
https://cdc.gov/std/tg2015/chlamydia.htm; 2015
THANK YOU VERY MUCH TEAM