B.

REPRODUCTIVE SYSTEM:
Learning Outcomes:
1. Describe the structures and functions of the male and female reproductive systems.
2. Summarize the functions of the major hormones essential for the functioning of the male
and female reproductive systems.
3. Explain the physiologic changes during the stages of sexual response for both a man and a
woman.
4. Link the age-related changes of the male and female reproductive systems to the differences
in assessment findings.
5. Select the significant subjective and objective data related to the male and female
reproductive systems and information about sexual function that should be obtained from a
patient.
6. Select the appropriate techniques to use in the physical assessment of the male and female
reproductive systems.
7. Differentiate normal from common abnormal findings of a physical assessment of the male
and female reproductive systems.
8. Describe the purpose, significance of results, and nursing responsibilities related to
diagnostic studies of the male and female reproductive systems.

Structures and Functions of Male and Female Reproductive Systems

The reproductive system of both males and females consists of primary (or essential) organs and
secondary (or accessory) organs. The primary reproductive organs are referred to as gonads. The
female gonads are the ovaries; the male gonads are the testes. The main responsibility of the
gonads is secretion of hormones and production of gametes (ova and sperm). Secondary (or
accessory) organs are responsible for (1) transporting and nourishing the ova and sperm and (2)
preserving and protecting the fertilized eggs.

Male Reproductive System

The three primary roles of the male reproductive system are (1) production and transportation
of sperm, (2) deposition of sperm in the female reproductive tract, and (3) secretion of
hormones. The primary reproductive organs in the male are the testes. Secondary reproductive
organs include ducts (epididymis, ductus deferens, ejaculatory duct, and urethra), sex glands
(prostate gland, Cowper’s glands, and seminal vesicles), and the external genitalia (scrotum and
penis)1 (Fig. 51-1).
Testes.

The paired testes are ovoid, smooth, firm organs measuring 1.4 to 2.2 in (3.5 to 5.6 cm) long and 0.8 to
1.2 in (2 to 3 cm) wide. They are within the scrotum, which is a loose protective sac composed of a thin
outer layer of skin over a tough connective tissue layer. Within the testes, coiled structures known as
seminiferous tubules form spermatozoa (immature sperm). The process of sperm production is
called spermatogenesis. Interstitial cells of the testes lie between the seminiferous tubules and produce
the male sex hormone testosterone.

Ducts.

Sperm formed in the seminiferous tubules move through a series of ducts. These ducts transport the
sperm from the testes to the outside of the body. As sperm exit the testes, they enter and pass through
the epididymis, ductus deferens, ejaculatory duct, and urethra.

The epididymis is a comma-shaped structure located on the posterosuperior aspect of each testis within
the scrotum (see Figs. 51-1 and 51-2). It is a very long, tightly coiled structure that measures about 20 ft
in length.1 The epididymis transports the sperm as they mature. Sperm exit the epididymis through a
long, thick tube known as the ductus deferens.
The ductus deferens (also known as the vas deferens) is continuous with the epididymis within the
scrotal sac. It travels upward through the scrotum and continues through the inguinal ring into the
abdominal cavity. The spermatic cord is composed of a connective tissue sheath that encloses the
ductus deferens, arteries, veins, nerves, and lymph vessels as it ascends up through the inguinal canal
(see Fig. 51-2). In the abdominal cavity, the ductus deferens travels up, over, and behind the bladder.
Posterior to the bladder the ductus deferens joins the seminal vesicle to form the ejaculatory duct
(see Fig. 51-1).

The ejaculatory duct passes downward through the prostate gland, connecting with the urethra. The
urethra extends from the bladder, through the prostate, and ends in a slitlike opening (the meatus) on
the ventral side of the glans, the tip of the penis. During the process of ejaculation, sperm travels
through the urethra and out of the penis.

Glands.

The seminal vesicles, the prostate gland, and Cowper’s (bulbourethral) glands are the accessory glands
of the male reproductive system. These glands produce and secrete seminal fluid (semen), which
surrounds the sperm and forms the ejaculate.

The seminal vesicles lie posterior to the bladder and between the rectum and bladder. The ducts of the
seminal vesicles fuse with the ductus deferens to form the ejaculatory ducts that enter the prostate
gland. The prostate gland lies beneath the bladder. Its posterior surface is in contact with the rectal wall.
The prostate normally measures 0.8 in (2 cm) wide and 1.2 in (3 cm) long and is divided into the right
and left lateral lobes and an anteroposterior median lobe. Cowper’s glands lie on each side of the
urethra and slightly posterior to it, just below the prostate. The ducts of these glands enter directly into
the urethra.

Secretions from the seminal vesicles, prostate, and Cowper’s glands make up most of the fluid in the
ejaculate. These various secretions serve as a medium for the transport of sperm and create an alkaline,
nutritious environment that promotes sperm motility and survival.

External Genitalia.

The external genitalia consist of the penis and the scrotum. The penis consists of a shaft, and the tip is
known as the glans. The glans is covered by a fold of skin, the prepuce (or foreskin), that forms at the
junction of the glans and the shaft of the penis. In circumcised males the prepuce has been removed.
The shaft of the penis consists of erectile tissue composed of the corpus cavernosum, the corpus
spongiosum (the fibrous sheath that encases the erectile tissue), and the urethra. The skin covering the
penis is thin, loose, and hairless.

Female Reproductive System

The three primary roles of the female reproductive system are (1) production of ova (eggs), (2) secretion
of hormones, and (3) protection and facilitation of the development of the fetus in a pregnant female.
Like the male, the female has primary and secondary reproductive organs. The primary reproductive
organs in the female are the paired ovaries. Secondary reproductive organs include the ducts (fallopian
tubes), uterus, vagina, sex glands (Bartholin’s glands and breasts), and external genitalia (vulva).

Pelvic Organs

Ovaries.

The ovaries are located on either side of the uterus, just behind and below the fallopian (uterine) tubes
(Fig. 51-3). The almond-shaped ovaries are firm and solid, approximately 0.6 in (1.5 cm) wide and 1.2 in
(3 cm) long. Their functions include ovulation and secretion of the two major reproductive hormones,
estrogen and progesterone.
Female reproductive tract.

The outer zone of the ovary contains follicles with germ cells, or oocytes. Each follicle contains a
primordial (immature) oocyte surrounded by granulosa and theca cells. These two layers protect and
nourish the oocyte until the follicle reaches maturity and ovulation occurs. However, not all follicles
reach maturity. In a process termed atresia, most of the primordial follicles become smaller and are
reabsorbed by the body. Thus the number of follicles declines from 2 million to 4 million at birth to
approximately 300,000 to 400,000 at menarche. Fewer than 500 oocytes are actually released by
ovulation during the reproductive years of the normal healthy woman.

Fallopian Tubes.

Normally, each month during a woman’s reproductive years, one ovarian follicle reaches maturity, and
the ovum is ovulated, or expelled, from the ovary through the stimulus of the gonadotropic hormones,
follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The ovum then travels up a fallopian
tube where fertilization by sperm may occur, if sperm are present. An ovum can be fertilized up to 72
hours after its release.

The distal ends of the fallopian tubes consist of fingerlike projections called fimbriae that “massage” the
ovaries at ovulation to help extract the mature ovum. The tubes, which average 4.8 in (12 cm) in length,
extend from the fimbriae to the superior lateral borders of the uterus. Fertilization usually takes place
within the outer one third of the fallopian tubes.

Uterus.
The uterus is a pear-shaped, hollow, muscular organ (see Fig. 51-3). It is located between the bladder
and the rectum. In the mature nulliparous (never pregnant) woman, the uterus is approximately 2.4 to
3.2 in (6 to 8 cm) long and 1.6 in (4 cm) wide. The uterine walls consist of an outer serosal layer,
the perimetrium; a middle muscular layer, the myometrium; and an inner mucosal layer,
the endometrium.

The uterus consists of the fundus, body (or corpus), and cervix (see Fig. 51-3). The body makes up about
80% of the uterus and connects with the cervix at the isthmus, or neck. The cervix is the lower portion of
the uterus that projects into the anterior wall of the vaginal canal. It makes up about 15% to 20% of the
uterus in the nulliparous female. The cervix consists of the ectocervix, the outer portion that protrudes
into the vagina, and the endocervix, the canal in the opening of the cervix. The ectocervix is covered with
squamous epithelial cells, which give it a smooth, pinkish appearance. The endocervix contains a lining
of columnar epithelial cells, which give it a rough, reddened appearance. The junction at which the two
types of epithelial cells meet is termed the squamocolumnar junction and contains the optimal types of
cells needed for an accurate Papanicolaou (Pap) test to screen for malignancies.

The cervical canal is 0.8 to 1.6 in (2 to 4 cm) long and is relatively tightly closed. However, the cervix
allows sperm to enter the uterus and also allows menses to be expelled. The columnar epithelium,
under hormonal influence, provides elasticity during labor for the cervix to stretch to allow passage of a
fetus during the birth process. The entrance of sperm into the uterus is facilitated by mucus produced by
the cervix under the influence of estrogen. Under normal conditions, the cervical mucus becomes
watery, stretchy, and more abundant at ovulation. The postovulatory cervical mucus, under the
influence of progesterone, is thick and inhibits sperm passage.

Vagina.

The vagina is a tubular structure 3 to 4 in (7.6 to 10 cm) long that is lined with squamous epithelium. The
secretions of the vagina consist of cervical mucus, desquamated epithelium, and, during sexual
stimulation, a watery secretion. These fluids help protect against vaginal infection. The muscular and
erectile tissue of the vaginal walls allows enough dilation and contraction to accommodate the passage
of the fetus during labor, as well as penetration of the penis during intercourse. The anterior vaginal wall
lies along the urethra and bladder. The posterior vaginal wall is adjacent to the rectum.

Pelvis.

The female pelvis consists of four bones (two pelvic bones, sacrum, coccyx) held together by several
strong ligaments. The sections of these bones that lie below the iliopectineal line are important during
birth and are often a factor determining the ability of a woman to deliver a child vaginally.

External Genitalia.

The external portion of the female reproductive system (Fig. 51-4), commonly called the vulva, consists
of the mons pubis, labia majora, labia minora, clitoris, urethral meatus, Skene’s glands, vaginal introitus
(opening), and Bartholin’s glands.
The mons pubis is a fatty layer lying over the pubic bone. It is covered with coarse hair that lies in a
triangular pattern. (The male hair pattern is diamond shaped.) The labia majora are folds of adipose
tissue that form the outer borders of the vulva. The hairless labia minora form the borders of the vaginal
orifice and extend anteriorly to enclose the clitoris.

The vestibule is a boat-shaped fossa between the labia minora, extending from the clitoris at the
anterior end to the vaginal opening at the posterior end. The perineum is the area between the vagina
and the anus. The vaginal introitus is surrounded by thin membranous tissue called the hymen. In the
adult woman the hymen usually appears as folds or hymenal tags and separates the external genitalia
from the vagina. At the posterior aspect of the vagina, a tense band of mucous membrane connecting
the posterior ends of the labia minora is referred to as the posterior fourchette.

The clitoris is erectile tissue that becomes engorged during sexual excitation. It lies anterior to the
urethral meatus and the vaginal orifice and is usually covered by the prepuce. Clitoral stimulation is an
important part of sexual activity for many women.

Ducts of the Skene’s glands lie alongside the urinary meatus and are thought to help lubricate the
urinary meatus.2 The Bartholin’s glands, located at the posterior and lateral aspects of the vaginal
orifice, secrete a thin, mucoid material believed to contribute slightly to lubrication during sexual
intercourse. These glands are not usually palpable unless sebaceous-like cysts form or they are swollen
in the presence of an infection, such as a sexually transmitted infection (STI).

Breasts.

The breasts are a secondary sex characteristic that develops during puberty in response to estrogen and
progesterone. Cyclic hormonal changes lead to regular changes in breast tissue to prepare it for
lactation when fertilization and pregnancy occur.
The breasts extend from the second to the sixth ribs, with the tail reaching the axilla (Fig. 51-5). The fully
mature breast is dome shaped and contains a pigmented center termed the areola. The areolar region
contains Montgomery’s tubercles, which are similar to sebaceous glands and assist in lubricating the
nipple. During lactation, the alveoli secrete milk. The milk then flows into a ductal system and is
transported to the lactiferous sinuses. The nipple contains 15 to 20 tiny openings through which the milk
flows during breastfeeding. The fibrous and fatty tissue that supports and separates the channels of the
mammary duct system is primarily responsible for the varying sizes and shapes of the breasts in
different individuals.

FIG. 51-5 The lactating female breast. A, Glandular structures are anchored to the overlying skin and the
pectoralis muscle by suspensory ligaments of Cooper. Each lobule of glandular tissue is drained by a
lactiferous duct that eventually opens through the nipple. B, Anterior view of a lactating breast. In
nonlactating breasts, glandular tissue is less evident with adipose tissue comprising most of the breast.

The breast has a rich lymphatic network that drains into axillary and clavicular channels (see Fig. 52-5).
Superficial lymph nodes are located in the axilla and are accessible to examination. This system is often
responsible for the metastasis of a malignant tumor from the breast to other parts of the body.